McDonald's Corporation pay $4 million damage settlement

The McDonald's Corporation has agreed to pay the US government $4 million in damages for failing to inform the Consumer Product Safety Commission (CPSC) of playground injuries at some of its restaurants. The settlement resolves a dispute arising from enforcement of a 1995 Playground Equipment Reporting Agreement between McDonald's and the government. The cooperative agreement announced in June also establishes important new playground facility reporting and safety guidelines.

The injuries involved the “Big Mac Climber”, a metal platform resembling a hamburger, that is no longer in any McDonald's playgrounds. According to the CPSC, from the 1970s through the 1980s, more than 400 children were injured on Big Mac Climbers, mostly in falls, including nearly 20 who suffered concussions or skull fractures and 80 who suffered broken bones. Injuries declined significantly in the 1990s as McDonald's began removing the climbers. All the climbers have now been removed and scrapped.

British Airways toddler seat

British Airways has unveiled what it claims is the world's first airline seat for the under 2s, enabling them to travel in safety in their own seat—at no extra charge. Designed by Britax, the UK's leading manufacturer of children's car seats, the seats are suitable for babies from birth up to 2 years old. They fix securely on the bulkhead position and—unlike the existing flat carrycots—can be moved through a range of positions from horizontal to upright. More than 1000 infant seats will be available for booking on British Airways long haul flights, with plans to extend them to short haul services in the future.

Indictments in lighters case

The US CPSC announced in July that two people have been indicted on charges arising from its investigation into the removal of child safety mechanisms from disposable cigarette lighters. The indictments are part of an ongoing investigation by the CPSC and the US Justice Department into the illegal sale of cigarette lighters with their child resistant features disabled. Before cigarette lighters were required to be child resistant, during the period 1988–90, an average of 150 persons were killed and nearly 1100 injured per year as a result of residential fires started by children younger than 5 who were playing with lighters. Average annual property damage from such fires totalled almost $70 million. Each of charges carries a maximum penalty of five years' imprisonment.

Airbags planned for jumbo jets?

Airbags, the safety devices designed to protect motorists and their passengers, could soon become standard equipment on commercial aircraft. Unlike airbags in cars, installed in dashboards or steering wheels, the airline versions would be incorporated in seat belts. In a crash or forced landing, they would inflate to form pillows, preventing passengers from falling forward and injuring their heads. To date, the only planes to carry airbags have been military helicopters and private jets. These have airbags more like the ones used in cars, designed to be fitted in cockpits to prevent injuries to flight crew. Two companies are developing inflatable seat belts for airline passengers in response to new safety rules in America that require additional protection against head injuries. These are a particular risk on seats that face the bulkhead or emergency exits, where the seats in front have hard backs; the backs of ordinary seats are designed to collapse forward when passengers behind fall on to them.

New helmets for old in Malaysia

In Malaysia, the use of certified motorcycle helmets is mandatory by law. Although the government introduced the more stringent new standards, MS 1:1988, to replace the old MS 1: 1969, they are yet to be enforced universally. Twenty five motorcycle helmets bought randomly from retailers in Kuala Lumpur and Petaling Jaya were tested at the Standards and Industrial Research Institute (SIRIM) for compliance with MS 1: 1988. Twenty two helmets failed the physical testing (shock absorption, penetration resistance) while chin strap attachment failed in four of the helmets. The study suggests that most helmets in the market do not comply with the new standards, MS 1: 1988. Though helmet manufacturers now comply with the new standards, helmets that meet old standards are still widely in use by motorcyclists and need to be replaced. Further information: Dr R Krishnan, Department of Primary Care Medicine, Faculty of Medicine, University of Malaya, 50603 Kuala Lumpur, Malaysia, tel: +60 3 750 2306, fax +60 3 757 7941, e-mail: rajamk{at}medicine.med.um.edu.my.

Safety awards

Primary Children's Medical Center's Hold on to Dear Life seat belt campaign has earned three Telly Awards in the 20th annual national Telly Award competition in the US. The honour is one of the most prestigious for non-network and cable TV commercials. Their campaign was made up of advertisements and public service announcements—Trooper, Faces, and Airbag—which featured real life stories of accident victims, photos of children killed in car accidents, and the dangers to children in the front seat with airbags.

Sarifa Kabir, an accident and emergency nurse at the Royal Preston Hospital, England, has won one of the first Beacon awards for health improvement and good practice. Her work over the past four years has been researching injury trends among under 16s and promoting community based accident prevention campaigns at the hospital.

