Winter storm-related injuries in Oklahoma, January 2007.

INTRODUCTION: A January 2007 ice storm occurred in Oklahoma, causing power outages and hazardous travel conditions. The objective of this investigation was to describe the nature of winter storm-related injuries among Oklahoma residents, to determine populations at risk, and to inform prevention-planning personnel. METHODS: Winter storm-related injuries were a temporarily reportable condition; all acute-care hospitals and the state medical examiner logged storm-related injuries and deaths during January 12-30, 2007. Medical records were retrospectively abstracted. Risk of injury was described by demographic group, injury type, and mechanism. RESULTS: Among 6,047 persons experiencing winter storm-related injuries, 74% were injured in falls, 13% in motor-vehicle collisions (MVCs), 8% while sledding, 1% by unintentional carbon monoxide poisoning, 1% in cleanup activities, and 3% by other mechanisms. Median age of injured persons was 39years. Persons aged ≥ 40 years were 1.4 times more likely to experience falls as the cause of injury than those aged < 40 years, and falls were twice as likely as other mechanisms to cause fractures among persons aged ≥ 40 years. Injured persons aged < 40 years were 2.2 times more likely to experience MVC-related injuries, and 19 times more likely to experience sledding-related injuries than persons aged ≥ 40 years. CONCLUSIONS: Younger persons were more likely injured in MVCs and sledding incidents, whereas older persons were more likely to experience falls and fractures. IMPACT ON INDUSTRY: Prevention messages for winter storm-related injuries should target winter-driving safety tips to younger adults and precautions regarding falls to older adults.

Hemolytic Uremic Syndrome After an Escherichia coli O111 Outbreak.

BACKGROUND: In August 2008, the largest known US serotype 1 Escherichia coli O111 outbreak occurred in Oklahoma, causing 341 illnesses, including hemolytic uremic syndrome (HUS). HUS is not well described in non-O157 E coli outbreaks but occurs in 2% to 15% of O157 infections, predominantly among children. We examined outbreak-related hospitalizations to characterize E coli O111 illness, the HUS attack rate, and factors associated with subsequent HUS diagnosis among hospitalized patients. METHODS: Medical records were reviewed for clinical presentation and evidence of HUS among hospitalized patients identified during the outbreak investigation. Characteristics of hospitalized patients with vs without HUS were compared. RESULTS: HUS was identified in 26 of 156 (16.7%) confirmed or probable E coli O111 infections; 65.4% of patients with HUS required dialysis, and 1 patient died. The median age of patients with HUS was 43.5 years (age range, 1-88 years); adults composed 57.7% of HUS cases. Characteristics at hospital admission associated with subsequent HUS diagnosis included white blood cell count of at least 20 000/µL (adjusted odds ratio [aOR], 11.3; 95% confidence interval [CI], 1.7-75.3), elevated serum creatinine level for age (9.7; 1.4-69.2), and vomiting before hospital admission (6.8; 1.5-31.3). Administration of antimicrobial agents (risk ratio [RR], 1.0; 95% CI, 0.5-1.8) or medication with antimotility effects (1.4; 0.6-2.9) was not associated with subsequent HUS. CONCLUSIONS: The HUS attack rate in this E coli O111 outbreak was comparable to that for E coli O157-related illnesses, but most cases occurred among adults. On admission, factors associated with subsequent HUS can identify patients who require close monitoring and early aggressive supportive care to improve outcomes.

Increase in unintentional medication overdose deaths: Oklahoma, 1994-2006.

