Avoiding Unintentional Injuries

Among people of all ages there were about 161,374 deaths in 2016 from unintentional injuries in the U.S.^[1] They were, for the first time, the third leading cause of death, exceeded in number only by diseases of heart, and cancer.^[2] Figure 2 shows the pattern of unintended injury and other causes of death according to age group.  In 2014, unintended injury was the leading cause of death up to age 45.^[3] 

There were 40,327 motor vehicle fatalities in 2016 and unintentional opioid overdose deaths from drugs including prescription opioid pain relievers, heroin, and illicitly-made fentanyl totaled 37,814.  The Centers for Disease Prevention and Control counted an additional 4,435 opioid related deaths because the CDC also includes intentional deaths like homicide and suicides as well as deaths with undetermined intent.  Other leading causes of unintentional injury deaths in 2014 were from falls, numbering nearly 32,000, and 33,736 deaths caused by firearms.^[4]Unintentional injuries—such as those caused by burns, drowning, falls, poisoning and road traffic—are the leading cause of illness (morbidity) and mortality among children in the United States.^[5] Each year, among those 0 to 19 years of age, more than 12,000 people die from unintentional injuries and more than 9.2 million are treated in emergency departments for nonfatal injuries. 

The CDC Childhood Injury Report provides an overview of unintentional injuries related to drowning, falls, fires or burns, poisoning, suffocation, and transportation–related injuries among others, during the period 2000 to 2006.^[6] Key findings from the report include the following:

Injury Deaths

• An estimated 9.2 million children annually had an initial emergency department visit for an unintentional injury.
• Males generally had higher nonfatal injury rates than females.
• For children 1 to 19 years of age, nonfatal injury rates were higher among males than females, while the rates were approximately the same for those under 1 year.
• Injuries due to falls were the leading cause of nonfatal injury.
• Each year, approximately 2.8 million children had an initial emergency department visit for injuries from a fall.
• For children less than 1 year of age, falls accounted for over 50% of nonfatal injuries.
• The majority of nonfatal injuries are from five causes.
• Falls was the leading cause of nonfatal injury for all age groups less than 15.
• For children ages 0 to 9, the next two leading causes were being struck by or against an object and animal bites or insect stings.
• For children 10 to 14 years of age, the next leading causes were being struck by or against an object and overexertion.
• For children 15 to 19 years of age, the three leading causes of nonfatal injuries were being struck by or against an object, falls, and motor vehicle occupant injuries.
• Nonfatal injury rates varied by age group.
• Nonfatal suffocation rates were highest for those less than 1 year of age.
• Rates for fires or burns, and drowning were highest for children 4 years and younger.
• Children 1 to 4 years of age had the highest rates of nonfatal falls and poisoning.
• Injury rates related to motor vehicles was highest in children 15 to 19 years of age.

Lack of sleep impairs attention, judgment, and thinking so it makes a person more likely to have an unintentional injury.  With a sleep deficit, we become prone to accidents and dangerous to ourselves and others.  Unintentional injuries can happen anywhere and during almost any activity, at home, during sports and other recreation such as in or on the water, as a pedestrian or in a motor vehicle.

Safety in the Home

Among older adults, falls are the leading cause of injuries, both fatal and nonfatal.  Some preventive measures to avoid falls include staying active to maintain strength and balance, getting physical checkups that include vision screening and eye care, attention to any medications with side effects like feeling dizzy or sleepy, and safety precautions at home.  Most falls happen at home and their risk can be diminished by keeping a home well lit; the floors clutter-free by dispensing with small throw rugs or using double-sided tape to secure them to the floor; adding grab bars in the bathroom both beside and inside the tub and next to the toilet. Handrails and lights on all staircases are especially important.

