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Global Injury Prevention and Safety Promotion

Global Injury Prevention and Safety Promotion. Catherine A. Lynch, MD Assistant Professor of EM and Global Health Co-Director, Section EM Global Health Eric Ossmann, MD Associate Professor of EM Director of Prehospital & Disaster Medicine. Overview. WHY INJURY Epidemiology

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Global Injury Prevention and Safety Promotion

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  1. Global Injury Prevention and Safety Promotion Catherine A. Lynch, MD Assistant Professor of EM and Global Health Co-Director, Section EM Global Health Eric Ossmann, MD Associate Professor of EM Director of Prehospital & Disaster Medicine

  2. Overview • WHY INJURY • Epidemiology • Why is risk increasing? • HOW? • Surveillance/Prevention/Public Policy • Prehospital/ Hospital Trauma care quality improvement • PROJECTS?

  3. Scope

  4. Scope of Injury: US Injury Deaths Compared to Other Leading Causes of Death for Persons Ages 1-44, United States, 2007* http://www.cdc.gov/injury/overview/leading_cod.

  5. Types of Injuries

  6. All Injury Deaths

  7. Burden (GBDI, 2010) • Preliminary findings (Lancet Nov 2012) • Injuries cause 5.1 million deaths and 12.1% DALY • All cause deaths 20% (CD 25%NCD 20%, Injuries 8%) • Transport (28%), Falls(10%) Drowning (7%) Fires(6.6%), Self Harm (17.4%) • RTI #8, Self Harm #13, Falls #22 cause of death • 35-45% of codes in come countries are “garbage codes” (Argentina) so these numbers can be much higher Injuries have a large and increasing health loss risk which is decreasing much less than other NCDs and CD

  8. Injury Types • Intentional • Self Directed • Suicide • Self Harm • Interpersonal Violence • Intimate Partner • Child Abuse • Elder Abuse • Collective Violence • War • Non-Intentional • Transport • Pedestrian • 4 wheel motorized (Dr/Pa) • 2 wheel motorized • 2 wheel non-motorized • Fall • Assault • GSW • Stabbing • Fist • Work related Injury • Bite (Human, Animal) • Poisoning

  9. Road Traffic Crashes • Road Traffic crashes in low and middle income countries cost approximately $65 billion per year • This is more than total dollar amount these countries receive in development assistance

  10. Global Status Report on Road Safety. Geneva, World Health Organization, 2009.

  11. Why? • Urbanization • Motorization • Limited Care • Limited Prevention • Road/vehicle conditions • Signage • Pedestrians/VRU • Legislation/Regulation

  12. Violence and Homicides

  13. SUMMARY, WHY INJURY: • >5 Million people die annually • 16,000 people die daily from injuries • Persons 15-44, injuries account for 6 of the 15 leading causes of death. • For each 1 that dies, thousands have permanent sequelae Krug EG, Sharma GK, Lozano R. The global burden of injuries. Am J Public Health 2000; 90 523-26

  14. RF for injury • Age • Sex • Race/ Ethnicities • Socioeconomic Groups • Alcohol/Drug • Vulnerable road users: • Pedestrian, 2 wheel motorized and non-motorized

  15. Development Issues • Disproportionate impact on the poorest • More exposed to risk • Less access to prevention and care • Disproportionate impact on young people • High economic costs • Care • Rehabilitation • Productivity

  16. Injury Prevention: PH Model

  17. Injury Prevention: Haddon Matrix

  18. Event

  19. Injury Prevention: Haddon Matrix

  20. Injury Prevention: Haddon Matrix

  21. Injury Prevention: Haddon Matrix

  22. Trauma Care System

  23. Republic of Mozambique “Traumas of various types, particularly those cause by road accidents, have reached epidemic proportions…” Strategic Plan for the Health Sector 2001-2005 Ministry of Health, Republic of Mozambique

  24. Republic of Mozambique • Maputo Central Hospital • 300+ patients per day • > 30% due to Injury • Road traffic crashes are the leading cause of death Maputo Central Hospital, Maputo, Mozambique

  25. Obstacles, Challenges and Risks • Medical Imperialism • Financial Considerations • Political, administrative, and regulatory • Cultural nuances and Language Razzak, JA and Kellermann AL. Emergency medical care in developing countries: is it worthwhile? Bulletin of the World Health Organization, 2002, 80 (11) Sasser SM, Varghese M, Joshipura M, Kellermann A. Preventing death and disability through the timely provision of prehospital trauma care. Bulletin of the World Health Organization, July 2006, 84 (7)

  26. Obstacle, Challenges, and Risks • Medical Education, System, Personnel • Capability and Capacity • Lack of data • Human resources Razzak, JA and Kellermann AL. Emergency medical care in developing countries: is it worthwhile? Bulletin of the World Health Organization, 2002, 80 (11) Anderson P, Petrino R, Halpern P, Tintinalli J. The globalization of emergency medicine and its importance for public health. Bulletin of the World Health Organization, October 2006, 84 (10)

  27. Developing Emergency Care Systems Guiding Principles

  28. Simplicity Emergency medical care systems need not be complicated and expensive. Much may be accomplished by providing simple but cost-effective treatment in a timely manner

  29. Sustainability Emergency medical care systems should rely on locally available supplies, equipment, training, and resources

  30. Practicality Implementation should not require overhaul of the country’s healthcare infrastructure

  31. Efficiency Design, implementation, and operation should enable emergency medical care systems to optimally utilize the resources available to them, no matter how scarce they may be

  32. Flexibility Emergency medical care systems should be adaptable to suit local conditions, values, norms, and economic resources

  33. Emergency Medical Care

  34. Prehospital Medical Care Estimate of world’s population covered by: • EMS at ALS level: 5 – 15% • EMS at BLS level: 20 – 35% • No formal EMS: 50 – 75% Mock, C. Improving Prehospital Trauma Care in Rural Areas of Low-Income Countries. Journal of Trauma-Injury Infection & Critical Care. 54(6):1197-1198, June 2003. International Approaches to Trauma Care. Trauma Quarterly, Vol. 14, No. 3, 1999.

  35. Improving prehospital care • Strengthen existing prehospital care systems • Organization/administration/quality • Logistics and operations • Deployment • Target high risk areas • Training and Education

  36. Sasser, et al. Assessment of Emergency Medical Services in Maputo, Mozambique. Prepared for the World Health Organization, 2005

  37. Making it Successful • Government support • Academic support • Provider support • Institutional support • Community support • Long-term commitment

  38. Current EM GH ProjectsHow to get involved?

  39. Tucumán, Argentina

  40. Tucumán, Argentina • Aim: Develop a evidence based provincial injury prevention initiative • Location: Tucumán, Argentina • Methods: • Community Based Qualitative** • Hospital Based Quantitative**

  41. Moshi, Tanzania

  42. Moshi, Tanzania

  43. Moshi, Tanzania Aim: To determine the burden of injury at KCMC and the increased risk of injury due to alcohol Location: KCMC, Moshi Tz Methods: Hospital Based Epidemiology • Healthcare worker KAP study • Self-survey • Nested case crossover

  44. Moshi, Tanzania Aim: To improve TBI acute care management Locations: KCMC, Moshi Tz Methods: • Systematic Review • Mediated Modeling* • TBI Protocol Evaluation*

  45. QUESTIONS?

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