Ch 2 - Injury Prevention - Scope of the Problem

Scope of the Problem

Death from injuries is a major health problem worldwide, resulting in more than 14,000 deaths daily ( Figure 2-1 ). In most countries, regardless of their level of development, injuries appear among the five leading causes of death. 4 Although causes of injury deaths vary little between countries, wide variability does exist between which causes have the greatest impact on specific age groups . Because of economic, social, and developmental issues, the cause of injury-related death varies from country to country and even region to region within the same country.

FIGURE 2-1 Worldwide Injury-Related Statistics, 2004
All figures compiled from World Health Organization data.

FIGURE 2-2 Distribution of global injury mortality by cause, 2000. (From World Health Organization: The Injury Chart Book, Geneva, 2002, WHO.)

For example, in low-income and middle-income countries of the western Pacific, the leading injury-related causes of death are road traffic injuries, drowning, and suicide, whereas in Africa the leading causes are road traffic injuries, war, and interpersonal violence. In high-income countries of the Americas, the leading cause of death among people between 15 and 29 years of age is road traffic injuries. In low-income and middle-income countries of the Americas, the leading cause is interpersonal violence for the same age group. 4 Figure 2-2 demonstrates that injury plays a leading role in the global burden of disease. In the United States, injuries are the fifth leading cause of death, accounting for more than 179,000 deaths annually 3 ( Figure 2-3 ). Injury is an especially serious problem for the youth of America as well as of most industrialized nations of the world. In the United States, injury kills more children and young adults than all diseases combined (over 32,000 in 2006). 3 Unfortunately, deaths from injury are only the tip of the iceberg. The “injury triangle” provides a more complete picture of the public health impact of injury ( Figure 2-4 ). In the United States in 2006, in addition to the 167,000 people who died from injury, another 1.9 million were hospitalized because of nonfatal injuries. Injury also resulted in more than 31 million emergency-department visits. 3 The impact can be further realized by examining the number of years of potential life lost (YPLL) as a result of injury. YPLL is calculated by subtracting age-at-death from a fixed age of the group under examination, usually 65 or 70 years or the life expectancy of the group. Injury unnecessarily kills or disables people of all ages, but it disproportionately affects children, youth, and young adults, especially in industrialized nations. Because injury is the leading killer of Americans between 1 and 44 years of age, it is responsible for more YPLL than any other cause. In 2006, injury stole an estimated 3.68 million years from its victims compared with 1.8 million years for cancer, even though cancer claims more lives than injury. 3 A third measure of injury severity can be demonstrated financially. The economics of injury are felt far beyond the patient and the immediate family. The cost of injury is spread across a wide spectrum.  All members of society feel the effect because the costs of injury are borne by federal and other agencies, private insurance programs that pass the expense on to other subscribers, and employers as well as the patient. As a result, everyone pays when an individual is seriously injured. Cost estimates for injury run as high as $ 325 billion annually, which includes the direct cost of medical care and indirect costs such as lost earnings. 6 Data from the World Health Organization (WHO) indicate that prevention activities are a good investment:

FIGURE 2-3 Ranking of Causes of Injury-Related Deaths by Age Groups, 2006 *Data not applicable or available Extracted from: National Vital Statistics System, National Center for Health Statistics, CDC, Office of Statistics and Programming, National Center for Injury Prevention and Control, CDC: Ranking of Causes of Injury-Related Deaths by Age Groups, 2006.

FIGURE 2-4 Injury triangle. (Data from the US Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Health Statistics. Injury in the United States 2007 Chartbook.)

Every US dollar invested in motorcycle helmets results in a $ 32 savings of medical costs.
Seatbelts decrease the risk of ejection and suffering serious or fatal injury by 40– 65%.
The toll of injury in terms of morbidity, mortality, and economic stress is excessive: Injuries have always been a threat to the public’s well-being, but until the mid-twentieth century, infectious diseases overshadowed the terrible contribution injury made to human morbidity and mortality. Public health’s success in other areas has left injury as a major public health concern, one that has been termed “the neglected epidemic.” 6 Society is calling on all segments of the medical community to increase its prevention activities. With more than 600,000 prehospital providers in the United States alone, EMS systems can make a tremendous contribution to community-based injury-prevention efforts. Injury in EMS Obtaining a clear picture of the impact of injury on the EMS provider is difficult because no single, national data-gathering process deals with the industry. Even determining how many providers are in the United States is only an estimate of 600,000 to 832,000. However, several studies and publications have sought to answer this question. EMS personnel are undoubtedly exposed to a wide variety of situations that can result in worker injury. They go where people are hurt and sick. Sometimes those scenes are unsecured, despite the best efforts of EMS personnel and law enforcement, because these scenes involve people in emotional and physical crisis. Even the very nature of the work presents opportunities for injury. Just driving to the scene can be hazardous. Lifting, exposure to environmental hazards and infectious diseases, and the stress of the job also present opportunities for injury. For the years 1992 through 1997, an estimated 12.7 fatalities occurred per 100,000 workers per year in EMS. 7 , 8 This compares with a national average fatality rate of 5.0 per 100,000 for all workers over the same period. More than 58% of those EMS fatalities involved ambulance crashes; 9% involved assault or homicide. As with fatalities, estimating nonfatal injury can be difficult as well. However, one serious, disabling injury requiring hospitalization per 31,616 dispatches has been documented among urban providers. 9 These numbers reveal a disturbing truth. “The most dangerous times for EMS personnel are when they are inside their truck when it is moving or when they are working at a crash scene near other moving vehicles.” 10 It is critical that EMS personnel know and understand the concepts of injury and injury prevention so that the risks inherent in EMS can be identified and corrected. From almost the first day of EMT education, students are taught that no one is more important at the scene than the EMT, so his or her safety must come first. Seat belt use in the ambulance is the first step of safety.