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Global road fatalities

The newly published Transport Research Laboratory report Estimating global road fatalities (report TRL445) reveals that in 1999 between 750 000 and 880 000 were killed world wide in road accidents. Eighty five per cent of them were in developing and transitional countries where vehicle ownership levels are low, and almost half of them in the Asia/Pacific region. A crude estimate of the annual cost of road accidents world wide suggests a figure in excess of US$500 billion. The study was funded by the World Bank, the UK Department for International Development, and the TRL. To obtain the report, contact Sue Stoneman (email: sstoneman{at}, web site:

Portuguese injury prevention ad wins international award

The press advertisement “Do not touch” was created by the Portuguese advertising agency MKT and offered to APSI, the Portuguese Association for Child Safety Promotion. It follows the injury prevention philosophy of this non-profit organization: its an adult's job to keep the environment safe. And for this ad, the way to draw attention to this fact is by saying that even adults are not obedient and they cannot rely on a change in natural child behaviour because they too have the same trait, part of human nature—curiosity. It is very interesting that this ad “selling” injury prevention won a “Bronze Lion” in the International Advertising Festival in Cannes in the press and poster category. The campaign presented two images—an electric socket in a wall—and the same one covered with a strip saying “do not touch” (see below). People search for what is underneath and find out the message: “it looks like saying don't touch wasn't enough; every year, thousands of children are victims of domestic accidents. Prevention is the best solution”. The strategy adopted was to choose one of the serious accidents that happen at home and use it as an example to draw attention to the need for a safer environment. We were very grateful that an agency used their creativity and imagination in such a good way and very happy that their commitment to this important cause was acknowledged at an international level and so rewarding.

New Zealand Network off the ground

The Injury Prevention Network of Aotearoa New Zealand has been established and held its first national forum in Wellington in May. A constitution has been developed and considerable effort has been made to establish processes for encompassing Maori, Pacific peoples, pakeha, Asian, and other ethnic groups. The network plans to develop an effective injury prevention network based on the Treaty of Waitangi; undertake national advocacy and facilitate communications, particularly on policy and legislation; organise a national conference in 2001; create an interactive web site and discussion group; organise workforce development workshops; and consult with members on the development of a national strategy. Further details from Network Coordinator Pania Shingleton, 19 Manse Street, Whangarei, New Zealand (email: panias{at}

School transport safety assessment

The National (US) Academy of Sciences has appointed a blue ribbon committee to study the comparative safety of transporting students to school by school bus with various other modes of transportation, including private vehicles, walking, bicycles, transit bus and rail, and passenger van. Over the next two years, the committee will review national databases of fatalities and injuries to school age children and vehicles involved in such crashes while transporting school age children. Although vehicle design characteristics will be considered, the emphasis will be on operational characteristics such as driver training, safety procedures when passengers board or disembark, and distance of stops from residence. Fourteen committee members (editorial board member Phyllis Agran among them) have been appointed and the first meeting was held last July.
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EURORISC main findings

The final newsletter from the EURORISC project, led by ISCAIP President Dr David Stone at Yorkhill Hospital in Glasgow, provided a comprehensive overview of some of the project's main findings. It reported that almost 70% of injury fatalities in the European Union between 1984 an 1993 were the result of unintentional injury, with the under 25s and older people being at greatest relative risk. Twenty four per cent of injury deaths were suicide or self inflicted injury, 2% were homicide while other violent causes accounted for 5%. The newsletter lists a range of the specially designed injury surveillance systems in the EU, and outlines why these systems were developed. A key component of the EURORISC project was the development of a consensus statement of good injury surveillance practice. The main points in the draft statement include:

  • An injury surveillance system (ISS) should be practical.

  • An ISS should be stable, with changes in definitions, denominators etc, being carefully managed; and with a balance being struck between stability and function.

  • Data should be comparable with other systems.

  • Injury surveillance data should be valid—representative, have tightly defined inclusion criteria, sensitive, specific, accurate, regularly evaluated and monitored.

  • Injury surveillance data should be relevant, accessible, and timely.

  • Data should be useful for the evaluation of injury control measures.

Further information: Carolyn Roulston, PEACH Unit, Department of Child Health, Yorkhill Hospital, Glasgow G3 8SJ, UK (tel: +44 (0)141 201 9362, fax: +44 (0)141 201 6943, email: cmr1e{at}, web site:

Canadian child restraint misuse tragedy

Improper use of an approved child car seat contributed to the death of a 2 year old girl in rural Alberta in July, according to press reports of the police investigation. The single vehicle crash occurred when the driver, the child's mother, drifted into the gravel shoulder of the paved highway, lost control of the car, hit a tree, and rolled down an embankment. Both the mother and an older child suffered only minor injuries, but the 2 year old was ejected from the vehicle. Police concluded that the ejection occurred because the seat's tether strap had not been installed and because the child straps were not properly done up. The investigation also showed that the seat itself was in good working order before the crash. While the problem of incorrect car seat use is the focus of much public education across Canada, this kind of highly public and tragic evidence is rare.

