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"Unintentional injuries are the leading cause of morbidity and mortality among children in the United States. This report uses data from the National Vital Statistics System and the National Electronic Injury Surveillance System - All Injury Program to provide an overview of unintentional injuries related to drowning, falls, fi res or burns, transportation-related injuries, poisoning, and suffocation, among others during the period 2000 - 2006. Results are presented by age group and sex, as well as the geographic distribution of injury death rates by state" - p. 3 ; 1. About this report -- 2. Methods -- 3. Comparison of external cause of injury mortality matrix and the modified matrix -- 4. Unintentional injury deaths among children 0 to 19 years, United States, 2000-2005 -- 5. Nonfatal unintentional injury estimates among children 0 to 19 Years, United States, 2001 -2006 -- -- Appendix 1. Cause of unintentional injury death categories based on ICD-10 external cause-of-injury codes -- 2: Categorization of cause of death: numbers of deaths from unintentional injuries among children 0 to 19 years, United, States, 2000-2005 -- Appendix 3: Number of unintentional injury deaths among children 0 to 19 years, by state and age group, United States, 2000-2005 -- Appendix 4: Number of unintentional injury deaths among children 0 to 19 years, by state and cause, United States, 2000-2005 -- Appendix 5: Nonfatal unintentional injuries and rates among children 0 to 19 years, by sex and cause, United States, 2001-2006 ; Nagesh N. Borse, Julie Gilchrist, Ann M. Dellinger, Rose A. Rudd, Michael F. Ballesteros, David A. Sleet. ; "December 2008." ; "The release of this CDC Childhood Injury Report coincides with the launch of the World Report on Child Injury Prevention (2008) developed by the World Health Organization and UNICEF. Our report complements the World Report and highlights the nature of the problem in the United States." - p. 5 ; Also available via the World Wide Web. ; References: p. 102-103. ; Borse NN, Gilchrist J, Dellinger AM, Rudd RA, Ballesteros MF, Sleet DA. CDC Childhood Injury Report: Patterns of Unintentional Injuries among 0 -19 Year Olds in the United States, 2000-2006. Atlanta (GA): Centers for Disease Control and Prevention, National Center for Injury Prevention and Control; 2008.

a report from the NIOSH-CSTE Surveillance Planning Work Group, submitted to NIOSH Surveillance Coordinating Group. ; Title from title screen (viewed March 21, 2005). ; Mode of access: Internet.

Lung injury is frequently a component of the polytrauma sustained by military personnel surviving blast on the battlefield. This article describes a case series of the military casualties admitted to University Hospital Birmingham's critical care services (role 4 facility), during the period 1 July 2008 to 15 January 2010. Of the 135 casualties admitted, 107 (79.2%) were injured by explosive devices. Plain chest films taken soon after arrival in the role 4 facility were reviewed in 96 of the 107 patients. In 55 (57.3%) films a tracheal tube was present. One or more radiological abnormalities was present in 66 (68.75%) of the films. Five patients met the consensus criteria for the definition of adult respiratory distress syndrome (ARDS). The majority of casualties with blast-related lung injury were successfully managed with conventional ventilatory support employing a lung protective strategy; only a small minority received non-conventional support at any time in the form of high-frequency oscillatory ventilation. Of those casualties who survived to be received by the role 4 facility, none subsequently died as a consequence of lung injury.

Council of State and Territorial Epidemiologists in collaboration with the National Institute for Occupational Safety and Health Centers for Disease Control and Prevention. ; Title from title screen (viewed March 21, 2005). ; "June 2004." ; Mode of access: Internet. ; Includes bibliographical references.

