Traumatic Injury Research at NIOSH

Reviews of Research Programs of the National Institute for Occupational Safety and Health

Committee to Review the NIOSH Traumatic Injury Research Program

Board on Population Health and Public Health Practice

INSTITUTE OF MEDICINE AND NATIONAL RESEARCH COUNCIL OF THE NATIONAL ACADEMIES

THE NATIONAL ACADEMIES PRESS

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Traumatic Injury Research at NIOSH Reviews of Research Programs of the National Institute for Occupational Safety and Health Committee to Review the NIOSH Traumatic Injury Research Program Board on Population Health and Public Health Practice

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THE NATIONAL ACADEMIES PRESS • 500 Fifth Street, N.W. • Washington, DC 20001 NOTICE: The project that is the subject of this report was approved by the Governing Board of the National Research Council, whose members are drawn from the councils of the National Academy of Sciences, the National Academy of Engineering, and the Institute of Medicine. The members of the committee responsible for the report were chosen for their special competences and with regard for appropriate balance. This study was requested by the National Institute for Occupational Safety and Health of the Centers for Disease Control and Prevention and supported by Award No. 211-2006-19152, T.O. #1, between the National Academy of Sciences and the Centers for Disease Control and Prevention. Any opinions, findings, conclusions, or recommendations expressed in this publication are those of the author(s) and do not necessarily reflect the view of the organizations or agencies that provided support for this project. International Standard Book Number-13: 978-0-309-12507-9 International Standard Book Number-10: 0-309-12507-3 Additional copies of this report are available from the National Academies Press, 500 Fifth Street, N.W., Lockbox 285, Washington, DC 20055; (800) 624-6242 or (202) 334-3313 (in the Washington metropolitan area); Internet, http://www.nap.edu. For more information about the Institute of Medicine, visit the IOM home page at: www.iom.edu. Copyright 2009 by the National Academy of Sciences. All rights reserved. Printed in the United States of America Cover credit: Photos reprinted with permission from Abe Martinez and Don Pollard, 2008. Suggested Citation: IOM (Institute of Medicine) and National Research Council. 2009. Traumatic Injury Research at NIOSH. Committee to Review the NIOSH Traumatic Injury Research Program. Rpt. No. 6, Reviews of Research Programs of the National Institute for Occupational Safety and Health. Washington, DC: The National Academies Press.

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The National Academy of Sciences is a private, nonprofit, self-perpetuating society of distinguished scholars engaged in scientific and engineering research, dedicated to the furtherance of science and technology and to their use for the general welfare. Upon the authority of the charter granted to it by the Congress in 1863, the Academy has a mandate that requires it to advise the federal government on scientific and technical matters. Dr. Ralph J. Cicerone is president of the National Academy of Sciences. The National Academy of Engineering was established in 1964, under the charter of the National Academy of Sciences, as a parallel organization of outstanding engineers. It is autonomous in its administration and in the selection of its members, sharing with the National Academy of Sciences the responsibility for advising the federal government. The National Academy of Engineering also sponsors engineering programs aimed at meeting national needs, encourages education and research, and recognizes the superior achievements of engineers. Dr. Charles M. Vest is president of the National Academy of Engineering. The Institute of Medicine was established in 1970 by the National Academy of Sciences to secure the services of eminent members of appropriate professions in the examination of policy matters pertaining to the health of the public. The Institute acts under the responsibility given to the National Academy of Sciences by its congressional charter to be an adviser to the federal government and, upon its own initiative, to identify issues of medical care, research, and education. Dr. Harvey V. Fineberg is president of the Institute of Medicine. The National Research Council was organized by the National Academy of Sciences in 1916 to as- sociate the broad community of science and technology with the Academy’s purposes of furthering knowledge and advising the federal government. Functioning in accordance with general policies determined by the Academy, the Council has become the principal operating agency of both the National Academy of Sciences and the National Academy of Engineering in providing services to the government, the public, and the scientific and engineering communities. The Council is administered jointly by both Academies and the Institute of Medicine. Dr. Ralph J. Cicerone and Dr. Charles M. Vest are chair and vice chair, respectively, of the National Research Council. www.national-academies.org

