Ten years ago we first published an issue of Pediatric Annals devoted to accidents. It was under the Guest- Editorship of Dr. George Wheatley, one of the early activists in the area of accident prevention. In the 1950s, he frequently presented striking exhibits on the subject at conventions of the American Academy of Pediatrics and the American Public Health Association. In 1952, he organized the first committee on accident and poison prevention of the AAP. This committee soon became a primary influence in the United States and throughout the world.
As 1 recall, the greatest effort during those early years was devoted to infants and young children. Much progress was made under AAP influence. Among these advances were fire-retardant clothing, safe cribs, safety seats for automobiles, safe toys, and child-proof caps for medicine bottles.
Efforts to control adolescent injuries followed. Athletic injuries are still a major cause of morbidity. The pediatrician may be called on to treat injuries sustained while playing football, wrestling, basketball, soccer, weight lifting, and even break dancing.
However, the greatest danger to adolescents involves motor vehicle accidents. Not only is the adolescent a comparatively new driver, but he (boys are involved more frequently than girls) is often very competitive and daring, and likely to drive under the influence of alcohol and without a safety belt. It should be realized by all pediatricians and all physicians caring for adolescents that accidents are by far the greatest cause of death and injury to boys . and girls of this age. The subject is of vital importance.
This issue of Pediatric Annals devoted to adolescent injuries is under the Guest-Editorship of Dr. Paul Dyment, who has long been involved in this area. Dr. Dyment is Professor of Pediatrics at the University of Vermont in Burlington, Vermont, and Chief of Pediatrics at the Maine Medical Center in Portland, Maine.
The first article in the symposium deals with "The Epidemiology of Injuries in Adolescents" and is contributed by Dr. Jerome A. Paulson, Clinical Associate Professor of Pediatrics at the Georgetown University School of Medicine, Washington, DC. The discussion focuses on unintentional injuries and carefully presents the problems associated with the numerous causes. Dr. Paulson emphasizes that among these the most frequent are accidents and deaths from motor vehicles, motorcycles, and drowning.
It is stressed that alcohol plays a leading role in fatal injuries in adolescents, accounting for a great number of motor vehicle accidents and deaths. I might add that at this time throughout the country, efforts are being made to overcome this problem from several directions. The first is by raising the legal age of alcohol sales to 21 years. The second is through watchful organizations such as MADD (Mothers Against Drunk Driving).
Dr. Paulson then fully discusses the dangers related not only to automobiles, but also to motorcycling, and even walking in the roadway. One startling statistic is presented: 25% of adolescent drivers in fetal daytime multivehicle crashes have a high blood alcohol content, as do nearly 75% of adolescent drivers in fatal nighttime single vehicle accidents.
Next, the author discussed injuries in the school and sports environment. He notes that football is the most dangerous sport- one of the few with some possibility of mortality. He concludes with an examination of accidents in the home and farm environments. This is a superb and very informative article on this important subject.
The following article is by Dr. Dyment and discusses "Initial Management of Minor Acute SoftTissue Injuries." At the outset Dr. Dyment notes that millions of young people are taking part in sports activities, with many injuries resulting. Especially frequent are sprains and strains. There is an excellent discussion of the diagnosis and treatment of these conditions. Step by step, the author presents the four methods of treatment: rest, ice, compression, and elevation. Each of these means of therapy is carefully considered with advice on obtaining the maximum relief and healing. This is an excellent article and should be read and retained by all practicing pediatricians, for sprains and strains are not uncommon among adolescents.
The next contribution to the symposium concentrates on "Motor Vehicle Injuries During Adolescence" and has been written by Dr. Frederick P. Rivara. Dr. Rivara is associated with the Harborview Injury Prevention and Research Center, and the Departments of Pediatrics and Epidemiology of the University of Washington, Seattle, Washington.
This article is a valuable supplement to the article by Dr. Paulson, for it concentrates on the various approaches for the prevention of motor vehicle injuries among adolescent drivers. The author reviews the evidence presented for each of the following: high school driver education programs, driving curfew laws, delaying the age of licensure, raising the minimum age for the purchase of alcohol, legislation requiring mandatory seat belt and motorcycle helmet use, and airbags.
Of special interest is the well documented report on the value of driver education programs. The results of the studies are startling. Also startling is the report that among 16 year old male drivers, the nighttime fatality rate is four times higher than their daytime rate. This is a most interesting article, presenting clearly the evidence which, if followed, would greatly reduce the mortality rate of adolescent drivers. Pediatricians and legislators alike will find this study not only interesting, but extremely valuable.
The fourth article discusses "Non-Automotive Vehicle Injuries in Adolescents," and has been contributed by Dr. Joseph Greensher, Professor of Clinical Pediatrics at the State University of New York at Stony Brook, Long Island, and Director of Clinical Pediatrics at the Winthrop-University Hospital, Mineóla, New York.
Dr. Greensher points out that bicycle riding has increased tremendously in recent years, and with this rise there has been a marked increase in accidents and deaths. He notes that riding against traffic and nighttime riding are among the leading causes of accidents, and advises the use of helmets by bicycle riders.
Skateboard injuries are discussed, with some amazing figures on the number in use and resulting accidents. It is estimated that 350,000 skateboardrelated injuries will occur annually in the next few years.
The potential dangers of powered off-road use cycles, such as minibikes and trailbikes, are next considered. These are used largely by younger adolescents, with nearly 50% of the accidents occurring in the 10 to 15 year old age group. The types and causes of the injuries are also presented.
A discussion on the use of mopeds is followed by the dangers accompanying motorcycle driving. The dangers of the latter activity are considerably higher than the potential dangers of driving automobiles. The drivers are largely male adolescents or those in their early twenties, with one third of the deaths from motorcycle driving occurring in those under 20 years of age.
The article concludes with an important discussion of all terrain vehicles, which are becoming more and more popular, especially with children and adolescents. These off-road vehicles represent a new hazard. They can speed up to 50 miles per hour. Dr. Greensher notes the rapid rise in injuries from the use of these vehicles. The dangers to children are evident from the figures he presents: 45% of the accident victims were under 16 years old, and 20% under 12 years old. The American Academy of Pediatrics has been actively involved in the demands that the manufacturers improve the engineering to provide greater safety.
The final article in this symposium considers "Adolescent Drownings - Swimming, Boating, Diving and Scuba Accidents." It is written by Dr. James P. Orlowski, Director of Pediatric Intensive Care, The Cleveland Clinic Foundation, Cleveland, Ohio.
Dr. Orlowski states at the outset of his article that drowning is the second leading cause of unintentional injury and death among adolescents. The causes of drowning are discussed, including the prominent involvement of drugs and alcohol. Boating and diving accidents are in many cases related to the use of drugs or alcohol, as are deaths from scuba diving.
In his discussion, the author notes that there are very few restrictions on swimming and water sports except for those patients with epilepsy, where the risk of drowning is four to five times greater than for the normal person.
The article closes with a full report on treatment of near-drowning victims. Dr. Orlowski states that the most important single step in the treatment of a submersion accident victim is immediate resuscitati ve measures. What steps, then, can be taken if the person is pulled from the water by a swimmer far from land? If the airway is obstructed, is the Heimlich maneuver indicated? Should a cyanotic, near-drowning victim be hospitalized, and if so, for what length of time? These are some of the problems considered in this final article.