BACKGROUND: During 1999-2006, rates of unintentional drug-related deaths increased 120% in the U.S. PURPOSE: This report describes demographics and trends of unintentional medication overdose deaths among Oklahoma residents to target prevention strategies. METHODS: Oklahoma medical examiner data regarding fatal unintentional poisonings involving at least one prescription or over-the-counter medication during 1994-2006 and opioid retail sales data during 1997-2006 were analyzed during 2008-2009 to determine demographic-specific rates of overdose deaths and changes in 3-year mean death rates. RESULTS: A total of 2112 fatal unintentional medication overdoses were identified (4.7 deaths/100,000 population) involving a median of two substances/decedent. The highest fatality rates occurred among men (5.9/100,000) and people aged 35-54 years (11/100,000). Crude overdose death rates increased sevenfold during the investigation period, peaking at 11/100,000 in 2006. Death rates increased more for women (ninefold) than men (sixfold); rates among residents of rural counties increased more (eightfold) than urban county rates (sixfold). Leading drug types involved in fatalities were opioids and anxiolytics. The individual drugs contributing most frequently included methadone (31%); hydrocodone (19%); alprazolam (15%); and oxycodone (15%). During 1997-2006, Oklahoma prescription opioid sales increased fourfold. Methadone was associated with the highest number of deaths per equianalgesic dose sold (23.3), whereas hydrocodone and oxycodone had the highest increases in deaths per equianalgesic dose sold (threefold increase each). CONCLUSIONS: Unintentional medication-related deaths are increasing in Oklahoma and often involve multiple substances. Substances most frequently contributing to deaths were prescription opioid analgesics. Prevention strategies should target people aged 35-54 years and emphasize the dangers of coingesting substances and misusing prescription pain medications.

Increasing aspirin use among persons at risk for cardiovascular events in Oklahoma.

BACKGROUND: Cardiovascular disease (CVD), including coronary heartdisease (CHD)and stroke, is the leading cause of death in the United States and in Oklahoma; Oklahoma ranks 48th worst in CVD deaths.This paper will present Oklahoma-specific data and review current recommendations regarding aspirin use for the prevention of CVD events. METHODS: Average annual age-adjusted death rates were calculated. Oklahoma Behavioral Risk Factor Surveillance System (BRFSS) data were used to determine past history of CHD, risk factors for CHD and stroke, and aspirin use among persons 45 years and older. A literature review of recommendations regarding aspirin use was conducted. RESULTS: Between 2005-2008, 14.8% of Oklahomans 45 years of age and older reported a history of coronary heart disease and 6.4% a history of stroke. Approximately 50% of Oklahomans 45 years and older reported a history of hypertension and hypercholesterolemia; 21.5% were current smokers and 16.0% had diabetes. Nearly 10,000 Oklahomans die annually from CHD or stroke. The United States Preventive Services Task Force recommends 81mg per day of aspirin for men 45 to 79 and women 55 to 79 years of age unless they are at risk for bleeding complications. Daily aspirin use in Oklahoma was 44-57% among those with risk factors but no history of CHD or stroke. Fewer than 50% of Oklahomans 45-79 years reported being counseled by a health professional to take aspirin. Among those persons without a history of CVD who were counseled by a healthcare professional regarding aspirin, 79% were taking daily aspirin compared to 18% among persons not counseled. Aspirin sales increased significantly in Stephens County following a multifaceted community-based aspirin campaign. CONCLUSION: Low-dose aspirin is being underutilized as a strategy for reducing the excessive numbers of cardiovascular events and deaths in Oklahoma. Health professionals play an important role in educating patients about appropriate use of low-dose aspirin. Community-based interventions can also be effective.

Outcome of a hepatitis C outbreak among patients in a pain management clinic.

BACKGROUND AND AIMS: The aims of this study are to evaluate the natural history and response to therapy of patients following a hepatitis C outbreak in a pain management clinic. METHODS: A retrospective cohort study was conducted on patients who acquired hepatitis C virus (HCV) at a pain management clinic. Medical records were retrospectively reviewed for 77% of patients with hepatitis C included in the outbreak to obtain data regarding laboratory results, treatment, and outcomes. Chi-square, Fisher's exact, and Student's t-test were used to determine variables that were significantly associated with spontaneous clearance or sustained virologic response to therapy. RESULTS: Fifty Caucasian patients (31 women, 19 men; mean age 52 years) were included. Eleven of 50 (22%) patients cleared HCV spontaneously (clearers). The mean age of clearers was 47 years as compared with 57 years for nonclearers (P = 0.04). Liver biopsies were obtained by treating gastroenterologists in 31 patients with mean grade and stage of 2.1 and 1.7, respectively. Gastroenterologists treated 31 of 39 patients with pegylated interferon and ribavirin after a median of 354 (range 140-1,099) days post exposure. Sustained viral response (SVR) was observed in 65% (20/31) on an intention-to-treat basis. In patients who completed therapy, 91% (20/22) achieved SVR. Age, sex, weight, pretreatment alanine aminotransferase (ALT), and histologic parameters were not associated with SVR. CONCLUSIONS: In this large cohort of US immunocompetent patients with recent HCV infection, 22% resolved spontaneously. Younger age was the only predictor of spontaneous clearance. In patients with early chronic HCV, 65% achieved SVR.

