| What
is injury?
Injuries include unintentional injuries, such as those caused
by motor vehicle crashes, drowning, falls, and fires, and intentional
injuries, such as suicide and violence.
An injury is defined as "unintentional or intentional damage
to the body resulting from acute exposure to thermal, mechanical,
electrical or chemical energy, or from the absence of such essentials
as heat or oxygen (CDC)."
Violence is further defined as the "threatened or actual use
of physical force or power against another person, against oneself,
or against a group or community, that either results in or has a
high likelihood of resulting in injury, death, or deprivation (CDC)."
What is injury prevention?
Injuries are preventable by changing the environment, individual
behavior, products, social norms, legislation and governmental and
institutional policies to reduce or eliminate risks and increase
protective factors. Some useful frameworks for injury and violence
prevention are the Haddon Matrix, the Spectrum of Prevention, the
National Healthy People 2010 Objectives for Injury and Violence
Prevention and the Virginia Violence Prevention Logic Model
Haddon Matrix
In choosing among potentially useful preventive measures, priority
should be given to the ones most likely to effectively reduce injuries.
In general, these will be measures that provide built-in, automatic
protection, minimizing the amount and frequency of effort required
of the individuals involved." (Haddon, 1974)
The Haddon Matrix developed by Dr. William Haddon, the first administrator
of what is now the National Highway Traffic Safety Administration
and the founder of the Insurance Institute For highway safety is
a very useful tool for identifying injury prevention opportunities.
According to this framework, injuries occur with a certain time
sequence. The time before the event occurs would be the pre-event
phase. The precise time of the injury would be the event phase.
This would be followed by the post-event phase. Additionally, said
there are other factors involved in injury occurrence. For instance,
there's the host or the person who's involved in the injury, and
the equipment (e.g vehicle, firearm) that's involved in the injury.
There are also different environmental situations, physical and
social, in which an injury might take place. Combining these two
axes results in a matrix called the Haddon Matrix. Prevention can
be focused in any cell of the Haddon's matrix. For example, interventions
can address the host/pre-event cell (e.g. teaching people to change
behavior to avoid injury) or the pre-event/equipment cell (e.g.
improvements in vehicle safety such as antilock brakes). Interventions
can also be implemented to change the physical environment that
would reduce the risk of injury pre-event, during the event or post-event
(e.g. absorbent cushioning to reduce head injury during a playground
fall, removing trees from the edge of the road to minimize fatalities
as a result of collisions if cars swerve off the road, improving
the speed and skill of first responders to provide victims treatment
earlier). Changes can also be made in the social environment (e.g.
reducing bystander behavior that encourages bullying or changing
social norms around sexual violence).
In addition to the matrix, Haddon identified ten strategies that,
when combined with the matrix can be used to determine the best
possible interventions for a given injury event:
- Prevent the creation of the hazard in the first place (e.g.
yard darts, three-wheel ATV's, "cop-killer" bullets)
- Reduce the amount of the hazard that exists (e.g reduce vehicle
horsepower, restrict motorcycle licensing to older drivers)
- Prevent the release of the hazard (e.g. gun safes, trigger locks,
childproof medicine containers)
- Modify the rate of spatial distribution of release of a hazard
from its source (e.g. breakaway baseball bases, ski bindings)
- Separate people in time or space from the hazard and its release
(e.g. bicycle and pedestrian pathways)
- Separate people from the hazard by interposing a material barrier
(e.g. raised median strips, guard rails)
- Modify the relevant basic qualities of the hazard (e.g safer
play equipment, softer surfaces, water setting below 120 degrees)
- Make the person more resistant to damage (e.g physical conditioning
of athletes)
- Counter the damage already done (e.g. EMS services)
-
Stabilize, repair and rehabilitate the injured
person (e.g. reconstructive surgery, physical therapy)
Examples taken from Quick Guide to
Effective Injury Prevention, David Short http://www.nanlee.net/ems/quickguide.htm
For more information, take a free introductory course
on injury prevention and control, VINCENT (Violence and Injury Control
through Education, Networking and Training on the World Wide Web),
sponsored by the Injury Prevention Research Center at the University
of North Carolina at Chapel Hill (http://www.ibiblio.org/vincentweb/toc.html)
.
