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					Injury Control
In this Issue... Injury compensation system has important effects on recovery after whiplash injury . . . . . . .1 Playground equipment injuries . . . . . . . . . . . . .2 Safe Kids Week theme is playground safety . . . . .2 Emergency guideline and poster package . . . . . . . .3 Doctor triumphs over injury tragedy . . . . . . . .3 Calendar . . . . . . . . . . . .3 Motorcycle related injury facts . . . . . . . . . . . . . . .4

ALBERTA
Insurance compensation system has important effects on recovery after whiplash injury
BY J. DAVID CASSIDY, PHD AND LINDA J CARROLL, PHD ASSOCIATE PROFESSORS (EPIDEMIOLOGY) DEPARTMENT OF PUBLIC HEALTH SCIENCES

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ach year, thousands of Canadians are involved in traffic collisions and many file insurance claims for these injuries. The most common claim is for whiplash injury. Whiplash results from accelerationdeceleration forces applied to the neck, which causes strain to the soft tissues of the cervical spine, including the muscles, tendons, fascia and joints. Symptoms can include neck/shoulder/arm pain, headache, jaw pain, dizziness, ringing in the ears, and memory and concentration problems. However, because of the subjective nature of these symptoms, there is controversy over the determination of severity of the injury and the appropriate amount of compensation. Now, a new Saskatchewan study reveals that the type of insurance compensation has a profound effect on the number and recovery of whiplash claims. The study, reported in the April 20th edition of the prestigious New England Journal of Medicine and authored by Drs. David Cassidy and Linda Carroll from the Alberta Centre for Injury Control and Research, looked at all adult whiplash claims in the province of Saskatchewan, both before and after legislation for no-fault insurance.1 Data was collected during the last six months of the old tort system and the first two six-month periods of the

new no-fault system, between July 1994 and December 1995. Claimants were followed for one year by self-report questionnaires. Under the tort system, claimants could sue for "pain and suffering," while under the no-fault system, there are no payments for pain and suffering, but improved medical and income replacement benefits. This legislative change practically eliminated court actions for whiplash injury. Over the 18 months of the study, there were 9006 injury claims of which 7462 (83%) were for whiplash. The sixmonth incidence of whiplash claims fell from 417 per 100000 Saskatchewan adults in the last six months of the tort system to 302 and 296 per 100000 over the first two six-month periods of the no-fault system. The greatest reductions occurred in males, young persons and in the lowest income group. During tort, the median time to claim closure was 433 days. This fell to 194 days and 203 days during the two no-fault periods, an average decrease of over 200 days in recovery time. Twenty-two percent of tort claimants had retained a lawyer to help with their claim and this fell to 5 per cent during no-fault. One of the most important factors in determining recovery was whether or not a lawyer was involved. Given the same degree of injury, those that retained a lawyer during the tort period took about 250 days longer to recover than those that had not retained a continued on page 4

Injury Control Alberta
A monthly publication of the Alberta Centre for Injury Control & Research University of Alberta 4075 EDC 8308 - 114 Street Edmonton, Alberta, Canada T6G 2V2 Phone: (780) 492-6019 Fax: (780) 492-7154 E-mail: acicr@ualberta.ca Internet: www.med. ualberta.ca/acicr

Vol 2, No. 9 May 2000

Injury Control
ALBERTA

Playground Equipment Injuries
Falls from Playground Equipment In 1997, 264 Albertans were hospitalized due to injuries sustained in a fall from playground equipment.1 • Nearly 95% of these patients were children aged 1 through 14. • Over half of these patients were admitted to the hospital in the evening after 5 p.m. • Fractures to the upper limbs were the most common type of diagnoses (68.6%), followed by intracranial injuries (11.0%). Between April 1, 1997 and March 31, 1998, over 3100 Albertans were treated in an Emergency Room for injuries sustained from a fall from playground equipment.2 • Nearly half of these patients were children aged 1-14. Other Playground Injuries3 In the Capital Health Region between April 1, 1997 and March 31, 1998 the most common types of playground equipment involved in injury were: • Monkey Bars (33.3%) • Slides (24.1%) • Swings (19.8%) Note: Not all RHA's are collecting sport and recreation data. ACICR records indicate that, as of press time, the Chinook, Calgary, Northern Lights, David Thompson and Capital health regions were the only regions collecting this information. In order to do a breakdown by type of playground equipment for your region, please contact your local health records department to see if they are collecting this information. 1. ACICR, 1997 Inpatient Database. 2. ACICR 97-98 ER Visit Database. 3. Capital Health, 1997-98, Planning Evaluation and Information.