Unintentional motor vehicle-train collisions--Oklahoma, 1995-2003.

BACKGROUND: Rates of persons injured in motor vehicle (MV)-train collisions in the state of Oklahoma (1.13/100,000 population) are more than 2 times the United States rate (0.51/100,000 population). METHODS: To better understand and describe unintentional MV-train collisions in Oklahoma, we collected information on MV-train collisions during 1995-2003 from the United States Federal Railroad Administration and from statewide medical examiner reports. Intersections were classified into train-activated gates, train-activated flashing lights, and passive signage (crossbucks or stop signs). For each type of intersection, MV-train collisions were calculated as the average annual number of collisions/1,000,000 vehicles/100,000 trains. RESULTS: A total of 444 unintentional MV-train collisions occurred; 48% had at least one injury. The average annual intersection collision rate with passive signage (5.15) was eight and 37 times, respectively, the rate of train-activated lights (0.63) and train-activated gates (0.14). Of drivers involved in collisions at intersections with gates, 83% ignored the gate warning. Twenty-five percent of drivers were aged < 25 years, compared with 16% of registered drivers in Oklahoma (p = 0.0001); 74% of drivers were male, compared with 49% of registered drivers in Oklahoma (p < 0.0001). Of fatalities tested for the presence of alcohol, 22% were legally intoxicated. CONCLUSIONS: Increasing the number of intersections with active warnings and instituting structural changes (i.e., gates that close across both lanes of traffic) would likely reduce the number of MV-train collisions in Oklahoma and throughout the U.S.

State-based surveillance to determine trends in meningococcal disease.

OBJECTIVES: Meningococcal disease (MD), is a leading cause of meningitis in the U.S. The purpose of this study was to determine the epidemiology of MD in Oklahoma, including trends, high-risk populations, and outcomes. METHODS: Cases from the statewide passive reporting system with disease onset between 1988 and 2004 were included; 2002-2004 cases were linked to hospital discharge data. We performed a multivariate logistic regression of variables predicting death. RESULTS: There were 545 total cases (mean annual incidence rate 1.0/100,000); 13% died. Rates were highest for children younger than 2 years of age; black males had rates two times higher than the state rate and a different age distribution than other race-gender groups. Mean length of hospital stay was 12 days and mean charges were $37,724. For every 10 years of age, the risk of death increased 13% (adjusted odds ratio 1.13, 95% confidence interval [CI] 1.05, 1.22). People younger than age 40 who developed MD between October and February were 68% more likely to die than those who developed it in other months (rate ratio [RR] 1.68, 95% CI 1.39, 2.05); an increased risk of death during these months was not statistically significant in people aged 40 and older (RR 1.19, 95% CI 0.83, 1.69). CONCLUSION: Using statewide public health surveillance data to characterize the epidemiology of MD is important to understand local trends and risk factors.

Factors associated with injury severity in Oklahoma City bombing survivors.

