Classification of Injuries

• Injuries are physical damage from the human body being subjected to intolerable levels of energy suddenly or briefly.
• Injuries can be caused by acute exposure to physical agents like mechanical force, heat, electricity, chemicals, and ionizing radiation.
• Injuries can be caused by a sudden lack of essential agents like oxygen or heat.
• Injuries are a major public health concern, and a growing problem.
• Approximately 199,800 people die from injuries annually.
• 2.5 million people were hospitalized because of injuries in 2014.
• 26.9 million people were treated in an emergency department for injuries in 2014.

Classification of injuries

• Injuries are classified based on intentionality.
• Unintentional injuries include:
  • Transport injuries like road injuries and railway accidents.
    • Falls
    • Drowning
    • Fire, heat and hot substances
    • Poisonings
    • Exposure to mechanical forces
    • Adverse effects of medical treatment
    • Animal contact
    • Foreign body
    • Other unintentional injuries
• Intentional injuries include:
  • Self-harm, including suicide.
    • Exposure to forces of nature
    • Interpersonal violence
    • Collective violence, for example, war.
    • Disasters, for example, volcanos and earthquakes

Unintentional Injuries Burden

• Unintentional injuries are most common in young people age 15 to 29.
• Poisonings are most common in persons aged 45 to 59.
• Injuries due to falls are most common in persons aged 70 to 79.
• Males have higher unintentional injury rates than females.

Causal Model for Injuries

• Injuries are caused by the relationship between the host, agent, vector, and environment
• Host: The person injured
• Agent: The force or energy causing the injury
• Vector: The person/thing applying the force, transferring the energy, or prohibiting its transfer.
• Environment: The conditions/situation under which the injury happens.

Agents Causing Injury (Energy)

• Mechanical: Impact with a moving or stationary object such as a surface, knife, or vehicle.
• Radiant: Blinding light or a shockwave from an explosion.
• Thermal: Air or water that is too hot or too cold.
• Electrical
• Chemical: Poison or intoxicating substance such as alcohol or a drug.

Falls

• Falls are the most common cause of hospital visits for non-fatal injuries.
• Falls are the second leading cause of unintentional injury death, after road traffic injuries.

Risk Factors For Falls

• Occupations at elevated heights or other hazardous working conditions
• Alcohol or substance use
• Socio-economic factors like poverty, overcrowded housing, young maternal age
• Underlying medical conditions, such as neurological, cardiac, or other disabling conditions.
• Side-effects of medication, physical inactivity and loss of balance, particularly among older people
• Unsafe environments, particularly for those with poor balance and limited vision

Prevention and Control for Falls

• For Children: multifaceted community programs, engineering modifications of nursery furniture/playground equipment, and legislation for the use of window guards.
• For Older Individuals: Implementing a fall prevention program can include screening within living environments, clinical interventions, home assessment, prescription of assistive devices, and muscle strengthening and balance retraining.

Drowning

• Drowning includes unintentional injuries.

Risk Factors for Drowning

• Age is a major risk factor.
  • Children under 5 years of age have the highest drowning mortality rates worldwide
• Gender
  • Males are especially at risk with twice the overall mortality rate of females
• Access to water
  • Commercial fisherman and subsistence fisherman who use small boats in low-income countries are prone to drowning
  • Children who live near open water sources such as ditches, ponds, irrigation channels, or pools are at risk.
• Other risk factors consist of:
  • Infants left unsupervised or alone, or with another child in a bathtub
  • Unsafe or overcrowded transportation vessels lacking flotation devices
  • Alcohol use near water
  • Medical conditions like epilepsy
  • Tourists unfamiliar with local water risks and features
  • Floods and cataclysmic events such as tsunamis

Prevention and Control of Drowning

• Engineering methods to help remove the hazard, legislation to enforce prevention.
• Development and implementation of safe water systems, such as drainage systems and flood control embankments in flood prone areas
• Building four-sided pool fences or barriers preventing access to standing water
• Creating and maintaining safe water zones for recreation
• Covering of wells or open cisterns
• Emptying buckets and baths, and storing them upside-down
• Educating individuals and communities to build awareness of risk and to aid in response if a drowning occurs.
• Laws or regulations targeting risk factors for drowning include laws requiring regular safety checks of transportation vessels and laws on alcohol use while boating or swimming.
• Ensure immediate resuscitation

Burns

• Burns, considered unintentional injuries, occur when thermal heat destroys skin or other tissues.
• The agent causing the burn can be:
  • Hot liquids (scalds)
  • Hot solids (contact burns)
  • Flames (flame burns).
• The rate of child deaths from burns is approximately seven times higher in low- and middle-income countries than in high-income countries.