OBJECTIVE: By 2022, the Chinese government intends to have more than 30 million primary-, middle- and high-school children and adolescents regularly participate in campus football. In contrast, epidemiology of campus football injuries is completely missing. The goal of this descriptive epidemiological study was to determine the current state of campus football injuries and then to recommend appropriate prevention and management strategies. METHODS: This retrospective epidemiological study conducted a survey of students, physical education and football teachers in primary, middle and high schools in the Ningxia Autonomous Region to determine the campus football injuries that occurred throughout the preceding 12-month period. The survey comprised questions on demographic characteristics, the occurrence, causes, and management of campus football injuries. RESULTS: A total of 1,285 students and 200 teachers returned eligible surveys. 25.7% of students had encountered injury accidents while participating in campus football activities. 31.3% of high school students, 23.8% of middle school students, and 19.2% of primary school students have sustained injuries. Football competition, accounting for 45.4% of all injuries, is the leading cause of injury. Football class teaching, which accounted for 3.0% of all injuries, had the lowest injury rate of any campus football activity. Students and teachers reported that a lack of safety awareness and injury prevention education were the primary causes of injuries. Only 18.7% and 11.4% of students are familiar with first aid basics and cardiopulmonary resuscitation, respectively. 10.6% and 7.5% of students lack any first aid basics and skills, respectively. 43.9% of students lack insurance coverage for athletic injuries. 62.5% and 38.5% of teachers reported that schools lack first aid training and an emergency plan for injuries, respectively. CONCLUSION: Students in Ningxia's campus football programs have a high injury risk. Injury prevention and management strategies lag ...

Objectives: To provide an overall perspective on musculoskeletal injury (MSI) epidemiology, risk factors, and preventive strategies in military personnel. Design: Narrative review. Methods: The thematic session on MSIs in military personnel at the 5th International Congress on Soldiers' Physical Performance (ICSPP) included eight presentations on the descriptive epidemiology, risk factor identification, and prevention of MSIs in military personnel. Additional topics presented were bone anabolism, machine learning analysis, and the effects of non-steroidal anti-inflammatory drugs (NSAIDs) on MSIs. This narrative review focuses on the thematic session topics and includes identification of gaps in existing literature, as well as areas for future study. Results: MSIs cause significant morbidity among military personnel. Physical training and occupational tasks are leading causes of MSI limited duty days (LDDs) for the U.S. Army. Recent studies have shown that MSIs are associated with the use of NSAIDs. Bone MSIs are very common in training; new imaging technology such as high resolution peripheral quantitative computed tomography allows visualization of bone microarchitecture and has been used to assess new bone formation during military training. Physical activity monitoring and machine learning have important applications in monitoring and informing evidence-based solutions to prevent MSIs. Conclusions: Despite many years of research, MSIs continue to have a high incidence among military personnel. Areas for future research include quantifying exposure when determining MSI risk; understanding associations between health-related components of physical fitness and MSI occurrence; and application of innovative imaging, physical activity monitoring and data analysis techniques for MSI prevention and return to duty.

