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Injury Prevention. Mazen S. Zenati , M.D., MPH, Ph.D. University of Pittsburgh Department of Surgery and Epidemiology. Driver Fatality Rates by Age and Gender, 1996. Trauma Death by Age & Gender. National Trauma Data Bank, Report 2002. Trauma Death. Prevention. Prevention. Prevention.

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Injury Prevention

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Injury prevention

Injury Prevention

Mazen S. Zenati, M.D., MPH, Ph.D.

University of Pittsburgh

Department of Surgery and Epidemiology

Driver fatality rates by age and gender 1996

Driver Fatality Rates by Age and Gender, 1996

Trauma death by age gender

Trauma Death by Age & Gender

National Trauma Data Bank,

Report 2002

Trauma death

Trauma Death

Prevention prevention prevention

Prevention. Prevention. Prevention.

In Trauma The Only Treatment of

Immediate Death

is Through Prevention

  • A reduction in therapeutically preventable deaths is the cause of trauma improvement in the past century, the future improvement will be through injury prevention

  • A dramatic improvement in trauma (no error, cure most of MODF, sepsis, and pulmonary embolus) would decrease trauma mortality by 13%

  • In contrast more than half of all deaths are potentially preventable with pre-injury behavioral changes

  • Stewart RM. etal. Seven hundred fifty-three consecutive death in level I trauma center: The argument for injury prevention, Journal of Trauma. 54(1):66-71;2003

Injury definition

Injury Definition

Injury is the unintentional or intentional damage to the body resulting from acute exposure to thermal, mechanical, electrical, or chemical energy or from the absence of such essentials as heat or oxygen.

Injury is a major public health problem

Injury is a Major Public Health Problem

  • The most common cause of death among people 1- 44 years of age

  • The leading cause of disability and a significant contributor to the loss of productive years of life and a major contributor to health care cost

  • Constitutes over 35% of all emergency department visits and 10% of all physician office visits

  • In the U.S. 90,000 unintentional deaths, 20,000 homicides and 20,000 suicides

  • The life time cost of injuries in 1990 is estimated to reach about $215 billion

Injury pyramid

Injury Pyramid




Hospital discharges



Emergency department visits



Episodes of injuries reported
















Injury prevention

Injuries are one of the most significant public health problems not only in magnitude but also compared with other problems. Injuries kill more American children, adolescents, and young adults than any other cause.

Injury prevention

Injury Globally

Source: Fingerhut LA, et al. Advance Data Number 303, October 7 1998, US National Center for Health Statistics, International Comparative Analysis of Injury Mortality. Findings From the ICE on Injury Statistics.NB: The number and particular years that go to make up each countries' estimate differ.

Injury from a global perspective

Injury from a Global Perspective

Each year > 5 million people die of injuries.

2/3 are males and the majority are young adults aged 15-44

MV crashes are the largest cause of injury death.

General model for injury control

General Model for Injury Control

Epidemiological model

Epidemiological Model

Injuries and the Factors Underlying Injuries can be Examined

from an Epidemiological


Injury prevention

Haddon Phase-Factor Matrix

Injury prevention

Haddon Phase-Factor Matrix

Motor vehicle crash

Injury control strategies

Injury Control Strategies

1.Preventing creation of the agent:stop production of the agent before it can present a hazard

  • Examples:

    • Highly toxic pesticides

    • Fireworks

Injury control strategies1

InjuryControl Strategies

2.Reducing the amount of the agent: identifying a hazard and reducing its presence in an environment.

  • Package toxic drugs in smaller, safe amounts

  • Reduce speed limits

Injury control strategies2

Injury Control Strategies

3.Preventing release of the agent; reduce exposure by deterring it from entering the environment

  • Ban very speedy cars

  • Make bathtubs less slippery

Injury control strategies cont

Injury Control Strategies–Cont.

4.Modifying the rate or spatial distribution of the agent;

altering the mechanism by which energy is transferred to the host

  • Adjust the design

  • Require automobile seatbelts and air bags

  • Require soft playground surfaces

Injury control strategies cont1

Injury Control Strategies–Cont.

5.Separating the host and agent,in time and space: eliminating contact between energy source and host

  • Install pedestrian sidewalks

  • Reroute high speed traffic around residential neighborhoods or slow it with speed bumps and roundabouts

  • Spray pesticides at a time of day when people aren’t around

  • use red light cameras

Injury control strategies cont2

Injury Control Strategies–Cont.

