Injury Violence and Accidents PDF

Injury violence and accident Dr Nighat Nisar Professor Community Medicine DUHS  Objectives By the end of this lecture students would be able to: Define injury, accidents, violence, disability, impairment and handicap Identify risk factors of injuries and...

Injury violence and accident Dr Nighat Nisar Professor Community Medicine DUHS  Objectives By the end of this lecture students would be able to: Define injury, accidents, violence, disability, impairment and handicap Identify risk factors of injuries and accidents analyze magnitude of problem of injury and accidents in Pakistan Appreciate types of injury suggest preventive strategies  Injury An injury is, physical damage to the body, resulting from acute exposure to various kinds of energy– mechanical, thermal, electrical, chemical or radiant – in amounts that exceed the threshold of physiologic tolerance  Types of injuries Unintentional injuries: - injuries resulting from traffic collisions - burns - Falls - poisonings  Intentional injuries: - injuries resulting from deliberate acts of violence against oneself or others  Accident An accident is an event that is not expected, foreseen or intended which may result in physical damage to the body of a person. The word “accident” implies a degree of inevitability  Magnitude of the problem Globally, more than 5 million people die from injuries every year Injuries kill more people than HIV/AIDS and malaria combined Nearly 3,500 people die on the world's roads every day. Tens of millions of people are injured or disabled every year. Approximately 2.3 million died from violence About 2.3 million died from injury-related causes, including falls, drowning, burns and poisoning About 1.2 million died from road traffic collision Many more people survive their injuries, and suffer from impairments, disabilities and handicaps. A survey conducted by the United Nations in 29 countries has put Pakistan at fourth number in the world in respect of vehicular accidents while it has no match in the accident rate in the Asian region.  For people age 5-29 years, 3 of the top 5 causes of death are injury-related, namely road traffic injuries, homicide and suicide Injuries and violence place a massive burden on national economies, costing countries billions of US dollars each year in health care, lost productivity and law enforcement Preventing injuries and violence will facilitate achievement of several Sustainable Development Goal (SDG)  Children, pedestrians, cyclists and the elderly are among the most vulnerable of road users WHO works with partners - governmental and nongovernmental - around the world to raise the profile of the preventability of road traffic injuries and promote good practices related to helmet and seat-belt wearing, not drinking and driving, not speeding and being visible in traffic  Impairment : any loss or abnormality of anatomic, physiologic or psychologic structure or function. It results from abnormalities of body structure, appearance, organ or system function, generally impairments represent dysfunction or disturbance at the organ level A disability: any restriction or lack of ability to perform an activity, within the range, considered normal, being the result of an impairment, and affects the person, rather than an organ. It does not necessarily lead to handicap A handicap: a disadvantage that results from an impairment or disability that limits or prevents the fulfillment of a role, that is normal for the individual, and influences interaction between people  INTENTIONAL INJURIES Intentional injuries or “violence”, is defined as: The intentional use of physical force or power, threatened or actual, against oneself, another person or against a group or community, that either results in or has a high likelihood of resulting in injury, death, psychological harm, mal-development or deprivation  The WHO definition then subdivides violence into three broad categories according to the individual or entity that commits the violence: Self-directed violence, in which the perpetrator and the victim are the same individual Interpersonal violence, which refers to violence between individuals where there is no clearly defined political motive Collective violence, which refers to social, political and economic violence committed by larger groups of individuals or by states to advance a social agenda  Risk Factors major types of violence– self-directed, interpersonal and collective– has its own distinct risk factors Each type of violence can itself be a risk factor for the others  Risk Factors Risk factors and determinants common to all types of injuries includes: alcohol or substance use inadequate adult supervision of children Broad societal determinants of health such as: poverty economic and gender inequality unemployment lack of safety in the built environment, including unsafe housing, schools, roads and workplaces inadequate product safety standards and regulations easy access to alcohol, drugs, firearms, knives and pesticides weak social safety nets frail criminal justice systems inadequate institutional policies to address injuries in a consistent and effective manner, in part due to the availability of sufficient resources In settings where emergency trauma care services are weak or there is inequitable access to services, the consequences of injuries and violence can be exacerbated  Prevention The first dimension concerns time, and classifies interventions according the chain of risk factors and situational determinants The second dimension concerns the level of social inclusiveness, and ranges from prevention strategies that target everyone  Primary prevention can be achieved through interventions with universal and selected populations, while secondary and tertiary prevention can be implemented only within indicated populations where violence is occurring or has already occurred  On the time dimension, primary, secondary and tertiary prevention levels are identified Primary prevention includes any strategies or actions aimed at stopping violent events from