INTRODUCTION: Hand and distal forearm fractures are among the most common injuries worldwide. To date there is no data on the extent of hand and wrist fractures diagnosed radiologically in Malta. This audit aimed to quantify and analyse all hand and distal forearm fractures treated to establish the amount of hand and wrist injuries, to calculate the potential number of patients requiring specialist hand therapy services and to understand the requirements of the A&E department in the area of hand injuries. ; METHODS: Baseline data was obtained from analysing all orthopaedic X rays over three consecutive months taken in the local A&E department during the study period. Data on hand and distal forearm fractures was analysed. ; RESULTS: Results confirm that 18.6%(n=986) of all orthopaedic X-Rays were of the wrist and hand, 37% of which had confirmed fractures. Distal forearm fractures amounted to 58.4%(n=213) of all hand and wrist fractures. The most commonly injured hand bone was the 5th metacarpal in 24.3%, and 5.9% of all wrist fractures were scaphoid fractures. ; DISCUSSION: Our findings represent our local scenario. In view of an ageing and increasing Maltese population, one should expect numbers of hand and wrist fractures to increase. This data will help ensure the service is prepared with adequate specialised staffing levels to manage these cases. Implementing strategies to prevent such fractures through education programmes and collaboration with government entities, better workplace health and safety and treating osteoporosis early is of crucial. ; peer-reviewed

BackgroundDespite the growing burden of injuries in LMICs, there are still limited primary epidemiologic data to guide health policy and health system development. Understanding the epidemiology of injury in developing countries can help identify risk factors for injury and target interventions for prevention and treatment to decrease disability and mortality.AimTo estimate the epidemiology of the injury seen in patients presenting to the government hospital in Kampala, the capital city of Uganda.MethodsA secondary analysis of a prospectively collected database collected by the Injury Control Centre-Uganda at the Mulago National Referral Hospital, Kampala, Uganda, 2004-2005.ResultsFrom 1 August 2004 to 12 August 2005, a total of 3,750 injury-related visits were recorded; a final sample of 3,481 records were analyzed. The majority of patients (62%) were treated in the casualty department and then discharged; 38% were admitted. Road traffic injuries (RTIs) were the most common causes of injury for all age groups in this sample, except for those under 5 years old, and accounted for 49% of total injuries. RTIs were also the most common cause of mortality in trauma patients. Within traffic injuries, more passengers (44%) and pedestrians (30%) were injured than drivers (27%). Other causes of trauma included blunt/penetrating injuries (25% of injuries) and falls (10%). Less than 5% of all patients arriving to the emergency department for injuries arrived by ambulance.ConclusionsRoad traffic injuries are by far the largest cause of both morbidity and mortality in Kampala. They are the most common cause of injury for all ages, except those younger than 5, and school-aged children comprise a large proportion of victims from these incidents. The integration of injury control programs with ongoing health initiatives is an urgent priority for health and development.

Prospective and retrospective studies have examined traumatic injuries within competitive and recreational surfers worldwide using online surveys and health care facility (HCF; e.g., hospital, emergency department, medical record) data. However, few studies have provided a synthesis of all available literature. The purpose of this study was to obtain, critique and synthesise all literature specific to acute surfing injuries, and evaluate differences in injury type, mechanism and location between HCF and survey data. A systematic literature review design was used to identify relevant articles from three major databases. Peer-reviewed epidemiological studies of musculoskeletal surfing injuries were included. A modified AXIS tool was used for critical appraisal, and objective data was extracted and synthesized by lead researchers. Overall frequencies for injury location, type and mechanism were calculated from raw injury data. A total of 19 cross-sectional articles of fair to good quality (Modified AXIS 54.2–83.3%) were included in this study; 17 were National Health and Medical Research Council (NHMRC) level III-2 (retrospective) and two were level II (prospective). Articles examined competitive, recreational and combined populations. Injury data from Australia, Brazil, UK, USA, Portugal, Japan, Norway, and worldwide were represented. Skin (46.0%; HCF 50.1%, survey 43.8%) and being struck by own surfboard (38.6%; HCF 73.4%, survey 36.7%) were the most common injury type and mechanism. Head, face and neck injuries were most common in HCF (43.1%) versus lower limb injuries (36.4%) in survey data. Incidence proportion was highest in aerialists (0.48). Incidence rate (number of injuries per 1000 h) ranged from 0.74 in Australian surfers (Melbourne) to 6.6 in international contest surfers from medical record data. This review highlights the prevalence of skin, board-related, head, face and neck, and lower limb surfing injuries across available literature. Proposed use of protective equipment and foam-based surfboards in dangerous or crowded surf locations may reduce injury risk.