Safe Kids Week theme is playground safety
BY MARCI MAZURENKO PROGRAM ASSISTANT, KIDSAFE CONNECTION

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his year, Alberta will mark Safe Kids Week 2000 from May 29 to June 4. This initiative is held to heighten awareness of the toll injuries take upon children. Safe Kids Week will encourage individuals to take preventative, proactive measures for children's safety. This year's theme, as announced by Safe Kids Canada, is Playground Safety. Injuries on play equipment are a major health concern for children. Each year in Canada, thousands of children are seen in emergency rooms and doctors' offices for injuries sustained on playgrounds. In one year, in Alberta alone, more than 350 children are hospitalized as a result of playground injuries.1 Falls are the main cause of playground injuries, accounting for 70 per cent of injuries needing medical care.2,3,4,7 Strangulation is the most common cause of playground death.2,5,6,7 Communities are encouraged to become involved in Safe Kids Week 2000. In Calgary and Edmonton, playground media events will be held to increase awareness of playground safety and encourage parents and community members to become involved in children's safety. What can you do as injury prevention advocates? • Approach your local media for support of this initiative. • Write an article for the local paper or community newsletter highlighting injury prevention and playground safety. • Hold an event at a school or community playground and distribute playground safety information. Here are some key playground safety tips to include: • Supervise all young children on playgrounds. Encourage them to use equipment meant for their age and skill level. • Remove drawstrings and scarves from children's clothing. Do not allow skipping ropes on or around play equipment. • Choose equipment that combines safety and fun. • Ensure there is a 10 - 12 inch depth of loose, impact-absorbing surface such as

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pea-gravel or sand under and around all play equipment. Limit equipment height. Ensure hand and guardrails are in place. Eliminate gaps where clothing may catch. Ensure your children know the basic rules of safe play: · Always wear shoes. · Take off bike helmets while playing on the equipment. · Keep clear of moving things. · Slide down feet first and sitting up; only one person on the slide at a time. · No pushing or horseplay on play equipment and wait your turn. · Hold on with both hands when swinging and climbing.

KIDSAFE Connection has many playground safety resources available including: • Playground Safety Fact Sheet. • Soft Landings Brochure - developed by the Calgary Injury Prevention Coalition (CIPC). • Play Safe, Safe Play - A Curriculum Guide for Safe Playground Environments - available through the Calgary office for $20 per guide - developed by the CIPC. • Play Cool, Play Smart - Child Care Resource Package - available through the Calgary office for $10 per package - developed by the CIPC. • Play Cool, Play Smart - Elementary School Package - available through the Calgary office - developed by the CIPC. • Removing Playground Hazards for our Children's Safe: A Resource Guide for Alberta Communities - available for $10 per manual. Please contact KIDSAFE Connection in Calgary at (403) 229-7833 or in Edmonton at (780) 407-7250 for additional information on Safe Kids Week, playground safety or other childhood injury prevention issues.
1. Alberta Medical Assoc., Alberta SAFE KIDS Campaign. Removing playground hazards for our children's sake. 1994. 2. SAFE KIDS Canada. Playground fact sheet. 1996 3. Bond MT, et al. The risk of childhood injury on Boston's playground equipment and surfaces. AJPH: 83. 1993 4. Lesage D, et al. Does play equipment conform to the Canadian standards? CJPH: 86. 1995. 5. Health Canada. Playground safety tips. 1995. 6. Reichelderfer TE, et al. Unsafe playgrounds. Pediatrics: 64. 1979. 7. Health Canada. For the safety of Canadian children and youth. 1997.

Vol 2, No. 9 May 2000

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Emergency guideline and poster package
BY DOROTHY A. COCHRANE, A CUTE CARE PROGRAM MANAGER, ACICR

ast year, results of an Emergency Survey indicated the need for Protocols/Guidelines for the varying emergency conditions we may see in the Emergency Department. After several reviews by nursing groups, Medical Directors and various stakeholders, the protocols have been completed and will be sent out as originally planned. The word “protocols” has been substituted with the word “guidelines” because they are recommendations for the treatment of the emergency patient, but have the same common end-goal: the “best practice” as we know it to be. The completed Guidelines are as follows: 1. General Systems Trauma Patient, 2. Head Injury: Guideline for Treatment, 3. Spinal Cord Injury Guideline, and 4. Burn Guideline and General Information.

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The mailout package for these will also include the Directory for Alberta Emergency Departments which is an initial attempt to have a database of all emergencies in the province as well as the pre-hospital services available in the province. This will be an on-going database, as changes occur almost daily within our very flexible and fluid health care system. As well, four 11x17 posters (laminated) will be included in the mailout: 1. 2. 3. 4. Adult Burn - Rule of Nines, Pediatric Burn, Glasgow Coma Scale, and Pediatric Coma Scale.

