HOME ACCIDENT PREVENTION - Injury Observatory

November 2004

HOME ACCIDENTPREVENTION

Strategy &Action Plan2004 - 2009

INDEX

CONTENTS PAGE

CHAPTER 1 WHY WE NEED A STRATEGY 03

CHAPTER 2 THE STRATEGY’S AIM 09

CHAPTER 3 ACTION PLAN 13

CHAPTER 4 MAKING IT HAPPEN 19

ANNEX 1 EQUALITY IMPACT ASSESSMENT 21

ANNEX 2 ROLES AND RESPONSIBILITIES OF ORGANISATIONS 29

ANNEX 3 USEFUL CONTACTS 33

REFERENCES 40

A Five Year Home Accident Prevention Strategy and Action Plan 2004-2009

02

CHAPTER 1WHY WE NEED A STRATEGY



CHAPTER 1WHY WE NEED A STRATEGY

Introduction

1.1 Accidents can take place in a widevariety of environments, however,the home is the most likelylocation. Home accidents are amajor cause of death and injuryand contribute substantially topotential years of life lost.

1.2 In relation to home accidents, a“home” is categorised as any typeof house (including a farm, block offlats or caravan) together with itsgarden, yard, driveway, path, stepsand boundaries. It need not be thehome of the injured person. A“home” also includes anypermanent or voluntary institution,such as a home for older people orstudent hall, but not a temporaryor non-voluntary institution, suchas a hotel, boarding house,hospital, nursing home or prison.

Background

1.3 The Northern Ireland Executive, inits Programme for Government-Making a Difference 2002-2005under the theme “Working for aHealthier People”, gave a commitmentto promoting public safety byreducing the number of injuriesand deaths caused by accidents athome, at work and on the road.

1.4 The Investing for Health Strategy,published in March 2002, providesthe framework for theGovernment’s approach to improvehealth and wellbeing and reducehealth inequalities. It identifies theneed to reduce accidental injuries

and deaths, and gives acommitment to develop a HomeAccident Prevention Strategy.

1.5 A draft Strategy and Action Plan,prepared by an Inter-sectoralWorking Group, was issued forpublic consultation in January2003. Responses to theconsultation were received from anumber of sources including thehousing sector, local councils, thevoluntary and community sectors,the Fire Service and thoserepresenting the Health & PersonalSocial Services. The majority ofrespondents welcomed thisinitiative and the responses havehelped the Working Group tofurther develop the Strategy.

1.6 Other policies and strategiesalready underway or planned haverelevance to this Strategy and willhelp to reduce home accidents.Examples of these include theTobacco Action Plan, Drugs,Alcohol, Physical Activity, andChildren and Young PeopleStrategies.

Types of Home Accident

1.7 There are three main categories ofhome accident:• impact accidents including falls,

being hurt by falling objects andgeneral ‘bumping into’ typeaccidents;

• heat accidents including burnsand scalds; and

• through mouth and foreignbody accidents includingaccidental poisonings, suffocation,

04


choking and objects in theeye/ear/nose1.

THE PROBLEM

1.8 Evidence shows that accidentaldeaths in the home are mostcommonly caused by falls, fire andflames, and poisoning2. Theprincipal causes of accidental injuryin the home are falls, being struckby or collision with an object,being cut or pierced by an object,burns, scalds and poisoning3.

1.9 Falls are the predominant cause foradmission to hospital for bothchildren and older people. Theyare also one of the most commonreasons given for admission ofolder people into residential care.A recent Fall Support Programme inNorth & West Belfast for olderpeople recorded almost two thirdsof those assessed had at least oneprevious fall, and nearly 40% ofpatients reported a loss ofconfidence after a fall4.

1.10 Fire related deaths and injuriesoccur across all ages. Burn injuriescan cause life long scars requiringlong-term medical treatmentusually resulting in years ofphysical, psychological andoccupational therapy.

1.11 Accidental poisoning affects allages. In children it peaks between1-4 years and is primarily a result ofingesting medicines and householdproducts. Older people are moresusceptible through poormanagement of medication and

carbon monoxide poisoning.

1.12 A recent survey3 of 16 Accident andEmergency (A&E) departments inNorthern Ireland found that moreaccidents occurred inside the home(41.4%) than at work (15.2%) andon the roads (19.5%) put together(Figure 1);

Figure 1. Injury Location

The survey also found that:• 66% of home accidents occurred

inside the home and 34%occurred directly outside thehome i.e. in the garden, yard,driveway, path and steps andboundaries;

• 39.2% of home accidentsinvolved children aged 0-15years;

• 19.4% occurred in the under-5years age group;

• 24.3% of home accidentsinvolved adults in the 25-44 agerange;

• 11.9% of home accidentsinvolved those aged over 65years;

05

Leisure/Sport17.1%

School /Childcare

4.8%Other

2%

Roads19.5%

Work15.2%

Home41.4%

Roads

Work

Home

Leisure/Sport

School/Childcare

Other


• almost half of all home accidentsoccurred by either a fall on thesame level or being struck by anobject;

• almost half of those injured as aresult of a fall were under 10years or over 65 years;

• scalds and poisoning caused themost severe injuries in the under-five age group.

1.13 In 2000, 75 deaths (Figure 2) wereattributable to accidents in thehome – of which:• 27 were due to falls (15 were

people aged 65 and over); • 16 were due to fire and flames;

and • 16 were due to poisoning2.

Figure 2. Cause of Deaths from Accidents in the Home

1.14 In 2000-2001, there were 9,042hospital admissions resulting frominjuries received in homeaccidents5.

ECONOMIC COSTS OF ACCIDENTS

1.15 The cost of home accidents is high

in terms of the number of lives lostand resulting permanentdisabilities. It is also high in otherways. It is estimated that there is anaverage of over 70 deaths and72,300 injuries per annum (1,300very serious, 19,000 serious and52,000 slight). This is equivalent to1,820 Potential Years of Life Lost(PYLLs) (819 by accidentalpoisoning, 574 by fire & 427 fromfalls. 307 PYLLs (17%) affect under18 year olds). It is also estimated atotal of 83,000 working days arelost each year, which equates to£7.6 million in lost productivity.The cost to the Department ofHealth, Social Services and PublicSafety (DHSSPS) and to theeconomy is estimated to be £78million and £80 million per annumrespectively.