BackgroundDespite the growing burden of injuries in LMICs, there are still limited primary epidemiologic data to guide health policy and health system development. Understanding the epidemiology of injury in developing countries can help identify risk factors for injury and target interventions for prevention and treatment to decrease disability and mortality.AimTo estimate the epidemiology of the injury seen in patients presenting to the government hospital in Kampala, the capital city of Uganda.MethodsA secondary analysis of a prospectively collected database collected by the Injury Control Centre-Uganda at the Mulago National Referral Hospital, Kampala, Uganda, 2004-2005.ResultsFrom 1 August 2004 to 12 August 2005, a total of 3,750 injury-related visits were recorded; a final sample of 3,481 records were analyzed. The majority of patients (62%) were treated in the casualty department and then discharged; 38% were admitted. Road traffic injuries (RTIs) were the most common causes of injury for all age groups in this sample, except for those under 5 years old, and accounted for 49% of total injuries. RTIs were also the most common cause of mortality in trauma patients. Within traffic injuries, more passengers (44%) and pedestrians (30%) were injured than drivers (27%). Other causes of trauma included blunt/penetrating injuries (25% of injuries) and falls (10%). Less than 5% of all patients arriving to the emergency department for injuries arrived by ambulance.ConclusionsRoad traffic injuries are by far the largest cause of both morbidity and mortality in Kampala. They are the most common cause of injury for all ages, except those younger than 5, and school-aged children comprise a large proportion of victims from these incidents. The integration of injury control programs with ongoing health initiatives is an urgent priority for health and development.

Cross sectional study. Purpose: To characterize the pattern of injury, describe the current clinical management, and determine the outcomes in traumatic spine injury (TSI) patients presenting to a major government hospital in Phnom Penh, Cambodia. Overview of Literature: There is a paucity of literature on epidemiology or current clinical practices for TSIs in Cambodia. The findings from this study can thus serve as a valuable resource for future progress in treating TSIs in low-income countries. Methods: This study was a cross-sectional study of TSI patients admitted to Preah Kossamak Hospital in Phnom Penh, Cambodia. Demographics, cause of spinal injury, spinal level of injury, surgical procedures and techniques, complications, and American Spinal Injury Association (ASIA) grades were recorded and analyzed. Results: Eighty patients were admitted with TSI between October 2013 and June 2014. Falls from heights were the most common cause of TSI, followed by road traffic accidents. 78% of the admitted patients underwent at least one surgical procedure. Without intraoperative imaging, 4 patients (6%) had wrong level surgery, and 1 patient (2%) had misplacement of pedicle screws. Sacral decubitus ulcers were the most common non-surgically related complication. Antibiotics were administered to > 90% of patients. There were no in-hospital mortalities. Of the 60 spinal cord injury (SCI) patients, 32% (19/60) showed improvement in their ASIA grade at the time of discharge, and 52% (31/60) showed no change. At follow-up, 32% (19/60) of SCI patients reported improvement, and 8% (5/60) reported no change. However, 36 SCI patients (60%) were lost to follow-up. Conclusions: Despite technological limitations, outcomes of TSI patients in Cambodia appear favorable with evidence of clinical improvement and low mortality.

