Wiped Out!A literature review of current safety and injury prevention strategies for children and young people in the UK participating in school ski trips abroad. Nicky Brittle. Research Assistant. University of Birmingham Dr Jane Coad. Senior Research Fellow. University of the West of England
Objectives • Background • The extent of the problem • Aim of the review • The Literature review • Methodology • Results • Risk factors • Injury prevention strategies • Guidelines (schools, governments, authorities, associations) • Conclusion • Future directions
Background • Skiing and snowboarding are two of the leading causes of paediatric sport-related injuries. • Skiing produces among the most severe sports-related injuries in children (Hagel, 2005) • For young people the incidence of skiing injuries during school organized activities was 25% higher than during other outings. (Macnab and Cadman, 1996)
Fatalities Fatalities per million days of participation (2004) Skiing/snow boarding 0.79 1.26 Swimming Cycling (RTA) 0.38 NSAA Safety and risk management series, 2006
Injury rates in young persons • Skiers: 2.86 - 9.1/1,000 skier days • Snowboarders: 15/1,000 snowboarder days (Hagel, 2005)
Injury rates in young persons ctd. 14-17 yr-olds = 5.9 per 1,000 skier days 10-13 yr-olds = 6.1 per 1,000 skier days (Xiang, Kelleher, Shields, Brown, & Smith 2005) 3,387 secondary Schools (Eng) X 0.2 = 677 schools X 50 (per coach) = 33,870 pupils X 6 (days) = 203,220 skier days X 5.9/1000 = 1,199 injuries
BEPRASA 2005-2008Best Practices in Prevention of Skiing Accidents in Europe: The new challenge Aims: - collect and analyse data on injury and prevention measures in Europe - provide recommendations on best prevention strategies - disseminate results through a network of experts and associations - promote harmonization of prevention measures across Europe “Particular support needs to be given to children by families, educational institutions and highly specialized personnel. Children need to be taught about behaviours and rules during skiing activities.”
Aim To explore the existing body of evidence on current safety and injury prevention strategies for children and young people from the UK participating in school ski trips abroad
Methodology • A search filter was developed • keywords e.g. snow sports (MeSH), accident, injury, prevention, risk • Limits: Age groups (Child 6-12yrs, Adolescent 13-18yrs); English language; published after 1995 • Five electronic databases searched between Apr 2007 and Aug 2007: Medline, CINAHL, Sportdiscus, PubMed and the Cochrane collection. • Results exported to Reference Manager Database • Duplicates removed • Each citation was screened for relevance. • For inclusion, the study was required to: • relate to unintentional injury in downhill alpine skiing • involve the evaluation of an injury prevention strategy or give an indication of risk factors associated with the sport.
Methodology • Hand searching of reference lists from highly relevant articles & “review” articles. • Searching across websites of Authorities and organizations relating to injury prevention within the context of schools and/or skiing e.g. Department for Children, Schools & Families (DCSF) Royal society for the prevention of accidents (ROSPA) European Association for Injury Prevention and safety Promotion (Eurosafe) International society for skiing safety (ISSS) National Ski Areas Association (NSAA) 8. Grey Literature/personal contacts
Results Mechanism of Injury • Primary mechanisms = falls and collisions • Lower extremity injuries greater in skiers • Upper extremity injuries greater in snowboarders • Head = 5-51.5% skiers; 8-50% snowboarders • Neck/spine = 2.9-7.7% skiers; 2.9-5% snowboarders Type of Injury
Risk Factors • Fatigue • Knowledge • Inappropriate/ill adjusted equipment • Adverse slope conditions • Psychosocial behaviour (Hagel, 2005; Meyers, Laurent, Higgins and Skelly, 2007)
Injury prevention strategies • Equipment design e.g. ski bindings • Protective headgear • Knee bracing • Education
Recommendations Guidelines for Schools • Department for Children, Schools & Families • Health and safety of pupils on Educational Visits (HASPEV), • 1998 Standards for Adventure supplement, 2002 “ It is recognised as good practice for a school to share aspects of the risk assessment with parents and pupils” • Royal society for the prevention of accidents • Health and Safety at School: School Trips “ Any pupil taking part must be physically fit and mentally prepared”
Potential directions for research • Does knowledge of safety precautions reduce ski injury risk? • What pre-departure safety information is administered by secondary schools in the UK (including source of information)? • Is there a need to improve safety education for school children participating in school ski trips? • Does the perception of ski injury risk by school children in the UK differ to that of nationalities that are more accustomed to snow sports? Does it affect injury rates? • If so, how do we communicate the message to children and young people in an appropriate and meaningful way?
Limitations • Minimal research (especially in children, adolescents and UK participants) • Outdated research • Limited sample sizes • Majority of studies have a retrospective design • Non-uniform definitions (injuries sustained and populations studied) • Data collection challenges
Conclusions of the literature review • The bulk of the literature appears to focus on the demographics of skiing injury in relation to age, gender, and perceived cause. • There are surprisingly few well-designed and controlled studies investigating injury prevention strategies especially in children and adolescents. • Findings continue to reflect risk factors with limited research directed toward resolving the problem • Numerous organisations offer guidance on risk assessment and injury prevention during school trips but to our knowledge the consistency, use and implementation of this information has not yet been studied.
References • Department for Education and Employment 2002, Standards for Adventure [online]. Available at http://www.teachernet.gov.uk/_doc/2577/STANDARDS%20ADVENTURE%20FINAL%202002.doc (accessed 07/2007). • Department for Education and Employment 1998, Health and Safety of pupils on Educational visits: A good practice guide [online]. Available at http://publications.teachernet.gov.uk/eOrderingDownload/HSPV2.pdf (accessed 07/2007). • Hagel, B. 2005, “Skiing and snowboarding injuries”, Med Sport Sci, vol. 48, pp. 74-119. • Jørgensen, U., Fredensborg, T., Haraszuk, J. P., & Crone, K. L. 1998, "Reduction of injuries in downhill skiing by use of an instructional ski-video: a prospective randomised intervention study", Knee Surg Sports Traumatol Arthrosc, vol. 6, no. 3, pp. 194-200. • Josse, J. M. & Cusimano, M. 2006, "The effect of a skiing/snowboarding safety video on the increase of safety knowledge in Canadian youths--a pilot study", Int.J Circumpolar.Health, vol. 65, no. 5, pp. 385-388. • Macnab, A. J. & Cadman, R. 1996, "Demographics of alpine skiing and snowboarding injury: lessons for prevention programs", Injury Prevention: Journal Of The International Society For Child And Adolescent Injury Prevention, vol. 2, no. 4, pp. 286-289. • Meyers, M. C., Laurent, C. M., Higgins, R. W., & Skelly, W. A. 2007, "Downhill ski injuries in children and adolescents", Sports Medicine, vol. 37, no. 6, pp. 485-499. • NSAA 2006, Facts about Skiing/Snowboarding Safety, Nationaql Ski Areas Association, Colorado • Royal Society for the Prevention of Accidents 2001, Health & Safety at Schools: School trips: Part 1 [online]. Available at http://www.rospa.com/safetyeducation/schooltrips/part1.htm(accessed 07/2007). • Royal Society for the Prevention of Accidents 2001, Health & Safety at Schools: School trips: Part 2 [online]. Available at http://www.rospa.com/safetyeducation/schooltrips/part2.htm(accessed 07/2007).