SEA/ INJURIES/A1
In S o u t h -E a s t A s i a R e g i o n
Priorities for Policy and Action World Health Organization
"We must multiply our efforts to prevent people from falling victim to road traffic collisions, interpersonal violence, the savagery of war and conflict, or harm they may inflict upon themselves. Over the past few years, national and world leaders have become aware of what health professionals long have argued: that stable and prosperous societies cannot be achieved without investing in health. As such, investments in injury and violence prevention are ultimately investments in health and development."
Dr. Gro Harlem Brundtland Director General of WHO
Contents 1. 2. 3. 4. 5. 6. 7. 8. 9. Message from the Regional Director Injury as a disease Injuries in the South-East Asia Region Injury is preventable Work safety Road safety Burns Poisoning Drowning 1 2 4 6 7 8 10 11 12 13 14 16 17 18 19 Copies of this document are available from: Disability/ Injury Prevention and Rehabilitation, World Health Organization, Regional Office for South-East Asia, Mahatama Gandhi Marg, New Delhi 110 002, India. http://w3.whosea.org/dpr/reports.htm © 2002 World Health Organization This document is not a formal publication of the WHO, and all rights are reserved by the WHO. The document may however, be freely reviewed, abstracted, quoted, reproduced or translated, in part or in whole, but not for sale or use in conjunction with commercial purposes. The views expressed in documents by named authors are solely the responsibility of those authors. This document has been prepared for the Unit of Disability/ Injury Prevention and Rehabilitation of Department of Sustainable Development and Healthy Environment at the South-East Asia Regional Office (SEARO), World Health Organization. This has been prepared by Dr. Dinesh Mohan, Professor, Transportation Research and Injury Prevention Programme, Indian Institute of Technology, Delhi, India and Dr. Mathew Varghese, Director, St. Stephen's Hospital, Delhi, India.
10. Falls 11. Violence 12. Reducing the consequences of injury 13. References 14. Resolution of the Regional Committee, WHO SEAR,1994 15. The way forward
Message from the Regional Director
Injury now ranks among the leading causes of morbidity and mortality world over. At least five million people die each year from injuries; almost 25% of these are from WHO’s South-East Asia Region. About half the deaths in the 10-24 years age group are due to injuries. And yet, despite these grim facts, most countries have not adopted measures to effectively prevent and control injuries. The World Health Organization has initiated action for concerted efforts in this Region. A foundation has been laid by the development of a regional strategy for injury prevention. As countries have shown a keen interest to enhance their efforts in preventing injuries, WHO has been working with them to develop a national policy framework. The Regional Office has been gathering information on the infrastructure and human resources available in Member Countries and investing WHO resources to enable them to deal with the high burden of injuries. Despite some positive developments, there are numerous challenges ahead, the industrialization and fast pace of life have brought new hazards and risks into this Region. While the pace of modernization can not be checked, adequate awareness needs to be created among people to enable them to recognize potential hazards that can lead to injury, disability and even death. While it is important to make roads, workplaces - factories or farms - safe, it is equally, if not more, important to ensure that the home is safe from injuries, since a large number of injuries, particularly because injuries involving women and children,take place at home.
Injury prevention often requires very simple and low-cost protective measures, but policy-makers and professionals do not know about these. It is important to widely disseminate information regarding injury prevention and about important action to be taken when an injury occurs. This information booklet is expected to generate interest among policy-makers and professionals in the prevention and control of injuries, to minimize loss of life and unnecessary suffering. The WHO Regional Office for South-East Asia will collaborate with national governments, international agencies and interested partners to reduce human suffering to maximum possible. Let us join hands to promote safety and injury prevention in the South-East Asia Region.
