Wringer Arm
Tap Water Scalds
Residential Smoke Detectors
Child Window Falls
Flammability of Children's Pajamas
Hair Dryer Electrocutions
Child Resistant Packaging
The term "wringer arm" was introduced in a 1938 New England Journal of Medicine article that described more than two-dozen cases of children injured when their arm was drawn between the rollers of a wringer-type clothes washer. Over the next 35 years, more than 25 medical articles were written concerning the incidence and treatment of these injuries. One study, for example, analyzed more than 450 patients treated in a three-year period (1965-68) at the hand surgical service of Cook County hospital; 180 of the patients were between the ages of 3 and 5. Over one sixth of the patients required operative procedures.
In 1968, Underwriters' Laboratories certification began requiring that all new wringer washers have either a "dead man switch" or an "instinctive release" to stop the roller when meeting a 20 pound force. More important, by the early 1960s, sales of spin-dry washers were surpassing those of wringer washing machines. By 1970, wringer machines accounted for only 5% of sales of new machines; production of wringer washers ceased in the United States in 1983. Automatic spin dry machines are much safer; in the decade of the 1990s, although wringer machines represented only a small percentage of all operating washing machines, they accounted for almost half of all incidents in which a washing machine was the primary cause of an injury. Virtually all of the wringer injuries occurred to the arm; many were caused when the finger or hand was caught in clothing and the arm pulled through the ringers.
Automatic spin-dry washing machines include locking lid mechanisms and tubs that automatically stop agitating when the lid is open. While these mechanisms could often be improved, serious washing machine injuries appear to have fallen dramatically in the past decades; wringer arm is disappearing from American life. Most primary automatic spin-dry washing machine injuries now occur when the victim is hit by a falling lid, or deliberately places a body part into the running water. The large majority of secondary washing machine injuries involve children falling from or jumping from the washer, or people knocking into the machine. Safety experts now urge parents not to put children in car or baby seats on top of operating machines.
Moral: Technology can create and alleviate injury problems.
Sources:
MacCollum DW. Wringer arm: a report of 26 cases. New England Journal of Medicine. 1938; 218:549-554.
McCulloch JH, Boswick JA, Jonas R. Household wringer injuries: a three-year review. Journal of Trauma. 1973; 13:1-8.
Warner BL, Kenney BD, Rice M. Washing machine related injuries: a continuing threat. Injury Prevention. 2003; 9:357-360.
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Ordinary household tap water can be a major source of injury. The typical hot water temperature found in Canadian homes in the late 1990s was 140 degree Fahrenheit. Exposed to water at this temperature, a young child's skin will be severely burned in less than five seconds. For children, tap water scalds tend to be the most severe form of scalding injuries. For example, in the late 1990s, at the Hospital for Sick Children in Toronto, children scalded by hot tap water were hospitalized for approximately 23 days, while the average length of stay for children scalded from other sources was 10 days.
The United States has made better progress than Canada at reducing the tap water injury problem. In the 1970s, water heater industry practice was to factory preset water heaters at 140-150 degrees. In 1977, Seattle homes had a mean hot water temperature of 142 degrees. In 1983 a Washington state law required that all new water heaters be preset at 120 degrees. In 1988, the mean hot water temperature in Seattle homes had fallen to 122 degrees. Burn admission rates for King County (Seattle) children (under age 15) for tap water scalds fell dramatically, from 5.5 per year in 1969-1976, to 2.3 per year in 1984-1988. Most of the burns in the latter period were due to child abuse rather than accidents.
All new electric heaters in the United States are preset at 120 degrees, and are shipped with appropriate warning labels. Still, in 2000, the heaters were set at a higher temperature when exported to Canada. In the late 1990s, it was estimated that more than 500 Canadian children were hospitalized each year due to hot tap water burns.
Moral: Passive safety measures can effectively reduce severe injuries to children.
Sources:
Erdmann TC, Feldman KW, Rivara FP, Heimbach DM, Wall HA. Tap water burn prevention: the effect of legislation. Pediatrics. 1991; 88:572-577.
Huyer DW, Corkum SH. Reducing the incidence of tap-water scalds: strategies for physicians. Canadian Medical Association Journal 1997; 156:841-844.
Corkum S. Hot tap-water scalds. The Hospital for Sick Children Journal. 2000; 2: http://www.sickkids.on.ca/journal/vol2issue4/hotwater.asp
The most dangerous residential fires occur at night, when most people are asleep. Smoke detectors help protect the family by providing early warning of fire. It is estimated that a working smoke detectors reduces the risk of residential fire death by almost 50%.
In 1969 Randolph Smith and Kenneth House patented the first battery-powered smoke detector. Smoke alarms rapidly become a familiar presence in American homes. Home with smoke detectors increased from 5% in 1970 to 75% in 1985 to nearly 94% in 2000. The key factor for this increase was the low prices of these battery-powered alarms. In the early 1970s, the cost of protecting a three-bedroom home with professionally installed alarms was approximately $1,000. By the mid-1990s, the cost of owner-installed alarms in the same house had fallen to $10 per alarm, or less than $50 for the entire home.
Other factors, such as marketing campaigns, building code modifications, and legislation requiring detectors in homes were also significant. By the mid-1980s, for example, smoke alarm laws requiring that alarms be placed in all new and existing residences, existed in 38 states and thousands of municipalities. The increase in smoke detectors is generally credited with being an important reason why the residential fire fatality rate fell from approximately 2.4/100,000 in 1970 to 1.0/100,000 in 2000. A current concern is that many of the battery-powered alarms in homes are no longer in operable condition.
Moral: Technological innovations, leading to improved performance and lowered price, are often crucial in reducing injury.
