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Environmental and Occupational Injury Control


Injuries may be divided into two major categories: intentional and unintentional. Intentional injuries occur when the individual or individuals want to injure either someone else or themselves. Intentional injuries consist of all forms of violence including those related to assault, suicide, homicide, sexual situations, intimate partner situations, child mistreatment, youth violence, elder mistreatment, and bullying including electronic and/or social media aggression, especially in schools and school-related activities, etc. There will be a limited discussion in this area since an entire book will be written about the topic of violence and intentional injuries which are a major public health concern, with tens of thousands of deaths and millions of injuries. The injuries discussed in this chapter are mostly of the unintentional type. (See endnote 17, 29.)

Note: Wherever data are used within this chapter, they may vary depending on the source and date of the document, especially the data that are issued over the Internet. In fact, since the implementation of WISQARS (Web-based Injuries Statistics Query and Reporting System), an interactive database system, there has been a change in the database because there has been a change in the population used for compilation of the data. This change in the reference population started in September 2012. (See endnote 28.) Other data used will come from the report from the Trust for America’s Health and the Robert Wood Johnson Foundation of May 2012 entitled “The Facts Hurt: A State-by-State Injury Prevention Policy Report.” (See endnote 29.)

Injuries are not accidents. They can be prevented. An injury is the stress upon an organism that disrupts the structure or function and results in a pathological process. The stress may be: physiological due to age or chronic/acute disease, fatigue, mental, or physical infirmities such as deafness, blindness, poor balance, etc.; physical due to weather conditions, heat, cold, inadequate light, noise, and vibration; chemical due to pollutants, household substances, and pharmaceuticals; spatial due to misplaced objects or toys; environmental such as slippery surfaces and disrepair; and alcohol, excessive risk-taking, inexperience, and inattentiveness. Injury prevention is the recognition, evaluation, and control of hazardous situations or substances. (See endnote 1.)

Over 180,000 people die each year in the United States from unintentional injuries and violence. Over 26,000 people die from unintentional falls. Over 33,500 people die from traffic- related incidents. About 33,000 people die from unintentional poisoning. Over 31,500 people die from firearm discharge. Injuries are the leading cause of death for people between the ages of 1 and 44. It is estimated that injuries cost more than $400 billion a year in lost productivity and medical care. Because of injuries, violence, and the adverse effects of medical treatment, 41 million people annually utilize very expensive health care by being treated in an emergency department. There are a substantial number of medically untreated injuries that occur in all areas. These can lead to further difficulties either initially or long-term. Chronic illness or lasting disability from injuries may affect millions of people for a good portion of their lifetime and may reduce their normal lifespan. (See endnote 2.)

Each year in the United States over 60% of injuries to people involve the musculoskeletal system, including sprains, strains, fractures, open wounds, cuts and punctures, contusions, and bruises. While 10% of injuries occur during sports activities and 10% are automobile or pedestrian injuries, over 50% are believed to occur in homes and there is belief among experts that this number is under-reported. Falls represent the leading cause (29%) of the nonfatal musculoskeletal injuries. Among people aged 65 or older, 63% of the injuries are musculoskeletal. Over 57 million of these injuries yearly are seen in healthcare settings. (See endnote 5.)

A traumatic brain injury is an injury that disrupts how the brain works. It may be due to various reasons but the most frequent causes are falls, motor vehicle crashes, various contact sports, firearms, explosions, or intentional battering of the head. Males, young children, and older people are at greatest risk. About 1.7 million traumatic brain injuries occur in the United States each year with about 52,000 deaths, 275,000 hospitalizations, and 1,365,000 emergency department visits. The number of people who have traumatic brain injuries who do not seek medical care is unknown but is thought to be substantial. Weeks, months, or even years later traumatic brain injuries can lead to a variety of serious chronic conditions and early death. (See endnote 18.)

Injuries are the leading cause of death in children, with over 12,000 children each year in the United States, from birth to 19 years of age, dying from unintentional injuries. The ratio of male to female deaths is 2:1. Injuries from motor vehicles or bicycles lead to the highest number of deaths. Each year, 9.2 million children go to the emergency room for an unintentional injury, with 2.8 million of these children having experienced injuries from a fall. The cost for injuries is over $2 billion a year. (See endnote 3.)

Although behavior, age, physical fitness, and certain medications are important causes of injuries, there are many environmental factors that can be altered, such as storage and use of poisons, faulty heating equipment, electrical wiring, lack of smoke alarms and carbon monoxide detectors, slippery surfaces, improperly constructed physical facilities, etc.

Unintentional Injuries

The major categories of unintentional injuries which will be discussed are related to: the built environment (home and community); transportation; school facilities and people; sports and recreation facilities and people; healthcare facilities and people; and occupational facilities. (See endnote 16.)

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