Highlights | Injury and violence prevention
- Emergency room visits due to injury or violence account for 38 million encounters annually.
- Harborview Injury Prevention and Research Center (HIPRC) is working to change that.
- The interdisciplinary group is working on initiatives to improve safety around drowning, firearms and schools.
- Educational efforts train the next generation of injury and violence prevention experts.
- Nationwide, most health-related conversations about disability or death focus on cardiovascular disease or cancer. But these discussions largely overlook another significant reason for hospitalizations and medical service deliveries: injury and violence.
The Harborview Injury Prevention and Research Center (HIPRC), a joint venture founded in 1985 between Harborview Medical Center and UW School of Medicine, is actively working to turn the tide on injury and violence rates. To do so, this interdisciplinary group implements research and prevention programs designed to decrease injury risk.
“Our mission to prevent injury and violence is grounded in principles of equitable practice,” says Monica Vavilala, MD, director of HIPRC. “We gather and generate information and translate it into programs that offer community benefits — initiatives that actually improve the human condition.”
Improving human equity in injury and violence prevention has been a top priority for HIPRC. Recently, the center launched several new initiatives around drowning, firearm safety, school safety, and education. These initiatives are strategic in identifying equity gaps in injury and violence prevention and working within the communities most affected to improve health outcomes.
The widespread injury and violence problem
Worldwide, injuries due to accidents or violence are pervasive. According to the World Health Organization, these injuries account for 8% of all global deaths and 10% of all disabilities.
In the United States, the numbers are equally alarming. Across the country, accidents or violence makes up a substantial portion of emergency room (ER) visits: roughly 38 million encounters yearly. Of those patients, approximately 278,000 die.
Sadly, children, older adults, people of color and residents of rural areas are disproportionately affected. HIPRC’s efforts focus on reducing their risks.
Gathering evidence to prevent drowning
Every year, according to the Centers for Disease Control and Prevention (CDC), 4,000 people die from unintentional drowning — roughly 11 people daily. An additional 8,000 experience nonfatal drownings (almost 22 people each day). Many are children. In the U.S., between ages 1 and 4, unintentional drowning is the leading cause of death, and between ages 5 and 14, it’s the second leading cause. Among other factors, the CDC also finds that there are disparities among some racial and ethnic groups. For example, American Indian or Alaska Native people (ages 29 and younger) have two times higher drowning death rates than white people, and Black people have 1.5 times higher drowning death rates when compared to white people.
HIPRC partnered with Seattle Children’s Hospital in 2022 to reduce these deaths, focusing on two goals. First, it establishes and deepens relationships with communities of color and various organizations dedicated to water safety. Currently, no culturally resonant best practices around swimming exist in these communities. Researchers are targeting strategies that may prevent drowning.
Additionally, Vavilala says, HIPRC faculty are working with public health practitioners, water safety experts, drowning prevention experts and people who have experienced drowning to create a practical toolkit to prevent drowning at swimming pools and bodies of open water. They hope to share the toolkit within the year.
Promoting firearm safety
In Washington state, firearm safety is a critical issue. Every year, more than 780 people are killed by guns — 75% of those deaths are suicides. Currently, gun violence is the state’s No. 1 cause of death among children and teens. HIPRC has implemented several safety interventions to reduce those numbers.
“We’re trying to identify people at risk for firearm-related suicide and homicide,” says Vavilala. “We’re working to increase awareness with partners interested in talking with us, such as law enforcement and injury and violence prevention organizations that work with departments of health. Overall, we’re promoting safe practices.”
Together, they have created three toolkits:
Extreme Risk Protection Orders (ERPOs): This resource guides families and law enforcement through the process of obtaining a civil order that restricts an individual’s ability to buy and possess a firearm when there is a concern that they may harm themselves or others.
Firearm Safe Storage: Currently, only 36% of Washington gun owners practice safe firearm storage. This toolkit provides a list of secure storage options available throughout the area and recommendations for transporting a firearm to a safe storage facility.
Voluntary Do-Not-Sell: Individuals and their families concerned about suicide risk can ask to be placed on a Do-Not-Sell list restricting immediate access to firearm purchases. The goal is to reduce impulsive suicide attempts, and this resource details where and how to sign up.
Creating safer schools
While gun violence is currently the top school safety issue, it isn’t the only problem, Vavilala says. Bullying and psychological safety are still significant concerns.
“The psychological component of school safety, particularly among communities of color, has been relatively underappreciated because of concerns of disparate treatment,” she says. “We have a real problem with the school-to-prison pipeline for certain communities. So there’s a significant need for culturally resonant interventions to de-escalate issues, prevent criminalization and improve school safety.”
To address this need, HIPRC, in partnership with the University of Washington Population Health Initiative, created a program to reform how school resource officers interact with students. It’s a unique program that engages students for insights and feedback.
“We recognized that we need to make our schools a safer environment, but we need to get away from policing schools,” Vavilala says. “We’re working with King County and the Tukwila School District to find ways to do that.”
Through focus groups, participating community members, law enforcement and students share their fears and concerns and their ideas to reduce anxiety and promote psychological safety. So far, their suggestions have included the following:
- Having out-of-uniform authorities in schools to make them more approachable.
- Placing behavioral health experts in schools.
- Training authorities to de-escalate behaviors in culturally resonant and culturally appropriate ways.
Training the pipeline for injury and violence prevention
Training the next generation of injury and violence prevention experts is vital, and HIPRC has always provided educational opportunities for postdoctoral students. However, HIPRC recently launched several new innovative programs that target high school and undergraduate students to increase exposure and awareness of the field.
With National Institutes of Health funding, HIPRC partnered with several King County education programs to create the Summer Learning Experiences. As part of this initiative, the Health Occupation Students of America clubs from Rainier Beach and Franklin High Schools met with Harborview Medical Center providers. Participating nurses, physicians, radiology technologists and other professionals met with students to share information about their careers and responsibilities.
“Making these introductions is very important as we strive to have a diverse workforce in healthcare,” Vavilala says. “These connections and engagements provide an opportunity for both students and the community to benefit. It’s a long-term investment in our ability to provide equitable care.”
Additionally, HIPRC established the ACE Academy Summer Learning Experience. During this program, faculty members discuss their research and share their prevention strategies around several topics, including drowning, gun violence and mental health.
Injury and violence prevention creates healthier communities
Ultimately, Vavilala says, HIPRC hopes the data and insights gathered from its interventions will inform strategies and protocols to improve safety for the public. And community involvement is the key to realizing that achievement.
“Our big picture goal is to prevent injury and violence, make our communities healthier and translate our research for the greater community benefit,” she says. “Our success is rooted in our engagement of communities. We view this as a real partnership — we have certain skills, and they have a lot of expertise and real-world experience. Now, we’re coming together to address some of these bigger problems.”
Learn more about HIPRC’s community work in the 2022 Year In Review.