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Playgrounds & Injuries

by Arthur Mittelstaedt Jr., EdD, executive director, Recreation Safety Institute

The purpose of the ASTM F 1487 Standard for Play Equipment, the F 1292 Standard for Surfaces and most other standards is to prevent life threatening and debilitating injury, which is the reason why landscape architects, engineers, installers and manufacturers should embrace both the mandatory standards and various voluntary standards groups.

There is, however, a problem in the formulation of standards. The term "injury prevention" is ever evolving. The intent of this column is to reflect upon what is injury prevention exactly so that it can be put aside and allow professionals to advance safe and aesthetic environments.

"The term 'injury prevention' is ever evolving ... no definitions in ASTM can be found on 'life threatening' and or 'debilitating' .... Until we define these terms the laxity in standards formulation will continue." -Arthur Mittelstaedt Jr.

An ASTM staff member reported that no definitions in ASTM can be found on "life threatening" and or "debilitating." As an afterthought, maybe the CPSC might know of where to find such a definition. A call and letters to CPSC revealed no help. Until we define these terms the laxity in standards formulation will continue. Unless we can determine which of the injuries result from play, we have a hard time agreeing to a resolution of a standard.

The Centers for Disease Control and Prevention (CDC) has a new initiative on concussion in high school sports. This effort is being conducted by contractor staff at the Academy for Educational Development (AED). They have created a comprehensive educational tool kit on sports-related concussion targeted to high school coaches. This tool kit was developed after researching concussion literature, gathering input from experts and conducting focus groups with high school coaches. However, it has no scope reflective of injuries on playgrounds.

The draft tool kit materials were recently tested by coaches in eight additional focus groups across the country and were well received. The AED expects to conduct a pilot project in the fall with a random sample of high school coaches in California, Maine, Michigan, North Carolina and Texas, then evaluate the tool kit's effectiveness before launching a national effort in 2005.

There are many ways one can participate in this important initiative, such as assisting in promoting and disseminating the kit when the national effort takes place. With permission, they will acknowledge participation by listing the organization's name on the tool kit.

The tool kit contains: an introductory letter from the director of CDC's National Center for Injury Prevention and Control; a guide, a wallet card and clipboard sticker for coaches; fact sheets for athletes and parents (in English and Spanish); two posters; an educational video for coaches, athletes, parents and other appropriate school staff; and a CD-ROM with additional resources and references.

In addition to the Consumer Product Safety Commission's efforts to collect data on injuries particularly playgrounds, the National Playground Safety Institute, the I Play Safe Program of the Recreation Safety Institute and the National Program for Playground Safety could use CDC and other federal agencies for initiatives in playground safety.

The reorganization plans for the CDC could affect the National Institute for Occupational Safety and Health (NIOSH). Most recently, five former federal agency heads contended in a letter that "moving NIOSH lower in the departmental structure and obscuring the district identity and special role of NIOSH would markedly diminish its effectiveness."

According to a Safety Health article, CDC's new organizational plan calls for integrating the operating units into four centers: NIOSH, the National Center for Environmental Health, the Agency for Toxic Substances and Disease Registry, and the National Center for Injury Prevention and Control. Though NIOSH focuses on occupational safety and health it is an example of what is needed for the consumer. The agency is just one of a number of institutes and offices of the Centers for Disease Control and Prevention, which itself is part of the massive Department of Health and Human Services. Both NIOSH and OSHA were born out of the Occupational Safety and Health Act of 1970, but, in comparison, NIOSH leads a more charmed existence.

"NEISS, or a cooperating standards organization like ASTM, has not convened a nationwide conference to adopt a uniform accident/incident data reporting, collecting and analyzing system and to abandon the fragmented guesswork everyone seems to be engaged in. All places where injuries and fatalities occur must participate." -Arthur Mittelstaedt Jr.

