Injury-free Oklahoma 2010-2015 : strategic plan for injury and violence prevention.

              INJURYFREE Oklahoma
2010-2015
Strategic Plan for Injury and Violence Prevention
Injury Prevention Service
Oklahoma State Department of Health
Inside cover
i
INJURYFREE Oklahoma
2010-2015
Strategic Plan for Injury and Violence Prevention
Pam Archer, M.P.H.
Chief
Emily Samuel, M.P.H.
Special Projects Coordinator
October 2009
Injury Prevention Service
Oklahoma State Department of Health
1000 N.E. 10th Street
Oklahoma City, Oklahoma 73117-1299
Phone: (405) 271-3430 or 1-800-522-0204 (in Oklahoma)
Fax: (405) 271-2799
http://ips.health.ok.gov
ii
This publication is issued by the Oklahoma State Department of Health, as authorized by Terry Cline,
Ph.D., Commissioner of Health. One hundred (100) copies have been prepared by DocuTech at an
approximate cost of $215.00. Copies have been deposited with the Publications Clearinghouse of the
Oklahoma Department of Libraries.
Injury Free Oklahoma 2010-2015 is supported by cooperative agreement #U17/CCU624802 from the
Centers for Disease Control and Prevention. The content is solely the responsibility of the authors and does
not necessarily represent the official views of the Centers for Disease Control and Prevention.
iii
Table of Contents
Acknowledgements...................................................................................................................................... v
Foreword .................................................................................................................................................... vi
Residential Fires
Background ........................................................................................................................................... 1
Progress ................................................................................................................................................ 2
Goals/Objectives ................................................................................................................................... 3
Action Plan ............................................................................................................................................ 4
References ............................................................................................................................................ 5
Traffic-Related Injuries
Background ........................................................................................................................................... 6
Progress ................................................................................................................................................ 7
Goals/Objectives ................................................................................................................................. 10
Action Plan .......................................................................................................................................... 11
References .......................................................................................................................................... 12
Occupational Injuries
Background ......................................................................................................................................... 13
Progress .............................................................................................................................................. 14
Goals/Objectives ................................................................................................................................. 15
Action Plan .......................................................................................................................................... 15
References .......................................................................................................................................... 17
Unintentional Poisonings
Background ......................................................................................................................................... 18
Progress .............................................................................................................................................. 19
Goals/Objectives ................................................................................................................................. 21
Action Plan .......................................................................................................................................... 21
References .......................................................................................................................................... 22
Violence
Background ......................................................................................................................................... 23
Progress .............................................................................................................................................. 26
Goals/Objectives ................................................................................................................................. 29
Action Plan .......................................................................................................................................... 30
References .......................................................................................................................................... 32
Unintentional Falls
Background ......................................................................................................................................... 33
Progress .............................................................................................................................................. 33
Goals/Objectives ................................................................................................................................. 34
Action Plan .......................................................................................................................................... 35
References .......................................................................................................................................... 36
iv
Public Health Preparedness and Response
Background ......................................................................................................................................... 37
Progress .............................................................................................................................................. 41
Goals/Objectives ................................................................................................................................. 42
Action Plan .......................................................................................................................................... 42
References .......................................................................................................................................... 44
Policy and Legislation
Background ......................................................................................................................................... 45
Goals/Objectives ................................................................................................................................. 49
Action Plan .......................................................................................................................................... 50
References .......................................................................................................................................... 51
v
Acknowledgements
The Injury Prevention Service would like to thank all those whose interest and expertise made this publication
possible.
Mark Brandenburg, M.D.
Oklahoma Injury Prevention Advisory
Committee Chair
Roxie Albrecht, M.D.
University of Oklahoma
Medical Center
Cherokee Ballard
Office of the Chief Medical Examiner
Cyndi Basch, R.N.
University of Oklahoma
Medical Center
David A. Bates, B.S.
U.S. Department of Labor
J. Kevin Behrens
Oklahoma Highway Safety Office
Anne Bliss, M.P.H.
Oklahoma State Department
of Health
Christy Cornforth
Safe Kids Oklahoma
James Cox
Oklahoma Association of Chiefs
of Police
Jim T. Criswell, Ph.D.
Department of Entomology and Plant
Pathology
Harold Cully
Indian Health Service
Michael Echelle, M.P.H.
Pittsburg County Health Department
Martha Ferretti, M.P.H., P.T.
University of Oklahoma
Health Sciences Center
Laura Gamino, M.P.H., R.N.
University of Oklahoma
Medical Center
Tabitha Garwe, M.P.H.
Oklahoma State Department
of Health
Patrice Greenwalt, M.S., R.N.
Oklahoma State Department
of Health
Alan S. Grubb, Ph.D.
Cleveland County Board of Health
Jeff Hamilton, M.Div.
Interfaith Alliance Foundation
of Oklahoma
Andrea Hamor Edmondson
Oklahoma Coalition Against Domestic
Violence & Sexual Assault
Jessica Hawkins
Oklahoma Dept of Mental Health &
Substance Abuse Services
Tina Johnson, M.P.H., R.N.
Pottawatomie County Health
Department
Diana Jones
Oklahoma Department of Labor
Gayle Jones, B.A.
Oklahoma State Department
of Education
Fahad Khan, M.P.H.
Oklahoma State Department
of Health
Renae Kirkhart
University of Oklahoma
Medical Center
Dave Koeneke
Oklahoma Safety Council
Chief Jerry Lojka
Midwest City Fire Department
Lee McGoodwin, Pharm.D.
Oklahoma Poison Control Center
Margaret Phillips, Ph.D., CIH
Department of Occupational and
Environmental Health
Stacey Puckett
Oklahoma Association of Chiefs
of Police
Teresa Ryan, B.S.N., M.L.S.
Oklahoma State Department
of Health
Marcia Smith
Oklahoma Coalition Against Domestic
Violence & Sexual Assault
Mendy Spohn, M.P.H.
Carter County Health Department
Scott Sproat, M.S., FACHE
Oklahoma State Department
of Health
David C. Teague, M.D.
University of Oklahoma
Health Sciences Center
Captain Chris West
Dept of Public Safety
John Wilguess
Safe Kids Oklahoma
Inas Yacoub, M.D., M.P.H.
Office of the Chief Medical Examiner
vi
Foreword
The Oklahoma State Department of Health, Injury Prevention Service (IPS) was created in
1987 with a grant from the Centers for Disease Control and Prevention. Since that time,
the IPS has used surveillance data to identify risk factors and to develop, implement, and
evaluate prevention programs in Oklahoma communities.
Oklahoma’s injury fatality rates due to motor vehicle crashes, drowning, fire/burns, suicide
and homicide are higher than the national average. Unintentional injuries are the leading
cause of death among Oklahoma children and adults 1 to 44 years of age. Approximately
2,800 Oklahomans die every year from an injury, including nearly 2,000 unintentional
injury-related deaths. Injuries account for more premature deaths before 65 years of age
than cancer, heart disease, stroke, and diabetes combined. For every injury death in
Oklahoma there were nearly nine hospitalizations. For every nine dollars of inpatient
healthcare charges, one dollar was for injuries.
The IPS has partnered with several agencies and community organizations statewide to
strengthen efforts to reduce injuries and injury deaths among Oklahomans. Educational
materials, such as data reports and fact sheets, multiple distribution programs, and various
studies and publications have helped Oklahoma move forward in reaching this goal. For
example, statewide traffic safety programs have increased seat belt use from 68% in 2001
to 84% in 2009, and child safety seat use has increased from 66% in 2001 to 86% in 2009.
Since 2001, over 27,000 child safety seats have been distributed through county health
departments across Oklahoma. In an effort to reduce fire-related injury and death,
approximately 30,000 smoke alarms have been distributed in high-risk rural communities
through the IPS smoke alarm program since 2001.
Many of the injuries affecting our state are preventable. It is the collaboration among
community coalitions, health departments, health care professionals, first responders,
community leaders, and community members that continues to strengthen and expand
injury prevention and safety promotion efforts in the state of Oklahoma.
This document serves as compendium to Injury-Free Oklahoma published in 2004. Injury-
Free Oklahoma 2010-2015 contains new chapters on public health preparedness and
policy, updated goals, objectives, and strategies to serve as an additional resource to
continue prevention efforts toward an injury-free Oklahoma.
1
Residential Fires
BACKGROUND
National
According to the Centers for Disease Control and
Prevention (CDC), fatalities from fires and burns
are the fifth most common cause of unintentional
injury deaths in the United States. Fire and burn
deaths are also the third leading cause of fatal
home injury.1
The National Fire Protection Association (NFPA)
estimates that in the United States, a fire
department responds to a fire every 20 seconds.
In 2007, fire departments responded to
approximately 1.6 million fires in the United
States. Of the 530,500 structural fires, 78% were
in a place of residence.2 Eighty-four percent of
deaths and 77% of fire-related injuries occurred
in the home. Residential fires caused nearly
3,000 civilian deaths and 13,600 injuries resulting
in $7.4 billion in direct damage.3 On average,
eight people die due to home fire-related
incidents every day. 4
Kitchens were the leading area of origin for
residential fires. Kitchen fires accounted for
nearly half of home fires and 36% of home fire
injuries among civilians. From 2003 to 2006, the
leading cause of residential fires and fire injuries
originated from cooking equipment, and smoking
was the leading cause of home fire deaths.4
Smoking accounts for approximately one-quarter
of the 3,000 civilian deaths resulting from house
fires each year.5
Most home fires and home fire deaths occur in
the months of January, February, and December.
Home fires primarily occur between 5:00 p.m.
and 8:00 p.m.; however, home fires occurring
between 11:00 p.m. and 7:00 a.m. caused 52%
of all home fire deaths.4
Risk of fire injury and death is affected by age,
race, location, and community size. Children under
the age of 5 and older adults 65 years of age and
older are at higher risk for death due to fires than
other age groups.6 However, young adults are at a
greater risk of home fire injury.1 African American
and Native American populations, low-income
individuals, persons living in rural areas, and those
living in manufactured homes or substandard
housing are also more likely to be involved in a fire-related
injury or death.2
Oklahoma
From 2000 to 2006, Oklahoma had a higher fire
fatality rate (1.9 per 100,000 population) than the
national fire fatality rate (1.2 per 100,000).7
Unintentional fire-related injuries are the third
leading cause of injury death in Oklahoma
among children one to nine years of age and the
ninth leading cause among all ages combined. 8
According to burn injury surveillance data from
the Injury Prevention Service, the number of fire-related
deaths peaked in 2005 with 88 fatalities;
there were 69 and 62 deaths in 2004 and 2006,
respectively. Two-thirds of all fire-related fatalities
were among males. Males had the highest
mortality rates among all age groups, except
among one to four year olds, where females had
a 50% higher rate. Age-adjusted rates for males
were over two times higher than those of
females. Between 35 and 84 years of age, the
risk of fire-related death increased with age.
There were no deaths among infants less than
one year of age.8
For every unintentional fire-related death, there
were just over two hospitalizations in a burn
center for a fire-related injury. Males also
dominated the number and rate of unintentional
fire-related hospitalizations. Nearly three-quarters
2
of hospitalizations were among males (375 out of
521). Rates were particularly discrepant among
males and females aged 15 to 34 years, with
rates for males being five to six times higher.
Unintentional fire-related hospitalizations in burn
centers have increased since 2004. The overall
age-adjusted rate in 2006 was 59% higher than
the 2004 rate; males alone jumped 68%. The
highest age-specific hospitalization rates were
among individuals 65 years of age and older.8
PROGRESS
Funding
Funding for the smoke alarm program has been
provided to the Injury Prevention Service (IPS)
from the CDC since its implementation in 1989.
Current funding for the program will end in
September 2011. The CDC is not expected to
provide funding to states for this program beyond
2011; however, the IPS will continue to work with
fire marshals, fire departments, Oklahoma ABLE
Tech, and Oklahoma State University to promote
fire prevention and safety throughout the state.
Publications
Peer-Reviewed Publications
 Cost effectiveness analysis of a smoke alarm
giveaway program in Oklahoma City,
Oklahoma. Injury Prevention 2001;7(4):276-
281.
 Evaluating injury prevention programs: the
Oklahoma City smoke alarm project. The
Future of Children 2000;10(1):164-174.
 Fatal fires associated with smoking during
long-term oxygen therapy – Maine,
Massachusetts, New Hampshire, and
Oklahoma, 2000-2007. MMWR
2008;57(31):852-854.
 Smoke alarms and prevention of house-fire—
related deaths and injuries. Western
Journal of Medicine 2000;173:92-93.
Other Publications
 Oklahoma Injury Facts. September 2003.