6.Separating the agent from asusceptible host by interposition of a material barrier

  • Install fences around pools

  • Install cover guards on dangerous machinery

  • Install proper guardrails along roads

  • Use child-proof packaging

  • Store handguns in a locked metal box

  • Use extension cords with good insulation

Injury control strategies continued

Injury Control Strategies –Continued

7.Modifying relevant qualities of the agent

Make crib slat spacing too narrow to strangle a child

  • Modify equipment by rounding sharp corners

Place a barrier between the hazard and the potential victim

Place a Barrier Between the Hazard and the Potential Victim:

  • Child-Resistant Caps on Baby Aspirin

Injury control strategies continued1

Injury Control Strategies –Continued

8.Strengthening the susceptible host

  • Improve physical condition through proper nutrition and regular exercise

Injury control strategies continued2

Injury Control Strategies –Continued

9.Countering the injury already caused by the agent

  • Provide emergency medical care

Injury control strategies continued3

Injury Control Strategies –Continued

10.Stabilizing, repairing and rehabilitating the injured host

  • Provide of appropriate acute care and rehabilitation facilities and make them available all over the country

Proven injury prevention interventions

Proven Injury Prevention Interventions

  • Car safety seats and belts

  • Air bags

  • Motorcycle helmets

  • Bicycle helmets

  • Child resistant packaging

  • Swimming pool fencing

  • Smoke detectors

  • Self extinguishing cigarettes

Injury prevention success

Injury Prevention Success

  • Residential Fire Injuries

    • Smoke Alarm Distribution Programs Save Lives

  • Poison Prevention Packaging Act

    • 45% decrease in poisoning deaths

    • Child-proof containers

    • Packaging in non-lethal doses

  • Motor Vehicle Injuries:

    • Since 1920’s Six fold increase in number of drivers

    • 11 times the number of motor vehicles

    • 10 times the number of miles traveled

    • 90% decrease in the annual death rate per 100 million vehicle miles traveled

  • Mantra of injury prevention

    Mantra of Injury Prevention

    • Education

    • Transformation

    • Regulation

    • Legislation

    • Litigation.

    Injuries and related evidence based strategies for prevention

    Injuries and Related Evidence-Based Strategies for Prevention

    • Injury involving Motor Vehicles

      • Alcohol-Impaired Driving

      • Seat Belts and Air Bags

  • Motorcyclists

  • Pedestrians

  • Bicycling Injuries

  • Playground Injury

  • Poisoning

  • Fire

  • Injury from Firearms

  • Drowning

  • Falls

  • Falls

    65% of persons who die from falls are > 65

    Account for 87% of all fractures in older adults

    1 of 5 falls resulted in direct impact on the hip

    Hip fracture is the most frequent consequence

    Osteoporosis facilitates fractures

    The risk of Osteoporosis for 50-years WFW is 40%

    Risk Factors:

    History of previous falls

    cognitive impairment

    chronic illness

    balance and gait impairment

    a low body-mass index

    female sex

    general frailty

    use of diuretics

    use of psychotropic drugs

    hazards in the home


    Prevention of falls its consequences

    Prevention of Falls & its Consequences

    • Prevention of osteoporosis,.. Early in life

      • Adequate Ca intake with vitamin D in Childhood

      • Ca (1.2g) and Vit. D3 (800 IU) daily, reduces the risk of hip fracture in elderly by 23%

      • Hormone-replacement therapy may also be effective

      • Hormone-replacement has 25% reduction in hip fractures. (estrogen or with progesterone)

      • Thiazide diuretics my prevent hip fracture (ca excretion)

      • Furosemide may increase that risk

      • No evidence of the effect of calcitonin, fluoride & etidrone

    • Weight-bearing exercise, 40-50% HF reduction

    50 of prevention in behavior

    50% of Prevention in Behavior!

    Prevention through leading a healthy life

    Prevention Through Leading a Healthy Life

    The 5 es of incident prevention

    The 5 “Es” of Incident Prevention

    • Epidemiology: you can’t prevent it if you don’t understand it. Data collection is key.

    • Education: awareness, attitudes, cultural beliefs

    • Enforcement: rules, life safety codes etc.

    • Engineering: changing the environment to make it safer

    • Evaluation: did the changes made in education, enforcement, and engineering have the desired outcome on incidence?

    Mechanism of injury effects trauma outcome

    Mechanism of Injury effects Trauma Outcome

    National Trauma Data Bank

    2002 Report

    Hospital length of stay grouped by mechanism of injury. Blue bars represent blunt mechanisms of injury. Green bars represent violent mechanisms of injury. Red bar represents burns.

    Injury prevention

    Examples of State and Local Laws

    Trauma who is at fault

    Trauma Who is at fault

    • Gods

    • mortal

    • environment

    • designer

    • government

    • medical team

      Trauma is no accident but is our training

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