ACCIDENTS AND
INJURIES
Dr. PRACHETH R,
ASSISTANT PROFESSOR,
COMMUNITY MEDICINE,
YENEPOYA MEDICAL COLLEGE.
Outline
• Definition
• Measurement
• Problem statement
• Types of accidents
Road traffic accidents
Domestic accidents
Definition
• Unexpected, unplanned occurrence-injury
• WHO: unpremeditated event: recognizable damage
• Measurement:
Mortality: Proportional mortality rate, number of deaths
per million ,death rates /1000 vehicles
Morbidity: serious/ slight- Abbreviated Injury Scales
Disability: duration
Problem
• World:
4th leading cause
9% - deaths, 16%- disabilities
• India:
Mechanization, semi, unskilled workers, awareness, poor
implementation- safety
Low priority: policy makers
Road traffic accidents
• 1.3 million deaths-world, higher: young age
• <25: over 30% killed
• Half: vulnerable road users
• 90% deaths: low, middle income countries
• India:
 4.4 lakh accidents, Arunachal Pradesh
22.4% : two wheelers
Human factors
• Age, sex, education
• Medical conditions
• Fatigue
• Psychosocial:
Lack experience, risk taking, impulsiveness
Defective judgement, delay : decision, aggressiveness
• Lack of body protection
Helmets, safety belts
Environmental factors
• Road:
Defective, narrow roads
Defective lay-out: cross-roads
Poor lighting, lack of familiarity
• Vehicle:
Excessive speed, old vehicles, large number, overloaded
• Bad weather: inadequate law enforcement
• Mixed traffic ( slow, fast moving, pedestrians, animals)
Human
Environmental
Prevention
• Data collection:
Basic reporting system
Studies: risk factors, circumstances, chain of events
Police: investigate
Without: implementation not effective
• Safety education
Prevention
• Promote safety measures:
Seat belts, helmets
Leather boots: protect lower legs
Children: front seat ?
Door locks, proper vehicle design
• Alcohol: 50-80mg/100 ml.
• Barbiturates, canabis, amphetamines
Prevention
• Primary care:
Emergency care: accident site, transport, hospital
Accident Services Organization
Trauma care hospitals
• Eliminate causative factors:
Improve roads, speed limits, provision of fire guards,
marking danger points
Prevention
• Law enforcement:
 Driving tests, medical fitness, enforce speed limits, seat
belt, helmets, check blood alcohol conc, road side breath
test, periodic re-examination - over 55
• Rehabilitation services:
• Accident research:
Accidentology
Domestic accidents
• In home / immediate surroundings; not conncected-
vehicles/ traffic
Drowning
Burns
Poisoning
Falls
Injuries from sharp/ pointed instruments
Bites , injuries from other animals
Drowning
• Respiratory impairment from submersion/ immersion of
•
•
•
•
liquid
306,000 people died: drowning
Numbers exclude floods, boating, water transport
mishaps
3rd leading cause of unintentional injury
India : 43% of world’s drowning deaths
Risk factors
• Age: under 5 years
• Gender: males> females
• Access to water: fishing
• Others: infants unsupervised, unsafe/overcrowded
transport, alcohol use, unfamiliar with local water risks
Prevention
• Engineering methods to remove hazard
• Legislation to enforce prevention
• Education: individuals, communities
• Laws, regulations: safety checks transport, alcohol
• Engineering methods:
 Implement safe water systems: drainage systems, piped
water systems
Build four sided pool fences
Maintain safe water zones
Covering wells
Empty buckets , baths: store upside down.
Burns
• Definition: Injury to skin/ organic tissue: caused by heat,
radiation, electricity, friction or contact with chemicals
• Thermal: some/all cells in skin/tissues destroyed: hot
liquids, hot solids, flames
• Problem: 195,000 deaths annually, majority: low, middle
income countries, half: South East Asia
Risk factors
• Gender: females
• Age: children
• Socio-economic: low, middle income
• Other: occupations-exposure to fire, poverty,
overcrowding, medical conditions: epilepsy, alcohol,
smoking, inadequate safety measures for LPG
Prevention
• Address hazards for specific burn injuries, education:
vulnerable populations, train: first aid
• First aid: Do’s
Remove clothes, irrigate burns
Use cool running water: reduce temperature of burns
Roll on ground, blanket
Chemical burns: dilute chemical by irrigating large
volumes of water
Wrap in clean cloth/ sheet
Don’t’s
• Don’t start before ensure your safety
• Don’t apply: paste, oil, haldi
• No ice
• Not open blisters
• Not apply any matter directly to wound
• Avoid prolonged cooling with water.
Falls
• 424,000 fatal falls: every year. 2nd leading cause –
unintentional injuries after road traffic
• Over 80%: low, middle income countries
• Largest number –hospital visits: non fatal injuries
• Risk factors:
Occupations at elevated heights
Alcohol/substance use
Socio-economic factors
Underlying medical conditions: neurological/cardiac
Unsafe environment
Prevention
• Screen living environment: risk of falls
• Address clinical factors
• Environmental modification of homes
• Assistive devices: physical impairments
• Muscle strengthening/ balance training
• Education
Poisoning
• 252,000 deaths
• India: 28,012 deaths
• Srilanka: pesticides
• Accidental ingestion of kerosene
Snake bite
• Neglected issue
• 5 million snake bites each year
• 100,000 deaths
• Outcome: depends on species , area of body bitten,
amount of venom injected, health condition of victim
• Neurotoxic: respiratory paralysis
• Cytolytic: tissue destruction by digestion, heamorrhage
due to heamolysis
First aid
• National Snake Bite Protocol, 2007
Reassure
Immobilize like fractured limb
Remove clothes : constrict bitten limbs
Do not incise / manipulate bitten site
Transport to medical facility
Antivenom: IV, works by binding and neutralizing venom
enzymes
Other types of accidents
• Industrial accidents
• Railway accidents: 2010: 30,000 people died India. Main
factor: human failure
• Violence:
1,510,000 died : 2008. Accurate not available
Epidemiological pattern:
 Motivated person: injures, suitable environment
Risk factors for violence
• Societal acceptability of violence
• Availability of lethal weapons like fire arms
• Alcohol
• Violence due to wars, political unrests
Summary
THANK YOU 