Accidents & Injuries

This presentation has the following.
1. Definitions - accidents and injuries
2. The burden of accidents and injuries
3. Epidemiology of RTA, industrial accidents, railway accidents, violence, domestic violence, drowning, burns, domestic accidents, poisoning and snakebite.
4. Prevention and control of RTA, industrial accidents, railway accidents, violence, domestic violence, drowning, burns, domestic accidents, poisoning and snake bite.

2. Burden and Prevention of Domestic
injuries and RTA
Dr. Jayaramachandran S
Assistant Professor
Dept. of Community Medicine
MGMCRI

3. Definition –Accidents
•An unexpected unplanned occurrence which may involve injury
•Unpremeditated event resulting in recognizable damage
•Occurrence in a sequence of events which usually produces
unintended injury, death or property damage

4. Definition –Injuries
•A bodily lesion due to acute exposure to energy beyond the
physiological tolerance
•In some cases: due to insufficiency of a vital element
•Feeling of preventable nature

5. Burden
Mortality
•Proportional mortality rate
•No. of deaths / million population
•Death rate / 1000 vehicles per year
•No. of fatalities to no. of vehicles per km or no. of passengers per km
•Deaths of vehicle occupants per 1000 vehicles per year

6. Burden
Morbidity
•Measured : serious & slight injuries
•Assessed by abbreviated injury scale
•Less reliable because of under reporting and mis-reporting

7. Burden
Disability
•Can be temporary or permanent
•Usually only the duration is considered
•Psychological and social aspect is neglected
•International classification of impairments, disabilities and
handicapped

8. Problem –World
•2008 –RTA –4thleading cause of death
•9% of deaths & 16% of disabilities
•Major cause : 10 –24 yrs
•Unintentional : RTA, Poisoning, falls, fires, drowning, etc
•Intentional : self inflicted, violence, war

9. RTA trend

10. International fatality rates

11. Age wise distribution of RTA

12. Sex wise distribution of RTA

13. 78%
14.9%
2%1.8%
1.4%1%0.8%
Cause of Road Accidents in 2013
Fault of the Driver
All other causes
Fault of the Pedistrian
Defect in the condition of the
Motor vehicle
Defect in Road conditions
Unknown
Fault of the cyclist

15. Problem –India
•Accidents are definitely
increasing
•Increased mechanisation in
agriculture and industry
•Induction of semi-skilled and
unskilled workers
•Rapid increase in vehicular
traffic
•Over crowding
•Lack of awareness
•Poor implementation of safety
mechanism
•Causes –socio economic loss to
individuals, family, society and
country

16. Problem –India
•Traffic accidents
•Poisoning
•Sudden deaths
•Drowning
•Fire
•Natural calamity
•Falls
•Electrocution
•Explosions
•Fire arms
•Collapse of structures
•Factory / machine accidents
•Killed by animals
•Mines / quarry disaster
•Stampede
•Suffocation

17. Accidents & Injuries
1.Road traffic accidents
2.Industrial accidents
3.Railway accidents
4.Violence
5.Domestic accidents
•Drowning
•Burns
•Falls
•Poisoning
•Snake bite

18. 1. Road traffic accidents

19. 1. Road traffic accidents
•1.24 million die –world
•Every death
•10 –20 serious injuries
•20 –50 non fatal injuries
•< 25 yrs : 30 % deaths
•Males are more likely
•46% dying on road are
pedestrians, cyclists and
motorcyclists
•90% RTA deaths –low & middle
income countries
•Lower SES –in high income
countries are more involved

20. Risk factors for RTA

21. Risk factors for RTA
•Speed –directly related to impact
•Drunk and driving –< 0.04 g/dl
•Motorcycle helmets –reduces the severity of head injury
•Seat belts –reduces impact
•child restrains –reduces deaths by 70%
•Distracted driving –use of mobile phones, etc

22. Risk factors for RTA
•Low driving standards
•Widespread disregard of traffic rules
•Defective roads, poor lighting, defective roads and speed breakers
•Unusual behaviour of men & animals
•Pedestrian and animals share the roadways with slow & fast vehicle
•Old poorly maintained vehicles

23. Multiple causation
Human –90%
•Age
•Sex
•Education
•Medical conditions
•Fatigue
•Psychological factors
•Lack of body protection
Environment –10%
•Relating to road
•Relating to vehicle
•Bad weather
•Mixed traffic
Psychological factors
•Lack of experience
•Risk taking
•Impulsiveness
•Defective judgement
•Delay in decision
•Aggressiveness
•Poor perception
•Family dysfunction

24. Prevention of RTA
1.Data collection
2.Safety education
3.Promotion of safety measures
4.Alcohol and other drugs
5.Primary care
5.Elimination of causative
factors
6.Enforcement of laws
7.Rehabilitation services
8.Accident research

25. Health of vehicles should
be strictly enforced.
???
Prevention of RTA –Agent

26. Prevention of RTA –Host
•Road safety awareness from young age
•Raising of lower age limit to 21.
•Issue of Driving license is to be made more stringent and foolproof.
•Helmet should be made compulsory: Rider & Pillion
•Maintain distance between 2 vehicles
•Heavy Penalty -who cross speed limits
•Speed limits at accident prone areas & Cancellation of license
•Vision of old aged driving license holders should be tested periodically.
•License of drunkard drivers / riders should be cancelled immediately .