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COMMITTEE TO REVIEW THE NIOSH TRAUMATIC INJURY RESEARCH PROGRAM BRIAN L. STROM (Chair), Professor and Chair, Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania School of Medicine, Philadelphia, PA ROBIN BAKER, Director, Labor Occupational Health Program, School of Public Health, University of California at Berkeley LESLIE I. BODEN, Associate Chair and Professor, Department of Environmental Health, Boston University School of Medicine, Boston, MA BARRY BOZEMAN, Ander Crenshaw Professor of Public Policy and Regents’ Professor of Public Policy, State Data and Research Center, Department of Public Administration and Policy, University of Georgia School of Public Health and International Affairs, Athens STEPHEN W. HARGARTEN, Professor and Chair, Department of Emergency Medicine, Director, Injury Research Center, Wisconsin Injury Research Center, Medical College of Wisconsin, Milwaukee BRIAN M. KLEINER, Professor, Grado Department of Industrial and Systems Engineering, Virginia Polytechnic Institute and State University, Blacksburg TOM B. LEAMON, Director Emeritus, Liberty Mutual Research Center for Safety and Health, Vice President, Liberty Mutual Insurance Company, Hopkinton, MA JAMES M. MELIUS, Director, New York State Laborers’ Health and Safety Fund, Safety Trust Fund, Albany MARK S. REDFERN, Vice Chair and Undergraduate Program Professor, Departments of Bioengineering, Otolaryngology, and Industrial Engineering, University of Pittsburgh School of Engineering, Pittsburgh, PA GORDON R. REEVE, Corporate Epidemiologist (retired), Occupational Health and Safety, Ford Motor Company, Canton, MI (resigned from the committee May 4, 2007) JOSEPH J. SCHWERHA, Professor and Director, Environmental Medicine Residency, Occupational and Disaster Preparedness Programs, Graduate School of Public Health, University of Pittsburgh School of Public Health, Pittsburgh, PA v

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Framework Committee Liaison LETITIA K. DAVIS, Director, Occupational Health Surveillance Program, Massachusetts Department of Public Health, Boston Project Staff KATHLEEN STRATTON, Study Director MORGAN A. FORD, Program Officer KRISTINA VAN DOREN-SHULKIN, Senior Program Assistant vi

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Independent Report Reviewers This report has been reviewed in draft form by individuals chosen for their diverse perspectives and technical expertise, in accordance with procedures ap- proved by the National Research Council’s Report Review Committee. The purpose of this independent review is to provide candid and critical comments that will assist the institution in making its published report as sound as possible and to ensure that the report meets institutional standards for objectivity, evidence, and responsiveness to the study charge. The review comments and draft manuscript remain confidential to protect the integrity of the deliberative process. We wish to thank the following individuals for their review of this report: John C. Bailar III, Department of Health Studies, University of Chicago Marion Gillen, Center for Occupational and Environmental Health, University of California at Berkeley Fernando A. Guerra, San Antonio Metropolitan Health District Guohua Li, Department of Anesthesiology, College of Physicians and Surgeons, Columbia University Barbara Materna, Occupational Health Branch, California Department of Health Services Franklin E. Mirer, School of Health Sciences, Hunter College of the City University of New York Corinne Peek-Asa, Injury Prevention Research Center, University of Iowa Peter Rosen, Harvard University Medical School vii

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Independent RepoRt RevIeweRs viii Gordon S. Smith, Department of Epidemiology and Preventive Medicine, University of Maryland Lorann Stallones, Colorado Injury Control Research Center, Department of Psychology, Colorado State University Although the reviewers listed above have provided many constructive com- ments and suggestions, they were not asked to endorse the conclusions or recom- mendations nor did they see the final draft of the report before its release. The review of this report was overseen by Enriqueta C. Bond, Burroughs Wellcome Fund, and Michael I. Posner, University of Oregon. Appointed by the National Re- search Council and Institute of Medicine, they were responsible for making certain that an independent examination of this report was carried out in accordance with institutional procedures and that all review comments were carefully considered. Responsibility for the final content of this report rests entirely with the authoring committee and the institution.

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Contents ABBREVIATIONS AND ACRONYMS xiii SUMMARY 1 1 INTRODUCTION 19 Impact of Occupational Injuries, 19 Mission and Organization of NIOSH and the TI Research Program, 20 NIOSH TI Research Program Goals, 26 Study Charge and Evaluation Committee, 31 Evaluation Process, 38 References, 41 2 ASSESSMENT OF PROGRAMMATIC RELEVANCE AND IMPACT 43 External Factors with Broad Impact on the TI Research Program, 44 Organizational Design, 47 Surveillance, 49 Goal 1: Reduce Injuries and Fatalities Due to Motor Vehicles, 52 Goal 2: Reduce Injuries and Fatalities Due to Falls from Elevations, 57 Goal 3: Reduce Injuries and Fatalities Due to Workplace Violence, 62 Goal 4: Reduce Injuries and Fatalities Due to Machines, 67 Goal 5: Reduce Acute Back Injury, 73 Goal 6: Reduce Injuries and Fatalities Among Workers in Alaska, 77 ix

