10/06/2015 1 UNINTENTIONAL CHILDHOOD INJURIES Children's Health and the Environment WHO Training Package for the Health Sector World Health Organization

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UNINTENTIONAL CHILDHOOD INJURIES

Children's Health and the EnvironmentWHO Training Package for the Health Sector

World Health Organization

www.who.int/ceh

TRAINING FOR THE HEALTH SECTORTRAINING FOR THE HEALTH SECTOR [Date …Place …Event…Sponsor…Organizer] [Date …Place …Event…Sponsor…Organizer]

Unintentional childhood injuries

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LEARNING OBJECTIVESLEARNING OBJECTIVES

1. What are childhood injuries?

2. Injuries and their classification

3. Burden of injuries among children

4. Environmental risk factors/settings

5. Why has so little action been taken?

6. The public health approach to injury prevention: Haddon’s matrix

7. What are effective interventions/measures to prevent unintentional child injury?

8. What can the health sector do?


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Injury is the main cause of death and a major Injury is the main cause of death and a major cause of ill health and disability in childhood cause of ill health and disability in childhood


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SOMESOME GENERAL PRINCIPLESGENERAL PRINCIPLES

Injuries are preventable:• “accident” versus “injury event”

Unintentional versus intentional injury

Injury prevention and control


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INJURIES AND THEIR CLASSIFICATIONINJURIES AND THEIR CLASSIFICATION

UNINTENTIONAL

Road traffic injuries Poisoning Falls

Fires and burn injuries

Drowning

Other

INTENTIONAL

Interpersonal – Family/partner Intimate partner

Child abuseElder abuse

Interpersonal – community

AcquaintanceStranger

Self-directed -Suicidal behaviourSelf-harm

Collective violence – social, economic, political (war, gangs)


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CATEGORIZINGCATEGORIZING INJURYINJURY

Severity (level of medical treatment required)

Setting (e.g. home, school, workplace, road)

Activity (e.g. sport, recreation, work)

Mechanism (e.g. fall, burn, dog bite, motor vehicle crash, drowning)

Intent (intentional, unintentional)

Nature of injury (e.g. fracture, burn)


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GLOBAL FIGURESGLOBAL FIGURES


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GLOBAL FIGURESGLOBAL FIGURES

WHO. World report on child injury prevention. 2008


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INJURIES AND "ACCIDENTS“INJURIES AND "ACCIDENTS“

Global figuresGlobal figures

Unintentional Unintentional injuries: injuries:

•About 2270 children About 2270 children die every day as a die every day as a result of an result of an unintentional injuryunintentional injury

•Survivors may Survivors may remain disabled remain disabled foreverforever



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MAGNITUDE OF THE PROBLEMMAGNITUDE OF THE PROBLEM



18/04/2311SEARO


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INJURYINJURY PYRAMIDPYRAMID

Deaths

Injuries resulting in hospitalization

Injuries resulting in ambulatory and

emergency treatment

Injuries resulting in treatment inPrimary care settings

Injuries treated by paramedics only(school nurse, physiotherapist, first aid)

Untreated injuries or injuries which werenot reported


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INJURYINJURY DATA SOURCESDATA SOURCES

Source: adapted from Krug et al., eds., 2002.

Types of data and potential sources of information on violent events

Data category Potential data source

Mortality Death certificates, verbal autopsies, vital statistics registries, reports from mortuaries, medical examiners or coroners

Morbidity and health-related Hospital, clinic and medical recordsSelf-reported Surveys, focus groups, mediaCommunity-based Demographic records, local government

recordsLaw enforcement Police records, judiciary records, prison

records, crime laboratoriesEconomic-social Institutional or agency records,

special studiesPolicy or legislative Government and legislative records


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1) SurveillanceWhat is the Problem?

2) Risk FactorIdentification

What are the causes?

4) ImplementationHow is it done?

3) Develop andEvaluate interventions

What works?

PUBLIC HEALTH APPROACH TO INJURY PREVENTIONPUBLIC HEALTH APPROACH TO INJURY PREVENTION


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AN ENVIRONMENTAL HEALTH APPROACH TO INJURY PREVENTION?


