Dr.Rajkumar PatilAsstt. Prof., Community Medicine

AVMCH, Pondicherry

Accident

Unpremeditated events resulting in recognizable damage

Feeling of misfortune,unavoidable nature

Injury

A bodily lesion due to acute exposure to energy beyond the physiological tolerance.

In some cases injury is due to insufficiency of a vital element

Feeling of preventable nature

Leading contributor in global diseases

1990

1.Lower Rasp. Infec.2.Diarrhoea3.Prenatal condition4.Unipolar major depression5.IHD6.Stroke7.TB /HIV8.Measles9.Road traffic Injury10.Congenital

2020

1.IHD2.Major Depression3.Road Traffic Injury4.Stroke 5.COPD6.Lower Resp. Inf.7.TB8.Perinatal condition9.Diarrhea Diseases10.HIV

Types of Injuries and Global burden

Unintentional(3.5 million deaths,6.2% of total deaths)

Intentional(1.6 million deaths,2.8% of total deaths)

RTA(2.1%) Self inflicted(1.5%)

Falls(0.7%) Interpersonal violence(homicide)(1%)

Drowning(0.7%) War(0.3%)

Poisoning(0.6%)

Fires(0.5%)

Others(1.6%)

Injuries in SEA More than 25% deaths due to injuries occur in SEAR

Prioritization of injury problem in India RTA>Work related>Burns>Violence>Poisoning>Drowning

Injury related mortality rate in India 97 deaths/100,000 population

Epidemiology of Injuries

Injury as a disease

Pathologic condition

Host Agent Vector/vehicle

Inter-action

Malaria Human

Plasmodiumvivax

Mosquito Bite

Skull fracture

Human

Mechanical Energy

Motorcycle

Crash

Host factors

Age:15-44 yrs(50% mortality)

Sex: More in males

Education: Low educational status

Diseases: Defective vision,sudden illness,fatigue

Psychological factors:Inexperience,aggresiveness,defective judgement,Alcoholism,drugs,stress

Road Traffic Accidents(RTA) 90% of all RTA deaths occurs in low,middle income countries

Causes of RTA

1.Pedestrians and animals sharing common road 2.Fast and slow moving vehicles 3.Old,poorly maintained vehicles 4.Low driving standards 5.Overloaded vehicles 6.Disobey of traffic rules 7.Defective roads,speed breakers,poor street lighting 8.Unusual behaviour of men and animals

Prevention and control of RTA/RTI

1.Education regarding safety

“If accident is a disease,education is its vaccine”

2.Promotion of safety measures

Seat beltsSafety helmetsChildren on back seatsParking at a suitable placeLow beam headlightsAvoidance of mobile phonesDoor locksProper vehicle designAvoidance of alcohol and drugs

3.Elimination of causative factorso Marking of danger pointso Improvement of road conditionso Imposition of speed limit

4.Enforcement of lawso Medical fitness of drivero Alcohol conc. In blood (80 mg/100 ml limit in India)o Driving testo Seat belt wearingo Speed limito Helmetso Vehicle inspectiono Periodic examination of drivers

5.Emergency care serviceso Planning,organization and management of trauma treatment and emergency care serviceso Emergency care at the point of accident

Domestic Accidents

1.Drowning

• Most common cause of accidental deaths in Bangladesh and Maldives• 98000 lives lost (SEAR,2002)

Prevention and control of drowning

Availability of life jackets and flotation devices around pools & boats

Supervision of children by adults

Fencing of lakes and ponds

Creation of safety standards for public and private swimming pools

Ensuring availability of weather reports to fishermen and to those working on rivers and seas

2.Fire/Burn

184,000 deaths (SEAR,2002)

SEAR accounts for >50% of all fire related mortality

Risk factors Cooking on open fire Explosion of pressure stoves Instability of small stoves Use of open fires in winter Use of inflammable materials in house Use of fire crackers

Prevention and control of burns Stable stoves/lamps Replacement of pressure stoves with wick and gas stoves Installation of fire and smoke alrama Promotion of cold water for first aid and burns

3.Poisoning 95,000 death(SEAR,2002) Agents: pesticides,kerosene,prescription drugs, household chemicals

Prevention and control of poisoning

Restricting availability of hazardous pesticides Promotion of alternative non-chemical methods of pest control Safe packaging of pesticides,insecticides and other chemicals Dying kerosene blue and treating it with bittering agents Selling therapeutic drugs in child resistant containers Educating medical practitioners,health workers and community on effective antidotes to poisons common in community

                                                                    

                                                                   

                                                                   

4.Falls

Responsible for largest number of hospital visits for non-fatal injuries

Prevention and control of falls

1.Safer playground(Use of mud & sand surfaces instead of paved ones)2.Safer furniture & house designs3.Use of grills on windows4.Safer design of stairs,balconies and rooftops with railings and bars5.Safer working techniques for construction workers

5.Injuries from sharp objects6.Animal bites

Industrial accidents

200,000 deaths per year in SEARRisk factors Physical(Heat) Chemical(Pesticides) Biological(Animal bites)

4 “M”s Mechanical Injuries(Thressure) Manual labour Man machine interaction Mental condition

Prevention and control of industrial accidents Ensuring the cost effective protection measures Enforcing safety regulations and standards Creating awareness among workers

Intentional Injuries

1.6 million deaths(Globally-2002)390,000 deaths in SEAR66% suicides in 15-34 years age groupIntentional injuries require:

• Motivated person who injures• Suitable target• Suitable environment

Risk factors• Violence as a means to solve the problem• Lethal weapons availability• Alcohol and drug consumption• Political uninterest• Gender unequality• Depression

Prevention and control of violence Avoidance of risk factors

Prevention of Accidents and Injuries

1.Inter-sectoral coordination2.Reporting of all accidents3.Safety education4.Promotion of safety measures5.Alcohol and other drugs6.Primary care7.Enforcement of laws8.Rehabilitation services9.Accident research

extent types environment human behaviour evaluation of control measures