LETTERS TO THE EDITOR
New York (14.1 per cent), a possible reflection of different levels of sophistication among hospitals within and outside of New York City. Analysis is continuing on the New York City data and further reports will be forthcoming. We believe analysis of data based on at least a one-year experience has greater validity than an initial six-month period following the introduction of newly added items on the birth certificate. Sol Blumenthal, PhD Acting Director for Biostatistics and Frieda Nelson Assistant Director Bureau of Health Statistics & Analysis New York City Department ofHealth 125 Worth Street New York, NY 10013
REFERENCES 1. Zdeb MS, Logrillo VM: Prenatal monitoring in upstate New York. Am J Public Health 69:499-501, 1979.
Medical Alert Center at USC; not at UCLA The article by Dr. James, "Impacts of the Medical Malpractice Slowdown in Los Angeles County: January 1976,"' contains an error on page 440. The Medical Alert Center is erroneously identified as being situated at Los Angeles County-UCLA Medical Center. In fact, the Center is located at the Los Angeles County/University of Southern California Medical Center. Joseph K. Indenbaum, MD Medical Director County of Los Angeles Department of Health Services 313 North Figueroa Street Los Angeles, CA 90012
REFERENCES
1. James JJ: Impacts of the medical malpractice slowdown in Los Angeles County: January 1976. Am J Public Health 69: 437-442, 1979.
In Support of the Child Restraint Law In his evaluation of "The Tennessee Child Restraint Law,"' Williams documents well the increase of hazard AJPH August 1979, Vol. 69, No. 8
to children from a safety law enacted with apparent good intentions. Quite appropriately he calls attention to the "double jeopardy" of an infant held in the arms or lap of an adult in the right front seat of a moving vehicle. In his article, "The Fault Doctrine and Injury Control,"2 Wigglesworth notes the relative futility of attempting to reduce accidents through punitive countermeasures. He cites as an example the ineffective legislative approach in Sweden and Norway to drinking while driving. I suspect that morbidity and mortality data from Tennessee and Kentucky following the enactment of the child restraint law will give further support to the argument favoring the use of passive restraints. John H. Hughes, MD Director, Emergency Services Associate Professor of Surgery, and ofFamily and Community Medicine University of Arizona Tucson, AZ 85724
chased and put jet airplanes into use since 1961! Ridiculous! Let's encourage researchers to recognize that an injury transmitting agent (tractor, airplane, ladder, etc.,) may experience wide variances in both hours of use and type of use over a period of time. Even conclusions based on changes in accidents per million hours of use must consider changes in type of use (i.e., 55 mph speed limit) before comparing findings with prior
REFERENCES
The report, Farm Tractor Fatalities: The Failure of Voluntary Safety Standards, February 1979, is very misleading. First of all, the voluntary safety standard can work if people are educated as to the benefits of protection. At present, there are 850,000 roll over protective structures in use across the United States on agricultural tractors. There are an additional 250,000 in use on industrial tractors. Most of these were put on before promulgation of the agricultural ROPS standard which took effect on October 25, 1976. There are still many old tractors in use without ROPS, however, the percentage of new tractors being sold with ROPS reaches 100 per cent in Nebraska on the tractors of 80 horsepower and above. I am quite disturbed in that authors Karlson and Noren have not referenced any of the true farm tractor overturn studies. Most of those listed relate to information that was gleaned from health statistics. These are only death certificates and do not address themselves to the true circumstances of the fatality. Furthermore, these are only for deaths and not injuries. Nothing is said about the benefits of ROPS. If I didn't know better, I
1. Williams AF: Evaluation of the Tennessee child restraint law, Am J Public Health, 69:455-458, 1979. 2. Wigglesworth EC: The fault doctrine and injury control, Journal of Trauma, 18: 789-794, 1978.
Three Comments Received on Farm Tractor Safety Factors I am disturbed by the erroneous conclusions reported in the Karlson Noren article, "Farm Tractor Fatalities: The Failure of Voluntary Safety Standards,"'I in the February Journal. The authors used the statistic that accidents per 100,000 male farm residents in Wisconsin went up significantly to support a conclusion that "voluntary standards are not protecting the farm population." This conclusion ignores the significant increases in both numbers of tractors and hours of tractor use per 100,000 male farm residents over the past 10 years. Using death rates per capita instead of death rates per hour of use also could have lead Karlson and Noren to conclude that there has been a horrible increased risk of death on airlines that have pur-
years.
Richard G. Pfister, PhD Professor and Extension Safety Engineer Department ofAgricultural
Engineering Michigan State University
REFERENCES 1. Karlson T, Noren J: Farm tractor fatalities: the failure of voluntary safety standards. Am J Public Health 69:146-149,
1979.
