This document provides information about accidents and injuries. It begins with classroom rules and definitions of accidents and injury. It then discusses the epidemiology of injuries and leading causes of death worldwide. Specific information is given about accidents in Pakistan, types of accidents, causes of accidents, and prevention strategies. Measurement of injury problems includes mortality, morbidity, and disability rates. The public health model for injury control is described as a cycle of surveillance, risk factor identification, and intervention/evaluation. Risk factors and potential interventions are discussed in detail.

1. ACCIDENTS & INJURIES
DR SINDHU ALMAS
MBBS, MPH (MHPE), (PHD)
DEPARTMENT OF COMMUNITY
MEDICINE & PUBLIC HEALTH SCIENCES
LUMHS

2. CLASSROOM RULES
• NO CROSS TALK
• RAISE HAND IF YOU HAVE QUESTION
• CELLPHONE: SWITCH OFF OR PUT ON SILENT MODE

4. ACCIDENTS

5. • 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.

6. DEFINITION OF INJURY
A BODILY LESION DUE TO ACUTE
EXPOSURE TO ENERGY BEYOND THE
PHYSIOLOGICAL TOLERANCE.

7. • 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

8. EPIDEMIOLOGY OF AN INJURY
• INJURY EPIDEMIOLOGY IS THE
CHARACTERIZATION OF INJURY OCCURRENCE,
THE IDENTIFICATION OF RISK FACTORS AND THE
STRENGTH OF EFFECT OF THOSE FACTORS, AS
WELL AS POTENTIALLY PROTECTIVE FACTORS
RELATED TO THE DEVELOPMENT AND
EVALUATION OF INJURY PREVENTION STRATEGIES
AND PROGRAMS.

9. LEADING CAUSES OF DEATH IN
THE WORLD
• HEART DISEASE: 696,962.
• CANCER: 602,350.
• COVID-19: 350,831.
• ACCIDENTS (UNINTENTIONAL INJURIES): 200,955.
• STROKE (CEREBROVASCULAR DISEASES): 160,264.
• CHRONIC LOWER RESPIRATORY DISEASES: 152,657.
• ALZHEIMER'S DISEASE: 134,242.
• DIABETES: 102,188.

10. ACCIDENTS IN PAKISTAN
• ACCORDING TO THE LATEST WHO DATA
PUBLISHED IN 2020 ROAD TRAFFIC
ACCIDENTS DEATHS IN PAKISTAN REACHED
28,170 OR 1.93% OF TOTAL DEATHS. THE AGE
ADJUSTED DEATH RATE IS 15.18 PER 100,000 OF
POPULATION RANKS PAKISTAN #95 IN THE
WORLD.

11. TYPES OF ACCIDENTS
• ACCIDENTS AT WORK.
• ROAD TRAFFIC ACCIDENTS.
• SPORTS RELATED INJURIES.
• DOMESTIC ACCIDENTS
• DROWNING – BURNS – FALLS
• INDUSTRIAL ACCIDENTS
• RAILWAY ACCIDENTS
• VIOLENCE

12. WHICH INJECTION IS USED FOR
ROAD ACCIDENT IN PAKISTAN?
• THE TETANUS TOXIN INJECTION IS
GIVEN TO PREVENT ANY POISONING
FROM ENTRY OF FOREIGN BODIES.

13. TYPES OF INJURIES
• THEY INCLUDE CUTS, SCRAPES,
SCRATCHES, AND PUNCTURED SKIN.
THEY OFTEN HAPPEN BECAUSE OF
AN ACCIDENT, BUT SURGERY,
SUTURES, AND STITCHES ALSO
CAUSE WOUNDS.

