Before they were fired, staff at the Centers for Disease Control and Prevention were about to launch a new data system to improve how the U.S. tracks concussions.
They were planning to release updated guidance on diagnosing traumatic brain injury in children and publish new findings on drownings after natural disasters. They were combing the web for data on suicides to forecast trends and studying changes in how people are injured during car crashes.
All of this came to a halt when health secretary Robert F. Kennedy Jr. to the Department of Health and Human Services this month.
Much of the federal workforce focused on injury and violence prevention was cut, according to researchers, advocates and five former employees whose jobs were eliminated.
NPR is not disclosing their names because they are still on administrative leave and not authorized to speak to the press.
Entire teams based at the CDC's injury center that focused on motor vehicle crashes, child maltreatment, drowning, traumatic brain injury, falls in the elderly, and other issues were eliminated.
"A lot of the work we do will not be picked up by anyone else," one senior health scientist who lost their job tells NPR.
, whose nonprofit Safe States Alliance works closely with CDC and state health departments, knows of more than 200 positions that were eliminated at the CDC's injury center.
And while some areas, such as the division of overdose prevention and a branch that focuses on suicide, were largely spared, they now lack technical support to carry out some of their work.
Researchers warn the firings jeopardize the federal government's ability to systematically track injuries -- the leading cause of death in the U.S. for people under 45.
"One of my concerns is we will not have this comprehensive surveillance system," says , executive director of , an injury and violence prevention nonprofit.
"We will not know what is killing us and that's very scary."
For example, the entire branch charged with analyzing data for the injury center and maintaining a key database were fired, leaving the systems largely unattended, according to interviews with several former CDC employees.
"This is critical work that's been done at such a low cost with such a high return and a lot of it's unseen," says Beth Moracco, who directs the UNC Injury Prevention Research Center.
In an emailed statement, HHS told NPR that "critical CDC programs will continue as a part of Secretary Kennedy's vision to streamline HHS to better serve the American people, including the important work that helps research injury and violence prevention, as well as behavioral and substance-related harm prevention."
But advocates like Gilmartin aren't clear exactly how that will happen when scientists and subject matter experts in the federal government with decades of experience were laid off.
Moracco warns that datasets on injury and violence could end up scattered across the federal government, unavailable to researchers and state health officials who rely on this centralized source of information to steer on-the-ground-efforts to prevent top killers like overdoses, motor vehicle accidents, drownings and more.
And, in some cases, data won't be collected at all.
Last week, the CDC shuttered a long-running initiative that offered a broad picture of injuries across the country based on ER records collected from about 100 hospitals.
The National Electronic Injury Surveillance System relied on contractors reviewing thousands of and categorizing them by cause, including motor vehicle accidents, adverse drug events, firearms, drownings, poisoning, dog bites.
This particular data source was unique because it provided real-time monitoring of non-fatal injuries, as well as why and how the injury occurred, which isn't done elsewhere in the federal government.
In a statement, the Consumer Product Safety Commission, which had partnered with the CDC on the system, told NPR it would continue collecting ER data on injuries related to products, but would stop collecting all the other data because of CDC staff cuts.
Even though the Trump administration has made no secret about its intentions to downsize and remake federal health agencies, many in the field of injury and violence prevention weren't expecting their corner of the CDC to be hit so hard.
"There's nothing partisan about injuries," says Dr. Mark Rosenberg, the first director of the CDC's injury center, which was established in the early '90s.
"These are our kids who are being shot, our kids who are drowning, our kids who are being abused and neglected," he says.
Over the years, the CDC center has been instrumental in advancing public health interventions like better airbags and vehicle design, smoke detectors and bicycle helmets. It's behind a public health program on how to identify concussions that by high school sports programs all over the country.
The scope of the work is incredibly broad and varied. Certain areas, in particular gun violence, are more politically fraught. But the underlying premise, Rosenberg explains, rests on the belief that injuries should be viewed as public health problems to be solved, rather than accidents that are bound to happen.
"One of the jobs of the injury center was to help people understand that you can predict these and you can prevent them," he says.
Last year the agency's budget was over $700 million. The bulk of its funding goes directly out the door to state health departments, a network of research centers at universities and community organizations. For example, the YMCA, which runs a drowning prevention program, says much of that work may be in jeopardy.
Because the staff who managed these external funding streams were fired, Gilmartin expects that money to dry up, too.
"There's a direct line between federal employees and the states and communities they serve," she says. "We've severed that."
Rexing says these cuts will have a huge ripple effect. The CDC has been the organizing force and a major funder for injury prevention for many years.
"I do see it as a collapse in the field," says Rexing, "The development of the field. The knowledge we already have on solving these really complex issues."
Have information you want to share about the ongoing changes across the federal government? Reach out to these authors via encrypted communications: Will Stone @wstonereports.95
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