Injury prevention laws save lives, report shows

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.
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)

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.

New threats are emerging that will require study to determine the best methods of prevention. They include texting while driving, prescription drug overdoses, bullying, concussions in school sports and falls among the aging Baby Boomer generation.

Once research shows what works, the public still will need convincing. Gielen noted drunken driving as an example. Laws were passed but injuries did not go down until Mothers Against Drunk Driving publicized the problem. The next step, Gielen and other researchers say, are mandatory ignition interlocks for all convicted drunken drivers.

But unintended consequences also could be a problem as new laws take effect, Levi said. For example, simply banning texting could make some drivers try to hide their phones from law enforcement, diverting their eyes longer from the road.

"There is definitely an educational component, for the lawmakers and for the public," he said.

Nathaniel Thomas, who takes his young son to see a pediatrician at Johns Hopkins' Harriett Lane Clinic, said becoming a father meant a huge learning curve for him. He said he'd never given much thought to baby gates, outlet covers and cabinet locks before having Nathaniel Jr. just over a year ago.

Now that his son is walking, he sees all kind of hazards and said he's benefited from a safety center opened in his doctor's office. The certified health educators there have shown him how to keep Nathaniel Jr. safe with products provided at low cost.

"This is my first child, and it's all new to me," said Thomas, who recently returned to the center for a second baby gate. "After I get it installed, I'll feel more confident about his safety. It'll keep him from getting into everything."

Stephanie Parsons, project director for a mobile version of the Hopkins' safety center, said even when people understand they need child safety seats, for instance, they don't always use them correctly. About 90 percent of the seats are not installed properly.


"They turn them around too fast or don't belt them in properly," Parsons said. "People know they need smoke detectors but then don't test them to see if they work. Everyone needs to be taught about prevention."


The 10 measures:

Seat belts: Have a primary seat belt law (32 states, including Maryland).

Drunken driving: Have mandatory ignition interlocks for all convicted drunken drivers (16 states).

Motorcycle helmets: Require helmets for all riders (19 states, including Maryland).

Booster seats: Require seats to age 8 (33 states, including Maryland).

Bicycle helmets: Require helmets for all children (21 states, including Maryland).

Intimate partner violence: Allows people in dating relationships to get protection orders (44 states, including Maryland).

Teen dating violence: Several measures recommended (6 states).

Concussions: Several measures recommended, including baseline exams for school sports (36 states, including Maryland).

Accidental prescription drug overdose or use: Have an active monitoring program (48 states, including Maryland).

Ecodes: Include a code on patient discharge forms from emergency rooms showing the injury cause for research purposes (23 states, including Maryland).

From the report:

•Maryland scored eight out of 10 on key injury-prevention laws focused on seat belts, child seats, bike and motorcycle helmets, domestic violence, concussions, prescription drug use and research.

•Maryland's rate of injury-related deaths is 56.1 per 100,000 people, or 15th in the nation.

•Seat belt laws nationwide saved about 69,000 lives from 2006-2010.

•Motorcycle helmet laws nationwide saved about 8,000 lives from 2005-2009.

•Child safety seat laws nationwide saved about 1,800 lives from 2005-2009.