Ylipaino altistaa nuoren miehen polvivammalle Väitöskirjatutkimus selvittää polvivammojen yleisyyttä, riskitekijöitä ja diagnostiikkaa Polvivammat ovat yleisiä erityisesti alle 30-vuotiailla miehillä, mutta sairaalahoitoa vaativien polvivammojen ilmaantuvuudesta ja riskitekijöistä ei ole esitetty tarkkaa tietoa. Väitöskirjatutkimus selvitti aihetta suomalaisilla 18 30-vuotiailla miehillä varusmiespalveluksen aikana (n=128 584). Tulokset osoittivat, että sairaalahoitoon johtaneiden polvivammojen ilmaantuvuus oli 11 potilasta 1000 henkilövuotta kohden [95 % luottamusväli (CI): 10,4 11,7] tarkoittaen sitä, että joka vuosi noin yksi sadasta varusmiehestä joutuu sairaalahoitoon polvivamman vuoksi. Merkittävimmät riskitekijät polvivammoille olivat korkeampi ikä, jonka ristitulosuhde oli 1,7-kertainen yli 20-vuotiailla, sekä ylipaino, jonka ristitulosuhde oli 1,6-kertainen verrattuna niihin, joilla ylipainoa ei ollut. Kirurginen toimenpide tehtiin kahdelle kolmasosalle kaikista sairaalassa hoidetuista potilaista ja pidempiaikainen haitta (palveluskelpoisuusluokan muutos) jäi yhdelle kolmasosalle potilaista. Tiedot sairaalahoitoon johtaneista polvivammoista ja kirurgisista toimenpiteistä saatiin selvitettyä kansallisen hoitoilmoitusrekisterin avulla. Tiedot palveluskelpoisuusluokan muutoksista ja mahdollisesti polvivammoihin yhteydessä olevista riskitekijöistä saatiin puolustusvoimien Vartti- ja palveluskelpoisuusluokanmuutosrekistereistä. Palveluskelpoisuusluokan muutosta käytettiin tutkimuksessa kuvaamaan pidempiaikaista haittaa. Polvivammojen riskitekijöitä analysoitiin logistisella regressiolla. Väitöskirjatutkimus paneutui myös polvivammojen ja polven etuosan kiputilan magneettikuvauspainotteiseen diagnostiikkaan suomalaisilla varusmiehillä. Magneettikuvausta pidetään yleisesti herkkänä ja tarkkana polvivammojen tutkimisvälineenä, mutta polven etuosan kiputilassa, tuoreissa rustovaurioissa ja vanhoissa nivelkierukkarepeämissä sen merkitys on epäselvempi. Tutkimustulokset osoittivat, että lähes puolet syvistä, tuoreista polven rustovaurioista jäi diagnosoimatta normaalin kliinisen työn yhteydessä suoritetussa 1.0 Teslan magneettikuvauksessa. Huolimatta normaalista magneettikuvauslöydöksestä saattaa polvinivelen tähystystutkimus paljastaa korjaustoimenpiteisiin soveltuvia syviä rustovaurioita. Magneettitutkimuksen diagnostisessa validiteetissa nivelkierukkarepeämän diagnostiikassa ei todettu eroa akuutissa polvivammassa ja kroonisissa, yli 6 kk kestäneissä polvioireissa. Polven etuosan kipua käsittelevässä aineistossa yleisimmät löydökset olivat polvilumpion rustovaurio (45 % polvista) ja nivelkalvon poimu (45 %). Oireiden, löydösten ja polvilumpion rustovaurion asteen välillä ei todettu selkeää yhteyttä (p = 0,83). Tulokset tukevat aiempia havaintoja siitä, että polvilumpion rustovaurioita ei voida luotettavasti diagnosoida polven etuosan kiputilaan liittyvien oireiden ja statuslöydösten perusteella. Tässä aineistossa 1.0 Teslan magneettikuvauksessa käytettiin erityisesti polvilumpion ruston arvioimiseen sopivaa kuvausleikettä (aksiaalinen 3D T1 FS SPGR). Herkkyys oli alhainen pinnallisille polvilumpion rustovaurioille (13 %), mutta selkeästi parempi syvemmille rustovaurioille (83 %). Magneettikuvausta tällä menetelmällä voidaankin käyttää diagnostisena apuvälineenä polvilumpion syvempien, mahdollisesti operatiivista hoitoa tarvitsevien rustovaurioiden diagnostiikassa. Tuoreita rustovaurioita käsittelevässä retrospektiivisessa aineistossa oli 32 potilasta, joilla oli todettu artroskopiassa tuore traumaattinen rustovaurio. Tuoreiden ja vanhojen nivelkierukkarepeämien magneettikuvausdiagnostiikkaa vertailevien aineistojen mukaanottokriteerit täytti 82 potilaista, joilla oli tuore polvivamma, ja 40 potilasta, joilla oli pidempikestoinen polviongelma. Pitkäaikaiseen polven etuosan kiputilaan liittyvien oireiden ja löydösten yhteyttä tähystystutkimuksen tuloksiin tutkittiin prospektiivisesti 56 potilaan aineistossa. Kaikissa diagnostiikkaa käsittelevissä osatutkimuksissa magneettikuvauksen tuloksia verrattiin polvinivelen tähystystutkimuksen tuloksiin. Tutkimukset suoritettiin keskussotilassairaalassa Helsingissä. Tutkimuspotilaat olivat varusmiehiä, joiden ikä oli tutkimushetkellä 18 25-vuotta. ; Knee injuries and anterior knee pain are frequently encountered and treated by orthopaedic surgeons and general practitioners in daily clinical practice. Knee injuries are most common in those under 30 years of age and especially in males. Accurate incidence rates of knee injuries requiring hospitalisation (i.e. inpatient care admission) in this high-risk