There is renewed vigor in accident research relating to the etiology and prevention of severe trauma.
1. INJURY SURVEILLANCE
Fundamental accident data, investigations and analyses are being provided by the National Electronic Injury Surveillance System (NEISS).1,2 This innovative program, based on a pilot study of the National Commission on Product Safety, was fully developed by the Bureau of Product Safety in the U.S. Department of Health, Education and Welfare and began operating in July, 1972. Presently the most important epidemiological program in the field of consumer product safety, NEISS collects data from 119 statistically selected hospital emergency rooms throughout the country. For the first time, valid projections of various types of accidents that will be seen in hospital emergency rooms can be made for the total U.S. population through mathematical formulae.
NEISS provides rapid transmission and computer processing of data.
Frequent reporting enables the Bureau to monitor continuously trends in product-related injuries. In order to study a broader spectrum of injury patterns in the future, the system may eventually be expanded to include data from private physicians' offices, hospital inpatient admissions, community clinics, household surveys and death certificate records for fatal injuries from all 50 states. Hospital emergency rooms report approximately 38 per cent of all injuries.
2. BURNS AND FABRICS
The third annual report to the President and the Congress by the Secretary of Health, Education and Welfare3,4 includes a 1971 analysis of more than 1,000 burn case investigations. The report examines the data from fabric ignition accidents with respect to such variables as age and sex of victims, time of accidents, general and specific body locations involved and the victim's activities preceding the injury. Common to all of the cases was the fact that clothing, bedding or other household fabrics ignited, directly causing a burn injury or contributing to the extent and severity of the burn. The extent of burn injuries, problems of medical management and financial costs were greater when fabric ignition was involved.
Based on basic fire research and data analysis, the Department of Commerce has promulgated certain standards pursuant to the Flammable Fabrics Act of 1967. 5
The textile industry is spending more than $20 million yearly on research and development of fire retardant fabric that is competitively priced. The goal is to provide the consumer with safer, more attractive, comfortable and durable goods.
Chemically treated cellulosics such as cotton and rayon, modacrylics, high-temperature resistant nylon and other flame retardant man-made fibers are becoming generally available for clothing. Fibrous glass and blends of other fire retardant materials are available for decorator fabrics in attractive designs and weaves.6 All carpeting now marketed in the United States meets the preliminary carpet standard developed by the National Bureau of Standards.
Scientists and industrial designers involved with practical applications of physical anthropology related to furniture, toys and recreational equipment have increasingly been concerned with the lack of data concerning the basic dimensions of infants and children. In April, 1972, the Bureau of Product Safety negotiated a contract with the Highway Safety Research Institute, Institute of Science and Technology, University of Michigan, to conduct an 18-month study documenting basic infant and child measurements.
Dr. Richard G. Snyder, a physical anthropologist, and Dr. Martha L. Spencer, a pediatrician, are coinvestigators for this study. Their study will provide representative measurements of the various sizes of openings a child's hand or fist can penetrate at various age levels, the distance the arm or leg can extend, the size opening the buttocks can slide through and related information. More than 45 measurements will be made on approximately 5,000 children. Socioeconomic, ethnic, nutritional and geographic variables were considered in the selection of the study sample.
Information derived from this study will be used by the Bureau of Product Safety to develop safety standards for toys, recreational equipment and furniture.
Several epidemiological studies on bicycle-related injuries have been completed recently. There is increasing concern for the estimated 1,000,000 injuries yearly involving bicycles.
In 1970 Dr. B. J. Campbell and associates at the University of North Carolina Safety Research Center conducted a study of bicycle accidents among 500 youthful riders in Raleigh, N. C. 7 Frequency, type and severity of injuries were related to bicycle design. The study showed bicycle mishaps mostly of a mild nature limited to cuts and scrapes. The youngest of the riders more often show up in accidents than older riders. Children begin riding at ages four or five, before exposure to school safety programs. Therefore, more intensive safety indoctrination must be directed to this age group.
