Injuries Are Not Accidents

Yuan, Zhanpeng, Ph.D.

Tel.： 6875 9982; 139 8612 0848

E-mail: zpyuan@whu.edu.cn

• To Get Aware of Accident in PH– New Course Content

• at least to me

• How to Deal with Accidents as a PH Practitioner?

Objectives

Contents

• Injury

• The Types and Study of Injuries

• Due to Accident?

• What to do from a PH perspective?

Injuries Defined by WHO

• Resulting from traffic collisions, drowning, poisoning, falls or burns - and violence - from assault , self-inflicted violence or acts of war–kill more than five million people worldwide annually and cause harm to millions more– Account for 9% of global mortality, and are a threat

to health in every country of the world.

• For every death, it is estimated that there are – dozens of hospitalizations, hundreds of emergency

department visits and thousands of doctors’ appointments

– A large proportion of people surviving their injuries incurs temporary or permanent disabilities.

Leading Injury Categories

Major Types of Injury in USA

• Motor Vehicle Injuries– Occupants– Road Sharers

• Pedestrains, Motorcyclists, and Bicyclists

• Firearms– 2nd leading cause in US

• Daily life

• Occupational Injuries

Other Places

Source: http://chartsbin.com/view/0lz

Injury from A PH Perspective

• An emerging topic in global health today– injury epidemiology– Injuries represent a significant burden today in

both developed and developing economies

• Capture our interest very frequently through catastrophes– an airplane crash or the car crash in which

Princess Diana died

• To reduce their burden into the future– Many questions remain about the appropriate

way to do this

… A couple drowns after their boat capsizes with no life vests on board. These incidents are often dismissed as "accidents." Correcting these misperceptions is part of the mission of the Harborview Injury Prevention and Research Center (HIPRC).

In 1985, the National Academy of Sciences issued a report that described injuries as the "most important public health problem facing our nation today". That same year the HIPRC was formed as one of the first centers in the nation specifically devoted to research on and prevention of injuries. 

http://www.nphw.org/nphw11/pdf/NPHWbrochWeb.pdf

To Study Injury

Injury EpidemiologyAn Introduction

From The Epidemiological Pstv

• What are injuries?

• Why should we have an interest in injuries and research into the epidemiology of injuries?

Causes of Injury

Source: http://www.pitt.edu/~super1/lecture/lec0231/index.htm

• All injuries can be characterized as such– Injuries arising from automobile crashes can

be characterized as injuries which arise from the transfer of energy between the victim and a stationary object (the ground) or a moving object (another vehicle), which lead to trauma and possibly death.

Abnormal Energy Transfer

Ways of Energy Transfer n Injury

• Penetrating

• Non-Penetrating

• Compressing

• Burn

Energy Transfer and Injury

• Penetrating– localized in one area

• Non-Penetrating– dispersed over a broad area

• Burn– thermal energy transfer

Major Mechanical Injuries

• Motor vehicle accidents

• Firearms

• Falls

• Other– They count for 74%

Facts about Injury in Ontario, CD

Where Does Epidemiology Tie in?

• Epidemiologists interested in injuries?– Injuries, a leading cause of mortality and m

orbidity • in both the developed and developing world• challenge to both understand the basic underpi

nnings of their occurrence (the frequency risk factors) and to develop intervention programs to reduce their impact

– the work of William Haddon• Elegantly outlined how epi applications have re

levance to injuries (discussed further later)

Where Do Injuries Stand among…

"The Global Burden of Disease", Harvard University Press, 1996.

Injuries Standings in USA

YLL, or YPLL as in The Textbook

What factors may account for this observation?

• What events could explain this observation? – Several factors

• The item of comparison, injury mortality, is quite broad. Injuries encompass a wide variety of categories, from accidents to homicides to falls and poisonings.

• Injuries from one category, e.g. crashes or violence, may be more common in some areas

• Public transport systems may be better developed in some areas

• Economic development in its initial stages may lead to higher rates of occupational injuries.

• Can you think of other reasons?

What to Do about Injuries?

• Injury Control– In its simplest form, injury prevention a

nd control represents a reduction in the incidence and/or prevalence of an injury

• John Last in the Dictionary of Epidemiology (Oxford University Press)– Prevention of injuries is characterized

by a reduction in the incidence of injury events.

– Injury control denotes the programs that seek to reduce the frequency and severity of injuries.

Without a doubt, the father of injury epidemiology and injury control is William Haddon. The former director of the National Highway Traffic Safety Administration and the Insurance Institute for Highway Safety played a leading role in bringing epidemiologic principles to injury research and intervention programs.

Risk F

Source: Hargarten SW. International travel and motor vehicle crash deaths; the problem, risks and prevention. Travel Medicine International 106-109, 1991.

Recommended Reading• Baker SP, O'Neill B, Ginsburg MJ, Li G: The Injury Fact Book. New York: Oxford Univ

ersity Press, 2nd ed., 1992. • Chang DC, Tencer AF, Triece B, et al: Geometric changes in the cervical canal during

impact. Spine 1993; 19:1(55-172. • Grossman DC, Milligan BC, Deyo RA: Risk factors for suicide attempts among Navajo

adolescents. Am J Public Health 1991; 81:870-4. • Jaffe KM, Fay GC, Polissar NL, et al: Severity of pediatric traumatic brain injury and n

eurobehavioral recovery at one year: A cohort study. Arch Phys Med Rehabil 1993; 74:587-595.

• Jurkovich GJ, Rivara FP, Gurney JG, et at: The effect of acute alcohol intoxication and chronic alcohol abuse on outcome from trauma. JAMA 1993; 270:51-56.

• Koepsell TD, Wolf ME, McCloskey L, et at: Medical conditions and motor vehicle collision injuries in older adults. J Am Geriatric Soc 1994; 42:695-700.

• National Academy of Sciences. Injury in America. Washington, DC: National Academy Press, 1985.

• Sloan JH, Kellermann AL, Reay DT, et at: Handgun regulations, crime, assaults and homicide: A tale of two cities. N Engl J Med 1988; 319:1256-1262.

• Thompson RS, Rivara FP, Thompson DC: A case control study of the effectiveness of bicycle safety helmets. N Engl J Med 1989; 320:1361-1367.

Thank you!