Summary Data Reports
 Burns and Smoke Inhalation in Oklahoma,
1988-2001
 Burns and Smoke Inhalation in Oklahoma,
1988-2002
 Burns and Smoke Inhalation in Oklahoma,
1988-2004
 Injuries in Oklahoma, 2004-2006
 Injuries in Oklahoma, 2005
 Injuries in Oklahoma, 2006
Injury Update Reports
 Brush and Trash Fire-Related Injuries in
Oklahoma, 1988-2000
 Burn Injuries Due to Cigarette-Related
Residential Fires, Oklahoma, 1988-2002
 Burn Injuries Due to Smoking While Using
Oxygen Therapy, Oklahoma, 2001-2005
 Burn Injuries Resulting from Working on a
Motorized Vehicle, Oklahoma, 1988-2002
 Fire Prevention Week, 2003
 Fireworks-Related Burn Injuries Admitted to
a Burn Center, Oklahoma, 1988-2000
 Fireworks-Related Burn Injuries Admitted to
a Burn Center, Oklahoma, 1988-2001
 Intentional Fire-Related Injuries in Oklahoma,
1988-2001
 Lawnmower-Related Burn Injuries in
Oklahoma, 1988-2000
 Methamphetamine Laboratory-Related Fire
and Burn Injuries in Oklahoma, 1988-2002
 Unintentional Campfire-Related Burn Injuries
in Oklahoma, 1996-2005
 Work-related Burns Among Restaurant and
Food Service Workers, Oklahoma, 1988-
2006
 Work-Related Burns Among Roofers,
Oklahoma, 1988-2006
Fact Sheets
 Burn Injuries Among Roofers
 Burn Injuries in Teen Restaurant Workers
 Burn Prevention Among Persons with
Diabetic Neuropathy
3
 Chemical Burns
 Fire-Safe Cigarettes Can Save Lives
 Fireworks-Related Burn Injuries
 Gasoline-Related Burns
 Hot Facts About House Fires
 Scald Prevention for Young Children
Pamphlets (also available in Spanish)
 House Fires: Causes and Prevention
(Fuegos de Casa: Causas y Prevención)
 LifeSavers: How to Survive a House Fire
(Salvadidas: Cómo Sobrevivir en un Incendio
de Casa)
Education and Planning Materials
 Injury Prevention Works: Strategies for
Building Safe Communities
 LifeSavers: Guide to Smoke Alarm Projects
 LifeSavers II: A Guide to Smoke Detector
Projects
Collaboration
The Injury Prevention Service (IPS) collaborates
with Oklahoma ABLE Tech and the Oklahoma
State University by referring persons who are
mobility impaired, deaf, hard of hearing, blind, or
have poor vision to the Fire Safety Solutions for
People with Disabilities program.9 Smoke alarms
are installed for these persons at no charge and
they receive appropriate safety messages.
Fire marshals and local fire departments provide
injury, death, and smoke alarm information on
house fires. They work with the IPS to promote
smoke alarm use, fire prevention, and fire safety
when residential fires occur in their communities.
Oklahoma Turning Point coalitions promote the
availability of smoke alarms and refer families to
their local fire departments.
Smoke Alarm Program
The IPS has had extensive experience in
implementing and evaluating residential fire injury
prevention programs funded by the National
Center for Injury Prevention and Control. The
smoke alarm program includes smoke alarm
giveaways/installations, educational efforts on
escape plans and common causes of residential
fires, as well as information on proper placement
and testing of smoke alarms. From 1998 to 2001,
a smoke alarm-canvassing project was
implemented in five communities in Oklahoma.
Since 2001, approximately 30,000 smoke alarms
have been distributed in high-risk rural
communities. Smoke alarms were distributed to
various community agencies and organizations
including fire departments, county health
departments, community action groups, and tribal
agencies for installation in homes. All community
agencies are required to work with their local fire
departments to install the alarms in the home,
discuss fire escape plans with residents, and
provide fire safety education materials to each
family who receives an alarm.
Legislation
The IPS developed a legislative fact sheet to
support fire-safe cigarette legislation in
Oklahoma. The fact sheet used IPS burn injury
surveillance data to present the number of
serious injuries and deaths due to cigarette-related
residential fires. The bill had strong
support and was passed in the 2008 Oklahoma
legislative session. This piece of legislation will
be an important additional prevention strategy for
cigarette-related fires. A bill prohibiting the sale of
novelty lighters was introduced in the 2009
legislative session; however, it failed to pass.
GOALS/OBJECTIVES
Goals
 Increase the number of functioning smoke
alarms in single and multi-family dwellings.
 Implement smoke alarm installation
programs in at least five Oklahoma
communities.
4
Objective
 Reduce residential fire-related deaths by
15% by 2012.
Baseline: 2006 IPS data for Oklahoma:
residential fires=1.43 per 100,000 population;
2006 CDC WISQARS data for Oklahoma:
residential fires=1.62 per 100,000 population.
ACTION PLAN
 Choose two to three Oklahoma communities
annually to commit to a year-long smoke
alarm installation project through 2011.
 Smoke alarms will be installed in homes by a
firefighter.
 Smoke alarms will be installed on each level
of the home, outside sleeping areas, and in
the bedrooms of smokers.
 Smoke alarm applications will be completed
for each home that receives an alarm. All
applications will be sent to the IPS.
 At the time of installation, educational
information will be given to residents on fire
prevention, safety, and developing and
practicing a fire escape plan. Educational
brochures will be provided by the IPS.
 IPS staff will conduct follow-up evaluations
six to twelve months after the smoke alarm is
installed to inquire if smoke alarms are still
present and functional.
 Collaborate and partner with community
organizations to further educate high risk
groups, and distribute and install smoke
alarms to persons in need through 2011.
 Health department organizations and
programs including: Children First, Oklahoma
Child Abuse Prevention, Sooner Start,
Oklahoma Lead Poisoning Prevention
Program, Turning Point Coalitions, and other
programs that involve home visits to high risk
populations.
 Community organizations and programs
including: Meals on Wheels, Mobile Meals,
American Association of Retired Persons
(AARP), senior citizen centers, community
centers, faith-based organizations, churches,
schools, and cultural and ethnic groups.
 Encourage county health department staff to
provide fire safety and prevention education
to clients and the community through 2015.
 Promote smoke alarm use among health
department clinic patients.
 Promote/conduct smoke alarm
canvassing events in communities.
 Prepare and disseminate fact sheets related
to fire safety and prevention through 2015.
 Continue to support fire safety legislation by
providing partners and legislators with
relevant data, reports, fact sheets, and
educational information through 2015.
 Research local smoke alarm ordinances and
determine if they include all new, existing, or
sold homes.
5
REFERENCES
1Centers for Disease Control and Prevention. Fire Deaths and Injuries: Fact Sheet. Retrieved 13 January
2009, from: http://www.cdc.gov/ncipc/factsheets/fire.htm.
2National Fire Protection Association. An Overview of the U.S. Fire Problem. Retrieved 13 January 2009,
from: http://www.nfpa.org/assets/files//PDF/Research/Fire_overview_2009.pdf.
3National Fire Protection Association. Fires in the United States During 2007. Retrieved 13 January 2009,
from: http://www.nfpa.org/assets/files//PDF/firelossfacts2.pdf.
4National Fire Protection Association. U.S. Home Structure Fires. Retrieved 13 January 2009, from:
http://www.nfpa.org/assets/files//PDF/Homesfactsheet.pdf.
5Centers for Disease Control and Prevention. Press Release: Reductions in Smoking Show Promise for
Reducing Home Fire Deaths. 8 August 2008.
6National Fire Protection Association. Socioeconomic Factors and Fire: December 2008. Retrieved 13
January 2009, from: http://www.nfpa.org/assets/files//PDF/OS.SocFactors.pdf.
7Centers for Disease Control and Prevention. WISQARS. Retrieved 19 August 2009, from:
http://www.cdc.gov/injury/wisqars/index.html.
8Injury Prevention Service, Oklahoma State Department of Health. Injuries in Oklahoma, 2004-2006.
9Oklahoma ABLE Tech. Fire Safety Solutions FAQ. Retrieved 5 August 2009, from:
http://www.ok.gov/abletech/Fire_Safety/index.html.
6
Traffic-Related Injuries
BACKGROUND
National
According to the National Highway Traffic Safety
Administration (NHTSA), the number of traffic
fatalities decreased nearly 10% from 2007 to
2008 in the United States. However, over 37,000
lives were still lost in traffic-related fatalities in
2008. More than half of persons killed while
traveling in passenger cars were unrestrained
(55%). Motorcycle fatalities increased in the
same year accounting for 14% of traffic fatalities
(5,290 deaths).1
Approximately 13,250 lives were saved in 2008
by the use of seat belts in passenger cars, and
244 lives of children younger than 5 years of age
were saved by the use of child restraints. An
additional 4,152 lives would have been saved if
all unrestrained passenger vehicle occupants 5
years of age and older had been using a restraint
device. Frontal air bags saved the lives of 2,546
occupants 13 years of age and older and
motorcycle helmets saved 1,829 lives. If all
motorcyclists who were involved in a crash had
been wearing helmets, 823 more lives could
have been saved. In addition, more than 700
young adults 18 to 20 years of age were saved
by minimum drinking age laws (21 years old).2
From 2000 to 2006, motor vehicle crashes were
the leading cause of unintentional injury death
overall in the United States, resulting in over
300,000 fatalities.3 In 2008, nearly 970 children
birth to 14 years of age were involved in fatal
motor vehicle crashes and approximately
168,000 were injured.4 More than one in three
deaths are a result of motor vehicle crashes
among teens, and drivers 16 to 19 years of age
are more likely to be involved in traffic-related
incidents than any other age group. On average,
approximately 12 teens 16 to 19 years of age die
every day from motor vehicle-related injuries.
Teenagers and young adults 15 to 24 years of
age account for 14% of the nation’s population.
However, males in this age group account for
30% ($19 billion) of motor vehicle-related medical
costs and females 15 to 24 years of age account
for 28% ($7 billion). According to the Centers for
Disease Control and Prevention (CDC), teen
drivers who are at high risk of being involved in
crashes include males, teens driving with other
teen passengers, and those who are newly
licensed.5
In 2006, over 175,200 adults 65 years of age and
older were injured as result of motor vehicle
crashes. Older drivers are more likely to suffer
from fatal motor vehicle injuries than are younger
drivers. Older adults may have a higher risk of
being involved in a motor vehicle crash due to
poor vision, cognitive functions, and physical
impairments. Seventy-six percent of older drivers
and passengers involved in fatal crashes were
wearing seat belts at the time of the crash
compared to 62% of adult occupants younger
than 65 years old.6
Oklahoma
Motor vehicle crashes were the leading cause of
unintentional injury death among children and
adults 1 to 64 years of age from 2000 to 2006 in
Oklahoma. Each year, approximately 770
persons lose their lives in traffic-related fatalities.
Overall fatality rates were highest among novice
drivers 15 to 24 years of age and drivers 65
years of age and older.3,7
Teen Drivers
In 2006, over 20,200 teens 16 to 19 years of age
were involved in motor vehicle crashes in
7
Oklahoma. Sixty-eight teens in this age group died
at a traffic crash scene or in a hospital emergency
room. Of these, 36 were drivers, 26 were
passengers and 6 had unknown occupant
position. Unsafe speed (44%) and failure to stop
or yield (14%) were the most common noted
causes of the fatal motor vehicle crashes. Alcohol
was a contributing factor in 8% of teen drivers.
Seat belt use was known for 55 persons involved
in these fatal crashes; of these, 67% were not
restrained. Among the 218 teen drivers who were
hospitalized, over half were male (61%). Fifty-seven
percent of teen motorcyclists were not
wearing a helmet; 80% of teens who died in a
hospital were not wearing a seat belt.8
Older Drivers
In 2006, there were approximately 288,000
licensed drivers 70 years of age and older in
Oklahoma, and motor vehicle crashes were the
second leading cause of injury death in this age
group. Older drivers were involved in 7,562 out of
75,408 motor vehicle crashes. The highest rate
of injuries occurred among males, 80 to 84 years
of age. Older drivers had lower fatality rates than
younger drivers age 16 to 24 years of age.
Failure to stop or yield (34%), improper turning
(17%), and improper backing and/or changing
lanes unsafely (16%) were the most common
causes of motor vehicle crashes involving older
drivers. There were 2,005 injuries (nearly 8
injuries per person) sustained by older adults
who were hospitalized (257 hospitalizations).9
PROGRESS
Funding
The Injury Prevention Service (IPS) receives
funding from the Oklahoma Highway Safety Office
(OHSO) to conduct the Oklahoma Traffic Data
Linkage Project (TDLP). The goal of the TDLP is
to obtain comprehensive information on traffic
crashes by linking data from multiple sources. The
IPS links data from traffic crashes, hospitals, and
death certificates (traffic record data, Oklahoma
Hospital Inpatient Discharge data, and vital
statistics data). Linking traffic crash reports and
data from the medical care system provides a
more complete array of information to better
understand motor vehicle crashes and their
effects. The data can be used to develop, inform,
and evaluate traffic injury prevention programs in
Oklahoma. Crash data findings on teen drivers
have been presented on national and local levels.
A website has been developed for the TDLP, and
the TDLP Board of Directors is assisting with
additional promotion efforts.
From 2001 to 2009, the IPS received funding
from the OHSO to implement an occupant
protection program which was offered through
county health departments statewide. In October
2009, the OHSO funded Safe Kids to coordinate
the occupant protection program statewide, with
a focus on rural areas. IPS staff will continue to
provide support and assistance as needed.
Publications
Peer-Reviewed Publications
 All-terrain vehicle crash factors and
associated injuries in patients presenting to a
regional trauma center. Journal of Trauma,
Nov 2007;63(5):994-9
 All terrain vehicle-related central nervous
system injuries in Oklahoma. Journal of the
Oklahoma State Medical Association May
2005;98(5):194-199
 All-terrain vehicle related nonfatal injuries
among young riders: United States, 2001-
2003. Pediatrics 2005;116;608-612.
 Blood alcohol content (BAC)-negative victims
on alcohol-involved injury incidents.
Addiction, 2002;97(7):909-914.
 Epidemiology of severe traumatic brain injury
among persons 65 years of age and older in
Oklahoma, 1992-2003. Brain Injury June
2007;21(7):691-9.
 Magnitude of major trauma in Oklahoma.
Journal of Oklahoma State Medical
Association 2004(2);97:70-74.
8
 Prevention of traffic deaths and injuries: the
role of physicians. Journal of the Oklahoma
Medical Association 2001;94(6):192-194
 Unintentional motor vehicle-train collisions--
Oklahoma, 1995-2003. Journal of the
Oklahoma State Medical Association 2009
Aug;102(8):263-6.
Other Publications
 Oklahoma Injury Facts. September 2003.
