Injury as a Significant Public Health Issue v2

Moving Towards Competency in Injury Prevention Lecture Objectives

Injury as a Significant On completion of this lecture, …
Public Health Issue you as a reader and listener should be able to:

Thomas Songer, PhD 1. Identify the public health definition of
University of Pittsburgh injury and its classification
Center for Injury Research & Control
2. Describe how injury compares with other
leading health issues

3. Identify how injury differs by population
groups

4. Illustrate the different types of injury
prevention

Core Competencies for Injury I. How Injuries are Viewed
and Violence Prevention

www.injuryed.org

Core Competency #1:
Ability to describe and explain injury and/or
violence as a major social and health problem.

What comes to mind Common ways in which injuries
when you see or hear are referred to:
• accident
the term “injury”? • misfortune
• mishap
• medical injury
• casualty
• disaster
• misadventure

Fatalism as a global “Accident Causation”
perception to injuries
• Historically, efforts focused on
accident prevention rather than injury
prevention

• Shaped by early efforts to reduce
industrial accidents

– If you could understand what led to the
accident, then you could intervene to
that circumstance and reduce future
events.

Domino Theory of Accidents Personal responsibility as the primary
event in the chain of accident causation
• HW Heinrich; “accidents are the result
of a chain of sequential events” An event for which no
one, except the victim,
was responsible.

Current public health thinking Current thinking in public health
about injuries differs markedly about injuries was influenced by
from the fatalistic or personal
biomechanical research
responsibility perspectives
• Hugh DeHaven
• John Stapp
• Cornell Automotive Crash Injury

Research

What are Injuries? Injuries occur as
the result of
How should we define
them? energy transfer that is
delivered in excess of

a threshold

Injuries and energy transfer

• Add film here • Types of energy that can cause
injury
• http://www.youtube.com/watch?v=XxfsmA
WILjQ

–Electric - Chemical

–Mechanical - Thermal

–Radiation

Match the Type of Injury to the Match the Type of Injury to the
Energy Form Involved Energy Form Involved

1. Motor Vehicle Crash A. Electric 1. Motor Vehicle Crash A. Electric
2. Lacerations/Cut B. Mechanical 2. Lacerations/Cut B. Mechanical
3. Poisoning C. Radiation 3. Poisoning C. Radiation
4. Drowning D. Thermal 4. Drowning D. Thermal
5. Falls E. Chemical 5. Falls E. Chemical
6. Gunshot Wound 6. Gunshot Wound
7. Concussion 7. Concussion
8. Burns from Fires 8. Burns from Fires
9. Electrocution 9. Electrocution

Comprehensive Definition II. Public Health Classification
of Injury
• Injury results either from an energy form in
the environment that exceeds the body’s
threshold for tolerance (of that energy
form)……….or

• Because normal body mechanisms for
using energy elements are blocked by
external means

JA Waller

Further Classification of Energy Basic Elements for Presenting
Transfer Injury Data in Public Health

• Manner of Energy Transfer • Mechanism/Cause • Manner/Intent
(intention underlying transfer)
– Cut/Pierce – Unintentional
– Intentional – Drowning
– Unintentional – Intentional
– Fall
• Mechanism of Energy Transfer
– Firearm • Suicide
– What delivers the energy transfer
– Motor Vehicle • Homicide
Crash
• Undetermined
– Poisoning

– Other • Other

– Unspecified

Injury Matrix for Data Presentation Environment Host

Intent of injury Agent – Energy Transfer

Mechanism Unintentional Suicide Homicide Undetermined Other

Cut
Firearm
Poisoning
Struck by/
against
Suffocation
Etc…..

