Injury Control

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					   Injury Control
Injury Prevention Center

Department of Emergency Medicine
Rhode Island Hospital, Hasbro Children’s Hospital &The Miriam Hospital
Brown University School of Medicine
            Injury in the U.S.

   Average Day
     405  people die as result of injuries
     7,500 people hospitalized from nonfatal
     Approximately 150,000 people suffer
      injuries severe enough that they seek
      medical attention
               Injury in the U.S.
 Injury the leading cause of death and
  disability among children and young
 Nearly 150,000 die each year from
       41,000 - motor vehicle crashes
       28,000 - fires, drownings, falls, poisonings
       30,500 - suicide
       25,500 - homicide
Injuries - Rhode Island Statistics
  ED visits - incidence 112 per 1000
   population in 1992

  For   each injury death
    – 17 hospitalizations
    – 325 outpatient ED visits
    – 500 required some professional treatment
The Injury Pyramid




Injury Control in the ED

   37% of all emergency department visits
    can be attributed to injuries
Injury Control in the ED
   Emergency Personnel
     Exposed   to this problem by specialty
     Opportunity   to improve patient care
      – Improve community care
      – Control health care costs
Cost of Injuries in the U.S.

 Approximately 12% of all medical
 $260 billion dollars was spent in 1995
  on injuries
Cost of Injuries in the U.S.
   Calculating the Costs of Injuries
     Direct Costs
     Indirect Costs
Injury Costs
   Costs - Who pays?
       Financial costs
         – Public sources (federal, state, local) pay 28%
         – Private sources pay 72%
         – Federal Government
             $12.6 Billion in medical costs

             $18.6 Billion in disability and death benefits

            Source: Centers for Disease Control and Prevention
Comparing Years of Potential Life Lost
(YPLL) of Injuries and Other Diseases
Injury and Age

 Injury is the leading cause of death in
  children and young adults
 Injuries kills more Americans aged 1-34
  than all other disease combined.
The Five Leading Causes of Death
      by Age Group for 1996

              Adapted from National Center for Injury Prevention and Control,, CDC
Injury Control Concepts
   Injuries can be described in the same
    manner as other diseases
     Seasonal  variations
     Epidemic in certain populations
     Affected by environmental conditions
     Susceptibility factors identifiable
     Predictable patterns
Injury Control Concepts
   Scientific approach to injuries
     Injuries are preventable
     Identify and describe problem through
     Study what puts people at risk
     Design and evaluate an intervention
Myth: Injuries are Accidents
 Injuries are no accident
 Injuries are no accident
 Injuries are no accident
 Injuries are no accident
 Injuries are no accident
 Injuries are no accident
 Injuries are no accident
Definition of an Injury

 An injury is tissue damage caused
 by the transfer of energy to the
 body above or below the tolerance
 of human tissue
Types of Energy
 Kinetic
 Thermal
 Electrical
 Chemical
 Radiation
The Injury Triangle


Injury Triangle Example
 Brain Injury in Children
                 host                                    Children

        vector                        Bicycle Riding

agent                                   Kinetic Energy              Neighborhood Streets
 Concepts of Injury Control
  Haddon’s     Matrix

              Pre-Injury   Injury   Post-Injury
      Injury Prevention:
        The Three E’s
 Education

 Enforcement

 Engineering
The Three E’s:   Education
 Aim is to provide community with
  information on how to avoid injury
 Alter attitudes about risk reduction
 Modify behaviors by educating
  community about why they must adopt
The Three E’s:    Education
   Particularly useful for:
     Teaching   young children lifelong safety
     Certain injury patterns where education
      about hazard is only option
     Altering social norms about risk of injury
     Promoting societal policy change for safer
The Three E’s: Engineering

   Use modifications in environment to
    reduce injury risks by providing passive

     Examples:
       – Road design: separate bike lanes, rumble strips
         in road shoulder

       – Auto design: airbags, padded dashboards,
         reinforced side panels
The Three E’s: Enforcement

 Enforcement is usually more effective
  than education
 Most injury prevention laws at state
 Laws can have varied focus:
     individualbehaviors
     engineering of environment
     consumer products design
Active Intervention Strategies
   Requires repeat action by individual and
    benefit is only by those individuals
    performing action
     example:   seatbelt use
        Passive Intervention
   No action required by the individual
    once it has been put in place

   It frequently requires altering the
    environment to prevent energy transfer
    or reduce damage from energy transfer
Active vs. Passive Strategies
   Active Strategies
       Require continual upkeep
       Not uniformly accepted
       Frequently less expensive to implement
   Passive Strategies
       Universal application by protecting all members of
        the community
       Don’t decay in efficacy
       Avoids individual’s risk values
       Doesn’t have to be perfect fit for all individuals
Haddon’s Ten Strategies for Injury
Prevention Countermeasures

1. Stabilize, Repair and Rehabilitate
  provide best practice standards of emergency,
    hospital, and rehabilitation care
2. Counter damage already done
  transporting head injured and spinal cord injured
3. Increase resistance to injury
  education about calcium intake in preventing
Haddon’s Ten Strategies for Injury
Prevention Countermeasures

4. Modify the relevant basic qualities of
  the hazard
  padded dashboards
5. Separate the hazard and its release by
  a material barrier
  four sided pool fencing
6. Separate people from the hazard and
  its release using time or space
  pedestrian crossing lights, bike lanes
  Haddon’s Ten Strategies for Injury
    Prevention Countermeasures

7. Change the rate or spatial distribution
  at which the hazard is released
     release bindings on skis
8. Prevent inappropriate release of hazard
     storing firearms in locked cases
9. Reduce Amount of Energy
     limiting horsepower in motorized vehicles
10. Prevent Creation of Energy
     don’t manufacture firecrackers
Injury Control - Role of
   Educate

   Injury surveillance

   Conduct research

   Advocate change
Injury Control - Role of
   ED data useful to target prevention
     Number   of injuries from a specific cause
     Severity of injuries
     Likelihood of success or preventative
Injury Control - Role of
   Patient care
     injury science can be used to improve
      clinical care
   Recognition of injury patterns
     Rationalapproach
     Timely definitive therapy
     Reduces the possibility of missed injuries
Injury Control - Role of
   Education
     Patient specific
     Public groups
     Legislators

   Publish
Injury Control - Role of
   Surveillance
     Defines  injury patterns in a community
     Limited data available on non-fatally
      injured people
     E - Codes
     Legislators need good information
     Linkages between ME’s office, DPH, ED’s
Injury Control - Advocacy
   Influence policy
     Regional
     State
     National

   Prior legislative involvement
     seatbelts
     motorcycles
     all   terrain vehicles
Injury control - Partners
  Public safety - Police, Fire, EMS
  Local government
  Schools
  Business
  Community groups
  Health care providers
  Public health agencies
Past Successes in Injury Control
   Seatbelts
         decrease in motor vehicle crash moralities
   Crib design
         decrease in strangulation's with smaller slat
   Child Resistant Caps
         decrease in childhood poisoning
   Blade Brake on Lawn Mowers
         decrease in hand/foot amputations
   Window Guards
         decrease in window falls for children
 Injury is a preventable disease
 Involve patients in discussions about
  their own injuries and their role in
 Integrate principles of injury control
  into your discharge instructions

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