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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
Outline • 1. Extent and nature of problem. • 2. Injury prevention • 3. Trauma care (care of the injured) • 4. Surveillance • 5. Conclusions
Burden of Injury: Deaths • Source: Injuries and Violence: The Facts, WHO, 2010. Available from www.who.int
Injury-related Mortality Rates (per 100, 000 population) Source: www.who.int
Source: Injuries and Violence: The Facts, WHO, 2010. Available from www.who.int
Injury problem is getting worse Source: Injuries and Violence: The Facts, WHO, 2010. Available from www.who.int
Disability 16% of all disabilities are injury related.
WHO budget Lopez, The Lancet Nov 2008
Trends in Motor Vehicle Deaths:USA Deaths/100,000/yr Washington State Source: Baker et al, Injury Fact Book, 1992; NHTSA, Traffic Safety Facts.
Spectrum of Injury Control Surveillance Prevention Pre-Hospital Care Hospital Care Acute care Rehabilitation
Outline • 1. Extent and nature of problem. • 2. Injury prevention • 3. Trauma care (care of the injured) • 4. Surveillance • 5. Conclusions
INJURY PREVENTION:A SCIENTIFIC FIELD • Research into Risk Factors • Programs to Target Risk Factors • Evaluate Results
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
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.
Roadway • Intersection • Alignment Vehicle • Design • Maintenance Road Safety Human Factors • Alcohol • Speeding • Traffic Laws • Seatbelts • Vision
Roadway Infrastructure Seattle Monterrey, Mexico
Monterrey barrels Decrease in deaths from crashes into fixed objects.
Roadway • Intersection • Alignment Vehicle • Design • Maintenance Road Safety Human Factors • Overspeeding • Traffic Laws • Seatbelts • Vision • Alcohol
Side impact protection: Before: situation with no protection
Side impact standard improvements Use of side impact beams in doors: Less intrusion = less injury.
Vehicle factors Low availability of safety related spare parts • Tires • Brake components • Brake fluid • Source: Injury Prev, 1999.
Roadway • Intersection • Alignment Vehicle • Design • Maintenance Road Safety Human Factors • Alcohol • Speeding • Traffic Laws • Seatbelts • Vision
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.
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.
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
Occupational risks Occupational risks and social issues
Preventive measures Use of space
Preventive measures Priority to pedestrians Traffic calming
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
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.
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
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
Informal, locally made speed bump: Kumasi – Sunyani road, May 2013
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
Outline • 1. Extent and nature of problem. • 2. Injury prevention • 3. Trauma care (care of the injured) • 4. Surveillance • 5. Conclusions
Spectrum of Injury Control Surveillance Prevention Pre-Hospital Care Hospital Care Acute care Rehabilitation
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
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
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.
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
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.