Community medicine topic-Epidemiology of accidents and injuries

1. ACCIDENTS & INJURIES
BY GROUP C- ROLL NO 60-90

2. INDRODUCTION:
• DEFINITION OF ACCIDENT:An accident is defined as”an unexpected
,unplained occurence which may involve injury”.
• A WHO advisory group in 1956 defined accident as ‘an unpremeditated
event resulting in recognizable damage’.
• Accident represent a major epidemic of non-communicable disease in the
present century.
• If death occurs at once or within a week after the accident,is called fatal
accident.If death occurs after a week but within a month ,it is called death
due to accident or killed in accident and if death occur after one year it is
called sequel of accident.

4. MEASUREMENT OF THE PROBLEM
• Mortality- 1.Proportional moratlity rate
2. Number of death per million population
3. Death per 1000 or 10000 registered vehicles per year
. 4. Number of accidents or fatalities as a ratio of the number of vehicles per kilometer or
pessengers per kilometre
5. Deaths of Vehicle occupants per 1000 vehicles per year
•Morbidity – This is measured in terms serious injuries and slight injuries . The seriousness of the injury is
assessed by a scale known as “Abbreviated Injury Scale” . Morbidity rates are generally less reliable because
of under reporting or mis reporting .
• Disability – an important outcomes of the accident process is disability , which may be temporary
parmanentb, partial or total. Measurement of disability in terms of duration is a limited concept , it does not
take into consideration the psychological or social aspects of the injury
• The International classification of Functioning , Disability and Health (ICF) is an attempt by WHO to
estimate the disabilty of individuals at given moment

5. PROBLEM STATEMENT
• A.World:Injuries constitute a variable epidemic.Injuries are commonly classified based on
“intentionality”.Most road traffic injuries,poisoning,falls,fire,burn injuries and drowning are
unintentional.Intentional injuries include interpersonal violence(homicide,sexual
assault,neglect,abandonment and other maltreatment),suicide and collective violence.
TABLE SHOWING THE GLOBAL ESTIMATED DEATHS,BY TYPE OF INJURY,PERCENTAGE OF TOTAL DEATHS
,CRUDE DEATH RATE PER LAKH POPULATION,AGE SPECIFIC DEATH RATE PER LAKH POPULATION DUE TO
INJURIES DURING THE YEAR 2016

6. • Injuries and violence are included in multiple SUSTAINABLE DEVLOPMANT
GOALS TARGETS(SDG).RTA and unintentional injuries are included in the health
goal SDG 3 with targets related to violence and disaster part of other goals.
THIS TABLE ENUMERATES THE INDICATORS RELATED TO THE GOAL TARGETS,THE GLOBAL AND
INDIAN SCENARIO

7. SCENARIO IN INDIA
Accidents are definitely on an increase in Indian. Increasing mechanization in agriculture and industry
, induction of semi skilled and unskilled workers in various operations and rapid increase in vehicular
traffic have resulted in an increase in morbidity and mortality due to accidents .
Overcrowding,lack of awareness and poor implementation of essential safety precautions result in an
increasing no. of accidents.Consumption of poisonus substances accidentally or intentionally is also
on the rise .Today injuries are low in priority for policy markers and only plans are drawn for injury
prevention.

8. TYPES OF ACCIDENTS
1. Road traffic accident.
2. Domestic accident
•Drowning
•Burn
•Fall
•Poisoning
•Injury from sharp & pointed objects
•Snakebite
3.Indrustial accidents
4.Railway accidents
5.Violence

9. ROAD TRAFFIC ACCIDENT(RTA):
• In many countries,motor vehicle accidents rank first among all fatal accidents.Every year about 1.25
million people die from road accidents in the world.In addition,for every death there are ss many as 20-
50 non-fatal injuries and 10-20 serious injuries requiring long periods of expensive care ,nursing and
treatment.
• Road traffic fatality rate is higher in younger age group.Children and young people under the age of 25
years account for over 30% of those killed and injured in RTAs.
• From younger ages,males are more likely to be injured by road traffic crashes than females.
• More than 90% deaths that results from RTAs occur in low & middle income countries.Even in High-
income countries,people from lower socio-economic backgrounds are more likely to be involved.
• Type of accidents----
1.Hit pedestrians,
2.Rear-end collision,
3.Head on collision,
4.Overturning.

