1. CHP 200: Community Health Program-l Mohamed M. B. Alnoor SAFETY and INJURY PREVENTION

2.  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 Purpose

3.  Injury: Physical damage due to transfer of energy kinetic thermal chemical electrical radiant  Over a period of time, “exposure” that is either acute or chronic Definition:

4. KSA Traffic accidents  > 275,000 persons (men, women and children)  6,000 deaths ( 16 per day ) - 60% : reckless driving - 34 % : speeding  1/3 of all hospital beds  SR26 billion The toll:

5. In USA  80% blunt, 20% penetrating  Motor vehicle, gunshot, falls etc..  Drowning, poisonings  5th leading cause of death (1996)  First, age 1 through 44 (1996) Mechanism, Outcomes

6.  Disability far exceeds death rate  First, age 1- 44  “Years of life lost” (YLL) concept: - Life expectancy for young shortened by death from injury - Comparable with heart disease and cancer - Young and productive members of society! Disability, Outcomes

7.  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! Injury, Not Accident!

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

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

10. ENVIRONMENTVEHICLEHUMAN VISIBILITY PAVEMENT SIGNALS CONSTRUCTION DEFECTS BREAKS TIRES AVOIDANCE SYSTEMS AGE EXPERIENCE ALCOHOL DRUGS SPEED PRE EVENT GUARD RAILS MEDIANS BREAKAWAY POSTS AIR BAGS AUTOMATIC BELTS CRASHWORTHINESS BELT USE HELMET USE TOLERANCE EVENT EMS SYSTEM FIRST RESPONDER BYSTANDER CARE FUPOST-CRASH FIRE EL LEAKS AGE PHYSICAL CONDITION POST EVENT Factors influencing Road Injuries, The Haddon Matrix

11. Public Health Approach Five steps: What is the problem? Surveillance What is the cause? Risk identification What works? Intervention How do you do it? Implementation Did it work? Outcome measurement

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

13. Examples of effective injury prevention: National highway speed limits Apartment window guards Smoke detectors Child passenger restraint laws “Cycle” helmet laws Strategies of injury prevention:

14.  Direct Costs Medical Costs (including worker’s comp) Indemnity Payments  Indirect Costs Time Lost (by worker and supervisor) Schedule delays Training new employees Cleanup time / equipment repairs Legal fees Cost of Accidents

15. The Iceberg Effect Cost of Accidents On average, the indirect costs of accidents exceed the direct costs by a 4:1 ratio

16. Causes of Accident Accidents are caused by: – Unsafe conditions – Unsafe acts

17. Unsafe Conditions  Easiest to correct (and very cost effective)  Easiest to prevent Safety audits Safety inspections Maintenance schedules for equipment Encouraging employee reporting Good housekeeping Causes of Accident

18. Unsafe Acts  Most difficult to address Changing behavior isn’t easy  Best prevented by developing a “safety culture” Causes of Accident

19.  Establish accountability for safety  Define safety responsibilities Safety Cultures

20.  Establish accountability for safety Employees should be evaluated on their safety performance Doing a job correctly includes doing it safely Safety Cultures

21.  Define safety responsibilities Employee responsibilities include Safety Cultures  Maintaining good housekeeping  Recognizing and reporting safety hazards  Using personal protective equipment (PPE)

22.  Define safety responsibilities Employer responsibilities include Safety Cultures  Providing access to information  Providing personal protective equipment  Providing training

23. Preventing Sports Injuries  Equipment / Field Changes  Rule Changes / Coaching  Individual Preparation

24. Equipment Changes to prevent injuries Add equipment :  Chin protectors Field/Equipment Changes  Helmets Preventing Sports Injuries

25. Field modifications to prevent injuries  Avoid :  Potholes  grates  Anchoring soccer goals Field/Equipment Changes Preventing Sports Injuries

26. Rule Changes/Coaching  Rule changes to adjust for injury patterns Example = “spearing” in football  Officials Must enforce the established rules  Coaches Teach the appropriate techniques Preventing Sports Injuries

27.  Learn about the game prior to signing up  Is this sport appropriate for your child?  Does your child wish to participate?  Who will be supervising practices/games?  Purchase the recommended equipment  Pre-participation physical exam  Preseason conditioning Individual Preparation Prior to Participation Preventing Sports Injuries

28.  Practice within your limits  Stay well-hydrated  Know and follow the rules of the game Preventing Sports Injuries Individual Preparation At Participation

29.  If injured  Seek medical attention prior to returning to play  Adequate rehabilitation is essential Preventing Sports Injuries Individual Preparation At Participation

30. ENVIRONMENTVEHICLE HUMAN PRE EVENT EVENT POST EVENT Factors influencing Road Injuries, The Haddon Matrix