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Injury Control and Emergency Health Services
Section Newsletter
Winter 2010

Patient Deaths in Hospitals

~ submitted by P. Hannah Davis


Patient Deaths in Hospitals Cost Nearly $20 Billion


One of every three people who died in 2007 in the United States was in the hospital for treatment at the time of death, according to a recent report from the Agency for Healthcare Research and Quality.  The cost of their hospital stays was about $20 billion.


The federal agency's analysis of 765,651 hospital patient deaths in 2007 found that the average cost of hospital stays in which patients died was $26,035, versus an average of $9,447 for patients who were discharged alive.  The costs were higher for patients who died because their hospitals stays were longer than those of patients who lived (8.8 days vs. 4.5 days).


The study also found that:


  • Medicare patients accounted for 67 percent of in-hospital deaths and $12 billion in hospital costs, while privately insured patients accounted for 20 percent of deaths and $4 billion.  Medicaid patients accounted for 2 percent of deaths and $2.4 billion, and uninsured patients, 3 percent and $630 million.


  • The average cost for each Medicaid patient who died was $38,939 — roughly $15,000 more than the average cost of a Medicare or uninsured patient who died, and about $10,000 more than a privately insured patient who died.


  • About 12 percent of patients who died had been admitted for an elective procedure or other non-urgent reason, and 72 percent were emergency admissions.  Roughly 7 percent of patients who died were admitted for accidents or intentional injury, and about 2 percent were newborn infants.


  • Septicemia, a life-threatening blood infection, was the major cause of death, accounting for 15 percent of all deaths, followed by respiratory failure (8 percent); stroke (6 percent); pneumonia (5 percent); heart attack (5 percent); and congestive heart failure (4 percent).  Other leading causes of death included cancer, aspiration pneumonia and kidney failure.


These findings are based on data described in The Costs of End-of-Life Hospitalizations, 2007.  The report uses statistics from the 2007 Nationwide Inpatient Sample, a database of hospital inpatient stays that is nationally representative of inpatient stays in all short-term, non-federal hospitals.  The data are drawn from hospitals that comprise 90 percent of all discharges in the United States and include all patients, regardless of insurance type, as well as the uninsured.


Hopkins Summer Injury Prevention Institute

~ submitted by Maryanne Bailey


Johns Hopkins Bloomberg School of Public Health

Center for Injury Research and Policy


The 18th Annual Summer Institute:

Principles and Practice of Injury Prevention

June 6-9, 2010



·        The Summer Institute offers attendees the opportunity to gain in-depth knowledge on injury and violence as public health problems. This year’s program will also include sessions on the Trauma Survivor’s Network and alcohol screening and brief intervention programs.  

·        Lecture and discussions are led by some of the nation’s leading experts in injury control.

·        Small group exercises are held to enable participants to use what they are learning in lecture through hands-on activities. 

·        Epidemiologists, first responders, trauma professionals, students, nurses, pediatricians, health department personnel, health & safety educators, fire prevention professionals, and public health practitioners are encouraged to attend.

Please e-mail Maryanne Bailey ( to reserve your space now. Early registrants will receive a $125 discount.


First Global Ministerial Conference on Road Safety

~ submitted by Steven Lauwers

On Nov. 20, 2009, more than 70 ministers of transportation, health and interior and other senior government officials from 150 countries adopted the "Moscow Declaration" at the close of the First Global Ministerial Conference on Road Safety. This historic document invites the United Nations General Assembly to declare a Decade of Action for Road Safety 2011-2020. It also encourages further implementation of the recommendations of the World report on road traffic injury prevention; calling for particular efforts to address the needs of pedestrians, cyclists, motorcyclists and users of public transport; promoting harmonization of road safety and vehicle safety regulations and good practices; recommending strengthening road safety legislation and enforcement; supporting enhancing emergency trauma care systems; and requesting additional funding from the international development community, especially for low-income and middle-income countries.

Hosted by the Government of the Russian Federation on Nov. 19-20 2009, the First Global Ministerial Conference on Road Safety represented a unique opportunity to make progress on tackling a leading cause of death and disability. President Dmitry Medvedev addressed the meeting attended by about 1,500 government ministers; representatives of UN agencies; officials from civil society organizations; leaders of private companies; and other road safety experts. Participants drew attention to the need for action to address the large and growing global impact of road traffic crashes; reviewed progress on implementation of the World report on road traffic injury prevention; and shared information and good practices on road safety.