14. CAUSES OF ACCIDENTS
• ACCIDENTS ARE COMPLEX PHENOMENA WITH MULTIPLE
CAUSATION
• ETIOLOGICAL FACTORS ARE CLASSIFIED TO – HUMAN –
ENVIRONMENTAL – PSYCHOSOCIAL FACTORS

16. HUMAN FACTORS
• AGE
• SEX
• EDUCATION
• MEDICAL CONDITIONS
• SUDDEN ILLNESS
• HEART ATTACK
• IMPAIRED VISION
• FATIGUE

17. PSYCHOSOCIAL FACTORS FOR
ACCIDENTS AND INJURIES
• LACK OF EXPERIENCE
• RISK TAKING BEHAVIOUR
• IMPULSIVENESS
• DEFECTIVE JUDGMENT
• DELAY IN DECISION
• AGGRESSIVENESS
• POOR PERCEPTION
• FAMILY DYSFUNCTION

18. ENVIRONMENTAL FACTORS FOR
ACCIDENTS AND INJURIES
• RELATED TO ROADS: – DEFECTIVE
AND NARROW ROADS – DEFECTIVE
LAY OUT OF CROSS-ROADS, – SPEED
BREAKERS – POOR LIGHTING

19. ENVIRONMENTAL CONT.
• RELATED TO VEHICLES: – HIGH SPEED
– POORLY MAINTAINED VEHICLES –
LARGE NUMBER OF 2-3 WHEELERS –
OVERLOADED BUS – LOW DRIVING
STANDARDS
• BAD WEATHER

20. ENVIRONMENTAL CONT.
• INADEQUATE LAWS
• MIXED TRAFFIC – PEDESTRIAN –
ANIMALS AND VEHICLES

21. PRECIPITATING FACTORS
• INCREASED EMOTIONAL TENSION
• USE OF ALCOHOL DURING DRIVING
• USE OF …
• STOLEN VEHICLE
• GROUP TRAVELING

22. 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.

23. ROAD SAFETY ADVERTISING

24. HOW ACCIDENTS IN DEVELOPING
COUNTRIES DIFFER FROM
DEVELOPED COUNTRIES
• TWO WHEELERS ARE MORE INVOLVED
• PEDESTRIANS ARE MORE INVOLVED
• LARGE NUMBER OF OLD AND POORLY MAINTAINED VEHICLES
• OVERLOADED BUSES
• DISREGARD TOWARDS TRAFFIC RULES
• POOR ROAD STANDARDS
• UNUSUAL BEHAVIOUR OF HUMAN AND ANIMALS
• UNUSUAL BEHAVIOUR OF CAR

25. 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.

27. DROWNING
• AFTER IMMERSION IN WATER VICTIM
LOSES CONSCIOUSNESS WITH IN 2
MIN. AND
• IRREVERSIBLE BRAIN DAMAGE
OCCURS AT 4 – 6 MINUTES.

28. PREVENTION AND CONTROL OF
DROWNING
• AVAILABILITY OF LIFE JACKETS AND FLOTATION DEVICES
AROUND POOLS & BOATS
• SUPERVISION OF CHILDREN BY ADULTS
• FENCING OF LAKES AND PONDS
• CREATION OF SAFETY STANDARDS FOR PUBLIC AND
PRIVATE SWIMMING POOLS
• ENSURING AVAILABILITY OF WEATHER REPORTS TO
FISHERMEN AND TO THOSE WORKING ON RIVERS AND SEAS

29. 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

30. 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

31. POISONING
• MOST COMMON AGENTS ARE – –
KEROSENE – PESTICIDES –
HOUSEHOLD CHEMICALS – DRUGS
• KEROSENE POISONING COMMON
AMONG CHILDREN.

