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Committee to Review the NIOSH Traumatic Injury
Research Program
Board on Population Health and Public Health Practice
Traumatic Injury Research at NIOSH
Reviews of Research Programs of the National
Institute for Occupational Safety and Health
THE NATIONAL ACADEMIES PRESS • 500 Fifth Street, N.W. • Washington, DC 20001
NOTICE: The project that is the subject of this report was approved by the Governing Board of the
National Research Council, whose members are drawn from the councils of the National Academy
of Sciences, the National Academy of Engineering, and the Institute of Medicine. The members of
the committee responsible for the report were chosen for their special competences and with regard
for appropriate balance.
This study was requested by the National Institute for Occupational Safety and Health of the Centers
for Disease Control and Prevention and supported by Award No. 211-2006-19152, T.O. #1, between
the National Academy of Sciences and the Centers for Disease Control and Prevention. Any opinions,
findings, conclusions, or recommendations expressed in this publication are those of the author(s)
and do not necessarily reflect the view of the organizations or agencies that provided support for
this project.
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International Standard Book Number-10: 0-309-12507-3
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Cover credit: Photos reprinted with permission from Abe Martinez and Don Pollard, 2008.
Suggested Citation: IOM (Institute of Medicine) and National Research Council. 2009. Traumatic
Injury Research at NIOSH. Committee to Review the NIOSH Traumatic Injury Research Program.
Rpt. No. 6, Reviews of Research Programs of the National Institute for Occupational Safety and

v
COMMITTEE TO REVIEW THE NIOSH
TRAUMATIC INJURY RESEARCH PROGRAM
BRIAN L. STROM (Chair), Professor and Chair, Center for Clinical
Epidemiology and Biostatistics, University of Pennsylvania School of
Medicine, Philadelphia, PA
ROBIN BAKER, Director, Labor Occupational Health Program, School of Public
Health, University of California at Berkeley
LESLIE I. BODEN, Associate Chair and Professor, Department of Environmental
Health, Boston University School of Medicine, Boston, MA
BARRY BOZEMAN, Ander Crenshaw Professor of Public Policy and Regents’
Professor of Public Policy, State Data and Research Center, Department of
Public Administration and Policy, University of Georgia School of Public
Health and International Affairs, Athens
STEPHEN W. HARGARTEN, Professor and Chair, Department of Emergency
Medicine, Director, Injury Research Center, Wisconsin Injury Research
Center, Medical College of Wisconsin, Milwaukee
BRIAN M. KLEINER, Professor, Grado Department of Industrial and Systems
Engineering, Virginia Polytechnic Institute and State University, Blacksburg
TOM B. LEAMON, Director Emeritus, Liberty Mutual Research Center for
Safety and Health, Vice President, Liberty Mutual Insurance Company,
Hopkinton, MA
JAMES M. MELIUS, Director, New York State Laborers’ Health and Safety Fund,
Safety Trust Fund, Albany
MARK S. REDFERN, Vice Chair and Undergraduate Program Professor,
Departments of Bioengineering, Otolaryngology, and Industrial Engineering,
University of Pittsburgh School of Engineering, Pittsburgh, PA
GORDON R. REEVE, Corporate Epidemiologist (retired), Occupational Health
and Safety, Ford Motor Company, Canton, MI (resigned from the committee
May 4, 2007)

