COMMUNITY MEDICINE

ACCIDENTS AND INJURIES

Moderator:
Team Members :-
Dr. Tamizhmathi
1. Reux Roshaane Andreaas J
2. Rithika R
3. Rithin Raj
4. Roshni Sree
INTRODUCTION

INJURIES
“ Damage caused to the health or life of a person resulting
from an acute transfer of energy(which may be
mechanical, thermal, electrical, chemical or radiational)”

 There are two types of injuries :-

1. Unintentional injuries
2. Intentional injuries
INJURIES…
ACCIDENTS ( UNINTENTIONAL INJURIES)

“ Unmediated, unintentional and unplanned occurrences,

involving transfer of energy from the environment to the
human being, either directly or through a vector, leading
to illness, disability, or death of the human being”
ACCIDENTS ( UNINTENTIONAL INJURIES)…
LEADING CAUSES OF INJUIRES AND DEATHS IN WORLD 2016
% of total Crude death Age specific death
Types of injury Deaths
deaths rate rate
1. Road injuries 1,402 2.5 18.8 18.7
2. Poisonings 107 0.2 1.4 1.4
3. Falls 660 1.2 8.8 8.4
4. Fire, heat and hot substances 153 0.3 2 2
5. Drowning 322 0.6 4.3 4.3
6. Exposure to mechanical forces 150 0.3 2 2
7. Natural disasters 2 0 0 0
8. Other unintentional injuries 633 1.1 8.5 8.2
B. Intentional injuries 1,454 2.6 19.5 19.4
1. Self harm 793 1.4 10.6 10.5
2. Interpersonal violence 477 0.8 6.4 2.5

3. Collective violence and legal intervention 184 0.3 2.5 2.5

Total 4,883 8.6 65.4 64.4

SELECTED INDICATORS OF SUSTAINABLE DEVELOPMENTAL GOALS, GLOBAL
AND INDIA SCENARIO

Causes Global India

1. Average death rate due to natural disasters (per
< 0.1 < 0.1
100,000 population) 2016

2. Mortality rate due to homicide (per 100,000

6.4 2.1
population) 2016

3. Estimated direct deaths from major conflicts (per

2.5 < 0.1
100,000 population) 2016

4. Suicide mortality rate (per 100,000 population) 2016 10.6 14.7

5. Road traffic mortality rate (per 100,000 population)

18.8 8
2016
 REPORTS - NUMBER OF ACCIDENTAL DEATHS
IN INDIA BY MAIN CAUSES
Causes No. of deaths

2018 2019
A. Natural Calamity 6,891 8,145

B. Un-natural causes
1. Air-crashes 15 12
2. Collapse of structures 2,017 1,929
3. Drowning 30,187 32,671
4. Electrocution 12,154 13,432
5. Explosions 696 655
6. Falls 20,201 20,901
7. Factory/Machine accidents 694 1,001
8. Fire 12,748 10,915
Causes No. of deaths
2018 2019
A. Natural Calamity 6,891 8,145

B. Un-natural causes
9. Fire Arms 528 320
10. Sudden Deaths 46,003 47,295
11. Killed by Animals 1,130 1,420
12. Mines or quarry disaster 125 82
13. Poisoning 21,646 21,196
14. Stampede 6 12
15. Suffocation 1,921 1,598
16. Traffic accidents 1,78,832 1,81,113
17. Causes Not Known 58,010 58,576
18. Other causes 14,634 16,666
Total(B) 4,01,547 4,09,799
Total(A+B) 4,08,438 4,17,944
MAGNITUDE OF THE PROBLEM
World :
 About 5.8 million people die each year as a result of injuries. This
accounts for 10% of the world’s deaths.

 Globally, the three leading causes of death due to injuries are Road traffic
accidents(RTA), homicides and homicide and suicide.

 Road traffic crashes are predicted to become the 5th leading cause of
death by 2030, with suicide and homicide to become the 12th and 18th
leading causes of death, respectively.
MAGNITUDE OF THE PROBLEM
India:
 According to a recent report of the Indian Council of Medical
Research(ICMR) and Public Health Foundation of India(PHFI), 10.7%
of all deaths in India are due to injuries.

 The overall death rate due to injuries in India is likely to be 80(deaths

due to injuries) per lakh population, with road accidents, suicides and
falls being the leading causes.

