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JHCIRP: 25 Years

Celebrating Silver,
Reaching for Gold:
25 Years of Injury
Research and Policy

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Success Stories of People Touched by the Center

The work of the Center for Injury Research & Policy can best be understood through the voices of the people it has touched. These powerful stories of a mother, a legislator, a fire safety official and a public health officer help to illustrate the Center’s mission.

Child Injury Prevention
Domestic Violence Prevention
Child Transportation Safety

Alcohol and Transportation Safety
Engineering Safety
Fire Safety
Trauma Care and Emergency Medical Systems
Training and Education

child injury preventionIn early studies and with Center support, Dr. Andrea Gielen, Professor and now Center Director, with her team identified many barriers faced by low-income parents trying to protect their children from unintentional injurythe leading cause of child death in the U.S.. Working with the Johns Hopkins Department of Pediatrics, they developed, implemented, and evaluated a successful program that trained pediatricians to counsel families about safety, and created the Children’s Safety Center. There, families learn about safety, and can see, try, and buy (at low or no cost) many life-saving safety products.

Since opening in 1997, the CSC has been sustained by leveraging Center core support to find new funding partners, resulting in two new safety centers at Johns Hopkins. Under the leadership of Eileen McDonald, Director of the Children’s Safety Centers, the model has been replicated in other hospitals in the U.S. and abroad, helping thousands of children live to their full potential.

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domestic violence preventionWith Center support, Core Faculty Daniel Webster and colleagues used evidence showing that a few simple risk assessment questions could predict a domestic violence survivor’s homicide risk to develop and evaluate a novel intervention for DV service providers and police officers. The program assesses women’s risk, provides tailored feedback, and connects women to crisis counselors.

This award-winning Lethality Assessment Program has been disseminated statewide in Maryland, and the Maryland Network Against Domestic Violence has trained police and service providers in 30 other states to implement the program. The program offers women a chance to live to their full potential, free from the violence that often dominates their lives.

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CHILD TRANSPORTATION SAFETyAlexa's Story

Referred through a local community center, Alexa Zelaya sought safety education from the Johns Hopkins Children's Safety Center (CSC). While Alexa didn't speak spanish, she was able to speak with Akisha Price, child passenger safety technician, through translations offered by the Johns Hopkins Medicine International and Special Services.

With the help of Akisha, Alexa received a new car seat and education that will help her newborn daughter and her two other children-- teen daughters. In addition to learning about how to install the car seat, Alexa also reviewed proper positioning of the infant in the car seat, as well as the do's and don'ts of using a car seat with a child. Akisha also outlined Maryland state laws about traveling with children in vehicles.

"I took my daughter to the pediatrician yesterday," said Alexa. "The seat worked perfectly! Thank you very much."

Nadra’s Story

On September 24, 2007, at 6:30 p.m., Nadra Robinson was driving home with her one-year-old son Antoine buckled into his car seat. A few minutes later, she was standing on the sidewalk staring at her wrecked car. Another car had run a red light and smashed into the passenger side of Robinson’s car where Antoine sat in his rear-facing car safety seat. 

After the immediate relief she felt when she knew that her son was unhurt, Robinson’s first thought was, “Thank God I listened to Kisha.”
 
Kisha is Akisha Price, a health educator at the Johns Hopkins Children’s Safety Center (CSC). Just a few weeks before the crash, Robinson visited the CSC to replace Antoine’s infant car seat with a larger convertible seat, which she wanted installed facing forward. Price explained that Antoine was too small to sit forward-facing, and still needed to be rear-facing. In fact, Maryland law requires children to ride rear-facing in their car seat until they are one year old and weigh at least 20 pounds.  

“Many moms want to turn their child forward-facing as soon as possible,” Price said. “I clarify the law for them but, more importantly, I talk about the safety advantages of remaining rear-facing as long as possible.” 

“Had I not done that,” Robinson said. “I’d likely be visiting my son in a trauma center or at a grave site. The Children’s Safety Center saved Antoine’s life.”

Laticia’s Story

Laticia Cannon first visited the Children’s Safety Center at the referral of her son Mica’s pediatrician. A health educator conducted a personalized injury risk assessment and provided Laticia with a referral to the Baltimore City Fire Department for free smoke alarms. She returned to the center for a car seat appropriate for  Mica’s age and weight, as well as instructions on how to use it correctly. 