subgroup, however, are not known. Also unclear are the roles of intrinsic modifiable factors, such as body mass index (BMI), weight, aerobic fitness, and muscular strength, as risk factors for knee injuries. The epidemiologic section of this dissertation is based on population-based data among Finnish young adult male conscripts. Our aim was to determine the incidence and possible risk factors for knee injuries requiring inpatient care. Moreover, knee injuries were analysed by specified diagnosis (cruciate and collateral ligament tears, meniscal tears, traumatic chondral lesions, and patellar dislocations). The total number of Finnish male conscripts performing their compulsory military service during the study period was 128,584 and total exposure time was 97,503 person-years. Risk factor analyses were performed by logistic regression. The person-based incidence of inpatient care admissions for knee injury in general was 11 cases per 1000 person-years (95% confidence interval [CI]: 10.4 11.7). The most important risk factors were higher age (odds ratio [OR] 1.7; 95% CI: 1.3 2.2) and obesity (OR 1.6; 95% CI: 1.03 2.5). Two-thirds of all subjects admitted to inpatient care for knee injuries had surgery, and one-third had long-term notable disability. The diagnostic section of this dissertation addresses three diagnostic challenges: fresh traumatic chondral lesions, fresh meniscal tears, and anterior knee pain (AKP). Study populations were based on conscripts treated at the Central Military Hospital in Helsinki, Finland. Arthroscopic results served as the gold standard for calculating the sensitivity, specificity, and accuracy of magnetic resonance imaging (MRI) findings. The validity of MRI for fresh traumatic chondral lesions and for fresh vs. old meniscal tears was studied retrospectively. Study populations comprised young adult conscripts in whom both knee MRI and arthroscopy were performed at the Central Military Hospital. In the first sample, 32 patients, ranging in age from 19 to 21 years (median, 19 years), with arthroscopically proven fresh traumatic chondral lesions of the knee met the inclusion criteria. In the samples used for comparing MRI validity in fresh traumatic and old meniscal tears, 82 patients, ranging in age from 18 to 25 (median, 20 years) met the inclusion criteria with acute knee trauma (MRI within 30 days from trauma) and 40 patients with chronic knee symptoms (symptoms lasting over 6 months before MRI). Diagnostic studies revealed that routine clinical use of 1.0 Tesla (T) MRI has poor sensitivity (36%) for detecting fresh traumatic articular cartilage lesions. Sensitivity was associated with the lesion grade and was only 17% for superficial lesions and moderately better, 57%, for full-thickness lesions. Thus, almost half of the full-thickness cartilage lesions remained undiagnosed following preoperative MRI. Despite negative MRI findings, arthroscopy may reveal lesions amenable to cartilage repair procedures.The diagnostic validity of MRI for meniscal tears in acute knee trauma and in knee symptoms lasting over 6 months in young adults was similar. This study also suggests that effusion and haemarthrosis are not associated with the diagnostic validity of MRI for meniscal tears. The association between the clinical symptoms and arthroscopic findings, and the role of MRI in AKP were studied prospectively. Fifty-six young adult conscripts (median age, 19.5 years) with AKP were prospectively selected for the study and MRI of the knee followed by arthroscopy was performed at the Central Military Hospital in Finland. Arthroscopy con?rmed the presence of patellar chondral lesions in 25 (45%) of 56 knees of patients with AKP. Synovial plicae were as common a finding as patellar chondral lesions and was present in 25 knees. Normal anatomy was observed in only six knees. The presence of retropatellar crepitus or pain on manipulation of the patella was not associated with a higher proportion of patellar chondral lesions in patients with typical clinical AKP symptoms. The severity of patellar chondral lesions observed at arthroscopy was not associated with clinical symptoms of AKP syndrome (p = 0.83). This data supports earlier reports that patellar chondral lesions cannot be distinguished from other causes of AKP based on clinical symptoms and physical examination signs. The routine MRI protocol used for patients with AKP showed a sensitivity of only 13% for superficial patellar chondral lesions. For more severe lesions, the sensitivity was substantially higher, 83%, and 1.0T MRI may be considered a sensitive diagnostic tool in these cases.