823
New York (14.1 per cent), a possible reflection of different levels of sophistication among hospitals within and outside of New York City. Analysis is continuing on the New York City data and further reports will be forthcoming. We believe analysis of data based on at least a one-year experience has greater validity than an initial six-month period following the introduction of newly added items on the birth certificate. Sol Blumenthal, PhD Acting Director for Biostatistics and Frieda Nelson Assistant Director Bureau of Health Statistics & Analysis New York City Department ofHealth 125 Worth Street New York, NY 10013
REFERENCES 1. Zdeb MS, Logrillo VM: Prenatal monitoring in upstate New York. Am J Public Health 69:499-501, 1979.
Medical Alert Center at USC; not at UCLA The article by Dr. James, "Impacts of the Medical Malpractice Slowdown in Los Angeles County: January 1976,"' contains an error on page 440. The Medical Alert Center is erroneously identified as being situated at Los Angeles County-UCLA Medical Center. In fact, the Center is located at the Los Angeles County/University of Southern California Medical Center. Joseph K. Indenbaum, MD Medical Director County of Los Angeles Department of Health Services 313 North Figueroa Street Los Angeles, CA 90012
REFERENCES
1. James JJ: Impacts of the medical malpractice slowdown in Los Angeles County: January 1976. Am J Public Health 69: 437-442, 1979.
In Support of the Child Restraint Law In his evaluation of "The Tennessee Child Restraint Law,"' Williams documents well the increase of hazard AJPH August 1979, Vol. 69, No. 8
to children from a safety law enacted with apparent good intentions. Quite appropriately he calls attention to the "double jeopardy" of an infant held in the arms or lap of an adult in the right front seat of a moving vehicle. In his article, "The Fault Doctrine and Injury Control,"2 Wigglesworth notes the relative futility of attempting to reduce accidents through punitive countermeasures. He cites as an example the ineffective legislative approach in Sweden and Norway to drinking while driving. I suspect that morbidity and mortality data from Tennessee and Kentucky following the enactment of the child restraint law will give further support to the argument favoring the use of passive restraints. John H. Hughes, MD Director, Emergency Services Associate Professor of Surgery, and ofFamily and Community Medicine University of Arizona Tucson, AZ 85724
chased and put jet airplanes into use since 1961! Ridiculous! Let's encourage researchers to recognize that an injury transmitting agent (tractor, airplane, ladder, etc.,) may experience wide variances in both hours of use and type of use over a period of time. Even conclusions based on changes in accidents per million hours of use must consider changes in type of use (i.e., 55 mph speed limit) before comparing findings with prior
REFERENCES
The report, Farm Tractor Fatalities: The Failure of Voluntary Safety Standards, February 1979, is very misleading. First of all, the voluntary safety standard can work if people are educated as to the benefits of protection. At present, there are 850,000 roll over protective structures in use across the United States on agricultural tractors. There are an additional 250,000 in use on industrial tractors. Most of these were put on before promulgation of the agricultural ROPS standard which took effect on October 25, 1976. There are still many old tractors in use without ROPS, however, the percentage of new tractors being sold with ROPS reaches 100 per cent in Nebraska on the tractors of 80 horsepower and above. I am quite disturbed in that authors Karlson and Noren have not referenced any of the true farm tractor overturn studies. Most of those listed relate to information that was gleaned from health statistics. These are only death certificates and do not address themselves to the true circumstances of the fatality. Furthermore, these are only for deaths and not injuries. Nothing is said about the benefits of ROPS. If I didn't know better, I
1. Williams AF: Evaluation of the Tennessee child restraint law, Am J Public Health, 69:455-458, 1979. 2. Wigglesworth EC: The fault doctrine and injury control, Journal of Trauma, 18: 789-794, 1978.
Three Comments Received on Farm Tractor Safety Factors I am disturbed by the erroneous conclusions reported in the Karlson Noren article, "Farm Tractor Fatalities: The Failure of Voluntary Safety Standards,"'I in the February Journal. The authors used the statistic that accidents per 100,000 male farm residents in Wisconsin went up significantly to support a conclusion that "voluntary standards are not protecting the farm population." This conclusion ignores the significant increases in both numbers of tractors and hours of tractor use per 100,000 male farm residents over the past 10 years. Using death rates per capita instead of death rates per hour of use also could have lead Karlson and Noren to conclude that there has been a horrible increased risk of death on airlines that have pur-
years.
Richard G. Pfister, PhD Professor and Extension Safety Engineer Department ofAgricultural
Engineering Michigan State University
REFERENCES 1. Karlson T, Noren J: Farm tractor fatalities: the failure of voluntary safety standards. Am J Public Health 69:146-149,
1979.
823
