ACCIDENTS AND INJURIESDr. Muhammedirfan H. MominAssistant ProfessorCommunity Medicine DepartmentGovernment Medical College, Surat.
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DEFINITIONS• ACCIDENT• Unexpected, unplanned occurrence of an event which may involve injury.• In 1956 WHO advisory group defined accidents as – Unpremeditated event resulting in recognizable damage.• Occurrence in a sequence of events which usually produce unintended injury, death or property damage.
DEFINITIONS INJURYA bodily lesion due to acute exposure to energy beyond the physiological tolerance.
• Accidents are the part of prize we are paying for technological advances.• Like other diseases accidents are also having – • Natural history of disease and • Agent, Host and Environmental factors
Epidemiology of Injuries Injury as a diseasePathologic Host Agent Vector Inter-condition /vehicle actionMalaria Human Plasmodium Mosquito Bite vivaxSkull Human Mechanical Motorcycle Crashfracture Energy
Leading contributor in global diseases1990 20201.Lower Rasp. Infec. 1.IHD2.Diarrhoea 2.Major Depression3.Prenatal condition 3.Road Traffic Injury4.Unipolar major depression 4.Stroke5.IHD 5.COPD6.Stroke 6.Lower Resp. Inf.7.TB /HIV 7.TB8.Measles 8.Perinatal condition9.Road traffic Injury 9.Diarrhea Diseases10.Congenital 10.HIV
How to Measure the Problem of AccidentMortality:• Proportionate Mortality Rate – Number of deaths due to accidents out of 100 total deaths• Number of deaths per million population – Killed in Road Traffic Accident (RTA) is defined as any person who was killed outright or who died within 30 days as a result of accident.• Death Rate per 1000 registered vehicles per year• Number of accidents or fatalities as a ratio of number of vehicles per km OR passenger per km.
• Morbidity: – Measured in terms of • Slight injury and • Serious injury• Disability: – Disability is one of the important outcome of accidents • Temporary or Permanent disability • Partial or Total disability
Problem statementWorld:• Accidents are endemic all over the world• Accidents are major cause of deaths in the age-group of 10-24 yrsIn developed countries -• 57% of male death and• 43% of female death in 10-24 yrs are due to accidents.• RTA and drowning are the main causes of death in that age-group.
In SEAR:• Out of total 5.1 million accident deaths in the world 1/4th in SEAR.• So thousands of children saved from Nutritional and infectious disease are killed by accidents.India:• Increasing trends in India due to – Mechanization in agriculture and industries – Increase in vehicular traffic• Plus factors like – Overcrowding – Lack of awareness and – Poor implementation of safety precautions
Causes of accidents• Accidents are complex phenomena with multiple causation• Etiological factors are classified to – Human – Environmental – Psychosocial factors
Human factor Environmental factor • Age • Relating to road • Sex • Relating to • Education vehicle • Psychological • Bad weather factor • Mix traffic • Lack of body Increase protection vulnerability and riskPrecipitating factor situation ACCIDENT
Human factor• Age:15-44 yrs(50% mortality)• Sex: More in males• Education: Low educational status• Medical condition • Sudden illness • Heart attack • Impaired vision• Fatigue• Lack of protection – Helmet
Psychosocial• Lack of experience• Risk taking behavior• Impulsiveness• Defective judgment• Delay in decision• Aggressiveness• Poor perception• Family dysfunction
Environmental• Related to Roads: – Defective and narrow roads – Defective lay out of cross-roads, – speed breakers – Poor lighting
Environmental• Related to Vehicles: – High speed – Poorly maintained vehicles – Large number of 2-3 wheelers – Overloaded bus – Low driving standards• Bad Weather
Precipitating factors• Increased emotional tension• Use of Alcohol during driving
Precipitating factors• Stolen vehicle• Group traveling
Road Traffic Accident• “Road Safety is No Accident” – was the slogan given by WHO for World Health Day – 2004.• 85% of all road accident deaths occur in developing countries and nearly half in the Asia-Pacific region.• India has one of the largest highway and road networks second only to road network of U.S.
