Unintentional injuries to students at school

Surveillance-based injury epidemiology in schools in Germany

The two objectives of this article are: a) to describe the German School Injury Surveillance System and b) to determine major trends and patterns of different school-associated injury indicators. The database covers all children and adolescents from nursery school through university during their time at school and day care, including their way to and from school. Presently, this results in 17.5 million insured young persons, or 21.2% of the German general population. The surveillance system includes two main informational sources: school accident and medical accident reports.In 2003 over 1.5 million school-related injuries received medical attention in Germany. This is an incidence rate of about 86 injuries per 1000 students. Between 1975 and 2003, the mortality rate declined from 23.4 to 7.7 per million. This is a drop of 67% in about 30 years.

Injuries sustained by students in shop class

OBJECTIVE

Injuries in the school environment are a serious public health problem. Injuries occurring within the school shop class are a part of this problem that has received little to no attention. The purpose of our study was to describe the epidemiology of shop class injuries in Utah public schools for the years 1992-1996.

METHODS

Utah statewide grades 7 through 12 school injury data for 1992-1996 were used. The data were generated from a standardized Student Injury Report form completed by school personnel immediately after the occurrence of an injury on school premises that: 1) caused loss of at least one half of a day of school; and/or 2) warranted medical attention and treatment. Shop injuries were defined as injuries that occurred in industrial art classes, vocational educational classes, or automotive classes. To determine the medical outcome and hospital charges associated with shop class injuries, we linked the Student Injury Report database to Utah statewide emergency department (ED) records (available for 1996 only), and to Utah statewide hospital inpatient discharge records (1992-1996).

RESULTS

During 1992-1996, 14 133 students in grades 7 through 12 were injured at school, of which 1008 (7.1%) were injured during a shop class. The majority (88. 4%) of shop injuries involved equipment use. Equipment was misused in 37.9% and malfunctioned in 3.5% of the incidents. The leading injuries reported for shop equipment were lacerations (70.9%), burns (6.0%), and abrasions (4.6%), whereas the leading for nonequipment injuries were lacerations (45.4%), fractures (9.2%), and pain/tenderness (6.7%). In 1996, 167 students were injured in a shop class and 45 (26.9%) visited an ED as a result of the shop injury. Equipment was a factor in 88.9% of the shop injuries admitted to the ED. Table saws (15.0%), other saws (15.0%), and band saws (12.5%) were involved in nearly one half of the equipment injuries. Equipment was misused in 44.7% and malfunctioned in 10.5% of the incidents resulting in an ED visit. The majority (64.4%) of students sustained an open wound injury. The total ED charges were $16 571. For 1992-1996, 1008 students were injured in a shop class, 7 (.7%) required inpatient hospital care. Six of the students were injured using a table saw and 1 sustained injuries attributable to automotive cleaning fluid. Equipment was used improperly in 4 of the table saw injuries. Six of the students sustained hand injuries, with 3 suffering a traumatic amputation of a finger or thumb. The total inpatient charges were $26 747.

CONCLUSION

School shop injuries have a great impact on students, their families, and schools because of the loss of productivity for the student and the financial impact. Many of the injuries are preventable. These findings stress the need for school administrators, teachers, and students to develop and improve safety policies and practices in school shop classes. In addition, the findings may provide useful information to pediatricians and enable them to better inform patients of risks in school shop classes.

Prehospital emergency care for children at school and nonschool locations

OBJECTIVE

The purpose of this study was to ascertain whether school-based emergency medical services (EMS) incidents are different from nonschool-based EMS incidents for school-aged children.

METHODS

We examined South Dakota EMS incident reports involving children ages 5 to 18 years old from 1994 through 1996 (n = 12603). Patient characteristics, dispatch reason, primary medical complaint, injury type, contributing factor of injury, and performed interventions were analyzed.

RESULTS

During the study period, there were 140455 total EMS incident reports, of which 12603 (9.0%) were for school-aged children. EMS dispatches to a school represented 755 (6.0%) of all EMS incidents for school-aged children. The number of school-based EMS incidents was highest at the beginning of the school year, whereas the number of nonschool-based EMS incidents was highest during the summer months. School-based EMS incidents peaked at noon, whereas nonschool-based EMS incidents peaked after school. For both locations, the average age of the patient was 14 years old. The dispatch reason for school-based EMS incidents differed from those for nonschool-based EMS incidents. The top three school-based EMS dispatch reasons were falls (36.2%), other trauma (27.0%), and medical illness (24.5%). Motor vehicle crashes (30.8%), medical illness (26.2%), and other trauma (11.4%) were the leading nonschool-based EMS dispatch reasons. Injuries accounted for a significantly greater proportion of school-based than nonschool-based EMS incidents (70.7% vs 62.6%). Excluding pain, the most frequent type of injury was a fracture or dislocation in school-based EMS incidents and open soft-tissue injury in nonschool-based EMS incidents. A total of 11 students sustained an injury resulting in paralysis. The body region that was most commonly injured was a lower extremity (23%) in school-based incidents, whereas the head was the most commonly injured body region in nonschool-based incidents (20%). Sports were the largest contributing factor in school-based incidents, whereas alcohol/drug use was the largest contributing factor in nonschool-based EMS incidents among school-aged children. A medical illness was the primary complaint for 206 (27.3%) of the school-based incidents and 3599 (30.4%) of the nonschool-based incidents. The chief medical complaints were breathing difficulty (18.4%), seizure (16%), and other illness (12.3%) for school-based EMS incidents. Other illness (20.0%), breathing difficulty (13.7%), and abdominal pain (12.0%) were the chief complaints for nonschool-based EMS incidents. Treatment was rendered by the EMS provider in 11 753 (93.3%) of the incidents. Frequency of EMS intervention was the same for school-based incidents and nonschool-based incidents. Transportation to a medical facility was more frequent in school-based incidents than nonschool-based incidents.

