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Accident Prevention - Does it Prevent Traumatic Injury?

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 (5).

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 appropriately (8).

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.

Ann McGinley
Clinical Nurse Specialist,
Trauma & Anaesthesia Research

Royal London Hospital 5:2 2000


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  2. Office for National Statistics : The health of adult Britain 1841-1994. Vol 2. London: The Stationary Office, 1997
  3. Robertson, C., and Redmond, A. D. (1994) The management of major trauma. 2nd ed. Oxford: Oxford University.
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  5. Hamilton, A. The exploratory development of injury awareness programme for 10-12 year old children in Southampton. Southampton: Unpublished MSc dissertation, 1994
  6. Orzel, M. N. Injury minimization programme for schools. Accident and Emergency Nursing. 4 139-144, 1997
  7. Tenn, ND. and Dewis, M.E. An evaluation of a Canadian peer-driven injury prevention programme for high risk adolescents. Journal of Advanced Nursing. 23 329-337, 1996
  8. YarcheskiI, A., Mahon, N. E, and Yarcheski, T.J. Alternative models of positive health practices in adolescents. Nursing Research. 46(2):85-92, 1997
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  12. Roberts, H. Empowering communities: the case of childhood accidents. In Kendall, S. Ed. (1998) Health and empowerment - research and practice. London: Arnold. , 1998
  13. Jeffs, J., Taylor, R., Sainsbury, B. and Pordage, K. Health alliances in child accident prevention. Health Visitor. 69(6):234-235 1996