Ways to Stay Safe from Fires ^{[7] [8]}

• Do not smoke. If you do smoke, never smoke in bed. Avoid smoking while consuming alcoholic beverages.
• Never throw a lighted cigarette or a match anywhere. Extinguish and dispose of them in proper ashtrays.
• Be very cautious around any type of open flames.
• Supervise children carefully.
• Follow electrical safety rules. Never put electrical appliances or cords in or near water.
• Do not touch downed power lines.
• Install smoke and carbon monoxide alarms on every floor, test and maintain them.
• Create and practice a family fire escape plan
• Use safe cooking practices, such as never leaving food unattended heating on the stove.
• Check water heater temperature and to prevent scalding of infants and small children set water heater thermostats to 120 degrees Fahrenheit or lower.

Water Safety ^[9]

Drowning is the fifth leading cause of unintentional injury death for people of all ages, and the second leading cause of injury death for children ages 1 to 14 years. Water safety precautions include the following:

• Learn life-saving skills---cardiopulmonary resuscitation (CPR).
• Know the basics of swimming  
• Fence in backyard swimming pools.
• Require life jackets in and around water, including in pools for weaker swimmers
• Closely supervise children at all times.
• Adults watching kids in or near water should avoid distracting activities like playing cards, reading books, talking on the phone, and using alcohol or drugs.

Sports Safety ^[10]

• Use proper safety equipment for the sport, especially helmets
• Slowly increase intensity and duration of physical activities to improve physical fitness--being in good condition can protect you from injury
• Practice sports skills to prevent injuries, e.g. in football and soccer
• Pay attention to extreme temperatures to prevent heat-related injuries or illness--make sure that players are hydrated, appropriately dressed and not overworked in hot weather.

Avoiding Poisonings ^[11]

• Keep medicines and toxic products, such cleaning solutions and detergent pods in their original packaging and where children can’t see or get them.
• Know the nationwide poison control center phone number, 1-800-222-1222; they can be reached 24/7. Call 911 if you have a poison emergency and your child has collapsed or is not breathing.
• Read the label, warnings and follow directions carefully
• Don’t keep and safely dispose of medicines and toxic products if you don’t need them.  Many localities have take-back programs. 

Motor Vehicle Safety ^[12]

Over the past two years (2014-2016), traffic deaths increased by nearly 14% to 40,327 in 2016.  The increase is attributed to more driving thanks to low gas prices and an improving economy, and more use of smart phones and other causes of distracted driving.  Even hands-free use of phones is a distraction. ^[13]

The National Highway Traffic Safety Administration reported that fatal crashes where drugs were involved increased from 2,003 in 1993 to 7,438 in 2015.  Some of these deaths seem to have been related losing consciousness after opioid overdoses.

Avoiding buzzed (drug impaired) driving is important.  Experimental studies show a clear and dose dependent relationship between marijuana use and a number of indicators of driving impairment.  There is evidence from a meta-analysis of nine studies that drivers who use cannabis (marijuana) up to three hours before driving are about twice as likely to cause a collision with serious injury or death as those who have not used cannabis. ^[14] Although increased legalization of marijuana might make this a more frequent problem, in one study of states that enacted medical marijuana laws and legalized dispensaries, this has not been found. ^[15] The trend line in driving deaths was not statistically different in Washington and Colorado in the three years after legalization compared to 8 states that did not change their marijuana laws. ^[16]

Alcohol-impaired driving is a common cause of collisions, injuries and deaths.  Every day, 28 people in the United States die in motor vehicle crashes that involve an alcohol-impaired driver.  The annual cost of alcohol-related crashes totals more than $44 billion. Alcohol involvement for the driver or the pedestrian was reported for 49% of the traffic crashes that resulted in pedestrian death. 

In most jurisdictions, a quantitative measurement such as a blood alcohol content (BAC) in excess of a specific threshold level, such as 0.05% or 0.08%, defines the offense with no other requirement to prove impairment or intoxication. In some jurisdictions, there is an aggravated category of the offense at a higher BAC level, such as 0.12%. In California it's illegal to operate a motor vehicle with any of the following blood alcohol concentration (BAC) percentages:

• 0.08% or higher― 21 years old or older operating a regular passenger vehicle.
• 0.04% or higher―operating a commercial vehicle.
• 0.01% or higher―younger than 21 years old.