Franklin E. Mirer, School of Health Sciences, Hunter College of the City
University of New York
Corinne Peek-Asa, Injury Prevention Research Center, University of Iowa
Peter Rosen, Harvard University Medical School
Independent Report Reviewers
viii
I n d e p e n d e n t R e p o R t R e v I e w e R s
Gordon S. Smith, Department of Epidemiology and Preventive Medicine,
University of Maryland
Lorann Stallones, Colorado Injury Control Research Center, Department of
Psychology, Colorado State University
Although the reviewers listed above have provided many constructive com-
ments and suggestions, they were not asked to endorse the conclusions or recom-
mendations nor did they see the final draft of the report before its release. The
review of this report was overseen by Enriqueta C. Bond, Burroughs Wellcome
Fund, and Michael I. Posner, University of Oregon. Appointed by the National Re-
search Council and Institute of Medicine, they were responsible for making certain
that an independent examination of this report was carried out in accordance with
institutional procedures and that all review comments were carefully considered.
Responsibility for the final content of this report rests entirely with the authoring
committee and the institution.
ix
Contents
ABBREVIATIONS AND ACRONYMS xiii
SUMMARY 1
1 INTRODUCTION 19
Impact of Occupational Injuries, 19
Mission and Organization of NIOSH and the TI Research Program, 20
NIOSH TI Research Program Goals, 26
Study Charge and Evaluation Committee, 31

Strategic Planning, 127
Coordination and Collaboration, 129
Workforce Development, 132
Transfer, 133
The Changing Nature of Work, 134
Summary, 136
Reference, 136
APPENDIXES
A Framework for the Review of Research Programs of the 137
National Institute for Occupational Safety and Health
B Methods and Information Gathering 182
C Information Provided by the NIOSH Traumatic Injury 189
Research Program
D NIOSH TI Research Program Draft Strategic Goals for the Future 191
E Biographical Sketches of Committee Members 203
xi
Tables, Figures, and Boxes
TABLES
1-1 Matrix Management Components of the NIOSH Program Portfolio, 23
1-2 TI Research Program Budget by Research Goal, 32
FIGURES
1-1 Organizational components of NIOSH, 22
1-2 Combined intramural and extramural funding for individual goals and for
all goals combined, 27
1-3 NIOSH Research Program evaluation flowchart, 40
BOXES
S-1 Goals and Subgoals of the NIOSH Traumatic Injury Research Program, 4
S-2 Scoring Criteria for Relevance, 5
S-3 Scoring Criteria for Impact, 5
S-4 Summary of Recommendations, 11

ESA Employment Standards Administration
FAA Federal Aviation Administration
FACE Fatality Assessment and Control Evaluation (Program)
FFFIPP Fire Fighter Fatality Investigation and Prevention Program
FISH Fishing Industry Safety and Health
FLSA Fair Labor Standards Act
FTE full-time equivalent
FY fiscal year
HEROES Homeland Emergency Response Operational Equipment Systems
HHS U.S. Department of Health and Human Services
HO Hazardous Occupations Order
IAFF International Association of Fire Fighters
IAWG Interagency Working Group
IFISH International Fishing Safety and Health
IOM Institute of Medicine
ITCP internal traffic control plan
JAMA Journal of the American Medical Association
M-CAIS Minority Farm Operator Childhood Agricultural Injury Survey
NASS National Agricultural Statistics Service
NATE National Association of Tower Erectors
NAWS National Agricultural Workers Survey
NCCRAHS National Children’s Center for Rural and Agricultural Health and
Safety
NCIPC National Center for Injury Prevention and Control
NEISS National Electronic Injury Surveillance System
NFPA National Fire Protection Association
NHTSA National Highway Traffic Safety Administration
NIH National Institutes of Health
NIMS National Incident Management System
NIOSH National Institute for Occupational Safety and Health