Spectrum of Prevention
The spectrum of prevention is a tool for developing a multifaceted,
comprehensive approach to injury and violence prevention across
six interrelated action levels. Activities at each of these levels
have the potential to support each other and promote overall community
health and safety. http://www.preventioninstitute.org/spectrum_injury.html
| Level of Spectrum |
Definition of Level |
| 1. Strengthening Individual Knowledge,
Skills, and Protections |
Enhancing an individual's capability
of preventing injury or illness and promoting safety |
| 2. Promoting Community Education |
Reaching groups of people with
information and resources to promote health and safety |
| 3. Educating Providers |
Informing providers who will
transmit skills and knwledge to others |
| 4. Fostering Coalitions and Networks |
Bringing together groups and
individuals for broader goals and greater impact |
| 5. Changing Organizational Practices |
Adopting regulations and shaping
norms to improve health and safety |
| 6. Influencing Policy Legislation |
Developing strategies to change
laws and policies to influence outcomes |
Ecological Model
The ecological model supports a comprehensive public health approach
that not only addresses an individual’s risk factors, but
also the norms, beliefs, and social and economic systems that create
the conditions for sexual violence to occur. The examples presented
in the below diagram are included to illustrate the levels of the
ecological model for sexual violence. The examples of risk factors
are from the chapter on sexual violence in the World
Report on Violence and Health and are not a comprehensive list
of risk factors for sexual violence perpetration. There is a lack
of research on protective factors, so no such examples are presented
in the model.
- Individual level influences are biological and personal history
factors that increase the likelihood of an individual becoming
a victim or perpetrator of violence. For example, factors such
as alcohol and/or drug use; attitudes and beliefs supportive of
sexual violence; impulsive and other anti-social tendencies; preference
for impersonal sex; hostility towards women; childhood history
of sexual abuse or witnessing family violence may influence an
individual’s behavior choices that lead to perpetration
of sexual violence (Dahlberg and Krug, 2002). Interventions for
individual-level influences are often designed to target an individual’s
social and cognitive skills and behavior and include approaches
such as counseling, therapy, and educational training sessions
(Powell et al., 1999).
- Interpersonal relationship level influences are factors that
increase risk as a result of relationships with peers, intimate
partners, and family members. A person’s closest social
circle—peers, partners and family members—has the
potential to shape the individual’s behavior and range of
experience (Dahlberg and Krug, 2002). Interventions for interpersonal
relationship level influences could include family therapy, bystander
intervention skill development, and parenting training (Powell
et al., 1999).
- Community level influences are factors that increase risk based
on community and social environments where an individual has experiences
and relationships such as schools, workplaces, and neighborhoods.
For example, lack of sexual harassment policies in the workplace
can send a message that sexual harassment is tolerated, and there
may be few or no consequences for those who harass others. Interventions
for community level influences are typically designed to impact
the climate, systems, and policies in a given setting.
- Societal level influences are larger, macro-level factors that
influence sexual violence such as gender inequality, religious
or cultural belief systems, societal norms, and economic or social
policies that create or sustain gaps and tensions between groups
of people. For example, rape is more common in cultures that promote
male sexual entitlement and support an ideology of male superiority
(Dahlberg and Krug, 2002). Interventions for societal level influences
typically involve collaborations of multiple partners to change
laws and policies related to sexual violence or gender inequality.
Another intervention would be to determine societal norms that
accept violence and identify strategies for changing those norms
(Powell et al., 1999).
National Healthy People 2010 Injury Prevention
Objectives
Injury Prevention Web
http://www.safetypolicy.org/hp2010/hp2010.htm
Virginia Violence Prevention Logic Model: http://www.vahealth.org/civp/VA
Violence Prevention Logic Model 2003.pdf
Additional Resources for Learning about
Injury Prevention
States are involved in injury prevention
State health department injury prevention programs, including the
Center for Injury and Violence Prevention, use the public health
approach "to learn about injury problems and decide what to
do about them, and then put in place the necessary programs, infrastructure,
trained staff, and policies that will prevent injuries, deaths and
disabilities in the future." This approach involves five components:
1. Collecting and Analyzing Injury Data
2. Designing, Implementing, and Evaluating Interventions (i.e. behavioral,
engineering, environmental)
3. Building a Solid Infrastructure for Injury Prevention
4. Providing Technical Support and Training
5. Affecting Public Policy
The State Injury Prevention Directors' Association has developed
a comprehensive document that further describes state health department
injury prevention approaches (http://www.stipda.org/safestates.htm).
Communities are involved in injury prevention
Communities are encouraged to identify community needs and engage
in diverse but proven injury prevention practices including: providing
age appropriate injury, suicide and violence related anticipatory
guidance; coordinating education, dissemination and/or installation
of safety devices in homes or cars; convening or participating in
community coalitions or work groups to identify and rectify hazardous
environments; and implementing community or school based education
and training about injury prevention, risk and protective behaviors.
http://www.vahealth.org/civp/community.asp
Schools are involved in injury prevention
There are many roles for schools in injury prevention including
providing safe transportation and safe physical, emotional and social
environments, providing students with injury and violence prevention
knowledge and life skills and getting them involved in community
injury and violence prevention. http://www.vahealth.org/civp/educator/index.asp
Health Providers are Involved in Injury Prevention
Physicians can do much to prevent injury in the areas of screening,
counseling, referral and community involvement
Best Practices in Injury and Violence Prevention
A number of national research centers and other organizations have
identified what works in injury and violence prevention
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