1.16 The benefits of prevention are clearand quantifiable in terms of healthand economic costs:• potential to save lives;• improved quality of life; • reduction in the cost of hospital

care;• reduction in the cost of

continued community supportrequired after hospital discharge;and

• improved productivity throughpeople’s contribution to theeconomy.

INEQUALITIES

1.17 Home accidents occur in all socio-economic groups and ages, butsome types of accidents are linkedto those in the lower socio-

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Falls

Fire & Flames

Poisoning

Choking & Suffocation

Other

Poisoning21%

Choking &Suffocation

11%

Other11%

Falls36%

Fire &Flames21%


economic groups and to particularage groups. Research suggeststhat:• the social class gradient is

steepest for fire deaths, the risk offire related death for a child insocial class V (unskilled) is 16times that of children in socialclass I (professional)6;

• alcohol is a contributory factor todeaths from accidents, which alsoshow a pronounced socio-economic gradient7;

• residential areas with higherproportions of lower social classand lower income householdshave higher accident rates8;

• those injured by home accidentsare more likely to be resident inhouseholds where the chiefincome earners are housewives,unemployed or retired3;

• home accidents have beenidentified as a hazard forTravellers9.

EQUALITY

1.18 Section 75 of the Northern IrelandAct 1998 requires public authoritiesin carrying out their functions topromote equality of opportunitybetween persons of differentreligious belief, political opinion,racial group, age, marital status,sexual orientation, gender, disabilityand persons with dependants orwithout. DHSSPS has identifiedhome accident prevention as a newpolicy requiring Equality ImpactAssessment (EQIA). An EQIA wasdeveloped and is included asAnnex 1.

1.19 The New Targeting Social Need(New TSN) policy aims to tacklepoverty and exclusion by targetingthe efforts and available resourcesof public agencies towards thepeople, groups and areasobjectively defined as being ingreatest social need. New TSNincludes a special focus on tacklingthe problems of unemployment,but also targets inequalities inhealth, housing, education andother policy areas. Paragraph 1.17highlights the link between sometypes of home accidents and thosein the lower socio-economicgroups. The development of aHome Accident Prevention Strategyis therefore included in the DHSSPSNew TSN Action Plan 2003-2004.Subsequent New TSN Action Planswill monitor and report progress ofactions set out in the Strategy toreduce the incidence of homeaccidents in the lower socio-economic group categories.

1.20 The Human Rights Act 1998 camefully into force in October 2000. Itprovides additional focus andemphasis to the rights andfreedoms of individuals guaranteedunder the European Convention onHuman Rights. There are some 18Convention rights and protocolswhich range from the Right to Lifeto the Right to Education. The Actrequires legislation, whereverenacted, to be interpreted as far aspossible in a way which iscompatible with the Conventionrights; makes it unlawful for apublic authority to act incompatiblywith the Convention rights; and, if

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it does, allows a case to be broughtin a court or tribunal against theauthority. DHSSPS will ensure thatthe Home Accident PreventionStrategy is compatible with theHuman Rights Act.

1.21 Chapter 2 describes the aim of theStrategy, Chapter 3 outlines anAction Plan to support homeaccident prevention and Chapter 4sets out how the Strategy will betaken forward. Annex 1 outlinesthe EQIA, Annex 2 outlines theresponsibilities of the organisationswith a role to play and Annex 3provides useful contacts.

08

CHAPTER 2THE STRATEGY’S AIM



CHAPTER 2THE STRATEGY’S AIM

2.1 The overall aim is:“To reduce the number ofaccidental deaths and injuries in the home.”

2.2 It is recognised that this aim willtake time to achieve and thereforethis 5 year Plan represents only thefirst phase of a long-term strategyto increase people’s awareness ofthe dangers and to highlight waysto prevent home accidents. Inaddition, the aim will only berealised through an integratedpartnership approach includingstatutory, voluntary and communitysectors.

OBJECTIVES OF THE STRATEGY

2.3 The key objectives are:• to reduce home accidents,

particularly in those most at risk;• to raise awareness of the causes

of home accidents and promoteeffective preventative measures toreduce such accidents;

• to promote and facilitate effectivetraining, skills and knowledge inhome accident prevention acrossall relevant organisations, groupsand individuals.

2.4 These objectives will be metthrough integrated and effectiveapproaches including:• education and information

programmes to promote homesafety, and promote a change inpublic behaviour towards homeaccident prevention; and

• the use of evidence basedpractice, models of good practice,and by evaluating home accidentprevention initiatives.

OUTCOMES

2.5 If successful, implementation of thisstrategy will lead to a reduction inthe number of home accidents andcontribute to the outcome“reduction in preventable deathsand diseases and improvement inwellbeing” set out in the NorthernIreland Priorities and Budget 2004-2006.

VALUES AND PRINCIPLES

2.6 The Strategy adopts the values andprinciples set out in Investing forHealth. These include:• health as a fundamental human

right;• actively pursuing equality of

opportunity and the promotion ofsocial inclusion;

• reducing social inequalities;• encouraging community

involvement; and• maximising opportunities for

individuals, families andcommunities to protect andimprove their own health.

PRIORITIES

2.7 Improving the health of the entirepopulation and reducing healthinequalities are the main aims ofInvesting for Health. Accidents inthe home are a major cause ofdeath, and injuries ensuing fromhome accidents can have a majorlong-term impact on health.Reducing the number of accidentswill save lives and reduce disability.

2.8 While this Strategy is aimed at the

10


population as a whole, Chapter 1highlights that there is a strongassociation between poverty andthe likelihood of injury in the homeand that particular age groups aremore at risk3. It will therefore beimportant to target the sociallydisadvantaged, children and olderpeople. In addition, those with adisability or from a black andminority ethnic community haveparticular requirements in accessinginformation, advice and servicesand these must also be addressed.

TARGETS

2.9 Investing for Health sets two targetsrelating to accidental death andinjuries:(i) to reduce the death rate from

accidents in people of all agesby at least one fifth between2000 and 2010; and

(ii) to reduce the rate of seriousinjuries from accidents inpeople of all ages by at leastone tenth between 2000 and2010.

2.10 The following targets, which havebeen developed to help achieve theInvesting for Health targets, will beused to measure the overall aim ofthe Home Accident PreventionStrategy:

(i) To reduce the death ratefrom home accidents for allages by 15% ie to 3.9 deathsper 100,000 in 2009.Baseline: 4.6 deaths per 100,000in 2001.

Source: General Register Office; MidYear Population Estimates; Census ofPopulation data.