Summary Data Reports
 Injuries in Oklahoma, 2004
 Injuries in Oklahoma, 2005
 Injuries in Oklahoma, 2004-2006
Injury Update Reports
 Dangers of Traveling by Foot: Pedestrian-
Related Traumatic Brain Injuries in
Oklahoma, 1992-2002
 Fatal Injuries Among Children Left
Unattended In or Around a Motor Vehicle in
Oklahoma, 2000-2004
 Pedestrian-Related Traumatic Brain Injuries
in Oklahoma, 1992-2002
 Work Zone-Related Deaths, Oklahoma, July
1997-December 2006
Fact Sheets
 Adolescent Injury in Oklahoma
 Alcohol-Related Crash Injuries and Deaths,
Oklahoma, 2006
 Child Passenger Safety Common Errors
 Child Passenger Safety FAQ
 Impaired Driving
 Motorcycle Crash Injury
 Motor Vehicle Crash Injury Laws Q&A
 Motor Vehicle Crash Injuries
 Motor Vehicle Crash Injuries Among Children
and Car Seat Use
 Older Driver-Related Crash Injuries and
Deaths, Oklahoma, 2006
 Pedestrian-Related Injuries
 Teenage Traffic Injuries
 Tips For Keeping Your Child Happy in a Car
Seat
 Traffic Crash Data Linkage Results Among
Oklahoma Teens 16-19 Years of Age, 2006
Education and Planning Materials
 Breaking Away--Teaching Injury Prevention
to Young Bicycle Riders
 PTA Guide to Bicycle Helmet Projects
Collaboration
From 2001 to 2009, the IPS partnered with the
OHSO to implement an occupant protection
program. This program offered eligible families
the opportunity to receive child safety seats at no
cost. Child passenger safety staff educated and
instructed each family on how to properly secure
a car or booster seat in their vehicle. Every family
receiving a child safety seat was required to
watch a child passenger safety video and was
given additional information about child safety
seat use. Family members were encouraged to
participate in the installation process.
In October 2009, Safe Kids assumed management
of the occupant protection program statewide. The
IPS will continue to support the program by
providing technical assistance, instructing one-day
and four-day training classes, and conducting
safety seat installations and checks.
A symposium on underage drinking was
conducted in Oklahoma in 2006. Using the
Spectrum of Prevention, a template of
recommendations was prepared and distributed
to various stakeholders following the symposium.
Legislation
Occupant Protection
In 2004, Oklahoma legislators passed a child
safety seat law which requires children birth to five
years of age to be properly restrained in a car seat
or booster seat when traveling in a motor vehicle.
Children ages six to twelve years old must be
properly restrained in a child safety seat or seat
belt. Prior to 2004, children birth to three years of
9
age were required to be in a car seat, and children
four to five years old could be restrained in a seat
belt, regardless of their seating position in the
vehicle. Oklahoma’s primary seat belt law covers
all persons 13 years of age and older seated in
front vehicle seating positions.
The Forget-Me-Not Vehicle Safety Act was
passed in 2008, making it illegal for caregivers to
leave children six years of age or younger
unattended in a motor vehicle, unless
accompanied by a person at least 12 years of
age or older.
In 2009, child endangerment offenses were
expanded to include any parent or guardian who
knowingly permits a child to be present in a
vehicle when the driver is impaired or under the
influence of alcohol or other intoxicating
substance, or when the parent or guardian is the
impaired driver or under the influence of alcohol
or other intoxicating substance.
Cell Phone Use and Text Messaging
Currently, Oklahoma has no laws relating to cell
phone use or text messaging while driving. In 2009,
nine legislative bills relating to cell phone use were
introduced; however, none of them passed.
Helmet Use
Oklahoma has a partial helmet law that requires
all motorcyclists younger than 18 years of age to
wear a motorcycle helmet. The state does not
have any helmet laws pertaining to bicyclists.
All-terrain Vehicles
All-terrain vehicles (ATVs) purchased on or after
July 1, 2005 must be registered and titled in
Oklahoma. Use of ATVs are prohibited on streets
and highways except to cross these roads, for no
more than 300 feet to cross a railroad track
during daylight hours, or on unpaved roads on
United States Forest Service property.5
Oklahoma state law requires riders younger than
18 years old to wear a helmet when operating an
ATV on public lands, and prohibits operators of
ATVs on public lands from carrying passengers
unless the vehicle was designed by the
manufacturer for passengers. A bill to make
ATVs street legal was introduced in the 2009
session, but did not pass.
Graduated Driver Licensing
Oklahoma established a Graduated Driver
Licensing (GDL) law in 1999. GDL consists of
four levels of licensing; no license, learner permit,
intermediate license, and unrestricted license.
This system allows full driving privileges to
novice drivers gradually, and requirements vary
with each level. GDL restricts the number of
passengers and the amount of driving time
allowed for young, novice drivers. Table 1 from
the Oklahoma Department of Public Safety
shows GDL as it affects Oklahoma drivers 15 to
18 years of age.
Table 1. Oklahoma Graduated Driver Licensing Law
License Type Driving Privileges Requirements
With Driver Education No Driver Education
No License
When: While receiving
instruction from and
accompanied by a certified
driver education instructor
-At least 15 years old
-While receiving instruction from
a certified instructor
(Not eligible)
Learner
Permit
When: While accompanied by
a licensed driver at least 21
years old
-At least 15 1/2 years old
-Must be currently receiving
instruction in or have
-At least 16 years old
-Must have passed written
driving exam
10
Underage Drinking
According to Oklahoma’s zero tolerance law, if
drivers younger than 21 years of age are found to
have a blood alcohol level over 0.02 percent
before or while operating a motor vehicle, they
may be charged with impaired driving offenses.
Oklahoma passed a law in 2006 making it illegal
for a person to knowingly and willfully give
alcohol or controlled dangerous substances to a
minor (person under 21 years of age) who is
invited by that person to a residence, building, or
property owned or procured by that person. If this
act results in the death of a person, violators will
be fined and/or convicted of a felony. Fifty-five
Oklahoma communities have taken this law a
step further by adopting social host ordinances
which prohibit persons from knowingly hosting
gatherings where alcoholic beverages are
available to minors.
Ignition Interlock Devices
A measure related to the installation of an alcohol
ignition interlock device as a condition of
modifying license revocation or driving privileges
becomes effective November 1, 2009. Another
bill requiring persons to use ignition interlock
devices when convicted of first-time driving under
the influence offenses became dormant after
failing to be heard in committee.
GOALS/OBJECTIVES
Goal
 Collect relevant data and provide educational
information to reduce traffic-related injuries
and deaths.
Objectives
completed driver education
-Must have passed written
driving exam
-Must have passed vision exam
-Must have passed vision
exam
Intermediate
License
When: 5am to 11pm, unless
for activities related to school,
church, or work or any time if
accompanied by licensed
driver at least 21years old
Passengers: 1 passenger or
only people who live in the
driver's home or any
passenger if accompanied by
licensed driver at least
21years old
-Must have had a Learner
Permit for at least 6 months
-Must have had at least 40
hours (10 hours at night) of
behind-the-wheel training from
licensed driver at least 21
years old and licensed for at
least 2 years
-Must have no traffic
convictions on driving record
-Must have passed driving skills
exam
-Must have had a Learner
Permit at least 6 months
-Must have had at least 40
hours (10 hours at night) of
behind-the-wheel training
from licensed driver at least
21 years old and licensed for
at least 2 years
-Must have no traffic
convictions on driving record
-Must have passed driving
skills exam
Unrestricted
License
When: unrestricted
Passengers: unrestricted
-Must have had an Intermediate
License for at least 6 months
-Must have no traffic
convictions on driving record
-Must have had an
Intermediate License for at
least 1 year
-Must have no traffic
convictions on driving record
-OR-
-Must be at least 18 years old
-Must have passed all driving and vision exams
11
 Increase seat belt use to 92% by 2015.
Baseline: 2009 Oklahoma Highway Safety
Office data for Oklahoma: seat belt
use=84.2%.
 Increase child safety seat use among
children birth to six years of age to 90% by
2015.
Baseline: 2009 Oklahoma Highway Safety
Office data for Oklahoma: proper restraint
use=86.3%.
 Decrease the proportion of high school age
students who have driven a vehicle when
drinking alcohol within a given month to 10%
by 2015.
Baseline: 2007 Youth Risk Behavior Survey
data for Oklahoma: students who have
driven a vehicle when drinking alcohol during
the past 30 days=13.3%.
ACTION PLAN
 Continue to support statewide programs to
reduce traffic-related deaths through 2015.
 Maintain the TDLP through 2015.
 Continue to support and participate in the
TDLP Board of Directors through 2015.
 Continue to support and participate in the
Statewide Buckle Up Committee through 2015.
 Continue to conduct child safety seat checks
and provide technical assistance to parents
and caregivers through 2015.
 Continue to provide technical assistance to
county health department program contacts
and participate in child safety seat check
events and instruct child passenger safety
trainings through 2015.
 Continue to collect surveillance data on
traumatic brain injuries, ATV and traffic
injuries and fatalities using Oklahoma
Medical Examiner data, Vital Records data,
and Oklahoma Highway Safety Office data
through 2015.
 Work with the Oklahoma Highway Safety
Office and the Department of Public Safety to
increase awareness of Graduated Driver
Licensing laws among parents and
caregivers of novice drivers through 2015.
 Prepare and disseminate traffic-related news
releases, fact sheets, and reports through
2015.
 Fulfill traffic-related data requests as need
through 2015.
 Support traffic safety legislation by providing
partners and legislators with relevant data,
reports, fact sheets, and educational
information through the 2015 as appropriate.
 Support legislation restricting cell phone use
and texting while driving by providing
relevant data, reports, fact sheets, and
educational information through the 2015
legislative session.
12
REFERENCES
1National Highway Traffic Safety Administration. 2008 Traffic Safety Annual Assessment – Highlights.
Retrieved 17 September 2009, from: http://www-nrd.
nhtsa.dot.gov/Cats/listpublications.aspx?Id=F&ShowBy=DocType.
2National Highway Traffic Safety Administration. Lives Saved in 2008 by Restraint Use and Minimum
Drinking Age Laws. Retrieved 17 September 2009, from: http://www-nrd.
nhtsa.dot.gov/Cats/listpublications.aspx?Id=F&ShowBy=DocType.
3Centers for Disease Control and Prevention. WISQARS. Retrieved 17 September 2009, from:
http://www.cdc.gov/injury/wisqars/index.html.
4Centers for Disease Control and Prevention. Child Passenger Safety: Fact Sheet. Retrieved 17 September
2009, from: http://www.cdc.gov/MotorVehicleSafety/Child_Passenger_Safety/CPS-Factsheet.html.
5Centers for Disease Control and Prevention. Teen Drivers: Fact Sheet. Retrieved 17 September 2009,
from: http://www.cdc.gov/MotorVehicleSafety/Teen_Drivers/teendrivers_factsheet.html.
6Centers for Disease Control and Prevention. Older Adult Drivers: Fact Sheet. Retrieved 17 September
2009, from: http://www.cdc.gov/MotorVehicleSafety/Older_Adult_Drivers/adult-drivers_factsheet.html.
7Injury Prevention Service, Oklahoma State Department of Health. Injuries in Oklahoma, 2004-2006.
8Injury Prevention Service, Oklahoma State Department of Health. Fact Sheet: 2006 Traffic Crash Data
Linkage Results Among Oklahoma Teens 16-19 Years of Age.
9Injury Prevention Service, Oklahoma State Department of Health. Fact Sheet: Older Driver-Related Crash
Injuries and Deaths, Oklahoma, 2006.
13
Occupational Injuries
BACKGROUND
National
In 2007, there were over 146,000 persons 16
years of age and older in the work force.1
Management and professional occupations;
sales and office occupations; and service
occupations were the leading industries, and
employed 77% of all workers in the United
States. There were slightly more male workers
(54%) employed in the workforce than female
workers (47%); however, males accounted for
92% of the 5,657 occupational fatalities.2
Each year, almost 6,000 persons die from
occupational injuries in the United States.3 In
2007, occupational fatalities decreased 3% from
the previous year (5,657 in 2007 and 5,840 in
2006), and the rate for work-related deaths was
3.8 per 100,000 workers. Persons 45 years of
age and older had a higher work-related injury
death rate than the overall national rate. Fatal
occupational injury rates were the highest for the
agriculture, forestry, fishing, and hunting (27.9
per 100,000 workers); transportation and
warehousing (16.9 per 100,000); and
construction (10.5 per 100,000) industry sectors.
However, the construction industry had the
highest number of fatal injuries during this time.
Highway incidents (1,414 deaths), homicides
(847 deaths), and falls (628 deaths) were the
most frequent incidents associated with work-related
fatalities.2
Nearly 1.8 million workers were employed full-time
in the agriculture industry in 2007.
Agriculture-related activities have consistently
had one of the highest work-related fatality rates.
This industry is one of the few occupations that
also pose a risk of fatal and nonfatal injury to
families of farmers, since the agricultural work is
often shared among family members and takes
place at the family’s residence.4
Oklahoma
In Oklahoma, approximately 100 occupational
injury deaths are reported each year to the Injury
Prevention Service. Transportation incidents
account for the highest number of deaths,
followed by agriculture-related deaths.3 From
January 1, 1998 to December 31, 2007, 1,122
workers in Oklahoma lost their lives to work-related
deaths – an average of 112 deaths per
year. Historically, Oklahoma’s annual death rate
has been higher than the national average.2
Twenty-four percent of deaths occurred among
workers between 35 and 44 years of age, and
20% of deaths were among those 45 to 54 years
of age. Ninety-three percent of all work-related
deaths were among males. Sixty-nine percent of
work-related incidents occurred between 8:00
a.m. and 8:00 p.m., with the highest occurrences
between noon and 4:00 p.m.5
The leading causes of work-related deaths
included motor vehicle crashes (37%), machinery
(16%), and falls from elevation (12%). Truck
driving/delivery was the occupation resulting in the
greatest number of fatalities (24%), followed by
farming/ranching (17%), and construction (10%).5
Workers who were involved in fatal injuries most
frequently suffered multiple traumatic injuries
(35%). Traumatic head injuries accounted for
21% of fatalities and traumatic chest injuries
accounted for 7%.5
Occupational health indicator data revealed that
Oklahoma rates were higher than national rates
for the following work-related conditions:
hospitalizations, amputations, and pesticide-
14
associated illnesses/injuries reported to poison
control centers. Work-related rates were lower in
Oklahoma than the United States for hospitalized
burn injuries, pneumoconiosis and malignant
mesothelioma as well as for elevated blood lead
levels.