The following table shows approximate blood alcohol percentages according to number of drinks and weight for men and women:

Driving defensively, staying within legal speed limits, and avoiding distracted driving are critical to driving safely.  Defensive driving means that to reduce the risk of a collision, a driver will both stick to the rules of the road and go beyond them by anticipating and being ready to compensate for errors made by other drivers or other dangerous situations caused by weather or other adverse road conditions.

Per mile driven, teen drivers ages 16 to 19 are nearly three times more likely than drivers aged 20 and older to be in a fatal crash.  Speeding is one of the most prevalent factors contributing to traffic crashes.  The National Highway Traffic Safety Administration (NHTSA) estimated that the annual economic cost to society of speeding-related crashes in 2012 was $40.4 billion and that year speeding was a contributing factor in 30 percent of all fatal crashes, with more than 10,000 lives lost.  Among males, 37 percent of 15- to 20-year-old and 37 percent of 21- to 24-year-old drivers involved in fatal crashes were speeding.  Among speeding drivers involved in fatal crashes, 42% had blood alcohol concentrations (BACs) of .08 grams per deciliter (g/dL) or higher, compared to only 16% of non-speeding drivers involved in fatal crashes. ^[17]

The chances of being distracted when driving is increasing with the popularity of smart phone use, eating, texting, using a navigation system and other interactive dashboard controls and displays. According to the NHTSA, 71% of young people say that they have sent a text while driving.  In 2013, nearly one in five crashes (18%) in which someone was injured involved distracted driving.  In 2014, 431,000 people were injured in motor vehicle crashes involving distracted drivers, an almost 10% increase since 2011, and more than 3000 deaths were attributed to distracted driving. ^[18]

There are three main types of distraction:

1. Visual: taking your eyes off the road;
2. Manual: taking your hands off the wheel; and
3. Cognitive: taking your mind off of driving.

While any of these distractions can endanger the driver and others, texting while driving is especially dangerous because it combines all three types of distraction.
Use of appropriate in-vehicle restraints is important to avoid injury or death when a motor vehicle crash does occur.  Seat belts reduce serious and fatal injuries by more than half.  All adults and especially parents and caregivers should always wear a seat belt and set a good example for children.  Infants and children should be buckled in age- and size-appropriate car seats or booster seats. Buckle all children aged 12 and under in the back seat and seat children in the middle of the back seat when possible, because it is the safest spot in the vehicle.  Don't seat children in front of an airbag, they can kill young children riding in the front seat. Never place a rear-facing car seat in front of an air bag.

Elderly adults should consider potential alternatives to driving, such as riding with a friend or using public transit.  They can also take several steps to stay safe on the road, including:

• Exercising regularly to increase strength and flexibility.
• Asking your doctor or pharmacist to review medicines–both prescription and over-the counter–to reduce side effects and interactions.
• Having eyes checked by an eye doctor at least every two years. Wear glasses and corrective lenses as required.
• Driving during daylight and in good weather.
• Finding the safest route with well-lit streets, intersections with left turn arrows, and easy parking.
• Planning your route before you drive.
• Leaving a large following distance behind the car in front of you.
• Avoiding distractions in your car, such as listening to a loud radio, talking on your cell phone, texting, and eating.

Some final thoughts on ways to reduce injuries:

1. Wear the proper helmet for your activity
2. Wear a life jacket when on water
3. Have your eyes checked
4. Remove tripping hazards around your house
5. Learn how to swim
6. Store medicine out of reach of children
7. Take medication only as directed
8. Place children in the proper booster or car seat
9. Wear your seatbelt
10. Walk on a sidewalk when possible

Endnotes and Links

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