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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
      injuries
     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
  adults
 Nearly 150,000 die each year from
  injury
       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


               DEATHS




         HOSPITAL DISCHARGES




      EMERGENCY DEPARTMENT VISTS




   EPISODES OF INJURIES REPORTED
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
  spending
 $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
      surveillance
     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
                 HOST




        VECTOR




                        ENVIRONMENT
AGENT
Injury Triangle Example
 Brain Injury in Children
                 host                                    Children




        vector                        Bicycle Riding




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

              Pre-Injury   Injury   Post-Injury
Host
Agent
Environment
      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
  behavior
The Three E’s:    Education
   Particularly useful for:
     Teaching   young children lifelong safety
      skills
     Certain injury patterns where education
      about hazard is only option
     Altering social norms about risk of injury
     Promoting societal policy change for safer
      environment
The Three E’s: Engineering

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

     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
  level
 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
            Strategies
   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
     appropriately
3. Increase resistance to injury
  education about calcium intake in preventing
    osteoporosis
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
Practitioners
   Educate

   Injury surveillance

   Conduct research

   Advocate change
Injury Control - Role of
Practitioners
   ED data useful to target prevention
    activities
     Number   of injuries from a specific cause
     Severity of injuries
     Likelihood of success or preventative
      measures
Injury Control - Role of
Practitioners
   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
Practitioners
   Education
     Patient specific
     Public groups
     Legislators

   Publish
Injury Control - Role of
Practitioners
   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
    distancing
   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
Summary
 Injury is a preventable disease
 Involve patients in discussions about
  their own injuries and their role in
  prevention
 Integrate principles of injury control
  into your discharge instructions

				
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