ers died each week as a result of injuries sustained on the job. According to
the Bureau of Labor Statistics, in 2006, 3.9 million nonfatal injuries were
sustained by U.S. workers in private-sector employment—a number that is
widely recognized as a substantial underestimate. The National Institute for
Occupational Safety and Health (NIOSH) is the federal agency tasked with
conducting research and making recommendations for the prevention of oc-
cupational injury and illness.
The Institute of Medicine convened a committee of experts to review
NIOSH’s Traumatic Injury (TI) Research Program. The committee evaluated
the relevance and impact of the TI Research Program’s efforts for the years
1996-2005, reviewed the program’s strategic goals for the future, and provided
recommendations for program improvement. Using a five-point scoring scale
(where 5 is highest), the committee assigned the TI Research Program a score
of 4 for both relevance and impact. The committee concluded that research
was in priority areas and led to demonstrated effects on some end outcomes
or on well-accepted intermediate outcomes. The committee concluded that the
TI Research Program’s strategic goals for the future were focused on major
Summary
2 t R a u m a t I C I n j u R y R e s e a R C h a t n I o s h
contributors to occupational injuries and deaths and are sensitive to popula-
tions and groups at disproportionate risk. In future iterations of its strategic
goals, the TI Research Program should work toward focusing its efforts. The
committee developed nine recommendations for program improvement in
the areas of strategic planning, coordination and collaboration, workforce
development, transfer, and the changing nature of work.
INTRODUCTION
In 2006, 5,840 workers—more than 110 workers each week—died as a result
of injuries sustained on the job. These deaths occurred across all industry sec-
tors (BLS, 2008). Nonfatal work-related injuries far outnumber fatalities and are
much more difficult to count. According to the Bureau of Labor Statistics (BLS),

improvement in work-place safety and health.”
CHARGE TO THE COMMITTEE
NIOSH has requested that the National Academies, through the National Re-
search Council (NRC) and the Institute of Medicine (IOM), conduct a series of
reviews of its research portfolio. This report contains a review and evaluation of
the TI Research Program. NIOSH defines work-related traumatic injury as “any
damage inflicted to the body by energy transfer during work with a short duration
between exposure and health event.” Safety research is an interchangeable term in
NIOSH publications for traumatic injury research.
The TI Research Program is described by eight goal areas (Box S-1). Within
each of the eight goals are two to three subgoals, with the exception of the goal for
workplace violence, which does not have any subgoals. Currently, four of the TI
Research Program’s efforts—agricultural injuries among children, firefighter safety,
workplace violence, and workers in Alaska’s high-risk industries—are directed by
congressional initiatives (NIOSH, 2007, p. 44).
Using an evaluation framework developed by the National Academies Com-
mittee to Review the NIOSH Research Programs, the “Framework Committee” (see
Appendix A), this committee was to evaluate the relevance and impact (using an
integer score from 1-5, with 5 being the highest) of the TI Research Program, as
well as its future directions. (See Boxes S-2 and S-3 for more information on the
scoring system.) The committee was also encouraged to provide recommendations
for program improvement.
The committee was comprised of 10 members and one Framework Committee
liaison.
1
The committee had expertise in the areas of occupational health, public
health education, medicine, injury prevention and control, epidemiology and
biostatistics, labor, industry, program evaluation, ergonomics, and bioengineering.
The committee evaluated the TI Research Program for the period 1996-2005, the
first decade of the National Occupational Research Agenda (NORA). The infor-

6.2. Reduce injuries and fatalities in helicopter logging operations
6.3. Reduce injuries and fatalities in Alaska aviation
7. Reduce injuries and fatalities to emergency responders
7.1. Reduce injuries and fatalities to firefighters
7.2. Improve protection for ambulance workers in patient compartments
7.3. Improve protection for emergency workers responding to large-scale disasters
and terrorist attacks
8. Reduce injuries and fatalities to working youth
8.1. Influence legislative changes to protect young workers
8.2. Reduce child agricultural injuries
8.3. Foster the development and widespread use of safety materials and intervention
strategies to protect young workers
a 
The numbering of the goals here is consistent with the numbering of the goals as presented
in the evidence package prepared by NIOSH for the committee. The numbering is not a
ranking of goals by research priority.
s u m m a R y 5
committee. For its assessment of the NIOSH process for targeting new research
areas and identifying emerging issues in occupational safety and health, the com-
mittee relied primarily on a review of the TI Research Program’s strategic goals
for the future (a list of these goals was included in the evidence package provided
to the committee by NIOSH).
BOX S-2
Scoring Criteria for Relevance
5 = Research is in high-priority subject areas and NIOSH is significantly engaged in appro-
priate transfer activities for completed research projects or reported research results.
4 = Research is in priority subject areas and NIOSH is engaged in appropriate transfer
activities for completed research projects or reported research results.
3 = Research is in high-priority or priority subject areas, but NIOSH is not engaged in
appropriate transfer activities; or research focuses on lesser priorities but NIOSH is

