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    National hospital initiative targets preventable injuries

    A pediatric surgeon’s local program begun to stop kids’ falls from windows has evolved into a nationwide coalition model for injury prevention in children.

    Unintentional injury is ranked number one among the 10 leading causes of death in children. In fact, injuries, ranging from car and bike crashes to poisonings and gunshot wounds, kill more children than anything else, starting at age 1 year to age 44 years.1

    Wendy J Pomerantz, MD, MS“We spend all this time thinking about cancer and heart disease and all this stuff, and, in kids, injury is the number one cause of mortality over the age of 1 [year]. It’s responsible for more deaths than all diseases combined, which is pretty staggering,” says Wendy J Pomerantz, MD, MS, professor of Pediatrics at the University of Cincinnati, Cincinnati Children’s Hospital, Ohio.

    Pomerantz is president-elect of the Injury Free Coalition for Kids (www.injuryfree.org/), a national effort created and led by front-line doctors, including pediatricians. With funding from the Robert Wood Johnson Foundation, Injury Free Coalition for Kids has more than 42 independently run sites based in hospital trauma centers in the United States. Each site is headed by a physician and a community coordinator charged with addressing the injuries that are the most prevalent in their community.

    This is a long-running coalition, started in 1981 by Barbara Barlow, MD, then chief of pediatric surgery at New York City’s Harlem Hospital. After noting that kids were falling from multistory apartment buildings in Harlem, Barlow established the “Children Can’t Fly” program in New York City, mandating window guards in buildings. She established the program in 1979 and by 1983 her paper on the effort, published in the Journal of Pediatric Surgery, showed a 96% decrease in falls from windows requiring hospitalization in Harlem.2

    Since then, the coalition has blossomed into sites in cities from San Diego and Seattle to Ann Arbor and Miami. Its members have published outcomes in many peer-reviewed publications. The coalition’s persistence has resulted not only in saved lives and quality of life, but also with new laws designed to protect children, as well as design modifications in products such as the microwave.3

    To start a coalition site, pediatricians or pediatric trauma surgeons and other team members use a model the coalition refers to as the “ABCs of injury prevention.”4

    The key to the coalition’s work is program diversity according to the needs of each community, notes Pomerantz. “This isn’t like big brother going in and saying this is what we see; we need to fix this. [Often,] we don’t have any idea what’s really going on in the community,” she explains.

    She uses the example that emergency department (ED) and trauma staff might see that kids are getting hit by cars. However, the children might be getting hit by cars because they’re running to get away from drug dealers on one side of the street. “The root of the problem is to get rid of the drug dealers, so people don’t have to cross the street,” Pomerantz says. “People in the neighborhoods know these things, so it’s helpful to have both sides.”

    When Pomerantz and colleagues started a coalition in Avondale, a community just up the street from Cincinnati Children’s, the data revealed a high percentage of African American school-aged children, most below poverty level, were getting injured in the after-school hours. “We found out they had nothing to do other than hang out in the streets. So, what we did in that community was start an after-school program, to give kids something to do,” she says. “In another community we went into, we figured out the kids that were getting injured were mostly under [age 5 years] and it was happening in the home. So, we started a home safety program.”

    Part of the model is to do something tangible in Injury Free Coalition for Kids’ communities, according to Pomerantz. An example: Injury Free sites around the country have built more than 50 playgrounds, to give children safe places to play.

    Trauma triggers action

    Sometimes, it’s a particularly emotional issue that prompts people to want to do something about injury prevention.

    Michael P Hirsh, MDMichael P Hirsh, MD, pediatric surgeon, chief of Pediatric Surgery and Trauma at the University of Massachusetts (UMass) Memorial Children’s Medical Center, Worcester, and co-principal investigator of the Injury Free of Worcester, was a surgical resident at Columbia-Presbyterian Hospital, New York City, in the 1980s when something happened that put gun violence front and center.

    “I lost my best friend to gunfire. He was a resident with me and asked me to hold onto his beeper for a minute. He stepped out in front of the building and got shot right in front of the building,” Hirsh says.

    To make some sense of it all, the hospital brought in speaker and gun control advocate Sarah Brady, whose husband, White House press secretary James S. Brady, was shot and partly paralyzed in the attempted assassination of President Ronald Reagan in 1981. Brady’s message, according to Hirsh who was in attendance for the lecture, was that the one thing that raised most confrontations from nonlethal to lethal was the handgun.

    Hirsch kept that in mind and made note of the work Barlow was doing in Harlem. When he moved to Pittsburgh, Pennsylvania, to take a post at Allegheny General Hospital, Hirsh says he studied the data and got community input to see which injuries were most lethal for kids there. He found that although pedestrian fatalities topped the list, the public was clamoring for help with something else.

    Related: What you can do about gun safety

    “You can’t take the public out of public health, and the public was clamoring for violence control,” Hirsh says. “This was 1993. The entire Pittsburgh scene had been taken over by the crack cocaine epidemic. Gangs were setting up turf wars . . . with gun fights. We were seeing many gunshot wounds coming in each week to the pediatric trauma service . . . . Finally, in 1994, a child was killed in front of the mayor’s house in Pittsburgh with an AK-47.”

    Hirsh and a pediatric intensivist colleague had heard about a New York City carpet store owner who was so disgruntled with neighborhood gun violence that he offered free carpet in exchange for people bringing in their firearms. “He got almost 2000 weapons in a single day,” Hirsh says. “We adapted the idea to Pittsburgh.”

    Allegheny County’s “Goods for Guns” program was born. Instead of carpet, the site, based out of Allegheny General Hospital, gave gift certificates to local department stores. It was around Christmas when the group did its first gun buy-back. Word got out, and that first day people were lined around the block with their weapons in hand, giving them peacefully in exchange for a gift certificate. “We retrieved in 1400 weapons that first year. [That program in Pittsburgh has gone on since 1994 to this date, and they’ve collected over 12,000 weapons in the 22 years,” Hirsh says.

    Hirsh has since started a Goods for Guns program in Worcester, which collected more than 2900 guns between 2002 and 2016, removing unwanted guns from homes and raising community awareness about firearm safety.5

    Although Hirsch doesn’t have the data to directly correlate Goods for Guns with statistics that show Worcester County has the lowest penetrating trauma rate of any county in Massachusetts, he says that the program, which also has distributed about 1400 free gun safety trigger locks, has raised awareness about gun safety and is contributing to the county’s lower gunshot fatality rate.

    “The total cost for us of doing these 14 years of gun buybacks is about $150,000, and that’s less than the costs of caring for gunshot wound victims,” Hirsh says.

    Like other coalition sites, Worcester offers more than 1 safety initiative. Hirsh says others include a mobile safety street, which goes to locations to show kids how to be safer on the street, as well as a mobile driving education unit for high school kids, which simulates bad weather and distracted driving. Worcester also offers a child passenger safety checkpoint, for people who need a free car seat or need one installed properly.

    Still another local program takes first-time driving offenders through an all-day experience in the trauma center. The reality dose was associated with a big drop in the recidivism rate, which was 6% at 6 months for kids in the program versus 56% at 6 months in the control group.6


    NEXT: Making microwaves safer

    Lisette Hilton
    Lisette Hilton is president of Words Come Alive, based in Boca Raton, Florida.


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