Road traffic injuries (RTIs) are a major public health problem. Iran has one of the highest RTI mortality and morbidity rates in the world. This thesis aims to contribute understandings on fatal road-user patterns and characteristics as well as RTI numbers and rates, and to explore stakeholders perceptions both on barriers to - and facilitators of road-user safety and on prevention of this problem in the Iranian region. Quantitative and qualitative methods have been combined to explore road traffic injury phenomena. This thesis includes a cross sectional study (Paper I) and employs the capture-recapture method (Paper II), and grounded theory method (Paper III and Paper IV). Data for the first two studies were collected between March 2004 and March 2005 in the West Azarbaijan Province (WAP) of Iran and data for the third qualitative study were collected between March and December 2007 in both WAP and on the national level. Paper I describes the pattern of fatal RTIs and crash circumstances in WAP. The majority (85%) of the deceased were men. Females were mainly killed as either car passenger or pedestrians. Close to two-thirds of victims were rescued by untrained people and nearly four out of five were taken to hospital by passenger car rather than by ambulance. Paper II presents two register-based studies estimating the number and rate of fatal RTIs in WAP employing the capture-recapture method. The Death Registration System (DRS) and Forensic Medicine System (FMS) had recorded 669 and 665 fatalities respectively (roughly 22 fatal RTIs per 100 000 inhabitants). The capturerecapture method estimated 1 018 deaths (34 per 100 000). Overall, the DRS and the FMS ascertained 65% of the estimated number of fatal RTIs. In Paper III, the aim was to study pre-crash possibilities for prevention of RTIs and the core variable was identified as lack of system approach to road-user safety . Related barriers were identified: human factors; lack of safety in the transportation system; and lack of organizational coordination. Suggestions for improvement included education, more effective legislation, more rigorous law enforcement, improved engineering in road infrastructure, and an integrated organization to supervise and coordinate preventive activities. Focusing on post-crash management in Paper IV, the major barriers were identified as: involvement of laypeople; lack of coordination; inadequate pre-hospital services; and shortcomings in infrastructure. Suggestions for laypeople included: 1) a public education campaign in first aid, the role of the emergency services and cooperation of the public at the crash site, and 2) target-group training for professional drivers, police officers and volunteers involved at the crash scene. In conclusion the pattern of fatal RTIs in WAP differs somewhat from similar low- and middle-income countries. More attention should be paid to vulnerable road-users; young people, the over-65s and those living in rural areas. The burden of fatal road traffic injury in WAP is 1.53 times higher than records in the current data sources suggest. The lack of a system approach to road-user safety was the most important concern in the stakeholder study. There is a need for both a major change in stakeholders attitudes to road-user safety and an integrated system to lead and coordinate all RTI prevention activities.