5 December 2002 New Delhi
Dr Uton Muchtar Rafei Regional Director
1
Injury as a disease It is always healthier to prevent injuries than to cure them In all other aspects of public health we do not depend solely on changing the behaviour of all concerned to control a disease. We will never be able to completely eliminate carelessness, absentmindedness and even neglect in any day-to-day activity. However, by designing our products and environment to be more tolerant of these normal variations in human performance, we can minimize the number of resulting deaths and injuries. Therefore, we have a social and moral responsibility to design our products, environment and laws so that people find it easy and convenient to behave in a safe manner, without sacrificing their need to earn a living and fulfil their societal obligations. The systems must be such that they are safe not only for "normal" people but for those individuals who may not be able to act in an ideal manner.
1. Injury is a disease resulting from an interaction of agent, host and environment. 2. Injuries are predictable, therefore preventable. 3. A multisectoral approach is more appropriate for injury prevention than behavioural modification alone. Injury has long been considered an "accident". It has been seen from a medicolegal and criminal perspective and not as a public health problem. Once a person enters a health system for treatment of an injury, only then is it considered a health problem. Injuries occur due to an acute transfer of energy between the human body and the environment around it. Therefore, injuries result from an interaction of the agent, host and environment like any other disease. (See Table 1), There are no basic scientific distinctions between injury and disease (1). While most countries have recognized the high burden of morbidity and mortality resulting from injuries, it is only recently that injuries have been recognized as a public health problem in many countries around the world. We should not stigmatize people for having a disease. This approach has helped us in controlling and eradicating a large number of diseases around the world. The same should be adopted now for dealing with injuries. Injuries when viewed from a criminal justice perspective alone, focus our attention on assigning blame on individuals, rather than changing the environment to promote safety. Once we are clear that injury control activities involve the same principles as any other public health problem, then we can put in place policies and programmes for institutionalizing safety promotion.
Table 1. Similarities between a communicable disease and injury.
Injuries are the predictable consequence of people's action within a risky environment, therefore, should not be regarded as "accidents".
2
"Safety is a fundamental right and an essential condition for the sustainable development of societies" (2) Box 1. Change in rank order of years of life lost for the 10 leading causes worldwide, 1990 -2020 (3).
Every day around the world almost 16 000 people die from injuries. 3
Injuries in South-East Asia Region The medical, social, economic and human cost of injuries and violence is overwhelming in the South East Asia Region of the WHO. Deaths, disabilities and hospitalizations due to injuries continue to increase in all countries. Injuries rank high as a cause of death and for years of life lost (Figures 1 and 2).Yet, injury prevention is not a priority in the public health agenda of the member countries.
Injuries are a leading cause of death in the working age group.
Figure 1. Ranking of injuries among all leading causes of death in the South-East Asia Region, 2001 Estimates (4).
Figure 2. Years of life (million) lost in India for individuals older than 4 years, 1994.
Source: Estimate based on statistics on medical certification of cause of death, Registrar General of India (5).
The traditional view of injuries as “accidents” has resulted in the neglect of this area of public health. 4
Of the 5.1 million deaths from injuries globally, more than a quarter are estimated to occur in the countries of the SEA Region (4). In fact, road traffic injuries alone were ranked as the primary cause of disease among children in the age group of 5 to 14 years, and the third leading cause among people between the age of 15 to 29 years in 2000. It is an irony that thousands of children saved from nutritional and infectious diseases were killed or maimed by injuries. Over a period, such a heavy burden can have a major impact on the quality of life and economy of nations. Injuries can occur everywhere, on the road, at home, at work, at public places or during recreational and leisure time activities. At a recent intercountry consultation on injury prevention and control, experts and programme managers from the countries of the SEA Region identified road traffic injuries as the most common injuries in all countries except DPR Korea and Maldives (6).
