©©ACS

ACS1999
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:
 Lifeexpectancy 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 A causal

relationship!
 Environment
 General Principles
The 4 E’s:
 Education
 Enactment/Enforcement
 Engineering
 Economic incentives and penalties
 The Haddon Matrix
HUMAN VEHICLE ENVIRONMENT

AGE DEFECTS VISIBILITY

PRE-EVENT EXPERIENCE BRAKES PAVEM ENT
ALCOH OL TIRES SIGNALS
D RUGS AVOIDANCE SYSTEMS CONSTRU CTION
SPEED

BELT USE AIR BAG GUARD RAILS

EVENT HELMET USE AUTOMATIC BELTS MEDIANS
TOLERANCE CRASH-WORTH IN ESS BREAKAWAY POSTS

AGE POST-CRASH EMS SYSTEM

PH YSICAL C ONDITION FIRE FIRST RESPON DER
PO ST-EVENT FUEL LEAKS 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!