BACKGROUND: Terrorist bombings are an increasing source of violent death and injury worldwide. Injuries in building bombings have been previously reported in descriptive studies, but no comparative analyses have quantitatively assessed factors influencing the severity of nonfatal bombing injuries. The objective of this study was to identify personal and environmental risk factors for injury severity in the Oklahoma City bombing, on April 19, 1995. METHODS: We conducted a retrospective comparative analysis of 509 nonfatally injured occupants of four buildings surrounding the detonation site. The source of data was the 1995 Oklahoma City Bombing database, a registry of all injuries and fatalities related to the bombing. Multivariable logistic regression was used to assess two outcomes: (1) medically-attended injury among injured occupants; and (2) hospital admission among occupants with medically attended injuries. RESULTS: Increased odds of sustaining medically attended injuries were associated with being struck by flying glass (adjusted odds ratio [AOR], 5.3; 95% confidence interval [CI], 1.9-14.8) and location above the first floor of buildings (OR, 4.0; 95% CI, 1.4-11.7) after adjustment for other factors. Adjusted odds of hospital admission were associated with location in the collapsed region (AOR, 43.4; 95% CI, 4.4-434.1), being blown by the blast wind (AOR, 5.3; 95% CI, 2.1-13.8), and being trapped (AOR, 3.1; 95% CI, 1.2-7.7). CONCLUSIONS: The severity of nonfatal injury in the Oklahoma bombing was primarily associated with structural and environmental factors. Improved architectural design may prevent many injuries in building bombings. These finding provide evidence for future injury prevention activities.

Injury perceptions of bombing survivors--interviews from the Oklahoma City bombing.

INTRODUCTION: Bombings, including the 1995 Oklahoma City bombing, remain an important public health threat. However, there has been little investigation into the impressions of injury risk or protective factors of bombing survivors. OBJECTIVE: This study analyzes Oklahoma City bombing survivors' impressions of factors that influenced their risk of injury, and validates a hazard timeline outlining phases of injury risk in a building bombing. METHODS: In-depth, semi-structured interviews were conducted within a sample of Oklahoma City bombing survivors. Participants included 15 injured and uninjured survivors, who were located in three buildings surrounding the detonation site during the attack. RESULTS: Risk factor themes included environmental glass, debris, and entrapment. Protective factors included knowledge of egress routes, shielding behaviors to deflect debris, and survival training. Building design and health status were reported as risk and protective factors. The hazard timeline was a useful tool, but should be modified to include a lay rescue phase. The combination of a narrative approach and direct questioning is an effective method of gathering the perceptions of survivors. CONCLUSIONS: Investigating survivors' impressions of building bombing hazards is critical to capture injury exposures, behavior patterns, and decision-making processes during actual events, and to identify interventions that will be supported by survivors.

Non-fire carbon monoxide-related deaths, Oklahoma 1994-2003.

The purpose of this study was to determine the magnitude of non-fire carbon monoxide (CO)-related deaths and assess temporal trends, high-risk groups, and sources of CO resulting in deaths to Oklahoma residents from 1994-2003. Mortality data was collected from the Oklahoma Office of the Chief Medical Examiner. There were 281 non-fire, carbon monoxide-related deaths; 77% of CO deaths were suicides, 19% were unintentional, and 4% were unknown intent. The average annual death rate for males was nearly three times higher than females (12.0 vs. 4.7 per million population). Seventy-six percent of unintentional CO deaths in dwellings involved a furnace or heater. An audible CO detector in homes is the most promising technology available to prevent unintentional deaths, and there are several promising methods currently being researched to prevent suicides via CO exposure. Public and mental health authorities and health providers should educate the public regarding prevention of CO exposures.

Aspirin use in the prevention of cardiovascular events.

