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Surveillance of Disaster—A View From The Denominator
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    The National Institute of Occupational Safety and Health (NIOSH) is dedicated to achieving "safety and health at work for all people -- through research and prevention." An important procedure in pursuing this goal is the NIOSH surveillance studies where the number of injuries are monitored according to demographic, employment, and injury characteristics. These numeric data are then used to identify injury risk factors, develop safety programs, and monitor implemented remediation methods. In essence, ongoing surveillance data form the bases for directing the resources of NIOSH in setting of research and prevention priorities, and in evaluating safety procedures. This surveillance techmque, which is based on the Public Health Service approach to identification and control of disease (1, 2, has been used quite successfully in dealing with relatively high number injuries such as hearing loss, musculoskeletal disorder, respiratory disorder, falls, etc. (2). However a problem arises when extending this paradigm to lower frequency traumatic events; particularly those often referred to as disasters (i.e., high impact events like mine explosions, airplane crashes, etc.). One can ask the question - there hasn't been a coal mine fire fatality in the U.S. for over ten years, to what extent should we be concerned with mine fire safety (resource-wise)? - The National Traumatic Occupational Fatalities (NTOF) system (4J which NIOSH uses to survey occupational fatalities annually, would suggest that underground mine fires would not be a high priority item in occupational safety. Yet, miners' (i.e., the exposed workers) do consider mine fires and explosions to be major safety concerns. I believe that we need to rethink our evaluation of work place disasters, what is worker exposure, and what are the underlying assumptions (both explicit and implicit) as to the impact that economic, societal and degree of hazard factors make on risk evaluation. The answers to all these problems, will require much broader considerations than those in current surveillance safety and health models. This paper discusses some facets of those considerations.

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