Injuries to rescue workers following the Oklahoma City bombing.

The objective of this study was to identify and describe physical injuries to rescue workers in the aftermath of the Oklahoma City bombing. Data were obtained from medical records from 16 hospital emergency departments and specialty clinics in the Oklahoma City area, and reported visits to medical providers at the bombing site. Participants were rescue personnel from the Oklahoma City Fire Department, the mutual aid fire stations in the Oklahoma City area, the Federal Emergency Management Agency's Urban Search and Rescue teams, and military personnel stationed near Oklahoma City. All participants were involved in the rescue and recovery operation. The two main outcome measures were (1) the number, types, and rates of injuries; and (2) comparisons of case-finding methods, including medical chart review and telephone interview. The most common injuries were strains and sprains (21.4%), foreign bodies in eyes (14.5%), and laceration/crush/puncture wounds (18.4%). Of the four case-finding mechanisms, telephone interviews following the event identified the largest number of cases (84.5%). Most injuries were minor; some injuries such as chemical burns were preventable. The potential utility of other data collection mechanisms is considered.

Trends in death associated with traumatic brain injury, 1979 through 1992. Success and failure.

OBJECTIVE: To report updated national trends in traumatic brain injury deaths from 1979 through 1992. DESIGN: Retrospective analysis of Multiple Cause-of-Death Public Use Data Tapes from the National Center for Health Statistics. All deaths associated with traumatic brain injury were identified, the underlying causes of death were categorized, and the annual rates were calculated per 100,000 US residents. PATIENTS: Residents of the United States who died with traumatic brain injury from 1979 through 1992. RESULTS: An average of 52,000 US residents die each year with traumatic brain injuries. The brain injury-associated death rate declined 22% from 24.6 per 100,000 US residents in 1979 to 19.3 per 100,000 US residents in 1992. Firearm-related rates increased 13% from 1984 through 1992, undermining a 25% decline in motor vehicle-related rates for the same period. Firearms surpassed motor vehicles as the largest single cause of death associated with traumatic brain injury in 1990. CONCLUSIONS: These data highlight the success of efforts to prevent traumatic brain injury due to motor vehicles and failure to prevent such injuries due to firearms. The increasing importance of penetrating injury has important implications for research, treatment, and prevention of traumatic brain injury in the United States.

Incidence rates of firearm injuries in Galveston, Texas, 1979-1981.

Firearm injury mortality rates have been characterized in various settings, but little is known of the total magnitude of firearm injury, including morbidity. The authors determined population-based incidence rates of firearm injury among residents of Galveston, Texas, from 1979-1981 by using police, emergency department, hospital, emergency medical services, medical examiner, and vital records to identify 239 firearm injury cases. Vital records, medical examiner, and police records each identified more than 95% of the fatalities, but police records (sensitivity = 98%) were better than emergency department or hospital records (sensitivity = 82% and 28%, respectively) for identifying all nonfatal cases. The annual age-adjusted incidence rate of firearm injury was 128 per 100,000 persons. Black males, with the highest firearm injury rate (459 per 100,000 persons), were injured at 46 times the rate of white females (10 per 100,000 persons). The overall case fatality rate was 30%, including 25% of the assaults/homicides, 81% of the parasuicides/suicides, and 0% of the unintentional injuries. On the basis of the case fatality rates, an estimated 140,000 firearm injuries occur in the United States annually. The case fatality rate for penetrating head injuries was 80% versus 48% for chest injuries and 6% for all other parts of the body. The results are discussed with respect to policy recommendations for reducing firearm injuries.

The incidence of fall injury events among the elderly in a defined population.

Falls are a leading cause of death from injury among older persons in the United States, and about one in three older persons falls each year. Yet, reliable estimates of the incidence of fall injury events in a population-based setting are not readily available. Therefore, the authors analyzed population-based surveillance data, between July 1985 and June 1987, from the Study to Assess Falls Among the Elderly, Miami Beach, Florida. The rate of fall injury events coming to acute medical attention increased exponentially with age for both elderly men and women (predominantly white), reaching a high for those aged 85 years or more of 138.5 per 1,000 for males and 158.8 per 1,000 for females. Compared with males, females had a higher incidence of fractures other than skull. Males were nearly twice as likely to die, however, following a fall injury event than were females. Of those fall injury events identified through the surveillance system, about 42% resulted in hospital admission. The mean length of hospital stay was 11.6 days overall and was 15.5 days for hip fracture, 9.8 days for skull fracture/intracranial injury, 11.2 days for all other fractures, and 9.1 days for all other injuries. About 50% of fall injury events that occurred at home and required hospital admission resulted in a person being discharged to a nursing home.

Measuring the impact of trauma care on survival: rates of preventable death, effectiveness, and efficacy.

This paper focuses on the appropriateness of outcome measures to evaluate trauma care. The preventable death rate (PDR), based on the study of deceased patients only, has been the traditional measure of the impact of trauma care on improving the survival of patients with severe trauma. Another measure frequently used in other ares of evaluation research is the effectiveness rate--i.e. the survival rate in the total population of severe trauma patients. Because both the PDR and the effectiveness rate vary with the proportion of patients who would die even under conditions of optimal care, these two measures can be misleading. We illustrate their inadequacy by using published data on the impact of regionalization of trauma care. We propose the use of a third outcome measure of the impact of trauma care on survival, the efficacy rate--i.e. the survival rate among severe trauma patients with a potential for survival. Evaluation of trauma care should also measure outcomes other than survival and need not be restricted to patients with the most severe trauma. Evaluation of trauma care therefore requires outcome measures, such as the efficacy rate, which are based on the population at risk of manifesting the outcome of interest.

