Steven Baldwin, MD, Professor of Pediatrics, University of Alabama at Birmingham
Jennifer Price, MA, Managing Editor, Southern Medical Journal

Summertime is a time of year that many people look forward to. The warm and sunny weather is invigorating and allows many opportunities for people to engage in outdoor activities. But it is also a time when injuries become more prevalent.

Unintentional injuries during the summer are common, mostly minor, and usually self-limited. Examples include abrasions, contusions, sunburn, and minor sprains. More significant injuries such as concussions, fractures, heat exhaustion, eye injuries, and others often result in medical visits but usually are associated with good recoveries. Sadly, too many injuries are associated with serious disability or fatality. Submersion injuries and drownings, serious head injuries, and major internal organ injuries are examples. Unintentional injuries remain the leading cause of death for children, adolescents, and adults less than 45 years of age. According to the Centers for Disease Control and Prevention, deaths due to unintentional injuries totaled 120,000 in 2010 – the 5th leading cause of all deaths in the United States

The good news is most serious injuries are preventable. The bad news is many serious injuries represent failures to take appropriate precautions. Prevention is the best strategy to minimize serious injuries. Effective prevention first requires awareness of the effective prevention intervention. Consistent and correct use of the prevention strategy must also occur.

Some leading causes of serious injuries are year-round risks. It is important to recognize these risks and vigilantly apply the appropriate prevention precautions. Automobile accidents are the classic example. Car seats for infants and children and seatbelts for adolescents and adults are corresponding precautions that should be always used. Common everyday risks have a tendency to desensitize people because they are so commonplace. Mundane activities do not trigger concern or thoughts for safety like unusual activities do.

Other serious injuries tend to be more of a seasonal risk. For example, in temperate climates water safety is usually perceived as more of a seasonal concern; however, caution is warranted because in some contexts seasonal risks can occur out of season.

How can one improve his or her awareness and performance with respect to injury prevention? Certainly one can take a few minutes and search the Internet or other sources for recommended safety measures relevant to specific activities. Manufacturers, safety experts, other persons who engage in the activity of interest, or other parties may be helpful. There are a few themes that may be useful frameworks as well.

Injuries Related to Blunt Force
Many serious injuries result from large energy forces acting on critical areas of the body, particularly the brain. Automobile accidents, ATV accidents, major falls, and direct blows from heavy or high-speed objects transmit profound amounts of energy to the body when impacts occur. Vehicles and objects that travel faster than a person can run; activities involving heights above a person’s height; and games that involve high speed, hard balls or other game objects can cause serious injury and warrant avoidance or safety measures. Effective prevention strategies to reduce the chance of serious injury from these types of activities may include reducing the speed of vehicles or game objects being used, using soft balls or other soft game objects, restraining devices, and wearing protective ‘armor’ such as helmets. The goal is to reduce the amount of energy transmitted to vital organs if an impact were to occur.

Injuries Related to Heat Exposure and Hot Weather
Some significant and serious injuries result from exposure to the sun or hot weather. Unprotected sun exposure can lead to significant sunburn which is uncomfortable but also increases the long-term risk of skin cancer. Sunburn also interferes with sweating which predisposes to serious heat-related injuries such as heat exhaustion. During hot weather, the body gains heat from the surrounding environment. The only way for the body to counteract the heat is by sweating. Inflamed skin, certain medications, dehydration, cardiac or other issues that interfere with circulation, high humidity, or remaining in places that are too hot – can interfere with sweating and lead to injuries such as heat exhaustion.

Prevention strategies for sun exposure include staying in shaded areas, covering skin with light clothing, and using sunscreen. Prevention interventions for heat exposures include finding cooler areas, maintaining hydration, and avoiding hot environments when medications, circulatory problems, or skin conditions may preclude effective sweating. To illustrate the importance of sweating, one first aid measure that has been applied to victims of heat exposure is to cool them by ‘artificial’ sweat. Wetting the skin and fanning the individual causes cooling by evaporation of the water applied to his or her skin, just as sweat works. For otherwise healthy people, maintaining hydration is usually the most important prevention principle for hot weather. A healthy adult will need to drink at least half a liter an hour while being inactive in very hot weather. If very strenuous work or exercise is being performed in very hot weather, a healthy adult may need to drink 3-4 liters of water or more per hour to maintain hydration. Sensations of thirst, urination that is less frequent than every few hours, or very concentrated urine are all indicators of inadequate drinking. People often wonder what is the best fluid to drink to prevent heat injuries. The main ingredient needed is water to replace the water being lost as sweat. People often find that cold drinks or flavored drinks make it easier to drink the large quantities of water needed. This is generally fine.

Injuries Related to Inappropriate Supervision
Some serious injuries result from supervision issues. This theme is especially relevant to children but also applies to adults. Children in particular have developmental contexts that predispose them to injuries. Supervision is needed to protect them from their not-yet-fully developed ability to recognize danger and to exercise good judgment. Very young children are particularly vulnerable -- not until late adolescence or early adulthood are these abilities fully developed. Supervision is also important to allow people to have help available when they need to be extricated from dangerous situations. This is the reason swimming alone should be avoided.

Injuries Related to Impaired Cognitive Function
The risk of accidents and injuries is much higher when people are less alert and focused on the activity they are performing. Avoiding activities that can pose danger when one is not able to perform at his best is an important paradigm. Sleep deprivation, several prescription medications, alcohol, drugs, texting, and distractions are well-recognized examples of factors that can impair the performance of people across most activities.

The summer season ends with the transition back to school and other autumn activities. This is a good trigger to do an individual and family safety check for the autumn season.

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