Road traffic accidents represent a major public health problem globally and in India. They are one of the leading causes of death, especially among young people. Other common accidents include falls, burns, drownings, and poisonings. Prevention strategies are needed that address human behaviors like speeding, alcohol use, as well as improving infrastructure like road safety and reducing access to poisons. Collecting accurate data on accidents is important to identify risk factors and evaluate prevention programs.
Epidemiology, prevention and control of road traffic accidentsDr.Hemant Kumar
Road Traffic Accidents(RTAs)are Major Global Health problems and 8th leading cause of death leading to more than 1.2 million deaths and 20-50 million injuries annually.While the situation in many countries in now improving, India still holds the dubious distinction of being only country who faces more than 14 fatalities and 53 injuries every hour due to RTA.
This presentation has the following.
1. Definitions - accidents and injuries
2. The burden of accidents and injuries
3. Epidemiology of RTA, industrial accidents, railway accidents, violence, domestic violence, drowning, burns, domestic accidents, poisoning and snakebite.
4. Prevention and control of RTA, industrial accidents, railway accidents, violence, domestic violence, drowning, burns, domestic accidents, poisoning and snake bite.
Epidemiology, prevention and control of road traffic accidentsDr.Hemant Kumar
Road Traffic Accidents(RTAs)are Major Global Health problems and 8th leading cause of death leading to more than 1.2 million deaths and 20-50 million injuries annually.While the situation in many countries in now improving, India still holds the dubious distinction of being only country who faces more than 14 fatalities and 53 injuries every hour due to RTA.
This presentation has the following.
1. Definitions - accidents and injuries
2. The burden of accidents and injuries
3. Epidemiology of RTA, industrial accidents, railway accidents, violence, domestic violence, drowning, burns, domestic accidents, poisoning and snakebite.
4. Prevention and control of RTA, industrial accidents, railway accidents, violence, domestic violence, drowning, burns, domestic accidents, poisoning and snake bite.
This lecture looks specifically at measures of disease frequency: morbidity and mortality. You will see how morbidity data can be used, how routinely collected mortality data can begin to throw light on very important issues that might determine health. You will review the sources of important, routinely collected population data in Malaysia: demographic data (e.g., population census) and health event data (e.g., mortality, hospital and general practice data).
NCDs, also known as chronic diseases, tend to be of long duration and are the result of a combination of genetic, physiological, environmental and behaviours factors.
The main types of NCDs are cardiovascular diseases (like heart attacks and stroke), cancers, chronic respiratory diseases (such as chronic obstructive pulmonary disease and asthma) and diabetes
An overview of a key statistical technique in epidemiology – standardization - is introduced. The process and application of both direct and indirect standardization in improving the validity of comparisons between populations are described.
What are the cardiovascular disorders?
Public Health importance
Burden of disease
Risk factors of cardiovascular disorders
Causation
Prevention strategies
Global Action Plan for the Prevention and Control of NCDs
India - National programme (NPCDCS)
NCD Prevention and Control as a Health System Strengthening InterventionAlbert Domingo
Lecture on NCD Prevention and Control as a Health System Strengthening Intervention delivered by Dr Albert Francis Domingo at the UP Manila College of Public Health on 19 January 2018.
This lecture looks specifically at measures of disease frequency: morbidity and mortality. You will see how morbidity data can be used, how routinely collected mortality data can begin to throw light on very important issues that might determine health. You will review the sources of important, routinely collected population data in Malaysia: demographic data (e.g., population census) and health event data (e.g., mortality, hospital and general practice data).
NCDs, also known as chronic diseases, tend to be of long duration and are the result of a combination of genetic, physiological, environmental and behaviours factors.
The main types of NCDs are cardiovascular diseases (like heart attacks and stroke), cancers, chronic respiratory diseases (such as chronic obstructive pulmonary disease and asthma) and diabetes
An overview of a key statistical technique in epidemiology – standardization - is introduced. The process and application of both direct and indirect standardization in improving the validity of comparisons between populations are described.
What are the cardiovascular disorders?
Public Health importance
Burden of disease
Risk factors of cardiovascular disorders
Causation
Prevention strategies
Global Action Plan for the Prevention and Control of NCDs
India - National programme (NPCDCS)
NCD Prevention and Control as a Health System Strengthening InterventionAlbert Domingo
Lecture on NCD Prevention and Control as a Health System Strengthening Intervention delivered by Dr Albert Francis Domingo at the UP Manila College of Public Health on 19 January 2018.
Prevalence of Psychiatric Morbidity among Road Traffic Accident Victims at th...inventionjournals
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This is presentation of road accident for college submit.
We all that day by day accident increase on road for only.
A traffic collision, also called a motor vehicle collision, occurs when a vehicle collides with another vehicle, pedestrian, animal, road debris, or other moving or stationary obstruction, such as a tree, pole or building.
ROAD TRAFFIC
INJURIES
Road Traffic
Injuries
Approximately 1.35 million
people die each year as a result
of road traffic crashes
Between 20 and 50
million more people
suffer non-fatal
injuries
Many incur
disabilities as
a result of
their injury
Road Traffic Injuries
Cause considerable economic losses to individuals, their families, and
to nations as a whole
Losses arise from the cost of
treatment
Lost productivity for those killed or disabled by
their injuries, and for family members who need to
take time off work or school to care for the injured
Road traffic crashes cost most countries 3% of their gross domestic
product.
