Injury Control and Emergency Health Services
Section Newsletter
Fall 2010

Dr. Linda Degutis to Direct the National Center for Injury Prevention and Control

Since our last ICEHS newsletter, Centers for Disease Control and Prevention Director Thomas Frieden, MD, MPH, announced that Linda C. Degutis, DrPH, MSN, has been selected to serve as director of CDC's National Center for Injury Prevention and Control effective Nov. 7, 2010.

In his announcement, Frieden highlighted Degutis’ distinguished career. Her expertise crosses a broad spectrum of public health and injury disciplines. Degutis is currently an associate professor in the Department of Emergency Medicine and School of Public Health, and associate clinical professor of nursing at Yale University. She is the research director for emergency medicine and directs the Yale Center for Public Health Preparedness, as well as the Connecticut Partnership for Public Health Workforce Development in the School of Public Health. From 1998-2002, she was the director of the New Haven Regional Injury Prevention and Control Program. She is a past president of APHA, as well as past chair of its Executive Board, and chair of the Injury Control and Emergency Health Services Section. At the state level, Degutis served as the chair of the Connecticut Coalition to Stop Underage Drinking, which focuses on environmental and policy change, and served on various committees and workgroups that focused on trauma system development in Connecticut. In addition, Degutis serves on the Institute of Medicine's Advisory Board for the Robert Wood Johnson Health Policy Fellowship Program and the Executive Boards of Advocates for Highway and Auto Safety and the American Trauma Society.

Degutis' research interests have centered on issues related to alcohol and injury, with a particular focus on interventions and policy issues. She is known internationally for her work in public health, injury, substance abuse and policy, and has served as the principal investigator or co-investigator for grants on a wide range of topics including: alcohol interventions; screening, brief intervention, and referral to treatment (SBIRT); public health preparedness; public health workforce training; public health systems research; and interventions for opioid addiction.

Please join Frieden and the ICEHS membership in welcoming Linda Degutis to her new position. We are all very excited about the experience, leadership, and vision she will bring to the Injury Center.

Comments from Dr. Linda Degutis on her Appointment as NCIPC Director

I am honored and delighted to be selected as the next director of the National Center for Injury Prevention and Control. There are so many things to think about as I make this transition to my new position at CDC – taking on a new role, moving to a new city, learning the language of a federal agency, etc. But one of the best things about all of this is the opportunity to work with dedicated and smart people, both at CDC and in the injury field. This is an exciting time for our field, with the attention that is being paid to injury at so many levels – locally, statewide, nationally and globally. We are starting to see injury being recognized as a public health problem not only by those who focus their work in the field of injury prevention and control, but by organizations such as the Association of State and Territorial Health Directors (ASTHO), who have been working to decrease motor vehicle related mortality and morbidity. The Global Road Traffic Safety Initiative recognizes the growing problem of motor vehicle related injury and death in developing countries, and Dr. Frieden has identified motor vehicle injury prevention as one of the "winnable battles" that CDC will take on. Health reform provides other opportunities for prevention activities. It is clear that others are starting to see the importance of preventing injuries, both intentional and unintentional, across the lifespan.

The ICEHS Section has been instrumental in moving the injury field forward, and I am proud to be a member of such a great group. I am looking forward to continuing my membership in the Section, and to working with all of you in growing the field of injury prevention and control.

2010 APHA Annual Meeting to be held November 6-10

From Nov. 6-10, 2010, join us in Denver for the  APHA 138th
Annual Meeting and Exposition. More than 1,000 cutting edge scientific
sessions will be presented by public health researchers, academicians,
policy-makers and practitioners on the most current public health issues
facing the nation today. For more information about the Annual Meeting

Our section will have a strong presence at the meeting. View the
sessions sponsored by our section by visiting the interactive Online
Program .
Search the program using keyword, author name or date. Don't forget to
stop by our new booth in the Section and SPIG pavilion in
the Public Health Expo next to Everything APHA.

