Accident Prevention - Does it Prevent Traumatic
Unintentional injury is a major health hazard
of epidemic proportions. Whilst death related injuries account
for some 16,061 fatalities per annum in England and Wales
many more people will be injured requiring a period of treatment
and/or hospitalisation. The total cost to society is incalculable,
although it is known that 7% of National Health Service funding
is consumed by injury alone (1,2).
The irony is that trauma is the only disease
that is truly preventable. This concept however, appears to
escape the average individual who generally views injury as
a totally unpredictable event over which they have little
or no control. Moreover, people only consider trauma as a
real concept if they have personal experience of a friend
or relative struck down unexpectedly through injury.
Even high profile cases such as the death of Princess
Diana punctuated the media for a period of time but have subsequently
faded into a subliminal message rarely recalled or enacted by the
public. Yet the whole scenario surrounding Diana's untimely death
had many key messages i.e. the perils of avoiding seat belt compliance;
driving under the influence of alcohol or drugs; speed and the distraction
of the paparazzi. Whilst the paparazzi will not be an issue to the
average man in the street the other factors are very applicable
to all car users. At traffic lights I frequently spy young children
moving about the back of vehicles - potential missiles for a collision
that has obviously not yet involved their parents or carers.
So what is the solution? According to Roberts
and Redmond accident prevention requires legislation; engineering
and education (3). As health care professionals we have the potential
to influence all three factors. The American Trauma Society has
stated that 'Trauma is no accident' and thus dispels the myth of
the unpredictable nature of injury (4). This philosophy would appear
to support the education route.
For some time now the British public has had to
rely on voluntary organisations to deliver vital information regarding
injury awareness and accident prevention. Others however, have relied
on TV shows to gain vital information that should be provided by
health care workers.
Where accident prevention programmes have been
introduced they have been well received and said to have an impact
on altering the perceptions of the audience. Two such programmes
are worthy of further consideration here in the UK:
In the early 1990s Abigail Hamilton in conjunction
with health educationalists in Southampton did an inductive study
of 10-12 year old school children to gain an insight into their
perception of injury and in particular what caused head injury.
Using a 'write and draw' technique Hamilton and her co-workers analysed
the findings and designed a health education programme for the children.
The success of the programme was borne out by the children's ability
to implement a protocol for children and teachers that cycled to
school. At the end of the programme the children were asked to repeat
the 'write and draw' technique to establish what learning had occurred.
All the children were better informed regarding how easy it is to
sustain injury and what measures they could take to counteract it
In 1994 a group from the John Radcliffe Hospital,
Oxford designed the Injury Minimisation Programme for Schools (IMPS).
This programme also involved health care workers collaborating with
local schoolteachers to develop a curriculum for 10-11 year old
children. IMPS was integrated into the whole of the national curriculum
e.g. the children studied the history of cars, as well as learning
about speed and performing epidemiological studies of their peers
regarding injury which could be presented in their mathematics classes.
Whilst this method of teaching profiled injury awareness the children
were also taught how to react should injury occur (6). Developing
such educational strategies would appear to offer one way forward.
The preadolescent population are an important group as these children
have some cognitive abilities to understand; are just about to embark
upon their teenage years wherein risk taking behaviour dramatically
increases and where peer pressure is a real concept (7). Moreover,
influencing today's children may have long term benefit, as they
will be informed adults who may subsequently instruct their children
Achieving the government targets to reduce injury
by 20% in all age groups by 2010 requires the widespread deployment
of innovative accident prevention techniques (9). Within the literature
there is a consensus that local initiatives that engage the community
in identifying problems and determining solutions is superior to
national campaigns (10, 11, 12). Any programme which raises injury
awareness; increases knowledge and changes attitudes should make
a positive contribution to the war against trauma (13). Whilst engineering
and legislation are said to have greater compliance, the effects
of research based education programmes in empowering public opinion
and instituting environmental change requires close monitoring.
In the meantime what is abundantly clear that maintaining the status
quo is not an option.
Clinical Nurse Specialist,
Trauma & Anaesthesia Research
Royal London Hospital
trauma.org 5:2 2000
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