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INJURYINJURY PREVENTIONPREVENTION

Types of injury and violence prevention:

Temporal - primary, secondary and tertiary

Targeted - universal, selective, indicated

Passive versus active


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Defining characteristics of the public health approach

Population-based Multidisciplinary Evidence-based Collective action Prevention

THE PUBLIC HEALTH APPROACH


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HADDON'S 10 BASIC STRATEGIESHADDON'S 10 BASIC STRATEGIES

1. Prevent creation of hazard2. Reduce amount of hazard3. Prevent release of hazard4. Modify the rate or distribution of hazard5. Separate (in space or time) hazard from that to be

protected6. Separate hazard from that to be protected with barrier7. Modify relevant basic qualities of hazard8. Make that to be protected more resistant to damage9. Counter damage already done by hazard10. Stabilize, repair and rehabilitate the object of the damage


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Host

(person)

Agent (vehicle or product)

Physical

environment

Socio-economic

environment

Pre-event

Is the person pre-disposed or overexposed to risk?

Is the agent hazardous?

Is the environment hazardous?Possibility to reduce hazards?

Does the environment encourage or discourage risk-taking and hazard?

Event

Is the person able to tolerate force or energy transfer?

Does the agent provide protection?

Does the environment contribute to injury during event?

Does the environment contribute to injury during event?

Post-event

How severe is the trauma or harm?

Does the agent contribute to the trauma?

Does the environment add to the trauma after the event?

Does the environment contribute to recovery?

THE HADDON MATRIXTHE HADDON MATRIX


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THETHE HADDON MATRIX APPLIEDHADDON MATRIX APPLIED FACTORS

PHASE Human Vehicles and equipment

Environment

Pre-crash Crash prevention

Information Attitudes

Impairment Police

enforcement

Roadworthiness Lighting Braking Handling

Speed management

Road design and layout

Speed limits Pedestrian

facilities

Crash Injury prevention

during crash

Use of restraints

Impairment

Occupant restraints Other safety devices

Crash-protective design

Crash-protective roadside objects

Post-crash

Life sustaining treatment

First aid skills Access to

medics

Ease of access Fire risk

Rescue facilities

Congestion

Source: WHO, 2004.


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INJURIES FROM ENVIRONMENTAL RISK FACTORSINJURIES FROM ENVIRONMENTAL RISK FACTORS

Road trafficRoad trafficFallsFallsBurnsBurnsDrowningDrowningPoisoningPoisoningAnimal-relatedAnimal-related


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ROAD TRAFFIC INJURIES ROAD TRAFFIC INJURIES DEFINITIONDEFINITION

Traffic-related injuries or road traffic injuries (RTI) are injuries due to any crash originating, terminating or involving a vehicle partially or fully on a public highway.


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INJURIES – ROAD TRAFFICINJURIES – ROAD TRAFFIC GLOBALGLOBAL BURDENBURDEN

Road traffic injuries are the

leading cause of death

among 10 to 19 year olds



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INJURIES – ROAD TRAFFIC - INJURIES – ROAD TRAFFIC - GLOBAL BURDENGLOBAL BURDEN


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• Environmental speed- unsafe roads- no signalisation- high density- multiple users

RISK FACTORS ASSOCIATED RISK FACTORS ASSOCIATED WITH ROAD TRAFFIC INJURIESWITH ROAD TRAFFIC INJURIES

• Individual- male gender, youth- substance abuse (youth)- speeding- not wearing seat-belts or helmets- sleep disorders- mobile phones- non-conspicuity of vulnerable road users- lack of experience

• Vehicle- absence of seat-belts- roadworthiness- vehicle size and centre of gravity- poor conspicuity


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ROAD TRAFFIC INJURIES CAN BE REDUCEDROAD TRAFFIC INJURIES CAN BE REDUCED

A rapid and significant reduction in road injuries can be achieved with political will and commitment

Requires a scientific approach:

the provision, careful analysis and interpretation of good data;

the setting-up of targets and plans; the creation of national and regional

research capacity;

institutional cooperation across sectors.

WHO


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INJURIES – FALLSDEFINITION

A fall is an event which results in a person coming to rest inadvertently on the ground or floor or other lower level.