BACKGROUND: Cardiovascular disease (CVD) is the leading cause of death in the United States and Oklahoma, and Oklahoma ranks 50th in CVD deaths. This paper will describe CVD and coronary heart disease (CHD) mortality in Oklahoma and review current recommendations regarding aspirin use for the prevention of CHD events. METHODS: The CDC Compressed Mortality File for 1999-2004 was accessed. Average annual age-adjusted or age-specific death rates per 100,000 population were calculated. A literature review of data and recommendations regarding aspirin use was conducted. RESULTS: From 1999-2004, there were 50,170 CHD deaths in Oklahoma (age-adjusted rate 232.1 per 100,000). Persons 75 years and older, males, and blacks had the highest death rates; the death rates declined for all persons except those aged 35-54 years. Aspirin use has been shown to be effective in reducing the number of nonfatal myocardial infarction (MI) and fatal CHD, though studies of aspirin effects in women have found a significant reduction in ischemic stroke but no significant effect on fatal or nonfatal MI or CVD death. Aspirin use slightly increases rates of gastrointestinal bleeding and hemorrhagic stroke. CONCLUSION: Continued commitment to counseling patients regarding tobacco cessation, nutrition and exercise, and treatment to reduce blood pressure, cholesterol, tobacco use, and blood sugar are essential. The Oklahoma State Medical Association Physicians Campaign for a Healthy Oklahoma has made it a priority to increase awareness of the risk and benefits of aspirin use among high-risk persons. Oklahoma physicians should assess patients at highest risk, such as healthy men older than 40 years, postmenopausal women (especially >or= 65 years), and younger people with risk factors for coronary heart disease (e.g., hypertension, hyperlipidemia, diabetes, or smoking) and discuss the potential benefits and harms of aspirin use.

The epidemiology of severe traumatic brain injury among persons 65 years of age and older in Oklahoma, 1992-2003.

PRIMARY OBJECTIVE: To describe the epidemiology of traumatic brain injury (TBI) among persons 65 years of age and older in Oklahoma from 1992-2003. RESEARCH DESIGN: Descriptive epidemiology of data collected through active statewide surveillance on TBI inpatient hospitalizations and fatalities. METHODS AND PROCEDURES: Data collected from hospital medical records and the Office of the Chief Medical Examiner. TBI was defined by ICD-9-CM codes for skull fracture 800.0-801.9, 803.0-804.9, concussion or other intracranial injury 850.0-854.1 and head injury, unspecified 959.01; all cases included a description of TBI. MAIN OUTCOME AND RESULTS: TBI rates increased 79% for the study population; however, case-fatality rates decreased from 32% in 1992 to 18% in 2003. The TBI rate increase was observed among all elderly age groups, both genders and all races. Unintentional injuries nearly doubled while both assault and self-inflicted injuries decreased. Fall-related TBI increased by 126%, while MVC-related TBI increased by 17%. Survivors were hospitalized for an average of 6.8 days and over half required post-acute care. CONCLUSIONS: The increased TBI rate and decreased case-fatality rate among elderly persons means potentially more persons living with TBI disability. TBI prevention efforts among the elderly must be expanded, especially for fall-related TBI.

Preventing fatalities in building bombings: what can we learn from the Oklahoma City bombing?

BACKGROUND: Bombings are an increasing threat to the public's health. Descriptive studies of blast injuries have been published, but these injuries have not been studied using analytical epidemiological methods. This study assesses factors associated with fatality risk among individuals exposed to the 1995 Oklahoma City bombing. METHODS: Retrospective case-control analysis using multivariable logistic regression. Odds ratios (OR) of fatality are calculated among occupants of the Alfred P. Murrah Federal Building on April 19, 1995. RESULTS: Of the 348 occupants exposed, 163 (46.8%) were fatally injured. Fatality risk was greatest in the collapsed region of the building (adjusted OR 176.7, 95% confidence interval [CI] 65.9-474.2). Age > or =40 was also associated with a significantly increased risk of fatality (OR 3.7, 95% CI 1.4-9.8). Among people found in the noncollapsed region of the building, employees' status compared to a visitor's or child's status was protective (OR 0.13, 95% CI 0.01-1.3). CONCLUSIONS: Structural collapse is the most important risk factor for fatality in a building bombing. Progressive collapse may be prevented through more supportive building design. Protection of vulnerable building occupants can be improved by placement of relevant facilities in more structurally reinforced areas. Regular evacuation training of personnel and clear egress routes may also reduce fatality in a building bombing.

A large, travel-associated outbreak of legionellosis among hotel guests: utility of the urine antigen assay in confirming Pontiac fever.

