Surveillance data played a critical role in the design and evaluation of a successful intervention to reduce burns and fatalities in residential fires in Oklahoma City. The city's surveillance system was used in designing the intervention, which consisted of providing homes with smoke detectors in neighborhoods with elevated rates of fires and then evaluating the intervention. Continued surveillance confirmed that the smoke detector program reduced the fire injury rate by 74 percent in areas targeted by the intervention, as compared with a small increase in the rest of the city. Additional information collected about each house and its occupants did not suggest any unexpected or undesirable outcomes as the result of the intervention (Mallonee et al., 1996).
The mechanisms of airbag-associated deaths were elucidated through the Special Crash Investigation (SCI) program at the National Highway Traffic Safety Administration (NHTSA) (Winston and Reed, 1996). Through a voluntary national reporting network, the SCI program identified unusual crash circumstances in which minor- to moderate-severity collisions resulted in airbag-associated deaths. In-depth crash investigations were conducted in a timely manner across the United States, and the information was used by the automotive safety community to improve the performance of state-of-the-art safety systems. At the same time that data were collected regarding the role of airbags in fatal crashes, surveillance systems in trauma centers for the study of nonfatal injuries identified another unexpected outcome of the airbag intervention (Loo et al., 1996). In severe frontal crashes the occupants would survive but would sustain severe injuries to the lower feet, ankles, and lower legs. Although these types of injuries had always been present, they were of little consequence because the occupants usually died without the added protection of airbags.1
Surveillance data are needed at the national, state, and local (community) levels. National data are critical for drawing attention to the magnitude of an injury problem, for monitoring the impact of federal legislation, and for examining variations in injury rates by region of the country and by rural versus urban or suburban environments. They are also useful in aggregating sufficient numbers of rare cases of a particular type of injury to identify patterns of injury and mechanisms. State and local data better reflect injury problems in specific communities and are therefore more useful in setting program priorities and evaluating the impact of local policies and expenditures. Therefore, local data are usually needed to advocate effectively for the establishment of an injury-related policy or program at the local level.
As discussed in this chapter, significant strides over the past decade have greatly enhanced our understanding of the magnitude and impact of injury as a