PROGRESS
Funding
The Injury Prevention Service (IPS) receives
funding for activities associated with occupational
injuries and fatalities through two program grants
from the National Institute for Occupational Safety
and Health: the Oklahoma Fatality Assessment
and Control Evaluation (OKFACE) and the
Occupational Safety and Health Surveillance
programs. The grant funding for OKFACE ended
on August 31, 2007. The Occupational Safety and
Health Surveillance Program is currently funded
through June 30, 2010.
Publications
For the OKFACE grant, comprehensive data
were collected on all occupational fatalities, and
on-site investigations were conducted for a
subset of the deaths. For the Occupational
Safety and Health Surveillance Program, the
Injury Prevention Service established a
fundamental surveillance system to collect data
on occupational hazards, diseases, injuries, and
deaths in Oklahoma. These data were collected
and analyzed to determine the magnitude and
trends of occupational indicators. In addition,
detailed information continued to be collected on
all occupational deaths from multiple sources
including death certificates, Medical Examiner
reports, and Occupational Safety and Health
Administration reports. Data were used to
prepare summary data reports, Injury Updates,
fact sheets, and occupational death investigation
reports (listed below). These materials were
distributed and posted on the Injury Prevention
Service website (http://ips.health.gov) to be
utilized in safety trainings by employers and
safety managers. A news release on nail gun-related
injuries was also prepared and distributed
to statewide media outlets.
Summary Data Reports
 Occupational Fatalities in Oklahoma, 1998-
2001
 Occupational Fatalities in Oklahoma, 1998-
2002
 Occupational Fatalities in Oklahoma, 1998-
2005
 Occupational Fatalities in Oklahoma, 1998-
2006
 Oklahoma Occupational Health Indicators,
2003
 Oklahoma Occupational Health Indicators,
2003-2005
Injury Update Reports
 Construction-Related Fatalities, Oklahoma,
1998-2001
 Hospitalizations Paid by Workers’
Compensation, Oklahoma, 2005
 Jump-Start/Bypass-Start-Related Fatalities in
Oklahoma, July 1997-February 2005
 Work-Related Burns Among Restaurant and
Food Service Workers, Oklahoma, 1988-2006
 Work-Related Burns Among Roofers,
Oklahoma, 1988-2006
 Work-Related Deaths Among Young
Workers Under 25 Years of Age, Oklahoma,
1998-2004
 Work-Related Deaths in Oklahoma, 1998-
1999
 Work-Related Deaths in Oklahoma, 1998-
2007
 Work-Related Homicides, Oklahoma, 1998-
2004
 Work Zone-Related Deaths, Oklahoma, July
1997-December 2006
OKFACE News Reports
 Construction Safety
 Life and Death in the Oil Field
 Tractor Safety
15
Fact Sheets
 Burn Injuries Among Roofers
 Burn Injuries in Teen Restaurant Workers
 Chemical Burns
 Electric Current Safety
 Safety in Eating and Drinking Establishments
 Work-Related Falls
OKFACE Death Investigation Reports
A total of 53 death investigation reports were
completed on the following fatal injuries:
 Machine-related deaths
 Highway work zone fatalities
 Immigrant deaths
 Work-related fatalities among youth younger
than 18 years of age
Reports are available on the National Institute for
Occupational Safety and Health
(http://www.cdc.gov/niosh/).
Data and investigation reports were distributed to
the National Institute of Occupational Safety and
Health, Council of State and Territorial
Epidemiologists, partners in other states involved
in occupational injury prevention, Oklahoma
Department of Labor, Occupational Safety and
Health Administration, Oklahoma Workers’
Compensation Court, Office of the Chief Medical
Examiner, Future Farmers of America groups,
farm co-ops, county extension offices, career and
technology education centers, Oklahoma Safety
Council members, Oklahoma Occupational
Safety and Health Surveillance Advisory
Committee members, and special target groups
specific to each publication.
Collaboration
A scientific advisory committee was established
to provide input on the Oklahoma Occupational
Safety and Health Surveillance program and to
promote collaborations. Members of the
committee include representatives from Vital
Statistics, hospital discharge database,
Oklahoma Workers’ Compensation Court,
Oklahoma Central Cancer Registry, Adult Blood
Lead Epidemiology and Surveillance Program,
Department of Labor, Occupational Safety and
Health Administration, Oklahoma Poison Control
Center, and university and career and technology
instructors with various occupational specialties.
Partnerships have also been created with rural
farm co-ops and specific industry groups who are
at high risk for work-related injuries to provide
safety information through educational
campaigns and Injury Updates. In addition, the
Injury Prevention Service has collaborated with
county health departments, the Worker Policy
Safety Council, and a co-op council. Farm safety
information was distributed through county health
department services (i.e., flu clinics). The Worker
Policy Safety Council was created by legislation
and meets four times per year to study and
formulate reforms to reduce work-related injuries.
The co-op council, that includes all co-ops in the
state, works to decrease risk factors associated
with occupational injuries.
GOALS/OBJECTIVES
Goal
 Collect relevant data and provide educational
information to reduce work-related injuries
and deaths.
Objective
 Reduce deaths from work-related injuries to
7.0 deaths per 100,000 workers by 2015.
Baseline: 2007 America’s Health Rankings
data for Oklahoma: occupational
fatalities=8.3 deaths per 100,000 workers.
ACTION PLAN
 Continue to collect occupational indicator
data through 2010.
 Continue to collect occupational fatality data
through 2010.
16
 Continue to provide partners with relevant
data, reports, and fact sheets to be utilized in
safety trainings by employers and safety
managers through 2015.
 Prepare and disseminate occupational
safety information to construction and
restaurant groups.
 Prepare and disseminate transportation-related
injury reports and fact sheets.
 Prepare and disseminate fact sheets on
work-zone safety.
 Prepare and disseminate fact sheets on
young workers.
 Prepare and disseminate fact sheets on
workers 45 years of age and older.
 Partner with occupational safety groups
to promote farm safety education through
their quarterly publications.
 Prepare and disseminate fact sheets in
Spanish.
 Prepare and disseminate news releases
related to occupational injuries (at least one
on work-zone safety) through 2015.
17
REFERENCES
1Bureau of Labor Statistics, U.S. Department of Labor. Current Population Survey. Retrieved 17 June 2009,
from: http://www.bls.gov/cps/tables.htm#charemp.
2Bureau of Labor Statistics, U.S. Department of Labor. 2007 Census of Fatal Occupational Injuries Charts,
1992-2007 (revised data). Retrieved 16 June 2009, from: http://www.bls.gov/iif/wshwc/cfoi/cfch0006.
3Injury Prevention Service, Oklahoma State Department of Health. Oklahoma Occupational Safety and
Health Surveillance Program Final Progress Report. 30 September 2008.
4National Institute for Occupational Safety and Health. NIOSH Safety and Health Topic: Agricultural Safety.
Retrieved 20 May 2009, from: http://www.cdc.gov/niosh/topics/aginjury/
5Injury Prevention Service, Oklahoma State Department of Health. Injury Update: Work-Related Deaths in
Oklahoma, 1998-2007. 31 July 2008.
18
Unintentional Poisonings
BACKGROUND
National
Unintentional poisoning occurs when a certain
amount of a chemical agent is ingested, inhaled,
injected or absorbed and unexpectedly causes
illness or death. In 2006, unintentional poisonings
claimed the lives of 27,531 Americans, and were
the second leading cause of unintentional injury
deaths following motor vehicle crashes.
However, poisoning deaths exceeded deaths
caused by motor vehicle crashes among adults
35 to 54 years of age. Poisoning deaths in this
age group increased approximately 113%
between 1999 and 2006.1 Ninety-five percent of
unintentional and undetermined poisoning deaths
were drug-related. Opioid pain medications were
the most common cause, followed by cocaine
and heroin. Men were 2.1 times more likely to die
from unintentional poisoning than women, and
the highest death rates were among Native
Americans. The economic cost of poisoning
injuries reached $26 billion in the year 2000.2
Poison control centers across the nation reported
approximately two million unintentional poisonings
or poison exposure cases in 2006. The National
Poison Data System (NPDS) of the American
Association of Poison Control Centers logged
more than four million poison-related incidents
from 61 participating poison control centers in the
United States. Approximately 2.4 million cases
were concerning human exposure to a chemical
substance (8.0 exposures per 1,000 population).
The most frequent cause of poison exposure in all
individuals was analgesics (pain medications), and
in children less than six years of age, poisoning
was most commonly caused by cosmetics and
personal care products. The NPDS also reported
1,229 fatalities.3
On average, 6,937 human exposure cases were
handled by all poison centers in the United
States per day. More calls were received during
warmer months (7,246 in June) than in the winter
months (6,524 in January). Higher volumes of
calls were also received between 4:00 p.m. and
11:00 p.m. with 93% of poisonings occurring at a
place of residence.3
Oklahoma
Between 2000 and 2006, unintentional poisoning
deaths increased by 144% in the State of
Oklahoma. Unintentional poisoning has become
the second leading cause of unintentional injury
death among all ages resulting in over 54,000
years of potential life lost before the age of 65.
Seventy percent of unintentional poison-related
deaths occurred among persons 30 to 54 years
of age with the greatest mortality occurring
among persons 40 to 49 years of age. Children
birth to 14 years of age had the lowest number of
deaths associated with unintentional poisonings.1
Over two thousand persons in Oklahoma died
from unintentional poisoning during this time. More
men (62%) died from unintentional poisonings
than women (38%), and racial groups which were
most affected by unintentional poisoning deaths
were whites (9.7 per 100,000 population), Native
Americans (9.1 per 100,000), and African
Americans/blacks (5.8 per 100,000).1,4
Oklahoma hospitals reported over 6,000 hospital
discharges associated with poison exposure from
2002 to 2006. The majority of discharges were
among children one to four years of age and
adults 40 to 49 years of age.5
The Oklahoma Medical Examiner’s Office reported
487 unintentional drug-related poison deaths in
Oklahoma in 2006. More men (300 persons) died
19
from unintentional drug poisonings than women
(187 persons) and the highest rate of deaths
occurred among whites (12.3 per 100,000), Native
Americans (0.8 per 100,000) and African
Americans/blacks (0.8 per 100,000). Approximately
60% of persons were 40 to 59 years of age, and
34% were between the ages of 20 and 39. Fifty
percent of deaths were unintentional poisonings
associated with a single drug (methadone, cocaine,
and fentanyl resulted in the most deaths), and 241
were multiple drugs deaths.6
Carbon Monoxide Poisoning
During the winter storm in January 2007, 66
persons were treated at a hospital for carbon
monoxide (CO) poisoning, and 96% of these
injuries occurred in a home. CO poisonings had
the second highest hospitalization rate of all
winter storm-related injuries.7 CO poisoning
occurs when carbon monoxide, an odorless,
colorless, poisonous gas, is inhaled in significant
concentrations causing illness and/or death. It is
commonly reported after major power outages
resulting from natural or man-made disasters.
When alternative sources of fuel or electricity are
used for heating, cooling, or cooking during these
events, CO can build up quickly in enclosed or
partially enclosed areas.8 During a subsequent
winter storm in December 2007, two persons
died from CO poisoning caused by a generator.
Oklahoma Poison Control Center
The Oklahoma Poison Control Center was
founded in the 1960’s. In 1962, the center
answered about 500 poison calls; today, the
center answers over 50,000 phone calls a year
and includes a 24-hour, toll-free telephone
service. The poison center staffs specially trained
licensed pharmacists and nurses who provide
emergency poisoning management advice to
Oklahoma residents and health care
professionals. The center provides information
concerning the prevention and management of
potentially toxic exposures to the people of
Oklahoma. The center's goal is to save lives as
well as to provide a cost-effective service to
patients and residents by promoting the
appropriate use of health care resources. The
Oklahoma Poison Control Center is a certified
poison center as independently evaluated by the
American Association of Poison Control Centers.
Maintaining funding of poison centers enables
more poisoning cases to be safely managed at
home, decreasing the need for emergency
department treatment.9
The Oklahoma Poison Control Center received
54,178 calls in 2007. Of the 37,381 human
exposure cases, 14,276 were drug-related
poisonings. Children under five years of age
accounted for 56% of all poisoning cases.
Analgesics (pain medications),
cosmetics/personal care products, and
household cleaning substances were the leading
causes of poison exposure among all
Oklahomans. Substances most commonly
involved in adult exposures include analgesics,
sedatives/hypnotics/antipsychotics, and
household cleaning products. Among
Oklahoma’s children, cosmetics/personal care
products, household cleaning products, and
analgesics were the most frequent cause.9
PROGRESS
Prescription Drug Use
The Injury Prevention Service (IPS) is preparing
a manuscript on unintentional prescription drug
poisoning deaths in Oklahoma, Unintentional
Medication Overdose Deaths – Oklahoma, 1994-
2006. Preliminary results show that Oklahoma is
one of the states leading the nation in the rate of
prescription drug overdose deaths (11.8 per
100,000 population), and this rate continues to
increase. Inappropriate use of legal prescription
opioid painkillers, particularly methadone, is a
primary contributor to these deaths. An
increasing proportion of deaths are from
oxycodone and hydrocodone. Most persons who
die from unintentional prescription drug
20
overdoses are middle-aged adults, and tend to
be white males. However, deaths among females
are rising at a faster rate than among males.