BACKGROUND: During March 2004, a large outbreak of legionnaires disease and Pontiac fever occurred among hotel guests in Oklahoma. An investigation was conducted to identify the source and evaluate the utility of the Legionella urine antigen assay and serologic testing for the identification of Pontiac fever. METHODS: A retrospective cohort investigation of hotel guests and employees and an environmental evaluation were performed. Participants were interviewed, and clinical specimens were collected from consenting individuals. RESULTS: Six cases of legionnaires disease and 101 cases of Pontiac fever were identified. Exposure to the indoor pool and hot tub area was associated with legionellosis (relative risk, 4.4; 95% confidence interval, 2.8-6.9). Specimens from the pool and hot tub tested positive for Legionella pneumophila serogroup 1 by polymerase chain reaction. For Pontiac fever, the sensitivity and positive predictive value were 35.7% and 100%, respectively, for the urine antigen assay, and 46.4% and 90%, respectively, for serologic testing. The specificity and negative predictive value were 100% and 47.8%, respectively, for the urine antigen assay, and 89.3% and 45.5%, respectively, for serologic testing. CONCLUSIONS: Urine antigen testing, with or without serologic testing, can be used to confirm outbreak-associated cases of Pontiac fever caused by L. pneumophila serogroup 1.

Evaluation of death certificate-based surveillance for traumatic brain injury--Oklahoma 2002.

OBJECTIVES: Death certificate data are used to estimate state and national incidence of traumatic brain injury (TBI)-related deaths. This study evaluated the accuracy of this estimate in Oklahoma and examined the case characteristics of those persons who experienced a TBI-related death but whose death certificate did not reflect a TBI. METHODS: Data from Oklahoma's vital statistics multiple-cause-of-death database and from the Oklahoma Injury Surveillance System database were analyzed for TBI deaths that occurred during 2002. Cases were defined using the Centers for Disease Control and Prevention (CDC) ICD-10 code case definition. In multivariate analysis using a logistic regression model, we examined the association of case characteristics and the absence of a death certificate for persons who experienced a TBI-related death. RESULTS: Overall, sensitivity of death certificate-based surveillance was 78%. The majority (62%) of missed cases were due to listing "multiple trauma" as the cause of death. Death certificate surveillance was more likely to miss TBI-related deaths among traffic crashes, falls, and persons aged > or = 65 years. After adding missed cases to cases captured by death certificate surveillance, traffic crashes surpassed firearm fatalities as the leading external cause of TBI-related death. CONCLUSIONS: Death certificate surveillance underestimated TBI-related death in Oklahoma and might lead to national underreporting. More accurate and detailed completion of death certificates would result in better estimates of the burden of TBI-related death. Educational efforts to improve death certificate completion could substantially increase the accuracy of mortality statistics.

Rapid needs assessment of Hurricane Katrina evacuees-Oklahoma, September 2005.

INTRODUCTION: On 04 September 2005, 1,589 Hurricane Katrina evacuees from the New Orleans area arrived in Oklahoma. The Oklahoma State Department of Health conducted a rapid needs assessment of the evacuees housed at a National Guard training facility to determine the medical and social needs of the population in order to allocate resources appropriately. METHODS: A standardized questionnaire that focused on individual and household evacuee characteristics was developed. Households from each shelter building were targeted for surveying, and a convenience sample was used. RESULTS: Data were collected on 197 households and 373 persons. When compared with the population of Orleans Parish, Louisiana, the evacuees sampled were more likely to be male, black, and 45-64 years of age. They also were less likely to report receiving a high school education and being employed pre-hurricane. Of those households of > 1 persons, 63% had at least one missing household member. Fifty-six percent of adults and 21% of children reported having at least one chronic disease. Adult women and non-black persons were more likely to report a pre-existing mental health condition. Fourteen percent of adult evacuees reported a mental illness that required medication pre-hurricane, and eight adults indicated that they either had been physically or sexually assaulted after the hurricane. Approximately half of adults reported that they had witnessed someone being severely injured or dead, and 10% of persons reported that someone close to them (family or friend) had died since the hurricane. Of the adults answering questions related to acute stress disorder, 50% indicated that they suffered at least one symptom of the disorder. CONCLUSIONS: The results from this needs assessment highlight that the evacuees surveyed predominantly were black, of lower socio-economic status, and had substantial, pre-existing medical and mental health concerns. The evacuees experienced multiple emotional traumas, including witnessing grotesque scenes and the disruption of social systems, and had pre-existing psychopathologies that predisposed this population to post-traumatic stress disorder (PTSD). When disaster populations are displaced, mental health and social service providers should be available immediately upon the arrival of the evacuees, and should be integrally coordinated with the relief response. Because the displaced population is at high risk for disaster-related mental health problems, it should be monitored closely for persons with PTSD. This displaced population will likely require a substantial re-establishment of financial, medical, and educational resources in new communities or upon their return to Louisiana.

