Assault surveillance establishment of a local injury surveillance system
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ASSAULT SURVEILLANCE: ESTABLISHMENT OF A LOCAL INJURY SURVEILLANCE SYSTEM. Zara Anderson and Linda Turner Thursday 8 th September 2005 11.30 – 12.15pm. Objectives. Trauma and Injury Intelligence Group Injury Surveillance System Assault Surveillance Barriers Benefits Summary.

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Zara Anderson and Linda Turner

Thursday 8th September 2005 11.30 – 12.15pm


  • Trauma and Injury Intelligence Group

  • Injury Surveillance System

  • Assault Surveillance

  • Barriers

  • Benefits

  • Summary

What is the Trauma and Injury Intelligence Group (TIIG)?

  • A partnership group across Cheshire and Merseyside with representation from PCT's, Academia, Fire Service, Police and Ambulance

  • Objectives include:

    • Informing and advising the local Public Health Network and Strategic Health Authority on injury intelligence

    • Advising and supporting injury information providers

    • Informing injury prevention strategies through needs assessment, monitoring and evaluation

    • Making available the best evidence

    • Collaborating with partners on related initiatives (e.g. robbery and violent crime)

  • The injury surveillance system is the primary mechanism for delivering objectives

Why is an injury surveillance system needed?

Injuries are a key public health issue

  • cause people to die prematurely

  • major cause of disability, impairment, poorer quality of life

  • links to the inequality agenda

    National drivers

  • Recommendation from BMA that:

    “injury surveillance centres should be established”

  • Report to Chief Medical Officer - Preventing Accidental Injury: Priorities for Action

    “Public Health Observatories, together with their counterparts in local government, should play a key role in the surveillance of accidental injury”

    Local drivers

  • Merseyside conference prioritised theme of improving information about injuries and those at risk

  • Defining the problem

    Collecting the data

    Entering the data

    Evaluating the surveillance system

    Assessing the data

    Interpreting the data

    Using the results to plan prevention / treatment

    Reporting the results

    Other stakeholders

    Private sector and NGOs

    Health departments

    Other public service agencies

    Steps in a surveillance system

    Source: Injury surveillance guidelines centres for disease control and prevention

    What is the Merseyside and Cheshire model?

    • Covers both intentional and unintentional injuries

    • Brings together a variety of data sources in one place

    • Sustainable surveillance system that is passive (data collected in the course of doing other routine tasks)

    • Consistent collection of data items by using core data sets with local flexibility

    • Wider coverage than other surveillance systems in UK and internationally

    • Regular reporting on aggregated data

    Injury datasets

    Assaults – UK perspective

    Some key facts

    Estimated 2.7 million incidents of violence every year in England and Wales

    At peak times 70% of A&E admissions are due to alcohol

    • Costs of domestic violence per year

    • £23 billion (NHS £1.4 billion)

    • Costs of violent crime per year

    • £24.4 billion

    Crime and Disorder Reduction Partnerships – crime audits

    Impacts on services – health, local authority, criminal justice

    • Types of violence:

    • youth

    • intimate partner

    • child maltreatment

    • elder abuse

    • sexual violence

    Reporting of violent crime and assaults – as low as 12% of worst cases of serious sexual assault

    Impacts on health – injuries, long-term physical, mental and sexual health problems, death

    Police fear late licences will lead to chaos

    Drinking free-for-all 'will take police off the beat'

    Assaults – Cheshire and Merseyside, UK

    • Hospital admissions

      • Cheshire and Merseyside

    • Accident and Emergency attendances

      • Arrowe Park

      • Royal Liverpool

    • Ambulance call outs

      • Cheshire and Merseyside

    Mortality and hospital admissions

    Cheshire and Merseyside: -

    • 2002:- 7 deaths directly associated with assault

    • 2002/2003: -2,978 assault-related hospital admissions

      • Leading cause of hospital admissions for males aged 15 -24 years

      • Second leading cause for males aged 25 – 34 years

    Assault A&E attendances by age group

    April 2004 to March 2005

    Royal Liverpool – 4,314 (12%)

    Arrowe Park – 2,872 (7%)

    Over 70% of assault attendances were male

    Assault attendances by number of attackers

    Royal Liverpool A&E

    • 91% attackers male

    • 70% attacked by a stranger

    • 51% not informed police

    • Type of attack: - 1,415 struck (e.g. fist), 212 blunt object, 206 bottled/glassed, 93 stabbed

      Arrowe Park A&E

    • Type of attack: - 2,213 struck, 341 Wound/cut, 32 stabbed, 23 bites, 20 falls, 19 glassed

    Assault attendances by location of incident, Royal Liverpool A&E

    Liverpool City Centre

    Bold Street

    Concert Square

    Slater Street

    Assault attendances by location of incident, Arrowe Park A&E

    49% of assault attendances drank alcohol prior to their attack

    85% of assault attendances between 2am and 4am Saturday morning drank alcohol prior to their attack

    86% of assault attendances between 2am and 4am Sunday morning drank alcohol prior to their attack

    Mersey Regional Ambulance Service

    • Cheshire and Merseyside

    • Patient demographics

    • Time/date

    • Hospital of attendance

    • Location of call out

    Assault/Rape call outs, April to June 2005

    • 2,313 Assault/Rape call outs

    • 34% aged 15 – 29 years

    • 67% male

    • 50% taken to emergency room

      • -Royal Liverpool 22%, Arrowe Park 16%, Whiston 13%, Aintree 12%

    Time/day of assault/rape ambulance call outs, April to June 2005

    Violence against the person offences by Crime and Disorder Reduction Partnership area, rate per 1,000 population, Cheshire and Merseyside, 2002/2003 to 2003/2004

    Data summary

    • Victims: 15 – 29 years, male

    • Attackers: male

    • Peak times: weekend evenings

    • Peak location: night time environment

    • 49% victims drank alcohol prior to attack

    • Not all assaults reported to the police

    Data Constraints

    • Variations in data collection

    • Data quality

    • Resources/Targets

    • Accountability/Ownership

    • Training

    Implementation of a local Injury Surveillance System

    What can be achieved?

    • Data has potential to…..

    • Identify Hotspots

    • Identify Licensed Premises

    • Identify Vulnerable groups

    Police and other agency response: -

    Short term

    • Targeted Deployment of Resources

      ( multi agency )

    • CCTV

    • Targeting Licensed Premises

      Longer term

    • Planning/license restrictions

    • Multi agency interventions e.g P.C.T re Binge Drinking

    • Parenting programmes etc.

    • Inform strategies/Evaluate interventions



    • Violent crime


    • Ambulance call outs

    • A&E admissions

    • Hospital admissions

    Meet National Targets

    • Improve:

      • Improve health

      • Improve night time economy

      • Increase diversity

    • Free up resources

    • Facilitate information sharing and partnership working


    • Violence is a health and criminal justice issue

    • Multiple data sources should be shared and used

    • Priority to improve data collection

    • Multi-agency approach


    Zara Anderson (TIIG analyst) (Data queries)

    Centre For Public Health

    Liverpool John Moores University

    Castle House North Street

    Liverpool, L3 2AY

    Tel: +44 (0)151 231 4505

    Email: [email protected]

    Linda Turner (TIIG Commissioner) (Strategic queries)

    South Sefton Primary Care Trust

    Burlington House


    Liverpool, L22 0QB

    Tel: +44 (0)151 478 1262

    Email: [email protected]


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