ICEHS Business Meeting to be held Sunday, November 7


This year, the ICEHS Section-Wide Annual Business Meeting will be held Sunday, Nov. 7, 2010, at 3:00 p.m. Please schedule your flights so that you can arrive in time for our one Section-wide meeting, which will include ICEHS Committee Meetings as well as the ICEHS Section-Wide Business Meeting. For more information, please contact ICEHS Chair-Elect Bella Dinh-Zarr at (202) 701-5656 or 


2011 SAVIR - Safe States Alliance Joint Annual Meeting






APRIL 6-8, 2010

Iowa City, Iowa

2011 Joint Annual Meeting of the Safe States Alliance, Society for the Advancement of Violence and Injury Research (SAVIR) and CDC Core I & II State Injury Grantees

As the theme of this year’s meeting is "Progress through Partnerships." Of particular interest are abstracts that reflect the importance of partnerships between research and practice. Through these partnerships, the fields of practice and research can mutually inform one another to create injury and violence prevention and control programs that are evidence-informed and effective.

THE ABSTRACT SUBMISSION DEADLINE IS FRIDAY, OCT.  29, 2010 AT 5:00 p.. EDT. No late abstracts will be accepted.

Acceptance of an abstract to be an oral or poster presentation will be sent to the abstract author via e-mail in December 2010. FOR MORE INFORMATION OR TO SUBMIT AN ABSTRACT, VISIT:

A "Save the Date" card with more information about the 2011 Joint Annual Meeting is attached to this message.

For additional information, visit the Safe States Alliance website at

Transportation Policy Impacts on the Nation's Health

ICEHS incoming Chair-elect Dr. Bella Dinh-Zarr forwarded this message on how transportation policy affects the nation's health and contributes to health inequalities.

Transportation systems and policies impact the public's health in myriad ways, partly via roadway fatalities and injuries, air pollution impacts and opportunities for physical activity. Two new fact sheets contain statistics that highlight how transportation affects health, as well as specifics on what initiatives and policies APHA supports.

Additional information may be found online in APHA's online toolkit at .

Additional APHA reports are available online at:

* Shifting the Course of Our Nation's Health: Prevention and Wellness as National Policy:

* America Breathing Easier: Working Together, We Can Alleviate the Burden of Asthma and Keep America Breathing Easier:

* At the Intersection of Public Health and Transportation:

Promoting Healthy Transportation Policy:

Learn more at APHA's Annual Meeting, Nov. 6-10 in Denver. This year's theme is Social Justice: A Public Health Imperative.

Health Care Reform Impacts on the Injury Control Field

ICEHS member Lee Annest provides us this update on Health Care Reform activities relevant to our work in injury surveillance and prevention.

DHHS and CMS have issued their final rulings regarding Electronic Health Records (EHRs) Meaningful Use Criteria for reimbursement for Medicare and Medicaid claims by hospitals and physicians offices. This is part of implementation of the Health Information Technology for Economic and Clinical Health Act (HITECH). Below is a link to a brief NEJM article which summarizes the "meaningful use" regulation by Dr. Blumenthal. In order for hospitals and physicians to receive full reimbursement, they need to comply with these meaningful use criteria. There will be some financial incentives available to help hospitals get set up to comply. I think these regulations apply to what is expected in 2011 and 2012.

As some of you may know, there is a public health reporting component. We submitted a recommendation to include external-cause-of-injury coding as a required data element in the EHR system. It didn’t get attention in this regulation, but I still think we will be okay because ICD-9-CM/ICD-10-CM coding is included in the EHR. There are a couple of more stages of implementation of the Act, so I will be following those activities to look for other opportunities to express our recommendations and needs.

I think coming up with some good quality of care assessment indicators for injuries that rely on external cause of injury (e.g., falls among older persons) would be the next avenue to explore — as mentioned in our action plan published last December. See

The EHR system will make allowance for implementation of ICD-10-CM so there will be lots of changes associated with the introduction of this new and more extensive morbidity coding system. There are many more codes and some different orientations of external-cause-of-injury coding. We will need to come up with new external-cause-of-injury and diagnosis code matrices for reporting injury data in federal and state-based emergency department and hospital discharge data systems.

Relevant New England Journal of Medicine articles include:

The "Meaningful Use" Regulation for Electronic Health Records (Blumenthal)

Finding My Way to Electronic Health Records

Agency for Healthcare Research and Quality (AHRQ) Announcements

One in Four Patients Experienced Revolving-Door Hospitalizations

Roughly one-quarter of all hospital patients were readmitted for the same conditions that prompted their initial hospitalization over a two-year period, according to a recent report from the Agency for Healthcare Research and Quality (AHRQ).

