Preventing Paediatric Window Falls: A Collaborative Approach to Effecting

National Building Code ChangeDecember 3, 2019 12:00 PM EST

Dr. Michelle Simonelli and Mr. Bruce Schultz

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Preventing Paediatric Window Falls: A Collaborative Approach to Effecting National

Building Code Change

December 3, 2019 12:00 PM EST

Dr. Michelle Simonelli and Mr. Bruce Schultz

Preventing PaediatricWindow Falls

A COLLABORATIVE APPROACH TO EFFECTING NATIONAL BUILDING CODE CHANGE

DR. MICHELLE SIMONELLI, MD, FRCPC

MR. BRUCE SCHULTZ, CODES OFFICER

Objectives

▪ Identifying The Problem

→ City of Calgary

▪ Collecting The Data:

→ Numbers

→ Injury Patterns

▪ Journey To Change The National Building Code

▪ Next Steps

▪ Building Partnerships Outside The Health Care/IP community

Identifying The Problem

▪ The Building Code is

less restrictive for

single and two family

houses than for

multifamily houses

▪ Window sills for

openable windows

can be at floor

level

Identifying The Problem

▪ Building Code not

treating similar

hazards the same

Identifying The Problem

Proposed Change to National Building Code

Existing Code with Proposed Change:5) Windows need not be protected in accordance with Sentence (4),

where the bottom edge of the openable portion of the window is

a) more than 900 mm above the finished floor, or the window serves a dwelling unit that is not located above another suite,

a) the window serves a house with a secondary suite,

b) the only opening greater than 100 mm by 380 mm is a horizontal opening at the top of the window,

c) the window sill is located more than 450 mm above the finished floor on one side of the window, or

d) the window is located in a room or space with the finished floor described in Clause (d) b) located less than 1 800 mm above the floor or ground on the other side of the window.

(See Note A-9.8.8.1.(4).)

Effectively:

▪ Openable window in a single or two

family residence to be the same as for

multi-family dwellings requiring:

• Guard

• Limiter (permanent)

• Minimum 900mm (35”) openable sill above floor OR

• Maximum 1800mm (70”) openable sill above grade

But Where’s the Data?: The Beginning of an Intra-Professional Alliance

▪ City of Calgary approached ACH Trauma Director

▪ Required data to demonstrate severity of problem

▪ Required assistance from the medical community to advocate for urgent change

Pediatric Injury in Canada: Leading Cause of Death

Canadian Pediatric Falls

▪ As with adults, falls are the leading cause of injury admissions & ED visits in Canadian children

▪ 42% of injury related hospitalizations

▪ 36% of injury related ED visits

Pediatric Window Falls

In 2016, 23% of ACH Major Trauma Patients were injured in a fall

➢ 56% of these falls were multi-storeyfalls from windows

▪ Why does it happen?

▪ How big is the problem nationally?

Problem Scope: National Data Sources

I. Canadian Institute for Health Information (CIHI)

➢National Ambulatory Care Reporting System (NACRS)

➢The Hospital Morbidity Database (HMD)

➢The Discharge Abstract Database (DAD)

II. Canadian Hospital Injury Reporting and Prevention Program (CHIRPP via PHAC)

CHIRPP

▪ 19 national CHIRPP ED sites

▪ Front of form collects descriptive data by pt

➢Date, location, sport/MVC (protective equipment), free text description of injury

➢Rich descriptive qualitative data

▪ Back of form injury data by HCP

➢Nature of injury, body part, disposition, follow up

▪ Entered into eCHIRPP database

▪ Site or nationwide queries

CIHI National Data: Pediatric Falls from Buildings

▪ Annually, 124 children ages 0-9 admitted for falls from buildings

▪ PQ: 31*

▪ BC:31

▪ ON:27

▪ AB: 14

▪ SK: 5

▪ MB: 5

▪ NS: 3

▪ NB:3

▪ NWT, NFLD, Nunavut: 1 each

National Pediatric Window Falls Ages 0-9 Years

▪ 70% of falls from buildings were falls from windows

▪ 20% of children seen in ED were admitted

Year ADMITTED AFTER

FALL FROM

BUILDING

EST. ADMITTED

AFTER FALL

FROM WINDOW

EST. ED VISITS

AFTER FALL FROM

WINDOW

2011 138 97 483

2012 120 84 420

2013 112 78 392

2014 124 87 434

2015 128 90 450

2016 120 84 420

TOTAL 742 520 2599

AVERAGE 124 87 433

Limitations of the Data

▪ Robustness of NACRS and DAD

▪ Provincial annual counts less than 5 are suppressed

▪ “Jurisdictions that choose to participate”

▪ NACRS & DAD data indicate Ontario has less 2 x the number of window falls of Alberta despite having 3.3 times the population

Limitations of the Data

Windows and Balconies Falls related Pediatric Injuries in Northern Alberta, Kundra M. and Craig, W.