 Statistics from the Ministry of Road Transport and Highways(MoRTH)

indicate that as many as 1130 road accidents and 422 deaths due to them
occur every day in India.
EPIDEMOLOGY OF ACCIDENTS :
AGENT-HOST-ENVIRONMENT TRIAD MODEL

Agent: It is the energy which could occur in many forms including mechanical,
thermal, or electrical. It is transferred to the human host who manifests the
symptoms of injury. Energy can be transferred to host through vehicles or
vectors.
Host factors: They can be intrinsic factors such as age , pre existing medical
conditions, etc. In addition, there are extrinsic factors in the host, such as fatigue,
alcohol use etc.
Environment: It refers to the place where energy can be transmitted to a host and
is influenced by many physical, social, economic, demographic and cultural
factors.
Haddon’s matrix

 The epidemiological model of Agent-Host-Environment is used in the Haddon’s

matrix.
 It is used for explaining the causation and prevention of various accidents,
particularly RTAs.

The Haddon matrix is a grid with four columns and three rows.

 The rows represent different phases of an injury (pre-event, event, and

post event)

 The columns represent different influencing factors (host, agent/vehicle,

physical environment, social environment).
TYPES OF ACCIDENTS
Road Traffic Accident
• Road accidents – a leading cause of injuries, deaths and disabilities.

• The number of Road traffic deaths continues to rise steadily, reaching 1.35
million in 2016.

• Road traffic injuries are the 8th leading cause death for children and young
adults aged 5-29 years.

• With an average rate of 27.5 deaths per 1,00,000 population, the risk of a road
traffic deaths is more than 3 times higher in low- income countries than in
high income countries where the average rate is 8.3 deaths per 100,000
population.
• Pedestrian and cyclist – 26% of all deaths.

• Motorized two or three wheelers- 28% of all deaths.

• Car occupants – 29% of all deaths.

• Non fatal injuries – 20 – 50 million.

• Serious injuries- 10- 20 million

 In 2021 In 2022

Total number of Road accidents - 4,12,432. Total number of accidents- 4,61,312.

• Fatalities – 1,53,972. • Fatalities- 1,68,491.

• In Tamil Nadu , • In Tamil Nadu,

Total no. of. Accidents – 55682 Total no. of. Accidents- 64,105
Fatalities – 15,384. Fatalities- 17,884

• In Puducherry, • In Puducherry,
Total no. of. Accidents- 1049 Total no. of. Accidents -1181
Fatalities- 140 Fatalities - 181
 Risk factors

• Speed – pedestrians has 90% chance of surviving a

crash at 30Km/h or below.

Less than a 50% chance of surviving an impact of

45Km/h or above.

• Drink – driving – the risk of being involved in a crash

increases significantly above a blood alcohol
concentration (BAC) of 0.04 g/dl.

Laws that establish BACs of 0.05 g/dl or below are

effective at reducing the number of alcohol related
crashes.
 Risk factors

• Motor cycle helmets – wearing helmets can reduce the risk of

death by almost 42% and risk of severe head injury by over 69%.

When Motorcycle helmet laws are enforced effectively, helmet

wearing rates can increase to over 90%.

• Seat- belts and child restraints- reduces the risk of fatality among
front seat passengers by 40-50 % and of rear seat passengers by
between 25-75 %.

If correctly installed and used, child restraints reduce deaths among

infants by approximately 70%, and deaths among small children by
between 54% and 80%.
 Distracted driving
• There are many types of distractions that can lead to impaired
driving .

• The distraction caused by mobile phones can impair driving

performance in a number of ways, e.g. longer reaction times,
impaired ability to keep in the correct lane, and shorter
following distances.

• Drivers using phone are approximately four times more likely

to be involved in a crash than when a driver does not use a
phone.
 Reasons for more accidents in Developing Country

• Large number of pedestrians and animals share the common

roadway.
• Large number of old, poorly maintained vehicles.
• Large number of buses often overloaded.
• Large number of motor cycles, scooters and mopeds.
• Low driving standards.
• Widespread disregard of traffic rules.
• Defective roads, poor street lighting, defective layout of cross
roads and speed breakers.
• Unusual behavior of men and animals.
 Multiple causation
Human factors:

1. Age - 50% of the global mortality due to

road traffic injury occurs among young
adults aged between 15 and 44 years.
2. Sex- males account for almost three-
fourths of all road traffic deaths.
3. Education
4. Medical conditions- sudden illness, heart
attack, impaired vision.
5. Psychological factors – lack of
experience, risk- taking, impulsiveness,
etc.
6. Lack of body protection- helmets, safety
belts.
 Environmental factors

Relating to road – defective narrow roads.

defective lay out of cross roads and speed breakers.
Poor lighting.
Lack of familiarity.