Persons 35 to 44 years of age have the highest
medication overdose death rates (11.4 per
100,000) followed by persons 45 to 54 years of
age (10.7 per 100,000). Methadone, hydrocodone,
alprazolam, oxycodone, and morphine were the
most common substances involved in
unintentional medication overdose deaths and
accounted for half of all deaths. Alcohol, narcotics,
and antianxiety medications accounted for three-fourths
of all overdose deaths.
Many prescription drug deaths can be attributed
to poly-substance ingestion – the ingestion of
multiple medications at the same time. With poly-substance
ingestion, levels of any one of the
substances may not be fatal; however,
consuming multiple medications concurrently or
combining them with alcohol or illicit drugs can
be lethal.
The IPS initiated a surveillance system for
unintentional poisoning deaths among Oklahoma
residents in December 2008. The system utilizes
medical examiner data and crosschecks Vital
Statistics data, gathering as much detailed
information on deaths as possible. Data will be
used in developing reports, collaborating with
other interested groups, and potential data linking
to other sources such as the Oklahoma
Prescription Monitoring Program (PMP).
Funding
Currently, the IPS does not have specific funding
to address unintentional poisoning deaths.
Publications
Peer-Reviewed Publications
• The association of pseudoephedrine sales
restrictions on emergency department urine
drug screen results in Oklahoma. J Okla State
Med Assoc, Nov 2007;100(11):436-439.
• Unintentional medication overdose deaths –
Oklahoma, 1994-2006 (Pending)
Summary Data Reports
• Injuries in Oklahoma, 2004
• Injuries in Oklahoma, 2005
• Injuries in Oklahoma, 2004-2006
Injury Update Reports
• Undetermined Manner Drug Poisoning
Deaths, Oklahoma, 2004-2006
Fact Sheets
• Carbon Monoxide Poisoning Deaths
• Unintentional Carbon Monoxide Poisoning
Deaths
Education and Planning Materials
• Injury Prevention Works: Strategies for
Building Safe Communities
Collaboration
In March 2009, the Oklahoma State Department
of Health and the Oklahoma Poison Control
Center hosted an Unintentional Poisoning Deaths
Symposium. The purpose of the symposium was
to initiate a collaborative effort among agencies
and organizations statewide to assess
unintentional poisoning deaths in Oklahoma due
to prescription drug use, identify probable
solutions, and develop a plan of action and a
timeline.
Presentations and discussions related to
unintentional poisoning deaths, specifically
pertaining to prescription drug use among 35 to
54 years of age in Oklahoma, were conducted.
The symposium served as an avenue in bringing
different agencies and organizations together to
discuss current local and statewide injury trends
and existing injury projects. It provided a forum
for community partners to discuss prevention
strategies and strengthen efforts by fostering
opportunities to collaborate on effective
strategies and link resources among agencies
21
and organizations statewide. These agencies
and organizations provided pertinent information
and valuable insight on unintentional poisoning
death trends which will support future injury
prevention efforts in the state.
GOALS/OBJECTIVES
Goals
 Increase awareness of unintentional
poisonings.
 Enhance data and knowledge about poison
exposures and circumstances of the events.
 Capitalize on partnerships formed in the
unintentional poisoning symposium to
strengthen prevention efforts associated with
unintentional drug poisoning deaths.
 Increase the use of evidence-based injury
and violence prevention interventions
statewide.
Objectives
 Identify characteristics and demographics of
target/at-risk populations by 2010.
 Educate prescribers, pharmacists, physicians
and other medical professionals on the
proper use of prescription drugs, the
Prescription Monitoring Program, and the
use and availability of community resources
for patient referrals through 2015.
 Educate parents and persons in at-risk
populations through 2015.
 Reduce deaths caused by unintentional
poisonings to 12.1 deaths per 100,000
population by 2015.
Baseline: 2006 CDC WISQARS data for
Oklahoma: unintentional poisoning=13.4 per
100,000 population.
ACTION PLAN
 Work with medical licensing entities to
distribute Prescription Monitoring Program
information with licensure renewal letters to
increase awareness of program availability
through 2015.
 Promote linking Medical Examiner data with
Prescription Monitoring Program data
through 2015.
 Work with Medicaid to encourage or require
physicians to check the Prescription
Monitoring Program every 3 months on every
patient through 2015.
 Communicate progress and share
information among unintentional poisoning
taskforce members through 2015.
 Assist with preparing educational information
to present to graduate schools (medicine,
pharmacy, nursing, dentistry, etc) through
2015.
22
REFERENCES
1Centers for Disease Control and Prevention, National Center for Injury Prevention and Control. Web-based
Injury Statistics Query and Report System (WISQARS) [online]. (2005). Retrieved 25 August 2008,
from: http://www.cdc.gov/ncipc/wisqars.
2Centers for Disease Control and Prevention. Poisoning in the United States: Fact Sheet. Retrieved 8
August 2008, from: http://www.cdc.gov/ncipc/factsheets/poisoning.htm.
3American Association of Poison Control Centers. 2006 Annual Report of the American Association of
Poison Control Centers’ National Poison Data System (NPDS). Retrieved 22 September 2008, from:
http://www.aapcc.org/archive/Annual%20Reports/06Report/2006%20Annual%20Report%20Final.pdf.
4Vital Records Division, Oklahoma State Department of Health. Vital Statistic Mortality Database.
5Health Care Information Division, Oklahoma State Department of Health. Oklahoma Inpatient Discharge
Database.
6Office of the Chief Medical Examiner, State of Oklahoma. Office of the Chief Medical Examiner Annual
Report: 2006 January 1-December 31, State of Oklahoma. Retrieved 22 September 2008, from:
http://www.ocme.state.ok.us/2006_annualreport.pdf.
7Piercefield, E. Winter storm-related injuries, Oklahoma, 2007. Retrieved 29 October 2008, from: Injury
Prevention Service, Oklahoma State Department of Health.
8Centers for Disease Control and Prevention. Carbon monoxide poisoning after a disaster. Retrieved 28
October 2008, from: http://www.bt.cdc.gov/disasters/carbonmonoxide.asp.
9Oklahoma Poison Control Center. Poisoning Statistics - 2007. Retrieved 22 September 2008, from:
http://www.oklahomapoison.org/facts/.
23
Violence
BACKGROUND
National
Violent Deaths
In the United States, approximately 50,000
violent deaths occur each year and cost over
$52 billion in medical care and lost productivity.
According to the Centers for Disease Control
and Prevention (CDC), violence results from
intentional use of threatened or actual physical
force (including the use of poisons/drugs) or
power, against oneself, another person, group,
or community.1
In 2006, more than 33,000 suicides occurred in
the United States and 18,000 persons were
victims of homicide. Suicide rates for males were
highest among persons age 75 and older (35.7
per 100,000), and among females ages 45 to 54
(8.4 per 100,000).3 Fifty-one percent of suicides
and 69% of homicides involve firearms. Firearm-related
incidents are the second leading cause of
injury death in the United States.1
The National Violent Death Reporting System
(NVDRS) is a federally funded surveillance
system created in 2003 to track violent deaths.
Eighteen states currently participate, including
Oklahoma. The NVDRS was created as a tool for
criminal justice, public health, and injury
prevention communities and their partners to
assist in understanding and ultimately reducing
violent death events through planning, policy,
and prevention programs at local, state, and
national levels.2 Violent deaths tracked in the
system include suicides, homicides, deaths from
legal intervention, unintentional firearm deaths,
deaths of undetermined manner, and deaths
resulting from acts of terrorism.
Sexual Violence
Approximately 11% of women and 2% of men
report being raped at sometime in their lives. For
60% of female victims and 69% of male victims
the first rape occurred before the age of 18.
Among female victims, the perpetrators of the
rape were most often intimate partners (30%),
family members (24%), or acquaintances (20%).
Among male victims, perpetrators were reported
to be acquaintances (32%), family members
(18%), friends (18%), or intimate partners (16%).3
Intimate Partner Violence
From 2001 to 2005 in the United States, 22% of
females and 4% of males 12 years of age or
older had experienced nonfatal intimate partner
violence (IPV) in their lifetime. Both males and
females who were separated or divorced had the
greatest risk of victimization, and those who were
married or widowed had the lowest risk of
experiencing IPV. In most cases, victims reported
that the offender’s age was close to their own
age. Forty-two percent of all nonfatal IPV victims
reported that alcohol or drugs were involved.
Nonfatal IPV most often occurred between the
hours of 6:00 p.m. and 6:00 a.m. The majority of
victimizations among males (60%) and females
(63%) occurred at the victim’s home.4
In general, IPV-related homicides declined
among both males and females between 2001
and 2005. Females accounted for 30% of IPV-related
homicides and males accounted for 5% of
IPV-related homicides. Between 1976 and 2005,
approximately 11% of homicide victims were
suspected to have been killed by an intimate
partner. In recent years, approximately 3% of all
male homicide victims and one-third of all female
homicide victims were killed by an intimate
partner.4
24
Bullying
In a 2001 study, approximately 30% of students
in the United States reported being involved in
moderate or frequent bullying, either as a bully
(13%), a victim (11%), or as both (6%). In a study
of 8 to 11 year olds and 12 to 15 year olds,
students identified bullying and teasing as the
most serious problem for their age groups – more
than drugs or alcohol, sex, violence,
discrimination or other problems. Sixty percent of
pre-teens characterized as bullies in middle
school had at least one criminal conviction by the
age of 24. Twenty percent of student perpetrators
in school-related homicide incidents were known
to have been victims of bullying.5,6
Oklahoma
An annual average of 891 violent deaths of
Oklahoma residents occurred in Oklahoma from
2004 to 2006. More than half (58%) of the deaths
were suicides, 24% were homicides, 16% were
undetermined manner deaths, 1% were legal
intervention deaths, and 1% were unintentional
firearm deaths. There were no terrorism deaths
in Oklahoma during this period. Seventy-three
percent of the victims were male and 27% were
female. The majority of the injuries (74%)
occurred on a home premise. Four percent of
violent deaths occurred while the person was in
custody or in the process of being arrested, 22
victims were homeless, and 18% of violent death
victims had served in the United States Armed
Forces. Forty-one percent of all violent deaths in
Oklahoma were among Oklahoma and Tulsa
County residents. The rate of violent death per
100,000 population was generally higher in
eastern Oklahoma, and lower in the Panhandle
and western regions of the state.2
Suicides
In Oklahoma, suicide is the fourth leading cause of
death among persons 1 to 44 years of age.
Suicide was the most prevalent type of violent
death, accounting for 1,544 deaths (14.5 suicides
annually per 100,000 population) from 2004 to
2006. During this time period, the rate of suicide
increased by 5%. Seventy-eight percent of suicide
victims were male and 22% were female. In 42
suicide deaths, victims killed at least one other
person before taking their own life, resulting in 51
homicide deaths. Males 75 to 84 years of age had
the highest suicide rate among all ages. Females
at greatest risk for suicide were women 35 to 54
years of age. White males had the highest suicide
rate (23.9), followed by Native American males
(23.2), black males (10.6), and Asian males (3.0).
Firearms were used in 59% of the suicide deaths,
hanging/strangulation was used in 18%, poisoning
in 17%, and other methods were used in 5% of
suicides. A substantial number of suicides were
associated with a current depressed mood,
intimate partner problem, mental health problem,
or crisis in the past two weeks. Physical health
problems were more often associated with suicide
among persons 65 years of age and older.
Intimate partner problems were more often
associated with suicides of persons less than 65
years of age. Almost one in five suicide victims
had a history of suicide attempts, and 29% had
stated their intent or expressed suicidal feelings to
another person.2
Homicides
In Oklahoma, homicide is the fifth leading cause
of death for persons 1 to 44 years of age. From
2004 to 2006, there were approximately 210
homicide deaths annually. Seventy-three percent
of homicide victims were male and 27% were
female. Males ages 15 to 34 had the highest rate
of homicide. Females 25 to 34 years of age had
the highest rate of homicide among females (4.9
per 100,000 population).2
Victims were often the acquaintances, intimate
partners, family members, friends or roommates,
or other known person of the suspect. Females
were more often killed by an intimate partner or
family member, and males were more often killed
by an acquaintance or rival gang member. The
suspect was a stranger in 15% of homicides. An
25
argument or interpersonal conflict was a
precipitating factor in 40% of homicides, and 23%
of homicides were precipitated by a crime.
Suspected drug dealing or illegal drug use was
involved in 17%, and 10% were gang-related
incidents. Firearms were used in 60% of
homicides, sharp or blunt instruments were used
in 23%, hanging/strangulation in 5%, and other
weapons were used in 12%.2
Unintentional Firearm-Related Deaths
An average of 10 deaths per year were
associated with unintentional firearm injuries. The
majority (83%) of victims were male and nearly
half of all unintentional firearm-related deaths
were among males less than 25 years of age.