Retrospective review & 2 year prospective study at Stollery 2009-2017

▪ 107 falls (15.2 per year) <17 yrs

▪ Mean age 5.14, Median age 4, Mean height 110.8cm

▪ 63.2% boys

▪ 55.7% fell in own home

▪ 50.5% through window screen

▪ Only 20% had sills higher than ‘knee height’

▪ 28.6% had furniture pushed up to the window

▪ 28.3% were admitted

Demographics of Pediatric Window Falls ACH

▪ 66% are 4 years of age or less

▪ 78% are 5 years of age or less

▪ Majority are boys

▪ Majority fall from their own homes

Admission Rates and Injury Patterns

▪ 28% admitted to Alberta Children’s Hospital or Stollery

▪ Skull fractures & traumatic brain injuries (TBI)*

▪ Cervical spine fractures

▪ Facial and long bone fractures

▪ Splenic or liver lacerations

▪ 53% of Stollery admissions required surgery

▪ 72% treated & discharged from ED

▪ 13% ACH ED discharges required specialist follow up

Costs of Pediatric Window Falls

Human Cost

Health Care Costs

▪ Direct and Indirect Costs

▪ In 2010, falls for children 0-9 years cost $1,000,000,000

▪ Multi storey falls are the most severe pediatric falls

▪ Most children admitted after multi storey falls are <5 and have a TBI

The younger the patient, the higher the costs

The Journey to Change the National Building Code:

▪ Why change the National Building Code?

▪ The National Building Code is the model code for Canada

▪ Each province chooses how to adopt the code in their jurisdiction

The Journey to Change the National Building Code:

The Journey to Change the National Building Code

Formulate Proposal

Submit Code Change Request

(CCR) to NRC

NRC forwards to Standing

Committee (SC)

SC forwards to Task Group

(TG)

TG Recommends to SC

To public review

TG reviews public review

comments

TG Recommends to SC

SC recommends to

Commission (CCBFC)CCBFC approves inclusion

in code

09/2012-09/2015

11/2016

04/2017

12/2016

05/2018

10/2018

04/2019

05/2019

06/2019

Gather support from medical

communityProvincial

process in

parallel

The Journey to Change the Building Code

▪ What needs to be addressed in a code change request

▪ What is the problem?

▪ What is the proposed solution and how does it address the problem

▪ Which of the stated objectives and functional statements of the code

will the proposed solution assist in achieving?

▪ What are the cost benefit implications

▪ What are the enforcement implications

Responses

Supportive of change as proposed 103

Supportive of change with minor

potential modifications9

Non supportive/ request

modifications2

The Journey to Change the NBC

Slow road to change

▪ 14,072,080 Canadian dwellings

▪ 8,000,000 (60%) single or duplex dwellings

▪ In 2018: 80,000 single & duplex housing starts

▪ New Code for new construction→

▪ 1% of current single & duplex housing inventory

▪ Not all provinces will adopt NBC immediately

▪ Not all the current housing stock has non conforming windows

▪ New Code also applies to renovations

▪ Architectural changes with new National Energy Standards (smaller windows)

Next Steps: Existing Dwellings

▪ After market devices

available that meet

recognized standards

Next Steps: Existing Dwellings

▪ Install guards or limiters restricting opening to 4” (10 cm)

▪ Close & lock windows with low sill heights when small children in house

▪ Don’t push furniture up against windows

▪ Understand that screens are NOT safety devices

Next Steps: Existing Dwellings

Next steps: Public Awareness

Next Steps: Public Awareness

Next Steps: More Codes to Be Changed..

▪ It’s long. It’s complicated. It’s unwieldy. YEARS.

▪ It takes an expert with the seat at the table, like Bruce.

Building Partnerships: The NRC Framework

Building Partnerships: How to Become Involved?

▪ How can you participate in the process?

▪ Participate in public reviews

▪ Opportunity for the public to take a detailed look at proposed changes and to comment on

each one

▪ Attend a Codes Canada meeting

▪ Meeting schedules posted on NRC Website https://nrc.canada.ca/en/node/344

▪ Volunteer for committee membership

▪ Participate in national codes development on a standing committee or as a CCBFC member

▪ Request a code change

Building Partnerships: How to Become Involved?

▪ How can you participate in the process?

▪ Get to know your local and provincial authorities

▪ Make it known as a group when you have a concern and that you have data to

support it

▪ When you have a concern approach the provincial authority for assistance in

the provincial and national process

▪ Make it known to authorities that you have data available on the effects of

safety related issues

▪ Be ready when the authorities come calling

Lessons Learned

▪ You need an inside expert

▪ It’s a team sport

▪ High level and committed City of Calgary staff

▪ An “in” with committees that make the changes (TG, SC)

▪ 20 different institutions across Canada providing letters of support

Lessons Learned

▪ Health Care voices are amplified when we take them outside of our natural domain

Acknowledgements

▪ Mr. Bruce Schultz

▪ Mr. Marco Civitarese

▪ Mr. Steven McFaull, CHIRPP, PHAC

▪ Ms. Trudi Senger

▪ Dr. Manu Kundra, Dr. William Craig and Ms. Neelam Mabood

▪ Dr. Jonathon Guilfoyle and Ms. Sherry McGillivray

▪ IP Professionals across Canada who helped advocate for this change

Questions?

Type your questions into the Q&A box.

THIS WEBINAR IS BEING RECORDED.THE SLIDE DECK AND RECORDING WILL BE

EMAILED AFTER THE WEBINAR.

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