Road safety advertising
How accidents in developing countries differ from developed countries: • Two wheelers are more involved • Pedestrians are more involved
How accidents in developing countries differ from developed countries:• Large number of old and poorly maintained vehicles• Overloaded buses
How accidents in developing countries differ from developed countries:• Disregard towards traffic rules
How accidents in developing countries differ from developed countries:• Poor road standards
How accidents in developing countries differ from developed countries:• Unusual behavior of human and animals
• Unusual behavior of car
Domestic accidents• Accidents which takes place in home or in its immediate surrounding, which are not connected with traffic vehicles or sports.• Common domestic accidents are- – Drowning – Burns by flame, – hot liquid, – electricity, – crackers, chemicals – Falls – Injury by sharp objects – Animal bites.
Drowning• After immersion in water victim loses consciousness with in 2 min. and• Irreversible brain damage occurs at 4 – 6 minutes.
Prevention and control of drowningAvailability of life jackets and flotation devicesaround pools & boatsSupervision of children by adultsFencing of lakes and pondsCreation of safety standards for public andprivate swimming poolsEnsuring availability of weather reports to fishermen and to those working on rivers and seas
Burns• Factors associated with burns – Explosion of pressure stove. – Cooking on open fire – Use of open fire during winter – Use of inflammable material – Method of suicide
Prevention and control of burns Stable stoves/lamps Replacement of pressure stoves with wick and gas stoves Installation of fire and smoke alarm Promotion of cold water for first aid and burns
Poisoning• Most common agents are – – Kerosene – Pesticides – Household chemicals – Drugs• Kerosene poisoning common among children.
Fall• Large number of hospital visits among children and young adults for non-fatal injuries.• Fall from – Roof, balcony, stair-case, window are common.• Among construction workers are common
• Prevention and control of falls• 1.Safer playground (Use of mud & sand surfaces instead of paved ones)• 2.Safer furniture & house designs• 3.Use of grills on windows• 4.Safer design of stairs, balconies and rooftops with railings and bars• 5.Safer working techniques for construction workers
Industrial accidents• Approximately 580 million workers in SEAR.• 60-80% are in small scale units
Prevention and control of industrial accidents Ensuring the cost effective protection measures Enforcing safety regulations and standards Creating awareness among workers
Railway accidents• In India railway accidents are in increasing trend due to – Increasing number of trains – More number of passengers
Violence• Risk factors for violent behavior: – Exposure to violence and societal acceptability of violence as a mode to solve the problem – Availability of lethal weapon at home – Consumption of alcohol
• Suicide are increasing in SEAR region – 36/1,00,000 in India – 22/1,00,000 in Thailand – 11/1,00,000 in Bangladesh – 8/1,00,000 in Srilanka• Common methods of suicide: – Hanging – Drowning• 70% of cases of suicide in 15-35 yrs age• M:F ratio is 1:13 to 1:3
Prevention of Accidents• Multi-sectorial approach approach for prevention.Data collection:• Reporting system for accidents• Special surveys for accidents – Risk factors – Circumstances – Chain of event• No effective system of prevention without data collection.
Safety education:• “Accident is a Disease – Education is its Vaccine” – Should start from school days – Drivers trained for vehicle maintenance and safe driving. – Education about traffic rules – Training in First Aid.Promotion of Safety measures: – Helmets – Seatbelts – Leather clothing and boots
Promotion ofSafety measures: Children on back seats Parking at a suitable place Low beam headlights Avoidance of mobile Door locks Proper vehicle design Avoidance of alcohol and drugs
Alcohol and other Drugs:• Alcohol - 30-50 % of RTA• Alcohol and drugs like• Barbiturates,• Amphetamine must be avoidedPrimary care• Planning, Organization and Management of Trauma treatment and Emergency care• Emergency care should begin at the site, continue during the transport and conclude in the hospital.• Trauma care hospitals in all major cities
Elimination of Causative Factors: – Improper roads – Speed limits – Marking danger points – Fire guards – Use of safety equipments – Safe storage of drugs, poison and weapon.Enforcement of Lawo Medical fitness of drivero Alcohol conc. In blood (80 mg/100 ml limit in India)o Driving testo Seat belt wearingo Speed limit
Enforcement of Lawo Helmetso Vehicle inspectiono Periodic examination of driversRehabilitation – Medical – Social – OccupationalAccident Research