Editor's note: While there are plenty of studies documenting misuse rates, there appear to be very few that quantify the consequences of the misuse, a fact that can block the need for action to improve matters and get the topic take seriously.

Australian national coroners' database launched

After 10 years of talking and three years of work, the National Coroners' Information System (NCIS) was launched in August. In the past collecting information on reportable deaths nationally had involved physical investigation of paper records in a large number of centres. All coroners' investigations will now be electronic and available to coroners across Australia. Subject to some conditions the database will also be available to researchers. In launching NCIS, the Victorian coroner, Graeme Johnstone, spoke of a seminal case that gave impetus to the change. In the late 1980s two children died in a Melbourne house fire caused by a cooling fan, the subsequent investigation led largely by chance to the identification of one other Victorian death and 120 fire incidents, all caused by a product that had been given an Australian design award a decade before. Coroner Johnstone also noted that if a national database had been in operation from then there would be 75 000 cases with which to work to ensure that all that could be done to prevent deaths was being done (web site:

Vietnam motorcycle helmet law

The government of Vietnam held a traffic safety conference recently. One measure taken immediately was that starting on 1 September 2000, all motorcycle riders on highways must wear safety helmets.

Canadian course development

The Canadian Injury Control Curriculum Project is developing a tool to help build a critical mass of knowledgeable frontline practitioners across the country. The project will produce a flexible, modular curriculum for adult learners working in injury prevention and evaluate the training materials after running a series of pilot workshops in 2001. A coalition of provincial level injury prevention centres initiated the project. For more information, contact coordinator Shannon McCourt at the Alberta Centre for Injury Control and Research (email: shannon.mccourt{at}

Death from soda syphon bulb prompts sales control

Syphon bulbs are small non-refillable metal canisters containing either carbon dioxide to make soda water or nitrous oxide to make whipped cream. They are generally available, usually in packets of 10, and cost from 3–10 Australian dollars. A series of incidents prompted the New South Wales (NSW) minister responsible for consumer affairs to instigate an investigation and subsequently ban the sale of syphon bulbs to children under 16 years of age from 1 July 2000. The issues of concern involved the bulbs being used as propellants for projectiles, as bombs, and children heating them until they explode. A 10 year old boy died in March 2000 when a fragment from an exploding soda bomb pierced his skull. A 13 year old NSW boy lost an eye and suffered severe facial injuries in the same way in May 2000 and subsequent investigations showed that half of his schoolmates had exploded soda bombs. The penalty for retailers who sell the syphon bulbs to those under 16 is up to $22 000 for an individual and $110 000 for a corporation.

Motorized carts recalled after girl's death

Over 90 000 motorized recreational carts have been recalled in the US for safety reasons. Popularly known as go-karts, the US Consumer Product Safety Commission (CPSC) has said that the vehicles are dangerous because riders' long hair or loose clothing can become entangled in rotating parts behind the driver's seat despite guards meant to prevent such accidents. The Indiana manufacturer had received a report of one death—a 13 year old Idaho girl whose neck was broken when her hair caught in a drive chain—and two serious head injuries. The CPSC said the manufacturer was cooperating, as it did in a 1996 recall after a death and serious injuries were linked to exposed rear axles.

Ride-on toys recalls

Electric powered ride-on toys seemed to be getting a bad press in the US during August. A series of press releases from the CPSC announced the recall of over 520 000 of the toys for different reasons—battery chargers overheating, and foot pedals that could stick in the “on” position. There were reports of hands being burned and house fires from the electrical problems, and cuts and bruises when a 3 year old on his motorcycle ride-on ran into a home.

New Zealand safety issues

The July 2000 issue of Safety Update from New Zealand's Plunket Society reported a coordinated campaign to alert parents to the potential hazards in cot use, launched by the Ministry of Consumer Affairs. This follows three deaths possibly linked with the placing, assembly, and maintenance of cots. A mandatory standard for cots was introduced in New Zealand in July 2000. A campaign to legislate to have children seated on school buses has attracted national support. A petition to stop children standing in bus aisles has been organised by two campaigners from Bluff. Safety Update is available from Royal New Zealand Plunket Society, 126–132 Lambton Quay, PO Box 5474, Wellington, New Zealand (tel: +64 (0)4 471 0177, fax: +64 (0)4 471 0190).