Her visits to the center proved to be lifesaving. After Laticia and Mica were in a car crash, Mica surivved with no injuries.  

Laticia has continued to visit the safety center to replace Mica’s car seat , buy him a bicycle helmet and an infant car seat for his new baby sister. The young mother, like thousands of others who have visited the facility, has been able to provide her children with the best in safety practices and products.

More on the Johns Hopkins Children’s Safety Center

Since it opened in March of 1997, the Children’s Safety Center (CSC) has served more than 10,000 clients. The first service of its kind in the U.S., the CSC provides free, personalized child safety consultations, demonstrations and hands-on learning. 

Based on research demonstrating the impact of the CSC, it has become a service program at Johns Hopkins Hospital and a model for others. Two new safety centers now serve Baltimore families: the CARES Mobile Safety Center that travels throughout the city and SafetyLane in the Johns Hopkins Harriet Lane Clinic. Nationally, many other children’s hospitals and institutions that serve children are now creating their own centers.

Partnerships are essential to success. We work closely with the Johns Hopkins Department of Pediatrics and the Pediatric Trauma Service, as well as the Baltimore City Fire Department, Maryland Institute College of Art and the Maryland Science Center to bring child safety to the community.

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ALCOHOL AND TRANSPORTATION SAFETY
William A. Bronrott, a delegate in the Maryland General Assembly, has been working to make our roads a safer for almost three decades. Motor vehicle safety is a theme that has repeated itself throughout Bronrott’s life. As a child, a student and an adult he has been affected by the sudden loss of friends, neighbors and loved ones in car crashes. 

He was moved to action in 1979 when a friend, Cindi Lamb, and her infant daughter Laura were hit head-on by a drunk driver. Laura’s spinal cord injury made her the nation’s youngest quadriplegic.

“I followed up in 1980 by organizing a news conference at the U.S. Capitol where I brought my friend and her wheelchair-bound, 16-month-old daughter and another young mother, Candy Lightner from California, whose daughter had been recently killed by a drunk driver,” Bronrott said. “Together we launched the first Mothers Against Drunk Driving (MADD) chapter here in Maryland, and the national MADD movement’s war on drunk driving was underway.”

Bronrott’s dedicated efforts since that time have resulted in tougher legal consequences for drunk drivers. He has also been heavily involved in the passage of several Maryland laws requiring the use of seat belts, child booster seats and motorcycle helmets. In his battles to reduce injury, Bronrott relies on expert sources like the Johns Hopkins Center for Injury Research and Policy as an integral part of a multifaceted approach to designing new policies.

“There is no question that the Center for Injury Research and Policy lends great credibility to any public health policy debate.” Bronrott said. “It can be very persuasive in educating policymakers to do the right thing. If used in a timely and effective way, the research can make all the difference in getting the votes needed to pass laws that prevent death and injury.”

More on policy approaches to injury prevention

For some injury problems, legislation, law enforcement  and regulation are essential for prevention. 

Center research was used to create more effective mandatory toy warning labels to indicate that small parts pose choking hazards to children. Our research on young, novice drivers has demonstrated that the presence of additional passengers in the car increases risk, while more comprehensive graduated driver licensing programs significantly reduce the risk of death. This research has been used to create lifesaving legislation in many states across the country.

These are but a few examples of how research can help strengthen the partnership between the Center and those legislators and activists who are passionate about injury prevention. By empowering these advocates with solid scientific evidence, the Center has been able to inform their efforts to reduce many types of fatal and debilitating injuries.

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ENGINEERING SAFETY
An experienced whitewater kayaker, Isaac Ludwig had made about 30 trips down the Green River in North Carolina and 10 times down the Gorilla rapids. His eleventh trip on April 1, 2007, was nearly his last. When he got to the Gorilla, a 15-foot waterfall that lands on a shallow rock shelf, things started to go terribly wrong. He’s convinced that his WRSI helmet— the result of a collaboration between the Center and other partners— saved him when he hit his head on a rock.  

“After the drop, I immediately flipped and hit the back of my head on a rock, knocking my face into my boat,” Ludwig recalled. “I’m pretty sure that my WRSI helmet saved my life. The protection to the back of the head is better than a lot of whitewater helmets, and if I would have had something of lesser quality on, I probably wouldn’t have been protected as well.”