Earlier in 2004, NIOSH gathered with other researchers worldwide to share scientific findings about the potential effects of long working hours and extended working schedules on occupational health, safety and well-being.
Many agencies share concerns of injuries, fatalities and sicknesses at work and play.

The National Safety Council indicated that 13,900 people in the 15-24 age group lost their lives due to injuries. The leading cause is motor vehicle crashes (77 percent); homicide is second, followed by suicide; drowning (6%) and firearms (4%). The base source of data is most often the National Electronic Injury Surveillance System (NEISS) maintained by the Consumer Products Safety Commission. There are problems with such data.

1) NEISS is not the only injury/fatality reporting system--there are at least 11, including the National Sporting Goods Assoc., CDCP, the NCAA and AAAM. In short, NEISS data is not universally adopted by government agencies, institutions; associations and organizations.

2) NEISS has not been updated to reflect all of the known activities, facilities, equipment, encounters and other known places and spaces of occurrences of injury, fatality and sickness.

3) It does not reflect all of the anatomy that could be traumatized. NEISS should also go beyond the recreational experience.

4) NEISS, or a cooperating standards organization like ASTM, has not convened a nationwide conference to adopt a uniform accident/incident data reporting, collecting and analyzing system and to abandon the fragmented guesswork everyone seems to be engaged in. All places where injuries and fatalities occur must participate.

5) The National Injury, Fatality, Illness Data Center has not incorporated the efforts of CDCP and reported the yearly findings to all agencies and groups that are concerned with prevention and intervention.

6). Agencies tend not to apply remedies to the cause but focus on the effects.

7) Organizations are not contributing their prevention and intervention programs to their central agency so that the methodologies can be used as models and facts can be evaluated and data files and systems up-dated or corrected.

Some agencies are developing their own missions for prevention and intervention. The National Safety Council has responded and its recreation section of the Community Safety Division has started to address issues related to recreational injuries, fatalities and illnesses.

"Focus on the Future" is a proposed initiative of the National Safety Council (NSC) board of directors. The intent was to pick a topic of national concern and jointly work together through the various divisions toward a solution.

After reviewing the injury and fatality data, though skewed, it became apparent that the NSC target should be the 15-24 year-old group. This, however, is not our playground safety group--the two to 12 year old.

The 15-24 group is the future workers of America. Their injury and mortality rates have not changed significantly in the past 20 years. The NSC's executive board feels a need to direct the attention of its volunteers to address this concern through a concerted, division-wide joint effort. Other organizations have also targeted such groups, however, the problems and their causes are not targeted unless there is a national and universal data collection and interpretation system providing the details for solutions. NEISS must be updated and a standard established for data records.

There must be a uniform data set that allows governments and agencies to collect consistent information from which adequate cause and effect information can be derived and statistics compiled. The differing types and formats of forms and the information requested are just too divergent and inconsistent from agency to agency.

The major areas to be included in such a format or data set should include:

o Institution/participant; onset/return time; season

o diagnosis; primary mechanism; occasion; when stricken;

o position; activity; situation; surface;

o surface condition; protection; equipment involved;

o nature of injury/illness; action taken; management of injury;

o insurance information.

The formation of a minimal data set must be use at the scene of an incident. It is to encompass the information set forth by NEISS and not to present a burden to that system in any revamping. However, it is to go beyond the NEISS data so that individuals on the scene of an event can compile data on the accident. This will allow researchers a better opportunity to identify the cause and effect.

Until such data is obtained, what is life threatening and debilitating is still debated.

The National Safety Council and the CPSC will not agree on the number playground injuries in a given year. What does this discrepancy imply? Until we have more definitive data to establish the cause and effect it has to be assumed that every effort must be made to reduce any risk or possibility of an injury occurring. This is a professional utilization of landscape architects, engineers, specifiers and others in the planning and designing of playgrounds as well as in construction and installation as well as maintenance and operation.

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December 6, 2019, 1:50 pm PDT

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