Within the WHO database fall-related deaths and non-fatal injuries exclude those due to assault and intentional self-harm. Falls from animals, burning buildings and transport vehicles, and falls into fire, water and machinery are also excluded.

www.who.int/violence_injury_prevention/unintentional_injuries/falls/falls1/en/WHO


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INJURIES DUE TO FALLS


Injury pyramid for fall-related injuries

among children 0–17 years


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HORSE – – RELATED INJURIES

Deaths are relatively uncommon

Hospital admission rate for equestrian injuries is 14/100,000 population, Victoria Australia

Highest hospital admission rate for equestrian injuries in Victoria is 68/100,000 for girls aged 10 -14

Hospital admitted paediatric rates are also high in the UK

Most serious injuries are to the head

UK horse-racing deaths per 100,000 rides: flat racing 419/100,000 rides; jumps racing 646/100,000 rides

Equestrian event riding has higher serious injury rates than general riding


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HORSE-RELATED INJURIES

Reduce risk factors by:

Use of correctly designed helmets, stirrups, shoes and tack

Adult supervision of young childrenAvoid standing where the horse may kickTraining of horses, riders and horse handlers


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CHILD DEVELOPMENT CHARACTERISTICS RELATED TO RISK OF INJURY

Age

groupDevelopmental characteristics* Link to injury area

Birth to 1 year

Reflexive & cannot control body movements

Reaches & mouths objects & imitates others

Becomes mobile, but with poor balance

Has limited ability to obey verbal commands

Can wiggle off tables and other surfaces; can get head or body stuck

Can choke, poison, cut, bruise, scald themselves; can get electric shock

Can fall, reach dangerous objects that can choke, cut, bruise, scald, shock

Cannot rely on verbal commands to avoid accidents

1 to 3 years old

Balance improves, learns to climb and run

Asserts independence Can play alone or with others &

engages in make believe play Can follow only simple directions

Can fall into unprotected accumulations of water, trip, reach dangerous objects that can choke, cut, bruise, scald, shock

Can attempt dangerous activities that are beyond their skill level

Cannot leave unsupervised Cannot rely only on verbal commands or

instruction to avoid accidents

*http;//childrenshosp-richmond.org/families/developmental

http://allpsych.com/psychology101/development.html


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CHILD DEVELOPMENT CHARACTERISTICS RELATED TO RISK OF INJURY

Age

groupDevelopmental characteristics* Link to injury area

3 to 4 years old

Increased mobility, climbing, running, more outdoor play

Asserts independence Curious, asks many questions Plays interactively with others, enjoys

make believe Improved cognitive & language skills Begins to understand relationships

between things

Can fall off playground equipment or other surface; can get head or body stuck

Tries to do more dangerous activities independently and during play with others, such as climbing, running (e.g., into street)

Can begin to understand danger and respond to warnings or commands; can learn routines (e.g., buckling up)

Caregivers may reduce supervision inappropriately (e.g. both working in fields)

5 to 14 years old

Continues developing independence Interacts with more adults (e.g., teachers)

in new settings Can think in concrete terms, and begins

developing abstract thinking skills Improves understanding of relationships

between things Experiences more new environments,

sports & recreation activities

Can fall off playground equipment or other surface; can get head or body stuck

Tries to do more dangerous activities independently and during play with others, such as climbing, running (e.g., into street)

Understands specific risks, but may not generalize to new situations

Supervision may vary across caregivers Can learn safety practices best through direct experience Inexperience with sports and inappropriate safety practices can

lead to injury (e.g., fractures, head injury)

*http;//childrenshosp-richmond.org/families/developmental

http://allpsych.com/psychology101/development.html


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Environmental Risk Factors of Fall Injuries in ChildrenLocation Environment factors

Stairs, furniture, outdoors

- Open access to top and bottom of stairs, balconies-Lack of protective railings on stairs, bridges- Use of baby walkers with wheels- Lapses in supervision

Windows - Windows left open in warm weather - Windows opened from the bottom instead of the top- Windows left open more than two inches- Expectation that screens will keep child from falling out

- Lapses in supervision and expectation that child cannot open window

Sports and recreation areas

-Equipment that is inappropriate for age of child- Safety equipment not available or not required - Unsafe, slippery, broken equipment - Unprotected rooftops used for playing- Streets with deep ditches and construction areas accessible to children- Hard/unforgiving surfaces- Lapses in supervision and unrealistic expectations about child’s ability

