Medical/Clinical Study: Environmental, Personal, and Behavioral Risk Factors Associated with Event-Related Fatal and Non-Fatal Injuries

Goals:

Study the association between risk and protective factors and event-related fatal and nonfatal injuries. Obtain relative risks for environmental, behavioral, and personal factors identified in the previous descriptive study.

Who would use the data?

Medical and public health professionals, and other community policymakers and planners who must prepare for future mass casualty events.

Example:

Mallonee S, Shariat S, Stennis G, Waxweiler R, Hogan D, Jordan F. Physical injuries and fatalities resulting from the Oklahoma City bombing. JAMA 1996;276(5):382-7.

Research questions

• What risk factors are associated with injury or death? What protective factors are associated with surviving or not being injured?
• What is the extent of long-term injury, impairment and disability directly attributable to the event? What are the risk factors associated with these outcomes?
• What treatment-related factors were associated with adverse outcomes? For example, length of time to receive medical assistance, initial care received, location of initial care, location of follow-up care, type of treatment received.

Methods:

• Target population: Victims directly impacted by the event
• Study design: Case-control study. Record abstraction, other data collection as needed; personal interviews with cases; personal interviews with controls identified through area surveys (e.g., house-to-house, random-digit-dial), employment lists, etc.
• Sample plan: Case-control study. Cases will be victims included in the victim registry or identified through previous descriptive studies. All cases or a sample of the cases will be selected depending on the number of victims. Controls will be randomly selected from uninjured people in the study area. The study area will need to be defined and may be a building, neighborhood, town, or region depending on the event.

Data sources:

• Primary data source: Hospital EDs, EMS, ME, private clinic records; survey interviews
• Secondary data source: Red Cross, DMAT teams, newspaper searches

Sample variables:

Age, race/ethnicity, sex, type of injury, fatal or non-fatal, cause of injury, specific mechanism of injury, source/location of initial care, source/location of follow-up care, hospitalized or released, location when injured or killed, activity at time of injury, work-relatedness, objects/substances involved, time of day injured, long term injury, disability, lost activity days, length of time to receive treatment, initial medical assistance received, type of treatment received.

Time frame:

Two weeks to four years after event.

Potential partners/collaborators:

• State and local health departments and hospitals
• Local university researchers, especially schools of public health
• CDC, NCIPC staff

IRB needed:

Depends upon how the data are used.