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Global Injury Prevention and Safety Promotion. Catherine A. Lynch, MD Assistant Professor of EM and Global Health Co-Director, Section EM Global Health Eric Ossmann, MD Associate Professor of EM Director of Prehospital & Disaster Medicine. Overview. WHY INJURY Epidemiology

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global injury prevention and safety promotion

Global Injury Prevention and Safety Promotion

Catherine A. Lynch, MD

Assistant Professor of EM and Global Health

Co-Director, Section EM Global Health

Eric Ossmann, MD

Associate Professor of EM

Director of Prehospital & Disaster Medicine

    • Epidemiology
    • Why is risk increasing?
  • HOW?
    • Surveillance/Prevention/Public Policy
    • Prehospital/ Hospital Trauma care quality improvement
scope of injury us
Scope of Injury: US

Injury Deaths Compared to Other Leading Causes of Death for Persons Ages 1-44, United States, 2007*

burden gbdi 2010
Burden (GBDI, 2010)
  • Preliminary findings (Lancet Nov 2012)
    • Injuries cause 5.1 million deaths and 12.1% DALY
    • All cause deaths 20% (CD 25%NCD 20%, Injuries 8%)
      • Transport (28%), Falls(10%) Drowning (7%) Fires(6.6%), Self Harm (17.4%)
    • RTI #8, Self Harm #13, Falls #22 cause of death
    • 35-45% of codes in come countries are “garbage codes” (Argentina) so these numbers can be much higher

Injuries have a large and increasing health loss risk which is decreasing much less than other NCDs and CD

injury types
Injury Types
  • Intentional
    • Self Directed
      • Suicide
      • Self Harm
    • Interpersonal Violence
      • Intimate Partner
      • Child Abuse
      • Elder Abuse
    • Collective Violence
      • War
  • Non-Intentional
    • Transport
      • Pedestrian
      • 4 wheel motorized (Dr/Pa)
      • 2 wheel motorized
      • 2 wheel non-motorized
    • Fall
    • Assault
      • GSW
      • Stabbing
      • Fist
    • Work related Injury
    • Bite (Human, Animal)
    • Poisoning
road traffic crashes
Road Traffic Crashes
  • Road Traffic crashes in low and middle income countries cost approximately $65 billion per year
  • This is more than total dollar amount these countries receive in development assistance
  • Urbanization
  • Motorization
  • Limited Care
  • Limited Prevention
    • Road/vehicle conditions
    • Signage
    • Pedestrians/VRU
    • Legislation/Regulation
summary why injury
  • >5 Million people die annually
  • 16,000 people die daily from injuries
  • Persons 15-44, injuries account for 6 of the 15 leading causes of death.
  • For each 1 that dies, thousands have permanent sequelae

Krug EG, Sharma GK, Lozano R. The global burden of injuries. Am J Public Health 2000; 90 523-26

rf for injury
RF for injury
  • Age
  • Sex
  • Race/ Ethnicities
  • Socioeconomic Groups
  • Alcohol/Drug
  • Vulnerable road users:
    • Pedestrian, 2 wheel motorized and non-motorized
development issues
Development Issues
  • Disproportionate impact on the poorest
    • More exposed to risk
    • Less access to prevention and care
  • Disproportionate impact on young people
  • High economic costs
    • Care
    • Rehabilitation
    • Productivity
republic of mozambique
Republic of Mozambique

“Traumas of various types, particularly those cause by road accidents, have reached epidemic proportions…”

Strategic Plan for the Health Sector 2001-2005

Ministry of Health, Republic of Mozambique


Republic of Mozambique

  • Maputo Central Hospital
    • 300+ patients per day
    • > 30% due to Injury
    • Road traffic crashes are the leading cause of death

Maputo Central Hospital, Maputo, Mozambique

obstacles challenges and risks
Obstacles, Challenges and Risks
  • Medical Imperialism
  • Financial Considerations
  • Political, administrative, and regulatory
  • Cultural nuances and Language

Razzak, JA and Kellermann AL. Emergency medical care in developing countries: is it worthwhile? Bulletin of the World Health Organization, 2002, 80 (11)

Sasser SM, Varghese M, Joshipura M, Kellermann A. Preventing death and disability through the timely provision of prehospital trauma care. Bulletin of the World Health Organization, July 2006, 84 (7)

obstacle challenges and risks
Obstacle, Challenges, and Risks
  • Medical Education, System, Personnel
  • Capability and Capacity
  • Lack of data
  • Human resources

Razzak, JA and Kellermann AL. Emergency medical care in developing countries: is it worthwhile? Bulletin of the World Health Organization, 2002, 80 (11)

Anderson P, Petrino R, Halpern P, Tintinalli J. The globalization of emergency medicine and its importance for public health. Bulletin of the World Health Organization, October 2006, 84 (10)


Emergency medical care systems need not be complicated and expensive. Much may be accomplished by providing simple but cost-effective treatment in a timely manner


Emergency medical care systems should rely on locally available supplies,

equipment, training, and resources


Implementation should not require overhaul of the country’s healthcare infrastructure


Design, implementation, and operation should enable emergency medical care systems to optimally utilize the resources available to them, no matter how scarce they may be


Emergency medical care systems should be adaptable to suit local conditions, values, norms, and economic resources

prehospital medical care
Prehospital Medical Care

Estimate of world’s population covered by:

  • EMS at ALS level: 5 – 15%
  • EMS at BLS level: 20 – 35%
  • No formal EMS: 50 – 75%

Mock, C. Improving Prehospital Trauma Care in Rural Areas of Low-Income Countries. Journal of Trauma-Injury Infection & Critical Care. 54(6):1197-1198, June 2003.

International Approaches to Trauma Care. Trauma Quarterly, Vol. 14, No. 3, 1999.

improving prehospital care
Improving prehospital care
  • Strengthen existing prehospital care systems
    • Organization/administration/quality
    • Logistics and operations
    • Deployment
      • Target high risk areas
    • Training and Education

Sasser, et al. Assessment of Emergency Medical Services in Maputo, Mozambique. Prepared for the World Health Organization, 2005

making it successful
Making it Successful
  • Government support
  • Academic support
  • Provider support
  • Institutional support
  • Community support
  • Long-term commitment
tucum n argentina1
Tucumán, Argentina
  • Aim: Develop a evidence based provincial injury prevention initiative
  • Location: Tucumán, Argentina
  • Methods:
    • Community Based Qualitative**
    • Hospital Based Quantitative**
moshi tanzania2
Moshi, Tanzania

Aim: To determine the burden of injury at KCMC and the increased risk of injury due to alcohol

Location: KCMC, Moshi Tz

Methods: Hospital Based Epidemiology

  • Healthcare worker KAP study
  • Self-survey
  • Nested case crossover
moshi tanzania3
Moshi, Tanzania

Aim: To improve TBI acute care management

Locations: KCMC, Moshi Tz


  • Systematic Review
  • Mediated Modeling*
  • TBI Protocol Evaluation*