Bicycles - Lack of safe riding paths and lack of availability of bicycle helmets- Poor quality or poorly maintained bicycles- Lack of mandatory or universal helmet use- Hard/unforgiving surfaces

National Safe Kids, CDC/NCIPC, Barss et al,1998


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Prevention Strategies for Fall Injuries in Children

Injury cause

Prevention

countermeasure Stairs, furniture

Ensure stairs are well lit, have rails, maintained Use carpeting on flooring and buffer sharp edges on

furniture Never use baby walkers with wheels Closely supervise children on stairs; elevated

surfaces (e.g. dressing infants) Use straps to secure child in high chairs and on

changing tables

Windows Use window guards Open windows from the top only Move furniture away from windows Closely supervise children

Play areas Closely supervise children Install protective railings on roofs Avoid unsafe playgrounds with concrete, soil or

grass surfaces or broken equipment Use playground equipment appropriate for age of

child Fix and maintain unsafe ditches and surfacing

Bicycle Require helmet use Maintain bicycle in good working order Establish and maintain safe bike paths Enforce traffic safety laws related to bicycles

Barriers Facilitators

Inadequate knowledge

Unsupportive beliefs and myths

Time and inconvenience of addressing safety

High cost of products and equipment

Lack of product safety regulations

Inadequate social support

Lack of resources in the community

+ Provide free information and counter myths

+ Lower cost of safety products and improve access

+ Assist with installation of safety products

+ Organize community members to take action

+ Educate policy makers and decision makers

+ Advocate for funding and action

National Safe Kids, AAP, CDC/NCIPC, Barss et al,1998


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www.who.int/violence_injury_prevention/unintentional_injuries/burns/burns2/en/

According to the International Society for Burn Injuries, a burn occurs when some or all of the different layers of cells in the skin are destroyed by a hot liquid (scald), a hot solid (contact burns) or a flame (flame burns).

Skin injuries due to ultraviolet radiation, radioactivity, electricity or chemicals, as well as respiratory damage resulting from smoke inhalation, are also considered to be burns.

INJURIES – BURNS DEFINITION


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GLOBAL BURDEN OF BURNS



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By reducing hot water temperature, you minimize the risk of a scald burn…but you don’t eliminate it!

Time needed to produce serious burn

Water

temperature ADULTS CHILDREN

120oF (49oC) > 5 minutes About 3 minutes

125oF (52oC) 1 ½ to 2 minutes About 45 to 60 seconds

130oF (54oC) About 30 seconds About 15 seconds

135oF (57oC) About 10 seconds About 5 seconds

140oF (60oC) < 5 seconds About 2 ½ seconds

CHILDREN’S SKIN IS MORE VULNERABLE


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HOW DO BURNS OCCUR?

WHO

WHO


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ENVIRONMENTAL RISK FACTORS OF BURN INJURIES IN CHILDREN

LocationLocation Environment factors Environment factors

Home Home environmentenvironment

- use of candles, lanterns, fires, kerosene, gas use of candles, lanterns, fires, kerosene, gas heaters and portable stovesheaters and portable stoves

- location and lack of enclosures for open fires, location and lack of enclosures for open fires, flames, hot potsflames, hot pots

- hot water temperatureshot water temperatures

- lack of exits, functioning smoke alarmslack of exits, functioning smoke alarms

- poor quality, flammable construction and poor quality, flammable construction and furnishingsfurnishings

ProductsProducts - flammable, loose fitting clothingflammable, loose fitting clothing

- fireworksfireworks

- lighters that are not child resistantlighters that are not child resistant

- toxicity of materials used in furnishings toxicity of materials used in furnishings Barss et al, 1998www.who.int/violence_injury_prevention/unintentional_injuries/burns/burns2/en/index1.html


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BURN PREVENTION

Raising or enclosing cooking areas Raising or enclosing cooking areas Electrification to reduce dependence on candles and kerosene Electrification to reduce dependence on candles and kerosene Safe stove design Safe stove design Improved house construction Improved house construction Installation and maintenance of smoke alarms and sprinkler Installation and maintenance of smoke alarms and sprinkler

systems systems Education about prevention and first-aid management of burns Education about prevention and first-aid management of burns Water temperature regulation Water temperature regulation Flame retardant fabrics Flame retardant fabrics

www.who.int/violence_injury_prevention/unintentional_injuries/burns/burns2/en/index1.htmlBarss et al, 1998


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Drowning is the process of experiencing respiratory impairment from submersion or immersion in liquid. Drowning outcomes are classified as death, morbidity and no morbidity.