(ii) To reduce the number ofaccidental injuries in thehome for all ages resulting inan admission to hospital by30% to 400.0 per 100,000 in2009.Baseline: 571.3 admissions per100,000 in 2003. Source: Korner Return KP22; Mid YearPopulation Estimates.

(iii) To reduce the number ofhome accident injuries forchildren resulting in anadmission to hospital by 20%to 344.0 admissions per100,000 in 2009.Baseline: 430.0 admissions per100,000 in 2003.Source: Korner Return KP22; Mid YearPopulation Estimates.

(iv) To reduce the number ofinjuries resulting in anadmission to hospital due topoisonings in the home forall ages by 18% to 50.0admissions per 100,000 in2009Baseline: 61.3 admissions per100,000 in 2003. Source: Korner Return KP22; Mid YearPopulation Estimates.

(v) To reduce the number of fallsin older people resulting inan admission to hospital by25% to 454.3 admissions per100,000 in 2009.Baseline: 605.7 admissions per100,000 in 2003.

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Source: Korner Return KP22; Mid YearPopulation Estimates.

(vi) To reduce the number ofinjuries from accidental firesfor all ages by 10% to 145injuries in 2009. Baseline: 161 injuries in 2002/03.Source: Fire Authority for NorthernIreland.

TAKING THE STRATEGY FORWARD

2.11 The Strategy comprises a numberof actions grouped under fourareas, which will ensure its aim andobjectives are met.

(a) Policy development

(b) Improving awareness

(c) Improving training

(d) Accident information

2.12 Chapter 3 sets out for each ofthese areas, the action to be taken,initial target dates and the mainpartners.

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CHAPTER 3ACTION PLAN



CHAPTER 3ACTION PLAN

Policy Development

3.1 Accidents in the home areinfluenced by behavioural, socialfactors and environmental hazards,and in some cases, social andeconomic circumstances. Althoughmuch good work is alreadyunderway a considerable amountof this effort tends to befragmented and ad hoc rather thanpart of comprehensive policies andprogrammes.

3.2 For example, there are manyschemes across Northern Ireland toprevent home accidents includingvarious risk assessment tools inrelation to falls in older people andadaptations/equipment for disabledand older people. However, theassessments tend to varydepending on the focus of theprofession involved. Some includepersonal factors which can causefalls such as medication, mobility,footwear or eyesight, while othersinclude environmental factors suchas the use of stairs, lighting, trailingflexes etc.. and the presence ofgrab rails or a second handrail etc.Partnership working across allsectors combining expertise andresources would enable acomprehensive and co-ordinatedassessment resulting in moreeffective home accidentintervention.

3.3 Research shows that good homesafety visits can reduce homeaccidents to children by up to26%10. These usually involve ahome safety audit and if necessary

referral to relevant agencies forsmall improvements or for safetyequipment. The quality andtherefore the value of theseschemes vary depending on theexperience/skills of the key person,their training, the checking toolsbeing used, the use of theinformation gleaned and availablefunds.

3.4 It is important to promote HomeAccident Prevention from an earlyage. The Education Sector canmake an important contributiontowards reducing home accidentsin children and young people. Forexample, during key stage 1, 2 and3 simple messages can be taughtto children who often take themessage home and ensurebehaviour is modified to safebehaviour. Dramas staged in areasof social disadvantage and targetedat 3-6 year olds and their carershave raised awareness of the causesand prevention of the dangers ofhousehold poisons by 76%11.

3.5 In addition LASER (Learning AboutSafety by Experiencing Risk)schemes, which are known by avariety of names such asStreetsmart, BeeWise or Streetwise,are interactive interventions onsafety related issues that provide anexcellent series of scenarios. Thereis evidence that this sort ofexperiential learning where childrenare able to experience riskysituations first hand and learn howto deal with them in a controlledand supervised environment is aneffective way to raise awareness12.

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3.6 To support home accidentprevention the following actionsare to be taken forward:

Action 1The Department of Health, SocialServices and Public Safety (DHSSPS)will establish a multi-agency HomeAccident Prevention StrategyImplementation Group to manage theimplementation of the Home AccidentPrevention Strategy.Target date: February 2005

Action 2The Home Accident PreventionStrategy Implementation Group willreport progress on implementation ofthe Strategy to the Ministerial Groupon Public Health (MGPH).Target date: Annually

Action 3The Investing for Health Partnerships,together with Health and Social Services(HSS) Boards and local councils, willreview home accident prevention roleswithin their areas and develop programmesto reduce injuries and deaths by raisingawareness and implementing homeaccident prevention interventions withparticular focus on those most at risk.Target date: March 2006

Action 4The Department of Education (DE) willask the Council for the Curriculum,Examinations and Assessment (CCEA)to develop guidance for the teaching ofhome accident prevention which wouldbe taught to school age childrenthrough a range of subject areas in thecurriculum.Target date: September 2005

Action 5Local councils, in exercising theirdiscretionary powers to promote safetyin the home, will have regard to theHome Accident Prevention Strategy andthe policies and programmes developedby the Investing for Health Partnerships.Target date: Ongoing.

Action 6The Northern Ireland HousingExecutive (NIHE), in partnership withthe voluntary and community sectorswill address home safety issues byidentifying tenants at risk and by takingappropriate action to control risk, forexample by fitting grab rails/ hand rails(bathrooms/ stairs), poison cabinets inkitchens and hard wired smoke alarms.Target date: September 2005

Improving Awareness

3.7 Behaviour is the main factor inhome accidents and so changing tosafe behaviour is crucial to reducingsuch accidents. While manyindividuals and organisations havemade a real contribution to homeaccident prevention, much stillremains to be done to raiseawareness that accidents are linkedto behaviour, product design andenvironment and to change theperception that accidents don’t‘just happen’.

3.8 As outlined in paragraph 3.2adaptations can be made to ahome and equipment madeavailable to reduce the risk ofaccidents e.g. handrails, smokealarms etc. However, many older

15


people and people who acquire adisability are not aware of theavailable help and support.

3.9 Accidental poisoning in children isalso preventable. The numbers ofpoisonings dropped dramaticallyfollowing the introduction of childresistant closure guidelines.However, the tendency to continueto store poisonous substancesunder the kitchen sink and the lackof lockable kitchen storage resultsin many children still beingpoisoned. Clearly this is an areawhere behaviour could bechanged. In addition, childrenwhose homes are working farmsare particularly at risk of homeaccidents including poisoning andthere is a need to develop focusedinterventions.