Table 2. Prioritization of Injury Problem in the Member Countries of the WHO South-East Asia Region (1 = highest priority, 7 = lowest priority)
Source: (6)
Injuries: some regional concerns:
· The impact of socioeconomic loss to individuals, families, society and infrastructure is very high;
· There is a universal lack of reliable data for analysis of injury problems; · Injuries are low in priority for policy-makers; · Only a few countries have developed plans for injury prevention;
Government funding of injury prevention programmes are minimal when compared with funds for other comparable health problems. 5
Injury is Preventable down the incidence of electrocution and fires at home. Childproof medicine bottles and blister packs have saved thousands of children from poisoning. Sand or mudpacked playgrounds are safer to play on than brick paved ones. Pads and helmets save sportsmen from serious injuries. Traffic injuries have been brought down significantly in many countries around the world with safer design of roads, use of seat belts and helmets, and control of speeds. However, in the context of SouthEast Asia, the sad reality is that several of these measures are not often in place. Therefore, we must apply such measures through appropriate adaptation and innovation.
"Injuries have causes -- they don't simply befall us from fate or bad luck. To prevent injuries it is necessary to have information about the factors that contribute to their occurrence. With this information we may understand the options for prevention. Effective injur y prevention requires a multifaceted, multidisciplinary approach" (8) Injuries are now recognized to have resulted from a complex interaction of sociological, psychological, physical and technological phenomena. This understanding of injuries has helped us design safer products, environments, roads and traffic management systems. Once we accept that injury control is a public health problem, it becomes our ethical responsibility to arrange for the safety of individuals. This, in turn, makes it possible to initiate a scientific policy for injury control and safety promotion. Injury can be prevented by reducing the probability of energy exchange between human beings and their surroundings. This is done by lowering the amount of energy available (e.g. speed limits), reducing the amount of energy transferred (e.g. cushioning provided by sand in playgrounds, use of helmets and seatbelts, cushioning impacts), and physical separation of the energy source from human beings (e.g. insulation on electric wires). Workers' deaths in coalmines and factories were commonplace events about a hundred years ago. Now such occurrences have become a rarity in modern work places. The addition of smell to odourless cooking gas warns users of leaks and prevents tragedies. The invention of the simple "safety pin" has reduced skin punctures among millions. Better-insulated wires and circuit breakers have brought 6
Injury prevention goes beyond identifying the problem and educating the community towards designing safer products and environment.
Work Safety "The prevention of accidents, improvement of working conditions and enforcement of standards are often seen as a cost to business. Little is known about the costs of not preventing accidents or poor working conditions, or of the benefits of improvements for productivity and competitiveness." International Labour Organisation (9) provide automatic protection are ignored. Children and people who are challenged physically as well as mentally are at a greater risk of encountering occupational injuries. Adopting the following strategies could reduce death and disability due to occupational injuries:
There are approximately 580 million workers in the South-East Asia Region. Approximately 60-80 per cent of these workers are employed in agriculture, fisheries, home industries and small-scale units. Injuries due to these occupations result in an estimated 120 million injuries and 200 000 deaths per year. Though reliable estimates for work related injuries and deaths in the Region are not available, partly because a majority of the workers are employed in unorganized sectors, few studies indicate that nearly one per cent of deaths and 10 per cent of permanent impairment result from agricultural injuries.(7) In the rural areas of northern India, agricultural injuries were found to constitute 27 per cent of all injuries. Of these, the serious injuries were caused by mechanized equipment and tractors (10;11). Reports also suggest that other occupations, involving a significant amount of manual labour, such as building construction, and manufacturing can also be very hazardous (12). The unique features common to the workplace in this Region are that the manual labour content is high and the man–machine interaction is unsafe. In addition, there is greater emphasis on attempts to change the worker's behaviour, but designs that
· Creating · · · · ·
awareness among policy–makers on the possibility of introducing economically effective safety measures; Ensuring built in and cost-effective protection measures; Sensitizing workers' organizations for their right to safety and the implication of injuries in their lives; Establishing surveillance and research on occupational injuries; Enforcing safety regulations and standards; and Introducing no-fault insurance schemes for all workers in the formal and informal sectors.