INJURIES - DROWNINGDEFINITION


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FACTS ABOUT DROWNING AND CHILDRENFACTS ABOUT DROWNING AND CHILDREN

Among the various age groups, children under five years of age have the highest drowning mortality rates worldwide (Exception: New Zealand and Canada).

Drowning is the leading cause of injury death to children aged 1-14 years in China

In Bangladesh, 20% of all deaths in children aged 1-4 years are due to drowning

Drowning was the second leading cause of unintentional injury death in children aged 1-14in the United States in 2000.

Drowning is the leading cause of unintentional injury death in children aged 1-3 in every Australian state.

Drowning in young children is often associated with a lapse of supervision.


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INJURIES - DROWNING



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CHILD DROWNING DEATHS IN CHINA, 2001CHILD DROWNING DEATHS IN CHINA, 2001

Age Urban rate* Percentageof all child

injury deaths

Rural rate* Percentageof all child

injury deaths1-4 4.25 42.74 19.34 60.665-9 1.85 44.47 16.82 59.39

10-14 1.38 44.47 13.98 54.63* All rates per 100,000 people

Source: Ministry of Health People's Republic of China


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Environmental risk factors

Floods Transportation (vessels) Water containers Bath tubs Recreation (pools, ponds, lakes)

These are also risk factors for electrocution!!!!

RISK FACTORSRISK FACTORS

Other risk factors

Gender Age Occupation Alcohol Epilepsy Socioeconomic status


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DROWNINGDROWNING PREVENTIONPREVENTION

Remove the hazard

Create barriers

Protect those at risk

Counter the damage

WHO


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INJURIES – POISONING

Epidemiology of child poisoning 0-4 years

Peak age for child poisoning is 0-4 years Child unintentional poisoning is a major cause of child death in

low and middle income countries Deaths are now uncommon in high income countries Hospital admission rates remain high in high income countries Poisoning agents vary between countries and over time Agents are generally ingested Girls are over-represented in poisoning deaths in some regions


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GLOBAL POISONING MORTALITY



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RISK FACTORS FOR CHILD POISONING

Small mass of child affects size of toxic dose Crawling infants access agents at, or near, floor level (eg

rodenticides) After 12 months, serious exposures most often involve

pharmaceuticals in high income countries Children ingest agents that are readily accessible Older siblings may administer medications to younger children Children are attracted by the appearance of many poisonous

agents and plants In high income countries most ingestions occur in the home


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ATTRACTIVE APPEARANCE OF MEDICINES

Joan Ozanne-Smith


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COMMON CHILD POISONING AGENTSExamples by country and time

Agent Country Years

Rodenticides China 1990s

Paraffin South Africa 1990s

Paracetamol (acetaminophen)

Australia 1990s

Tobacco (< 2 years) Norway 1990-1993

Aspirin High income countries

Pre-1980s


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AVAILABLE COUNTERMEASURES

Child resistant packaging closures foil strips “mousers” other protective packaging (e.g. mothballs)

Child resistant storage

Regulatory control


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CHILD RESISTANT PACKAGING

Pharmaceuticals

Joan Ozanne-Smith


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Domestic chemicals


Joan Ozanne-Smith


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Joan Ozanne-Smith


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POISONING MEDICAL MANAGEMENT

Toxicology databases available electronically

Poisons Information/Control Centres provide telephone advice and triage in many countries To the public Restricted to medical practitioners (U.K.)

