From emergency departments in rural Mexico to those in the America's heartland, the scenario always plays out the same: the accident happened so fast that the parent could do nothing to stop it.
"I hear the same words from parents," said Dr. Gary Smith of Nationwide Children's Hospital in Columbus, Ohio. "They say, 'Doctor, I can't believe this happened to my child. I was right there, it just happened so quickly, there was nothing I could do."
That's why Smith is determined to prevent such situations from happening altogether.
With one foot in public health and the other in the clinic, Smith has been hard at work with a singular goal: accidental injury prevention among children and adolescents -- the leading cause of death in that age group, according to the CDC.
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As director of the hospital's Center for Injury Research and Policy, he's published over a hundred studies on accidents, most recently an analysis of the rate of falls from windows in the U.S.
He's not motivated by personal tragedy. Though he has two teenage sons, neither has suffered any more than the normal bumps and bruises of childhood -- "maybe a laceration here and there, or a concussion during a sports game."
Still, Smith said it's "hard to find anyone who hasn't had someone close to them affected by injury," and so he's driven by the thought of one day not having to face so many suffering parents in his emergency room.
Focus on Prevention
During his 21-year tenure at the hospital, Smith has analyzed nearly every type of childhood injury imaginable: choking, furniture tip-overs, bath and shower slips, bunk bed crashes, cheerleading falls, gymnastics accidents, bumps from cribs and playpens, and problems on the playground.
In the latest study on pediatric falls from windows, he and colleagues found that rates have hovered at around 5,000 emergency department admissions per year.
Rates improved, however, in cities like Boston and New York, where fall-reduction programs had been implemented. New York, for instance, mandates that any dwelling with a child under age 10 must have window guards or stops.
"We know what works, we just need to apply it," Smith said. One way to do so, he figured, was to establish the hospital's Center for Injury Research and Policy in 1999.
"It didn't make sense to me, to continue to treat these (pediatric) injuries, when prevention was a much better solution," he said.
The center's goal is to spearhead accident prevention through a combination of research, education, and community involvement. In addition the center-sponsored research, literature for parents is offered on the center's website, and it sponsors community events, such as bike-helmet handouts.
Smith and his colleagues have also been involved at both the local and state level, supporting, for example, initiatives such as booster seat and bike helmet laws.
He has also been a key player on the national safety scene, as a vocal supporter of bike helmet campaigns, as well as serving on a CDC bike safety committee as a representative of the American Academy of Pediatrics' committee on injury, violence, and poison prevention.
His work hasn't gone unrecognized. Dr. Barbara Barlow, professor emerita of surgery and epidemiology at Columbia University, who was a driving force in New York's mandatory window guard policy, said Smith "has worked tirelessly to prevent injury to children."
In 2006, the American Academy of Pediatrics' injury prevention committee presented him with the Fellow Achievement Award for that year, and in 2003, the Ohio chapter of the organization named Smith its state Pediatrician of the Year.
Smith describes his path to clinic and public health as "a bit of a zigzag."
First, there was medical school in California, followed by residency in pediatrics, and all the while there was part-time work in clinics in Latin America, mostly in hospitals in rural Mexico. That work steered his interest in public health -- he was intrigued by the types of injuries that were less common in the states: goring by livestock, drownings -- so he pursued a master's and then a doctorate at Johns Hopkins.
Since he still wanted to practice medicine, he followed the DrPH with a fellowship in pediatric emergency medicine in Kansas City, Mo., but continued to work in Latin America when he could.
He finally landed at Nationwide Children's Hospital in 1990, and currently holds appointments in public health and medicine at Ohio State University.
"My goal is to keep one foot on the public health side and one foot in the clinical side, and bring both of those sides together," he said.
Barlow, who also operates in both worlds, said there's a need for bridges between the two.
"Public health specialists do the data, but doctors see what happens to children who are injured," she said. "We have a passion. Dealing with the injured children makes a huge difference. Then, with data, we can see what problems there are and what's associated with them, so we can focus our work on the ground."
Barlow's efforts on the ground led to New York enacting its law on window guards in the late 1970s, which holds landlords and homeowners responsible for installing the safety devices.
The childhood injury prevention community is "a little fragmented," Smith said, noting that one challenge is to "figure out a way to pull all of the disparate groups together, so we can sing with one voice."
Smith said a 2008 report on injury prevention in children from the WHO helped bring much-needed attention to the issue with its alarming find that more than 2,000 children around the world die every day in accidents that could easily be prevented.
Still, he said, there's much work to be done to lower the rate of injuries among children.
"Arguably, it's the most compelling, and certainly the deadliest, public health problem facing children in our country," he said. "Our goal is to get injuries down to a low level. It's just a matter of political will and deciding that this is something that's a priority."