Many groups took the opportunity of the Ministerial Conference to announce new road safety initiatives. On the eve of the Ministerial Conference, Bloomberg Philanthropies announced a contribution of $125 million - the largest single donation to global road safety to date - to support projects in 10 countries and monitor progress at the global level.  The aims of the project are to: reduce drunk driving; increase the use of seatbelts, child restraints and motorcycle helmets; limit speed; promote sustainable transportation; and strengthen trauma care. In addition, several meetings were hosted in the margins of the Ministerial Conference. These included meetings of YOURS - Youth for Road Safety; the Private Sector Road Safety Collaboration; the network of NGOs advocating for road safety and road victims and the Commission for Global Road Safety. At the latter meeting officials with the World Health Organization, as well as the governments of the Russian Federation and the Sultanate of Oman and the World Bank, were handed a Prince Michael International Road Safety Award by HE Prince Michael of Kent.

The newly created "Friends of the Decade" also convened. This is an informal group of Member States which have expressed their commitment to carrying forward the idea of the Decade of Action for Road Safety 2011-2020 to the next discussions on road safety in the UN General Assembly, which may take place in March of 2010. They will also support the implementation of activities during the next ten years. The international community hopes that these discussions will result in the official declaration of the Decade, which will seek to halt or reverse the increasing trend in road traffic fatalities around the world by addressing road safety management, infrastructure, vehicles, road user behaviour and post crash care.

UN Road Safety Collaboration Web site dedicated to the Ministerial Conference

Closing by Dr Etienne Krug: A decade of action


Falls among Seniors

~ submitted by P. Hannah Davis


Agency for Healthcare Research and Quality Announcements


Falls Send More than Two Million Seniors to Hospital Emergency Departments

Hospital emergency departments (EDs) treated more than 2 million seniors for broken bones, head wounds, cuts and other injuries caused by falls in 2006 at a cost to hospitals of approximately $7 billion for emergency and subsequent inpatient care, according to a recent report from the Agency for Healthcare Research and Quality.  Falls are the leading cause of fatal and nonfatal injuries among Americans aged 65 and older. The cost for medical treatment, which is paid mainly by Medicare, is expected to increase as the number of older Americans grows.


The federal agency's analysis of hospital emergency department data for patients age 65 and older treated for injuries caused by falls shows that:


  • One in 10 ED visits by seniors were for injuries related to falls, and the number of ED visits related to injurious falls increases with age: 1 in 10 men and 1 in 7 women older than 85 have an emergency department visit for an injurious fall.


  • Of the seniors who went to the emergency department due to falls, 41 percent had fractures, primarily of an upper extremity or a hip. Other common injuries resulting from falls included open wounds (21 percent of visits), sprains and strains (10 percent), injuries to internal organs (5 percent), and joint dislocations (1.5 percent).


  • About 63 percent of the patients who had injuries to an internal organ and 51 percent of people with fractures were hospitalized.


  • About 41 percent of patients with fractures and 33 percent of those who sustained internal organ injuries were transferred to a nursing home or other type of long-term care facility.


These findings are based on data described in HCUP Statistical Brief #80: Emergency Department Visits for Injurious Falls Among the Elderly, 2006. The report uses statistics from the 2006 Nationwide Emergency Department Sample, a new 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. This represents 20 percent of all U.S. hospital emergency departments.


2009 ICEHS Program Report

~ submitted by Keshia Pollack and Shannon Frattaroli


Greetings! Thanks to all of you, the ICEHS Section members, this year’s APHA meeting was again a success! On the program side, our section hosted a total of 18 oral sessions, including two sessions that were jointly organized with other sections (mental health and vision care). We also hosted a total of 10 poster sessions. And from what we heard, all of the sessions were well-attended, and in some, there was standing room only!  We also learned that 100 percent of our section’s eligible scientific sessions were awarded continuing education units. This is extremely important for ICEHS because this means that APHA members seeking continuing education units can be exposed to an array of sessions related to injury prevention and control.


We thank you for your continued dedication and support. Thank you to all of those who submitted abstracts, reviewed and scored abstracts, moderated sessions, and attended the sessions. And while we were happy to serve the Section as the 2009 ICEHS Scientific Program Co-Chairs, we are looking forward to passing the baton to the 2010 ICEHS Scientific Program Co-Chairs: Michelle Canham-Chervak and Keith Hauret. Remember, our section and our presence at the Annual Meeting is only as strong as our member contributions. Please continue to support the section by submitting abstracts and participating in the review process. We hope to see you in Denver.


Best Wishes!

