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
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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!
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