Protecting children from gun violence

In July, President Clinton met over 80 high school students from Littleton, Colorado, and the Denver area to discuss the importance of enacting common sense gun legislation. The President insisted that Congress send to his desk for signature—without further delay—the reasonable gun measures already passed by the Senate.

In June, House leaders, bowing to the gun lobby, tried to pass a bill that would have weakened current gun laws instead of strengthening them. Since then, House and Senate leaders have failed to name conferees to resolve issues surrounding the juvenile crime bill—allowing the US gun lobby more time to try and stop gun legislation from becoming law.

After the meeting, the President urged Congress to listen to these students—instead of the gun lobby—and to act to strengthen US gun laws before the start of the next school year. Specifically, the President asked Congress to send him legislation to:

• Close the “gun show” loophole, stopping firearms from being sold at gun shows on a “no questions asked” basis.

• Require child safety locks with every handgun sold, to reduce the unauthorised use of handguns by a curious child or a teen looking to commit a crime.

• Ban violent juveniles from owning guns as adults.

• Ban the importation of all large capacity ammunition magazines, closing the loophole in current law that allows the continued importation of large numbers of high capacity ammunition clips that were generally banned by the 1994 assault weapons ban.

Editor's note: What has happened since this press release appeared?

Major recall of US infant car seats

Cosco Inc of Columbus, Indiana is recalling about 670 000 infant car seats/carriers, the CPSC and the National Highway Traffic Safety Administration (NHTSA) announced in July. When used as an infant carrier, the handle locks on each side of the seat can unexpectedly release, causing the seat to flip forward. When this happens, the infant can fall to the ground and suffer serious injuries. There have been 151 reports of the handle of the car seat/carrier unexpectedly releasing, resulting in 29 injuries to children. These reports include skull fractures, a broken arm, bumps to the head, black eyes, scrapes, and bruises. According to the reports, some injuries occurred to children who were restrained in the seat.

Cycle helmets should not be compulsory

Cyclists are advised to wear helmets but legislation to make them compulsory is likely to reduce the number of people choosing to cycle and would not be in the interests of health, concludes the British Medical Association's Board of Education and Science. The board's previous reports have concluded that the benefit to health of regular exercise from cycling outweighs the British cyclist's comparatively high risk of trauma. In countries such as the Netherlands and Denmark, pedestrians and cyclists form a much smaller proportion of those injured or killed on the road, though helmets are little used. Instead, these countries have concentrated on safety programmes to reduce motor traffic speeds to 30 km/h in urban areas and separate cyclists from fast moving traffic. Children are more likely to simply fall off their bicycles and may therefore derive more benefit from wearing a helmet. However, the cost, between £12 and £30, and the necessity of replacing helmets every few years as the child grows may be prohibitive. The report recommends that the government should consider subsidising this cost, along with other measures to promote helmets manufactured to the highest standard. It also recommends that every child should be given the opportunity to learn cycling proficiency and that the driving test should be modified to test specifically for awareness of cyclists and other road users.

Mark Rosenberg leaves CDC

In September Dr Mark Rosenberg left his position as Director, National Center for Injury Prevention and Control (NCIPC), Centers for Disease Control (CDC), to become Science Director at the Collaborative Center for Child Well-being (CCCW) at the Task Force for Child Survival and Development in Atlanta. For the past 16 years, Dr Rosenberg has been the driving force behind CDC's violence prevention program, and as Director of NCIPC since 1993, he has played a major part in the development and recognition of the center and the field of injury prevention and control.

Recall of spillproof sport bottles

Gerber Products is voluntarily recalling about 300 000 spillproof sport bottles. A valve inside the cap can detach, posing a choking hazard to young children. Gerber and the CPSC have received over 30 reports of valves detaching, including three reports of valves found in children's mouths. There have been no reported injuries.

What research is required to get injury prevention ahead?