Keshia Pollack and Shannon Frattaroli

Johns Hopkins Bloomberg School of Public Health

2009 ICEHS Program Co-Chairs

Report from Governing Council

~ submitted by Lois Fingerhut and Anara Gard


Because we did not have a chance to report back previously, and in case you had not heard, here are the results of the APHA elections:


President Elect - Linda Rae Murray

Executive Board - Drew Harris, Adewole Troutman and Beth Benedict


All policy statements were accepted as part of the consent calendar following the hearings — many thanks to Larry Cook, Doug Wiebe and Fred Von Recklinghausen for attending the hearings — our recommendations for changes to policy statements were all considered and most were taken.  There were two late-breaker policy statements submitted; one opposing the Stupak amendment prohibiting health care coverage of abortion that was passed, and one requiring mandatory flu vaccine for health workers that did not pass.


Lois Fingerhut and Anara Guard

Governing Councilors 2009

David Sleet Wins Distinguished Career Award

~ submitted by Kimberley Freire

It’s No Accident that David Sleet won a Distinguished Career Award in Injury Prevention

Injuries are reported to be the leading cause of death for Americans ages 1 to 44 and to cost an estimated $406 billion annually in lost productivity and medical expenses. David Sleet, PhD, associate director of science in the Division of Unintentional Injury Prevention (National Center for Injury Prevention and Control), has spent decades putting his knowledge to work in protecting the health of the public by showing the ways psychology – more accurately referred to as behavioral science – can be used to prevent these enormous losses.

The value of Sleet’s work in using behavior science to prevent injuries has been recognized by organizations such as MADD, which presented him and the NCIPC team with the National President’s Award in 2006 for systematic reviews of the effectiveness of strategies to reduce alcohol-impaired driving, such as using traffic checkpoints, setting the minimum legal drinking age, and server intervention programs.  The team’s scientific research on the effectiveness of reducing the legal blood alcohol concentration (BAC) for drivers from 0.10 g/dL to 0.08 g/dL, played a pivotal role in the passage of National legislation for 0.08 BAC. 

Known as one of the founders of the graduate school of public health at San Diego State University (SDSU), Sleet joined NCIPC as Associate Director for Science in 1992.  In 2000 SDSU’s College of Sciences presented him with its Monty Award for Distinguished Alumni of the Year.  Subsequently the U.S. House of Representatives honored Sleet with a Congressional Citation of Special Recognition for career contributions in public health.

Dr. Sleet stands out among the distinguished nominees because his efforts have made the world a safer place to live. Dr. Sleet has:

  • Spearheaded the CDC alert on the dangers of airbags to children (MMWR, 1993), long before the problem was recognized.  Subsequent deaths to children forced Congressional hearings which led to less aggressive airbag technology, an airbag on-off switch, and  a campaign to place children in the back seat.
  • Authored the National Highway Traffic Safety Administration’s Strategic Plan for Traffic Safety and Public Health which led to memoranda of understanding and a series of on-going collaborations between DOT (NHTSA) and HHS (CDC) for nearly 20 years. 
  • Initiated and helped plan the First Surgeon General’s Conference on Drunk Driving, setting a clear agenda for public health policy development and evaluation.  Dr. Sleet’s 1990 published review of the evidence on BAC and risk was used by the Australian government to pass a national legal limit of 0.05 percent BAC. 
  • Prepared the Presidential Proclamation on Child Passenger Safety, which resulted in a National Child Passenger Safety Awareness Day, a National Observance each year (since 1983) that still serves to unite advocates for child safety.
  • Conducted the first cost-benefit analysis of airbag safety outside the US, resulting in a National Program to exempt airbags from importation taxes in Finland.  .      

Responsible for banning the “WatchLighter” (a watch/cigarette lighter combination) in California and successfully petitioned the CPSC to add  “novelty lighters” to its rulemaking for a child-proof lighter standard, which has saved 200-300 child deaths annually from burns.       

Now Sleet has a new honor:  APHA’s Injury Control and Emergency Health Services Section has chosen him as its 2009 winner of the Distinguished Career Award, given for “outstanding dedication and leadership in injury control and emergency health services with contributions and achievements that have a significant and long-term impact on the field.”  APHA presented Sleet with the award Nov. 10, 2009, during its 137th Annual Meeting & Exposition in Philadelphia.  Former CDC Director William Foege, MD, is the only other CDC’er to have received this award since its inception in 1989.

