William Haddon, Jr., MD HIS LEGACY

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William Haddon, Jr., MDHIS LEGACY

• Susan P. Baker, MPH
• Carol W. Runyan, PhD
• The Johns Hopkins University
• Center for Injury Research and Policy
• The University of North Carolina
• Injury Prevention Research Center

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Bill Haddon 1926-1985
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• Haddons Ten Basic Strategies
• The Haddon Matrix

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HaddonsTen Basic Strategies

• Do not create the hazard
• Reduce the amount of hazard
• Prevent release of the agent
• Modify release of the agent
• Separate in time or space
• Separate with a physical barrier
• Modify surfaces and basic structures
• Increase resistance of the structure or person
• First aid and emergency response
• Acute care and rehabilitation

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Reduce human damage from terrorist bombing of
buildings

• The topic allows us to
• Illustrate the power and broad applicability of
  the model
• Discuss the issues involved in choosing
  approaches to be implemented
• Call attention to a serious present-day threat

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1. Do not create the hazard

• Prevent the accumulation of bomb components

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2. Reduce the amount of hazard

• Limit the amount of explosives that can be sold
• Reduce the number of people in the building
• Build lower buildings

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3. Prevent release of the agent

• Reduce animosity and cause for retaliation
• Ensure the world community would condemn such a
  bombing
• Develop more detectable bomb components (e.g.
  detectable odor)
• Trace acquisition of bomb components

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3. Prevent release of the agent (cont.)

• Improve bomb detection with canine or mechanical
  sniffers
• Identify likely targets
• Monitor known terrorists
• Monitor truck rentals
• Teach people to recognize and report suspicious
  persons or activity
• Provide early warnings

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4. Modify release of the agent

• Develop slower-acting explosives

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5. Separate in time or space

• Define no-vehicle zone near likely target area

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6. Separate with a physical barrier

• Construct barriers to reduce access to building
• Encourage wearing of protective clothing (e.g.
  helmets, fireproof materials)

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7. Modify surfaces and basic structures

• Install shatterproof glass in windows
• Tape existing windows

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8. Increase resistance of the structure or person

• Design buildings to withstand bomb forces
• Design elevators to be avenues of egress

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9. First aid and emergency response

• Train people in first aid and rescue skills
• Strengthen norms to encourage volunteer rescuers
• Ensure public health infrastructure adequate for
  emergency measures
• Publicize evacuation routes
• Install emergency call boxes to obtain help and
  locate survivors

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10. Acute care and rehabilitation

• Develop plans and adequate facilities for
  definitive care

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Haddon Matrix (bombings)
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Benefits of Haddon models

• Recognize that injury is a process
• Employ multi-disciplinary thinking
• Help to develop creative solutions
• Identify range of strategies

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But

• the models dont guide choices among multiple
  intervention options.

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So

• .there is a need for a third dimension to
  structure the decision-making process

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Three-dimensional Haddon Matrix
Runyan, CW. Injury Prevention, 1998(4)302-307.
Phases
Other??
Pre-Event
Feasibility
Preferences
Event
Stigmatization
Equity
Post-event
Freedom
Person Vehicle/ Vector) Physical
Environ Social Environ
Cost
Effectiveness
Decision Criteria
Factors
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First step

• Identify decision criteria based on values that
  are
• Suited to the problem setting
• Culturally appropriate
• Time sensitive

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Then

• Decide how important each criterion is
• Obtain information about each criterion from
  various sources
• Evaluate the strategy options according to
  criteria selected

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Examples of criteria

• Effectiveness
• Is there good evidence that it DOES work?
• SHOULD it work, based on
• theory
• judgment and/or
• experience?

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Examples of criteria (continued)

• Cost
• Of doing vs. not doing intervention?
• To whom (e.g. at risk person, general society,
  product manufacturer)

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Examples of criteria (continued)

• Freedom
• Whose freedom is infringed by the intervention?
• Whose freedom is protected?
• How much freedom is affected?
• What freedoms?

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Examples of criteria (continued)

• Equity
• Horizontal equity/universality
• equal treatment of everyone (e.g. same protection
  for all children)
• Vertical equity
• treat people differently to make more equal (e.g.
  poor get extra help)

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Examples of criteria (continued)

• Stigmatization
• Is stigmatization likely?
• Stigmatization of whom (e.g. crime victims vs.
  perpetrators)?
• How desirable/undesirable is it?

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Examples of criteria (continued)

• Preferences of persons affected
• Do people want this intervention?
• Will people accept this intervention?

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Examples of criteria (continued)

• Feasibility
• Technologic?
• Political?

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Advantages of 3rd dimension

• Forces clarity about whats important in decision
  process
• Encourages use of data to inform decisions
• Facilitates participation in decision making via
  a structured process
• Makes it easier to talk about the reasons for
  choices, potentially resulting in more effective
  advocacy

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Dr. Haddon
whose legacy continues to expand and enrich
our field Thank you.
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Selected references

• Haddon W. (1980). Advances in the Epidemiology of
  Injuries as a Basis for Public Policy. Public
  Health Reports. 95(5)411-421
• Runyan, CW. (1998) Using the Haddon Matrix
  Introducing the Third Dimension. Injury
  Prevention, (4)302-307.