Medical assessment using best practice protocols

Blood levels if indicated (e.g. paracetamol/ acetaminophen). Antidotes, chelating agents, activated charcoal, symptomatic treatment


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EXERCISE

PREVENTION Host Agent Environment

Pre-event

Event

Post-event

Haddon’s matrix


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ANSWER NOTESHaddon’s matrix

PREVENTION Host Agent Environment

Pre-event

Teach children not to help themselves to food or drink

Package small volumes Package low concentrations Child resistant closures Other child resistant designs Label clearly to avoid dosage errors

Parental, caregiver, professional education re: poisoning prevention Safe storage places Toxicology databases updated and readily available to relevant professionals Doctors, pharmacists, retailers warn of toxicity to children

Event

Supervision of children

Post-event

Seek advice from label, Poisons Information Centre, doctor or Emergency Department

Information from package and amount remaining identified

Details of poisoning events detailed in injury surveillance databases


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INJURIES - ANIMAL INVOLVEMENT

Attack/bite (dog, crocodile, shark, other wild animal) Envenomation (snakes, scorpions, spiders, sea

creatures) Fall from animal being ridden (most commonly horse) Transport related Crushed by animal (domestic) Allergic response to bee/wasp stings Disease carried by attacking animal (rabies, malaria,

etc) Consumption of poisonous creatures


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INJURIES - DOG ATTACKS

Death rate in United States: about 0.06/100,000

Rate in US is highest for infants

Hospital admission rate is 7.7/100,000 Australia, 2.6/100,000 Canada

Highest hospitalisation rate 0-4 years of age, then 5-9 years

Bites to face, scalp predominate for child; upper extremity for adults

Associated rabies occurs in 0.81/100,000 population Delhi, India (higher rate for 5-14 years of age)

Large number of rabies vaccine treatments is reported for Thailand


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DEVELOPING COUNTRY EXAMPLE

Child dog-bite in Vietnam

Proportion of all child animal bites 79.5%

Proportion of children hospitalised for animal bite injuries

61%

Proportion of severe child animal bite injuries

61%

Source: Report to UNICEF on the Vietnam Multi-Center Injury Survey. The Vietnam Public Health Research Network


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RISK FACTORS FOR DOG BITE Children, especially 0-5 yearsHouseholds with dogsCertain dog breeds and dog characteristicsChildren and the elderlyGender (males over-represented)Alcohol consumptionMale dogsVictim known to the dogHome location, especially

for children

WHO


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PREVENTION OF DOG ATTACKS

Prevention:

Reduce exposure to dogs by Avoid dog ownership in households with young children Avoid owning inappropriate breeds Dog regulations enforced (registration, leashes)

Public education: Never leave a young child alone with a dog All dogs should be socialized to accept children


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SNAKE BITE: GLOBAL ESTIMATES

Annually: More than 5 million cases

More than 50,000 deaths (registered)

400,000 amputations

Rates of bites as high as 600/100,000 for persons active in the rainforests of French Guiana

Envenomation reported in 17% of bites (Gabon)

Lethality varies between countries from 1% of bites to 15%


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SNAKEBITE

Prevention:

Reduce exposure to snakes by use of Protective clothing Culling/eradication in high risk areas

Improved access to early medical treatment and anti-venom


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SNAKEBITE:EXAMPLE OF PREVENTION IN SOUTH-EAST ASIA

Snakebite occurs more frequently in Sri Lanka than anywhere else in the world.

Public education campaigns were undertaken by the National Poisons Information Centre, Colombo, Sri Lanka

Stressing need to attend hospital without delay after a snake bite, Teaching people that pharmaceuticals are more effective than

traditional medicines for treating snake bites.

Public education campaigns from mid 1980s to mid 1990s, associated with a five-fold increase in hospital admissions due to snake bites, a reduction in mortality from 3.7% to less than 1%, and a reduction in morbidity.


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SCORPION STING

Widespread public health problem (e.g. Saudi Arabia, Israel, Algeria, Sub-Saharan Africa)

Of paediatric cases in Niger, 23% are fatal

Israel: 13% non-symptomatic; 72% mild; 15% moderate to severe

Anti-venom is available


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SCORPION STING: EXAMPLE OF PREVENTION IN NORTHERN AFRICA

Prevention programme undertaken by the Moroccan Centre Anti Poisons

Scorpion venom acts very quickly (within 24–48 hours), most stings occur in rural areas, a long way from health services.

At the time: no effective antivenom, physician’s undergraduate training did not include of effective treatment

for scorpion stings.