27. Prevention of RTA –Environment
•Roads should be properly
marked.
•Proper road maintenance
•Speed humps with proper signs
•Illumination and road markers
•Advertisements boards should
be installed at curves
•Signals for road crossings at
important busy places.
•Proper sign boards should be
installed.
•Footpaths and medians should
be made mandatory for
important roads.
•Zebra crossings should be
provided for pedestrians for safe
road crossings at appropriate
places.

28. 2. Industrial accidents

29. 2. Industrial accidents
•60 –80% : agriculture, fisheries, home industries, small scale units
•Majority of them work in unorganised sector
•1% of deaths & 10% of injuries : agriculture
•Agricultural workers are exposed to
•Physical –machines, sunlight
•Chemical –pesticides
•Biological –animal bites
•Agricultural injury : 116 / 1,00,000 workers
•Serious injuries –mechanised equipment & tractors

30. Industrial accidents
•Rapid industrialization –morbidity & mortality of many workers
•Manual labour content is high
•Man –machine interaction is unsafe
•Greater emphasis to change the behaviour of workers
•Children & people who are mentally and physically challenged are at
more risk of encountering occupational injuries

31. 3. Railway accidents

32. 3. Railway accidents
•Increase in the no. of trains and passengers –increase in the no. of
accidents and casualties
•The main factor involved in these accidents is human failure
•Ignorance of the public about various safety measures
•Violation of rules
•Unprotected crossing
•Impatience of the public

33. 4. Violence

34. 4. Violence
•World : 15,10,000 people died in 2008
•SEAR : 4,20,000
•Many go unreported or many don’t revel that its because of violence
•Violence behind closed doors goes grossly unreported
•Inspiteof low reporting, there is increase in the rate of violence
•Political and religious violence is more common

35. Violence –Risk Factors
•Exposure to violence
•Acceptance of violence as a mean to solve problem
•Availability of lethal weapons
•Consumption of alcohol and narcotic drugs

36. 5. Domestic accidents
•Drowning
•Burns
•Falls
•Poisoning
•Snake bites

37. Drowning

38. 5. Domestic accidents –Drowning
•Respiratory impairment from submersion / immersion into liquid
•One of the major public health problem
•3rdleading cause of unintentional death / injury
•96% –low & middle income countries
•High mortality rates
•Consciousness lost in 2 min, irreversible brain damage after 5 –6 min

39. Drowning –Risk Factors
•Age –under 5 years
•Gender –males
•Access to water
•Infant left unsupervised
•Unsafe or overcrowded transportation vessels with flotation devices
•Alcohol use
•Medical conditions –epilepsy
•Tourist unfamiliar with local water body risks

40. Drowning –Prevention
•Engineering methods
•Development and implementation of safe water supply / drainage system
•Four sides pool fence for water bodies
•Creating safe water zones for recreation
•Covering of wells
•Emptying buckets & bath tubs and storing them upside down
•Legislation to enforce prevention & assure decreased exposure
•Education for individuals and communities to build awareness risk and to aid in response if a drowning occurs

41. Burns

42. 5. Domestic accidents –Burns
•Injury to the skin or other organic tissue primary caused by heat or
due to radiation, radioactivity, electricity, friction or contact with
chemicals
•Thermal burns
•Hot liquids (scalds)
•Hot solids (contact burns)
•Flames (flame burns)

43. Burns –problem
•Estimated 1 million people are moderately or severlyburnt every year
in India.
•Non fatal burns –leading cause of morbidity, including prolonged
hospitalisation, disfigurement and disability, often with resulting
stigma and rejection

44. Risk Factors
•Gender –females
•Age –adult women, children (11thleading cause of death in children b/n 1-9 yrs& 5thMC cause of childhood injuries)
•Socio-economic factors –low & middle income countries
•Occupational exposure
•Poverty, overcrowding, lack of proper safety measures
•Placement of young girls in household roles

45. Burns –Risk Factors
•Underlying medical condition –epilepsy
•Alcohol abuse & smoking
•Easy access to chemicals
•Use of kerosene
•Inadequate safety measures for LPG and electricity

