INJURY PREVENTION FOR SURGEONS
Download
Report
Transcript INJURY PREVENTION FOR SURGEONS
© ACS 1999
INJURY PREVENTION
Presented by
The American College of Surgeons
Committee on Trauma
Purpose
Characterize injury as a public health problem
Detail the impact of injury
Identify control strategies
Highlight the key elements of effective programs
Address obstacles and catalogue resources
Identify provider’s role in prevention
Definition
Injury: Physical damage due to transfer
of energy ( kinetic, thermal, chemical,
electrical, or radiant)
Absence of oxygen or heat
Over a period of time, “exposure” that
is either acute or chronic
Frequency
59 million (1 in 4) Americans injured
per year
36 million ED visits
2.6 million hospital discharges annually
More than 145,000 deaths
Experts estimate costs at $260 billion;
acute care costs are 30% of total
Mechanism, Outcomes
80% blunt, 20% penetrating
MVCs, GSWs, falls
Drownings, poisonings
5th leading cause of death (1996)
First, age 1 through 44 (1996)
Disability, Outcomes
Disability far exceeds death rate
First, age 1 through 44
“Years of life lost” (YLL) concept:
Life
expectancy for young shortened by death
from injury
Numbers comparable with YLL from heart
disease and cancer
Most productive members of society!
Injury, Not Accident!
Accident: An unexpected occurrence,
happening by chance
Injury: A definable, correctable event,
with specific risks for occurrence
A result of risk poorly managed
“Disease of injury” concept
Injury can be prevented!
Epidemiologic Triangle
“Prevention is the vaccine for the disease of
injury.”
Host
AGENT
Environment
A causal
relationship!
General Principles
The 4 E’s:
Education
Enactment/Enforcement
Engineering
Economic incentives and penalties
The Haddon Matrix
HUMAN
PRE-EVENT
EVENT
PO ST-EVENT
VEHICLE
AGE
EXPERIENCE
ALCOH OL
D RUGS
SPEED
DEFECTS
BRAKES
TIRES
AVOIDANCE SYSTEMS
BELT USE
HELMET USE
TOLERANCE
AIR BAG
AUTOMATIC BELTS
CRASH-WORTH IN ESS
AGE
POST-CRASH
PH YSICAL C ONDITION FIRE
FUEL LEAKS
ENVIRONMENT
VISIBILITY
PAVEM ENT
SIGNALS
CONSTRU CTION
GUARD RAILS
MEDIANS
BREAKAWAY POSTS
EMS SYSTEM
FIRST RESPON DER
BYSTANDER CARE
Public Health Approach
Five steps:
Surveillance: What is the problem?
Risk identification: What is the cause?
Intervention: What works?
Implementation: How do you do it?
Outcome measurement: Did it work?
Control
Categories of injury prevention:
Primary prevention: Eliminate the event
Secondary prevention: Diminish effect
Tertiary prevention: Improve outcomes
Strategies
Examples of effective injury prevention:
National highway speed limits
“Cycle” helmet laws
Child passenger restraint laws
Apartment window guards
Smoke detectors
Violence/penetrating injury programs
Host Factors
Prevention strategies must include host
factor(s):
NOTE! Passive vs Active Prevention
Passive example: Air bag strategy
Active example: Seattle bike helmet
“Head Smart” program
A Successful Program
Anatomy of the “Head Smart” program:
Problem identification: Trauma registry
Collaborative, community-based,
prevention strategy
Economic incentives: Helmet purchase
Evaluation and measurement
Post-campaign persistence of effect
Community-based Programs
Ownership and empowerment
Novel partnerships and coalitions
Community-based data about etiology
Develop/test solutions, interventions
Consensus-based process
Implementation and evaluation
Health Care Provider’s Role
Problem identification
Data collection and analysis
Intervention design
Selection and participation in action
plan
Participation in effect evaluation
Obstacles to Participation
Uncertainty about effectiveness
Uncertainty about role
Uncertainty about value
Uncertainty about time commitment
Uncertainty about cost
Resources
Local, state, regional, and national
resources:
American College of Surgeons (ACS)
Centers for Disease Control and
Prevention (CDC)
Consumer Product Safety Commission
National Highway Traffic Safety
Administration (NHTSA)
Internet Web sites—“prevention links”
Effective Programs
Community-based, multidisciplinary
Public information and education
Accurate, population-based data
Unique, “homegrown” solutions
Evaluation and measurement of
effectiveness are essential!