CONCLUSION

Compared with nonschool-based EMS incidents, school-based EMS incidents are more often attributable to injury, more often related to a sports activity, and more often result in transport to a medical facility. Understanding the characteristics of school emergencies resulting in an EMS dispatch may help emergency medical providers be better prepared for school-based incidents. School personnel may benefit from increased knowledge about the EMS system and EMS programs. In addition, EMS incident data may provide useful information about school-based injuries and may provide a means for injury surveillance.

School-injury determinants and characteristics: developing an investigation instrument from a literature review

The school constitutes an environment of public-health concern since it is the location of occurrence of a major proportion of injuries sustained by children. This paper reviews a total of 42 empirical studies dealing with the determinants and characteristics of injuries to school pupils. On the basis of the review, a proposal is made for a specialized instrument (SIIR) dedicated to the analysis and registration of injuries and incidents at school. It addresses the 'who?', 'where?', and 'what?' questions usually posed in traditional instruments for injury surveillance but places far greater emphasis on the 'how?' and 'why?' questions of injury. SIIR enables the injury phenomenon to be subjected to greater scrutiny, and is designed to support preventive work at school level. For one school-year, it is also being employed for the creation of a data register for research and development purposes.

School injuries in an occupational health perspective: what do we learn from community based epidemiological studies?

OBJECTIVE

The paper reviews community based epidemiological studies of injuries at school. It discusses their main findings in the light of a frame of analysis that emphasizes multidimensionality of causes, and in a Swedish context, where school injuries are legally regarded as occupational injuries.

METHODS

A frame of analysis, inspired by research in the arena of occupational accident, was developed. It employs four key concepts to distinguish between injury and accident sequence, and between situational and structural factors as potential injury determinants. It also stresses the interaction between pupil, school, and community, in injury genesis. In parallel, a review of community based epidemiological studies of school injuries was undertaken after searching the relevant literature. The knowledge gathered from these studies is appraised in the light of the frame of analysis.

RESULTS

In general, the studies point to potential risk groups, and to hazardous locations and activities. They address injury characteristics, but largely fail to define typical mechanisms. The literature sheds little light on whether there are particular characteristics of the community, school, or pupil(s)--other than gender and age--that influence injury event occurrence.

CONCLUSIONS

Further research should devote attention to the sequences of events culminating in school injuries, and to the structural determinants of accident sequences. In this, surveillance systems might prove to be of great utility.

New Zealand's Injury Prevention Research Unit: reducing sport and recreational injury

The Injury Prevention Research Unit was established in 1990 to reduce the incidence, severity and consequences of injury. Research into sport and recreational injury is one of five major areas of research being undertaken. National data sources have been used to estimate the overall size of the problem and to describe the nature and circumstances of injury associated with a variety of sport and recreational activities. Analytical studies are now being undertaken to identify significant risk and protective factors. Research activity is being directed toward the development, implementation and evaluation of preventive measures.

The risk of childhood injury on Boston's playground equipment and surfaces

The Childhood Injury Prevention Program of the Boston Department of Health and Hospitals conducted a survey of injury risk in Boston's playgrounds. A standardized checklist was used to assess a 25% sample of public playgrounds for hazards. Climbers accounted for 34% of the hazards observed and had the greatest proportion of significant hazards. The surfacing material in 100% of the playgrounds observed was unsafe. Urban children risk exposure to hazardous playground equipment frequently situated above unsafe surfacing material.

Surface-specific fall injury rates on Utah school playgrounds

The purpose of this study was to estimate surface-specific rates of fall injuries on school playgrounds. Playground injuries related to falls from climbing equipment and the surfaces involved were identified from injury reports for 1988 to 1990 from 157 Utah elementary schools. Enrollment data and playground inspections were used to estimate student-years spent over each surface. The fall injury rates per 10,000 student-years were asphalt, 44; grass, 12; mats, 16; gravel, 15; and sand, 7. These data did not show that impact-absorbing surfaces reduce fall injuries on playgrounds better than grass. Improved field studies are needed to guide policy decisions for playground surfacing.