Injury Prevention

1. Injury Prevention Mazen S. Zenati, M.D., MPH, Ph.D. University of Pittsburgh Department of Surgery and Epidemiology

5. Driver Fatality Rates by Age and Gender, 1996

6. Trauma Death by Age & Gender National Trauma Data Bank, Report 2002

7. Trauma Death

8. Prevention. Prevention. Prevention. In Trauma The Only Treatment of Immediate Death is Through Prevention • A reduction in therapeutically preventable deaths is the cause of trauma improvement in the past century, the future improvement will be through injury prevention • A dramatic improvement in trauma (no error, cure most of MODF, sepsis, and pulmonary embolus) would decrease trauma mortality by 13% • In contrast more than half of all deaths are potentially preventable with pre-injury behavioral changes • Stewart RM. etal. Seven hundred fifty-three consecutive death in level I trauma center: The argument for injury prevention, Journal of Trauma. 54(1):66-71;2003

9. Injury Definition Injury is the unintentional or intentional damage to the body resulting from acute exposure to thermal, mechanical, electrical, or chemical energy or from the absence of such essentials as heat or oxygen.

10. Injury is a Major Public Health Problem • The most common cause of death among people 1- 44 years of age • The leading cause of disability and a significant contributor to the loss of productive years of life and a major contributor to health care cost • Constitutes over 35% of all emergency department visits and 10% of all physician office visits • In the U.S. 90,000 unintentional deaths, 20,000 homicides and 20,000 suicides • The life time cost of injuries in 1990 is estimated to reach about $215 billion

11. Injury Pyramid Deaths 147,891 ______________ Hospital discharges 2,591,000 ____________________________ Emergency department visits 36,961,000 ________________________________________ Episodes of injuries reported 59,127,000 |------------------------------- | | | 1/400 | | | | | |------- 1/18 1/14 2/3

12. Injuries are one of the most significant public health problems not only in magnitude but also compared with other problems. Injuries kill more American children, adolescents, and young adults than any other cause.

13. Injury Globally Source: Fingerhut LA, et al. Advance Data Number 303, October 7 1998, US National Center for Health Statistics, International Comparative Analysis of Injury Mortality. Findings From the ICE on Injury Statistics.NB: The number and particular years that go to make up each countries' estimate differ.

14. Injury from a Global Perspective Each year > 5 million people die of injuries. 2/3 are males and the majority are young adults aged 15-44 MV crashes are the largest cause of injury death.

15. General Model for Injury Control

16. Epidemiological Model Injuries and the Factors Underlying Injuries can be Examined from an Epidemiological Framework

17. Haddon Phase-Factor Matrix

18. Haddon Phase-Factor Matrix Motor vehicle crash

20. Injury Control Strategies 1.Preventing creation of the agent:stop production of the agent before it can present a hazard • Examples: • Highly toxic pesticides • Fireworks

21. InjuryControl Strategies 2.Reducing the amount of the agent: identifying a hazard and reducing its presence in an environment. • Package toxic drugs in smaller, safe amounts • Reduce speed limits

22. Injury Control Strategies 3. Preventing release of the agent; reduce exposure by deterring it from entering the environment • Ban very speedy cars • Make bathtubs less slippery

23. Injury Control Strategies–Cont. 4.Modifying the rate or spatial distribution of the agent; altering the mechanism by which energy is transferred to the host • Adjust the design • Require automobile seatbelts and air bags • Require soft playground surfaces

24. Injury Control Strategies–Cont. 5.Separating the host and agent,in time and space: eliminating contact between energy source and host • Install pedestrian sidewalks • Reroute high speed traffic around residential neighborhoods or slow it with speed bumps and roundabouts • Spray pesticides at a time of day when people aren’t around • use red light cameras