Redesigning for injury prevention

Changes to elastic luggage straps, vaporiser units, and the 10th revision of the International Classification of Diseases (ICD-10) were the key issues in the June 2000 issue of Hazard, the newsletter of the Victorian Injury Surveillance System. VISS data reveals that up to 640 people in Australia require hospital treatment for luggage strap injuries annually, with eye injuries being a particular problem. New regulations introduced in 1999 covered the labelling of the straps but did not address the inherent design faults in the products. A new standard for vaporiser units, the cause of burns and ingestions especially for children aged under 2 years, was introduced in July 2000 to deal with the electrical hazards but did not cover the more common injuries. Even the Australian modification of ICD-10, which was implemented in July 1998 providing a significant improvement in several areas, does not meet some essential research and injury prevention needs. The inability of ICD-10-AM to distinguish causes of falls needs to be rectified, note the Hazard authors. Recent issues of Hazard, along with other information and publications of the Monash University Accident Research Centre can be found at

Two ways to safety?

Are child pedestrians more at risk on one way streets, compared to two way streets? Contrary to other research suggesting that one way streets are safer for pedestrians, a recent study from Hamilton, Ontario—a mid-sized industrial city in Canada—found injury rates were 2.5 times higher on one way streets. The study considered many traffic and demographic facts, including socioeconomic status, traffic volumes, traffic control devices, but one way versus two way streets remained a significant factor in explaining differences in local area injury rates. The authors suggest that directionality of streets should be considered in future pedestrian injury research. The study is published in the May-June 2000 issue of the Canadian Journal of Public Health.

Four wheel drive vehicles over-represented in driveway runovers

A detailed investigation of 42 NSW cases of child knock-downs in driveways has provided some useful areas for preventive work. These cases represented 12% of all children admitted with pedestrian motor vehicle injuries. The recorded deaths over a 12 year period represented 8% of all paediatric pedestrian motor vehicle deaths reported. Typically, the injury involved a parent or relative reversing a motor vehicle in the home driveway over a toddler or preschool age child in the late afternoon or early evening. Four wheel drive or light commercial vehicles were involved in 42% of all injuries, although they accounted for about 30% of registered vehicles in NSW. These vehicles were associated with a 2.5 times increased risk of fatality (Holland A, et al. Driveway motor vehicle injuries in children. Med J Aust 2000;173:192–5;

Trampoline injuries

A detailed investigation of trampoline injuries has been undertaken and published by the Monash Accident Research Centre (MUARC). The annual hospitalisation rate for children under 16 was estimated to be 18.6/100 000. With 8.6% of Victorian households having trampolines 78% of the injuries occur at home. It is suggested that New Zealand's success in stabilizing an upward trend in injuries indicates that development and support of an Australian standard to facilitate the design, behavioural, and environmental changes required to reduce trampoline injuries. Further information: MUARC, PO Box 70A, Monash University, Clayton Victoria, 3800, Australia (

Editor's note: There are significant differences of opinion on how to address trampoline injuries, including suggestions for a ban on home use.

Gun lock recall

Over three quarters of a million gun locks have been recalled in the US due to a manufacturing “discrepancy”. The two halves of some gun locks can be manually separated without a key, giving children and others unauthorized access to a firearm. The manufacturer, Master Lock, reports it has not received any consumer reports of locks being disabled as a result of this discrepancy.

Manitoban scalds prevention campaign

The summer 2000 issue of Manitoba Child Injury Prevention News, the highly informative publication from Im-pact, the injury prevention centre of the Children's Hospital, Winnipeg, describes a cooperative project aimed at reducing the number and severity of tap water scalds—a joint campaign of the Child Protection Centre, the Burn Unit, City of Winnipeg, Office of the Fire Commissioner, and Winnipeg Regional Health Authority. The campaign, which targets injuries to children, the elderly and people with disabilities, seeks to reduce water to less than 54oC. Im-pact can be contacted at im-pact{at} and

Databases of Australian injury personnel

Two internet searchable databases of injury personnel are now available. The Research Centre for Injury Studies at Flinders University (incorporating the National Injury Surveillance Unit) has a database of injury personnel and also hosts the web site for the Australian Injury Prevention Network. Monash University Accident Research Centre has now put on line its database of expertise in product safety and safe product design. Further and

More concern for dogs than children

Following a spate of cases in America a few years ago, the risk to young children in being left in a hot car was brought home to Australians with the death of a child left alone in a car by a gambling parent. Simple experiments subsequently showed how fast and how high internal temperatures can rise. In an overcast 28oC day, a medium sized sedan reached 49oC after 12 minutes with three quarters of the rise in five minutes. The bad news was that it was found that the fine for keeping a dog in a closed car on a hot day was 10 times the fine for doing the same thing for a child. The good news was that in the next month there were at least six cases of passers-by calling emergency services when children were seen in closed cars.

