INJURY PREVENTION INJURY PREVENTION Presented byPresented by

TheThe American College of Surgeons American College of Surgeons Committee on TraumaCommittee on Trauma

© ACS 1999© ACS 1999

PurposePurpose

Characterize injury as a public health problem Characterize injury as a public health problem Detail the impact of injuryDetail the impact of injury Identify control strategiesIdentify control strategies Highlight the key elements of effective Highlight the key elements of effective

programsprograms Address obstacles and catalogue resourcesAddress obstacles and catalogue resources Identify provider’s role in preventionIdentify provider’s role in prevention

DefinitionDefinition

Injury:Injury: Physical damage due to Physical damage due to transfer of energy ( kinetic, transfer of energy ( kinetic, thermal, thermal, chemical, electrical, chemical, electrical, or radiant)or radiant)

Absence of oxygen or heatAbsence of oxygen or heat Over a period of time, “exposure” Over a period of time, “exposure”

that is either acute or chronicthat is either acute or chronic

FrequencyFrequency

59 million (59 million (1 in 41 in 4) Americans injured ) Americans injured per year per year

36 million ED visits 36 million ED visits 2.6 million hospital discharges 2.6 million hospital discharges

annuallyannually More than 145,000 deathsMore than 145,000 deaths Experts estimate costs at $260 billion; Experts estimate costs at $260 billion;

acute care costs are 30% of total acute care costs are 30% of total

Mechanism, OutcomesMechanism, Outcomes

80% blunt, 20% penetrating80% blunt, 20% penetrating MVCs, GSWs, fallsMVCs, GSWs, falls Drownings, poisoningsDrownings, poisonings 5th leading cause of death (1996)5th leading cause of death (1996) First, age 1 through 44 (1996)First, age 1 through 44 (1996)

Disability, OutcomesDisability, Outcomes

Disability far exceeds death rateDisability far exceeds death rate First, age 1 through 44First, age 1 through 44 “ “Years of life lost” (YLL) concept: Years of life lost” (YLL) concept:

Life expectancy for young shortened by Life expectancy for young shortened by death from injurydeath from injury

Numbers comparable with YLL from heart Numbers comparable with YLL from heart disease and cancerdisease and cancer

Most productive members of society!Most productive members of society!

Injury, Not Accident!Injury, Not Accident!

Accident:Accident: An unexpected An unexpected occurrence, happening by chanceoccurrence, happening by chance

Injury:Injury: A definable, correctable A definable, correctable event, with specific risks for event, with specific risks for occurrenceoccurrence

A result of risk poorly managedA result of risk poorly managed ““Disease of injury” conceptDisease of injury” concept Injury can be prevented!Injury can be prevented!

Epidemiologic TriangleEpidemiologic Triangle

““Prevention is the vaccine for the Prevention is the vaccine for the disease of injury.”disease of injury.”

HostHost

AGENTAGENT A causal A causal

relationship!relationship! EnvironmentEnvironment

General PrinciplesGeneral Principles

The The 4 E’s4 E’s:: EEducationducation EEnactment/Enforcementnactment/Enforcement EEngineeringngineering EEconomic incentives and penaltiesconomic incentives and penalties

The The HaddonHaddon Matrix Matrix

PRE-EVENT

EVENT

POST-EVENT

HUMAN VEHICLE ENVIRONMENT

AGE

EXPERIENCE

ALCOHOL

DRUGS

SPEED

BELT USE

HELMET USE

TOLERANCE

AGE

PHYSICAL CONDITION

DEFECTS

BRAKES

TIRES

AVOIDANCE SYSTEMS

AIR BAG

AUTOMATIC BELTS

CRASH-WORTHINESS

POST-CRASH

FIRE

FUEL LEAKS

VISIBILITY

PAVEMENT

SIGNALS

CONSTRUCTION

GUARDRAILS

MEDIANS

BREAKAWAY POSTS

EMS SYSTEM

FIRST RESPONDER

BYSTANDER CARE

Public Health ApproachPublic Health Approach

Five steps:Five steps: Surveillance: What is the problem?Surveillance: What is the problem? Risk identification: What is the Risk identification: What is the

cause?cause? Intervention: What works?Intervention: What works? Implementation: How do you do it?Implementation: How do you do it? Outcome measurement: Did it work?Outcome measurement: Did it work?

ControlControl

Categories of injury prevention:Categories of injury prevention: Primary prevention:Primary prevention: Eliminate the Eliminate the

eventevent Secondary prevention:Secondary prevention: Diminish Diminish

effecteffect Tertiary prevention:Tertiary prevention: Improve Improve

outcomesoutcomes

StrategiesStrategies

Examples of effective injury prevention:Examples of effective injury prevention:

National highway speed limitsNational highway speed limits ““Cycle” helmet lawsCycle” helmet laws Child passenger restraint lawsChild passenger restraint laws Apartment window guardsApartment window guards Smoke detectorsSmoke detectors Violence/penetrating injury programsViolence/penetrating injury programs

Host FactorsHost Factors

Prevention strategies Prevention strategies mustmust include host include host factor(s):factor(s):

NOTE!NOTE! Passive Passive vsvs Active Prevention Active Prevention Passive example:Passive example: Air bag strategy Air bag strategy Active example:Active example: Seattle bike helmet Seattle bike helmet

“Head Smart”“Head Smart” program program

A Successful ProgramA Successful Program

Anatomy of the “Anatomy of the “Head SmartHead Smart” program:” program: Problem identification: Trauma registryProblem identification: Trauma registry Collaborative, community-based, Collaborative, community-based,

prevention strategyprevention strategy Economic incentives: Helmet purchaseEconomic incentives: Helmet purchase Evaluation and measurementEvaluation and measurement Post-campaign persistence of effectPost-campaign persistence of effect

Community-based Community-based ProgramsPrograms

Ownership and empowermentOwnership and empowerment Novel partnerships and coalitionsNovel partnerships and coalitions Community-based data about Community-based data about

etiologyetiology Develop/test solutions, interventionsDevelop/test solutions, interventions Consensus-based processConsensus-based process Implementation Implementation andand evaluation evaluation

Health Care Provider’s Health Care Provider’s RoleRole

Problem identificationProblem identification Data collection and analysisData collection and analysis Intervention designIntervention design Selection and participation in Selection and participation in

action planaction plan Participation in effect evaluationParticipation in effect evaluation

Obstacles to Obstacles to ParticipationParticipation

Uncertainty about effectivenessUncertainty about effectiveness Uncertainty about roleUncertainty about role Uncertainty about valueUncertainty about value Uncertainty about time Uncertainty about time

commitmentcommitment Uncertainty about costUncertainty about cost

ResourcesResources

Local, state, regional, and national Local, state, regional, and national resources:resources:

American College of Surgeons (ACS)American College of Surgeons (ACS) Centers for Disease Control and Centers for Disease Control and

Prevention (CDC)Prevention (CDC) Consumer Product Safety CommissionConsumer Product Safety Commission National Highway Traffic Safety National Highway Traffic Safety

Administration (NHTSA)Administration (NHTSA) Internet Web sites—“prevention links”Internet Web sites—“prevention links”

Effective ProgramsEffective Programs

Community-based, Community-based, multidisciplinarymultidisciplinary

Public information and educationPublic information and education Accurate, population-based dataAccurate, population-based data Unique, “homegrown” solutionsUnique, “homegrown” solutions Evaluation and measurement of Evaluation and measurement of

effectiveness are essential!effectiveness are essential!