Children are more at risk at the work place than adults. 7
Road Safety Road traffic injuries and deaths have emerged as serious causes for concern in most countries of the South-East Asia Region (6). In the last three decades, the incidence of traffic crash fatalities and injuries has been reduced significantly in the high-income countries but not in this Region. The global burden of disease due to road traffic injuries is expected to move from the ninth position in 1990 to the third position in 2020 (3). Road traffic injuries are among the second to the sixth leading causes of death in the age groups 15 - 60 years (4). Recent estimates of national economic loss due to road traffic injuries show that these range from 1 - 2 per cent of the GDP of nations around the world (13). In countries of the SEA Region, most victims of road traffic crashes face some special problems. These include (14):
Measures that need to be adopted to enhance road safety include: Policy Measures · Establishment of road safety departments by national governments to build capacity at national and local levels to monitor the magnitude, severity and burden of road traffic collisions and injuries; · Setting up of safety standards for motor vehicles in consonance with international practice; · Setting up of research groups to focus on road safety; · Training of road safety professionals. Law and enforcement · Compulsory use of seat belt by car users; · Making it mandatory for children to ride in back seats only; · Mandatory helmet use by two-wheeler riders; · Daytime headlamp use by motorcyclists.
· Reallocation whole family;
of labour of family members and reduced productivity of the
· Permanent loss of job for the victim even if he/she survives; · Loss of land, personal savings, household goods; · Poor health and educational attainment of surviving members. Such losses have an adverse impact on the well being of our societies. However, none of the above issues is taken into consideration in the standard economic calculations done for estimating the cost of road crashes in poor societies. Research has revealed that in the countries of the SEA Region, the vulnerable road users, including pedestrians, bicyclists and motorized two-wheeler riders, sustain a vast majority of fatalities and injuries due to road traffic crashes (15). Unless we ensure the safety of these vulnerable road users, we will not be able to make any significant reduction in the health burden of road traffic injuries. Therefore, exposure control, intelligent separation of non-motorized traffic on major roads, safer vehicle designs, speed control and use of helmets by two wheelers are likely to play a much more important role.
· Designing roads and highways with special attention to the needs of vulnerable · · road users and promotion of traffic calming techniques; Earmarking separate lanes for bicyclists; Use of conspicuous colours (yellow) and reflectors by bicycles and other small and slow vehicles;
Environment Change
The safety of pedestrians, bicyclists and motor cyclists is essential for reducing road traffic fatalities in South-East Asian countries. 8
Education · Pedestrians educated to walk facing traffic in the absence of sidewalks.
Figure 3. Road traffic fatalities in countries of the SEA Region.
Figure 4. Distribution of fatalities by road user type.
Source: References (13;16;17)
Source: References (17-21)
An independent traffic safety agency is essential for promoting road safety. 9
Burns An estimated two-thirds of the global burden of burn mortality among females was from South-East Asia.
An estimated 128 000 persons died of burn injuries in countries of the SEA Region in 2000 (6). This burden accounts for more than half of the global burden of fire related burns. In fact, two-thirds of the global burden of fire-related burns among females was estimated to have occurred in South-East Asia. Burns often rank as another major source of morbidity and mortality after traffic injuries, falls and drowning. The majority of burns occur at home. The risk factors associated with burns include cooking on open fires, explosion of pressure stoves, instability of small stoves, use of open fires to keep warm during winters and use of inflammable materials in housing and furnishings. Housing and clothing fires are the most severe events but not as frequent as scalds (22). Use of fireworks during festivals and celebrations is common in countries of the SEA Region and result in a significant number of injuries (23). The impact of burns, especially severe ones, is worse in the Region compared to that in high-income countries because of infections and lack of adequate physiotherapy. Therefore, prevention and adequate treatment of burns must be an important part of injury control activities. Burns could be prevented by:
· Introduction of more stable stands for lamps and stoves; · Replacement of pressure-cooking stoves with more efficient wick and gas stoves; · Fire drills for evacuation from large buildings and public places; · Installation of fire and smoke alarms in public buildings; · Ban on use of dangerous fireworks and encouraging public displays rather · · · 10
Fatalities due to fire-related burns in countries of the SEA Region, 2000 estimates Disability adjusted life years (DALYs) lost
128 000 5 630 000
than private use; Temperature regulation (less than 54°C) in water heaters; Greater use of flame retardant fabrics and materials; and Promoting use of cold water for first aid of burns.