Circumstances surrounding the deaths included
playing around with a gun (47%), showing a gun
(20%), hunting (10%), loading the gun (7%), and
target shooting (7%). In 37% of firearm-related
incidents, the shooter thought the gun was
unloaded and in 13% of incidents, the gun
discharged when it was dropped.2
Sexual Violence
In 2007, there were over 1,500 rapes and
attempted rapes (85.1 per 100,000 females)
reported to the Uniform Crime Reporting System
by Oklahoma law enforcement officers. However,
it is well known that the prevalence of rape is
higher than crime statistics indicate. Survey data
consistently supports this fact. According to the
Oklahoma Women’s Health Survey, from 2001 to
2003, 12% of women 18 to 44 years of age
reported that they had been threatened, coerced,
or physically forced to engage in sexual acts
since their 18th birthday. Approximately two
percent had been forced to engage in sex in the
past 12 months.7
The 2008 Behavioral Risk Factor Surveillance
System data estimated that 7% of Oklahomans
18 years of age and older (12% of women and
1% of men) had been sexually assaulted in their
lifetime. The 2007 Youth Risk Behavior Survey
estimated that 8% of high school students (12%
of girls and 4% of boys) had been physically
forced to have sexual intercourse they did not
want. 7
In a statewide sexual assault survey conducted
by the Oklahoma University Public Opinion
Learning Laboratory in 2006, nearly one-third of
women 18 to 35 years of age reported they had
been sexually assaulted in their lifetime, and 1%
had been sexually assaulted in the past 12
months. Among women who were sexually
assaulted, three out of four women were younger
than 18 years of age when the first sexual
assault occurred. Most incidents occurred in a
home and the perpetrators were most often
current or former intimate partners.7
Intimate Partner Violence
A special study conducted in 2002 found an
estimated 2,457 persons 15 years of age and
older were treated and released from Oklahoma
hospital emergency departments for nonfatal IPV
injuries; 91% were females and 9% were males.
An additional 81 females 15 years of age and
older were hospitalized as a result of IPV injuries.
Over half of persons treated and released in
emergency departments were single (54%), 29%
were married, 14% were divorced or separated,
and less than 1% were widowed. The marital
status was unknown for 4% of persons treated.
The IPV injury rate among females (157.8) was
more than 10 times higher than for males (15.6).
For females, the IPV injury rate was highest
among 25 to 34 year olds (309.9) and for males,
the IPV injury rate was highest among 35 to 44
year olds (29.9). The highest rate of IPV injury
was among African Americans (327.1), followed
by Native Americans (107.9), and whites (63.6).
The perpetrator of the IPV assault was a current
partner for 90% of females and 98% of males.
From 1999 to 2007, 325 homicide deaths
occurred as a result of IPV accounting for an
average of 36 deaths annually (1.0 per 100,000
population). Thirty-one percent of victims were
26
among males and 69% among females. IPV-related
deaths included 296 intimate partner
victims and 29 bystanders killed in the incidents.
Intimate partner victims ranged in age from 16
to 19 years of age and bystander victims ranged
from infants to persons 59 years of age.
Excluding bystanders, the rate of intimate
partner homicide among females (1.3 per
100,000) was 2.6 times higher than the rate
among males (0.5 per 100,000). Oklahoma and
Tulsa county residents accounted for 42% of
IPV-related homicide victims. However, the
highest rates of IPV-related homicides were
generally in the southeastern region of the state.
Five counties (McCurtain, Delaware, Pittsburg,
Craig, and LeFlore) were two or more times the
overall state rate (1.0 per 100,000). African
Americans had the highest rate of IPV-related
homicide compared to other races. The IPV-related
homicide rate among African American
females (3.6 per 100,000) was three times
higher than the rate among white females (1.2)
and 3.6 times higher than the rate among Native
American females (1.0). Among African
American males (2.2), the rate was 7.3 times
higher than the rate among Native American
males (0.3) and 4.4 times higher than the rate
among white males (0.5).
In 2002, the death to injury ratio among women
18 to 44 years of age for IPV was estimated at
one death for every 2,010 emergency
department visits for IPV injuries.
Bullying
In 2005, the Oklahoma State Department of
Health conducted a study to determine bullying
perceptions of Oklahoma students. Of the 7,848
students in third, fifth, and seventh grades who
completed a survey, 33% reported occasional,
often, or daily involvement in bullying. Twelve
percent of students were involved as a bully,
14% as a victim, and 7% as both a bully and a
victim. Students were physically bullied by being
pushed, hit, or having things taken away from
them often or daily (14%) or socially bullied by
name-calling, put downs, hurtful teasing, or being
purposely left out of a group often or daily (23%).
Eight percent of fifth and seventh graders were
sexually bullied frequently or daily by words,
touches, or gestures of a sexual nature. Sixty-nine
percent of seventh graders, 54% of fifth
graders, and 40% of third graders reported that
bullying was a weekly or daily occurrence at their
schools. Nearly two-thirds of students who were
frequently bullied and half of students who had
not been bullied indicated they would feel safer at
school if there was better adult supervision.5
PROGRESS
Funding
The Injury Prevention Service (IPS) receives
annual funding from the CDC to participate in
NVDRS. NVDRS funding may only be used for
surveillance activities. NVDRS funding is used to
maintain the Oklahoma Violent Death Reporting
System (OK-VDRS) and supports IPS
administrative and professional personnel
working on OK-VDRS. Funding is also used to
support a contract with the OSBI to provide law
enforcement data.
The IPS receives funding from the CDC through
the Rape Prevention Education (RPE) grant.
RPE grant funds are primarily used for
prevention activities. RPE funds are used to
support IPS administrative and professional
personnel working in rape prevention, four local
prevention programs, and training. Two percent
of RPE funds may be used for sexual assault
surveillance. These surveillance funds are used
to support sexual assault questions on the
annual Behavioral Risk Factor Surveillance
System survey.
Additionally, the IPS receives a portion of the
Preventive Health and Health Services Block
Grant (PHHSBG) for rape prevention. These
funds are statutorily allocated for rape services
and prevention. PHHSBG funds are used to
27
support a statewide prevention coordinator
contracted through the Oklahoma Coalition
Against Domestic Violence and Sexual Assault
(OCADVSA) and to fund additional rape
prevention activities.
From 1999 to 2004, the IPS received funding
from CDC to conduct intimate partner violence
surveillance. Currently, the IPS has no funding
for activities related to intimate partner violence
or for school violence/bullying prevention.
Publications
Peer-Reviewed Publications
 A comparison of two surveillance systems for
deaths related to violent injury. Injury
Prevention 2005;11:58-63.
 Epidemiology of homicide-suicide events–
Oklahoma, 1994-2001. Am J of Forensic
Medicine and Pathology September
2005;26(3):229-235.
 Evaluation of sensitivity and predictive value
positive of manner-of-death classifications by
using the Oklahoma Violent Death Reporting
System. (Submitted to Injury Prevention—not
released for distribution)
 Intimate partner violence. Journal of the
Oklahoma State Medical Association.
October 2000.
 Students’ perceptions of bullying in
Oklahoma public schools. Journal of School
Violence 2009;8:3,216-232.
 Suicide among persons 65 years and older,
Oklahoma, 2004. J Okla State Med Assoc
2008;101(11):267-270.
Other Publications
 Intimate partner violence injury–Oklahoma,
2002. MMWR 2005;54(41):1041-1045.
 Oklahoma Injury Facts. September 2003.
 Violence against women: an assessment of
Oklahoma’s response. January 2003.
 Violence against women: Oklahoma’s
strategic plan. January 2003.
Oklahoma Intimate Partner Violence Newsletters
 Oklahoma Intimate Partner Violence, A
Newsletter for Emergency Department
Surveillance, September 2000.
 Oklahoma Intimate Partner Violence, A
Newsletter for Emergency Department
Surveillance, October 2000.
 Oklahoma Intimate Partner Violence, A
Newsletter for Emergency Department
Surveillance, January 2001.
Summary Data Reports
 Fatal and Nonfatal Self-Inflicted Injuries in
Oklahoma, 2002-2004
 Injuries in Oklahoma, 2004
 Injuries in Oklahoma, 2005
 Injuries in Oklahoma, 2004-2006
 Intimate Partner Violence Injuries in
Oklahoma
 Oklahoma Violent Death Reporting System,
2004-2005
 Oklahoma Violent Death Reporting System,
2004-2006
 Suicide and Suicide Attempts in Oklahoma,
2002
 Summary of Reportable Injuries in
Oklahoma, 2002
 Summary of Reportable Injuries in
Oklahoma, 2005
 Summary of Violent Deaths in Oklahoma:
Oklahoma Violent Death Reporting System,
2004-2006
Injury Update Reports
 Assault in the Oklahoma City Metropolitan
Statistical Area
 Attempted and Completed Suicides,
Oklahoma, 2002
 Bullying Perceptions of Third, Fifth and
Seventh Grade Students in Oklahoma Public
Schools, 2005
 Firearms and Homicide
 Firearm-Related Spinal Cord Injuries in
Oklahoma, 1988-2002
 Gang-Related Homicides, Oklahoma, 2004-
2006
28
 Methamphetamine Laboratory-Related Fire
and Burn Injuries in Oklahoma, 1988-2002
 Oklahoma Violent Death Reporting System
 Suicide Among Persons 65 Years and Older,
Oklahoma, 2004
 Undetermined Manner Drug Poisoning
Deaths, Oklahoma, 2004-2006
 Violence-Related Deaths Among Youth 10-
24 Years, Oklahoma, 2004
 Violence-Related Deaths, Oklahoma, 1987-
2001
 Violence-Related Spinal Cord Injury,
Oklahoma, 1988-2000
 Violent Deaths in Custody, Oklahoma, 2004-
2006
 Work-Related Homicides, Oklahoma, 1998-
2004
Fact Sheets
 Adolescent Injury in Oklahoma
 Facts About Sexual Violence
 Firearm Injuries in Oklahoma
 Safety Around Firearms
 Suicide Warning Signs
 Youth Suicide
Pamphlets
 Are You Tired of Hiding in the Shadow of
Abuse?
Education and Planning
 Rape and Sexual Violence Prevention:
Strategic Planning Convening Summary
 Injury Prevention Works: Strategies for
Building Safe Communities
 State Assessment and Comprehensive Plan
for Sexual Violence Prevention
Collaboration
The IPS contracts with the OCADVSA to provide
a statewide prevention coordinator to facilitate
the Oklahoma Sexual Violence Prevention
Planning Committee (OSVPPC) and provide
ongoing training and technical assistance for
sexual violence prevention. The planning
committee meets on a quarterly basis.
Additionally, the IPS contracts with four local
domestic violence and sexual assault programs
to conduct local prevention programs.
The IPS partners with the Oklahoma State
Department of Health Vital Records, the Office of
the Chief Medical Examiner, the Oklahoma State
Bureau of Investigation, and the Oklahoma Child
Death Review Board to collect data for the OK-VDRS.
The Oklahoma Association of Chiefs of
Police assisted in the implementation of OK-VDRS
and continues to play a role by serving as
liaison to law enforcement and providing
leadership for the OK-VDRS advisory committee.
The OK-VDRS advisory committee was
established in 2003 to provide guidance on
surveillance and uses of the data. The advisory
committee meets on a semi-annual basis.
IPS personnel serve on the Oklahoma Child
Death Review Board and the Oklahoma
Domestic Violence Fatality Review Board.
Activities on these boards have included multi-organizational
collaborative projects aimed at
preventing child maltreatment and domestic
violence.
Currently, the IPS is collaborating with the
University of Oklahoma Health Sciences Center,
College of Nursing, Arizona State University, and
John Hopkins University School of Nursing on
the Oklahoma Lethality Assessment Study. This
research study will evaluate a police intervention
to prevent domestic violence injuries and deaths.
Programs
Rape Prevention Education
Currently, four domestic violence and sexual
assault programs (Tahlequah, Miami, Oklahoma
City, and Stillwater) have been funded to
develop, implement, and evaluate
comprehensive sexual violence prevention
programs in their communities. These local
programs are funded through the RPE grant.
Funding supports a full-time prevention specialist
29
to conduct activities in one or more of the
following areas: Pre-K through 12 schools,
colleges and universities, faith communities,
and/or media. Each program conducts activities
suited to their community and works with
community partners and stakeholders.
The state level RPE program focuses on
providing training and technical assistance for
primary prevention programming and building
capacity throughout the state. Several statewide
competency-based trainings and workshops on
primary prevention have been conducted,
including the University of North Carolina Injury
Prevention Research Center PREVENT team
training and workshops on specific evidence-based
or promising programs. Additionally, the
state-level RPE program, the statewide
prevention coordinator, and the OSVPPC worked
together to prepare a statewide assessment and
draft comprehensive plan to prevent sexual
violence in Oklahoma.
National Violent Death Reporting System
Oklahoma is one of 18 states participating in the
NVDRS. The OK-VDRS is a state-based
surveillance system. Data is collected from death
certificates, medical examiner reports, police
reports, and supplemental homicide reports and
compiled in a unique database maintained by
IPS. The data is de-identified and transmitted to
NVDRS on a regular basis. The NVDRS
database is maintained by CDC and is
accessible to the public through the Web-based
Injury Statistics Query and Reporting System
(WISQARS). The Oklahoma data is analyzed
and disseminated through an annual summary
data report, periodic Injury Update reports,
presentations, and special data requests.
Legislation
In 2006, the Task Force to Stop Sexual Violence
was created by House Resolution 1010 and
charged with studying funding for victim services,
development of prevention education programs,
and improving sexual assault investigations. As a
direct result of this task force, a bill was passed
requiring six hours of evidence-based sexual
assault training for police officers.
The definition relating to assault/battery, and
domestic abuse was modified in the 2009
legislative session. Another bill passed in 2009
modified reporting requirements for sexual
assault by health care professionals. Also passed
in 2009 was a bill requiring individuals found
guilty of domestic violence to submit to a DNA
test for law enforcement identification purposes.
A bill to develop a model dating violence policy to
assist school districts in developing policies for
dating violence reporting and response was
introduced in 2009. A bill requiring certain
agencies to produce informational materials
related to emergency contraception was also
introduced in 2009. Both of these measures
became dormant.
GOALS/OBJECTIVES
Goals
 Improve surveillance of all forms of violence
to support violence prevention programs in
Oklahoma.
 Increase the number of organizations that
are involved in preventing intimate partner
and dating violence, sexual violence, youth
violence and bullying.
 Improve cultural influences and interactions
that promote healthy non-violent
relationships through training, technical
assistance, and information dissemination.
Objectives
 Maintain the OK-VDRS through 2013.
 Disseminate data and reports on violent
deaths in Oklahoma through 2013.