This is the question that an Australian committee with the brief of enhancing national research capacity and defining research and training agendas asked itself. The result is Paradigm shift in injury: from problem to solution. New research directions, an investigation into the status of injury research in Australia by the Strategic Research Development Committee (SRDC) of the National Health and Medical Research Council (NHMRC). The report, noting that injury was first recognised as a national health priority in 1986 and that injury is acknowledged as a major issue, argues that progress towards a systematic response has been slow and that new ways of doing things are required. “Developing the evidence base (for injury prevention) requires contributions from a wide range of disciplines and involves a wider range of research paradigms than have traditionally been accepted within the core health research paradigms. Intervention strategies also require structures within the health system that differ from those required to provide clinical services. A paradigm shift is needed to make adequate progress”. The report is aimed at facilitating discussion and to initiate change. Among other things, it recommends that the SRDC invest in research, investigation, and implementation of strategies around fall related injuries, injuries to young people, partnership development, and on the mortality information system. The report can be downloaded in PDF format from the NHMRC publications area of the Australian Federal Health Department web site at www.health.gov.au/nhmrc.

New steps on US youth violence

President Clinton announced in August two initiatives to help reduce youth violence:

• A new antiviolence public service advertising campaign—the prime time debut of public service ads on the theme of “Talking with Kids About Violence”. The ads feature children and the President talking about the need for parents to talk to their kids about violence. A free booklet for parents on how to talk about violence is available at www.talkingwithkids.org, or by calling 1-800-CHILD44 (in the US).

• $15 million in Justice Department Office of Community Oriented Policing Services (COPS) grants for local law enforcement agencies across the country to form innovative partnerships with schools or community organizations to target specific problems of crime and violence in or around schools. The 247 COPS School-Based Partnerships grants emphasize the use of community policing and problem solving methods to address the causes of school related crime and disorder problems, such as drug dealing and use, assaults, truancy, vandalism, and other student safety issues.

Play Fair with Working Children

A new report Play Fair with Working Children has been published by Save the Children. It is the first time that the views of children towards employment have ever been researched in Northern Ireland. It provides very comprehensive quantitative and qualitative data on the involvement of school pupils aged 15–16 years, in term time employment in Belfast. One in five of the children held a term time job at the time the survey was carried out and one in three of the non-working pupils had previous term time employment. Though the majority worked less than 10 hours per week, nearly one third worked over 10 hours per week. Children work during hours and in occupations prohibited by the current legislation. Only 60% stated that their employer had informed them about health and safety, 28% of the sample felt that their work was dangerous, and 26% had an accident during the course of their work with cuts, burns, and dog bites being the most common.

More belting up in Britain brings results

Nearly six out of 10 of all adults and over 90% of children are now belting up in the back of cars, the government announced in August. The figures from the Transport Research Laboratory mark the most substantial rise in rear seat belt wearing since their use became compulsory in 1991. Restraint Use by Car Occupants, 1997–99 examined rear seat belt use in 27 000 cars on different roads in Berkshire and Nottingham at six monthly intervals between October 1997 and April 1999. The figures show:

• The percentage of adults wearing rear seat belts has risen from 48% in April 1997 to 59% in April 1999.

• 84% of children in the 10–13 age group are wearing rear seat belts.

• Some 93% of children under 5 now use restraints.

Welcoming the figures, the transport minister commented, “This news is encouraging and shows people are taking seriously our message to belt up in the back for everyone's sake. Rear seat belt use is just as vital to car passenger safety as using a seat belt in the front. The campaign launched in July 1998 has had a significant impact in generating increased wearing”.

19 Million dive sticks recalled

In June, 15 US companies recalled more than 19 million dive sticks used in swimming pools. In shallow water, children can fall or land on a dive stick and suffer rectal or vaginal impalement. Facial and eye injuries also are possible when children attempt to retrieve the sticks under water. The CPSC knows of six impalement injuries and one facial injury to children 6–9 years old. Three of the children suffered rectal and three suffered vaginal impalements from dive sticks placed in backyard pools or, in one case, a hot tub. In four of the six incidents, the injuries that occurred required surgery and hospitalization. The facial injury occurred when a child bobbed down to retrieve a dive stick and lacerated her face just below her eye, requiring stitches. The dive sticks being recalled are hard plastic and are either cylinder shaped or shark shaped. When dropped into water, the dive sticks sink to the bottom of a pool and stand upright so that children can swim or dive down and retrieve them.

Falls from soft infant carriers

Over 300 000 front and back packs used for carrying babies have been recalled in the US because small infants can shift to one side and slip through the leg openings of these carriers and fall. Infants under 2 months of age are at greatest risk. The CPSC is aware of 13 reports of infants slipping through the leg openings of these carriers. One infant reportedly suffered a fractured skull and two infants received bruises in falls to the ground from the carrier.