3.10 The Northern Ireland Fire Brigade(NIFB) plays a vital role in raisingawareness and prevention of fires inthe home. It is working with localHome Accident Prevention Groupsand local councils to provide smokealarms in targeted “at risk” areas.The Fire Brigade’s “Ban the Pan”campaign is another example ofwhere behaviour has beenchanged. This campaign raisedawareness of the dangers of chippan fires and resulted in aconsumer shift towardsthermostatically controlled deep fatfryers.

3.11 If behaviour is to be changed it isimportant that preventative actionshould continue through thefurther development of sustained

public information and educationinitiatives taking account of thepriority and vulnerable groups,main causes of accidents andenvironmental issues such as houselayout, design and buildingregulations.

Action 7DHSSPS in partnership with the HealthPromotion Agency for NorthernIreland (HPANI), HSS Boards andTrusts, local councils, and thevoluntary and community sectors willdevelop a public information campaignto raise awareness of home accidentprevention taking account of theparticular needs of those most at riskincluding those with a disability or froma black and minority ethnic background.Target date: September 2006

Action 8The Department of Enterprise, Tradeand Investment (DETI), through theHealth and Safety Executive forNorthern Ireland (HSENI), will deliver acampaign entitled “Be Aware Kids”whichwill focus on the safety of children livingon or near farm premises. Target date: March 2007

Action 9The NIFB will continue to deliver 12 firesafety messages to the public, andfurther develop public informationcampaigns taking into account theparticular needs of vulnerable groupsincluding those with a disability or froma black and minority ethnic background. Target date: Annually

16


Action 10The NIFB will develop partnerships withlocal Home Accident PreventionGroups and other community groups toprovide active campaigns for communityfire safety.Target date: September 2005

Improving Training

3.12 Those working in a hospital orhome setting are well placed tooffer advice on the prevention ofhome accidents e.g. during homeassessments and home visits. It isessential that tailored training ismade available to all professionalstaff and volunteers in key roles ona continuous basis. Such trainingshould cover risk assessment,effective interventions, child safety,older people’s safety and homesafety audit. There is also a needfor information on training to bedisseminated across all relevantnetworks.

3.13 Investing for Health highlights therole of local communities inreducing health inequalitiesthrough the provision of services,information and support withintheir own localities. Training andsupport must be made available toensure they are in a position toidentify needs and make aneffective contribution towards theprevention of home accidents.

Action 11DHSSPS in partnership with HSS Boardsand Trusts, HPANI, local councils andthe voluntary and community sectors

will develop a regionally coordinatedprogramme of home safety training,taking account of the particular needs ofvulnerable groups, for all those with acontribution to make.Target date: September 2006

Accident Information

3.14 Information on accidents is collatedby HSS Trusts through a variety ofmechanisms. Accident &Emergency (A&E) Departments andMinor Injuries Units use a numberof operational systems such as theNorthern Ireland Regional Accident& Emergency System (NIRAES), thePatient Administration System (PAS)and other commercially availablesoftware packages. Regionally theDHSSPS collects summaryinformation using an aggregateddata collection (KP22); informationis also available on patients who areadmitted to hospital for a periodexceeding 24 hours from theHospital Inpatients System (HIS).However there is a clear need forconsistent and detailed informationat a regional level, identifying thecauses of home accidents and theinjuries they result in.

Action 12DHSSPS in partnership with HSS Boardsand Trusts will work together toimplement modifications to Accident &Emergency (A&E) systems to gatheradditional Home Accident information.Target date: April 2006

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Action 13 DHSSPS in partnership with the HSSBoards and Trusts and the voluntarysector will agree a Minimum Data Setfor the collection of data relating toHome Accidents, by IT systems in A&EDepartments and Minor Injuries Units.Target dates: Minimum Data Set to beagreed by December 2004Data Collection to be piloted in at leastone Trust by April 2005Data Collection to be implemented fullyby April 2006

Action 14DHSSPS in partnership with HSS Boardsand Trusts will develop a central servicefor the collection, analysis andinterpretation, and dissemination ofhome accident data.Target date: April 2006

18

CHAPTER 4MAKING IT HAPPEN



CHAPTER 4MAKING IT HAPPEN

Introduction

4.1 It will take time and partnershipworking between Governmentdepartments, statutory, voluntaryand community organisations in avariety of settings to achieve theaim of this Strategy and ActionPlan. If the objectives outlined inChapter 2 are to be met, it isessential that structures are in placeto oversee the programme ofaction. The Action Plan’s successwill also require sufficient resourcesand systematic arrangements formonitoring and accountability.

Managing the Action Plan

4.2 The Ministerial Group on PublicHealth (MGPH) will be responsiblefor the overall monitoring of theStrategy and Action Plan. A multi-agency Implementation Group willbe established to oversee and driveforward the actions outlined inChapter 3. The ImplementationGroup will report progress to theMGPH annually. The Strategy willbe reviewed after five years.

Research

4.3 The Implementation Group willwish to consider the need foradditional research to help monitorand evaluate progress. This couldinclude research on home accidentstreated in primary care,interventions to prevent homeaccidents and subsequentevaluation, interventions specificallyaimed at preventing homeaccidents amongst those most

disadvantaged, and drawingcomparisons with other countries.

Resources

4.4 The Department of Health, SocialServices and Public Safety will make£100,000 available in the first yearto implement the Strategy andAction Plan with continued supportover the five year lifespan.

Roles and Responsibilities

4.5 The implementation of the HomeAccident Prevention Strategy andAction Plan requires input from avariety of organisations, agenciesand individuals ranging fromGovernment departments,statutory bodies and the voluntaryand community sector, localcommunities and each persontaking responsibility in their ownhome. Annex 2 details the rolesand responsibilities of the mainorganisations.

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ANNEX 1EQUALITY IMPACT ASSESSMENT



ANNEX 1EQUALITY IMPACT ASSESSMENT

1. Introduction

Northern Ireland Act 19981.1 Section 75 of the Northern Ireland

Act 1998 requires the Departmentof Health, Social Services and PublicSafety (DHSSPS) in carrying out itsfunctions relating to NorthernIreland, to have due regard to theneed to promote equality ofopportunity- • between persons of different

religious belief, political opinion,racial group, age, marital status orsexual orientation;

• between men and womengenerally;

• between persons with a disabilityand persons without; and

• between persons withdependants and persons without.