A year earlier Vilardo and Andersen of the National Safety Council reported on a survey of 4,228 children in four counties to determine what children are doing with bicycles, how they are doing it and which children are involved.8 This study showed motor vehicle-bicycle accidents account for only about 12 per cent of all these accidents. By contrast, 45 per cent of bike accidents result from the cyclist falling to the ground, not being involved in any collision either with cars, trucks, other bikes or fixed objects. These falls might be attributable to any of a number of possible causes. Perhaps, the bike is oversized for the child. The youthful rider may lack adequate cycling skill; he momentarily is distracted or loses balance in a quick avoidance maneuver.
Nighttime accidents account for relatively few accidents. However, the severity of the accident is increased after dark. Based on data developed, most accidents are due to cyclist or activity error rather than to the style of the bike. The findings also suggest that the size of the bicycle in relation to the size of the child is an important factor in bicycle safety. The child riding a bike that is too large for him is more frequently involved in accidents.
Dr. Julian A. Waller reported in August, 1970 on a four-month study of bicycle ownership, use and injury patterns among 6,000 elementary school children in Vermont. 9 A total of 104 injured children were compared with uninjured neighbors.
The Campbell and Waller studies conclude that no greater number of injuries are associated with high-rise bicycle use than with conventionally designed bicycle use nor were there significant differences in severity or type of injury.
The Bicycle Manufacturers Association published on July 1, 1971, BMA6, 10 the first voluntary safety standard for bicycles. The Bureau of Product Safety has recommended additional safety factors that will be included in a mandatory federal standard scheduled for publication in early 1973. A staff analysis of bicycle accidents and injuries was published by the Bureau on March 24, 1972." This data plus engineering analyses and other special studies were used as references for the development of the revised safety standard.
5. OTHER ACCIDENT RESEARCH
Technical studies on burns from floor-furnace grills; lacerations from architectural glass; injuries from playground equipment, mini-bikes and snowmobiles are typical research projects now being completed by the Bureau.
1 White. W. National Electronic Injury Surveillance System. Food Drug Cosmetic Law J. 27:4 (1 972), 195200
2 NEISS News. October. 1972.
3. Flammable Fabrics, third annual report by U.S. Department of Health, Education, and Welfare to the President and the Congress, DHEW Publication (FDA) 72-7013, U.S. Government Printing Office, Washington. DC. 1972.
4. Barancik. J. and Shapiro, M. Pittsburgh Burn Study. Environmental Health Program, Department of Public Health Practice. Graduate School of Public Health, University of Pittsburgh. Pittsburgh, May. 1 972.
5. White. W. Flammable Fabrics Legislation and Regulation, speech presented at National Safety Congress, Chicago, October 26, 1971.
6. White. W. Flammable fabrics and the burn problem: a status report. Am. J. Pub. Health 61:10 (October, 1971).
7. Campbell. B.; Foley. J. and Pascarella, E. Characteristics of Youthful Bicycle Riders in an Urban Community and Events Accruing to Operation of their Vehicles. Chapel Hill, N. C: The University of North Carolina Highway Safety Research Center, 1971.
8. Vilardo, F. and Andersen, J. Research Report: Bicycle Accidents to School Aged Children, Report No. 169. Chicago: National Safety Council, 1969.
9. Waller. J. Bicycle Ownership. Use and Injury Patterns Among Elementary School Children in Chittenden County. Vermont. Study supported by Contract 69-30, Department of Health, Education and Welfare. Food and Drug Administration, Rockville, Maryland, Au£ust, 1970.
10. Bicycle Standard. BMA/6. Safety Standard for Regular Bicycles. Sponsored by Bicycle Manufacturer's Association of America. 122 E. 42nd St., New York, NY. 10017. As revised January 15, 1971.
11. Staff Analysis of Bicycle Accidents and Injuries. Department of Health. Education and Welfare. Food and Drug Administration. Bureau of Product Safety, Injury Data and Control Center, Bethesda, Maryland, March 24, 1972.