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ASSAULT SURVEILLANCE: ESTABLISHMENT OF A
LOCAL INJURY SURVEILLANCE SYSTEM
Zara Anderson and Linda Turner
Thursday 8th September 2005 11.30 – 12.15pm
Objectives
• Trauma and Injury Intelligence Group
• Injury Surveillance System
• Assault Surveillance
• Barriers
• Benefits
• Summary
What is the Trauma and Injury Intelligence Group (TIIG)?• A partnership group across Cheshire and Merseyside with
representation from PCT's, Academia, Fire Service, Police and Ambulance
• Objectives include:– Informing and advising the local Public Health Network and
Strategic Health Authority on injury intelligence – Advising and supporting injury information providers– Informing injury prevention strategies through needs
assessment, monitoring and evaluation– Making available the best evidence– Collaborating with partners on related initiatives (e.g.
robbery and violent crime)
• The injury surveillance system is the primary mechanism for delivering objectives
Why is an injury surveillance system needed?
Injuries are a key public health issue
– cause people to die prematurely
– major cause of disability, impairment, poorer quality of life
– links to the inequality agenda
National drivers
• Recommendation from BMA that:
“injury surveillance centres should be established”
• Report to Chief Medical Officer - Preventing Accidental Injury: Priorities for Action
“Public Health Observatories, together with their counterparts in local government, should play a key role in the surveillance of accidental injury”
Local drivers
• Merseyside conference prioritised theme of improving information about injuries and those at risk
Steps in a surveillance systemDefining the problem
Collecting the data
Entering the data
Assessing the data
Interpreting the data
Reporting the resultsUsing the results to plan prevention / treatment
Evaluating the surveillance system
Private sector and NGOs
Other public service agencies
Health departments
Other stakeholdersSource: Injury surveillance
guidelines centres for disease control and prevention
What is the Merseyside and Cheshire model?
• Covers both intentional and unintentional injuries • Brings together a variety of data sources in one place• Sustainable surveillance system that is passive (data
collected in the course of doing other routine tasks)• Consistent collection of data items by using core data
sets with local flexibility• Wider coverage than other surveillance systems in
UK and internationally• Regular reporting on aggregated data
Injury datasets
A&E Attendance
Records
Police Data
Hospital Admissions
Coroner’s Data
NHS Walk-in-Centres
Minor Injury Units
GP Practices
Mortality Data
Ambulance Data
Fire Service Data
Assaults – UK perspective
Some key facts
Estimated 2.7 million incidents of violence every year in England and Wales
Crime and Disorder Reduction Partnerships – crime audits
Types of violence:• youth
• intimate partner• child maltreatment• elder abuse• sexual violence
Reporting of violent crime and assaults – as low as 12% of worst cases of serious sexual assault
Impacts on services – health, local authority, criminal justice
Impacts on health – injuries, long-term physical, mental and sexual health problems, death
At peak times 70% of A&E admissions are due to alcohol
Costs of domestic violence per year
• £23 billion (NHS £1.4 billion)
Costs of violent crime per year
•£24.4 billion
Drinking free-for-all 'will take police off the beat'
Police fear late licences will lead to chaos
Assaults – Cheshire and Merseyside, UK• Hospital admissions
– Cheshire and Merseyside• Accident and Emergency attendances
– Arrowe Park– Royal Liverpool
• Ambulance call outs– Cheshire and Merseyside
Mortality and hospital admissionsCheshire and Merseyside: -
• 2002:- 7 deaths directly associated with assault
• 2002/2003: -2,978 assault-related hospital admissions– Leading cause of hospital admissions for
males aged 15 -24 years– Second leading cause for males aged 25 – 34
years
Assault A&E attendances by age group