 Maintain partnerships, data use agreements,
and contracts with state and local-level
30
organizations involved in violence
surveillance and violence prevention
programming through 2015.
 Conduct local sexual assault and intimate
partner violence surveys by 2015.
 Implement, review and revise, as needed, the
Comprehensive Sexual Violence Prevention
Plan for Oklahoma by 2011.
 Provide training for RPE-funded programs,
community organizations, providers and other
stakeholders on evidence-based practice and
research-based curricula for sexual violence
prevention through 2013.
 Provide training and build capacity for Pre-K
through 12 schools, colleges and
universities, and faith communities to provide
education on healthy relationships and dating
and sexual violence prevention through
2012.
 Partner with organizations to address
bullying prevention in schools by 2015.
 Provide data and technical assistance to
communities on intimate partner and sexual
violence through 2015.
 Participate on the Child Death Review Board
and Domestic Violence Fatality Review
Board through 2015.
ACTION PLAN
 Collect violent death data from death
certificates, medical examiner reports,
police/law enforcement and crime laboratory
reports, supplementary homicide reports, and
child fatality review records through 2013.
 Determine feasibility of electronically importing
data from other agencies by 2010.
 Maintain the OK-VDRS Advisory Committee
through 2013.
 Monitor the incidence and characteristics of
violent deaths in Oklahoma through 2013.
 Maintain data quality assurance for the OK-VDRS
including systematic review of data
accuracy, completeness, consistency
between reporting sources, and timeliness
through 2013.
 Evaluate the OK-VDRS surveillance system
according to CDC standard guidelines for
evaluating public heath surveillance systems
through 2013.
 Prepare reports on violent death data and
widely disseminate to stakeholders through
2013.
 Maintain working relationships with the OK-VDRS
data contributors including the Office
of the Chief Medical Examiner, Oklahoma
State Department of Health Vital Records,
Oklahoma State Bureau of Investigation,
Oklahoma Child Death Review Board, and
the Oklahoma Association of Chiefs of Police
through 2013.
 Collect quality data on rape and sexual
assaults from multiple data sources to
monitor prevalence and incidence and
support evaluation efforts by 2013.
 Collect data on intimate partner violence
homicides through the OK-VDRS by 2013.
 Provide copies of Medical Examiner reports
and death certificate data to the Oklahoma
Domestic Violence Fatality Review Board
and the Jail Death Reporting System through
2015.
 Work with the Oklahoma State Department
of Health School Health and Adolescent
Health Programs to support agency efforts to
address bullying prevention in Oklahoma
schools through 2015.
 Maintain the Oklahoma Sexual Violence
Prevention Planning Committee and conduct
quarterly meetings through 2010.
 Maintain working relationships with the
Oklahoma Coalition against Domestic
Violence and Sexual Assault, local RPE-funded
programs, and Oklahoma Attorney
General’s Office through 2015.
 Maintain affiliation with the University of
Oklahoma Health Sciences Center College
of Public Health and College of Nursing and
participate in educational and research
activities to increase the knowledge base
regarding violence through 2015.
31
 Attend quarterly meetings between the IPS
and Maternal and Child Health to collaborate
on adolescent health programs related to
healthy relationships, teen dating and sexual
violence prevention, school violence, and
bullying through 2015.
 Attend Child Death Review Board and
Domestic Violence Fatality Review Board
meetings monthly through 2015.
 Conduct training and distribute educational
materials on intimate partner violence and
sexual violence to health care providers and
other organizations through 2015.
32
REFERENCES
1Centers for Disease Control and Prevention. National Violent Death Reporting System. Accessed 3
September 2009, from: http://www.cdc.gov/ViolencePrevention/NVDRS/index.html.
2Injury Prevention Service, Oklahoma State Department of Health and Information Services Division,
Oklahoma State Bureau of Investigation. Summary of Violent Deaths in Oklahoma: Oklahoma Violent
Death Reporting System, 2004-2006. August 2008.
3Centers for Disease Control and Prevention. Violence Prevention. Accessed 3 September 2009, from:
http://www.cdc.gov/ViolencePrevention/index.html.
4Bureau of Justice Statistics, U.S. Department of Justice. Intimate Partner Violence in the U.S. Accessed 9
October 2009, from: http://www.ojp.usdoj.gov/bjs/intimate/victims.htm.
5Injury Prevention Service, Oklahoma State Department of Health. Bullying Perceptions of Third, Fifth and
Seventh Grade Students in Oklahoma Public Schools, 2005.
6Centers for Disease Control and Prevention. Understanding School Violence Fact Sheet. Retrieved 9
October 2009, from: http://www.cdc.gov/ViolencePrevention/youthviolence/schoolviolence/index.html.
7Injury Prevention Service, Oklahoma State Department of Health and Oklahoma Coalition Against
Domestic Violence and Sexual Assault. State Assessment and Comprehensive Plan for Sexual Violence
Prevention in Oklahoma. July 1, 2009.
8Injury Prevention Service, Oklahoma State Department of Health. Injuries in Oklahoma, 2004-2006.
33
Unintentional Falls
BACKGROUND
National
Unintentional fall-related death rates among older
adults have risen significantly over the past few
decades in the United States. In 2004, over 80% of
fall-related fatalities were among persons 75 years
of age and older. The following year, approximately
16,000 persons 65 years of age and older died
from fall-related injuries, and nearly two million
were treated in emergency departments. Men have
a higher fatality rate than women as a result of a
fall, while women are more likely than men to have
a nonfatal injury. In the United States, one in three
adults 65 years of age and older fall each year.
Twenty percent to 30% of older adults who fall
suffer moderate to severe injuries, including
bruising, hip fractures, head injuries.1
Among children birth to 19 years of age, falls are
the leading cause of non-fatal injury. Nearly 2.8
million children are treated in hospital emergency
rooms for fall-related injuries in the United States
each year – approximately 8,000 every day.2
Oklahoma
Oklahoma has had increasingly high rates of fall-related
injuries. The risk of injury increases with
age, particularly for persons 65 years of age and
older. Falls are the leading cause of injury death
for persons 65 years of age and older in
Oklahoma. From 2004 to 2006, 223 Oklahomans
died each year as the result of an unintentional
fall. The majority of deaths were among males
(54%). Seventy-five percent of unintentional fall-related
deaths occurred among persons 65 years
of age and older. Fall-related fatalities among
children and adolescents were less common,
accounting for 2% of the total deaths.
There were approximately 8,900 fall-related
hospitalizations each year, and hospitalizations
increased 11% between 2004 and 2006. Seventy-two
percent of hospitalizations were among those
65 years of age and older. Females 55 years of
age and older had higher hospitalization rates
associated with fall injuries than males (two times
higher than males).3
PROGRESS
Funding
Currently, the Injury Prevention Service (IPS)
does not receive specific funding for fall
prevention activities.
Publications
Peer-Reviewed Publications
 Epidemiology of severe traumatic brain injury
among persons 65 years of age and older in
Oklahoma, 1992-2003. Brain Injury June
2007;21(7):691-9.
 Spinal cord injuries due to falls from hunting
tree stands in Oklahoma, 1988-1999. Journal
of the Oklahoma State Medical Association
2004;97(4):154-157.
Other Publications
 Profile of Fall-Related Injuries in Oklahoma,
2006
Summary Data Reports
 Epidemiology of Falls and Falls-Related
Injuries Among Persons 65 Years and Older,
Oklahoma, 2006
 Injuries in Oklahoma, 2004
 Injuries in Oklahoma, 2005
 Injuries in Oklahoma, 2004-2006
34
 Profile of Fall-Related Injuries in Oklahoma,
2003
Injury Update Reports
 Fall-Related Traumatic Brain Injuries among
Oklahomans 65 Years and Older, 2005
 Traumatic Brain Injuries Resulting from Falls
on Stairs/Steps in Oklahoma, 1992-2003
 Fall-related Traumatic Brain Injuries among
Adults 65 Years of Age and Older,
Oklahoma, 1992-2003
Fact Sheets
 Children’s Safety Sheets
 Fall Prevention for Older Adults
 Fall Prevention for Young Children
Education and Planning Materials
 Injury Prevention Works: Strategies for
Building Safe Communities
Collaboration
Using data from the epidemiologic profiles, a review
of literature, and publications from the Centers for
Disease Control and Prevention (CDC) and the
State and Territorial Injury Prevention Directors
Association (STIPDA), the Injury Prevention
Service (IPS) is assessing and promoting projects
to reduce falls among persons 65 years of age and
older. The IPS will continue to collaborate with
agencies to disseminate information on the risks
and prevention of falls among older adults.
In 2009, the IPS worked with the Pottawatomie
County Health Department to identify elderly falls
as one of the leading causes of injury in the City
of Shawnee, Oklahoma. The IPS will continue to
work with this community to identify, implement,
and/or evaluate fall prevention programs in the
community as a component of the Safe
Communities America project. Detailed data are
being collected on fall-related hospitalizations for
Shawnee residents 65 years of age and older.
Nationally, a number of strategies are in place to
help reduce falls, such as risk assessments and
both focused and multifactor interventions. The
IPS has provided assistance to the Pottawatomie
County Health Department and other community
partners to review these strategies and
determine which interventions will best meet the
needs of the older adult population in Shawnee.
The IPS will continue to collaborate with
community agencies/organizations to develop
and/or evaluate fall prevention programs for older
adults. Similar fall prevention projects will be
expanded to include other communities.
The IPS plans to sponsor a symposium on fall
prevention among older adults, 65 years of age
and older in the Spring of 2010. The anticipated
target audience for the symposium includes
county health departments, senior centers,
community centers, faith-based organizations,
Turning Point partners, Mobile Meals/Meals on
Wheels, physicians, American Association of
Retired Persons (AARP), Areawide Aging and
district Area Agencies on Aging, additional
community organizations that work closely with
persons 65 years of age and older, and other
interested audiences.
GOALS/OBJECTIVES
Goal
 Collect relevant data and provide educational
information to reduce fall-related injuries and
deaths.
Objective
 Reduce unintentional fall-related injury
deaths among persons 65 years of age and
older by 10% by 2015.
Baseline: 2006 CDC WISQARS data for
Oklahoma: falls among persons 65 years of
age and older=39.23 per 100,000 population.
35
ACTION PLAN
 Prepare and disseminate fact sheets, data
reports, and news releases as appropriate
through 2015.
 Disseminate fall-related information to county
health departments, senior centers, faith-based
organizations, Turning Point partners,
community programs such as Mobile Meals,
physicians, and other identified interested
and appropriate audiences through 2015.
 Collect fall-related injury and death data
through 2015.
 Sponsor a symposium on fall prevention
among older adults, 65 years of age and
older by 2010.
 Continue to support the City of Shawnee,
Oklahoma with fall prevention efforts and
expand efforts to other communities through
2015.
36
REFERENCES
1Centers for Disease Control and Prevention. Falls Among Older Adults: An Overview. Retrieved 1 October
2009, from: http://www.cdc.gov/HomeandRecreationalSafety/Falls/adultfalls.html.
2Centers for Disease Control and Prevention. Protect the Ones You Love: Falls. Retrieved 1 October 2009,
from: http://www.cdc.gov/SafeChild/Falls/default.htm.
3Injury Prevention Service, Oklahoma State Department of Health. Injuries in Oklahoma, 2004-2006.
37
Public Health Preparedness and Response
BACKGROUND
National
The Centers for Disease Control and
Prevention’s (CDC) efforts in infectious disease
have evolved in the last several years from
addressing malaria control to global smallpox
eradication to containing the West Nile virus. The
agency’s focus has recently expanded to include
emerging infections and bioterrorism. The CDC’s
mission in public health preparedness and
response is to lead the effort in enhancing
readiness to detect and respond to bioterrorism
attacks and other public health emergencies,
including man-made and natural disasters.1
In order to protect communities in the United
States from infectious, occupational,
environmental, and terrorist threats, the agency
has included preparation for emerging health
threats under its Health Protection Goals. In
preparation for public health disasters, the CDC
will contribute to preparation and prevention
efforts of national, state, and local entities, and
will support partners at these three levels to
improve public health outcomes when a disaster
occurs. The CDC will also assist national, state,
and local efforts to recover and restore public
health functions after a disaster has occurred.2
The CDC developed a coordinated plan to
improve preparedness and response at the local,
state, and federal levels. The initiative includes
enhancing the capacity for detection, diagnosis,
and management of disease outbreaks;
improving the characterization and identification
of causative pathogens, toxins, or selected
chemical exposures; strengthening the public
health response capacities to control and contain
such emergencies; and improving the information
technology infrastructure to rapidly transfer data
and information necessary to prepare and
respond to such events. The goal is to ensure
that the United States has the appropriate
capacities for bioterrorism preparedness and
response for public and private health care
systems. These strategies will enable public
health and health care professionals to detect
and respond to incidents quickly, strengthening
the ability to identify and control emerging
infectious diseases, injuries, and other
emergencies as needed.1
Oklahoma
Oklahoma has faced several injury-related
disasters that have tested its capacity for public
health preparedness and response at state and
local levels. Events such as the 1995 bombing of
the Oklahoma City Alfred P. Murrah Federal
Building, the 1999 and 2003 Oklahoma tornado
outbreaks, the 2002 Interstate 40 bridge
collapse, and the 2007 ice storms have made the
need for a coordinated response to terrorism and
other public health emergencies a priority.
The State of Oklahoma is divided into eight
public health or homeland security regions so
that public health and medical system planning
efforts are carried out efficiently. Each region is
made up of a Regional Homeland Security
Advisory Council, a Regional Medical Planning
Group, and a Regional Trauma Advisory Board.
