Injury and Prevention

Some 2000 Canadians between the ages of one and 19 are killed each year because of injury, and over 85 000 are hospitalized. With the control of infectious diseases, injury has become the leading cause of death and disability in Canadian children and youth. The most frequent causes of fatal injury are traffic related, drowning, burns, suffocation, falls and poisoning. The vast majority of childhood injuries (95%) are the result of impact by moving objects, such as motor vehicles and hockey sticks; or impact of the victim against stationary surfaces, such as car windshields.

Burns account for 3% of all injuries; electric energy, poisoning and radiation, 2%. The head and face are the parts of the body most commonly injured in motor vehicle crashes, in falls, and in other home injuries. Because of the incidence of brain injury and the significant level of neurologic impairment resulting from moderate or severe levels of head injury, and the evidence that mild injury may have significant unfavourable consequences, these injuries are a significant public-health problem.

Under a medicare system, the treatment costs to a family are minimal and are measured mainly in days lost from school or work. However, the costs to the community for the care of victims of injury are staggering. In Canada, the direct cost in 1993 of treating all injuries, including those which occurred earlier, was $3.1 billion, and the indirect cost, mostly loss of income and potential loss from death and disability, was $11.2 billion.

Injury and Child Development

Many injuries are distinctly age related and developmentally determined. Infants, for example, are very susceptible to falls; and about 85% of injuries from birth to one year are due to falls, with baby boys being at greatest risk and head injury being the most frequent result. Scalds from hot bath water or a spilled hot beverage account for 10% of injuries to infants, poisoning for 5%. Regulations relating to size of soothers and toy objects have decreased choking deaths. The average infant travels some 8000 km annually in cars. If not protected by car safety seats or air bags, the threat of serious injury or death is significant. Studies of real accidents have found that a combination of seat belts and air bags is 75% effective in preventing serious head injuries and 66% effective in preventing serious chest injuries. However, even though air bags saved approximately 150 lives in Canada from 1990 to 1997 inclusive, and the number of lives saved annually increases as air bags become more common in vehicles, data on rare air bag injuries to a small number of children has prompted Transport Canada to recommend that those younger than 12 be seated in the rear of the vehicle.

Children who have learned to walk and are able to explore their environment are at especially high risk of injury. In fact this is the most vulnerable stage for injury to girls. Overall, one in 10 toddlers is treated in a hospital emergency room each year for trauma or poisoning; the latter accounts for 12% of injuries. Burns and scalds are common, but injury due to falls still predominates. Pedestrian and motor vehicle occupant injuries are the leading cause of death in this age group, and the death rate from drowning is higher at this stage than at any other.

From 3 to 6 years of age, the child's environment extends from the home to the neighbourhood. Pedestrian injuries are the most common cause of death and serious injury at this age. The use of tricycles and bicycles also leads to more injuries than the use of any other product. During the ages 7 to 18, the child enters the world of sports, recreation and traffic; 98% of injuries result from mechanical objects, particularly, until the teenage years, from playground hazards and bicycles. The Canadian Institute of Child Health is currently developing safety standards for playgrounds in Canada. A gradually increasing ability on the part of children to recognize hazards and to protect themselves accounts for the low death rates around age 10 from almost all injuries. In 1996, the Canadian Institute of Child Health began an unprecedented multiyear study of the potential impact on children of the air they breathe, the foods they eat, and the areas in which they play. Data is to be used to build awareness among legislators, policy makers, families and children, and to ensure that industry and government begin to address the issues.

Comprehensive national data on sports injuries is minimal, apart from the results of studies, mostly dated, in individual disciplines. The reduction in eye injuries since the compulsory use of hockey face masks is a notable Canadian accomplishment. Release bindings have reduced the incidence of leg fractures to skiers. In 1986 the Royal Lifesaving Society completed a national study of injury due to diving. The same year, Dr Charles Tater, head of neurosurgery at the University of Toronto, completed a study on 115 spinal cord injuries of hockey players of all levels.

During the teenage years, the rate of traffic injury reaches epidemic proportions. Over 50% of all deaths and serious injuries in this age group are traffic related, mainly to youths as drivers or passengers of motor vehicles. Transport injuries are the leading cause of brain injury (48%) and as a result produce more new quadriplegics and paraplegics each year than all other causes combined. Injuries to the brain are also the leading cause of epilepsy and of handicapping conditions in people between one and 19 years of age.

Injury Prevention

Injury prevention has received relatively little scientific attention. It is commonly believed that bad luck and chance are the cause of "accidents" and that fate is the main predisposing factor. The first step in influencing public policy would be a general realization that injuries are rarely accidental and most are preventable, and that the medical, social and human toll of injuries warrants a major investment in prevention.

Some preventive measures require the co-operation of relatively few individuals but can influence the lives of many (eg, reduction of crib slat spacing resulting in the eradication of crib strangulation deaths of infants). Preventive measures directed at changing human behaviour, on the other hand, require the co-operation of many individuals (eg, car seats that require parents to buckle up their child with each ride).

Preventive strategies (eg, preventing the creation of the hazard in the first place, separating the hazard by time or space or physical barriers, and countering damage already done) are an important conceptual contribution to the field of injury control. If implemented, as interrelated approaches applicable to all types of injury, they could drastically reduce the incidence of injury in Canada.

Occupational Fatalities and Injuries

Approximately one out of 10 working Canadians, or over 1 million persons each year, are injured on the job. About half of them receive first aid and return to work. The remainder require time off work (554 793 in 1985) or die as a result of their injuries. There were an estimated 844 occupational fatalities in Canada in 1985.

Over 15 million work days were lost in 1985 as a result of injuries and OCCUPATIONAL DISEASES, at a cost of over $3 billion nationally. The ECONOMIC COUNCIL OF CANADA has suggested that indirect costs of employment injuries and illnesses, including failure to meet customer demands, decreased efficiency, lowered employee morale, etc, could range from 2 to 10 times that of direct costs (ie, medical aid, compensation and administration of claims). Therefore, the total cost of employment injuries and illnesses in Canada (1985) can be estimated at between $6 billion and $30 billion.

Injury rates are highest for younger workers, and are higher for workers in hazardous industries such as fishing, forestry, mining and construction. The most frequent types of occupational injury are strains or sprains, bruises, cuts or lacerations, and fractures or dislocations. The body parts most frequently affected are the back, hands, feet and eyes. Occupational injuries result most frequently from overexertion (in lifting, pushing, pulling or carrying objects), being struck by objects, falls, and being caught in machinery or between objects.

Occupational safety can be improved through proper design, guarding and maintenance of tools and machinery, and through proper design of work procedures and methods. Workers can protect themselves in many cases through the use of protective equipment such as hard hats, safety shoes, eye protection and breathing apparatus.

Worker instruction and training regarding safe work procedures and the proper handling of chemicals and other dangerous substances is also important. Safety information and educational programs are available through provincial and federal government agencies responsible for occupational health and safety, labour and employer organizations, national and provincial safety associations, and the Canadian Centre for Occupational Health and Safety.