1.2 In addition, without prejudice tothe above obligation, DHSSPSshould also, in carrying out itsfunctions relating to NorthernIreland, have regard to thedesirability of promoting goodrelations between persons ofdifferent religious belief, politicalopinion or racial group.

2. Aim of the Strategy and Action Plan

2.1 Accidents in the home are a majorcause of death and injury. Chapter1 of this Strategy and Action Plansets out the extent of the problem,the types of home accidents, andthe health and economic costimplications for the individual andthe population.

2.2 The Strategy and Action Plan aimsto facilitate a reduction in thenumber of accidental deaths andinjuries in the home by raisingawareness of home safety,promoting a change in attitudesand behaviour towards homeaccident prevention and ensuringthat those with a contribution tomake are aware, knowledgeable,and skilled to implement effectivehome accident preventioninterventions.

2.3 Action to achieve the aim of theStrategy and Action Plan willinclude the development ofprogrammes in home accidentprevention, raising publicawareness of home safety mattersthrough public informationcampaigns, improvements in thetraining made available for thosewith a contribution to make in thepromotion of safety in the homeand improvements in informationrelating to home accidents.

2.4 The Strategy and Action Plan hasbeen defined by DHSSPS. It will beimplemented by DHSSPS inconjunction with otherGovernment departments,statutory bodies and voluntary andcommunity groups.

2.5 Implementation of the Action Planshould achieve a reduction in thenumber of accidents occurring inthe home, with an outcomereduction in the number ofaccidental injuries and deaths.

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3. Groups affected by the Policy

3.1 The policy will affect the health andwellbeing of the population ingeneral. It will therefore affect allthe Groups listed in 1.1.

4. Consideration of Available Data andResearch

4.1 Deaths due to home accidents.Source: General Register Office -Tables 1 – 3 and Figure 1.

Table 1. Gender

2001 2000 1999 1998 1997

Male 21 46 81 69 62

Female 18 29 56 22 34

Figure 1. Age and gender, 1997 – 2001

Table 3. Marital status, 1997-2001

Sex Single Married Widowed Divorced All

M 44% 35% 13% 8% 100%

F 28% 33% 31% 7% 100%

More males than females have diedas a result of home accidents,consistently over the last few years.In almost every age group there aremore male deaths due to homeaccidents. In age groups 1-4 to45-54, male deaths are more thantwice as common as female deaths.In the elderly age groups over 75,more women than men die fromhome accidents but this reversal ofthe trend can be explained by thepredominance of women in thissection of the population (Figure 1).

For men, the number of deathsrises sharply after the 10-14 agegroup and continues to be highthroughout all the remaining agegroups. With women, the rise ismore gradual but the number ofdeaths in the 75-84 age group isnoticeably higher than all otherages. The number of deaths due tofalls among females aged 75-84was three times the corresponding

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0

5

10

15

20

25

30

35

40

45

50

0 1-4 5-9 10-14 15-24 25-34 35-44 45-54 55-64 65-74 75-84 85+

Age

No

of d

eath

s fr

om h

ome

acci

dent

s Male

Female

Table 2. Age, gender and cause of death, 1997-2001

Cause of AllDeath Sex Ages 0 1-4 5-9 10-14 15-24 25-34 35-44 45-54 55-64 65-74 75-84 85+

Falls M 100 0 0 0 0 3 7 12 20 15 23 15 5F 52 0 0 0 0 1 1 3 4 5 7 22 9

Poisonings M 64 0 0 0 1 12 16 12 11 7 2 3 0F 37 0 0 0 1 3 5 8 5 8 6 1 0

Fires & Burns M 45 0 3 2 1 2 5 6 7 6 6 5 2F 35 1 0 1 0 3 3 2 7 3 4 8 3

Other M 70 1 4 0 4 4 11 7 9 3 11 13 3F 35 1 0 0 0 1 3 5 4 1 6 8 6

Total M 279 1 7 2 6 21 39 37 47 31 42 36 10F 159 2 0 1 1 8 12 18 20 17 23 39 18


figure for the 65-74 age group(Table 2).

Less married people died as a resultof a home accident than single,widowed and divorced peoplewhich might suggest people livingwith others or having regularvisitors are less at risk of having aserious accident and not being ableto contact emergency services.

Information is not collected inrelation to deaths on sexualorientation, religion, politicalopinion, racial group, disability oron persons with or withoutdependants.

4.2 Admissions to Northern IrelandHospitals Staying at least onenight as a result of a homeaccident.Source: Korner aggregate returnKP22, DHSSPS, 2000 - Tables 4and 5.

Table 4. Gender

Male Female Total

Falls 1188 2094 3282

Burns 74 47 121

Scalds 16 11 27

Poisoning 601 759 1360

Others 1884 2368 4252

Totals 3763 5279 9042

Table 5. Age

0-15 16-64 65+ Total

Falls 673 711 1898 3282

Burns 38 57 26 121

Scalds 14 7 6 27

Poisoning 171 1140 49 1360

Others 863 1935 1454 4252

Totals 1759 3850 3433 9042

Information is not available inrelation to hospital admissionsresulting from a home accident onmarital status, sexual orientation,religion, political opinion, racialgroup, disability or on persons withor without dependants.

4.3 Attendances at Accident andEmergency Departments as aresult of a home accident.Source: Accident and EmergencySurvey 2001.

Figure 2. Age

24

0

5

10

15

20

25

Under 5 5 to 9 10 to 15 16 to 24 25to 34 35 to 44 45 to 54 55 to 64 65+

19.4

10.49.4 9.6

12.511.8

7.9

6

11.9

Age

Perc

enta

ge %


Figure 3. Gender

39% of home accidents involvedchildren aged 0-15 years and 12%of home accidents involved thoseaged 65 years or over.Information is not available inrelation to home accidents treatedin Accident & EmergencyDepartments on marital status,sexual orientation, religion, politicalopinion, racial group, disability, oron persons with or withoutdependants.

4.4 Fatalities from accidentaldwelling fires.Source: Community Fire SafetyDepartment, Northern Ireland FireBrigade - Tables 6 and 7.

Table 6. Age

0-4 5-15 16-64 65+ Total

2000 1 0 7 6 14

2001 3 1 5 5 14

Table 7. Gender

Male Female Total

2000 12 2 14

2001 10 4 14

The figures are too small to beconclusive but appear to show thatabout 40% of deaths were peopleaged 65 or over. There were moremale than female fatalities in 2000and 2001 due to accidentaldwelling fires.

