Disproportionately high rates of unintentional injuries are a leading cause of death for American Indians and Alaska Natives. From their unique vantage point on the front lines of community health, nurses can make a life-saving difference in helping tribes reduce and prevent these deadly disparities.
When three young children from the same family were killed in a car accident on the Pine Ridge Indian Reservation in South Dakota about five years ago, the leaders of the Oglala Sioux Tribe realized that they needed to do more to reduce the high rates of child passenger fatalities in their community.
The tribe’s Department of Public Safety applied for a Tribal Injury Prevention Cooperative Agreement Program (TIPCAP) grant from the federal Indian Health Service (IHS) Injury Prevention Program. As a result, Pam Pourier, RN, was hired as her tribe’s full-time injury prevention coordinator. “The important thing about using Native nurses in injury prevention activities on their home reservations is that the nurses know, and can identify with, the community people,” she says.
Since then, Pourier has worked tirelessly to promote and increase the use of child-restraint car seats throughout the reservation’s nine districts. In addition to educating families about the importance of securing their kids in safety seats, she has distributed hundreds of free seats to parents who otherwise couldn’t afford them. Her efforts have made such an impact in the Oglala community that she has earned the nickname Super Car Seat Lady.

A Different Kind of Health Disparity
Injury prevention is a critical concern for the 566 federally recognized American Indian and Alaska Native (AI/AN) tribes in the United States. According to IHS, unintentional injury from preventable accidents—such as motor vehicle crashes, drownings, poisonings, fires, and falls—is the third leading cause of death in AI/AN communities (after cancer and heart disease). Even more troubling, accidental injuries are the number one killer of young AI/AN people between infancy and middle age.
Although American Indians and Alaska Natives make up only about 2% of the total U.S. population (as of the 2010 Census), their risk of dying from unintentional injuries is disproportionately high. Statistics from IHS, the Centers for Disease Control and Prevention (CDC), and the Alaska Native Tribal Health Consortium (ANTHC) reveal a litany of disparities:
AI/AN people have the highest motor vehicle-related mortality rates of any racial or ethnic group in the nation.
AI/AN infants younger than one year old are eight times more likely to die in motor vehicle accidents than non-Hispanic whites.
Death rates from poisoning and falls are twice as high for AI/AN people than for their Caucasian counterparts.
Alaska Native children are five times more likely to die of an accidental injury than U.S. children as a whole.
Overall, Alaska Natives die of unintentional injuries twice as often as non-Native Alaskans and almost three times as often as Americans in general.
What accounts for these unequal outcomes? The IHS Injury Prevention Program cites a number of interconnected factors, including: the high proportion of young adults in AI/AN communities; hazards associated with living in rural environments; limited resources for providing safety infrastructure, such as street lighting, on reservations; low seatbelt and car seat use among AI/AN people; the need for stronger enforcement of state and tribal traffic safety laws; and higher-than-average numbers of alcohol-related accidents.

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