Each of these entities are comprised of local,
regional, and state public health personnel, and
authorized to develop regional medical system
response plans as well as protocols to establish
coordinated public health and medical system
responses at each response level (Tier I, II, III,
IV, and V).3
The purpose of Oklahoma’s public health
preparedness program is to develop emergency
ready public health departments by upgrading,
integrating, and evaluating state and local public
38
health jurisdictions’ preparedness for and
response to terrorism, pandemic influenza, and
other public health emergencies with federal,
state, local, and tribal governments, the private
sector and non-governmental organizations. The
emergency preparedness and response efforts
are designed to support the National Response
Plan and the National Incident Management
System.4
The program is based on the CDC’s
preparedness goals to prevent, detect and report,
investigate, control, and recover from public
health disasters and improve strategies:
 Increase the use and development of
interventions known to prevent human illness
from chemical, biological, and radiological
agents as well as naturally occurring health
threats.
 Decrease the time needed to classify health
events as terrorism or naturally occurring
health threats in partnership with other
agencies.
 Decrease the time needed to detect and
report chemical, biological, or radiological
agents in tissue, food, or environmental
samples that cause threats to the public’s
health.
 Improve the time and accuracy of
communications regarding threats to the
public’s health.
 Decrease the time needed to identify causes,
risk factors, and appropriate interventions for
those affected by threats to the public’s
health.
 Decrease the time needed to provide
countermeasures and health guidance to
those affected by threats to the public’s
health.
 Decrease the time needed to restore health
services and environmental safety to pre-event
levels.
 Improve the long-term follow up provided to
those affected by threats to the public’s
health.
 Decrease the time needed to implement
recommendations from after action reports
following threats to the public’s health.
Oklahoma also implements the National Incident
Management System (NIMS). NIMS provides
consistent methodology for federal, state, tribal,
and local governments to collaborate effectively
and efficiently to prepare for, prevent, respond to,
and recover from domestic incidents, regardless
of cause, size, or complexity.4
Under the Emergency Operations Plan (EOP), the
State of Oklahoma is required to establish
procedures in response to the health, medical,
and environmental needs of the State in the event
of a man-made or natural public health
emergency. The Commissioner of Health is
responsible for coordination of all state health and
medical services in response to public health
emergencies. The Commissioner may mandate
injuries due to any condition as reportable for
special study, allowing access to hospital medical
records and Medical Examiner reports. The extent
of medical and health services will depend on the
size and type of disaster. The Oklahoma State
Department of Health collaborates with various
support agencies and medical system partners in
order to respond to the health and medical needs
of Oklahomans. Injury Prevention Service
personnel will assist in the event of a public health
emergency as needed. The Commissioner of
Health will also inform the Governor, Director of
Emergency Management, and Director of the
Oklahoma Office of Homeland Security of medical
and health services during emergency operations.
Emergent health-related information is distributed
to healthcare providers and public health
partners through an emergency communications
system known as the Oklahoma Health Alert
Network (OK-HAN) system. Message distribution
is via facsimile, telephone, and/or email. OK-HAN
is a secure website which enables registered
medical and public health personnel the ability to
view and share information, and update their own
39
professional and personal information in a secure
format to ensure delivery of notifications.
Tornadoes
Oklahoma has the highest concentration of the
most severe tornadoes per square kilometer in
the United States, and ranks second in the total
number of tornadoes. Nearly 55% of all
tornadoes in the United States occur between
April and June; approximately 80% occur
between noon and midnight, with the majority
occurring between 3:00 p.m. and 9:00 p.m.
According to the National Severe Storms
Laboratory in Norman, Oklahoma, 59 tornadoes
touched down on the evening of May 3, 1999.
Twelve Oklahoma communities suffered
damage, injuries, and/or deaths as a result.
Forty-five persons were killed and nearly 600
survivors were directly or indirectly injured in the
tornadoes. Approximately half of the injured
population was female, and one-third of injured
persons were 35 to 54 years of age. The most
common types of injuries were soft tissue
injuries, such as cuts, scrapes, bruises (81%);
fractures and dislocations (25%); and brain
injuries (20%). Thirty persons, including nine
children, suffered serious traumatic brain injuries
with a potential for long-term disabilities.
Common causes of injury among survivors
included flying or falling debris; being picked up
or blown by a tornado; collapsing walls, ceilings,
or roofs; and flying or falling wood or boards.5
Five tornadoes occurred between May 8 and
May 9, 2003 in Oklahoma. The May 2003
tornadoes resulted in $405 million in property
damage. There was one death and 91 persons
were treated for injuries. Sixty-nine percent of
Oklahomans with tornado-related injuries were
injured directly in the tornado, 8% while preparing
for the tornado, 4% were injured during tornado
cleanup or search and rescue, and the
mechanism of injury was unknown for 19% of
persons. Eighty-four percent of injured persons
were 25 years of age and older. The most
common types of injuries were soft tissue injuries
(87%); followed by fractures and dislocations
(21%); strains and sprains (21%); brain injuries
(9%); and foreign bodies (8%).6
During both the tornado disasters of 1999 and
2003, the Oklahoma Commissioner of Health
declared tornado-related deaths and injuries
reportable conditions, and investigations of
tornado-related injuries were conducted by the
Oklahoma State Department of Health, Injury
Prevention Service. Information from medical
records was collected, Medical Examiner reports
were reviewed, and community field surveys
were conducted.
Preparation is the most important measure that
could potentially decrease the incidence and
severity of tornado-related injuries. Other
prevention measures include:
 Develop an effective tornado preparedness
plan before a tornado alert.
 Activate a tornado preparedness plan as soon
as possible when a tornado warning is issued.
 Keep an emergency kit on hand with weather
band radio, flashlight, first aid supplies,
medications, important documents, keys, and
a whistle to blow for help.
 Check on the elderly, children, and pets
when a tornado watch has been issued.
 Evacuate mobile homes and motor vehicles
immediately when a tornado warning is
issued and find appropriate shelter.
 Be aware of the nearest accessible storm
shelter, safe room, or know the safest place
to take shelter in a home/building in the
event of a tornado.
 Protect the head with a helmet, if available,
and protect the body from debris with
blankets, heavy clothing, mattress, pillows,
and/or sturdy shoes.
 After a tornado, exit damaged areas with
caution and do not enter an evacuated area.
Stay clear of downed power lines, sparks,
fires, gas leaks, loose debris, and other
harmful materials.5,6
40
Winter Storm
In mid-January 2007, a severe winter storm
moved through Oklahoma over the course of four
to five days. Ice formed on trees, power lines,
and roadways causing downed trees, extensive
power outages, and hazardous travel conditions.
Approximately 122,000 Oklahomans were
without electricity and 10,000 were still without
electricity two weeks after the storm began. The
Oklahoma Highway Patrol responded to nearly
400 highway traffic collisions in the first three
days of the winter storm. All 77 Oklahoma
counties were under federal emergency
declaration and 44 counties became eligible for
disaster public assistance funds. Over 900
persons were housed in shelters and more than
63,000 meals were served to persons during this
time. The winter storm of 2007 cost Oklahoma
more than $39 million.
In the chaos and confusion of disasters,
unintentional injuries are more likely to occur.
Prevention of injuries in disaster victims and
evacuees is a primary function of the state and
local public health departments during times of
disaster. Some of the types of injuries that will
occur in disasters are unique while many
mechanisms are more commonplace.
The Oklahoma Commissioner of Health declared
winter storm-related injuries a reportable
condition, and emergency departments and the
Medical Examiner were asked to track injuries
associated with the storm between January 12
and January 30, 2007. The Oklahoma State
Department of Health, Injury Prevention Service
collected information on more than 6,000 storm-related
injury cases from 143 Oklahoma
hospitals.
Falls, motor vehicle crashes, and sledding
accounted for 95% of injuries to persons injured
during the winter storm. The majority of persons
injured were between the ages of 20 and 29, and
the highest rate of injuries occurred among
persons 30 to 39 years of age. Approximately
half of the injured population was male and half
was female. Fifty-two percent were injured at a
home or on a farm, and 34% were injured on a
roadway. The most common types of winter
storm-related injuries were superficial (32%),
sprains and strains (29%), and fractures and
dislocations (21%). There were 44 injury deaths
associated with the winter storm. Males had a
higher risk of deaths than females (2.7 times
higher), and there were no significant differences
in deaths among racial/ethnic groups or age
groups.7
During the winter storm in January 2007, 66
Oklahomans were treated for carbon monoxide
(CO) poisoning, and 96% of these injuries
occurred in the home. CO poisoning had the
second highest hospitalization rate of all injuries.7
CO poisoning occurs when carbon monoxide, an
odorless, colorless, poisonous gas, is inhaled in
significant concentrations causing illness and/or
death. It is commonly reported after major power
outages resulting from natural or man-made
disasters. When alternative sources of fuel or
electricity are used for heating, cooling, or
cooking during these events, CO can build up
quickly in enclosed or partially enclosed areas.8
During a subsequent winter storm in December
2007, two persons died from CO poisoning
caused by a generator.
It is important to provide carbon monoxide
poisoning prevention information to the public
before a power outage occurs. To prevent CO
poisoning:
 Install battery-powered CO detectors in the
home.
 Properly install, maintain, and operate all
fuel-burning appliances.
 Check and clean fireplace chimneys and
flues at least once a year.
 Keep generator outdoors and pressure
washers an appropriate distance away from
windows, doors, and vents while in use.
 Do not use generators, pressure washers,
charcoal grills, camp stoves, or other
41
gasoline/charcoal-burning devices inside the
home, basement, or garage; and do not use
gas ovens or stoves to heat the home.
 Do not leave motor vehicles running inside a
garage attached to the home, even if the
garage door is open.
 Seek immediate medical attention if CO
poisoning is suspected.9,10
Evacuation Centers
At particular risk of injury during and after
disasters are vulnerable populations, including
children, elderly, mentally ill, hospitalized, drug
addicted, etc. At no time in our nation's history
was this more evident than the weeks after August
29, 2005 when Hurricane Katrina made landfall
along the coastal regions of Louisiana and
Mississippi. Not only were the vulnerable
populations of New Orleans exposed to a
dangerous and highly injurious environment in and
around the floodwaters, but they were often
moved to shelters without injury prevention
programs in place to deal with their unique needs.
In the aftermath of Hurricane Katrina, the
Oklahoma State Department of Health directed
the operations of Oklahoma's primary evacuee
center at Camp Gruber. Several ad hoc injury
prevention programs were staged during this time
for the pediatric population. One such program
identified and reunited children who had been
separated from their family members. This
program partnered with the National Center for
Missing and Exploited Children and successfully
reunited 36 children with their legal guardians.11,12
Another injury prevention program focused on
childhood injuries most likely to occur to child-evacuees
in a military base setting. This program
dubbed, "Operation Child-Safe," teamed with the
local Safe Kids chapter to identify and remove
pediatric injury hazards from the camp. Hazards
such as dangerous chemicals, choking hazards,
electrical outlets, missing smoke detectors, auto
pedestrian dangers, inadequate car seats and
many others were identified and corrected.13 No
major injuries occurred to the nearly 300 Camp
Gruber child-evacuees during camp operations.
PROGRESS
Publications
The Injury Prevention Service (IPS) and
Oklahoma State Department personnel have
authored or contributed to many journal articles
relating to injuries and fatalities resulting from the
bombing of the Oklahoma City federal building
and other disasters in Oklahoma. Summary data
reports, Injury Updates, fact sheets and other
emergency preparedness articles were also
prepared (listed below).
Peer-Reviewed Publications
 Comparing reactions to two severe
tornadoes in one Oklahoma community.
Disasters 2005;29(3):277-287, Overseas
Development Institute, 2005.
 Factors associated with injury severity in
Oklahoma City bombing survivors. Journal of
Trauma 2009;66:508-515.
 Fatal and non-fatal injuries among U.S. Air
Force personnel resulting from the terrorist
bombing of the Khobar Towers. Journal of
Trauma 2004;57(2):208-215.
 Get off the bus: sound strategy for injury
prevention during a tornado? Prehospital and
Disaster Medicine 2005;20(3).
 Glass-related injuries in Oklahoma City
bombing. Journal of Performance of
Constructed Facilities 1999;13(2):50-56.
 Injury perceptions of bombing survivors:
interviews from the Oklahoma City bombing.
Prehosp Disaster Med 2009:23(6):500-506.
 Non-fatal bombing injuries: trends in severity
among Oklahoma City bombing survivors.
J Trauma 2009;66:508-515.
 Non-fire carbon monoxide-related deaths,
Oklahoma 1994-2003. Journal of the
Oklahoma State Medical Association
2007;100(10):376-9.
42
 Ocular injuries sustained by survivors of the
Oklahoma City bombing. Ophthalmology
2000;107(5):837-843.
 Planning + Practice = Preparedness: a case
study in injury prevention. Work
2004;23(3):199-204.
 Preventing fatalities in building bombings:
What can we learn from the Oklahoma City
bombing? Disaster Medicine and Public
Health Preparedness July 2007(1);27-31.
 Risk for tornado-related death and injury in
Oklahoma, May 3, 1999. American Journal of
Epidemiology 2005;161(12):1144-1150.
 Tornado-related deaths and injuries in
Oklahoma due to the May 3, 1999 tornadoes.
Weather and Forecasting, 2002;17(3):343-353.
 Winter storm-related injuries in Oklahoma –
January 2007 (Pending publication)
Other Publications
 Epidemiology of blast injuries. Protecting
people in buildings from terrorism:
technology transfer for blast-effects
mitigation. Committee for Oversight and
Assessment of Blast-effects and Related
Research. National Research Council.
National Academy Press. 2001.
 Funnel vision: practice and preparation save
1,200 GM employees from a tornado.
Safety+Health 168(3):44-50 (September
2003).
Summary Data Reports
 Summary of Reportable Injuries: Oklahoma
City Bombing Injuries
Injury Update Reports
 Carbon Monoxide-Related Deaths,
Oklahoma, 1994-2003
 Flood-Related Deaths in Oklahoma, 1998-
2000
 Injuries Treated in Hospitals Following the