2. Relating to vehicle – excessive speed.

Old, poorly maintained.
Large number of 2 or 3 wheelers.
Overloaded bases.
Low driving standards.

3. Bad weather- inadequate enforcement of existing laws.

4. Mixed traffic – slow and fast moving, pedestrians and animals

 Vehicular factors

• Increase in motorized two – wheeled vehicles.

• Vehicular speed
• Poor maintenance
• Poorly functioning brakes, lights, tires and horns.
 Prevention
• 1. Data collection- basic reporting system of
all accidents.
• Supplementation by national surveys.

• Eliciting the data about conditions and

environmental factors leading to accidents.

• Making police investigation of an accident

mandatory.

• 2. Safety education – initiated at the school

level.

• Educate regarding risk factors, traffic

rules, safety precautions and first aid.
• 3. Promotion of safety measures –
• Seat belts
• Safety helmets.
• Safety measures for children.
• Others : door locks, proper vehicle design,
use of laminated high penetrative
resistance windscreen glass, etc.

• 4.Alcohol and other drugs-

• Abstinence from alcohol and depressant
drugs before and during driving.
• Barbiturates, amphetamines and cannabis
– impaired driving ability.
• 5. Primary care –
• Planning, organization and management of trauma treatment
and emergency care services should be improved.
• Emergency care should begin at the accident site, continued
during transportation and conclude in the hospital emergency
room.
• Skill of the health care provider.
• Availability needed emergency equipment
• Accident services organization and one fully equipped specialized
trauma care hospital in all major cities.

• 6. Elimination of causative factors –

• Improvement of roads, imposition of speed limits, drunk and
drive, lack of body protection and marking of danger points.
• 7. Enforcement of laws –
• Driving tests, medical fitness to drive, Enforcement of speed limits,
• Compulsory wearing of seat belts and helmets,
• Checking of BAC, road side breath testing for alcohol
• Regular inspection of vehicles
• Periodic examination of drivers over the age of 55, etc.
• In India, the Motor Vehicles Act, 1988, amended in 2019, governs the regulation of
motor vehicular traffic throughout the country.
• The Good Samaritan Law.
Central Motor Vehicles Rules, 1989
Road Transport Corporations Act, 1950
Carriage by Road Act, 2007 (enacted to repeal Carriers Act, 1865)
effective from 01.3.2011
• Carriage by Road Rules, 2011 notified on 28.02.2011 and effective from
01.03.2011.

8. Rehabilitation services –
Medical Rehabilitation
• Social Rehabilitation
• Occupational Rehabilitation
Domestic accidents
 Definition and types

“Domestic accident" is meant an accident which takes place in the home

or in its immediate surroundings, and, more generally, all accidents not
connected with traffic, vehicles or sport

1.drowning
2. burns (by a flame, hot liquid, electricity, crackers or fire
works, chemicals)
3. falls
4. poisoning (e.g., drugs, insecticides, rat poisons, kerosene)
5. Injuries from sharp or pointed instruments.
6. bites and other injuries from animals
 DROWNING
• Drowning is the process of experiencing respiratory impairment from
submersion/immersion in liquid.
• Victims of drowning have a have a very slim chance of survival after immersion.
The victim loses consciousness after approximately 2 minutes of immersion, and
irreversible brain damage can take place after 4-6 minutes. Therefore, prevention
strategies are very important.
• In 2016, an estimated 322,000 people died from drowning, making
drowning a major public health problem worldwide.
• Injuries account for nearly 10% of total global mortality.
• Drowning is the 3rd leading cause of unintentional Injury death. It
accounts for 7% of all injury-related deaths. It is a common method
of suicide.