Information is not available inrelation to fatalities from accidentaldwelling fires on marital status,sexual orientation, religion, politicalopinion, racial group, disability, oron persons with or withoutdependants.

4.5 Source: A Package for the Future.The report of a seminar lookingat ways of improving the healthof Travellers. Ginnety, P., Warren,N., Leeson, P. 1993

Accidents (all types) are highlightedas one of the main causes of highmortality rates in Travellers.

4.6 Source: Home AccidentSurveillance System (HASS) 23rd

Annual Report 1999 data. (UKdata including representation fromNorthern Ireland).

Prevalence of home accidents byage/gender• More accidents in the older age

groups involve females ratherthan males (largely becausefemales live longer).

• For children under 15, boys havemore accidents than girls.

• In boys under-five years of age,the accident rate for burns ismore than five times that for boysaged 5-14 years of age.

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Male

Female

Female49%

Male51%


• The accident rates for falls in girlsunder-five years and in womenover 75 is similar, approximately6,000 per 100,000 population.

• The accident rate for falls in boysunder-five years is 8,000 per100,000 population, compared tonearly 4,000 per 100,000population in men aged over 75years.

4.7 There is limited informationavailable on accidents with regardto Section 75 groups and inparticular disability or racial group.However, discussions with thevoluntary sector have highlightedthe following issues:

Disability• access to information e.g. limited

knowledge of availability/type ofequipment for the home toreduce accidents, particularlythose people who acquire adisability;

• access to services e.g. length oftime waiting for OT assessment,home adaptations, receipt ofgrant;

• accessibility of information onlabelling of equipment, medicinesetc.

Racial Group• accessibility of information

relating to home accidents,labelling of equipment, medicinesetc;

5. Assessment of Impact

5.1 The policy aims to reduce thenumber of accidental deaths and

injuries in the home.

5.2 Consideration of the data inparagraph 4 indicates that:• more males than females died

from home accidents;• more males died as a result of a

fall in the home than females; • more males died from an

accidental dwelling fire thanfemales;

• more single, widowed anddivorced people died as a resultof a home accident than marriedpeople;

• older people are most at risk froma fatal fall in the home;

• females aged over 75 years weremore likely to die from a fall inthe home than those femalesaged 65-74 years;

• females are more likely to behospitalised as a result of a homeaccident than males;

• there is a higher prevalence ofhome accidents in those under-15years of age, with those under-five years most at risk.

5.3 The information available suggeststhat of the categories listed in 1.1,the groups most likely to beaffected by the Strategy and ActionPlan are age, gender and maritalstatus. No information is availableon home accidents by religion,dependants, disability, politicalopinion, ethnic minority or sexualorientation, however, discussionwith voluntary organisationssuggests that the Strategy will alsoaffect people with a disability andthose from a black and ethnicminority background.

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5.4 In developing the Strategy andAction Plan the Working Grouprecognised that age, gender andsocial disadvantage are associatedwith home accident rates.Although there is limitedinformation on home accidentprevalence here within the Section75 groups, the Working Group alsorecognised that people from ablack and minority ethnicbackground and people with adisability have particularrequirements in accessinginformation, advice and services.

5.5 The specific actions contained inthe Strategy and Action Plan havebeen developed with a view toreducing the number of homeaccidents across the population andit is the Department’s view thatthey should not have an adverseimpact on any of the groups. Theactions should promote equality ofopportunity by ensuring thateducation initiatives and publicinformation campaigns aredeveloped taking into account thespecific needs of vulnerable groups;and that professionals and otherswith a contribution to make in theprevention of home accidentsreceive relevant training and areaware of the particular needs ofdifferent groups.

6. Monitoring of impact of policy

6.1 An Implementation Group is to beestablished to take forward theStrategy and Action Plan. Thisgroup will advise on a researchprogramme and report progress on

an annual basis to the MinisterialGroup on Public Health.

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28

ANNEX 2ROLES AND RESPONSIBILITIES OF ORGANISATIONS



ANNEX 2ROLES AND RESPONSIBILITIES OF ORGANISATIONS

1.1 The Department of Health, SocialServices & Public Safety(DHSSPS) is responsible for thehealth and wellbeing of thepopulation and therefore has a keyrole to play in delivering the aimsof the Strategy and Action Plan.The Minister for DHSSPS chairs theMinisterial Group on Public Health(MGPH), which comprises seniorofficials from all departments.MGPH is responsible for co-ordinating and monitoring theimplementation of the Investing forHealth Strategy, including theHome Accident Prevention Strategyand Action Plan. Departmentalrepresentatives on MGPH will beresponsible for monitoring theprogress of the bodies for whichthey are responsible.

1.2 The Health and Personal SocialServices (HPSS) – has a key role indeveloping home accidentprevention programmes. Thisinvolves collaboration between HSSBoards, Trusts and primary care, aswell as the voluntary andcommunity sectors. In recognitionof the multi-sectoral approachrequired to effect improvement inhealth, HSS Boards have establishedInvesting for Health Partnerships.

1.3 The Investing for HealthPartnerships comprise the keyvoluntary, community and statutoryorganisations in the local area.Within the statutory sector, localcouncils, Housing Executive,Education and Library Boards andHSS Boards & Trusts will all beincluded. Beyond these core

members, the composition of thePartnerships will be determinedlocally, and is likely to evolve overtime. These multi-sectoralpartnerships will ensure that actionto improve health is properly co-ordinated and that a long-termcross-sectoral plan is developed toimprove the health and wellbeingof the population in line with theInvesting for Health Strategy.

1.4 The Health Promotion Agency –has a regional responsibility forhealth promotion. It will workclosely with DHSSPS, the HPSS andothers in developing itscontribution in the prevention ofhome accidents.

1.5 The Fire Authority for NorthernIreland – is responsible for creatinga safer environment for society byproviding an effective fire fighting,rescue and fire safety service,through the NIFB. Its Fire Safetydepartment aims to reduce thenumber of deaths and seriousinjuries caused by fire and increasefire awareness education.

1.6 The Department of Education – isresponsible for securing the placeof health education in schools andin the Youth Service. Healtheducation is currently a cross-curricular theme for all pupils up toage 16. The statutory curriculumhas been reviewed and proposalshave been accepted for a revisedcurriculum. The position of healtheducation will be given greaterfocus in the revised curriculum,which is targeted for implementation

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from September 2006.

