Elizabeth McLoughlin

Project Burn Prevention: outcome and implications

Project Burn Prevention was designed and implemented to determine the ability of a public education program to increase awareness about burn hazards and reduce the incidence and severity of burn injuries. Media messages were transmitted to residents of a large metropolitan area; separate school and community interventions were implemented in two demographically similar communities within the Standard Metropolitan Statistical Area (SMSA). A second metropolitan area and two of its communities served as control sites. Messages for specific, high-risk age groups emphasized flame burns because of their severity and scalds because of their frequency. Knowledge gains were demonstrable only as a result of the school program. Neither the school program nor the media campaign reduced burn incidence or severity; the community intervention may have brought about a moderate, temporary reduction in injuries. Multiplicity of messages, brevity of the campaign, and separation of the interventions are among possible reasons for the programs failure to significantly reduce burn injuries. Education for personal responsibility is not sufficient. Product modification and environmental redesign must be instituted through education and legislation for successful control of burn injuries.

Injury mortality and morbidity in New Zealand

An overview of the injury problem in New Zealand is presented. National mortality and morbidity data demonstrate that relative to other diseases injuries represent a significant community health problem. Injuries are the fourth leading cause of death and account for 32% of Potential Years of Life Lost between the ages of 1 and 70. Injuries are the second leading cause of hospital admission and account for nearly 12% of all admissions. Injury rates vary dramatically by age, sex, socioeconomic status, and race. In general, males, particularly those 20-24 years old, have higher death and hospitalisation rates than females. A notably exception is elderly females, who have a hospitalisation rate nearly twice as high as elderly males. Maori and those from low socioeconomic levels have the highest injury rates. The leading causes of injury death are motor vehicle crashes (37%) and self-inflicted injury (21%). This contrasts to some extent with the two leading causes of hospitalisation, namely falls (25%) and motor vehicle crashes (19%). The road, home, and places of recreation and sport are the most common places of occurrence of serious injury. Head injuries, in particular concussions, and fractures of the lower limbs, particularly the femur, account for 35% of all injury morbidity. Treatment and rehabilitation costs for injuries that resulted in hospitalisations, visits to accident and emergency centres, and a claim on the Accident Compensation Corporation cost an average of

A comparison of age-specific burn injury rates in five Massachusetts communities.

133 (1983) per head of population.

Improving Intimate Partner Violence Protocols for Emergency Departments An Assessment Tool and Findings

We measured burn incidence rates for residents of five Massachusetts cities. The data set included all non-occupational burn injuries and cases of smoke inhalation requiring treatment on an inpatient or an outpatient basis in a hospital, occurring between October 1, 1973 and September 30, 1976. Rates of burn injuries by age, and by burn type were calculated for each city. Examination of the data revealed large differences in the magnitude of the age-specific incidence rates among cities but remarkably similar patterns of rates for each city. Differences in the economic status among the cities and among census tracts within the cities appeared to explain a large proportion of the variation in the crude burn rates. A similar specificity of certain types of burn injury by age and sex was common to each city. These findings can be used by health education specialists to design and implement burn prevention programs in these communities appropriate for those individuals at highest risk.

One pediatric burn unit's experience with sleepwear related injuries. 1977.

A Protocol Assessment Tool (PAT) was developed to assess emergency departmentss (EDss) protocols regarding treatment of patients sustaining partner violence. Using this tool, project staff members evaluated the content of written protocols submitted by ED nurse managers in California and in a national sample in 1992-1993 and in 1996-1997. The number of protocols and their overall content improved significantly in California between 1992-1993 and 1996-1997, and there was a suggestion of improvement in the national sample. Advocacy efforts influenced Joint Commission on Accreditation of Healthcare Organizations guidelines and California laws, which in turn may have stimulated increases in the quantity and quality of protocols. The PAT permits readers to evaluate their local facilitys protocols.

Difficulties and bonuses of evaluation: evaluating New Zealand's Children's Nightclothes Act 1977

Review of the records of 678 children with acute injuries referred during an eight year period to this burn unit indicated that flame burns from a single ignition source (50%) outranked scalds (27%) or house fires (12%) as causes of injury. There was no temporal trend in the rank pattern. The majority of these single-source flame injuries were severe and involved ignition of the childs clothing. From 1969 through 1973, sleepwear was the clothing involved in 32% of the instances. Since that time and coincident with promulgation of strict federal and state standards for flammability of childrens night clothing, a dramatic decline in the number of children referred with injuries of this type has taken place. It is probable that the single factor most important to the decline, in our experience with these injuries, is lower fabric flammability but, because our data may not be representative, corroboration is needed before one can exclude factors such as altered garment design, fire safety related practices at home, or changing patterns of hospital referral.

Screening and intervention for intimate partner abuse: practices and attitudes of primary care physicians.

Difficulties and bonuses of evaluating injury prevention programmes are illustrated by reference to an evaluation of the New Zealands Childrens Nightclothes Act 1977. It is demonstrated that despite the difficulties encountered in that evaluation, and the equivocal results, there were significant bonuses which more than justified the resources devoted to the evaluation. The paper is presented in an attempt to encourage others to evaluate thermal injury countermeasures who may be hesitant to do so because of the difficulties they foresee.