32. 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

33. PREVENTION AND CONTROL OF
FALLS
• SAFER PLAYGROUND (USE OF MUD & SAND SURFACES
INSTEAD OF PAVED ONES)
• SAFER FURNITURE & HOUSE DESIGNS
• USE OF GRILLS ON WINDOWS
• SAFER DESIGN OF STAIRS, BALCONIES AND ROOFTOPS WITH
RAILINGS AND BARS
• SAFER WORKING TECHNIQUES FOR CONSTRUCTION
WORKERS

34. INDUSTRIAL ACCIDENTS
• AN INDUSTRIAL ACCIDENT IS A SERIOUS EVENT THAT
INVOLVES HAZARDOUS MATERIALS AND THAT CAN HAVE
CONSEQUENCES FOR THE SURROUNDING POPULATION AND
ENVIRONMENT. DEPENDING ON THE NATURE OF THE
PRODUCTS INVOLVED, THE ACCIDENT CAN TAKE THE
FORM OF A FIRE, AN EXPLOSION OR THE EMISSION OF
TOXIC OR RADIOACTIVE MATERIAL.

35. PREVENTION AND CONTROL OF
INDUSTRIAL ACCIDENTS
• ENSURING THE COST EFFECTIVE
PROTECTION MEASURES
• ENFORCING SAFETY REGULATIONS
AND STANDARDS
• CREATING AWARENESS AMONG
WORKERS

36. RAILWAY ACCIDENTS
• A TRAIN WRECK, TRAIN COLLISION, TRAIN
ACCIDENT OR TRAIN CRASH IS A TYPE OF
DISASTER INVOLVING ONE OR MORE TRAINS.
• THE MOST COMMON CAUSES OF TRAIN
ACCIDENTS INCLUDE: NEGLIGENCE. HUMAN
ERROR. RECKLESS PEDESTRIANS AND DRIVERS.

38. VIOLENCE
• RISK FACTORS FOR VIOLENT BEHAVIOUR: – EXPOSURE TO
VIOLENCE AND SOCIETAL ACCEPTABILITY OF VIOLENCE AS
A MODE TO SOLVE THE PROBLEM – AVAILABILITY OF
LETHAL WEAPON AT HOME – CONSUMPTION OF ALCOHOL

39. 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.

40. • 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

41. PROMOTION OF SAFETY
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

42. • INJURIES ARE A FOCUS OF PUBLIC HEALTH PRACTICE
BECAUSE:
 THEY POSE A SERIOUS HEALTH THREAT
 OCCUR FREQUENTLY
THEY CAN DESTROY FAMILIES
DEVASTATE COMMUNITIES
LEAVE INDIVIDUALS AND SOCIETIES WITH ENORMOUS
MEDICAL COST
EXTENSIVE REHABILITATION NEEDS
MAJOR LIFE STYLE ADJUSTMENTS &
DEPRESSION
• INJURIES ARE IN MOST SITUATIONS PREVENTABLE

44. WHY IS CAUSAL MODEL
IMPORTANT
• BECAUSE IT GUIDES TO MANY POTENTIAL AVENUES FOR
INTERVENTION
THUS
ENVIRONMENT CAN BE INFLUENCED BY PHYSICAL,
SOCIAL, ECONOMIC, DEMOGRAPHIC & CULTURAL FACTORS.
MODIFYING THE ENVIRONMENT CAN REDUCE THE POTENTIAL
FOR ENERGY TRANSFER.

45. VEHICLES & VECTORS CAN BE
MODIFIED TO REDUCE THE
LIKELIHOOD OF CAUSING AN
INJURY OR REDUCE THE AMOUNT
OF ENERGY TRANSMITTED.

46. HOST CAN BE FOCUSED TO RAISE HIS OR HER TOLERANCE
BY ATTENDING TO HIS/HER PRE EXISTING MEDICAL
CONDITIONS, FATIGUE, ALCOHOL HABIT & EDUCATING HIM
REGARDING THE SAFETY MAJORS, TRAFFIC RULES AND
PROTECTION DEVICES.

47. MEASUREMENT OF THE
PROBLEM
1. MORTALITY
TERM KILLED IS DEFINED AS ANY PERSON WHO WAS KILLED
OUTRIGHT OR WHO DIED WITHIN 30 DAYS AS A RESULT OF
THE ACCIDENT.
• MORTALITY RATE IS DEFINED AS THE NUMBER OF DEATHS
DUE TO ACCIDENTS PER 100 OR 1000 TOTAL DEATHS.