1.7 Education & Library Boards - areresponsible for ensuring thedelivery of health education acrossall sectors from early years to post-16s and in the youth service fromage 8 to age 25.

1.8 Department of Employment andLearning funding for FurtherEducation Colleges and HigherEducation establishments supportsthe initial professional education ofhealth and social care professionals.Further and Higher Educationestablishments also have aresponsibility for the continuousprofessional development of thosepractising in the health and socialcare profession.

1.9 The Health and Safety Executivefor Northern Ireland – is anExecutive Non-Departmental PublicBody, sponsored by theDepartment of Enterprise, Tradeand Investment. It is the leadbody responsible for the promotionand enforcement of health andsafety at work standards inworkplaces, including home-working environments such as farms.

1.10 The Department of Environment– is responsible for a range oflegislative provisions that areimplemented by district councils.The Local Government(Miscellaneous Provisions) (NI)Order 1992 enables councils topromote and contribute to thepromotion of safety in the home.

1.11 Local Councils – have manystatutory functions bearing directlyon health, and quality of life. Theseinclude, amongst others,environmental health, consumerprotection and building control.These functions can specificallyimpact on the prevention of homeaccidents.

1.12 The Northern Ireland HousingExecutive (NIHE) – is the regionalhousing authority with responsibilityto assess housing needs and toensure that housing programmesare targeted at those individualsand areas in greatest need. NIHEaims to improve housing conditionsacross tenures and promote highstandards of housing design.

1.13 The Voluntary Sector – can domuch to promote a change in theperception and behaviour in homeaccident prevention. For example,highlighting the dangers in thehome and ways to prevent homeaccidents. Organisations such asthe Royal Society for the Preventionof Accidents and Home AccidentPrevention NI have experience inthis area and can provide practicalhelp to those seeking advice onhome accident prevention.

1.14 The Community Sector – Localcommunities have an importantrole to play in reducing healthinequalities by providing services,support, information and advicewithin their own localities.

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32

ANNEX 3USEFUL CONTACTS



ANNEX 3USEFUL CONTACTS

Government Departments andAgencies

Department of Health, Social Servicesand Public SafetyHealth Promotion TeamBlock C4Castle BuildingsUpper Newtownards RoadBELFASTBT4 3SQTel: 028 9052 0500(www.dhsspsni.gov.uk)

Department of Enterprise, Trade andInvestmentNetherleigh HouseMassey AvenueBELFASTBT4 2JPTel: 028 9052 9900(www.detini.gov.uk)

Council for the Curriculum,Examinations and Assessments (CCEA)Clarendon Dock29 Clarendon RoadBelfastBT1 3BGTel: 028 9026 1200(www.ccea.org.uk)

Health Promotion Agency forNorthern Ireland18 Ormeau AvenueBELFASTBT2 8HSTel: 028 9031 1611(www.healthpromotionagency.org.uk)

Department of EducationCurriculum & Assessment BranchRathgael HouseBalloo RoadBANGORBT19 7PRTel: 028 9127 9279(www.deni.gov.uk)

Department of the EnvironmentClarence Court10-18 Adelaide StreetBELFASTBT2 8GBTel: 028 9054 0540(www.doeni.gov.uk)

Health & Safety Executive forNorthern Ireland83 Ladas DriveBELFASTBT6 9FRTel: 028 9024 3249(www.hseni.gov.uk)

Health and Social Services Boards

Northern Health & Social Services BoardHealth Promotion ServiceHomefirst Community TrustSpruce HouseBraid Valley Hospital SiteCushendall RoadBALLYMENABT43 6HLTel: 028 2563 5575(www.nhssb.n-i.nhs.uk)

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Southern Health & Social Services BoardHealth Promotion DepartmentWard 1St Luke’s HospitalLoughgall RoadARMAGHBT61 7HWTel: 028 3752 0500(www.goodhealthinfo.org.uk)

Eastern Health & Social Services BoardHealth Promotion Unit12-22 Linenhall StreetBELFASTBT2 8BSTel: 028 9055 3704(www.ehssb.n-i.nhs.uk)

Western Health & Social Services BoardHealth Promotion Unit12c Gransha ParkLONDONDERRYBT47 6WJTel: 028 7186 5127(www.whssb.org)

Health and Social Services Trusts

Altnagelvin Hospitals HSS TrustAltnagelvin Area HospitalGlenshane RoadLondonderryBT47 1SB(www.altnagelvin.n-i.nhs.uk)

Armagh and Dungannon HSS TrustSt Luke’s HospitalLoughgall RoadArmaghBT61 9AR(www.adhsst.n-i.nhs.uk)

Belfast City Hospital HSS Trust51 Lisburn RoadBelfastBT9 7AB(www.n-i.nhs.uk/trusts/bch)

Causeway HSS Trust8E Coleraine RoadBallymoneyBT53 6BP(www.chsst.n-i.nhs.uk)

Craigavon Area Hospital Group HSS Trust68 Lurgan RoadPortadownCraigavonBT63 5QQ(www.n-i.nhs.uk/cahgt)

Down Lisburn HSS TrustLisburn Health Centre25 Linenhall StreetLisburnBT28 1BH(www.dlt.n-i.nhs.uk)

Green Park HSS Trust20 Stockman's LaneBelfastBT9 7JB(www.greenpark.n-i.nhs.uk)

Mater Infirmorum Hospital HSS TrustCrumlin RoadBelfastBT14 6AB(www.n-i.nhs.uk/mater)

Ulster Community and HospitalsHSS Trust23-25 Regent StreetNewtownardsBT23 4AD(www.ucht.n-i.nhs.uk)

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Newry and Mourne HSS Trust5 Downshire PlaceNewryBT34 1DZ(www.n-i.nhs.uk/trusts/newry)

Northern Ireland AmbulanceService HSS TrustAmbulance Headquarters12/22 Linenhall StreetBelfastBT2 8BS(www.niamb.co.uk)

Royal Group of Hospitals and DentalHospital HSS Trust274 Grosvenor RoadBelfastBT12 6BP(www.royalhospitals.org)

Sperrin Lakeland HSS TrustStrathdene HouseTyrone and Fermanagh HospitalOmaghBT79 0NS(www.sperrin-lakeland.org)

Homefirst Community UnitThe Cottage5 Greenmount AvenueBallymenaCo AntrimBT43 6DA(www.homefirst.n-i.nhs.uk)