• The global burden and death from drowning is found in all economies
and regions, however, low and middle-income countries account for
95% of unintentional drowning deaths, over 50% of the world's
drowning occurs in the Western Pacific Region and South-East Asia
Region; China and India have particularly high drowning mortality
rates and together contribute 43% of the world's drowning deaths
and 41% of the total global DALYS (disability-adjusted life years)
lost related to drowning.
Risk factors

1.Age-mostly children under age of 5

2. Gender- males>females with twice mortality rate
3. Increased access to water.. prone to drowning. Children who
live near open water sources, such as ditches, ponds, irrigation
channels, or pools are especially at risk.
4. Others
a. Infants left unsupervised or alone, or with another
child in a bathtub;
b. Unsafe or overcrowded transportation vessels lacking flotation devices;
c. Alcohol use, near or in the water;
d . Medical conditions, such as epilepsy;
e. Tourists unfamiliar with local water risks and features
f. Floods and other cataclysmic events like tsunamis.
 Prevention of drowning

Engineering methods to eliminate exposure to water hazards are the most

effective strategy for drowning prevention. Examples include:
1.development and implementation of safe water systems, such as drainage
systems, piped water systems
2.flood control embankments in flood prone areas;
3 building four-sided pool fences or barriers preventing access to standing
water;
4.creating and maintaining safe water zones for recreation; covering of wells or
open cisterns
5.emptying buckets and baths, and storing them upside-down
 Burns

• A burn is an injury to the skin or other organic tissue primarily

caused by heat or due to radiation, radioactivity, electricity,
friction or contact with chemicals. Thermal (heat) burns occur
when some or all of the cells in the skin or other tissues are
destroyed by:
Hot liquids (scalds)
Hot solids (contact burns), or
Flames (flame burns).
 Global scenerio
• Burns are a global public health problem, accounting for an estimated
180,000 deaths annually.
• About 11 million people worldwide require medical attention due to
severe burns
• Non fatal burns are a leading cause of morbidity
• Over one million people are moderately or severely burnt every year in
India.
• In Bangladesh 1.73 lac children get moderate or severe burns every year
with about 17 per cent getting temporary. disability and 18 per cent
permanent disability. Burns are the second most common injury in rural
Nepal accounting for 5 per cent disabilities
 Risk factors
1. Gender
Females suffer burns more frequently than males. Women in the
South-East Asia Region have the highest rate(27% global deaths)
2. Age
Along with adult women, children are particularly vulnerable to
burns. Burns are the 11th leading cause of death of children aged
1-9 years and are also the fifth most common cause of non-fatal
childhood injuries.
3. Socio-economic factors
People living in low and middle-income countries are at higher
risk for burns than people living in high-income countries
 Other risk factors

There are number of other risk factors for burns,

1) Occupations that increase exposure to fire;
2) Poverty overcrowding and lack of proper safety measures,
3) Placement of young girls in household roles such as cooking
and care of small children;
4) Underlying medical conditions, including epilepsy, peripheral
neuropathy, and physical and cognitive disabilities
5. Alcohol abuse and smoking

6. Easy access to chemicals used for assault (such as in acid

violence attacks);

7. Use of kerosene (paraffin) as fuel source for non-

electric domestic appliances;

8. Inadequate safety measures for liquefied petroleum gas

and electricity
FIRST-AID

Do’s
1.Stop the burning process by removing clothing and irrigating the burns.

2. Use cool running water to reduce the temperature of the burn.

3. Extinguish flames by allowing the person to roll on the ground, or by applying a

blanket or by using water or other fire-extinguishing liquids.

4. In chemical burns, remove or dilute the chemical agent by irrigating with large
volumes of water.

5. Wrap the patient in a clean cloth or sheet and transport

to the nearest appropriate facility for medical care.
Don'ts
1. Do not start first-aid before ensuring your own safety (switch off
electrical current, wear gloves for chemicals
etc.)

2. Do not apply paste, oil, Haldi (turmeric) or raw cotton to the

burn.

3.Avoid prolonged cooling with water because it may lead to

hypothermia.

4.Do not apply ice because it deepens the injury.

5. Do not open blisters until topical antimicrobials can be

applied, by a health-care provider..
6. Do not apply any material directly to the wound as it might become infected.

7. Avoid application of topical medication until the patient has been placed under
appropriate medical care
 Falls

• An 6,46,000 fatal falls occur each year, making it the second

leading cause of unintentional injury death, after road traffic
injuries

• Though not fatal 37.3 million falls are severe enough to require
medical attention. Such falls are responsible for 17 million
DALYs lost.

