Frumkin, 2e Part 4: Environmental Health on the Local Scaleruby.fgcu.edu/courses/twimberley/EnviroHealthA/Frum22.pdf · Part 4: Environmental Health on the Local Scale Chapter 22:

Frumkin, 2ePart 4: Environmental Health on the Local ScaleChapter 22: Injuries

Injury

In cellular terms, injury is physical damage caused by the excessive transfer of energy or by the lack of essential factors for energy production, or for maintenance of homeostasis.

The combination of the strategies of prevention, acute care, and rehabilitation is termed injury control.

Injury Prevention and Control

Injury prevention and control follows 4 basic steps:

Define the health problem

Identify causes, risk factors, and protective factors associated with the problem

Develop and test interventions to reduce the problem’s impact, and

Implement successful interventions, evaluate their impact, and ensure widespread acceptance and implementation of prevention principles and strategies of control.

Defining the Problem

Injury control involves characterizing the distribution of injuries in given populations, quantifying the scope of an injury problem, monitoring patterns and trends, and evaluating the impact of countermeasures.

Several information sources may be used for this purpose, including hospital records, death certificates, etc.

Types of Injuries

The most widely used approach to classifying injuries is to divide them up by intent.

Purposefully inflicted injuries, or intentional injuries, including self-directed and interpersonal violence.

Unintentional injuries, on the other hand, include any accidental injuries that may occur.

Global Burden of Injury

Injuries are a significant cause of both morbidity and mortality throughout the world, ranking among the ten leading causes of death worldwide.

Injuries place a disproportionate burden on the world’s poor.

Men, young adults, children, parents of young children, and adolescents include some of the most injury prone groups.

The Injury Pyramid

Because, in general, nonfatal events greatly outnumber fatalities, the relationship among injury deaths, hospitalizations, and ED or office visits can be viewed as an injury pyramid.

The Injury Pyramid

Identifying Risk and Protective Factors

The second step of the public health approach calls for characterizing risk and protective factors associated with injuries.

In practice this is done through descriptive epidemiological studies. These studies characterize who is injured, what injuries are involved, and where, when, and, why particular injuries occur.

These data can also generate hypotheses for further investigation with analytical studies.

Developing and Testing Interventions

Once risk and protective factors have been investigated, interventions can be conceived, developed, and tested.

The Haddon Matrix is a particularly useful tool for managing this process of injury prevention and control.

Active Versus Passive Interventions

Most injury prevention strategies can be classified as either active or passive.

Active countermeasures require the conscious cooperation of the individual to be effective.

Examples include the use of manual safety belts, motorcycle helmets, child safety seats, etc.

Passive countermeasures require little or no cooperation by the person being protected. Examples include air bags in cars, sprinkler systems in public buildings, etc.

Three E’s of Injury Control

Education, enforcement of regulations, and engineering of physical structures

Educational interventions encourage the public to adopt safe behaviors and practices voluntarily.

Enforcement of laws and regulations may increase compliance when voluntary acceptance of an effective countermeasure is poor.

Combining education and enforcement usually works better than relying on either strategy alone.

Engineering solutions are the injury control strategy that draws most directly on the preventive paradigm of environmental health. Many injuries can be prevented by designing and building safety into products or environments.

Evaluating and Refining Interventions

Without continuing surveillance and other well-designed modes of program evaluation, it is difficult to assess which interventions have the greatest impact and likely should be reinforced and which have the least impact and likely should be changed or curtailed.

Intentional Injuries (Violence)

Violence is the intentional use of physical force or power, threatened or actual, against oneself, another person, or against a group or community that either results in or has a high likelihood of resulting in injury, death, psychological harm, mal-development or deprivation.

Nearly half of violence-related deaths in any given year are suicides, almost one-third are homicides, and about one-fifth are war related.

Protection against violence relies on education, firearms restrictions, and changing environments to make them less conducive to violence.

Burns

A burn occurs when some or all of the layers of the skin are destroyed by a hot liquid, a hot solid, or a flame. Burns can also be produced by exposure to ultraviolet radiation, radioactivity, electricity, and certain chemicals.

Burns cause hundreds of thousands of deaths and injuries worldwide, most typically occurring in homes.

Burn Countermeasures

Poisoning

A poison exposure is the ingestion of or contact with a substance that can produce toxic effects. Poisonings can be acute or chronic. Acute poisonings are classified as injuries.

Children are most often poisoned by accidentally ingesting dangerous chemicals, while adults are most often poisoned by accidentally by drugs.

Poison Countermeasures

Falls

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

There are two distinct at-risk populations for falls, children and the elderly.

Falls Countermeasures

Drowning

Drowning is fatal respiratory impairment from submersion or immersion in liquid.

People drown in floods, when being transported on water, and due to accidents in the home.

Among the various age groups, children under five years of age have the highest drowning mortality rates.

Drowning Countermeasures

The Workplace

Occupational injuries represent a considerable part of the injury burden on society, affecting people in the most productive years of their lives.

Occupational injuries cover a wide spectrum. They range from skin cuts to piercing wounds, burns, amputations, crush injuries, eye injuries, and chemical exposures.

Workplace Injuries Countermeasures

Playgrounds

In terms of Haddon’s approach, children are the host of playground injuries; the vector is often potential energy, in the form of gravity, as many playground injuries result from falls.

As children may not be supervised and cannot be relied on to generate active injury control themselves, the playground environment must be engineered with passive injury control in mind.

Roadways

Transportation injuries, especially those that occur on and near roadways, represent one of the leading categories of injuries worldwide.

For people under forty-four years of age, road traffic crashes are a leading cause of death and disability, second only to HIV/AIDS.

Transportation injuries are related to the way in which people use roadways, the ways the roads are designed, and the way vehicles are designed.

Countermeasures for Road Injuries

Home Injuries

The most common home injuries are falls, being struck or hit by an object (including intentional acts of violence), being cut, and overexertion injuries. Other home injuries include burns and scalds, poisoning, animal bites, and a host of less common types.

Countermeasures for Home Injuries