‘The impact was hard enough that the inside of the shell suffered a crack and I got a knot on my head.” he said. “In the end, everyone was O.K. and we hiked out for safety's sake.”

The WRSI helmet is the product of  the Whitewater Head Impact Protection Project, a 2002 partnership between the Johns Hopkins Center for Injury Research and Policy and the Whitewater Research and Safety Institute (WRSI).

WRSI was founded by Gil Turner after the death of his son Lucas, who was killed in a whitewater kayaking trip in Idaho. Lucas’s helmet came off after his kayak flipped, throwing him against a rock. Turner was convinced a better helmet would have saved Lucas, and began to research how a new design could be created and tested. He vowed that there was no need for this tragedy to happen again. After a nationwide search, he was connected with the Center. The helmet development costs were split between the WRSI and the Center, and a group of Johns Hopkins engineering students were enlisted as the designers.

Flash forward to a new, fully tested helmet designed to stand up to the demands of whitewater sports. More than 15,000 WRSI helmets were sold in 2007, making whitewater kayaking safer for enthusiasts like Ludwig. 

For more information on Johns Hopkins' contributions to the Whitewater Research and Safety Institute, click here.

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FIRE SAFETY
As a society, we invest vast resources every year to prevent fires and the tragic deaths and severe injuries they cause. What’s the return on this investment? FEMA and the CDC wanted to answer that question, so they partnered with the Johns Hopkins Center for Injury Research and Policy and the state of Delaware. 

“Being so close to Maryland, I knew Johns Hopkins was a great hospital but I never knew they had the same caliber of researchers until we started to work with the team from the Injury Center,” said Steve Austin, past-president of the Delaware Volunteer Fire Association (DVFA).

The evaluation of Delaware’s fire safety services used interviews, program review and surveillance data to describe the state’s fire trends and prevention activities.

Among the noteworthy findings was the strong and closeknit culture of the fire service in Delaware. For example, all fire houses in the state participate together in “Wake Up, Delaware,” a smoke alarm and battery distribution program to enhance protection to residents statewide. The Delaware fire service also uses policy advocacy effectively and consistently in its prevention program. Study results and recommendations for the state’s prevention program have been presented to the DVFA and other fire service leaders throughout the state.

“It’s always a good idea to have a third party validate what we thought was an effective program,” said Austin. “The team from Hopkins was extremely professional and respectful of our both our culture and our work.” 

More on Fire Prevention Research

U.S. fire departments are critical partners in the fight against injuries. Considered heroes long before September 11, 2001, fire fighters from the more than 21,700 fire departments across the U.S. are ready to risk their lives daily to protect us. 

While most people recognize the critical role fire personnel play in the emergency response system, few may appreciate their potential contributions to prevention. Center faculty are replicating the DVFA study in the state of Pennsylvania to learn more about how the fire service develops, delivers and evaluates prevention programs and policies to reduce fire deaths and injuries.

The Center has also evaluated fire service prevention efforts in a partnership with the national non-profit Home Safety Council. Together, we conducted the first-ever National Fire and Life Safety Education (FLSE) Survey to benchmark prevention programs in U.S. fire departments. Survey findings revealed that the vast majority of fire departments conduct FLSE, although there is substantial variation in its scope and potential impact. The survey documented the resources and training needed to expand and strengthen FLSE across the country.

In partnership with the Baltimore City Fire Department, the Environmental Justice Partnership ,  the Urban Health Institute, and the Baltimore Mayor’s Office , the Center is seeking ways to enhance the City’s existing smoke alarm canvassing program. Using community-based participatory research approaches, Center faculty have joined with local organizations and agencies, community health workers, and the CARES Safety Center team to find new ways to disseminate lifesaving smoke alarms and carbon monoxide detectors to families.

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TRAUMA CARE AND EMERGENCY MEDICAL SYSTEMSImproving Trauma Outcomes

Dr. Ellen MacKenzie, Professor and former Center Director, along with her research team, has spent years documenting the impact of severe trauma, and finding ways to improve outcomes. Leveraging Center support and core infrastructure has enabled her team to establish the Major Extremity Trauma Research Consortium (METRC), supported by the largest-ever federal investment in trauma outcomes research. Their early Center-supported work also led to the creation of the Trauma Survivors Network and effective self-management programs for trauma survivors. These programs are now operating in trauma centers around the country, helping survivors live to their full potential every day.

