Journey to injury free

Injury is the leading cause of morbidity and mortality for children and young adults living in the United States. Inner city children, living in poverty, have a higher rate of injury than children of more substantial means, (Durkin 1994).The Harlem Hospital Pediatric Trauma Service, working with the Columbia University School of Public Health, developed the Northern Manhattan Injury Surveillance System in 1984. The NMISS provides the ongoing population based epidemiology of severe injuries to children in northern Manhattan. The base line data for 1983 to 1987 (Davidson 1992) established the rate for injuries causing hospitalization and death for the 89,000 children under 17 who live in northern Manhattan as 846/100,000. In Harlem the rate was 1246/100,000. In comparison, the rate for rural northeast Ohio was 18/100,000 and the United States 656/100,000. The high rate of serious injury to children in the Harlem community created the impetus for the Pediatricians and Pediatric Surgeons to develop the Harlem Hospital Injury Prevention Program,(Laraque 1995). Rates for specific types of injury were falls 218/100,000; vehicle injury 141/100,000; ingestion 119/100,000; burns 110/100,000; blunt and crush 103/100,000; stab wounds 60/100,000; firearms 27/100,000; drowning 4/100,000. Vehicle related injuries were composed of (66%) motor vehicle pedestrian, (21%) bicycle, and (6%) motor vehicle occupant. Comparison of the injury data for northern Manhattan children to that for rural and suburban children demonstrated that urban children had a higher rate of injury and a higher rate of homicide. However, injury mortality was lower for city children most likely because of more rapid access to definitive medical care.

The Harlem Hospital Injury Prevention Program was established in 1988 to reduce injuries by providing safe play areas and safe supervised activities for community children, in addition to the injury prevention education program already in place. In order to achieve this goal, a broad based coalition was formed with state and local governmental staff, community groups, district school faculty, parents and hospital staff. The approach to injury prevention includes many other programs addressing the injury problems found in the community such as Children Can't Fly, Safety City for Motor Vehicle-Pedestrian Crashes¬, Bicycle Safety, Playground Safety¬, and Violence Prevention¬.

Since 1988 major injuries requiring hospital admission have decreased by 60% for children who live in Central Harlem. Violent injuries have decreased by 46% in Central Harlem while they have doubled in the neighboring community, (Durkin 1996). The Northern Manhattan Injury Surveillance study demonstrates that the decrease in major injuries is for the targeted injuries, in the targeted age group, and in the targeted community, (Davidson 1994). The Harlem Hospital Injury Prevention Program, based on community injury epidemiology and based on the development of a broad coalition of agencies and organizations, demonstrated that successful injury prevention programs can be developed in the inner city and that the ¬Safe Community Model is successful.

The Injury Free Coalition for Kids ®, based at Columbia University in New York City, and supported by a 15 million dollar grant from the Robert Wood Johnson Foundation, is an outgrowth of the successful Harlem Hospital program. Currently there are 27 Injury Free sites in Pediatric Trauma Centers across the country. Sites are established in 9 of the 10 United States Trauma Regions. Current sites are Harlem Hospital and Children's Hospital of New York, Children's Hospital Boston, Hasbro Children's Hospital/ Rhode Island Hospital in Providence, Connecticut Children's Medical Center in Hartford, University of Massachusetts Memorial Children's Medical Center in Worcester, Children's Hospital of Philadelphia, John's Hopkins Hospital, Children's National Medical Center in Washington, D.C., Pitt County Memorial Hospital in Greenville, N.C., Hughes Spalding Children's Hospital in Atlanta, Jackson Memorial Hospital in Miami, Children's Hospital of Pittsburgh, Mercy Hospital of Pittsburgh, Children's Hospital Medical Center in Cincinnati, St. Louis Children's Hospital, Children's Mercy Hospital/ Truman Medical Center in Kansas City, Children's Memorial Hospital in Chicago, University of Chicago Children's Hospital, Children's Hospital and Regional Medical Center/Harborview Medical Center in Seattle, Children's Hospital and Health Center of San Diego, Harbor-UCLA Medical Center in Los Angeles, Hennepin County Medical Center in Minneapolis, University Health System in San Antonio, Children's Hospital of Austin, Children's Hospital of Michigan and Arkansas Children's Hospital in Little Rock.