taking place, and thus relates to the time before violence actually occur Secondary prevention includes any strategies aimed at minimizing the harm that occurs once a violent event is taking place and examples include interventions to reduce the duration of an interpersonal violent event Tertiary prevention includes all efforts aimed at treating and rehabilitating victims and perpetrators and facilitating their re- adaptation to society, and is concerned with the period after violence has occurred  UNINTENTIONAL INJURY Unintentional injuries (accidents), are assuming large proportions in affluent countries and the same trend can be noticed in the developing countries with the advancement of technology In the developing world morbidity and mortality due to injury is rising The categories of unintentional injury or accidents: Traffic injury Domestic Injury Occupational Injury Recreational Injury  TRAFFIC INJURIES The various types of vehicles in Pakistan roads are automobiles, motor-bikes, camel carts, donkey carts, horse carriages, including tongas and rickshaws The greatest numbers of traffic accidents are accounted for by automobiles The proportion of accidents is high in public buses especially the microbuses, vehicular trucks and motor-bikes. The economic loss due to property damage, injuries and lives lost, runs into millions of rupees annually  In most cases these are due to pedestrian crossing. The Karachi Development Authority’s (KDA) Traffic Engineering Bureau (TEB) and overseas Unit of the Transport and Road Research Laboratory (TRRL) of the UK, undertook a comprehensive survey of accidents involving pedestrians prior to the commencement to the current decade According to the observations made, pedestrian accident in the largest city of Pakistan, Karachi has 50 percent of the total reported accidents. Over 30 percent fatality and 20 percent of the casualty, were in children under 10 years  Causes of Automobile Accidents Over speeding Failure to follow the traffic rules and lack of efforts in enforcement of traffic laws Overloading of public Accidents due to mechanical faults and overtaking of vehicles Lack of traffic sense: Highway accidents: Drunkenness Overwork, fatigue and conditions of stress Bad roads  HOME ACCIDENTS Home accidents in Pakistan are usually in the kitchen due to bursting of oil stoves or a sari catching fire Sometimes older people suffer fractures due to falls. In the Punjab and Northern areas as well as in Balochistan, carbon monoxide poisoning cases account for a small number of accidents during winter months A certain number of accidents due to consumption of foods contaminated with pesticides have also been reported  OTHER ACCIDENTS The construction of multistory residential apartments on a competitive basis has resulted in the use of substandard construction material especially cement, iron and wood The result is a building collapse even before the completion of the project Major projects of construction in Pakistan have resulted in injuring several employees and death of persons who get buried with the debris  Drowning Accidents due to drowning are an annual feature near the beaches in Karachi Entrapment of children in underground water tanks and open manholes is reported on several occasions The civic agency’s negligence on leaving open manholes is a major concern to the society, while parent’s negligence of children drowning in water tanks should be dealt with by the appropriate legislation  INDUSTRIAL ACCIDENTS In general terms the types of accidents met with in industries are: Injuries due to machine handling Chemical poisons affecting the G.I. tract Eye injuries in arc welding Entrapment in elevators  Injury Prevention The Haddon Matrix is the most commonly used paradigm in the injury prevention field Developed 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 or death By utilizing this framework, one can then think about evaluating the relative importance of different factors and design interventions  A typical Haddon Matrix looks like this: Personal Vector or Physical Social Factors Agent Environmen Environm Factors tal Factors ental Factors Pre-event Event Post- event  Possible ways of preventing injury during the various phases include: Pre-event Prevent the existence of the agent Prevent the release of the agent Separate the agent from the host Provide protection for the host Event 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 Provide a rapid treatment response for host Provide treatment and rehabilitation for the host  WHO response Developing and disseminating guidance for countries on evidence-based policy and practice, through such resources as: Save LIVES: a road safety technical package Preventing drowning: an implementation guide Step safely: Strategies for preventing and managing falls across the life-course; Violence prevention: the evidence INSPIRE: Seven strategies for preventing violence against children, RESPECT women: Preventing violence against women LIVE LIFE: suicide prevention implementation package SAFER: a world free from alcohol related harms providing technical support to countries through programs such as the Initiative for Global Road Safety and the Global Partnership to End Violence against Children  WHO response documenting and disseminating successful injury prevention approaches, policies and programs across countries monitoring progress towards achieving the Sustainable Development Goal targets linked to injury, violence prevention, mental health and substance use – namely targets 3.4, 3.5, 3.6, 5.2, 5.3, 16.1 and 16.2 clarifying the role of Ministries of Health as part of multi-sectoral injury-prevention efforts serving on the International Organizing Committee for the series of biannual World Conferences on Injury Prevention and Safety Promotion  References https://www.who.int/news-room/fact- sheets/detail/injuries-and-violence Maxcy-Rosenau-Last Public Health & Preventive Medicine, 16e Boulton ML, Wallace RB. Boulton M.L., & Wallace R.B. (Eds.),Eds. Public Health & Community Medicine By Muhammad Illyas 8th edition