So how are the results of work like Sleet’s used to prevent injuries?  Psychology can help answer questions such as what behaviors contribute to injuries, which behavioral interventions can prevent them, and what are the psychological impacts of traumatic injuries on people and their families.  Although environmental change has been the preferred method to prevent injuries, according to Sleet, nearly all injuries have a behavioral component. Even changes in vehicles and roads require some behavioral adaptation. By understanding these interactions between human behavior and environments, more injuries can be prevented.  

He is co-editor of the landmark 2004 World report on road traffic injury prevention (which won the HRH Prince Michael (of Kent) Premier International Road Safety Award) and has co-edited two additional recent books, unique to the field: Injury and Violence Prevention:  Behavioral Science Theories, Methods, and Applications (2006) and the Handbook for Injury and Violence Prevention (2007), a book of best practices.

He is former acting director of the Division of Unintentional Injury, and has served on the scientific staff of the National Highway Traffic Safety Administration, the Road Transportation and Geotechnical Laboratory (Finland), Vrije Universiteit (Brussels, Belgium), the Health Department of Western Australia,  and directed the Road Accident Prevention Research Unit at the University of Western Australia.  

He is the author of more than 160 scientific articles and has contributed to HEW and DHHS’s Healthy People and Objectives for the Nation in the area of injury prevention since their inception in 1979.   He is adjunct professor in behavioral science and health education at Emory University’s Rollins School of Public Health.

New Book by Dr. David Hemenway

"Does your mother know what you do for a living?  If you're not sure buy her this book"  


Does your family still not know what public health is, let alone injury control?  Then give them this highly readable book.  Your parents and even your teenagers will learn something about your work — and you too will learn more about the injury field.  While We Were Sleeping: Success Stories in Injury and Prevention (U Cal Press 2009) by Dr. David Hemenway emphasizes the importance of the work we are all doing to try to make the world a safer place.  Only $20 at!


New E-codes Report Released

~ submitted by Lee Annest

New External-Cause–of-Injury (E codes) Report Released


Dear Injury Colleagues,


I wanted to make you aware of a new report that was just released by NCIPC entitled:


Recommended Actions to Improve External-Cause-of-Injury Coding in State-Based Hospital Discharge and Emergency Department Data Systems


CDC is providing national leadership in an effort to develop and implement strategies and action plans to improve external-cause-of-injury coding (E-coding) in state morbidity data systems.  Improving E-coding in state morbidity data systems can provide better data for setting priorities for injury prevention and trauma care programs and evaluating their effectiveness at the federal, state, and local levels.  In February 2009, CDC conducted a partners meeting to discuss E-coding issues relevant to state morbidity data systems and to make recommendations for improvements.


CDC’s Injury Center has released this report summarizing actions recommended by participants in the February meeting aimed at (1) improving communication and collaboration among stakeholders, (2) demonstrating a business case for high-quality E-coding, (3) improving the collection of high-quality E-coded data, and (4)  improving and promoting the usefulness of E-coded data for state injury prevention efforts.


This report is available on the CDC’s Injury Center Web site at


Please help us disseminate this to your other colleagues who you think might be interested.


Thanks much and best regards,


Lee Annest, PhD
Director, Office of Statistics and Programming


APHA Call for Leadership Nominations

~ submitted by Ida Plummer, APHA




The nominating committee for APHA's Governing Council is looking for the following candidates for leadership roles in the organization:


  • APHA President Elect (three year commitment, one-year each as president-elect, president and past-president)
  • Executive board – three positions available (4-year term)
  • Speaker of the Governing Council (3-year term)
  • Treasurer (3-year term)


The APHA Governing Council will vote to select these officers at the November (2010) meeting, and they would begin serving immediately after the APHA conference (so terms would start Nov. 10, 2010).


As I'm sure you know, the next APHA Annual Meeting is Nov. 6-10, 2010, in Denver.


Applications are due March 31, 2010 and should include the relevant (attached) one-page form along with resume/CV of the nominee, and any letters of support. 

The nominating committee will meet May 6 to select the list of nominees for consideration by the governing council at the 2010 Annual Meeting.


We are hoping you will be able to think of individuals who would be excellent candidates for the above positions. 


Should you or a potential candidate wish further information on these positions, please refer to the job descriptions and nomination form available on the APHA Web site at


If you are interested in running we suggest you contact your APHA Section, SPIG, Caucus and/or Forum leadership to solicit their support and assistance with your nomination. 


All nominees for the Executive Board are selected from among the membership of the Association, except that the nominees for the offices of Honorary Vice-President may include persons who are not members of the Association.


For more information on the Nominating Committee contact Ida Plummer via e-mail at