25. Injury Control Strategies–Cont. 6.Separating the agent from asusceptible host by interposition of a material barrier • Install fences around pools • Install cover guards on dangerous machinery • Install proper guardrails along roads • Use child-proof packaging • Store handguns in a locked metal box • Use extension cords with good insulation

26. Injury Control Strategies –Continued 7.Modifying relevant qualities of the agent Make crib slat spacing too narrow to strangle a child • Modify equipment by rounding sharp corners

27. Place a Barrier Between the Hazard and the Potential Victim: • Child-Resistant Caps on Baby Aspirin

28. Injury Control Strategies –Continued 8. Strengthening the susceptible host • Improve physical condition through proper nutrition and regular exercise

29. Injury Control Strategies –Continued 9. Countering the injury already caused by the agent • Provide emergency medical care

30. Injury Control Strategies –Continued 10.Stabilizing, repairing and rehabilitating the injured host • Provide of appropriate acute care and rehabilitation facilities and make them available all over the country

31. Proven Injury Prevention Interventions • Car safety seats and belts • Air bags • Motorcycle helmets • Bicycle helmets • Child resistant packaging • Swimming pool fencing • Smoke detectors • Self extinguishing cigarettes

32. Injury Prevention Success • Residential Fire Injuries • Smoke Alarm Distribution Programs Save Lives • Poison Prevention Packaging Act • 45% decrease in poisoning deaths • Child-proof containers • Packaging in non-lethal doses • Motor Vehicle Injuries: • Since 1920’s Six fold increase in number of drivers • 11 times the number of motor vehicles • 10 times the number of miles traveled • 90% decrease in the annual death rate per 100 million vehicle miles traveled

33. Mantra of Injury Prevention • Education • Transformation • Regulation • Legislation • Litigation.

34. Injuries and Related Evidence-Based Strategies for Prevention • Injury involving Motor Vehicles • Alcohol-Impaired Driving • Seat Belts and Air Bags • Motorcyclists • Pedestrians • Bicycling Injuries • Playground Injury • Poisoning • Fire • Injury from Firearms • Drowning • Falls

35. 65% of persons who die from falls are > 65 Account for 87% of all fractures in older adults 1 of 5 falls resulted in direct impact on the hip Hip fracture is the most frequent consequence Osteoporosis facilitates fractures The risk of Osteoporosis for 50-years WFW is 40% Risk Factors: History of previous falls cognitive impairment chronic illness balance and gait impairment a low body-mass index female sex general frailty use of diuretics use of psychotropic drugs hazards in the home Falls

36. Prevention of Falls & its Consequences • Prevention of osteoporosis,.. Early in life • Adequate Ca intake with vitamin D in Childhood • Ca (1.2g) and Vit. D3 (800 IU) daily, reduces the risk of hip fracture in elderly by 23% • Hormone-replacement therapy may also be effective • Hormone-replacement has 25% reduction in hip fractures. (estrogen or with progesterone) • Thiazide diuretics my prevent hip fracture (ca excretion) • Furosemide may increase that risk • No evidence of the effect of calcitonin, fluoride & etidrone • Weight-bearing exercise, 40-50% HF reduction

37. 50% of Prevention in Behavior!

38. Prevention Through Leading a Healthy Life

39. The 5 “Es” of Incident Prevention • Epidemiology: you can’t prevent it if you don’t understand it. Data collection is key. • Education: awareness, attitudes, cultural beliefs • Enforcement: rules, life safety codes etc. • Engineering: changing the environment to make it safer • Evaluation: did the changes made in education, enforcement, and engineering have the desired outcome on incidence?

40. Mechanism of Injury effects Trauma Outcome National Trauma Data Bank 2002 Report Hospital length of stay grouped by mechanism of injury. Blue bars represent blunt mechanisms of injury. Green bars represent violent mechanisms of injury. Red bar represents burns.

41. Examples of State and Local Laws

42. Trauma Who is at fault • Gods • mortal • environment • designer • government • medical team Trauma is no accident but is our training