Introducing concepts of Injury Prevention to mid-level Emergency Care Providers in the District Hospital setting in rural Sub-Saharan Africa. An interactive lecture made for the Global Emergency Care Collaborative.

1. Introduction to
Injury Prevention
An interactive discussion for senior and
qualified ECPs
Nyakibale Hospital
Rukungiri, Uganda
Farooq Khan MDCM,
PGY4 Emergency Medicine
McGill University, Montreal, Canada

2. The learning contract
• We are all equal and deserve respect
• We are all knowledgeable in some areas
and deficient in others
• We are all here to learn from each other
• No question is a bad question
• Feel free to participate in the discussion
with your questions and comments

3. Goals
• After this session you should be able to:
1. Define 2 different types of prevention
2. Understand why injury prevention is
important in your region
3. List 5 simple but effective injury prevention
measures for road safety
4. Identify 5 basic areas of injury prevention for
children
5. Appreciate how you can be involved in injury
prevention

4. What is prevention?
• Primary prevention
• Secondary prevention

5. Why prevent injuries?
Let’s take the example of RTAs

6. International statistics
• RTAs are #9 cause of death worldwide in
2004 and expected to rise to #5 by 2030.
• 20% of these deaths are in Africa (even
though it has <2% of vehicles)
• #4 leading cause of death in age 5-44 in
Africa
• More males affected than females

9. National statistics
• 2800 reported deaths/year due to RTAs in
Uganda
• Estimate is closer to 7600 due to lack of
reporting
• 12 000 non-fatal injuries/year due to RTA

12. Is treatment enough?

13. Treatment in the ED
• What are the limitations of your environment?

14. Treatment outside the ED
• Prehospital care – no system in place yet to
bring patients emergently to hospital after
accidents
• Referral for specialized care
– Shortage of general surgeons, only 75 for 27 million
people
– Specialists few and concentrated in major cities
(Mbarara/Kampala) e.g. only 6 neurosurgeons
– Costly and difficult to access
• May not be able to reach in timely manner even if affordable

15. What about primary
prevention?
Brainstorming

16. What are risk factors for
injuries?
Take the example of RTAs

17. 5 simple but effective injury
prevention measures
For RTAs

19. Seatbelts
• Save more lives than any other
intervention
– Reduce the risk of death by 61%
– Child restraint reduces death by 71%
• Very little use in East Africa (close to 1%)
• Mandatory by law for all passengers in
Uganda
– Poorly enforced, especially in rural areas
• Community education is needed

21. Alcohol
• Drinking and driving increases risk of
death x17
• Especially in young drivers
• Legal limit in Uganda = 0.08 g/dl
– Poor enforcement
• Community education is needed

23. Speeding
• A pedestrian hit by a car at 30km/h has
90% chance of survival
– <50% chance at 45 km/h
– Almost 0% at 80 km/h
• Death increases x20 from 30-80 km/h
• Speed limits also poorly enforced in region
• Community education is needed

25. Helmets
• Reduce risk of fatal or serious head injury
by 45% in riders of bicycles and boda-
bodas
• Few people wear helmets in Uganda
despite police enforcement
– Availability, cost, weight, heat, discomfort,
impaired hearing, cosmetics
– Lack of education about risks
• Community education is needed

27. Visibility
• Daytime-running lights in boda-bodas and
cars reduce accidents by 15%
• Brake lights reduce accidents up to 50%
• Bicycle lights reduce collisions by 30%
• Wearing white helmets and brightly
colored or reflective clothing reduces
collisions by up to 45%
• Community education is needed

29. What about other types of
injuries in children?

31. Burns
• In Africa, child death from burns is 6x
more than high income countries
• In rural areas it is associated with:
– Use of cooking pots on ground level near
toddlers and young children
– Use of open wood fire
– Use of paraffin stoves and lamps that can be
knocked over and ignite
– Wearing of loose cotton clothing around fire

32. Burns
• Families should be encouraged to:
– Build enclosures around open fires
– Use safer stoves or lamps if possible
– Wear tighter or less flammable clothing
around the fire
– Learn about basic first aid for burns and how
to access emergency services

34. Falls
• Parent education should include:
– Increased supervision of younger children
• i.e. Do not leave unattended on high surfaces
– Modifying the home environment
• e.g. Floor padding/barriers on windows
• Advocacy at the community level should include:
– Encouragement of safer play areas
• e.g. Discourage climbing of tall trees
– Barriers around hazardous environments
• i.e. Tall trees, wells, pits, ditches, walls

35. Falls
• One of the leading causes of death and
disability in children in Africa
• Most often due to head or spinal cord
injury
• Children who can walk/run are at higher
risk
– Young children fall more at home
– Older children fall in outside the home i.e. in
schools, public/recreational areas

37. Drowning
• Rate of drowning is 6x higher in Africa
• Greatest in age 1-4
• Need to educate community about safety
– Placing barriers around water sources
• Ponds/irrigation ditches
– Covering wells
– Have escape mechanism (ropes)
– Teach basic resuscitation skills

39. Poisoning
• Child death by accidental poisoning is 3-4x
higher in Africa than the rest of the world and is
due to:
– Medicines (belonging to other family members)
– Illegal drugs/alcohol
– Fuels and solvents
– Pesticides/Household chemicals
– Poisonous plants/Animals/insects (snake) bites
– Carbon monoxide (indoor fires)

40. Poisoning
• Education of parents and communities
should include
– Removing toxic agents from the community
– Reducing the quantity/concentration of toxic
substances
– Using safe packaging techniques
– Encouraging safe storage of
substances/medications
– Using protective clothing around pesticides

41. What is wrong with this picture?

42. What is wrong with these pictures?

43. Why should ECPs be involved in
injury prevention?

44. ECPs are unique because:
• Regional experts in emergency care
• Real-life experience in ED with multiple
patients
• Understanding of impact of environment
and behavior on health
• Understanding of life and challenges of
Rukungiri community
• Respected by the community

45. How can you help?
• Educate and counsel patients at the time of
injury
– Prevent the next one! (Secondary Prevention)
• Outreach to community
– Talk to the right people
• Village elders
• Village health teams
• Schools, churches, community centers
• Boda-boda drivers
– Distribute posters/materials
• Collaborate with other health centers or
departments
– They may already be doing similar work

48. How can you help in the right way?
• Focus your efforts on the intervention that
is most important to do in your area
– Check the data in your trauma registry
• Which injuries are most frequent?
• Which are most severe?

49. How can you help in the right way?
• Choose intervention that is most likely to
work
– Low cost
– Requires few human resources
– Utilizes existing networks
– High chance of acceptance by society

50. How can you help in the right way?
• Check if the intervention is successful
– Collect injury surveillance data and follow it
– Analyze and publish the data to prove to
hospital administration that it can be effective
– Use the same data to prove to ministries and
other organizations that it is worth funding and
expanding

51. Reminder of Goals
Can you:
1. Define 2 different types of prevention
2. Understand why injury prevention is
important in your region
3. List 5 simple but effective injury prevention
measures for road safety
4. Identify 5 basic areas of injury prevention for
children
5. Appreciate how you can be involved in injury
prevention

52. Thank you for your
participation!