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

2. 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

3. 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

4. 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

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

6. 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!

7. 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!

8. Epidemiologic Triangle
“Prevention is the vaccine for the disease of injury.”
Host
AGENT A causal relationship!
Environment

9. General Principles The 4 E’s: Education Enactment/Enforcement
Engineering
Economic incentives and penalties

11. 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?

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

13. 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

14. 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

15. 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

16. 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

17. Health Care Provider’s Role
Problem identification
Data collection and analysis
Intervention design
Selection and participation in action plan
Participation in effect evaluation

18. Obstacles to Participation
Uncertainty about effectiveness
Uncertainty about role
Uncertainty about value
Uncertainty about time commitment
Uncertainty about cost

19. 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”

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