North and West Belfast HSS TrustGlendinning House6 Murray StreetBelfastBT1 6DP(www.nwbt.org.uk)

South and East Belfast HSS TrustTrust HeadquartersKnockbracken Healthcare Park31 Saintfield RoadBelfastBT8 8BH(www.sebt.n-i.nhs.uk)

Craigavon and Banbridge CommunityHSS TrustBannvale HouseMoyallen RoadGilfordBT63 5JX(www.n-i.nhs.uk/trusts/cbc)

Foyle HSS TrustRiverview HouseAbercorn RoadLondonderryBT48 6SA(www.foyletrust.org)

United Hospitals HSS TrustAntrim Area HospitalBush HouseAntrimBT41 2RL(www.unitedhospitals.org)

Local Councils

Antrim Borough CouncilThe SteepleSteeple HillAntrimBT41 1BJ(www.antrim.gov.uk)

Ards Borough Council2 Church StreetNewtownardsBT23 4AP(www.ards-council.gov.uk)

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Armagh City & District CouncilThe Palace DemesneArmaghBT60 4EL(www.armagh.gov.uk)

Ballymena Borough Council‘Ardeevin’80 Galgorm RoadBallymenaBT42 1AB(www.ballymena.gov.uk)

Ballymoney Borough CouncilRiada House14 Charles StreetBallymoneyBT53 6DZ(www.ballymoney.gov.uk)

Banbridge District CouncilCivic BuildingDownshire RoadBanbridgeBT32 3JY(www.banbridgedc.gov.uk)

Belfast City CouncilCity HallBelfastBT1 5GS(www.belfastcity.gov.uk)

Carrickfergus Borough CouncilTown HallJoymountCarrickfergusBT38 7DL(www.carrickfergus.org)

Castlereagh Borough CouncilCivic & Administrative OfficesBradford CourtUpper GalwallyBelfastBT8 6RB(www.castlereagh.gov.uk)

Coleraine Borough CouncilCloonavin60 Portstewart RoadColeraineBT52 1EY(www.colerainebc.gov.uk)

Cookstown District CouncilBurn RoadCookstownBT80 8DT(www.cookstown.gov.uk)

Craigavon Borough CouncilCivic CentrePO Box 66Lakeview RoadCraigavonBT64 1AL(www.craigavon.gov.uk)

Derry City CouncilCouncil Offices98 Strand RoadLondonderryBT48 9NN(www.derrycity.gov.uk)

Down District Council24 Strangford RoadDownpatrickBT30 6SR(www.downdc.gov.uk)

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Dungannon & South TyroneBorough CouncilCircular RoadDungannonBT71 6DT(www.dungannon.gov.uk)

Fermanagh District CouncilTown HallEnniskillenCo FermanaghBT74 7BA(www.fermanagh-online.com)

Larne Borough CouncilSmiley BuildingsVictoria RoadLarneBT40 1RU(www.larne.gov.uk)

Limavady Borough CouncilCouncil Offices7 Connell StreetLimavadyBT49 0EA(www.limavady.gov.uk)

Lisburn City CouncilIsland Civic CentreThe IslandLisburnBT27 4RL(www.lisburn.gov.uk)

Magherafelt District CouncilCouncil Offices50 Ballyronan RoadMagherafeltBT45 6EN(www.magherafelt.gov.uk)

Moyle District CouncilSheskburn House7 Mary StreetBallycastleBT54 6QH(www.moyle-council.org)

Newry & Mourne District CouncilMonaghan RowNewryBT35 8DJ(www.newryandmourne.gov.uk)

Newtownabbey Borough CouncilMossley MillCarnmoney Road NorthNewtownabbeyBT36 5QA(www.newtownabbey.gov.uk)

North Down Borough CouncilTown HallThe CastleBangorBT20 4BT(www.north-down.gov.uk)

Omagh District CouncilThe GrangeMountjoy RoadOmaghBT79 7BL(www.omagh.gov.uk)

Strabane District CouncilDerry RoadStrabaneBT82 8DY(www.strabanedc.com)

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Voluntary Organisations

Royal Society for the Preventionof Accidents (RoSPA)Nella HouseDargan CrescentBELFASTBT3 9JPTel: 028 9050 1161(www.rospa.com)

Home Accident PreventionNorthern Ireland (HAPNI)RoSPA OfficeNella HouseDargan CrescentBELFASTBT3 9JPTel: 028 9050 1160(www.rospa.com)

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REFERENCES

REFERENCES

1. Royal Society for the Prevention ofAccidents. Home Safety Factsheet.Available from:http://www.rospa.co.uk.

2. The Annual Report of the RegistrarGeneral. The Northern IrelandStatistics and Research Agency(NISRA) 2000.

3. Accident and Emergency Survey.Pricewaterhouse Coopers forDepartment of Health, SocialServices and Public Safety 2001.

4. “Towards a Primary Care Strategyfor Falls and Osteoporosis”. North& West Belfast Fall SupportProgramme Evaluation ReportMarch 2002.

5. Source: derived from theDepartment of Health, SocialServices and Public Safety. KornerAggregate Return KP22, 2000/01.

6. Roberts, I. et al. Childhood Injuries:extent of the problem,epidemiological trends, and costs.Injury Prevention 1998; 4(suppl):S10-S16.

7. Acheson, D.(Chairman).Independent Inquiry intoInequalities in Health Report.London: The Stationery Office, 1998.

8. Department of Trade and Industry.23rd Annual Report of the Homeand Leisure Accident SurveillanceSystem - 1999 data. London.March 2001.

9. Ginnety, P. The Health of Travellers.Belfast: Eastern Health and SocialServices Board, 1993.

10. Lucas P. Home visiting cansubstantially reduce childhoodinjury. What Works for ChildrenGroup Evidence Nugget 2003.

11. RoSPA research 2003 by MilwardBrown Ulster (following thePreventing Accidental ChildhoodPoisoning campaign).

12. An evaluation of the lifeskillsLearning for Living Programme,Oxford Evaluation Team for HSE2003 (Research report 2003).

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Published by: Department of Health, Social Services and Public Safety,Castle Buildings, Belfast BT4 3SQ

Telephone 028 9052 0534 Textphone (028) 9052 7668www.dhsspsni.gov.uk

November 2004

Ref: 184/04

Documents

HOME ACCIDENT PREVENTION - Injury Observatory