CALENDAR
FOIP 2000 (Freedom of Information and Privacy) May 29 - 30, 2000 Edmonton, Alberta Contact: (780) 436-0983 National Transportation Week June 4 - 10, 2000 St. John Ambulance First Aid Week June 18 - 24, 2000 Information Technology in Community Health 2000 August 23 - 27, 2000 Victoria, British Columbia Contact: (250) 721-8576 Canadian Conference on Injury Prevention & Control - 2000 October 19 - 21, 2000 Kananaskis, Alberta Contact: (780) 492-6019 14th Annual California Conference on Childhood Injury Control October 22 - 25, 2000 San Diego, California Contact: (619) 594-3691 Fourth Annual Safe Communities Foundation Conference October 26 - 27, 2000 Peterborough, Ontario Contact: (416) 964-0008

Any of the information that is presented may be photocopied and shared with anyone. Another exciting feature that will be available in June is the presence of all the guidelines on the ACICR Website (www.med.ualberta.ca/acicr).

Doctor triumphs over injury tragedy
BY ERIN BAMPTON MANAGER, WORKERS' COMPENSATION BOARD, MILLARD CENTRE

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t 33 years old, Dr. Claudia Osborn was a dedicated and hard-working doctor who couldn't imagine any other life for herself. Then, on a warm summer evening in 1988, a car collided with her bicycle. It soon became clear that she was no longer the same person. The severity of her head injury had caused profound brain trauma. After her injury, Osborn - a driven doctor enthralled by saving lives and teaching young interns - suddenly had trouble recognizing familiar people, making simple decisions, and engaging in conversation. She routinely forgot to eat and was exhausted and confused by simple tasks. Dr. Osborn underwent extensive rehabilitation in Manhattan at the Head Trauma Program of the New York University Medical Centre. Following her return home in Michigan, she began writVol 2, No. 9 May 2000

ing. At first, it was a form of therapy. It soon became a cause in itself, borne of a need to be understood by others, and resulted in publication of a book. Even with the assistance of her mother, who organized her notes and journal and edited her manuscript, the book took seven years to complete. Her book Over My Head was a success and started Osborn on the speaker circuit. She received rave reviews for her most recent presentation as key note speaker at the Pacific Coast Brain Injury Conference in Vancouver last fall. We are fortunate to have Dr. Osborn coming to Edmonton, Alberta. She will be the featured speaker at the Northern Alberta Brain Injury Society (NABIS) Annual Kick-Off Breakfast on June 2nd at the Westin Hotel. (For tickets call 479-1757) Dr. Claudia Osborn is currently an Associate Clinical Professor of Internal Medicine at Michigan State University College of Osteopathic Medicine.

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Injury Control
ALBERTA

Saskatchewan Study
continued from page 1 lawyer. Under no-fault, those with lawyers took about 100 days longer to recover. The study concludes that linking compensation to pain and suffering has a negative impact on recovery. Modern rehabilitative practices emphasize focusing on ability and not on disability. Under tort, claimants are forced to focus on their pain and suffering to claim their benefits, which is counterproductive for recovery. The study also concludes that legislators may wish to consider the advantages of removing compensation for pain and suffering from insurance coverage. 1. Cassidy JD, Carroll LJ, Côté P, Lemstra M, Berglund A, Nygren Å. Effect of eliminating compensation for pain and suffering on the outcome of insurance claims for whiplash injury. N Engl J Med 2000:342:1179-86.

Motorcycle related injury facts
• • • In 1998 there were 26 motorcycle-related deaths in Alberta.1 The majority of casualty collisions involved male drivers.1 Motorcycle drivers under age 25 had the highest involvement rate per 1000 licensed drivers, in particular ages 16 and 17 with a rate of 71.0/1000 licensed drivers which is over 4 times greater than the rate for licensed motorcycle drivers aged 20-24.1

# MOTORCYCLE RELATED DEATHS/YEAR - 6 YEAR COMPARISON1
1998 26 1997 8 1996 11 1995 15 1994 11 1993 24

In Alberta in 1997 there were 336 inpatient hospitalizations associated with injuries sustained by motorcyclists or their passengers.2 • • • • The ages of these hospitalized patients ranged from 7 through 88. Males accounted for over 85% of these 336 hospitalized patients. 22 of these patients were injured severely enough to require treatment in a special care unit (i.e., ICU) during their hospitalization. Fractures were the most frequently recorded most responsible diagnosis for these patients at 55%. Serious head injuries were second at 12%. Of note, 2 patients had a most responsible diagnosis of spinal cord injury.

Among Albertans between April 1, 1997 and March 1, 1998, there were nearly 1700 emergency room visits for either drivers or passengers of motorcycles.3 • • • • The ages of these patients ranged from 1 through 85. Ninety-four percent of these people treated in the ER were the drivers of the motorcycle.2 Males accounted for 88% of these people treated in ER. The most common diagnoses were fractures at 27% of all motorcycle related ER visits, followed by contusions (16.3%), sprains and strains (13.7%), open wounds (12.1%), and superficial injuries (10.7%).

1. Alberta Transportation & Utilities; Alberta Traffic Collision Statistics, 1997 2. Alberta Centre for Injury Control & Research; 1997 Inpatient Database 3. Alberta Centre for Injury Control & Research; 1997/98 ER Database

Vol 2, No. 9 May 2000

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