Application of cold water is the best first aid for burns.
Poisoning Poisoning is responsible for an estimated 82 000 fatalities in countries of the SEA Region (6). The most common agents responsible for poisoning are pesticides, kerosene, prescription drugs and household chemicals. Pesticides are widely used in many countries where agriculture is an important part of the economy. Reports from India, Indonesia, Sri Lanka and Thailand indicate that common availability and use of toxic pesticides is responsible for intentional and unintentional morbidity and mortality (24-27) . In Sri Lanka, pesticides are one of the main agents used in attempted suicide in rural areas. The use of organophosphorous insecticides in suicide events has been reported to be as high as 20-30 per cent. Paraquat intoxication is known to cause irreversible damage in patients (28). Many countries also report accidental ingestion of kerosene as a leading cause of poisoning, especially among children (29). A study from Thailand revealed that 54 per cent of cases of poisoning among pre-school children involved therapeutic drugs (24). Measures to control poisoning in countries of the SEA Region:
Establish poison control centers, restrict availability of most hazardous pesticides, add bittering agents and colour to kerosene.
· Restricting availability of the most hazardous pesticides; · Promoting alternative non-chemical methods of pest control; · Packaging pesticides and insecticides safely, making it difficult to ingest these · · · · chemicals accidentally or intentionally; Dying kerosene blue and treating it with bittering agents to distinguish it from edible drinks; Selling therapeutic drugs only in blister packs or child resistant containers; Educating medical practitioners, health workers and the community on effective antidotes to poisons common in the community; and Improving mental health and introducing stress management in the community.
Fatalities due to poisoning in countries of the SEA Region, 2000 estimates Disability adjusted life years (DALYs) lost accounted for poisoning
82 000 2 399 000
Pesticides are the most common form of fatal poisoning in South-East Asia. 11
Drowning Local studies and reports from the countries of the SEA Region indicate that drowning is also one of the causes of deaths and injury in the Region. Bangladesh and Maldives have identified drowning as the most common cause of accidental deaths. Deaths due to drowning were reported to account for about 10 to 25 per cent of child deaths during 1983-1995 in Bangladesh and for more than 80 per cent of all injury-related deaths in this age group (30). India reported more than 22 000 drowning fatalities in 1999 (16). A hospital-based study from Thailand reports that 35 per cent of the injury-related deaths among children were due to drowning (31). Most of the drowning related deaths take place in ponds, rivers, or the ocean, or during floods and cyclones. Very few of them are swimming poolrelated. In Bangladesh, since water transport is used more frequently because of the need to cross-waterways in the delta region, there are frequent reports of boats capsizing with passengers and vehicles on board. Victims of drowning have a very slim chance of survival after immersion. The victim loses consciousness after approximately 2 minutes of immersion and irreversible brain damage can take place after 4-6 minutes. Therefore, prevention strategies are more important. Very few preventive strategies have proven to be effective except in the case of fencing around private pools (32). Measures to reduce drowning related deaths:
· Creation of safety standards for public and private swimming pools. · Ensuring availability of weather reports to fishermen and others working rivers and seas.
on
· Development of strategies to ensure effective inspection and certification systems · · for safe surface transportation on water. Sensitization of policy-makers and community leaders for availability of life jackets, floatation devices around pools, and in boats and barges; Evaluation of the effectiveness of safety in water: these could be encouragement of adult supervision of children, swimming instruction, training of lifeguards, and fencing of deeper parts of lakes and ponds.
