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STRENGTHENING THE PREVENTION AND TREATMENT OF INJURIES GLOBALLY

STRENGTHENING THE PREVENTION AND TREATMENT OF INJURIES GLOBALLY. GHANA. Holy Family Hospital, Berekum, Ghana. Komfo Anokye Teaching Hospital: Kumasi. Outline. 1. Extent and nature of problem. 2. Injury prevention 3. Trauma care (care of the injured) 4. Surveillance 5. Conclusions.

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STRENGTHENING THE PREVENTION AND TREATMENT OF INJURIES GLOBALLY

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  1. STRENGTHENING THE PREVENTION AND TREATMENT OF INJURIES GLOBALLY

  2. GHANA

  3. Holy Family Hospital, Berekum, Ghana

  4. Komfo Anokye Teaching Hospital: Kumasi

  5. Outline • 1. Extent and nature of problem. • 2. Injury prevention • 3. Trauma care (care of the injured) • 4. Surveillance • 5. Conclusions

  6. Burden of Injury: Deaths • Source: Injuries and Violence: The Facts, WHO, 2010. Available from www.who.int

  7. Injury-related Mortality Rates (per 100, 000 population) Source: www.who.int

  8. Source: Injuries and Violence: The Facts, WHO, 2010. Available from www.who.int

  9. Injury problem is getting worse Source: Injuries and Violence: The Facts, WHO, 2010. Available from www.who.int

  10. Disability 16% of all disabilities are injury related.

  11. WHO budget Lopez, The Lancet Nov 2008

  12. Trends in Motor Vehicle Deaths:USA Deaths/100,000/yr Washington State Source: Baker et al, Injury Fact Book, 1992; NHTSA, Traffic Safety Facts.

  13. Spectrum of Injury Control Surveillance Prevention Pre-Hospital Care Hospital Care Acute care Rehabilitation

  14. Outline • 1. Extent and nature of problem. • 2. Injury prevention • 3. Trauma care (care of the injured) • 4. Surveillance • 5. Conclusions

  15. INJURY PREVENTION:A SCIENTIFIC FIELD • Research into Risk Factors • Programs to Target Risk Factors • Evaluate Results

  16. Injury Prevention UNINTENTIONAL INJURY Motor Vehicle Safety Pedestrian Safety Fire safety / burn prevention Drowning Prevention Household Safety Occupational Safety INTENTIONAL INJURY Suicide Prevention Violence Prevention

  17. 3 E’s • Engineering • E.g. smoke detectors, safety features in cars • Enforcement (and legislation) • E.g. laws against drunk driving or speeding • Education: social marketing to promote safe behaviors • E.g. seat belt or helmet use.

  18. Roadway • Intersection • Alignment Vehicle • Design • Maintenance Road Safety Human Factors • Alcohol • Speeding • Traffic Laws • Seatbelts • Vision

  19. Roadway Infrastructure Seattle Monterrey, Mexico

  20. Monterrey barrels Decrease in deaths from crashes into fixed objects.

  21. Roadway • Intersection • Alignment Vehicle • Design • Maintenance Road Safety Human Factors • Overspeeding • Traffic Laws • Seatbelts • Vision • Alcohol

  22. Side impact protection: Before: situation with no protection

  23. Side impact standard improvements Use of side impact beams in doors: Less intrusion = less injury.

  24. Vehicle factors Low availability of safety related spare parts • Tires • Brake components • Brake fluid • Source: Injury Prev, 1999.

  25. Roadway • Intersection • Alignment Vehicle • Design • Maintenance Road Safety Human Factors • Alcohol • Speeding • Traffic Laws • Seatbelts • Vision

  26. Ghana Drunk Driving Study • Random roadside breathalyzer • Based on NHTSA methodology • 722 drivers tested with breathalyzers Source: Mock C, Asiamah G, Amegashie J. A random, roadside breathalyzer survey of alcohol impaired driver in Ghana. J Crash Prevention and Injury Control, 2: 193 – 202, 2001.