According to the federal agency's analysis of data on 15 million patients in 12 States in 2006 and 2007, more than a third of those who had hardening of the arteries (called coronary atherosclerosis) were readmitted at least once to the hospital during the period. Multiple readmissions were also seen for 30 percent of patients with uncomplicated diabetes, 28 percent with high blood pressure, and 21 percent with asthma.

AHRQ also found that:

· Among Medicare patients, 42 percent experienced multiple hospital admissions and 38 percent multiple emergency department visits. For Medicaid patients, 23 percent experienced multiple hospital admissions, and 50 percent went to the emergency department more than once.

· About 22 percent of uninsured patients had multiple hospital readmissions, and 38 percent had multiple hospital emergency department visits but were not admitted.

· Privately insured patients were the least likely to require multiple hospital readmissions (19 percent) or make multiple visits to the emergency department (29 percent).

While some patients may be readmitted because of the severity and complexity of their underlying condition, research shows that many repeat admissions can be avoided if patients have better outpatient care. Readmissions can also drive up health care costs.

These findings are based on data described in Hospital Readmissions and Multiple Emergency Department Visits, in Selected States, 2006-2007. The report uses statistics from the HCUP State Inpatient Databases (SID) and HCUP State Emergency Department Databases (SEDD) for 12 States: Arizona, California, Florida, Hawaii, Massachusetts, Missouri, Nebraska, New Hampshire, New York, South Carolina, Tennessee and Utah.

Mental Disorders and/or Substance Abuse Related to One of Every Eight Emergency Department Cases

Nearly 12 million visits made to U.S. hospital emergency departments in 2007 involved people with a mental disorder, substance abuse problem, or both, according to another recent report from AHRQ. This accounts for one in eight of the 95 million visits to emergency departments by adults that year.

Of these visits, about two-thirds involved patients with a mental disorder, one-quarter was for patients with a substance abuse problem, and the remainder involved patients with both a mental disorder and substance abuse diagnosis.

The analysis also found that for the 12 million emergency department visits involving mental health and/or substance abuse:

· Depression and other mood disorders accounted for 43 percent of the visits, while 26 percent were for anxiety disorders and 23 percent involved alcohol-related problems.

· Mental health and/or substance abuse-related visits were 2.5 times more likely to result in hospital admission than visits not involving mental disorders and/or substance abuse. Nearly 41 percent of mental disorder and/or substance abuse-related visits resulted in hospitalization.

· Medicare was billed for 30 percent of all mental health and/or substance abuse emergency department visits; private insurance was billed for 26 percent; the uninsured for 21 percent; and Medicaid for 20 percent.

These findings are based on data described in

Mental Health and Substance Abuse-Related Emergency Department Visits among Adults, 2007
. The report uses statistics from the 2007 Nationwide Emergency Department Sample, an AHRQ database that is nationally representative of emergency department visits in all non-federal hospitals. The Nationwide Emergency Department Sample contains 26 million records from emergency department visits from approximately 1,000 community hospitals nationwide, approximating a 20 percent stratified sample of all U.S. hospital emergency departments.

~P. Hannah Davis

2010 NYC Child Fatality Review Team Report Released

ICEHS member Dr. Catherine Stayton from the New York City Department of Health and Mental Hygiene states that on behalf of my colleagues who chair (Dr. Laura DiGrande) and coordinate (Princess Fortin) NYC’s City Council-mandated Child Fatality Review Team, I am excited to share the team’s recently released annual report. The 2010 NYC Child Fatality Review Team Report is available online through the NYC Department of Health and Mental Hygiene at .

Italian Journal of Public Health Publishes Injury and Violence Epidemiology Issue

ICEHS member Dr. Muazzam Nasrullah, affiliated with NIOSH and the West Virginia Injury Control and Research Center, recently collaborated with Dr. Giuseppe La Torre, the editor-in-chief of Italian Journal of Public Health, as a "Guest Editor" for the special issue entitled "Injury and Violence Epidemiology." The special issue is now published and is available online at: The access of all articles is free, one has to register on the journal’s website (for free). The journal publishes thematic papers and free papers together, thus a few articles at the end of the issue are free papers. Articles that are either thematic or free are mentioned at each page of the article.