Sources:
MMWR Perspectives in Disease Prevention and Health Promotion. March 11, 1988; 37(9): 138-149.
U.S. Fire Administration. Home Fire Safety. Smoke Alarms: What You Need to Know.
http://www.usfa.fema.gov/public/hfs/alarms.shtm (accessed 9/04)
Aherns, Marty. Batteries not included. NFPA Journal. National Fire Protection Association. May/June 1998; 98-109.
McLoughlin E, Marchone M, Hanger L, German PS, Baker SP. Smoke detector legislation: its effect on owner-occupied houses. American Journal of Public Health. 1985; 75:858-862.
Window falls of children is a serious urban public health problem. For example, in a five-year period in the late 1960s in New York City, over 120 children aged 0-14 died after falling from a window. In 1972, the city Health Department initiated an education and prevention program called "Children Can't Fly" in a high-risk area of the Bronx. The education program included radio, TV, news stories, etc. In addition, over 16,000 free (costing the city $3 each), easy-to-install window guards were distributed to families with pre-school age children living in tenements. Reported falls in the Bronx fell 50% in two years. There were no falls reported from windows where guards had been installed.
The city Health Department mandated that by 1979, all owners of multiple dwelling in the city had to provide window guards in apartments where children under 11 years old resided. Harlem Hospital records showed a 96% decline in accidental falls from windows by children in 1979-1981, compared to 1970-1978--from average of 16 every three years, to one every three years.
Moral: Society can successfully help parents protect their children.
Sources:
Spiegel CN, Lindaman FC. Children Can't Fly": a program to prevent childhood morbidity and mortality from window falls. American Journal of Public Health. 1977; 67:1143-1146.
Barlow B, Niemirska M, Gandhi RP, Leblanc W. Ten years of experience with falls from a height in children. Journal of Pediatric Surgery. 1983; 18:509-511.
Flammability of Children's Pajamas
Flame burns are among the most serious and painful of injuries. In the early 1970s, the Consumer Product Safety Commission adopted two federal standards regarding the flammability of children's sleepwear. While national data are not available to evaluate the effect of the law, data from the Shriners pediatric Burn Institute in Boston, MA showed that pajama burns fell from 12 children per year in the five years before the standards (1969-1973) to 2 children per year for two years after the standard (1975-1976). There was no trend evident in referrals for burns because of ignition of clothing other than sleepwear. Similarly, data from the Shriners pediatric burn unit in Galveston, TX showed a decrease in sleepwear-related injuries from 11 per year (1966-1973) to fewer than 4 per year (1974-1977). There was no significant change in admissions due to ignition of other clothing; sleepwear-related injuries as a percentage of total burn cases dropped significantly. In most of the pajama burn cases after the law the victim had been wearing hand-me-down articles manufactured prior to the promulgation of the standards.
Moral: Changes in the product are often the most cost-effective way of reducing injury.
Sources:
McLoughlin E, Clarke N, Stahl K, Crawford JD. One pediatric burn unit's experience with sleepwear-related injuries. Pediatrics. 1977; 60:405-409.
Knudson MS, Bolieu SL, Larson DL. Children's sleepwear flammability standards: have they worked? Burns. 1980; 6:255-260.
Hair Dryer Electrocutions
In the United States in the early 1980s, hand-held hair dryers caused an average of 18 electrocution deaths per year; most of the victims were in bathtubs and children were at greatest risk. Government (the Consumer Product Safety Commission), industry and voluntary standards organizations (Underwriters Laboratories) (UL) worked together to prevent these tragedies. In 1980 the UL standard began requiring a pictorial warning against the use of hair dryers in bathtubs. In 1987 the standard required that new hair dryers provide protection against electrocutions when the product was immersed in water and the switch was off. In 1991 UL certified hand-held hair dryers required protection in the "on" as well as the "off" position. Both CPSC and manufacturer research and technology were key in enabling such improvements. The annual number of hair dryer-associated electrocutions fell to 4 per year in the early 1990s; by 2000 there was only one such electrocution.
Moral: Government, industry and voluntary standards organizations can work together to reduce injury.
Sources: Budnick LD. Bathtub-related electrocutions in the United States, 1979-1982. JAMA. 1984; 252:918-920.
U.S. Consumer Product Safety Commission. CPSC saves lives through voluntary efforts and oversight: making hair dryers safer. http://www.cpsc.gov/cpscpub/pubs/success/dryers.html accessed February 2004
U.S. Consumer Product Safety Commission. Alan Schoem letter to importers and manufacturers of hair dryers. November 25, 2002. http://www.cpsc.gov/BUSINFO/Hairdryer.pdf accessed February 2004
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In the 1960s more than 11,000 young children were poisoned each year from accidental overdoses of baby aspirin. The Poison Prevention Packaging Act of 1970 required that aspirin be packaged in child-resistant closures. In anticipation of the law, by 1970 the two largest manufacturers of baby aspirin had introduced safety closures. Comparing the three years prior to these changes (1967-1969) to the three years after (1971-1973) baby aspirin poisoning of children under five years old fell over 70%.
Since then, improved medical care, warning labels, the reduction in the number of tablets per bottle, and the decrease in baby aspirin use due to its connection with Reyes Syndrome, has dramatically reduced the number of young children accidentally dying from overdoses of aspirin. Unit dose packaging is another effective method of reducing accidental overdoses.
Moral: It is possible to protect children without changing their, or their parents' behavior.
Sources:
Clarke A, Walton WW. Effect of safety packaging on aspirin ingestion by children. Pediatrics. 1979; 63:687-693.
Rodgers GB. The effectiveness of child-resistant packaging for aspirin. Archives of Pediatrics and Adolescent Medicine. 2002; 156:929-933.