PowerPoint Presentation

Global Injury Prevention and Safety Promotion

Catherine A. Lynch, MDAssistant Professor of EM and Global HealthCo-Director, Section EM Global HealthEric Ossmann, MDAssociate Professor of EMDirector of Prehospital & Disaster Medicine

OverviewWHY INJURYEpidemiologyWhy is risk increasing?

HOW?Surveillance/Prevention/Public PolicyPrehospital/ Hospital Trauma care quality improvement

PROJECTS?

Scope

5.8 million people die annually as a result of injuries

Every 5 seconds a person in the world dies as a result of an injury

Approximately a quarter of the 5.8 million deaths from injuries are the result of suicideand homicide, while road traffic injuries account for another quarter. Other main causesof death from injuries are falls, drowning, burns, poisoning and war (4Scope of Injury: US

Injury Deaths Compared to Other Leading Causes of Death for Persons Ages 1-44, United States, 2007*http://www.cdc.gov/injury/overview/leading_cod.

Types of Injuries

*Other includes smothering, asphyxiation, choking, animal and venomous bites, hypothermiaand hyperthermia, as well as natural disasters.

3 times more people die each year from homicide than from war-related injury6

All Injury Deaths

road traffi c crashes, homicide and suicide are all predicted to rise in rank comparedto other causes of death, placing them among the top 20 leading causes of death inthe world by 2030.

Injury deaths have been steadily increasing in many low- and middle-income countries, especially RTC deaths and homicide.

8Burden (GBDI, 2010)Preliminary findings (Lancet Nov 2012)Injuries cause 5.1 million deaths and 12.1% DALYAll cause deaths 20% (CD 25% NCD 20%, Injuries 8%)Transport (28%), Falls(10%) Drowning (7%) Fires(6.6%), Self Harm (17.4%)RTI #8, Self Harm #13, Falls #22 cause of death35-45% of codes in come countries are garbage codes (Argentina) so these numbers can be much higher

Injuries have a large and increasing health loss risk which is decreasing much less than other NCDs and CD

ALAN LOPEZ-- 9Injury TypesIntentionalSelf DirectedSuicideSelf HarmInterpersonal ViolenceIntimate PartnerChild AbuseElder AbuseCollective ViolenceWarNon-IntentionalTransportPedestrian4 wheel motorized (Dr/Pa)2 wheel motorized2 wheel non-motorizedFallAssaultGSWStabbingFistWork related InjuryBite (Human, Animal)Poisoning

1190% in low-income and middle-income countries. Vulnerable road usersCosts exceed $65 billion, exceeding the total amount received in development assistance;

Road Traffic CrashesRoad Traffic crashes in low and middle income countries cost approximately $65 billion per yearThis is more than total dollar amount these countries receive in development assistance

Global Status Report on Road Safety. Geneva, World Health Organization, 2009.

Why?UrbanizationMotorizationLimited Care Limited PreventionRoad/vehicle conditionsSignagePedestrians/VRULegislation/Regulation

Violence and HomicidesSUMMARY, WHY INJURY:>5 Million people die annually

16,000 people die daily from injuries

Persons 15-44, injuries account for 6 of the 15 leading causes of death.

For each 1 that dies, thousands have permanent sequelae

Krug EG, Sharma GK, Lozano R. The global burden of injuries. Am J Public Health 2000; 90 523-26

RF for injuryAgeSexRace/ EthnicitiesSocioeconomic GroupsAlcohol/DrugVulnerable road users:Pedestrian, 2 wheel motorized and non-motorized

Development IssuesDisproportionate impact on the poorestMore exposed to riskLess access to prevention and careDisproportionate impact on young peopleHigh economic costsCareRehabilitationProductivity

18Injury death rates are higher in low-middle income countriesInjury rates higher among migrant populations (e.g. Germany 2x higher among migrant workers)Injury rates higher among indigenous communities (e.g. suicide rates among Inuits 5x or among young aboriginal Australians 3x higher) Homicide rates are highest in the poorest communities (e.g. studies in Brazil and South Africa)In developing countries: >70% of traffic deaths are among those who will never be able to afford a car... Injury Prevention: PH Model

Injury Prevention: Haddon MatrixHostEquipmentPhysicalSocialPre-EventEventPost Event

Event

Injury Prevention: Haddon Matrix

HostEquipmentPhysicalSocialPre-EventPoor VisionAlcohol UseTalking, TxtingPoor tiresFailing breaksNarrow shouldersCultural norms: speeding, DUIEventNo helmetsPoor helmet designs, poorly designed motorcyclePoorly designed guardrailsLack of vehicle design regulation/ helmet regulation

Post EventHigh susceptibility alcohol usePoorly designed fuel tankPoor EMS communication systemsLack of Trauma system QualityPUBLIC HEALTH BASIC HEALTH SERVICES AND RF EVALUATION22Injury Prevention: Haddon Matrix

HostEquipmentPhysicalSocialPre-EventPoor VisionAlcohol UseTalking, TxtingPoor tiresFailing breaksNarrow shouldersCultural norms: speeding, DUIEventNo helmetsPoor helmet designs, poorly designed motorcyclePoorly designed guardrailsLack of vehicle design regulation/ helmet regulation

