INJURY PREVENTION

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Purpose. Characterize injury as a public health problem Detail the impact of injuryIdentify control strategiesHighlight the key elements of effective programsAddress obstacles and catalogue resourcesIdentify provider's role in prevention. Definition. Injury: Physical damage due to transfer of e

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INJURY PREVENTION

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1. 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. 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

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

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!

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