Introduction to Injury Prevention

An interactive discussion for senior and qualified ECPsNyakibale HospitalRukungiri, Uganda

Farooq Khan MDCM, PGY4 Emergency Medicine

McGill University, Montreal, Canada

The learning contract

• We are all equal and deserve respect

• We are all knowledgeable in some areas and deficient in others

• We are all here to learn from each other

• No question is a bad question

• Feel free to participate in the discussion with your questions and comments

Goals

• After this session you should be able to:1. Define 2 different types of prevention2. Understand why injury prevention is

important in your region3. List 5 simple but effective injury prevention

measures for road safety4. Identify 5 basic areas of injury prevention for

children 5. Appreciate how you can be involved in injury

prevention

What is prevention?

• Primary prevention

• Secondary prevention

Why prevent injuries?Let’s take the example of RTAs

International statistics

• RTAs are #9 cause of death worldwide in 2004 and expected to rise to #5 by 2030.

• 20% of these deaths are in Africa (even though it has <2% of vehicles)

• #4 leading cause of death in age 5-44 in Africa

• More males affected than females

National statistics

• 2800 reported deaths/year due to RTAs in Uganda

• Estimate is closer to 7600 due to lack of reporting

• 12 000 non-fatal injuries/year due to RTA

Is treatment enough?

Treatment in the ED• What are the limitations of your environment?

Treatment outside the ED

• Prehospital care – no system in place yet to bring patients emergently to hospital after accidents

• Referral for specialized care – Shortage of general surgeons, only 75 for 27 million

people– Specialists few and concentrated in major cities

(Mbarara/Kampala) e.g. only 6 neurosurgeons– Costly and difficult to access

• May not be able to reach in timely manner even if affordable

What about primary prevention?

Brainstorming

What are risk factors for injuries?

Take the example of RTAs

5 simple but effective injury prevention measures

For RTAs

Seatbelts

• Save more lives than any other intervention– Reduce the risk of death by 61%– Child restraint reduces death by 71%

• Very little use in East Africa (close to 1%)• Mandatory by law for all passengers in

Uganda– Poorly enforced, especially in rural areas

• Community education is needed

Alcohol

• Drinking and driving increases risk of death x17

• Especially in young drivers

• Legal limit in Uganda = 0.08 g/dl– Poor enforcement

• Community education is needed

Speeding

• A pedestrian hit by a car at 30km/h has 90% chance of survival– <50% chance at 45 km/h– Almost 0% at 80 km/h

• Death increases x20 from 30-80 km/h

• Speed limits also poorly enforced in region

• Community education is needed

Helmets

• Reduce risk of fatal or serious head injury by 45% in riders of bicycles and boda-bodas

• Few people wear helmets in Uganda despite police enforcement– Availability, cost, weight, heat, discomfort,

impaired hearing, cosmetics– Lack of education about risks

• Community education is needed

Visibility

• Daytime-running lights in boda-bodas and cars reduce accidents by 15%

• Brake lights reduce accidents up to 50%

• Bicycle lights reduce collisions by 30%

• Wearing white helmets and brightly colored or reflective clothing reduces collisions by up to 45%

• Community education is needed

What about other types of injuries in children?

Burns

• In Africa, child death from burns is 6x more than high income countries

• In rural areas it is associated with:– Use of cooking pots on ground level near

toddlers and young children– Use of open wood fire– Use of paraffin stoves and lamps that can be

knocked over and ignite– Wearing of loose cotton clothing around fire

Burns

• Families should be encouraged to:– Build enclosures around open fires– Use safer stoves or lamps if possible– Wear tighter or less flammable clothing

around the fire– Learn about basic first aid for burns and how

to access emergency services

Falls

• Parent education should include:– Increased supervision of younger children

• i.e. Do not leave unattended on high surfaces

– Modifying the home environment • e.g. Floor padding/barriers on windows

• Advocacy at the community level should include:– Encouragement of safer play areas

• e.g. Discourage climbing of tall trees

– Barriers around hazardous environments• i.e. Tall trees, wells, pits, ditches, walls

Falls

• One of the leading causes of death and disability in children in Africa

• Most often due to head or spinal cord injury

• Children who can walk/run are at higher risk – Young children fall more at home– Older children fall in outside the home i.e. in

schools, public/recreational areas

Drowning

• Rate of drowning is 6x higher in Africa

• Greatest in age 1-4

• Need to educate community about safety– Placing barriers around water sources

• Ponds/irrigation ditches

– Covering wells– Have escape mechanism (ropes)– Teach basic resuscitation skills

Poisoning

• Child death by accidental poisoning is 3-4x higher in Africa than the rest of the world and is due to:– Medicines (belonging to other family members)– Illegal drugs/alcohol– Fuels and solvents– Pesticides/Household chemicals– Poisonous plants/Animals/insects (snake) bites– Carbon monoxide (indoor fires)

Poisoning

• Education of parents and communities should include– Removing toxic agents from the community– Reducing the quantity/concentration of toxic

substances– Using safe packaging techniques– Encouraging safe storage of

substances/medications– Using protective clothing around pesticides

What is wrong with this picture?

What is wrong with these pictures?

Why should ECPs be involved in injury prevention?

ECPs are unique because:

• Regional experts in emergency care

• Real-life experience in ED with multiple patients

• Understanding of impact of environment and behavior on health

• Understanding of life and challenges of Rukungiri community

• Respected by the community

How can you help?

• Educate and counsel patients at the time of injury – Prevent the next one! (Secondary Prevention)

• Outreach to community– Talk to the right people

• Village elders• Village health teams• Schools, churches, community centers• Boda-boda drivers

– Distribute posters/materials• Collaborate with other health centers or

departments– They may already be doing similar work

How can you help in the right way?

• Focus your efforts on the intervention that is most important to do in your area– Check the data in your trauma registry

• Which injuries are most frequent?• Which are most severe?

How can you help in the right way?

• Choose intervention that is most likely to work– Low cost– Requires few human resources– Utilizes existing networks– High chance of acceptance by society

How can you help in the right way?

• Check if the intervention is successful– Collect injury surveillance data and follow it– Analyze and publish the data to prove to

hospital administration that it can be effective– Use the same data to prove to ministries and

other organizations that it is worth funding and expanding

Reminder of Goals

Can you:1. Define 2 different types of prevention2. Understand why injury prevention is

important in your region3. List 5 simple but effective injury prevention

measures for road safety4. Identify 5 basic areas of injury prevention for

children 5. Appreciate how you can be involved in injury

prevention

Thank you for your participation!