Post EventHigh susceptibility alcohol usePoorly designed fuel tankPoor EMS communication systemsLack of Trauma system QualityPOLICY/ REGULATORY AND ENFORCEMENT ENVIRONMENTALENGINEERING AND BME23Injury Prevention: Haddon Matrix

HostEquipmentPhysicalSocialPre-EventPoor VisionAlcohol UseTalking, TxtingPoor tiresFailing breaksNarrow shouldersCultural norms: speeding, DUIEventNo helmetsPoor helmet designs, poorly designed motorcyclePoorly designed guardrailsLack of vehicle design regulation/ helmet regulation

Post EventHigh susceptibility alcohol usePoorly designed fuel tankPoor EMS communication systemsLack of Trauma system QualityHealthcare 24Trauma Care System

25Republic of MozambiqueTraumas of various types, particularly those cause by road accidents, have reached epidemic proportions Strategic Plan for the Health Sector 2001-2005 Ministry of Health, Republic of Mozambique

Republic of MozambiqueMaputo Central Hospital, Maputo, Mozambique

Maputo Central Hospital300+ patients per day> 30% due to InjuryRoad traffic crashes are the leading cause of death

Obstacles, Challenges and RisksMedical ImperialismFinancial ConsiderationsPolitical, administrative, and regulatoryCultural nuances and Language

Sasser SM, Varghese M, Joshipura M, Kellermann A. Preventing death and disability through the timely provision of prehospital trauma care. Bulletin of the World Health Organization, July 2006, 84 (7)Razzak, JA and Kellermann AL. Emergency medical care in developing countries: is it worthwhile? Bulletin of the World Health Organization, 2002, 80 (11)

Obstacle, Challenges, and RisksMedical Education, System, PersonnelCapability and CapacityLack of dataHuman resourcesAnderson P, Petrino R, Halpern P, Tintinalli J. The globalization of emergency medicine and its importance for public health. Bulletin of the World Health Organization, October 2006, 84 (10)Razzak, JA and Kellermann AL. Emergency medical care in developing countries: is it worthwhile? Bulletin of the World Health Organization, 2002, 80 (11)

Guiding PrinciplesDeveloping Emergency Care Systems

SimplicityEmergency medical care systems need not be complicated and expensive. Much may be accomplished by providing simple but cost-effective treatment in a timely manner

SustainabilityEmergency medical care systems should rely on locally available supplies, equipment, training, and resources

PracticalityImplementation should not require overhaul of the countrys healthcare infrastructure

EfficiencyDesign, implementation, and operation should enable emergency medical care systems to optimally utilize the resources available to them, no matter how scarce they may be

FlexibilityEmergency medical care systems should be adaptable to suit local conditions, values, norms, and economic resources

Emergency Medical Care

Prehospital Medical CareEstimate of worlds population covered by:EMS at ALS level: 5 15%EMS at BLS level: 20 35%No formal EMS: 50 75%

International Approaches to Trauma Care. Trauma Quarterly, Vol. 14, No. 3, 1999. Mock, C. Improving Prehospital Trauma Care in Rural Areas of Low-Income Countries. Journal of Trauma-Injury Infection & Critical Care. 54(6):1197-1198, June 2003.

37Most of the world's population does not have access to formal prehospital care. No personnel are employed for the sole purpose of dealing with medical emergencies outside of hospitals, and no transportation is dedicated to the task of getting patients in need of emergency care into hospitals. There is a paucity of literature on the effect of first responders, except for one study that evaluated a program to train a core group of paramedics, who then trained thousands of lay first responders in northern Iraq and Cambodia. No data are available on the effectiveness of lay responders compared with the more trained paramedics.Improving prehospital careStrengthen existing prehospital care systemsOrganization/administration/qualityLogistics and operationsDeploymentTarget high risk areasTraining and Education

Sasser, et al. Assessment of Emergency Medical Services in Maputo, Mozambique. Prepared for the World Health Organization, 2005Making it SuccessfulGovernment supportAcademic supportProvider supportInstitutional supportCommunity supportLong-term commitment

Current EM GH Projects

How to get involved?Tucumn, ArgentinaTucumn, ArgentinaAim: Develop a evidence based provincial injury prevention initiative

Location: Tucumn, Argentina

Methods:Community Based Qualitative**Hospital Based Quantitative**

Moshi, TanzaniaMoshi, TanzaniaMoshi, TanzaniaAim: To determine the burden of injury at KCMC and the increased risk of injury due to alcohol

Location: KCMC, Moshi Tz

Methods: Hospital Based EpidemiologyHealthcare worker KAP study Self-surveyNested case crossover

Moshi, TanzaniaAim: To improve TBI acute care management

Locations: KCMC, Moshi Tz

Methods: Systematic ReviewMediated Modeling*TBI Protocol Evaluation*

QUESTIONS?

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Maputo Prehospital Assessment and Initial Planning

Maputo City Prehospital Assessment Report Complete

Identify Key Stakeholders

Agency (Individual) in ChargeMedical DirectionMulti-Disciplinary Emergency Care Committee

Institute First-Responder Training

Community AssociationsVolunteersCommunity ActivistsPolice OfficersCommercial DriversPrivate Drivers

Strengthen Emergency Care at Fixed Facilities

Improve Access to the Emergency Care System

Universal NumberPublic Information Campaign

Institute Basic Prehospital Care Program

Institute System of Ambulance Transportation

Train Professional RespondersStrengthen Existing Infrastructure