Injury Prevention and Control Peter L. Lane, MD, FRCPC

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Injury Prevention and Control Peter L.
Lane, MD, FRCPC
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Introduction

• Prevention and Control
• Accident?
• An injury story
• Taxonomy of Injury Control
• Case studies

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Prevention and Control

• Unlike smallpox
• Reduction of harm reduction of incidence and
  severity of injuries, in order to reduce deaths
  and to reduce disabilities

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Accident?

• Event without apparent cause inevitable
• Prevent to come before to hinder
• Inevitable unavoidable sure to happen
  tiresomely familiar

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An injury story

• 22 y.o. male
• Recent college graduate
• Dove off a dock into lake
• Struck head on bottom
• Floated to the top face down

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An injury story (contd)

• Friends turned him over
• Taped and tied him to a door
• Drove him to the highway
• Ambulance to hospital
• Airlifted to trauma center

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An injury story (contd)

• C 6-7 fracture dislocation with bilateral jumped
  facets
• Insensate below nipples
• Complete quadriplegia
• Halo, surgical decompression, MPSS protocol
• 10 days trauma center
• 6 months rehab center

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An injury story (contd)

• Long term requirements include
• daily attendant services, am and pm
• Modified vehicle
• Wheelchair, adaptive devices
• Modified housing
• Career choice change

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An injury story - costs

• Acute care
• Rehab care
• Ongoing care
• p.a.
• 10 yr
• Foregone income
• p.a.
• 10 yr
• 10 yr Total

• 65,000
• 90,000
• 45,000
• 450,000
• 71,000
• 710,000
• 1.315M

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Taxonomy of Injury Control

• Primary prevention
• Secondary prevention
• Tertiary prevention

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Primary prevention

• Before disease present
• Before the event or behavior
• Reduce or remove risk factors

• Phase
• Strategy

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Secondary prevention

• Phase
• Strategy

• Asymptomatic disease
• Reduce or remove risk factors

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Tertiary prevention

• Phase
• Strategy

• Disease present
• Clinical course after the injury
• Reduce fatalities and complications
• Trauma care, rehabilitation and reintegration

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Prevention strategies

• Most common
• Least expensive
• Least effective
• Cumbersome
• Enforcement issues
• Freedom/civil rights issues
• By far the most cost effective measures

• Persuade
• Inform and educate
• Require
• Laws and regulations
• Automatic
• Engineering

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Risk Factor Identification

• Instrument/agent
• Environment
• Physical
• Social
• Human/individual

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HADDON MATRIX OF INJURY CAUSATION
VEHICLE AGENT INSTRUMENT HUMAN SOCIAL ENVIRONMENT
PRE-EVENT
EVENT
POST-EVENT
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Case studies

• Bicycle injuries
• ATV driver injuries
• Youth violence
• Elderly pedestrian injuries

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Risk Factor Identification

• __________________________________________________
  __________________________________________________
  __________________________________________________
  ______

• Instrument/agent
• Environment
• Physical
• Social
• Human/individual

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HADDON MATRIX OF INJURY CAUSATION
VEHICLE AGENT INSTRUMENT HUMAN SOCIAL ENVIRONMENT
PRE-EVENT
EVENT
POST-EVENT
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Prevention strategies

• Persuade
• Inform and educate
• Require
• Laws and regulations
• Automatic
• Engineering

• _________________________________________________
  __________________________________________________
  __________________________________________________
  _______

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Summary

• Prevention and Control
• Accident?
• An injury story
• Taxonomy of Injury Control
• Case studies