Fatalities due to drowning in the SEAR countries, 2000 estimates Disability adjusted life years (DALYs) lost accounting for drowning
97 000 2 752 000
Young children should receive constant supervision by an adult while in and around water. 12
Falls
Falls are responsible for the largest number of hospital visits for non-fatal injuries, especially for children and young adults, in many countries of the Region. Falls from rooftops, balconies, windows and staircases are still common here. Factors specific to the Region are: falls from trees of workers picking fruit or coconuts, tapping toddy; children falling from rooftops while flying kites, high incidence of falls among construction and forestry workers. As life expectancy increases in these countries, the incidence of hip and other fractures due to falls among the elderly are also assuming greater proportions. Some measures that could be taken to control injuries due to falls:
· Safer · · · · · ·
playground design including use of mud and sand surfaces instead of hazardous paved ones; Enactment of safety regulations for playgrounds; Guidelines and standards for safer walkers, chairs and other furniture for children; Sensitization of architects, builders and masons for safer designs of stairs, balconies and rooftops with appropriate railings, grab-bars and landings. Publicizing safety standards for grills on windows. Safer furniture and household design guidelines for the elderly and disabled; Encouragement / evolution of safer working techniques and harnesses for construction workers and window cleaners who work at heights and tree climbers.
Fatalities due to falls in the SEAR countries, 2000 estimates Disability adjusted life years (DALYs) lost
39 000 5 085 000
A two metre fall on to concrete can cause a serious head injury. 13
Violence in prevention by recognizing early risk factors for violent behaviour in their patients and providing for referrals to appropriate sources and advocacy for early intervention (36). Suicides An estimated 317 000 persons died in 2000 due to violence or intentional injuries - homicide, suicide and war - in countries of the SEA Region. None of the countries are able to provide accurate statistics, since not all those injured go to hospital or state that the injury is because of violence and not all cases go to police either (33). For example, violence behind closed doors such as child abuse and neglect, violence against intimate partners, and elderly abuse are grossly unreported (34). World Report on Violence and Health extensively reviews available evidences on several categories of violence available in the public domain. The report suggests several action measures to tackle violence as a public health problem (34). Like in the case of any other public health problem, attempts have been made to understand the morbidity and mortality of interpersonal and self-directed violence epidemiologically. However, this approach needs to analyse the role of political rivalries, ethnic conflict and social relations, and the social structure on violence more extensively. Prevention strategies for violence have to be multi-targeted. An intentional injury to be committed requires: The methods used for committing suicides vary among communities depending on the availability and the situation. These could vary from consuming poisons (pesticides or drugs), hanging, setting oneself aflame or jumping from heights. Suicides are also committed through imitation. The question of imitative behaviour is at the heart of suicide clusters (37;38). Imitation is a grave enough possibility, therefore news of suicides should not be dramatized. Neither the details of the method of suicide should be publicized, nor should the victims be portrayed as heroes or martyrs. Prevention strategies for suicides may include the following:
· School · ·
· A motivated person who injures; · A suitable target; · A suitable environment or the absence of a guardian. All coinciding in time and space, that is, in a critical situation (35). Often it may only be possible to initiate steps for prevention after an episode of violence has already taken place. Such a strategy is called post-vention. Health professionals are involved in the health consequences of violence. Therefore, they can help in reducing the consequences of violence by determining its epidemiology and help in its prevention. Primary care physicians have a clear role 14
· ·
and college based programmes for educating administrators, faculty, students and parents about warning signs of suicide and about available resources for help; Hospital-based programmes for patients who have attempted to commit suicide; phone-in help-lines or hotlines for crisis management; Reduce the availability of means of suicide and prompt treatment of attempted suicides. In Sri Lanka and India, one of the common methods of committing suicide is by consuming pesticides. Therefore, the supply of more toxic pesticides should be restricted and the possibility of consumption be minimized by safer packaging; Determining the risk factors associated with suicide in different locations and attempts to control the same, e.g. alcohol and substance abuse, violence directed against women and children; Collaboration of individuals in public health, mental health, medicine, education, and social services to develop violence control community programmes.