48. MEASUREMENT OF THE PROBLEM
2. MORBIDITY
IS MEASURED IN THE TERM OF SERIOUS
INJURIES AND SLIGHT INJURIES.
3. DISABILITY
TEMPORARY OR PERMANENT.
PARTIAL OR TOTAL. IT IS MEASURED IN
DURATION. IT MAY RESULT IN
IMPAIRMENT AND HANDICAPS.

49. PUBLIC HEALTH MODEL FOR INJURY
CONTROL
• PUBLIC HEALTH MODEL FOR INJURY CONTROL IS A CYCLE OF:
- SURVEILLANCE
- RISK FACTOR IDENTIFICATION &
- INTERVENTION, IMPLEMENTATION & EVALUATION

51. INJURY SURVEILLANCE
INJURY SURVEILLANCE PROVIDES:
 UNDERSTANDING OF THE INCIDENCE
 TRENDS &
 MAGNITUDE OF INJURIES
IT ALSO IDENTIFIES SPECIFIC POPULATIONS THAT HAVE A
HIGHER INCIDENCE OF INJURIES

52. RISK FACTORS ASSESSMENT
a) INTRINSIC: (HUMAN FACTORS)
• AGE
• SEX
• EDUCATION
• MEDICAL CONDITIONS
• SUDDEN ILLNESS
• HEART ATTACK
• IMPAIRED VISION
• FATIGUE

53. • PSYCHOSOCIAL FACTORS
• LACK OF EXPERIENCE
• RISK TAKING
• IMPULSIVENESS
• DEFECTIVE JUDGEMENT
• DELAY IN DECISIONS
• AGGRESSIVENESS
• POOR PERCEPTION
• FAMILY DYSFUNCTION
• LACK OF BODY PROTECTION
• HELMETS
• SAFETY BELTS

54. RISK FACTORS ASSESSMENT
B) ENVIRONMENTAL
• RELATING TO ROAD
• DEFECTIVE, NARROW ROADS
• DEFECTIVE LAY OUT OF CROSS ROADS AND SPEED BREAKERS
• POOR LIGHTING
• LACK OF FAMILIARITY

55. • RELATING TO VEHICLE
• EXCESSIVE SPEED
• OLD, POORLY MAINTAINED
• LARGE NUMBER OF 2 OR 3 WHEELERS
• OVERLOADED BUSES
• LOW DRIVING STANDARDS
• BAD WEATHER
• INADEQUATE ENFORCEMENT OF EXISTING LAWS
• MIXED TRAFFIC (SLOW AND FAST MOVING, PEDESTRIANS AND
ANIMALS)

56. INTERVENTION, IMPLEMENTATION &
EVALUATION
WHAT CAN BE DONE

57. • ALL COUNTRIES SHOULD HAVE MANDATORY
LAWS ON HELMET USE ON MOTORIZED TWO-
AND THREE WHEELERS.
• THESE LAWS SHOULD COVER ALL RIDERS WHO
ARE LEGALLY ALLOWED TO RIDE ON MOTORIZED
TWO OR THREE WHEELERS, ALL ENGINE TYPES
AND ALL ROAD TYPES.
• COUNTRIES NEED TO ENACT LAWS REQUIRING
HELMETS TO MEET A NATIONAL OR
INTERNATIONAL STANDARD.
• COUNTRIES NEED TO ESTABLISH SYSTEMS TO
COLLECT DATA ON RATES OF HELMET WEARING.