Centre organized training programmes addressed to health professionals.

It also produced and distributed a leaflet for the public describing how to prevent stings and what action should be taken in case of sting.

Prospective studies and retrospective studies of poisoning cases were undertaken in the main cities affected.


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JELLYFISH AND FISH STINGS

Fish stings (including stingray): small case series are reported from many countries, with few deaths

Hot water immersion relieves symptoms

Compression immobilization bandages may be counter-productive

Jellyfish stings: the response is generally hyper-sensitivity/anaphylaxis, with few deaths


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OTHER PREVENTIVE MEASURES

Jellyfish: warnings when prevalent, close beaches, netting-off “safe” swimming areas

Programs to prevent scorpion proliferation

Professional removal of bee hives and destruction of wasp nests in residential environs

Warning signage in wild animal habitats (crocodiles)

Wearing of protective gloves, footwear and clothing is recommended when handling fish


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VENOMOUS ANIMALS AND PLANTS

ICD-10 CODE

ICD-9 CODE

DESCRIPTION

X20 E905.0 Contact with venomous snakes and lizards

X21 E905.1 Contact with venomous spiders

X22 E905.2 Contact with scorpions

X23 E905.3 Contact with hornets, wasps and bees

X24 E905.4 Contact with centipedes and venomous millipedes (tropical)

X25 E905.5 Contact with other specified arthropods

X26 E905.6 Contact with venomous marine animals

X27 E905.7 Contact with other specified venomous animals

X28 Contact with other specified venomous plants

X29 Contact with other unspecified venomous animal or plant

E905.8 Other specified

E905.9 Other unspecified


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MEDICAL MANAGEMENT

Alerting mechanisms and access to medical careIdentification of animal involvedUse of anti-venom as indicatedControl bleeding and treat blood lossesAntidotes as availableManagement of allergic responsesSymptomatic management as requiredRabies vaccine in endemic regionsHot water immersion for stingray and jellyfish stings


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FUTURE DIRECTIONS FOR INJURY PREVENTION

Collection and dissemination of data Utilization of the full range of ICD injury codes Public health response Inter-sectoral collaboration Educate community and health workers on the

need for immediate and adequate post-exposure treatment

Research


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WHY SUCH LIMITED ACTION ON INJURIES?WHY SUCH LIMITED ACTION ON INJURIES?

Perception of injuries as ‘accidents’ - unpredictable and inevitable

Data hidden by place of occurrence, age, sex Lack of acknowledgement of what can be done Lack of ownership Multi-sectoral complexity Capacity to make the problem more visible Civil society organisations Loss of state regulations & enforcement after transition Donor priorities


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STRATEGIES OF INJURY INTERVENTION

Environmental, engineering designsEnforcement, legislative mandatesEducation, behaviourEconomic incentive, equityEmpowermentEvaluation


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CONSEQUENCES OF INJURIES

Large amount of disabilities

- Injuries to extremities- Traumatic brain injuries- Spinal cord injuries

Rehabilitation efforts


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STRATEGIES OF INJURY INTERVENTION

Cost benefit analyses have shown that injury prevention is value for money (European data):

• € 1 spent on smoke alarms saves € 69; • € 1 on child safety seats saves € 32; • € 1 spent on bicycle helmets saves € 29; • € 1 spent on prevention counselling by paediatrician

saves € 10


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MANY APPROACHES, ONE GOAL

• Collect and analyze data on injuries

• Evaluate risk factors

• Inform, educate, change behaviours

• Make environments safer

Prevention


18/04/2379

THE INTER-DISCIPLINARY NATURE OF INJURY STUDIES

Economics

Injury prevention

Law

Social sciences Healthsciences

Public health

Engineering

Education

Environment


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DIFFERENT ROLESDIFFERENT ROLES

Roles of:

Government

Industry

Donor organizations

Communities and individuals

Implementing proven interventions could save MORE THAN 1000 children's lives per day


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APPLYING KEY APPROACHES WILL SAVE CHILDREN'S LIVES



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POINTS FOR DISCUSSIONPOINTS FOR DISCUSSION

What data sources could you use to determine the injury burden in your country?

What sectors would you involve in setting up a injury prevention plan?