New Publication Issues Call for Injury Research Support

A new paper in the American Journal of Preventive Medicine, "An Urgent Call to Action in Support of Injury Control Research Centers" reports that funding disparities for research are enormous across health problems, with funding for injury, the third leading cause of death in the United States, far out of proportion to the magnitude of the problem. For example, the federally-funded Injury Control Research Center (ICRC) program, created in 1987 with a $10 million Congressional appropriation to support five Centers, now supports 11 Centers who receive less than $1 million annually to support their work. Using funding to the National Cancer Institute as the standard and calibrating based on total deaths, the researchers determined the actual figure should exceed $1.4 billion. The report is co-authored by Center Director Andrea Gielen along with leaders from six other Injury Centers.

"Despite the meager support provided, Injury Centers have made substantial progress and discoveries over the past two decades, demonstrating their continuing potential to advance the science and practice of injury control," said Dr. Gielen. "As evidenced in this paper, what’s urgently needed is increased investment to accelerate these discoveries and ensure our results impact communities."

The article includes select examples of research contributions by the ICRC program and presents four critical "Call to Actions" for Congress and the U.S. Department of Health and Human Services. These include: Cultivate investigator interest in injury control and further development of cutting-edge research through increased funding; Support training in the science of injury control; Launch a comprehensive national campaign to foster public support for eradication of injury as a health problem; and Support a comprehensive, multi-agency review to determine how best to fund basic, applied, and translational injury research.

The paper can be accessed at:

Special Report - Advancing Injury Research in China

With more than 800,000 injury deaths and 60 million medically treated injury events per year, injuries are one of the leading causes of mortality and morbidity in China. In 2004, an epidemiologic study of 200,000 farm families in rural areas of China yielded an annual estimate of more than 590,000 injury deaths and close to 3.5 million permanently disabled individuals. However, research efforts in injury and trauma in China are still at an early stage of development, with even fewer focusing on agriculture-related injuries. In response to this, the USA-China Agricultural Injury Research Training Project was created in 2007 with funding from the NIH/Fogarty International Center.

As a collaborative project between the Colorado Injury Control Research Center, the Center for Injury Research and Policy of The Research Institute at Nationwide Children’s Hospital and the School of Public Health, Tongji Medical College at Huazhong University of Science and Technology (Tongji School of Public Health), the long-term goal of the project is to increase training and agriculture-related injury research in China in order to develop an infrastructure for future sustainable agricultural injury research.

Details about the USA-China Agricultural Injury Research Training Project and the impact of the training on its trainees’ careers have been described in a special reported,

Advancing Injury Research in China: Success Stories of the NIH/Fogarty International Center funded USA-China Agricultural Injury Research Training Project (available online at


Huiyun Xiang & Lorann Stallones

Position Announcements




The Injury Research Center at the Medical College of Wisconsin is seeking a highly qualified candidate to manage the Violence Prevention Initiative Research and Evaluation activities of the Medical College of Wisconsin, along with other violence prevention-related activities and grants. The activities of the Violence and Evaluation Team include: identifying evidence-based violence prevention models; establishing national and international connections with violence prevention experts; providing evaluation expertise to the Initiative; and contributing a research perspective to the Initiative. The Program Manager will be responsible for identifying, preparing, and writing grants, including preparation of budgets for violence prevention-relevant research and programs. The Program Manager will also responsible for identifying, conducting, and contributing to the evaluation of violence prevention-relevant injury programs and research. The Program Manager will mentor and supervise medical and graduate students in conducting such programs and research. The successful candidate will prepare manuscripts for publication in peer review journals, as well as work with media, violence prevention community leaders, and the public to communicate research findings. Finally, the Program Manager will also be responsible for developing collaborative partnerships with violence prevention groups both internally and externally and at local, state, and national levels.


The successful candidate will have at least six years of progressively responsible experience in public health program management and/or public health research. Previous experience working in the field of injury or violence prevention and control strongly desired. Candidates must have an understanding of public health theories, principles, and practices and possess an understanding of skills such as: needs assessment; planning, implementing, and evaluating effective public health programs and policies. Candidates should also have experience developing, collecting, and analyzing qualitative and quantitative public health data, with computer expertise with a variety of software programs, including Access, Excel and statistical software such as SAS, SPSS, or STATA is required. A Master’s Degree in Health Sciences or Public Health or equivalent is highly recommended.

Contact Information:

Ann Christiansen, MPH
Assistant Director, IRC-MCW
8701 Watertown Plank Rd.
Milwaukee, WI 53226
Phone - (414) 456-7670
Fax – (414) 456-6470
E-mail –

Link to complete position description  





See for more information.