• Over 80% of fall- related fatalities occur in low and middle-

income countries, with regions of the Western Pacific and
South East Asia accounting for more than two-thirds of these
deaths
 Risk factors
1) Occupations at elevated heights or other hazardous working conditions;

2) Alcohol or substance use,

3) Socio-economic. factors including poverty, overcrowded housing, young

maternal age

4) Underlying medical conditions, such as neurological, cardiac or other disabling

conditions

5) Side effects of medication, physical inactivity and loss of balance particularly

among older people

6) Side-effects of balance, particularly among older people; unsafe environments,

particularly for those with poor balance and limited vision
 Prevention

For children, effective interventions include

1) Multifaceted community programmes
2) Engineering modifications of nursery
furniture, playground equipment and other
products
3) Legislation for the use of window guard
For older individuals, fall prevention programmes can include a number of components to
identify and modify risk, such as:
1) Screening within living environments for risks for falls;

2) Clinical interventions to identify risk factors, such as medication review and

modification, treatment of low blood pressure, Vitamin D and calcium supplementation,

3) Treatment of correctable visual impairment; home assessment and environmental

modification for those with known risk factors or history of falling
4) Prescription of appropriate assistive devices to address
physical and sensory impairments;

5) Muscle strengthening and balance retraining prescribed by a

trained health professional
Poisoning
• Poisoning represents the harmful effects on the human body of
accidental or intentional exposure to toxic amount of any
substance
Signs:
1)Fever
2) Dehydration
3)Skin lesions
4) Vomiting
CAUSES OF POISONING

● Household chemicals
● Therapeutic drug overdose – Paracetamol, Aspirin, iron tablets
● Toxic plants- poisonous mushroom
● Bites and stings of venomous animals –snakes, scorpions, bees,
spider
● Pesticides are widely used in many countries where agriculture is an
important part of their economy

● The use of organophosphorus insecticides in suicide event has been

increased

● Paraquat intoxication is known to cause irreversible damage

● Accidental ingestion of kerosene leads to poisoning mainly among

children
 SNAKE BITE

● Snake bite is a neglected public health issue in many tropical

and subtropical countries.
● India is estimated to have the highest snake bite mortality in
the world
● 2.8 million cases of snake bite with 46,900 deaths occurs
annually in India.
● Snake bite is an occupational hazard in an agricultural
countries
 Clinical manifestations:

● Manifestations of Rattle snake are:

Local pain, redness, swelling, extravasation of blood, perioral tingling,
metallic taste and coagulopathy.
● Manifestations of neurotoxic envenomation are:
Ptosis, dysphagia, diplopia, respiratory failure.
● Venom emitted from some typesnof cobra causes
necrosis of muscle tissue which results in accumulation of myoglobin in
renal tubules which leads to acute renal failure.
Early clues that a patient has severe envenoming:

● Snake identified as very dangerous one

● Rapid early extension of local swelling room the site of the bite
● Early tender enlargement of local lymph node which indicates spread of
venom in the lymphatic system
● Early systemic symptoms are collapse,nausea, vomiting,severe headache
● Heaviness of eyelids, inappropriate drowsiness
● Early spontaneous systemic bleeding
● Passage of dark urine
Management:
First aid
CARRY NO R.I.G.H.T
Carry-do not allow the patient to walk
No-do not apply any pressure, do not apply any compression in form of tight ligature,
do not give any alcoholic beverages as they are known vasodilators which may cause
easy absorption of venom.
R-Reassure the patient
I-immobilize the limb
GH-get to hospital immediately
T-tell the doctor of any systemic symptoms that you manifest
 Hospital Management:

● Asses for signs of local and systemic envenoming

● Check for whole blood clotting test and urine examination
● Analgesia
● Antivenom
● Management for shock(IV)
● In case of respiratory paralysis give oxygen mask
● If bite wound is necrotic give antibiotics and tetanus
prophylaxis
 Industrial accidents:

Industrial accidents is an occurrence in an industrial premise causing physical

injury to an employee which make them unfit toresume their duties for 48 hrs
There are approximately 580 million workers in the south east
asia region in which 60-80% of these worker are employed in:

● agriculture
● fisheries
● home industry
● small scale unit

Injuries due to these occupation results in an estimated 120

million injuries and 2 lakh deaths
The unique features common to the work place in these region
are
● the manual labour content is high
● man machine interaction is unsafe.
● Unsafe procedure
● Carelessness
● Unsafe equipment
● Improper lifting
Domestic violence
● It is an pattern of abusive behaviour in any relationship that
is used by one partner to gain or maintain power and control
over another intimate partner

● On studying statistics an estimated 15,10,000 persons died in

2008 due to violence or intentional injuries

RISK FACTORS FOR VIOLENT BEHAVIOUR :

1. Consumption of alcohol and other drugs is linked to almost

2/3 cases of violence
2. Availability of lethal weapons like firearms significantly
increases the possibility of both fatal and non fatal injuries