  27. Ghana Drunk Driving Study • % with BAC > 0.1 gm% (e.g. drunk) – weekend, PM • Ghana (1997) 11% • USA (1973) 5% (1996) 3% (2007) 2% • In Ghana (24 hour, 7 day per week averages) • Bus drivers: 3% intoxicated • Truck drivers: 8% intoxicated Source: Mock C, Asiamah G, Amegashie J. A random, roadside breathalyzer survey of alcohol impaired driver in Ghana. J Crash Prevention and Injury Control, 2: 193 – 202, 2001.

  28. Pedestrian Safety Over half of all who die from road traffic crashes globally are vulnerable road users (VRU): • Motorcyclists • Bicyclists • Pedestrians Much smaller part of problem in high-income countries

  29. Pedestrian behavior

  30. Multiple road users

  31. Occupational risks Occupational risks and social issues

  32. Preventive measures Use of space

  33. Preventive measures Priority to pedestrians Traffic calming

  34. Targeting risk factors: speed Vehicle speed: a risk to all, especially vulnerable road users Source: World Report on Road Traffic Injury Prevention, WHO, 2004. Available from www.who.int

  35. 40 60 80 100 120 140 Speed (km/hr) Research on vehicle speeds: 20,000 vehicles 8% 4% 0% James Damsere-Derry, Research officer, BRRI, Kumasi, Ghana UW Fogarty scholar Speed limit of 50 km/hr Advocacy: Newspapers, press conference, FM radio stations. First time that “speed control” addressed as topic of talk radio. Source: Damsere-Derry et al, Traffic Injury Prevention, 2007; Injury Control Safety Promotion, 2008.

  36. Speed reducing interventions Example: Traffic calming along Accra-Kumasi road: 2005: 2 locations - 2010: 10 locations Speed table Thermoplastic speed bump Asphalted speed bump Rubberized delineators Photos courtesy of James Damsere-Derry

  37. Effectiveness: • Suhum junction: • Crashes decreased 35% • Fatalities decreased by 55% • “Now people in the towns along the roads are demanding these.” • Francis Afukaar, BRRI, Nov, 2010

  38. Informal, locally made speed bump: Kumasi – Sunyani road, May 2013

  39. Injury Prevention UNINTENTIONAL INJURY Motor Vehicle Safety Pedestrian Safety Fire safety / burn prevention Drowning Prevention Household Safety Occupational Safety INTENTIONAL INJURY Suicide Prevention Violence Prevention

  40. Outline • 1. Extent and nature of problem. • 2. Injury prevention • 3. Trauma care (care of the injured) • 4. Surveillance • 5. Conclusions

  41. Spectrum of Injury Control Surveillance Prevention Pre-Hospital Care Hospital Care Acute care Rehabilitation

  42. PERCENT OF MODERATELY SEVERELY INJURED (Inj Sev Score 15-24) WHO DIE Percent mortality Source: Trauma Outcomes in the Rural Developing World: Comparison with an Urban Level I Trauma Center J Trauma, 1993

  43. Permanent Disability • Much injury-related disability is from extremity injury. • Example: Most (78%) of injury-related disabilities in Ghana are due to extremity injuries. • Amenable to improvements in: • Orthopedic care • Rehabilitation Source: Disabil Rehabil, 2003

  44. CHALLENGES AND GAPS A. Human Resources: Example: Surgeons per 100,000 USA 50 Latin America 7 Africa 0.5 B. Physical Resources (supplies, equipment) Shortages in many critical items, even those that are low cost.

  45. CHALLENGES AND GAPSC. Organization and Administration • Main hospital in Kumasi, Ghana: • 2022 trauma admissions • Prolonged time to emergency surgery: average 12 hours • Low utilization of: • fluid and blood resuscitation • airway equipment • chest tubes Source: London et al, J Trauma 2001

  46. IMPROVEMENTS POSSIBLEdespite financial restrictions

  47. Improving Existing Ambulance Systems Monterrey, Mexico Intervention: • 1. Increase number of ambulance stations • (2 to 4). • 2. Improved in-service training. Effect: Mortality of transported trauma patients decreased: 8.2% to 4.7%. Cost: 16% of EMS budget. Source: J Trauma, 48: 119, 2000.

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