10. • INDIA
HIT PEDESTRIANS REAR-END COLLISION
HEAD ON COLLISION OVERTURNING

11. • INDIA:During the year 2015,a total of 1.77 lakh traffic accidents deaths were reported in the
country.The rate of death per 1,000 vehicles has decreased from 1.6 in 2007 to 1.2 in 2011.The
rate of accidental deaths per 1,000 vehicles was highest in BIHAR and SIKKIM at 1.6 followed by
WEST BENGAL at 1.5.
24.9% of victims of RTAs were occupants of 2-wheelers.Maximum no. (73,001) of accidents
occured between 6pm and 9pm time period.Maximum no. Of road accidents were reported in the
month of May(43,064) followed by January(39,185).

12. 2018 report

13. • Risk factors:
1.Speed:An increase in average speed is directly related both to the likelihood of a crash occuring and
to the severity of the consequence of the crash.
a.Pedestrians have a 90% chance of surviving a car crash at 30km/h or below,but less than a 50%
chance of surviving and impact of 45km/h or above.
b.30 km/h speed zones can reduce the risk of a crash and are recommended in areas where
vulnerable road users are common(e.g residential areas,around schools.)
2.Drink-driving:Drinking and driving increases both the risk of a crash and the likelihood that death or
serious injury will result.
a.The risk of being involved in a crash increases significantly above a blood alcohol conc.(BAC) of
0.04g/dl.
b.Laws that establish BACs of 0.05g/dl or below are effective in reduction the no. Of alcohol-related
crashes.
c.Enforcing sobriety check-points and random breath testing will reduce the crashes by 20%(cost-
effective)

14. CONT...............................
• 5.Distracted driving:There are many types of distractions that can lead to impaired driving,but
recently there has been a marked increased around the world in the use of mobile phones by drivers
that is becoming a growing concern for road safety in a variable way i.e. Longer reaction
times,impaired ability to keep in the correct lane and shorter following distances.
A.Text messaging reduces the risk.
B.Drivers using a mobile phone are approx.4 times more likely to be in a crash than a driver
who doesn’t use a phone during driving.

15. • MULTIPLE CAUSATION:Accidents are a complex phenomena of multiple causation.The
aetiological factors can be classified into-----HUMAN &ENVIRONMENTAL
Primary factors in
accidents

16. PREVENTION:
• Since accidents are multi-factorial.They call for an inter-sectoral approach for both prevention and
care of the injured.The various measures comprise of the following-----
1.DATA COLLECTION:
• There should be basic reporting system for all accidents.The national data should be supplemented
by special surveys and in-depth studies,this will brimg out the risk factors.
• Detailed environmental data relating to the road,vehicle,weather must be collected.
• The poolice have a statutory duty in many countries to investigate accidents,for legal as well as
preventive purposes.The data collecting system should recognize this and take police record as their
starting points.
• Without adequate data collection, analysis,interpretation there could not be any effective
measures,evaluations and stratigies for prevention.
2.SAFETY EDUCATION:”IF ACCIDENT IS A DISEASE ,EDUCATION IS ITS VACCINE”
• Safety education must be started with school children.

17. CONT..............
• Young people need to be educated regarding risk factors,traffic rules and safety precaution.
3.PROMOTION OF SAFETY MEASURES:
A.Seat belts
B.Safety helmets,
4.ALCOHOL & OTHER DRUGS:Drugs such as Barbituates,Amphetamines,cannabis impaire ones
ability to drive safely.They should avoid it.
5.PRIMARY CARE:
• Planning,organization & management of trauma treatment and emergency care service should be a
fundamental element of health service managerial process.
• Emergency care should begin at the accident site,contiued during transportation ,and conclude in
the hospital emergency room.

18. CONT.............
6.ELIMINATION OF CAUSATIVE FACTORS:The factors which tend to cause accident must be
sought out and eliminated.e.g improvement of roads,imposition of speed limits and marking of
danger points.
7.ENFORCEMENT OF LAWS
8.REHABILITATION SERVICES
9.ACCIDENT RESEARCH:

19. HADDON MATRIX
• The Haddon matrix is the most commonly used paradigm in the injury prevention field.
• Devloped by WILLIAM HADDON in 1970,the matrix looks at factors related to personal
attributes,vector or agent attributes and environmental attributes,before,during and after an injury
/death.By utilizing this framework,one can think about evaluating the relative importance of different
factors and design interventions.

20. • These ten items are often called "Haddon's Strategies. Possible ways of preventing injury during
the various phases include:
• Pre-event/Pre-crash:
• Prevent the existence of the agent.
• Prevent the release of the agent.
• Separate the agent from the host.
• Provide protection for the host.
• Event/During crash:
• Minimize the amount of agent present.
• Control the pattern of release of the agent to minimize damage.
• Control the interaction between the agent and host to minimize damage.
• Increase the resilience of the host.
• Post-event/Post-crash:
• Provide a rapid treatment response for host.
• Provide treatment and rehabilitation for the host.