Connie's Story

The morning of July 20, 2004, Connie was driving her usual route to work on a scenic, two-lane, winding road in the horse country of Virginia, when a young man driving the opposite way fell asleep at the wheel and crashed head-on into her car.

At that moment, Connie’s life depended on the U.S. trauma system.

She was airlifted from the scene with life-threatening injuries, including a broken right forearm, a left foot broken in several places, a broken pelvis, a collapsed lung, a lacerated liver and a severely severed right foot. A month later, after several operations, the decision was made to amputate Connie’s right foot.

Three years after the initial trauma, Connie volunteered for Next Steps, an innovative, nine-week self-management program for trauma survivors created by Center faculty in partnership with the American Trauma Society.

Connie was one of 22 recovering trauma survivors who participated in sessions that covered a range of topics such as working with health care providers, strategies for building resilience, learning relaxation techniques and communication skills. “Being with people who have had their lives changed to the same degree mine was gave me a safe venue to identify and discuss problems and brainstorm solutions within the group,” Connie said. “Yes it was hard, yes it was painful, but it was one of the best things!”

More on Trauma Care and EMS

Most of us rarely give any thought to the sophisticated and complex U.S. trauma system that provides lifesaving care for the severely injured. This system provides a continuum of multidisciplinary care with the goal of returning the seriously injured to their pre-injury life.

The trauma system includes EMS 9-1-1/dispatch and medical oversight of pre-hospital care, appropriate triage and transport, emergency department trauma care, surgical intervention, in-hospital care, rehabilitative services, mental and behavioral health, social services, community reintegration plans, medical care follow-up, and prevention programs.

Center faculty conducted the first-ever national study of trauma systems, demonstrating their superior lifesaving benefits once an injury has occurred. Another JHCIRP-led study that focused on prevention activities within trauma centers revealed opportunities for partnerships between trauma care providers and public health professionals to collectively promote primary prevention.

Research by Center faculty has shed new light on ways to enhance trauma care. Tools for measuring both the severity and outcome of injury have been developed to evaluate trauma care and rehabilitation. Long-term studies of trauma survivors have identified important factors that help survivors return to work and live as they did before the trauma. This body of work has led to innovative new models of care and support for trauma survivors and their families.

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TRAINING AND EDUCATIOn
As a new epidemiologist for the Oklahoma State Department of Health’s Injury Prevention Service, Mendy Spohn’s first responsibility was surveillance of house fires, burn injuries and other injury events. To prepare her for this new position, the health department sent her to the 2001 Johns Hopkins Summer Institute on Principles and Practice of Injury Prevention.

“I was ready to learn strategies to prevent unnecessary deaths,” said Spohn. “The institute allowed me to understand injury as a broader issue, both on a national and global scale. It also showed me that there are different ways to reduce injuries: active prevention, such as educating people to make better choices, as well as passive prevention, such as changing the environment to make it automatically safer for everyone. I also learned how advocating for smarter policies can be an effective strategy in injury prevention.”

Mendy now serves as health department administrator for six agencies in south central Oklahoma, yet she continues to apply the knowledge and skills she gained during her week in Baltimore.

“Even though I am now directing all the public health services in my region, ranging from maternal and child health to tobacco control and beyond,” Spohn said, “I encourage a non-traditional approach by training all my staff  how to incorporate injury prevention into each of our programs.”

For Spohn, the Summer Institute was the first chance to learn the science behind injury prevention. She rates the experience as one of the best continuing education opportunities she has had as a practicing public health professional. Spohn spreads the injury prevention message by integrating it throughout the health department system, helping to make her state safer.

More on training in the science of injury prevention

In 2012, the Johns Hopkins Center for Injury Research and Policy hosted the 19th Annual Summer Institute on Principles and Practice of Injury Prevention. First conceived in the late 1980s, the Institute has grown and responded to the many innovations in the field of injury prevention over the past two decades.

As the science progressed and effective interventions were identified, the Institute expanded to supplement the basics of surveillance and mechanisms of injury with skill building in prevention strategies and the translation of research into effective programs and policies. In fact, the Institute’s curriculum is consistent with recently established national training competencies.

Hundreds of individuals have participated in this unique training opportunity, including medical care and public health professionals, community advocates and government officials at the local, state and national levels. The Summer Institute helps grow the field of injury prevention and control, with graduates serving in leadership roles in local, national and international agencies and organizations.

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