New York fire safe cigarette bill passed

With some surprise and pleasure, the New York State Legislature has passed and the governor has signed a fire safe cigarette law. The bill requires state standards to limit the burn and extinquishing rate of dropped lit cigarettes, for which industrial technology has been available for decades. The law “sunsets” upon enactment of federal standards. There was great public oral and written opposition by fire officials and the public to the veto of an earlier similar bill by the governor who then backtracked and requested some revisions on cigarette taxes that were “fast tracked” as a full legislative package, passed by the legislature, and then signed by him. As historical models suggest, as in other safety and other reforms, embarrassment with some facesaving for corrective action seemed to work again. See for a copy of the final amended bill/law.

Bicycle injuries in Canada

Bicycle injuries, particularly those associated with handlebars, were the focus of the June 2000 issue of CHIRPP News, the newsletter of the Canadian Hospitals Injury Reporting and Prevention Program. Over three quarters of handlebar injuries that required admission to hospital were to the abdomen, with over 84% being internal injuries. CHIRPP News is available from Adéle Gélinas, Bureau of Reproductive and Child Health, Health Canada, HPB Building, Tunney's Pasture (AL 0701D), Ottawa, Ontario K1A 0L2, Canada (email: CHIRPPNews{at}

ITS-RAM suffocation model

Every year, hundreds of suffocation related fatalities happen to children caused by consumer products. In an effort to understand the causes of suffocation, ITS-RAM has studied the variables involved in incidents and consulted with leading medical experts specialising in the respiratory physiology of children. A medical manikin, designed to represent the anatomical specifications of a 1 year old child (95th centile), and a mechanical lung system are utilised to stimulate the human breathing mechanism with precise flow volume, flow rate, and respiratory frequency. Airflow blockage is introduced by test samples placed on the face of the manikin and the peak pressure inside the mechanical lung is measured to determine if breathing can be sustained despite the blockage. ITS-RAM has worked closely with leading scientists, pulmonologists, and paediatricians to verify the accuracy of the suffocation model and assessment methods. ITS-RAM is currently in the process of developing new tools to enhance further their model. More information about the suffocation model or ITS-RAM from

. . . while Kellogg recalls toy cars in cereal boxes

Cereal giant Kellogg has recalled 837 000 toy cars that were packed inside some cereal boxes. The tires can detach from the wheels of these cars, posing a choking hazard for young children. Kellogg has received two reports of the tires detaching from the wheels of these toy cars. No injuries have been reported. The cars were distributed inside boxes of these cereals in the US from March to June 2000.

US National Health Interview Survey

A new report Injury and poisoning episodes and conditions; National Health Interview Survey, 1997 published by the National Center for Health Statistics provides a descriptive overview of the first year of data from the injury section of the redesigned US National Health Interview Survey. In addition, it provides details of the design of the survey, analytic methods, and a discussion of the strengths and weaknesses of the new design. Some highlights from the report include:

  • In 1997, there were 34.4 million medically attended episodes of injury and poisoning reported among the US civilian non-institutionalized population at a rate of 129 episodes of injury and poisoning/1000 persons (similar for crude and adjusted rates).

  • The injury and poisoning episodes resulted in 40.9 million conditions, at a rate of 154 conditions/1000 persons (similar for crude and adjusted rates).

  • The age adjusted injury and poisoning episode rate for males was 21% higher than the rate for females.

  • In 1997, falls were the leading external cause of injury with 11.3 million episodes of falls reported.

  • The home was the most frequently reported place of injury, with 24% of injuries occurring inside the home and another 18% outside the home.

  • Leisure activities and paid work were most often reported as the activities the person was engaged in when the injury episode occurred, accounting for 22% and 19%, respectively.

The report is available at the NCHS web site: (Warner M, Barnes PM, Fingerhut LA. Injury and poisoning episodes and conditions; National Health Interview Survey, 1997. Vital Health Stat 2000;10:202).


Contributors to these News and Notes include Les Fisher, Anara Guard, Helena Menezes, Barry Pless, Ian Scott, Margaret Warner, Amy Zierler. Michael Hayes has edited the contributions. Items for the June 2001 issue should be sent to Michael Hayes at the Child Accident Prevention Trust, 18–20 Farringdon Lane, London EC1R 3HA, UK (fax: +44 (0)20 7608 3674, email: mh{at} by 1 March 2001.