Comparing reactions to two severe tornadoes in one Oklahoma community.

The authors compared the effect of the 3 May 1999 F5 and 8 May 2003 F3 tornadoes on the community of Moore, Oklahoma, by canvassing damaged areas after both tornadoes and surveying residents. Significantly more 1999 than 2003 residents reported property damage and injuries. Television and tornado sirens were the most common warnings each year, however, more 1999 residents received and responded to television warnings. Importantly, storm shelters were used more frequently in 2003. Fifty-one per cent of residents who experienced both tornadoes took the same amount of protective action in 2003 as they had in 1999; 22% took less; and 27% took more. Residents who took less action said that the reason for doing so was inadequate warning and shelter. First-hand experience of tornadoes prompts people to heed warnings when adequate notification is received and to take effective protective action when adequate shelter is available.

Epidemiology of homicide-suicide events: Oklahoma, 1994-2001.

In Oklahoma, all nonnatural deaths must be reported to the Office of the Chief Medical Examiner (ME), whose trained investigators report cause of death using a centralized, statewide, standardized reporting system. The purpose of this study was to determine temporal trends of Oklahoma homicide-suicide events and characterize the epidemiology of these events. By reviewing all ME reports of homicides and suicides from 1994 through 2001, we identified 73 homicide-suicide events resulting in 73 suicides and 89 homicides. Suicidal perpetrators of homicide-suicide events were most often white men aged >or=30 years who killed a current or ex-spouse or intimate partner. Homicide victims tended to be younger women the same race as their killer. Firearms were the predominant method of death in both homicides and suicides, with handguns used most frequently. Divorce/estrangement was the main contributing factor to these events, and the most common relationship type was possessive. The existence of a statewide, centralized, and computerized ME system and the ability to access the detailed information in the ME narratives were critical to identifying homicide-suicide events and obtaining the type of detailed information necessary to fully investigate these events.

Get off the bus: sound strategy for injury prevention during a tornado?

INTRODUCTION: On 08 May 2003, a tornado categorized as an F-3 on the Fujita Tornado Scale (the "F Scale") struck an Oklahoma City, Oklahoma commuter bus carrying 24 passengers. The driver evacuated several passengers before the tornado struck. The tornado rolled the bus, and pelted it with debris. METHODS: A case-series investigation of tornado-related injuries was conducted among passengers who were evacuated to a ditch and those who remained on the bus when the tornado struck. RESULTS: Nineteen of 24 passengers sought care for injuries at hospital emergency departments (injury rate = 79.2%). While a greater number of passengers who were outside the bus when the tornado struck (11) sought care for injuries than did those who remained on the bus (8); passengers outside of the bus suffered fewer injuries than did those who remained on the bus (median number of injuries 3 versus 4), and their injuries were less severe (median injury severity score (ISS) 1 versus 4). CONCLUSION: For persons caught in motor vehicles during tornado events, this study supports currently accepted recommendations to immediately evacuate and lie in a low-lying area away from motor vehicles if other shelter is unavailable. However, generalizing the experience of bus passengers to automobile drivers might be inappropriate because buses lack the safety features that might protect automobile drivers from tornado-related injuries.