Archivists Attic

Archivist Attic: A Review of Alan Murray’s "The End of Management", WSJ, Aug 21-22, 2010, W3.

Worthy of consideration for not only business but for public health injury control public service, Alan Murray’s

Essential Guide To Management , (Dow Jones & Co. Published by Harper Business Imprint of Harper Collins Publishers, 2010), shows how (corporate) bureaucracy is no longer viable and what managers should do about that, namely, act like venture capitalists.

What does a book on the history of modern management and its future demise offer our IC disciplines?

When I moved in the NYS Dept of Health in the early 1970 to a newly created position, Director of Burn Injury Prevention, Burns Care Institute; my new boss, a well liked doc closely linked to the department’s leadership hierarchies oriented me to his work- organizational style: "Les, see this department policy and procedure (P&P) manual – that’s for everyone else – not for you (or us)." He explained that much of new research funding took place, promptly and expediently, for new Department resource allocations in creative collaboration with Health Research, Inc, (HRI), a NYS approved non-profit research, independent arm of the state health department. (Over many years, I was able to persuade and leverage HRI’s innovative administrative funding mechanism, as a principal investigator for federal and state injury prevention practice -research contracts and grants programs.)

Of course, my new boss did not mean to fully throw out the weighty P&P binders but he was offering me and the rest of his bureaus’ staff the chance, then, to innovate beyond Peter Drucker’s "the most important innovation of the 20th century", management- in a bureaucracy. And yet, per Murray, modern management’s (for me, not to be confused with modern leadership) fundamental role is toward self-perpetuation and does not take on the 21st

century whirlwind challenge of change that we need to face and re-think, especially in today’s accelerated downturns in economic and political systems.

That, as Murray mentions in the WSJ, is "heady stuff". However, in our work we too need to "devise a new form of (economics and polity) organization and a new science of management." And all that means more focus and action in the leadership quadrant of innovation (see signature below: APHA ICEHS community website, my

historiography, Figure 3. Page13ff. (Quinn, RE. Beyond Rational Management. San Francisco: Jossey-Bass Inc, 1988, 86-87, 96-97 and 102-103. With copyright permissions).

What will all that look like in the future public health injury control organization? That’s not an easy question to answer as we have great comfort for now in the old organization. However, per Murray: ‘we, fully vested in the status quo, will need quickly to adjust to the (for IC: public and private) marketplace developments...and become even more ‘ruthless in reallocating resources to new ventures’.

For we in IC, that might range from assuring our IC organizational program resource allocations are not only evidenced based but translatable to the fluxes of the real world, that our research background section paper shows dynamical trends of past historical successes and failures- and any lesson learned- and that our work does not just conclude that more research is needed but it offers that obviously needed working plan for public health practice, that we are not paralyzed by our analysis due to an imperfect world with few always clear answers, that our practice whims for new venture capital (grants and other funds) are based on some review of weighed and ranked innovative collaborative options with NIH, Kellogg Foundation, et al., that we apply modern leadership texts and archetypes and systems leadership, etc. (See APHA ICEHS community web, below: My Millennium historiography and also the conclusions in my Kansas City speech to Bureau of federal Maternal and Child Health leadership, circa 1975, as an invited speaker.)

As Haddon synergized medicine and engineering, we must better overlay and act with new effective leadership archetypes and models of change agents. The past is prologue.

Thus, also read again Julian Waller’s paper (Public health then and now: Reflections on half century of injury control.

Am. J. Public Health . April 1994;84; 664-70)and also Leon Robertson’s (Injury Epidemiology . Research and Control Strategies. Second Edition . New York: Oxford University Press; 1998) critiques and new creations of IP programs. Also, look at Sue Baker’s many publications, (Injury science comes of age. JAMA.1989;226:2284-5).

Murray concludes in his WSJ article: ‘Change, innovation, adaptability, all have to become orders of the day.’ I recommend a through read of his WSJ article and his book for its transfer value to our present and future IC histories.

My opinions do not necessarily reflect other groups nor organizations.

LFisher Copyrighted 2010

Les Fisher M.P.H. , Safety/Leadership Consultant, Archivist, American Public Health Association, Injury Control and Emergency Health Services Section - See my monthly Archivist Attic commentaries at and at Newsletters and my Millennium... a historiography , with figures posted for Part 1-4 , all on injury prevention leadership history-at:'s Bulletin Board