Suicide reporting in media should not dramatize the event or glorify the victim.
Homicide: The issue of violence in society is very complex, however, some successes have been reported by individual/community interventions to control it. Some of the risk factors for homicidal behaviour are:
In the South-East Asia region almost 900 people die every day from violence. · Promoting · ·
· Exposure to violence and societal acceptability of violence as a means to solve problems. The image of violence as an acceptable and effective tool for solving problems, whether across international borders, on the street, or around the home, may spill over into real behaviour (39). Availability of lethal weapons like fire-arms significantly increases the possibility of both fatal and non-fatal injuries; Consumption of alcohol and other drugs is linked to almost 2/3 of cases of violence according to several studies. A number of assaults and murders can be attributed to the effort by one person to steal drugs or money from a drug dealer (40).
· ·
Interventions to prevent injuries due to violence: Some societies have used very innovative methods to control the spread of violence. In Mumbai, India for example at the time of inter-religious riots, some police officers involved community leaders to maintain peace in their neighbourhoods. Lessons need to be learnt from such interventions and shared across communities. However, there are no clear-cut solutions. Some general guidelines may be considered.
· · · · ·
gender and social equality both through social and educational policies. Teaching women survival tactics; Collaboration between different agencies that deal with violence and its consequences. The criminal justice system that investigates and prosecutes criminals, the hospitals that treat the victims and the security services all need towork together to reduce the consequences of violence on a victim. Reduction in the availability of firearms is one of the most effective methods. Social justice and empowerment of weaker sections. Promoting non-violent methods of arbitration to resolve conflicts at all levels possible. Promoting and monitoring adherence to international treaties, laws and human rights mechanisms. Seeking practical, internationally agreed responses to the global drugs trade and the global arms trade. Figure 5. Estimate of lives lost due to violence in the countries of the SEA region in 2000.
· Control of alcohol and drugs; · Appropriate documentation of violence in health institutions; · Improving the care to victims of violence with adequate · The
sensitivity and
coordination; police should be trained to recognize social problems likely to lead to violence at home, perform training interviews and refer the parties to an appropriate agency;
World Report on Violence and Health extensively reviews evidences on Violence and Health. Source: Reference (4)
15
Reducing the Consequences of Injury The consequences of injury can be minimized by providing life sustaining care soon after injury. Bystander care of the injured with available materials and safe transportation to a definitive care facility may help protect limbs and lives. A recent systematic review of pre-hospital trauma care did not find evidence on the effectiveness of some frequently used interventions in pre-hospital care (41). Therefore, a careful attention is required while piloting pre-hospital trauma care programmes. Early and safe transportation of the injured to a definitive care centre is one of the key components of reducing the consequences of injury. In most countries of the South-East Asia Region only a few of the injured are transported by the ambulance services available. Safe transportation of the injured in an available, comfortable vehicle may help save lives / limbs in the injured. Managing the transportation of victims to the hospitals may be of no use when emergency and trauma care facilities and personnel are not equipped to manage trauma victims. Therefore, trauma care facilities in hospitals need improvement to provide comprehensive care including for the serious and multiple injured. The primary health care system can play a very important role in the prevention and control of injuries. Health centres can also collect data on injuries and highlight the most prevalent problems. However, the most important role of the health care providers could be in the popularization of the latest scientific knowledge regarding first-aid and immediate care methods. Most immediate care methods are easy to teach and do not require medicines or specialized equipment. Of all the materials available for first aid, water is the most useful for several types of injuries.