21. DOMESTIC ACCIDENTS
• It means the accident which takes place in the home or its
immediate surrounding and most generally not connected with
TRAFFIC,VEHICLES OR SPORT.The causes are--------
1.Drowning
2.Burns(by a flame,hot liquid,electricity,crackers or kerosene)
3.falls
4.Poisoining(drugs,insecticide,rat poisons,kerosene)
5.Injuries from sharp and pointed instrument,
6.Bites and other injuries from animals

22. 1.DROWNING----
• Drowning is the process of experiencing respiratory impairment
From submersion/immersion in liquid.
• The victim loses consciousness after approx.2 min. Of immersion
and irreversible brain damage can occur after 4-6 min.
• In 2016,an estimated 3,22,000 people died from drowning.Making
drowning a major public health problem worldwide,injuries account for
only about 9% of total global majority.Drowning is the 3rd leading
cause of unintentional cause of death.It accounts for 7% of all injury
related deaths.It is a common method of suicide.

24. •RISK factors:
1. Age-Age is one of the major risk factor for drowning.In general,children under 5
years of age have the highest drowning mortality rates worldwides.canada and
New Zealand are the two exception,where adult males drown at a higher rates.
2.Gender-Males are at higher risk with twice the overall mortality than the
females.Studies suggest it is due to the increased exposure to water,and riskier
due to increased alcohol consumption.
3.Access to water-Occupation like fishing,boating etc. Are at more Risk.also to the
children who lives around the ponds,ditches etc.
4.Others-Infants left unsupervised alone,alcohol uses,medical
conditions(epilepsy),flood or other cataclysmic event like tsunamis.

25. •Prevention-Prevention stratigies should be comprehensive and include
engineering methods which will remove the hazards.

26. 2.BURNS:
• A burn is an injury to the skin or other organic tissue primarily caused by heat or
due to radiation,radioactivity,electricity,friction or contact with chemicals.
• Thermal heat occurs due to exposure to the hot liquids(scald),hot solid(contact
burn) and flames(flame burn).

27. • PROBLEM STATEMENT:
• Burns are a global public health problem accounting for an estimated 1,80,000
deaths annually.
• About 11 million people worldwide require medical attention due to severe
burns.The majority of this occur in low and middle income countries and
almost half occur in SE regions.
• In some high income country burn death rates are decreasing nowadays.
• It is estimated that about 1 million people are moderately and severely burnt in
every year in India.

28. • RISK FACTORS:
1.Demographic-
• Age-Along with adult women,children are particularly vulnerable to burns.Burn is the 11th
leading cause of death among the children of 1-9 years age and 5th most common cause of non-
fatal childhood injuries.
• Gender-Females suffer burns more frequently than males.Women in SE Asia have the highest
rate of burns accounting for 27% of global burn death and nearly 70% of burn deaths in the
region.
• Rural-urban factors
2.Co-morbid conditions-
• Arthritis,
• Diabetes,peripheral neuropathy
• Dementia,confusion,forgetfulness and psychiactric illness
• Alcohol and drug abuse

29. • 3.others-
a.Occupation that exposes the person to the fire,
b.Poverty,overcrowding and lack of proper safety measures
c.Placement of young girls in household roles such as cooking,care of babies.
d.Alcohol abuse and smoking
e.Easy access to chemicals for assault(such as acid violence attacks)
f.Use of kerosene for non-electric domestic appliances.
g.Inadequate safety measures for petroleum gas and electricity.

30. • Prevention-Burns are preventable.prevention stratigies should adress the
hazards for specific burn injuries education for vulnerable populations,and training
of communities in first-aid.AN EFFECTIVE BURN PREVENTION PLAN SHOULD
BE MULTI-SECTORAL.There are a number of specific recommendations for
individuals,communities and public health officials to reduce risk.
• FIRST-AID-

31. 3.FALLS:
• Globally falls are the major health problem.
• An estimated 6,46,000 fatal falls occur each year,making it 2nd most common cause of unintentinal
death,after RTA.
• Though non-fatal 37.3 million falls are severe enough to require medical attention.
• Such falls are responsible for 17 million DALY’s lost.
• In all regions of the world death rates are highest among adults over the age of 65 years.
RISK FACTORS-
1.Occupations at elevated heights or other hazardous working conditions.
2.Alcohol or substance abuse.
3.Socio-economic factors e.g. Poverty,overcrowded housing,young maternal age.
4.Underlying medical conditions e.g.such as neurological,cardiac or other disabillities.