Magnitude and patterns of family and intimate assault in Atlanta, Georgia, 1984. Collaborative Working Group for the Study of Family and Intimate Assaults in Atlanta.

A sample of police incident reports was used to examine the magnitude and patterns of family and intimate assault involving weapon use or threat, bodily force, or verbal threat of assault in a defined urban population during 1984. More than half of the incidents involved partners (spousal and nonspousal), about a fourth involved prior or estranged partners, and the remainder involved family members and relatives. The 1984 rate of nonfatal family and intimate assault was estimated at 837 per 100,000 population--the fatal rate was 7 per 100,000 population. Fatal and nonfatal victimization rates for blacks and other races were three times the rates for whites. Fatal incidents predominantly involved handguns, and nonfatal incidents most often involved bodily force. Most nonfatal victims (66%) and some perpetrators (13%) suffered physical injuries. Data on prior police contacts suggest that family and intimate assaults occur within a context of repeated violence. Information about prior incidents might contribute to preventive efforts by identifying people at high risk of being victims or perpetrators.

Lung cancer mortality among nonsmoking uranium miners exposed to radon daughters.

Radon daughters, both in the workplace and in the household, are a continuing cause for concern because of the well-documented association between exposure to radon daughters and lung cancer. To estimate the risk of lung cancer mortality among nonsmokers exposed to varying levels of radon daughters, 516 white men who never smoked cigarettes, pipes, or cigars were selected from the US Public Health Service cohort of Colorado Plateau uranium miners and followed up from 1950 through 1984. Age-specific mortality rates for nonsmokers from a study of US veterans were used for comparison. Fourteen deaths from lung cancer were observed among the nonsmoking miners, while 1.1 deaths were expected, yielding a standardized mortality ratio of 12.7 with 95% confidence limits of 8.0 and 20.1. These results confirm that exposure to radon daughters in the absence of cigarette smoking is a potent carcinogen that should be strictly controlled.

Incidence of hip fractures, United States, 1970-83.

Hip fractures are a major cause of morbidity and mortality in the United States. Twenty to 40% of persons who fracture their hips die within 6 months of the injury, and many survivors need long-term care. To assess the public health impact of hip fractures in the United States, we analyzed sample-based data from the National Hospital Discharge Survey, National Center for Health Statistics, for the United States for the period 1970-83. For these years, an estimated annual average of 197,000 persons 45 years of age or older was hospitalized for hip fractures. The age-, race-, and sex-adjusted hospitalization rates for hip fractures rose from 28.9 per 10,000 persons in 1970 to 30.9 per 10,000 in 1983 (P less than .01). Hospitalization rates rose exponentially by successive 10-year age groups, with persons 85 years of age or older having the highest rate (251.4 per 10,000). For each age group, women had hospitalization rates twice those of men, and whites had hospitalization rates twice those of other races. Never-married and divorced persons had higher hospitalization rates than currently married persons. The percentage of mortality before discharge from hospital fell from 11% in 1970 to 6% in 1983, with most of the decrease occurring among persons 75 years of age or older. The age-adjusted mean length of hospital stay declined 24%, from 23.9 days in 1970 to 18.2 days in 1983.(ABSTRACT TRUNCATED AT 250 WORDS)

Increases in premature mortality due to homicide--United States, 1968-1985.

From 1968 to 1985, the rate of homicide in the United States has increased 44%. Its relative impact on premature mortality, as measured by the percentage of years of potential life lost (YPLL) before age 65 from all causes of death due to homicide, has nearly doubled (93% increase). This increase calls attention to the emerging importance of interpersonal violence relative to all public health problems affecting persons under 65 years of age. The percentage of YPLL from all causes of death due to homicide increased in each race/sex group and for both firearm and nonfirearm means of homicide. The increase in homicide YPLL was traced mainly to an increase in the number of homicide deaths and, to a smaller extent, to a decrease in the average age at death of homicide victims.

Injury surveillance at the 1985 National Boy Scout Jamboree.

Few studies have examined the rate of injuries for those attending summer camps and other recreational facilities. We developed a surveillance system for the 1985 National Boy Scout Jamboree to determine the incidence, nature, and cause of injuries among participants. To characterize the more severe injuries among scouts, we monitored referral visits to an onsite Army hospital. During the 9 day event there was a total of 179 injuries requiring referral visits among the 24,885 scouts, for an overall incidence of 8.5 injuries per 10,000 person-days. Twenty-eight injuries (16%) involved fractures. Ten injuries required hospitalization, for an overall rate of 0.5 per 10,000 person-days. Thirty-six (20%) of the injuries occurred during six organized athletic activities. Of these six, two new Jamboree activities, the bucking bronco and bicycle motocross racing, had the highest event-specific rates, 14.4 and 11.4 injuries per 10,000 participants, respectively. These two events also accounted for one-third of all fractures. In contrast, there were no firearm-related injuries among the 32,616 participants in riflery events. This simple and inexpensive surveillance system provided a mechanism for monitoring activity modifications, as well as useful information for the selection and planning of organized activities at future Jamborees and similar recreational events.