Current policies and principles for safety may need urgent revision to tackle hazards from new technologies. Water: The Best Medicine In a large number of situations you just need water to take immediate care of the injured before taking them to a doctor
· Burns: Immerse the burnt part immediately in cold water or pour water on the burnt area for at least 15-20 minutes until the pain subsides. Reason: This is the best way to reduce the heat and subsequent harm to the tissues with a lot of cold water.
· Chemical on the skin: Flush the areas of contact with plenty of water to wash off the chemical. Reason: This dilutes the chemicals and removes it from the skin at the same time.
· Foreign body in the eye: Tears may wash away the foreign body.
Pour clean water or saline solution gently over the open eye. Opening the eye gently under running water is also effective. Reason: By this method the foreign body is not pressed into the soft tissue of the eye.
· Poisoning: Have the patient drink one or two glasses of water or milk. Consult a doctor immediately for an antidote. Reason: The liquid dilutes the poison in the stomach and slows its introduction into the blood stream. Warning: Do not induce vomiting in case of ingestion of acids, dye, drain-cleaner, kerosene, petrol, and chemical solvents.
· Small cuts and bruises: Wash with mild soap and water.
Apply direct pressure until bleeding stops. Reason: Washing removes foreign bodies and pressure closes up the capillaries.
· Sprains: Immerse the sprained joint in ice-cold water for about 30 minutes. Reason: In sprains, there is internal bleeding. Lowering the temperature reduces the bleeding. 16
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Resolution of the Regional Committee, WHO South-East Asia Region, 1994 SEA/RC47/R3 ACCIDENT PREVENTION AND TRAUMA CARE MANAGEMENT The Regional Committee, Having considered the paper on the subject of accident prevention and trauma care management (SEA/RF47/22), Recognizing that accident injuries in the South-East Asia Region are among the five highest causes of mortality and result in a greater number of years lost than almost any other disease, Reaffirming WHO's global goal that, by 1995, at least 60 percent of the countries of the world should have assessed the magnitude and determinants of domestic and traffic accidents in their populations on the basis of epidemiological studies and that 50 percent of the countries should have developed national policies and programmes for accident prevention, 1.STRESSES the need for the Health Information Service to collect data on accidents and injuries; 2.URGES Member States: (a) to consider setting up trauma and care and management facilities; (b) to introduce legislation, where required, and to intensify efforts to enforce the safety laws, and (c) to improve community awareness programmes by using effective communication techniques to popularize safe practices, and 3.REQUESTS the Regional Director to enhance support to Member States in planning and implementing their strategies and programmes for trauma care and management as well as prevention of accidents. Handbook 4.9(New)Page 35 18
Eighth Meeting,29 August 1994 SEA/RC47/Min.8
The Way Forward Every country should:
· · · · · · · · · · · · ·
Develop and announce a national injury prevention programme and policy; Establish national resource and research centres on injury prevention and safety promotion; Establish injury surveillance systems and identify priorities for action and research; Review existing legislation and safety standards in all injury prevention areas; Improve pre-hospital care systems at all levels and institute training and educational programmes for trauma care specialists; Publicize scientific knowledge for proper first aid and treatment of injuries; Establish injury prevention departments/centres at selected institutions; Establish a high-powered national road safety department and promote proven road safety measures immediately (for example helmet and seat belt use, speed control, daytime head lamp use by motorcyclists, traffic calming, etc.); Institute special programmes for safety of workers in the unorganized sector, with special emphasis on agricultural occupations; Establish standards for use of fire resistant materials in public places and publicize use of cold water on burns; Establish poison control centres, restrict availability of most hazardous pesticides, add bittering agents and colour to kerosene; Develop safety standards and improve monitoring systems for water transport and public water recreation facilities; Develop safe community programmes for violence control and injury prevention. 19
SOUTH-EAST ASIA REGION DPR KOREA
NEPAL BHUTAN INDIA BANGLADESH MYANMAR
THAILAND
SRI LANKA MALDIVES
INDONESIA
The boundaries shown on the map do not imply official endorsement or acceptance by the World Health Organization
World Health Organization