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Piedt S, Rajabali F, Turcotte K, Barnett B, Pike I. The BC Casebook for Injury Prevention. BC Injury Research and Prevention Unit: Vancouver, BC; 2015.
B.C. Injury Research and Prevention Unit
Piedt, Shannon
Rajabali, Fahra
Turcotte, Kate
Barnett, Bronwen
Pike, Ian, 1958-
This Casebook makes the case for injury prevention in British Columbia (BC). Injury prevention addresses premature death and greatly reduces the frequency and severity of injuries. When sustained resources are available and collaborative efforts that use multiple strategies are applied, injuries can be prevented.
Casebook for Injury PreventionTHE BRITISH COLUMBIAAUGUST 2015Authors: Shannon Piedt, Fahra Rajabali, Kate Turcotte, Bronwen Barnett, Ian PikeAcknowledgements: The project team at the BC Injury Research and Prevention Unit extend their appreciation to the Provincial Health Services Authority (PHSA) for funding this report. Special thanks to the Casebook working group members for your valuable insights, input, time and participation in developing this report. Group members included:We also wish to thank Claire Yambao, Shelina Babul, Kayla Jasper, Yasmin Yassin and Jenny Green for assisting with content for the case studies.Finally, thank you to the Royal Society for the Prevention of Accidents (RoSPA) for providing the inspiration to undertake this project and to develop the BC Casebook for Injury Prevention.Reproduction, in its original form, is permitted for background use for private study, education instruction and research, provided appropriate credit is given to the BC Injury Research and Prevention Unit. Citation in editorial copy, for newsprint, radio and television is permitted. The material may not be reproduced for commercial use or profit, promotion, resale, or publication in whole or in part without written permission from the BC Injury Research and Prevention Unit.Suggested Citation: Piedt S, Rajabali F, Turcotte K, Barnett B, Pike I. The BC Casebook for Injury Prevention. BC Injury Research and Prevention Unit: Vancouver, BC; 2015.For any questions regarding this report, contact:BC Injury Research and Prevention Unit (BCIRPU)F508-4480 Oak StreetVancouver, BC V6H 3V4 CanadaEmail: bcinjury1@cw.bc.caPhone: (604) 875-3776 Fax: (604) 875-3569www.injuryresearch.bc.caShellie O’Brien and Denise Foucher Northern HealthLex Baas Interior HealthMurray Fyfe Island HealthKen Shaw Fraser HealthAdrienne Peltonen First Nations Health AuthorityZahra Hussein Vancouver Coastal HealthPamela Fuselli and Jacquelyn Quirk Parachute CanadaContentsChapter 1: Injury Prevention: A Call to Action .......................................................4The Purpose of this Book ..................................................4What Injuries are We Talking About? ................................5Why Focus on Injuries? ......................................................5What is Your Role? .............................................................5How to Take Action ...........................................................5Chapter 2: Injury Prevention in BC ..............6Why is Injury Prevention Important?................................6Partnerships & Collaboration ...........................................6Injury Prevention in BC: The Public Health Approach in Action ................................................................................7The Approach ....................................................................7Chapter 3: Injury Patterns in BC ..................8Injury Patterns ...................................................................8Known Patterns .................................................................8 Geographic Differences .....................................................9Chapter 4: The Injury Burden in BC .............10Injuries in BC ......................................................................10PYLL as a Proportion of All Injury Deaths .........................10Burden of Injury ................................................................10Infographic: Preventable Injury in BC ..............................11Chapter 5: Preventable Years of Life Lost (PrYLL) ...................................................12What is Preventable Years of Life Lost? ............................12Comparing Preventable Injuries to Preventable Diseases ........................................................13How is Preventable Years of Life Lost Calculated? ..........13Why this is Important for BC .............................................13Chapter 6: Children, Youth and Young Adults .................................................14Why Should Children, Youth and Young Adults be a Priority? .....................................................................14Ages and Stages ................................................................14The Burden of Injury to Children, Youth and Young Adults ......................................................................14What Can Be Done? ...........................................................15Chapter 7: The Cost of Injury .......................16Direct & Indirect Costs of Injury ........................................16Which Injuries Cost the Most? ...........................................16Chapter 8: Potential Return on Investment/Business Case ..........................18Forecasted Cost Savings ...................................................18Why Invest in Injury Prevention? ......................................19Chapter 9: Injury Prevention Links with Public Health Issues .....................................20Chapter 10: Taking Action ............................22Why Action is Needed .......................................................22What You Can Do ...............................................................22Case StudiesCase Study 1: Shaken Baby Syndrome ....................24Case Study 2: Injury Prevention Messaging .............26Case Study 3: Concussion Prevention ......................28Case Study 4: Injury Surveillance & Prevention.......30Case Study 5: Seniors’ Falls Prevention ...................32Case Study 6: Road Safety ........................................34Case Study 7: Alcohol-Related Injuries ....................36Case Study 8: Suicide Prevention .............................38Case Study 9: Social Marketing for Injury Prevention.......................................................40Frequently Asked Questions ........................42Further Resources ........................................43References ....................................................44Poem: The Ambulance Down in the Valley................514 | The BC Casebook for Injury Prevention01CHAPTERInjury Prevention: A Call to ActionEveryone has a role in injury prevention–working collaboratively to implement evidence-based solutions will save lives and prevent disabilities.The Purpose of this BookThis Casebook makes the case for injury prevention in British Columbia (BC). Injury prevention addresses premature death and greatly reduces the frequency and severity of injuries. When sustained resources are available and collaborative efforts that use multiple strategies are applied, injuries can be prevented.Sustained and collaborative effort has resulted in a steady decrease in the number of deaths on BC roads from 2000 to 2013. This reduction in road injuries is supported by continued resource and collaboration directed towards motor vehicle crash prevention such as improved vehicle safety, legislation restricting cell phone use while driving, and changes to enforcement of drinking & driving legislation.During the same time period, deaths due to injuries in the home and in the community have increased. Injury prevention efforts are required to see the same decreases to injuries in the home, at work and during sport and recreational activities in the community. For example, child poisonings from household products such as laundry soap pods could be reduced through partnerships between educators and laundry soap manufacturers. Similar to child-resistant caps on medicine bottles, developing child-resistant packaging along with enforcement aimed at manufacturers is likely to result in fewer children poisoned by laundry soap pods.3 Using concussion as another example, collaborative efforts between players/athletes, coaches, health practitioners, parents and school professionals will result in a standardized approach to concussion recognition, diagnosis treatment and management.4We know what to do. Years of injury research has identified the types of injuries that contribute to the greatest burden, the groups that are most affected, the societal factors that have an impact on injury rates and the injury prevention solutions that are proven to make a difference. It is time to work together to implement evidence-based solutions that prevent injuries so that British Columbians can live long lives to the fullest.COMPARISON OF INJURY DEATH RATES ON THE ROAD VS. THOSE OCCURRING IN THE HOME & COMMUNITYBC, 2009 - 20131,2Rate per 100,000 PopulationYear01020304050602018201720162015201420132012201120102009n Home & Community n RoadPhoto: Rawpixel/ShutterstockINJURY HOSPITALIZATIONS IN BC2010/11410%Intentional InjuryInflicted by another:Violence, AbuseSelf-Inflicted: Self-Harm, Suicide88%Unintentional InjuryMotor Vehicle Crashes, Falls, Poisoning, Drowning, Suffocation, Struck by Object, Fire and Burns & OtherInjury prevention prevents death and reduces the need for medical treatment so British Columbians can live long lives to the fullest.Chapter 1: Injury Prevention: A Call to Action | 5What Injuries are We Talking About?Injuries can be intentional, self-inflicted or inflicted by another person, or unintentional, what we have traditionally labelled “accidents.”Why Focus on Injuries?Injuries are the leading killer of British Columbians ages 1-44 years old.5 More than 400,000 residents of BC are injured each year, with over 2,000 dying from their injuries,6 yet as many as 90% of these injuries are both predictable and preventable.7What is Your Role?This Casebook is for senior decision makers, policy makers, legislators and others in BC who have a responsibility in injury prevention and/or a role in resource allocation. Establishing partnerships between professionals working in the areas of provincial government, municipal government, transportation, workplace & industry, insurance, regulation, business, injury prevention, sport and recreation, health, first response, trauma and acute care, as well as other areas will lead to effective injury prevention.How to Take ActionThe following chapters provide the rationale for why action is needed as well as outlining potential actions to be taken. This information is summarized in Chapter 10.Because the social determinants of health and other public health issues are connected to injury rates and patterns, addressing them will also address injury.8-10 Determining and acting upon the upstream investment for injury prevention will translate to injury costs avoided and financial resources available for reallocation to other important health care areas.11-13 Evidence-based solutions are available.Note: The remainder of the injuries were of undetermined intent.Photo: Monkey Business Images/Shutterstock6 | The BC Casebook for Injury Prevention02CHAPTERInjury Prevention in BCInjury prevention is conducted by collaborative partnerships that rely on multiple reinforcing strategies.Why is Injury Prevention Important?In practical terms, injury prevention means eliminating hazards and