32. 5.S/E of medicaltion ,physical inactivity and loss of balance,particularly among older people.
6.Unsafe environment,particularly for those with poor balance and limited vision.
PREVENTATION-
1.For children,effective multifaceted community programmes,engineering modifications of nursery
furniture,playground eqipments and other products and legislation for the window guard.
2.For older people,fall prevention programmes include a number of components to identify and modify
risk,such as,
a.Screening within living environment for risks for falls
b.Clinical interventions to identify risk factors such as medication review and modifications,treatment of low
BP ,VitD and ca2+ supplementation ,treatment of correctable visual impairment.
c.Home assesment and environmental modification for those with known risk factors or a history of falling.
d.Prescription of appropriate assistive devices.
e.Muscle strenghtening and balance retraining prescribed by a trained health profrssional.

33. 4.POISONING:
• Poisoning was responsible for an estimated 2,52,000 deaths during the year 2008 worldwide.
• In India,about 28,012 poisoning deaths were reported during the year 2010.
• The most common agents are pesticides,kerosene,precription drugs,and
househeld chemicals.
• Report from India,Indonesia,Sri Lanka,and Thailand indicate that common
availability and use of toxic pesticides is responsible for intentional or
Unintentional morbidity and mortality.
• The use of organophosphorus insecticides in suicidal events has been reported to be as 20-30%.
• Paraquate intoxication is known to cause irreversible damage in patients.
• Many countries also report accidental ingestion of kerosene as a leading cause of death among children.
• A study from Thailand revealed that 54 % of cases of poisoning among pre-school children involved
therapeutic drugs

34. SNAKE-BITE
• Snakebite is oneof the majorpublic health problems in the tropics.
• It is also emergingas anoccupational disease of agricultural workers.
•
• In viewof their strong beliefs andmanyassociated myths, people resort to magico –
religious treatment for snakebite thus, causingdelayin seekingproper treatment.
• Snakebites is aparticularly important public health problemin rural areas of tropical and
subtropical countries situated in Africa, Asia, OceaniaandLatin America.

35. EPIDEMIOLOGY
• Theannualnumberof cases of snakebite worldwideis about5 million,
amongwhichthere are some100000to 200000 deaths.
• In addition to the deaths, there are anestimated 400000snakebite-
related amputations each year around the world .
• Childrenhaveboth higher incidence rates andsuffer moresevere effects
than do adults, as a result of their smaller body mass

36. INDIA
• India is estimated to havethe highest snakebite mortality in the world.
• WorldHealth Organization (WHO)estimates place the numberof bites to be
83,000per annumwith 11,000 deaths
• Males: Female::2:1.
• Majority of the bites being on the lower extremities

37. CLASSIFICATION
• Worldwide, only about 15% of the more than 3000
species of snakes are considered dangerous to humans.
• The family Viperidae is the largest family of venomous
snakes, and members of this family can be found in Africa,
Europe, Asia, and the Americas.
• The family Elapidae is the next largest family of venomous
snakes.

38. SNAKES IN INDIA
• There are about 236 species of snakes in India, most of which
• are nonvenomous
• Their bites, apart from causing panic reaction and local
injury, do not harm the patient.
• 13 known species that are venomous and of these four, namely
commoncobra (Naja naja), Russell’sviper (Dabiola russelii), saw-
scaled viper (Echis carinatus) and commonkrait (Bungarus
caeruleus) are highly venomous and believed to be responsible
for most of the poisonous bites in India

39. CLINICAL FEATURES
• Local feature:
I. Fang marks
II. Local pain, bleeding
III.Lymphangitis
IV. Inflammation
• Systemic symptoms:
I. Nausea and vomiting
II. Shock
III.Cardiac arrest
IV. Bleeding from gum, epistaxis
V. Drowsiness
VI. Heavy eyelids
VII.Haemoglobinuria

40. SPECIES,SIGNS &SYMPTOMS
SIGNS/SYMPTOM
S AND
POTENTIAL
TREATMENTS
COBRA KRAIT RUSSELL’S
VIPER
SAW
SCALED
VIPER
OTHER
VIPERS
Local
pain/Tissue
damage
Yes No Yes Yes Yes
Ptosis/Neuroto
xicity
Yes Yes Yes No No
Coagulation No No Yes Yes Yes
Renal problem No No Yes No Yes
Neostigmine/A
tropine
Yes NO No No No

41. National snakebite management protocol, India

42. FIRST-AID
The first aid recommended is based around the mnemonic:
"Do it R.I.G.H.T.“
It consists of:
R. = Reassure the patient. 70% of all snakebites
are from non venomous species. Only 30% of bites by
venomous species actually enveno-mate the patient
I = Immobilize in the same way as a fractured limb.
Children can be carried. Use bandages or cloth to hold the
splints, not to block the blood supply or apply pressure. Do
not apply any compression in the form of tight ligatures, they
do not work and can be dangerous!
G.H. = Get to Hospital immediately. Traditional remedies have
NO PROVEN benefit in treating snakebite.
T = Tell the doctor of any systemic symptoms such as
ptosis that manifest on the way to hospital.

