Preventing Paediatric Window Falls: A Collaborative Approach to Effecting National Building Code Change December 3, 2019 12:00 PM EST Dr. Michelle Simonelli and Mr. Bruce Schultz THIS WEBINAR IS BEING RECORDED. THE SLIDE DECK AND RECORDING WILL BE EMAILED AFTER THE WEBINAR. STAY IN THE LOOP! WWW .FALLSLOOP . COM WWW .JR.FALLSLOOP . COM
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Preventing Paediatric Window Falls: A Collaborative Approach to Effecting
National Building Code ChangeDecember 3, 2019 12:00 PM EST
Dr. Michelle Simonelli and Mr. Bruce Schultz
THIS WEBINAR IS BEING RECORDED.THE SLIDE DECK AND RECORDING WILL BE
A COLLABORATIVE APPROACH TO EFFECTING NATIONAL BUILDING CODE CHANGE
DR. MICHELLE SIMONELLI, MD, FRCPC
MR. BRUCE SCHULTZ, CODES OFFICER
Objectives
▪ Identifying The Problem
→ City of Calgary
▪ Collecting The Data:
→ Numbers
→ Injury Patterns
▪ Journey To Change The National Building Code
▪ Next Steps
▪ Building Partnerships Outside The Health Care/IP community
Identifying The Problem
▪ The Building Code is
less restrictive for
single and two family
houses than for
multifamily houses
▪ Window sills for
openable windows
can be at floor
level
Identifying The Problem
▪ Building Code not
treating similar
hazards the same
Identifying The Problem
Proposed Change to National Building Code
Existing Code with Proposed Change:5) Windows need not be protected in accordance with Sentence (4),
where the bottom edge of the openable portion of the window is
a) more than 900 mm above the finished floor, or the window serves a dwelling unit that is not located above another suite,
a) the window serves a house with a secondary suite,
b) the only opening greater than 100 mm by 380 mm is a horizontal opening at the top of the window,
c) the window sill is located more than 450 mm above the finished floor on one side of the window, or
d) the window is located in a room or space with the finished floor described in Clause (d) b) located less than 1 800 mm above the floor or ground on the other side of the window.
(See Note A-9.8.8.1.(4).)
Effectively:
▪ Openable window in a single or two
family residence to be the same as for
multi-family dwellings requiring:
• Guard
• Limiter (permanent)
• Minimum 900mm (35”) openable sill above floor OR
• Maximum 1800mm (70”) openable sill above grade
But Where’s the Data?: The Beginning of an Intra-Professional Alliance
▪ City of Calgary approached ACH Trauma Director
▪ Required data to demonstrate severity of problem
▪ Required assistance from the medical community to advocate for urgent change
Pediatric Injury in Canada: Leading Cause of Death
Canadian Pediatric Falls
▪ As with adults, falls are the leading cause of injury admissions & ED visits in Canadian children
▪ 42% of injury related hospitalizations
▪ 36% of injury related ED visits
Pediatric Window Falls
In 2016, 23% of ACH Major Trauma Patients were injured in a fall
➢ 56% of these falls were multi-storeyfalls from windows
▪ Why does it happen?
▪ How big is the problem nationally?
Problem Scope: National Data Sources
I. Canadian Institute for Health Information (CIHI)
➢National Ambulatory Care Reporting System (NACRS)
➢The Hospital Morbidity Database (HMD)
➢The Discharge Abstract Database (DAD)
II. Canadian Hospital Injury Reporting and Prevention Program (CHIRPP via PHAC)
CHIRPP
▪ 19 national CHIRPP ED sites
▪ Front of form collects descriptive data by pt
➢Date, location, sport/MVC (protective equipment), free text description of injury
➢Rich descriptive qualitative data
▪ Back of form injury data by HCP
➢Nature of injury, body part, disposition, follow up
▪ Entered into eCHIRPP database
▪ Site or nationwide queries
CIHI National Data: Pediatric Falls from Buildings
▪ Annually, 124 children ages 0-9 admitted for falls from buildings
▪ PQ: 31*
▪ BC:31
▪ ON:27
▪ AB: 14
▪ SK: 5
▪ MB: 5
▪ NS: 3
▪ NB:3
▪ NWT, NFLD, Nunavut: 1 each
National Pediatric Window Falls Ages 0-9 Years
▪ 70% of falls from buildings were falls from windows
▪ 20% of children seen in ED were admitted
Year ADMITTED AFTER
FALL FROM
BUILDING
EST. ADMITTED
AFTER FALL
FROM WINDOW
EST. ED VISITS
AFTER FALL FROM
WINDOW
2011 138 97 483
2012 120 84 420
2013 112 78 392
2014 124 87 434
2015 128 90 450
2016 120 84 420
TOTAL 742 520 2599
AVERAGE 124 87 433
Limitations of the Data
▪ Robustness of NACRS and DAD
▪ Provincial annual counts less than 5 are suppressed
▪ “Jurisdictions that choose to participate”
▪ NACRS & DAD data indicate Ontario has less 2 x the number of window falls of Alberta despite having 3.3 times the population
Limitations of the Data
Windows and Balconies Falls related Pediatric Injuries in Northern Alberta, Kundra M. and Craig, W.
Retrospective review & 2 year prospective study at Stollery 2009-2017
▪ 107 falls (15.2 per year) <17 yrs
▪ Mean age 5.14, Median age 4, Mean height 110.8cm
▪ 63.2% boys
▪ 55.7% fell in own home
▪ 50.5% through window screen
▪ Only 20% had sills higher than ‘knee height’
▪ 28.6% had furniture pushed up to the window
▪ 28.3% were admitted
Demographics of Pediatric Window Falls ACH
▪ 66% are 4 years of age or less
▪ 78% are 5 years of age or less
▪ Majority are boys
▪ Majority fall from their own homes
Admission Rates and Injury Patterns
▪ 28% admitted to Alberta Children’s Hospital or Stollery