Risk Factors for Burns

• Gender
  • Females suffer burns more frequently than males
• Age
  • Adult women and children are particularly vulnerable to burns
• Socio-economic factors People living in low- and middle-income countries are at higher risk for burns than people living in high-income countries

Prevention and Control for Burns

• Public education
• Hot water regulator
• Enforce laws for Smoke detectors
• Fire extinguishers
• Safety zoning
• Specialized medical burn centers

Domestic Accidents

• Drowning
• Burns, which may be caused by flame, hot liquid, electricity, crackers, fireworks, or chemicals
• Falls
• Poisoning, which may be caused by drugs, insecticides, rat poisons, or kerosene
• Injuries from sharp or pointed instruments
• Bites and other injuries from animals

Violence

• Violence is classified as an intentional injury.

Risk Factors for Violent Behavior

• Exposure to violence and societal acceptance of violence as a means to solve problems.
• Availability of lethal weapons such as fire-arms increases the possibility of both fatal and non-fatal injuries
• Consumption of alcohol and other drugs is linked to almost 2/3 of violence cases.

Road Traffic Injuries (RTIs)

• Road traffic injuries (RTI) are any injury due to crashes originating, terminating or involving a vehicle partially or fully on a public highway

Global Burden of Road Traffic Injuries

• Road traffic injuries are the leading cause of death among young people aged 15-29 years.
• Globally, 1.25 million people die each year due to road traffic crashes.
• 93% of the world's road fatalities occur in low- and middle-income countries
  • These countries have approximately 60% of the world's vehicles
• Half of those dying on the world’s roads are “vulnerable road users": pedestrians, cyclists and motorcyclists

Road Traffic Injuries In Egypt

• Egypt has the highest road traffic injuries fatality rate in the EM Region.
• Egypt loses about 12,000 lives due to road traffic crashes every year.
• There is a road traffic fatality rate of 42 deaths per 100,000 population.
• Passengers of four-wheelers account for 48% of those killed.
• Pedestrians also constitute a significant proportion (20%) of those fatalities.
• While laws on speed, blood alcohol concentration, seat-belt wearing, and helmet wearing exist, they are poorly enforced.
• There is inadequate infrastructure for non-motorized modes of transport.

Differences in Developing Countries

• Developing countries differ from industrialized countries in environment and mix of vehicles in the traffic stream:
  • Large numbers of pedestrians and animals share the roadway with fast-moving and slow-moving vehicles with no segregation.
  • Large numbers of old, poorly maintained vehicles exist
  • Large numbers of motor cycles, scooters, and mopeds
  • Low driving standards
  • Large numbers of buses, often overloaded
  • Widespread disregard of traffic rules
  • Defective roads, poor street lighting, defective lay-out of cross roads and speed breakers
  • Unusual behavior of men and animals

Humans and Road Traffic Risk Factors

• Socioeconomic status
  • More than 93% of road traffic deaths occur in low- and middle-income countries, with the highest rates in the African region
  • People from lower socioeconomic backgrounds are more likely to be involved in road traffic crashes.
• Age
  • People aged between 15 and 44 years account for 48% of global road traffic deaths.
• Sex
  • Males are three times more likely to be involved in road traffic crashes than females.
• Nonuse of motorcycle helmets, seat-belts, and child restraints
  • Wearing a motorcycle helmet correctly reduces the risk of death by almost 40%
  • Wearing a seat-belt reduces the risk of fatality among front-seat passengers by 40–50%
  • Child restraints reduce deaths among infants by approximately 70% and deaths among small children by between 54% and 80% if used correctly.
• Distracted driving
  • Drivers using mobile phones are approximately four times more likely to be involved in a crash.
  • Hands-free phones are not much safer than hand-held phone sets, and texting increases the risk of a crash.
• Speeding
  • An increase in average speed is directly related both to the likelihood of a crash occurring and to the severity.
  • An increase of 1 km/h in mean vehicle speed results in an increase of 3% in crashes and 4-5% in fatal crashes
  • An adult pedestria,s risk of dying is less than 20% if struck by a car at 50 km/h but almost 60% if hit at 80 km/h.
• Inadequate post-crash care
  • Delays in detecting and providing care increase severity of injuries
  • Delays of minutes can make the difference between life and death
• Driving under the influence of alcohol/psychoactive substances
  • Increases the risk of a crash that results in death or serious injuries.

Vehicle Risk Factors

• Absence of safety features, such as seat-belts or airbags
• Lack of roadworthiness
• Unsafe vehicles must include regulations for electronic stability control airbags and seat-belts.
• Larger vehicles create a high risk for pedestrians and occupants of smaller vehicles

Environmental Risk Factors

• Unsafe road infrastructure should ideally be designed with safety of all road users in mind.
• Incorporate footpaths, cycling lanes, safe crossing points, and traffic calming measures to reduce injury risk.
• Roadside obstructions
• Inadequately enforced traffic safety laws
• Inadequate spaces for motor vehicles, pedestrians, and bicyclists.
• Climate changes: natural environmental conditions like darkness, rain, or fog.

Railway accidents

• As the number of trains and passengers increases, it is not unexpected that accidents and injured cases increase.
• The main factor involved in railway accidents is human failure.