Comparison of road casualty data sources

A paper in the autumn 1999 issue of Health Statistics Quarterly compared road casualty statistics from the England's Office for National Statistics, which collects all mortality data, and the Department of Transport figures derived from police data. The comparison revealed close agreement between the data sources for road traffic deaths, with a 40% decline in mortality rates since the early 1980s. This decline was most dramatic among young male motor cyclists. However, in recent years the authors report that the long term fall in mortality among users of all main modes of transport has halted or reversed. One notable advantage of linking the databases has been the ability to examine the length of time between the crash and any resulting deaths, with policy implications for resource allocation to emergency treatment, hospital care and safety measures to reduce crash severity. The linkage has only recently become possible due to the inclusion of postcode in the transport department data files.

Validation of injury surveillance in Queensland

The subject of the June 1999 edition of Queensland Injury Surveillance Unit's Injury Bulletin linked closely with papers in the September issue of Injury Prevention. The bulletin examined routine collected data from three emergency departments—one urban, one rural, and one remote—and compared them with interview data. The exercise showed that surveillance is possible in computerised departments, as long as there is adequate clerical staffing. Visit www.powerup.com.au/~qisu for further details.

Labelling of seat belt positioners

The NHTSA proposed in August that after market devices intended to realign car seat belts are not suitable for young or small children. This follows tests with dummies simulating a 6 year old that showed that they reduced the effectiveness of the belt. With a 3 year old dummy, restraint was inadequate and there was an increased risk of head injury. NHTSA officials are concerned that the devices may cause the lap belt to rise up in a crash and rest above the child's hips. The devices are intended to keep the shoulder belt off the child's neck. The American Academy of Pediatrics had petitioned the government to amend regulations relating to these devices.

Safekids New Zealand web site launched

Visit the attractive new site www.safekids. org.nz for the latest about the activities of the Auckland based group. The site covers advocacy and issues, a safe routes to school section, and information about Kidsafe Week.

California requires insurers to replace child seats

The Emergency Nurses Association of California are delighted that their efforts to require car insurers to replace child restraints after a crash have been successful. The State Governor signed into law a bill requiring such recompense from January 2000.

Housing New Zealand installs smoke alarms

Each bedroom, living room, and hallway in Housing New Zealand property now has a long battery life smoke alarm under the authority's fire safety programme, reports Housing New Zealand programme manager Doug Spick writing in the June issue of Safekids News, the newsletter of Safekids Aotearoa–New Zealand. The installation has taken less than a year to complete and there are already indications that the programme is bearing fruit.

Martinez leaves NHTSA

Dr Ricardo Martinez, Administrator of the NHTSA is leaving the US Department of Transportation after five years at the agency and returning to medicine and the private sector. His approach as a physician and a recognized expert on crash injuries changed NHTSA and the way industry and the public deal with motor vehicle safety. His focus on the patient—the customer—introduced safety as an element of competition in the automobile industry.

During his tenure Dr Martinez positioned traffic injuries as a public health problem, and markedly expanded and engaged the constituency on traffic safety issues to include business, athletes, education, health care, policymakers, public health officials, law enforcement, civic organizations, the judiciary, the media, and legislators. He succeeded in putting a human face on the tragedies of motor vehicle crashes, and called them “predictable and preventable”. On the vehicle safety side, Dr Martinez oversaw significant vehicle safety regulations, including advanced head injury protection for cars, a universal child restraint system to make child safety seats safer, and under-ride protection and antilock brakes for trucks.

Dr Martinez also helped establish the Safe Communities program in the US, an effort that encourages the management of safety problems at the local level. While he was in post, America increased the use of seat belts while reducing the level of alcohol related traffic fatalities to an historic low. Earlier this year Dr Martinez was honored by the American Medical Association for advancing public health.

Israeli National Forum for Injury Prevention and Control

The establishment of an Israeli National Forum for Injury Prevention and Control is an initiative of the Advanced Center for Health and Safety Education in Israel. The forum includes representatives from medical centers and communities from all over Israel, from the Ministry of Health, and from the Israeli Defense Forces. It also includes representatives from various medical disciplines such as pediatricians, pediatric surgeons, family doctors, and other public health professionals. This forum functions on a national level to decrease the rate of accidental injury within the country. The approach of the national forum is manifold, including patient education, increasing public awareness of injury prevention, legislation of safety laws within Israel, research, and lobbying. For further information contact the Advanced Center for Health and Safety Education (tel: +972 3 925 3183, fax: +972 3 924 7515, e-mail: chldsafe{at}netvision.net.il).