Harlem Hospital Center, a level I trauma center in northern Manhattan, started a Pediatric Trauma Service with a Pediatric Trauma Registry in 1975. It is the only designated Pediatric Trauma Service serving the 94,000 children in northern Manhattan. In 1984, the Pediatric Trauma Service with the Columbia University School of Public Health began an ongoing, population-based survey of injury to children in northern Manhattan, called the Northern Manhattan Injury Surveillance Study. The study gathered data from emergency departments, outpatient clinics, and school health rooms. The study revealed that children are seriously hurt and killed in traffic as passengers, pedestrians, and bicyclists, and they suffer injuries and death from burns, drowning, poisoning, choking, firearm injuries, and falls. The national injury rate for children is 656 per 100,000 population; the northern Manhattan rate was almost twice that at 1141. Injury types and rates were documented and the Harlem Hospital Injury Prevention Program (IPP) was established.

GOALS AND OBJECTIVES

In 1988, the Harlem Hospital Injury Prevention Program was started with a grant from the Robert Wood Johnson Foundation in order to reduce injury to the community children. Several approaches are used: changes in community social and physical environment, local awareness of the problems, and individual knowledge through education and training.

STRATEGIES AND ACTIVITIES

The program is involved in many activities in the community, including:

• Renovating all area public parks
• Building playgrounds with private funds for elementary schools
• Establishing dance and art programs at the hospital
• Developing programs to involve students, parents, and community members in gardening at schools and in public parks
• Educating the community in positive traffic safety behavior such as pedestrian and bicycle safety, occupant protection and child safety seat use, and non use of alcohol and drugs.

These strategies are designed to encourage positive activities and traffic safety behavior in these areas and discourage use for illicit purposes.

RESULTS

The Harlem Hospital Injury Prevention Program has shown a positive effect in virtually every aspect of its operation, including:

• Hospital admissions for major injuries to children have been reduced by 32 percent
• Admissions of injured children from Harlem have been reduced by 42 percent
• Motor vehicle-pedestrian, bicycle, and playground injuries dropped 50 percent
• Gun shot injuries have been reduced by 20 percent
• Stab wounds and assaults have gone down by 28 percent
• Falls from windows were virtually eliminated
• From 1992 to 1994, of the more than 600 children who participated in the KISS (Kids In Safety Seats) program, none were admitted for injuries.