Injury prevention

Nathaniel Thomas buys a gate and a childproofing kit at the Johns Hopkins Children's Safety Center after a doctors visit for his son, Nathaniel Thomas Jr., 1. Stephanie Parsons, a certifield health educator at Hopkins, helped him with his purchase. Johns Hopkins Children's Safety Center teaches injury prevention, both in the center and in a mobile unit. (Lloyd Fox, Baltimore Sun / May 21, 2012)

Tens of thousands of lives have been saved over the years because Americans more routinely wear seat belts and don't drive drunk.

But there are other public health threats from those who text while driving or overdose on prescription drugs.

That's why a group of researchers began looking at which prevention measures work and who is using them across the country to stem the rate of injuries of all kinds. Injuries are the third-leading cause of death for adults and the biggest killer of young people.

"Injuries are a huge problem hiding in plain sight," said Andrea Gielen, director of the Johns Hopkins Center for Injury Research & Policy and co-author of a new report released by the Trust for America's Health and the Robert Wood Johnson Foundation. "People don't necessarily recognize the toll."

Researchers believe it's the first time a report has identified 10 key injury-prevention measures and which states have adopted them. They hope their findings are used to influence public policy and laws and to change individuals' behavior.

Up to now, no state has adopted all of the measures that focus on such things as seat belts, bike and motorcycle helmets, child safety seats and prescription drug monitoring programs. The resulting injuries are not only a health issue, but a financial one, said Jeffrey Levi, executive director of the Trust for America's Health.

Annual federal funding for injury prevention has been cut by 24 percent in the past five years to $88.6 million, he said, and many lawmakers want to know what the return on the investment will be before boosting the money anew.

About 50 million Americans are treated for injuries every year, including 9.2 million children who are taken to emergency rooms, Levi said. About 12,000 children die from their injuries. The injuries also generate $4.6 billion in lifetime costs for medical care and lost productively.

But the report shows injury-prevention laws are making gains, he said. Seat belts saved an estimated 69,000 lives from 2005 to 2010. Motorcycle helmets saved about 8,000 lives, and child safety seats saved 1,800 from 2005 to 2009.

"There are some relatively simple and inexpensive things you can do to make a big difference," Levi said. "If every state passed every law, millions of lives and millions of dollars would be saved."

In Maryland, lawmakers have passed eight of the 10 key measures, according to the report. And the state beats the national death rate from injuries with 56.1 per 100,000 people. Nationally, the rate is 57.9 per 100,000 people.

Every year, public health officials lobby the state legislature or seek new regulations to ban risky behaviors, such as using cellphones while driving, and potentially harmful devices, such as crib bumpers implicated in a small number of infant suffocation deaths. This year, state health officials asked for and won approval of a law requiring children be kept in booster seats until age 8.

In the wake of the killing of Yeardley Love at the University of Virginia, another effort is under way to curb domestic violence among young people, said Frances B. Phillips, Maryland's deputy secretary for public health services. She said the new report will give officials more data to back up their arguments for laws and funding.

"We all know injuries can be extremely tragic and can lead to death, but we don't typically see them as preventable," Phillips said. "But these are not random events, and we can take steps to prevent them. And when we do, the outcome is really positive."

At the University of Maryland Shock Trauma Center, which treats 8,500 of the state's most severely injured patients annually, there are plenty of times doctors know the injuries were preventable, said Dr. Mayur Narayan, a trauma surgeon who launched the hospital's Center for Injury Prevention and Policy about a year and a half ago.

Maryland has made strides in passing laws, enforcing them and educating the public, but "a ton more needs to be done," he said.

To that end, Narayan produced a video showing the repercussions of driving while texting that will soon be mandatory viewing for all new teen drivers in the state. And he's developing another video that shows what happens to those who drink and drive, to be shown initially to offenders ordered by the courts to visit Shock Trauma to see accident victims.

"People need to see the ramifications of their actions," said Narayan, who noted that the videos graphically show how difficult everyday activities can become after injury. "When it comes to treating trauma patients, the best patient is the one we never see."

Officials in every state need to refocus on prevention, Narayan said. Some are doing better than others, according to the report. New York and California scored the highest, with nine of 10 laws passed. Montana and Ohio had passed just two of the 10.

The report's authors said research will continue to determine the best methods of preventing injury. Sometimes recommendations change. For example, Gielen said, children should be in booster seats until they are 8 years old and babies' seats should remain backward until occupants are 2, longer than previously thought.