Is Haddon’s matrix useful in developing prevention programmes?

What role does civil society have to play and how could you help them get involved?


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First draft prepared by Leda E. Nemer, Kathrin von Hoff, Dinesh SethiSeveral slides were kindly provided by the WHO/VIP department, TEACH VIP user's

manual (and the WHO World Report on Child Injury Prevention, 2008)

With the advice of the Working Group on Training Package for the Health Sector: Cristina Alonzo MD (Uruguay); Yona Amitai MD MPH (Israel); Stephan Boese-O’Reilly MD MPH (Germany); Stephania Borgo MD (ISDE, Italy;) Irena Buka MD (Canada); Lilian Corra MD (Argentina) PhD (USA);; Amalia Laborde MD (Uruguay); Ligia Fruchtengarten MD (Brazil); Leda Nemer TO (WHO/EURO); R. Romizzi MD (ISDE, Italy); Katherine M. Shea MD MPH (USA).

Reviewers: Argo Soon, Ludwine Casteleyn, Joanne Vincenten, Francesca Racioppi (European Child Safety Alliance, Eurosafe)

WHO CEH Training Project Coordination: Jenny Pronczuk MDMedical Consultant: Ruth A. Etzel MD PhD Technical Assistance: Marie-Noel Bruné MSc

Last update – December 2009

ACKNOWLEDGEMENTSACKNOWLEDGEMENTS

WHO is grateful to the US EPA Office of Children’s Health Protection for the WHO is grateful to the US EPA Office of Children’s Health Protection for the financial support that made this project possible and for some of the data, graphics financial support that made this project possible and for some of the data, graphics

and text used in preparing these materials.and text used in preparing these materials.


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DISCLAIMERDISCLAIMER The designations employed and the presentation of the material in this publication do not imply the The designations employed and the presentation of the material in this publication do not imply the

expression of any opinion whatsoever on the part of the World Health Organization concerning the legal expression of any opinion whatsoever on the part of the World Health Organization concerning the legal status of any country, territory, city or area or of its authorities, or concerning the delimitation of its status of any country, territory, city or area or of its authorities, or concerning the delimitation of its frontiers or boundaries. Dotted lines on maps represent approximate border lines for which there may frontiers or boundaries. Dotted lines on maps represent approximate border lines for which there may not yet be full agreement.not yet be full agreement.

The mention of specific companies or of certain manufacturers’ products does not imply that they are The mention of specific companies or of certain manufacturers’ products does not imply that they are endorsed or recommended by the World Health Organization in preference to others of a similar nature endorsed or recommended by the World Health Organization in preference to others of a similar nature that are not mentioned. Errors and omissions excepted, the names of proprietary products are that are not mentioned. Errors and omissions excepted, the names of proprietary products are distinguished by initial capital letters.distinguished by initial capital letters.

The opinions and conclusions expressed do not necessarily represent the official position of the World The opinions and conclusions expressed do not necessarily represent the official position of the World Health Organization.Health Organization.

This publication is being distributed without warranty of any kind, either express or implied. In no event This publication is being distributed without warranty of any kind, either express or implied. In no event shall the World Health Organization be liable for damages, including any general, special, incidental, or shall the World Health Organization be liable for damages, including any general, special, incidental, or consequential damages, arising out of the use of this publicationconsequential damages, arising out of the use of this publication

The contents of this training module are based upon references available in the published literature as The contents of this training module are based upon references available in the published literature as of June 2004. Users are encouraged to search standard medical databases for updates in the science of June 2004. Users are encouraged to search standard medical databases for updates in the science for issues of particular interest or sensitivity in their regions and areas of specific concern.for issues of particular interest or sensitivity in their regions and areas of specific concern.

If users of this training module should find it necessary to make any modifications (abridgement, If users of this training module should find it necessary to make any modifications (abridgement, addition or deletion) to the presentation, the adaptor shall be responsible for all modifications made. addition or deletion) to the presentation, the adaptor shall be responsible for all modifications made. The World Health Organization disclaims all responsibility for adaptations made by others. All The World Health Organization disclaims all responsibility for adaptations made by others. All modifications shall be clearly distinguished from the original WHO material.modifications shall be clearly distinguished from the original WHO material.

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