46. Burns –Prevention
•Hazards of specific burn injuries
•Education of vulnerable population
•Training of communities in first aid
•Multi-sectoral
•Increased efforts for implementation of safety measures

47. Burns –First Aid
Do’s
•Remove clothing & irrigation
•Use cool water for irrigation
•Roll on the ground
•Apply blanket
•Use fire extinguisher
•Chemical burns –water
•Wrap in clean cloth & transport
Don’ts
•Not ensuring your safety
•Not wearing gloves for chemicals
•Applying oil, turmeric, cotton
•Applying ice
•Prolonged cold water exposure
•Opening blisters
•Applying directly over wound

48. Falls

49. 5. Domestic accidents –Falls
•2ndleading cause of unintentional injury death after RTA
•80% fatal falls –low & middle income countries
•Death rates highest among adults > 60 years
•Children & young adults –largest no. of hospital visits
•Fall from rooftops, balcony, window , stairs –common
•SEAR –falling from coconut / palm tree, children fall from roof top
while playing kites, high incidence of falls among construction &
forestry workers

50. Falls –Risk Factors
•Occupation at elevated heights
•Alcohol / substance abuse
•Poverty
•Over crowding
•Young maternal age
•Neuro / cardiac condition
•Side effects of medication
•Physical inactivity
•Loss of balance, particularly among older people
•Unsafe environments
•Limited vision
•Poor balance
•Hazardous working condition

51. Falls –Prevention
Children:
•Multifaceted community programmes
•Engineering modification of nursery furniture, playground equipment
•Legislation for use of window guard

52. Falls –Prevention
Older individual:
•Screening the living environment / arrangements for risk of fall
•Clinical examination to identify risk factors
•Treatment of low blood pressure
•Vitamin D & calcium supplementation
•Treatment of visual impairment
•Home assessment & environmental modification for those at risk
•Prescription of appropriate assistive devices
•Muscle strengthening excercises

53. Poisoning

54. 5. Domestic accidents –Poisoning
•World –2,52,000 deaths (2008)
•India –28,012 deaths (2010)
•Most common agents : pesticides, kerosene, prescription drugs and
household chemicals
•Pesticides as widely used in places where agriculture is an important
part of the economy
•Organophosphorous, paraquetintoxication and kerosene

55. Snake Bite

56. 5. Domestic accidents –Snake Bite
•Neglected public health problem
•5 million snake bites each year
•2.5 million envenomation
•1,00,000 deaths
•MC in Asia, Africa and Latin America
•Africa : 1 million snake bites
•MC among children, women and farmers in poor rural communities in
low and ,middle income countries

57. Snake Bite –outcome
•Species of snake
•Area of the body bitten
•Amount of venom injected
•Health condition of the victim
•Feeling of tremor and panic are common
•Symptoms d/t ANS : tachycardia, nausea
•May trigger anaphylactic reaction
•Non venomous snake bite causing laceration might lead to infection

58. Snake Bite –toxin
Neurotoxin
•Respiratory paralysis
•Ptosis
•Dysphagia
•Diplopia
Cytolysis
•Tissue destruction by digestion
and haemorrhage d/t
haemolysis and destruction of
the endothelial lining of the
blood vessels.

59. Snake Bite –toxin
Cobras & almost all vipers
•Necrosis of muscle tissue
•Accumulation of myoglobin in
renal tubules
•Results in ARF
Rattle
•Local pain
•Redness
•Swelling
•Extravasation of blood
•Perioral tingling
•Metallic taste, nausea, vomiting
•Hypotension, coagulopathy

60. Signs of Envenomation
•Snake identified as dangerous one
•Rapid early extension of the swelling from the site of bite
•Early tender enlargement of lymph nodes
•Early systemic symptoms : collapse (hypotension, shock), nausea,
vomiting, diarrhoea, severe headache, heaviness of the eyelids,
inappropriate drowsiness and early ptosis
•Early spontaneous systemic bleeding
•Passage of dark brown / black urine

61. Snake bite –First Aid
•National snake bite protocol (2008)
•Reassure the patient
•Immobilise the bitten part
•Don’t give alcohol or stimulants
•Remove any tight clothing constricting the bitten part
•Do not incise or manipulate the bitten part
•Transport the patient for definitive treatment

62. Antivenom
•Neutralises the venom
•But can’t revert the damage done
•Antivenom should be administered asap after giving test dose and
taking blood for baseline parameters
•Patient may develop anaphylaxis. Those health care provider who can
tackle such emergencies only should administer antivenom
•If such health care institutions are absent, outweighing the risks
antivenom must be administered.