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Contents x Goal 7: Reduce Injuries and Fatalities to Emergency Responders, 85 Goal 8: Reduce Injuries and Fatalities to Working Youth, 92 Evaluation of Relevance, 102 Evaluation of Impact, 104 References, 109 3 TARGETING OF NEW RESEARCH AND IDENTIFICATION OF EMERGING RESEARCH NEEDS 111 The TI Research Program’s Process for Targeting New Research and Identifying Emerging Research Needs, 111 Committee Assessment of the TI Research Program’s Process for Targeting New Research and Identifying Emerging Research Needs, 114 Committee Review of the TI Research Program’s Strategic Goals for the Future, 116 References, 126 4 RECOMMENDATIONS FOR PROGRAM IMPROVEMENT 127 Strategic Planning, 127 Coordination and Collaboration, 129 Workforce Development, 132 Transfer, 133 The Changing Nature of Work, 134 Summary, 136 Reference, 136 APPENDIXES A Framework for the Review of Research Programs of the 137 National Institute for Occupational Safety and Health B Methods and Information Gathering 182 C Information Provided by the NIOSH Traumatic Injury 189 Research Program D NIOSH TI Research Program Draft Strategic Goals for the Future 191 E Biographical Sketches of Committee Members 203

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Tables, Figures, and Boxes TABLES 1-1 Matrix Management Components of the NIOSH Program Portfolio, 23 1-2 TI Research Program Budget by Research Goal, 32 FIGURES 1-1 Organizational components of NIOSH, 22 1-2 Combined intramural and extramural funding for individual goals and for all goals combined, 27 1-3 NIOSH Research Program evaluation flowchart, 40 BOXES S-1 Goals and Subgoals of the NIOSH Traumatic Injury Research Program, 4 S-2 Scoring Criteria for Relevance, 5 S-3 Scoring Criteria for Impact, 5 S-4 Summary of Recommendations, 11 1-1 Goals and Subgoals of the NIOSH Traumatic Injury Research Program, 34 1-2 Selected Data on Burden of Traumatic Injury, 36 xi

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tables, FIguRes, boxes xii and 2-1 Scoring Criteria for Relevance, 102 2-2 Scoring Criteria for Impact, 104 3-1 TI Research Program Strategic Goals for the Future, 117 B-1 Stakeholder Comments on NIOSH and the TI Research Program, 186

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Abbreviations and Acronyms AFS Alaska Field Station AKDOL Alaska Department of Labor ANSI American National Standards Institute AOISS Alaska Occupational Injury Surveillance System ASABE American Society of Agricultural and Biological Engineers ATR Alaska Trauma Registry AutoROPS auto-deploying rollover protective structure BLS U.S. Bureau of Labor Statistics CAIS Childhood Agricultural Injury Survey CARE Children’s Act for Responsible Employment CDC Centers for Disease Control and Prevention CFIT controlled flight into terrain CFIVSA Commercial Fishing Industry Vessel Safety Act CFOI Census of Fatal Occupational Injuries CFR Code of Federal Regulations CROPS cost-effective rollover protective structure DOL U.S. Department of Labor DSR Division of Safety Research (NIOSH) xiii

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a b b R e v I at I o n s aCRonyms xiv and EMS emergency medical services ERC Education and Research Center ESA Employment Standards Administration FAA Federal Aviation Administration FACE Fatality Assessment and Control Evaluation (Program) FFFIPP Fire Fighter Fatality Investigation and Prevention Program FISH Fishing Industry Safety and Health FLSA Fair Labor Standards Act FTE full-time equivalent FY fiscal year HEROES Homeland Emergency Response Operational Equipment Systems HHS U.S. Department of Health and Human Services HO Hazardous Occupations Order IAFF International Association of Fire Fighters IAWG Interagency Working Group IFISH International Fishing Safety and Health IOM Institute of Medicine ITCP internal traffic control plan JAMA Journal of the American Medical Association M-CAIS Minority Farm Operator Childhood Agricultural Injury Survey NASS National Agricultural Statistics Service NATE National Association of Tower Erectors NAWS National Agricultural Workers Survey NCCRAHS National Children’s Center for Rural and Agricultural Health and Safety NCIPC National Center for Injury Prevention and Control NEISS National Electronic Injury Surveillance System NFPA National Fire Protection Association NHTSA National Highway Traffic Safety Administration NIH National Institutes of Health NIMS National Incident Management System NIOSH National Institute for Occupational Safety and Health NOIRS National Occupational Injury Research Symposia NORA National Occupational Research Agenda

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a b b R e v I at I o n s aCRonyms xv and NRC National Research Council NTOF National Traumatic Occupational Fatality NTSB National Transportation Safety Board OISPA Occupational Injury Surveillance of Production and Agriculture OSH Act Occupational Safety and Health Act OSHA Occupational Safety and Health Administration PASS Personal Alert Safety System PWS proximity warning system r2p research to practice RAND Research and Development Corporation RFA request for application ROPS rollover protective structure SAE Society of Automotive Engineers SME small- to medium-sized enterprise STFs slips, trips, and falls TI traumatic injury TISF Traumatic Injury Surveillance of Farmers TWU transportation, warehousing, and utilities USCG U.S. Coast Guard USDA U.S. Department of Agriculture

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