43. • Investigations:
1.Twenty minute whole blood clotting test(20WBCT):Reliable test of coagulation which
can be carried out by Bedside and is considered to be superior to “Capillary
tube”method (for establishing clotting capability in a snake bite.”
2.Other useful tests(If facilities available)-
• Hb/Platelet count/PBS/PT/PTT
• Urine examination for proteinuria/RBC/Hemoglobinuria
• Myoglobinuria
• Biochemistry for serum creatinine/urea/potassium
• Oxygen saturation/ABG
• ELISA

44. • Treatment phase:
• Pain can be relieved with oral paracetamol/Tramadol.
• Aspirin/other NSAIDs should not be administered.
• ANTI-SNAKE VENOM(ASV):It is the mainstay of treatment.Antivenom is immunoglobulin[usually pepsin-
refined F(ab`)2 fragment of whole IgG]purified from the plasma of a horse ,mule or donkey(equine) or
sheep(ovine) that has been immunized with the one or more species of snake.
In India,Polyvalent ASV is effective against all the 4 common species e.g. Russel’s viper,Common
cobra,common krait and sae-scaled viper.
ASV is produced both in liquid & lyophilized forms.There is no evidence to suggest which form is
more effective.Liquid ASV require a reliable cold-chain and having 2 years of shelv-life.Lyophilized is in
powdery form,has 5 years shelf life and requires only to be kept cool.Only free unbound form of snake
venom is neutraltzed by ASV.
HOW LONG IT CAN BE GIVEN------It should be given as soon as it is indicated.It may reverse systemic
envenoming event when this has persisted for several days/in the cases of hemoststic abnormalities for
2 or more weeks.

45. Routes:IV injection
Local administration of ASV is not recommended as it is extremely
painful &increases intracompartmental pressure.
IM inj. Is not recommended because it is large fragmented,absorbed
slowly,bioavailability poor especially after intragluteal inj. And due to
the risk of hematoma formation.

46. INDUSTRIAL ACCIDENTS
• There are approximately 580 million workers in the South-East
Region.
• Approximately 60-80 percent of these workers are employed in
agriculture, fisheries, home industries and small-scale units.
• In India, 2% of total deaths comprise of such accidents.
• Most common age group affected: 21-35 years.

48. Types of Industry
Agriculture Industry
Chemical Industry
Type of units
commonly
involved
Manufacturing units
Chemical units
Mechanism of
injuries
Machine related
injuries
Falls from heights
Body parts
affected
Upper extremities
Middle bodily
extremities

49. PREVENTION
• Primordial prevention:
I. Health and safety awareness generation
• Primary prevention:
I. Mechanical engineering methods to reduce risk
II. Pre-placement examination
• Secondary prevention:
I. Periodic post-placement examination
II. Emergency care services liaison
• Tertiary prevention
I. Disability limitation (prosthesis and braces)
II. Rehabilitation

50. RISK FACTORS
• Age: 20-45 years mostly involved.
• Male sex at higher risk.
• Maximum reported in lower socio-economic class.
• It occurs mostly in daytime.
• Lack of concentration.

51. RAILWAY ACCIDENTS
• The main factor involved in railway accidents is human failure.
• During 2010, about 30,576 people died of railway accidents in India.
• The Ministry of Railways puts various efforts to make the passengers
safe.

52. VIOLENCE
• An estimated 15,10,000 persons died in 2008 due to violence or
intentional injuries worldwide, of which 4,20,000 SEAR countries.
• The accurate statistics are not available, as not all those injured go to
the hospital.
• So there are mostly unreported cases of violence behind the closed
doors.

53. SOME OF THE RISK FACTORS FOR
VIOLENT BEHAVIORS ARE :--
• Social acceptance of violence as a means to solve problems.
• Availability of lethal weapons like fire-arms, so possibilities of both
fatal and non-fatal injuries.
• Alcohol and other drugs consumption is linked to almost 2/3 of cases
of violence.

54. • Violence due to wars and political unrest is fairly common in several
countries.
• Suicides have been increasing at alarming rates in SEAR countries.
• In India, an average of 369 suicides take place everyday.