INJURY PREVENTION Presented by The American College of Surgeons Committee on Trauma © ACS 1999

Purpose l Characterize injury as a public health problem l Detail the impact of injury l Identify control strategies l Highlight the key elements of effective programs l Address obstacles and catalogue resources l Identify providers role in prevention

Definition l Injury: Physical damage due to transfer of energy ( kinetic, thermal, chemical, electrical, or radiant) l Absence of oxygen or heat l Over a period of time, exposure that is either acute or chronic

Frequency l 59 million (1 in 4) Americans injured per year l 36 million ED visits l 2.6 million hospital discharges annually l More than 145,000 deaths l Experts estimate costs at $260 billion; acute care costs are 30% of total

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

Disability, Outcomes l Disability far exceeds death rate l First, age 1 through 44 l Years of life lost (YLL) concept: Life expectancy for young shortened by death from injury Life expectancy for young shortened by death from injury Numbers comparable with YLL from heart disease and cancer Numbers comparable with YLL from heart disease and cancer Most productive members of society! Most productive members of society!

Injury, Not Accident! l Accident: An unexpected occurrence, happening by chance l Injury: A definable, correctable event, with specific risks for occurrence l A result of risk poorly managed l Disease of injury concept l Injury can be prevented!

Epidemiologic Triangle Prevention is the vaccine for the disease of injury. l Host l AGENTA causal relationship! l Environment

General Principles The 4 Es : l E ducation l E nactment/Enforcement l E ngineering l E conomic incentives and penalties

Public Health Approach Five steps: l Surveillance: What is the problem? l Risk identification: What is the cause? l Intervention: What works? l Implementation: How do you do it? l Outcome measurement: Did it work?

Control Categories of injury prevention: l Primary prevention: Eliminate the event l Secondary prevention: Diminish effect l Tertiary prevention: Improve outcomes

Strategies Examples of effective injury prevention: l National highway speed limits l Cycle helmet laws l Child passenger restraint laws l Apartment window guards l Smoke detectors l Violence/penetrating injury programs

Host Factors Prevention strategies must include host factor(s): NOTE! Passive vs Active Prevention l Passive example: Air bag strategy l Active example: Seattle bike helmet Head Smart program

A Successful Program Anatomy of the Head Smart program: l Problem identification: Trauma registry l Collaborative, community-based, prevention strategy l Economic incentives: Helmet purchase l Evaluation and measurement l Post-campaign persistence of effect

Community-based Programs l Ownership and empowerment l Novel partnerships and coalitions l Community-based data about etiology l Develop/test solutions, interventions l Consensus-based process l Implementation and evaluation

Health Care Providers Role l Problem identification l Data collection and analysis l Intervention design l Selection and participation in action plan l Participation in effect evaluation

Obstacles to Participation l Uncertainty about effectiveness l Uncertainty about role l Uncertainty about value l Uncertainty about time commitment l Uncertainty about cost

Resources Local, state, regional, and national resources: l American College of Surgeons (ACS) l Centers for Disease Control and Prevention (CDC) l Consumer Product Safety Commission l National Highway Traffic Safety Administration (NHTSA) l Internet Web sitesprevention links

Effective Programs l Community-based, multidisciplinary l Public information and education l Accurate, population-based data l Unique, homegrown solutions l Evaluation and measurement of effectiveness are essential!