problems. For example, the committee concludes that TI Research Program atten-
tion to workplace violence has highlighted a previously neglected area.
The committee concludes that, for the most part, the TI Research Program
goals are appropriate and relevant to the burden of traumatic injury in the work-
place. The burden of injury represented by the eight major goal areas is certainly
high, although the committee did not attempt to independently assess the burden
of injuries in all occupations or worksites in the country as part of its review.
Rather, the committee understands the challenges NIOSH faces in prioritizing re-
search with restricted resources and concludes that—given its limited budget—the
TI Research Program has made overall appropriate selections of general areas to
pursue.
Although the committee concluded that many of the goal areas were high pri-
ority (e.g., Alaska, falls from elevations), it identified gaps, particularly within the
subgoals (falls from the same elevation; several areas within workplace violence;
a narrow focus within machines). The TI Research Program engages in appropri-
ate transfer activity within some, but not all, of the goal areas. In summary, the
committee notes impressive work, including transfer, in priority goal areas. The
committee assigns a score of 4 for the relevance of the TI Research Program.
The committee commends the TI Research Program for its contributions
toward reducing occupational traumatic injuries. The TI Research Program is
associated with impact on either intermediate or end outcomes in each major
goal. The committee recognizes that external factors—specifically, severely limited
resources and inaction on the part of OSHA—can be significant barriers to the
TI Research Program’s progress in some goal areas. However, the committee notes
(1) the lack of demonstrated effect on end outcome data in three goal areas and in
some subgoals of the other five goals; (2) the inability to determine what degree of
responsibility the TI Research Program bears for the documented improvements
in end outcomes or for the intermediate outcomes; and (3) a lack of significant
intermediate outcomes for some subgoals. The committee assigns a score of 4 for
the impact of the TI Research Program.

3
The TI Research Program also organizes and hosts
periodic National Occupational Injury Research Symposia (NOIRS), which bring
together researchers from a broad range of disciplines to discuss research in prog-
ress and to form research and prevention partnerships. Workers, advocates, and
other nonresearch groups may also attend and have an opportunity to provide
input regarding traumatic injury research needs. At the inception of the four TI
research programs currently directed by congressional initiatives and mandates,
NIOSH held stakeholder meetings to obtain input on possible research directions
within these areas.
2
Personal communication from Nancy Stout.
3
Personal communication from Nancy Stout.
8 t R a u m a t I C I n j u R y R e s e a R C h a t n I o s h
The TI Research Program uses surveillance data on fatal and nonfatal injuries—
primarily from the BLS surveillance systems—to identify emerging research needs.
The program also has real-time access to data on injuries reported at hospital emer-
gency departments through the National Electronic Injury Surveillance System, as
well as data on fatal injuries in selected states through the NIOSH Fatality Assess-
ment and Control Evaluation (FACE) Program, which allow for quicker detection
of injury clusters and spikes (NIOSH, 2007, p. 46), as well as sentinel fatalities that
identify previously unrecognized hazards.
The NORA process and the relationships with stakeholders that result from it
are also an important means of identifying emerging issues. In NORA, a commit-
tee specifically addressed traumatic injury research needs; in the current NORA
II process, industry sector councils have been formed to address sector-specific
research needs. Traumatic injuries are addressed by each of these councils.
The committee is sensitive to the need for the TI Research Program to choose
its research activities carefully to make the best use of limited resources. Research