Road Traffic Injuries
Globally, road traffic
injuries are the leading
cause of death for
children and young
adults aged 5–29 years
Are the 8th leading
cause of death overall
Surpasses HIV/AIDS,
tuberculosis and
diarrheal diseases
EVERY 24
SECONDS
SOMEONE DIES
ON THE ROAD
Road Traffic Injuries
Low-income countries use 1%
of the world’s vehicles
Account for 13% of all deaths
High-income countries use 40%
of the world’s vehicles
Account for only 7% of all deaths
Road Traffic Injuries
Some reductions were observed in 48 middle- and high-income countries
Overall, the number of deaths increased in 104 countries during this period.
Between 2013 and 2016, no reductions in the number of road traffic deaths
were observed in any low-income country
100,000 population, 2000-2016
income category, 2016
population by WHO regions, 2013, 2016
At Risk Groups
More than half of global traffic deaths
are amongst pedestrians, cyclists, and
motorcyclists
Often still neglected in road traffic system design in
many countries
Road traffic injury death rates highest in the African region
People from lower socioeconomic
backgrounds more likely to be involved
in road traffic crashes
Even in high-income countries
At Risk Groups
◦ Males more likely to be involved in road traffic crashes
than females
◦ About three quarters (73%) of all road traffic deaths
occur among young males under the age of 25 years
◦ Almost 3 times as likely to be killed in a road traffic crash versus
young females
Risk Factors -
Speeding
◦ Increases in average speed directly related both to the
likelihood of a crash occurring and to severity of the
consequences of the crash
◦ Every 1% increase in mean speed produces a 4%
increase in the fatal crash risk and a 3% increase in
the serious crash risk
◦ Death risk for pedestrians hit by front of car rises
rapidly (4.5 times from 31 mph to 40 mph)
◦ In car-to-car side impacts, the fatality risk for car
occupants is 85% at 40 mph
Risk Factors – Alcohol and Drugs
◦ Driving under the influence of alcohol and any psychoactive drug increases the risk of a crash resulting in
death or serious injuries
◦ Risk of a road traffic crash starts at low levels of blood alcohol concentration (BAC) and increa.
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The people of Punjab felt alienated from main stream due to denial of their just demands during a long democratic struggle since independence. As it happen all over the word, it led to militant struggle with great loss of lives of military, police and civilian personnel. Killing of Indira Gandhi and massacre of innocent Sikhs in Delhi and other India cities was also associated with this movement.
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The Roman Empire, a vast and enduring power, stands as one of history's most remarkable civilizations, leaving an indelible imprint on the world. It emerged from the Roman Republic, transitioning into an imperial powerhouse under the leadership of Augustus Caesar in 27 BCE. This transformation marked the beginning of an era defined by unprecedented territorial expansion, architectural marvels, and profound cultural influence.
The empire's roots lie in the city of Rome, founded, according to legend, by Romulus in 753 BCE. Over centuries, Rome evolved from a small settlement to a formidable republic, characterized by a complex political system with elected officials and checks on power. However, internal strife, class conflicts, and military ambitions paved the way for the end of the Republic. Julius Caesar’s dictatorship and subsequent assassination in 44 BCE created a power vacuum, leading to a civil war. Octavian, later Augustus, emerged victorious, heralding the Roman Empire’s birth.
Under Augustus, the empire experienced the Pax Romana, a 200-year period of relative peace and stability. Augustus reformed the military, established efficient administrative systems, and initiated grand construction projects. The empire's borders expanded, encompassing territories from Britain to Egypt and from Spain to the Euphrates. Roman legions, renowned for their discipline and engineering prowess, secured and maintained these vast territories, building roads, fortifications, and cities that facilitated control and integration.
The Roman Empire’s society was hierarchical, with a rigid class system. At the top were the patricians, wealthy elites who held significant political power. Below them were the plebeians, free citizens with limited political influence, and the vast numbers of slaves who formed the backbone of the economy. The family unit was central, governed by the paterfamilias, the male head who held absolute authority.
Culturally, the Romans were eclectic, absorbing and adapting elements from the civilizations they encountered, particularly the Greeks. Roman art, literature, and philosophy reflected this synthesis, creating a rich cultural tapestry. Latin, the Roman language, became the lingua franca of the Western world, influencing numerous modern languages.
Roman architecture and engineering achievements were monumental. They perfected the arch, vault, and dome, constructing enduring structures like the Colosseum, Pantheon, and aqueducts. These engineering marvels not only showcased Roman ingenuity but also served practical purposes, from public entertainment to water supply.
The French Revolution, which began in 1789, was a period of radical social and political upheaval in France. It marked the decline of absolute monarchies, the rise of secular and democratic republics, and the eventual rise of Napoleon Bonaparte. This revolutionary period is crucial in understanding the transition from feudalism to modernity in Europe.
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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.
3.
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.
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.
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).
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.
23.
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.
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
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.
47.
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.