April 2004 to March 2005
Royal Liverpool – 4,314 (12%)
Arrowe Park – 2,872 (7%)
Over 70% of assault attendances were male
0
20
40
60
80
100
0 - 4 5 - 14 15 - 29 30 - 59 60 plus UnknownAge Group
Per
cent
age
Royal LiverpoolArrowe Park
Assault attendances by number of attackers
0
20
40
60
80
100
1 2 More than 2 Unknown
Number of attackers
Pe
rcenta
ge
Royal Liverpool
Arrowe Park
Royal Liverpool A&E
• 91% attackers male• 70% attacked by a stranger• 51% not informed police• Type of attack: - 1,415 struck (e.g. fist), 212 blunt object, 206
bottled/glassed, 93 stabbed
Arrowe Park A&E • Type of attack: - 2,213 struck, 341 Wound/cut, 32 stabbed, 23 bites, 20
falls, 19 glassed
Assault attendances by location of incident, Royal Liverpool A&E
Liverpool City Centre
Bold Street
Concert Square
Slater Street
46%
36%
Bar/pubClubOtherSomeone elses homeStreetUnable to answerWorkplaceYour homeUnknown
Assault attendances by location of incident, Arrowe Park A&E
45%Street
Public Space
Domestic violence/home
Public House
Club
Work
School
Public Park
Public transport
Other/Unknown
49% of assault attendances drank alcohol prior to their attack
85% of assault attendances between 2am and 4am Saturday morning drank alcohol prior to their attack
86% of assault attendances between 2am and 4am Sunday morning drank alcohol prior to their attack
Mersey Regional Ambulance Service
• Cheshire and Merseyside
• Patient demographics
• Time/date
• Hospital of attendance
• Location of call out
Assault/Rape call outs, April to June 2005
•2,313 Assault/Rape call outs
•34% aged 15 – 29 years
•67% male
•50% taken to emergency room
-Royal Liverpool 22%, Arrowe Park 16%, Whiston 13%, Aintree 12%
Time/day of assault/rape ambulance call outs, April to June 2005
0
5
10
15
20
25
30
35
12 -13.59
14 -15.59
16 -17.59
18 -19.59
20 -21.59
22 -23.59
0 -1.59
2 -3.59
4 -5.59
6 -7.59
8 -9.59
10 -11.59
Time group
Per
cent
age
of c
all o
uts
Sunday
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Violence against the person offences by Crime and Disorder Reduction Partnership area, rate per 1,000 population, Cheshire and Merseyside, 2002/2003 to 2003/2004
0.0
10.0
20.0
30.0
Congle
ton
Mac
clesfi
eld
War
ringt
on
Sefto
n
Ellesm
ere
Port &
Nes
ton
Vale R
oyal
Cheste
r
Knowsle
y
Crewe
St. Hele
nsW
irral
Halton
Liver
pool
Crime and Disorder Reduction Partnership area
Rat
e pe
r 1,
000
popu
latio
n
Data summary• Victims: 15 – 29 years, male• Attackers: male• Peak times: weekend evenings• Peak location: night time environment• 49% victims drank alcohol prior to attack• Not all assaults reported to the police
Data Constraints
• Variations in data collection
• Data quality
• Resources/Targets
• Accountability/Ownership
• Training
Implementation of a local Injury Surveillance System
What can be achieved?
Data has potential to…..
• Identify Hotspots
• Identify Licensed Premises
• Identify Vulnerable groups
Police and other agency response: -
Short term• Targeted Deployment of Resources
( multi agency )• CCTV• Targeting Licensed Premises
Longer term • Planning/license restrictions • Multi agency interventions e.g P.C.T re Binge Drinking• Parenting programmes etc. • Inform strategies/Evaluate interventions
BenefitsReduce:
– Violent crime
Reduce: – Ambulance call outs– A&E admissions– Hospital admissions
Meet National Targets
Improve:–Improve health–Improve night time economy–Increase diversity
Free up resources
Facilitate information sharing and partnership working
Summary
• Violence is a health and criminal justice issue
• Multiple data sources should be shared and used
• Priority to improve data collection
• Multi-agency approach
Contactdetails
Zara Anderson (TIIG analyst) (Data queries)Centre For Public Health
Liverpool John Moores UniversityCastle House North Street
Liverpool, L3 2AYTel: +44 (0)151 231 4505
Email: [email protected]
Linda Turner (TIIG Commissioner) (Strategic queries)South Sefton Primary Care Trust
Burlington HouseWaterloo
Liverpool, L22 0QBTel: +44 (0)151 478 1262
Email: [email protected]
Website: www.nwpho.org.uk/ait