58. oVEHICLE MANUFACTURES & ASSEMBLERS
SHOULD BE REQUIRED TO FIT SEAT BELTS IN
BOTH FRONT AND REAR SEATS OF ALL
VEHICLES, IRRESPECTIVE OF END MARKET.
oSEAT BELT LAWS MUST BE IMPROVED TO
COVER ALL OCCUPANTS.
oENFORCEMENT EFFORTS MUST BE
STRENGTHENED IN MANY COUNTRIES AND
MUST BE EQUALLY APPLIED TO THE
OCCUPANTS OF BOTH FRONT AND READ
SEATS IN CAR.

59. o COUNTRIES NEED TO ESTABLISH SYSTEMS TO COLLECT DATA
ON RATES OF SEAT BELT USE.
o ENFORCEMENT EFFORTS MUST BE BACKED BY INTENSIVE MASS
MEDIA EDUCATION PROGRAMMES THAT HIGHLIGHT THE RISK
OF INJURY WHEN NOT WEARING A SEAT BELT AND INCREASE
THE PERCEIVED LIKELIHOOD OF BEING DETECTED AND
PENALIZED.

60. CHILD RESTRAINT LAWS NEED TO BE ENACTED AND
ENFORCED. THESE LAWS SHOULD SPECIFY THE TYPE OF
RESTRAINT, THE CHILD’S AGE FOR WHICH EACH RESTRAINT IS
APPROPRIATE, AND THE SEATING POSITION.
MECHANISMS SHOULD BE ESTABLISHED TO IMPROVE ACCESS
TO AFFORDABLE CHILD RESTRAINTS.

61. COUNTRIES NEED TO ESTABLISH SYSTEM TO COLLECT DATA
ON RATES OF CHILD RESTRAINT USE.
PROGRAMMES TO INCREASE USE OF CHILD RESTRAINTS NEED
TO ADDRESS SOCIAL NORMS AND ENCOURAGE A CULTURE OF
SAFETY. THE PUBLIC NEEDS TO BE A WARE OF THE SAFETY
BENEFITS OF USING CHILD RESTRAINTS.

62.  ENCOURAGE THE USE OF THE 30-DAY DEFINITION OF ROAD
TRAFFIC FATALITY FOR HARMONIZATION ACROSS DATA
SOURCES.
 IMPROVE DATA LINKAGES BETWEEN POLICE, TRANSPORT AND
HEALTH SECTORS.

63.  INCREASE HUMAN CAPACITY TO UNDERTAKE DATA
COLLECTION, ANALYSIS AND INTERPRETATION.
 IMPROVE THE USE OF INTERNATIONAL CLASSIFICATION OF
DISEASES (ICD) CODING IN VITAL REGISTRATION TO
ADEQUATELY REFLECT ROAD TRAFFIC DEATHS.

64. STATUS OF INTERVENTION,
IMPLEMENTATION & EVALUATION
IN PAKISTAN
• THERE IS NO NATIONAL ROAD SAFETY STRATEGY
• SPEED LIMIT ENFORCEMENT IS ONLY 4 ON SCALE 10
• MOTOR CYCLE HELMET LAW ENFORCEMENT IS ONLY 4 ON
SCALE 10
• SEAT BELT ENFORCEMENT IS ONLY 3

65. • THERE IS NO CHILD RESTRAINTS LAW ENFORCEMENT
• CAR MANUFACTURES DO NOT ADHERE TO STANDARDS OF
ROAD SAFETY.
• THERE IS NO NATIONAL POLICY TO PROMOTE WALKING OR
CYCLING
• FACILITIES FOR POST CRASH CARE IS VERY LOW

66. THE RESULT IS: HIGH FATALITIES AND INJURIES
• FATALITIES 5565 (2007)
• NON FATAL ROAD TRAFFIC INJURIES 12990 (2007)

67. • THE SOLUTION LIES IN SERIOUS AND
FOCUSED ATTENTION TO THE CAUSES
DISCUSSED ABOVE SO THAT INJURIES,
ACCIDENTS AND THEIR RESULTANT
IMPACT ON THE AFFECTED
INDIVIDUAL, FAMILY, NATION AND
DALYS CAN BE MINIMIZED.