Injury Spectrum Injury Prevention

Event • Primary Prevention

Exposure Injury Disability Death – preventing injury/violence altogether

• Secondary Prevention

– preventing the development of the
complications of injury

• Tertiary Prevention

– preventing the development of the late-
stage factors in injury or preventing the
loss of functional capacity

Biomechanics

Public Acute Care Rehabilitation
Health
EMS tertiary
Programs ED prevention
Hospital

Policy Trauma Ctr

primary secondary III. The Burden of Injuries
prevention prevention

Susceptible Clinical Stage of Recovery, Disability, or Death
Person
Exacerbations

Injury Occurs

Death is the most common Leading Causes of Death, USA, 2004
measure of health and injuries
(Based on number of deaths)
across the world
1. Heart Disease
2. All Cancers
3. Stroke
4. Lung Diseases
5. Unintentional Injuries
6. Diabetes
7. Alzheimer’s Disease
8. Influenza/Pneumonia
9. Nephritis
10. Septicemia

WISQARS

Breakdown of Injury Deaths

6

8 31
13
MV Crash
Suicide
Poisoning
Fall
Homicide
Undetermined
Suffocation

17 21

Years of Potential Life Lost, USA, 2004

Unintentional Injury 5 10 15 20 25
Cancers Percentage of Total YPLL
Heart Dx
Perinatal
Suicide
Homicide

Congenital
HIV

Stroke
Liver Dx

Other

0

Leading Causes of Death Worldwide, 2000 Leading Causes of Death, Worldwide

(Based on number of global deaths) 1998

1. Ischemic Heart Disease Rank 0-4 years 4-14 years 15-44 years 45-59 years 60+ years Total
2. Cerebrovascular Disease lower
3. Lower Respiratory Infections 1 perinatal HIV/AIDS heart heart heart
4. HIV/AIDS conditions respiratory disease disease disease
5. COPD 2 infection
6. Perinatal Conditions lower stroke
7. Diarrhoeal Diseases 3 respiratory malaria road traffic stroke stroke lower
8. Tuberculosis injuries respiratory
9. Road Traffic Injuries 4 infection infection
10. Lung Cancers 5
6 diarrhoeal road traffic violence tuberculosis COPD HIV/AIDS
WHR 2001 7 diseases injuries suicide lung cancer lower
8 respiratory COPD
measles drowning infection diarrhoeal
9 malaria diarrhoeal diseases
10 congenital diseases tuberculosis cirrhosis lung cancer perinatal
anomalies conditions
HIV/AIDS war injuries war injuries HIV/AIDS tuberculosis
Pertussis stomach tuberculosis
heart liver cancer cancer
Tetanus stomach diabetes lung cancer
nephritis disease cancer mellitus road traffic

congenital COPD colo-rectal injuries
cancer
anomalies stroke

inflammatory

cardiac

disease cirrhosis

malnutrition HIV/AIDS drowning suicide cirrhosis

SOURCE: World Health Report 1999 Database

Leading Causes of Injury
Death by Region, 1998

Region Rank 1 Rank 2 Rank 3 Do all injuries result in death?

Africa War injuries Assault/Homicide Road accidents
Americas (high income) Self-inflicted Assault/Homicide
Americas (low income) Road accidents
EMRO (high income) Assault/Homicide Road accidents Self-inflicted
EMRO (low income) Road accidents Assault/Homicide
Europe (high income) War injuries Road accidents
Europe (low income) War injuries War injuries
India Road accidents Self-inflicted Self-inflicted
SE Asia Road accidents Self-inflicted
China Road accidents Drowning
W. Pacific (high income) Road accidents Fires
W. Pacific (low income) Self-inflicted Self-inflicted Self-inflicted
Road accidents Road accidents
Road accidents Self-inflicted

Drowning

WHO 1999

Degrees of Injury Severity

Injury Deaths
Hospitalization

Emergency Dept.
Physician Visit

Households

Other Measures of the Impact of
Injuries and Violence

• Morbidity
• Disease Burden
• Cost
• Quality of Life

Total Lifetime Cost of Injury Key Lecture Points

1988- $180 billion • The public perception of injury is often
2000 - $406 billion fatalistic or the blame is placed on the
victim.
Rice, 1989
Finkelstein, Corso, Miller, 2006 • Injuries are due to energy transfer that
exceeds a threshold.

• Injuries are classified by intent and
mechanism of energy transfer.

• The burden of injury is large both in the
US and globally.

Key Lecture Points

• Injuries disproportionately affect the
young and the very old.

• Injuries are more frequent in males.
• Injuries differ by ethnic group to varying

degrees depending upon the
mechanism of injury.
• Injuries are costly to society.