managing risk at all levels of society while maintaining healthy, active and safe communities and lifestyles. Individual and collective choices are strongly influenced by the social, economic and physical conditions where people live, work, learn and play. To prevent injuries, the social determinants and risk factors for injury must be addressed.1-3 Policy makers can make a difference by enabling supportive policy, programs and practices. Education must also be in place at all levels in these environments. Partnerships & CollaborationIn BC, Health Authorities work with stakeholders beyond the health system, such as local governments, non-governmental organizations (NGOs), researchers, communities, and private organizations that play a role in reducing or eliminating risk factors that can cause injuries. Collaboration aids in gaining a better understanding of the scale and impact of injuries so that professionals in all sectors can take informed and appropriate preventative action.For examples of how Government, Health Authorities, Communities and Researchers have worked together in BC to prevent injury, see the Partnerships section in the case studies on pages 24 through 41.Government: Government develops public health policy and provides leadership for population and public health. Government establishes expectations and target outcomes for health authority performance; monitors and evaluates health authority performance against those expectations; and reports to the public.Example of injury prevention at the government level: the provincial government created Child Safety Seat Regulations and updated the policy to include booster seats in 2008. Health Authorities: Together, the BC Ministry of Health, the Provincial Health Services Authority, the five regional Health Authorities and the First Nations Health Authority share responsibility for providing high quality, appropriate and timely health services province-wide. Health Authorities in BC have a mandate to understand the causes and burden of injury, and a responsibility to lead injury prevention.4,5Example of injury prevention at the Health Authority level: Public health nurses provide information to parents and caregivers about the right car seat or booster seat for their child. Health Authorities also provide trauma services to children who are injured and rehabilitation for those who are seriously injured.Community: Community consists of interested stakeholders that are self-mandated to improve the health and well-being of communities for the good of society. Community partners understand what works in their community and are therefore good advocates for local injury prevention.Example of injury prevention at the community level: Free child seat safety checks are offered by community partners such as fire departments. Organizations such as BC Automobile Association and the United Way of the Lower Mainland provide car seats to eligible NGOs and community groups in BC to use within their programs or provide to families who need them.Research: Research provides evidence in support of all of the above injury prevention activities. Research examines GovernmentResearch CommunityHealth AuthoritiesThe public health system, including Government, Health Authorities, Communities and Researchers, is ideally situated to reduce injury in BC.Chapter 2: Injury Prevention in BC | 7The ApproachThe following injury prevention approach is outlined in BC’s Guiding Framework for Public Health and is widely accepted by injury prevention practitioners. This approach integrates the following four domains and is consistent with the public health approach adopted in BC:Education: Educating individuals about changing behaviours that can lead to injuries.Enforcement: Involves safety legislation and policies, including passing, strengthening and enforcing voluntary standards, regulations and laws. Examples include making it mandatory to wear a bicycle helmet and use seatbelts and child car seats.Engineering and Environmental Design: Making the design, development and manufacturing of products and the built environment safer. Examples include creating dedicated bike lanes and ensuring that playground equipment is safe.Engagement: For example, the Ministry of Health, the federal government and the First Nations Health Authority work together under the Tripartite First Nations Health Plan on systemic change and improvement in injury prevention and safety promotion for and within First Nations communities.6which injuries are common, most serious, who is more likely to be injured and what works to prevent those injuries. Through research, answers can be found to injury prevention questions.Example of injury prevention research: Research with crash test dummies that represent average sized children helps to inform improved child safety design by child seat and vehicle manufacturers. Policy research informs governments on the best practice elements to include in legislation. Behavioural research identifies what works to get families to use booster seats.Injury Prevention in BC: The Public Health Approach in ActionInjury prevention has been identified as a priority in BC’s Guiding Framework for Public Health. It is one of seven goals to support the vision of “Vibrant communities in which all people achieve their best health and well-being where they live, work, learn and play. The inner ring of the circle illustrates the guiding principles/values for the public health system, and the outer ring symbolizes the critical connections required for the public health system to fulfill its role in improving population health and reducing health inequities.”6 Positive Mental Health & Prevention of Substance HarmsMaternal, Child & Family HealthPublic Health Emergency ManagementEnvironmental HealthInjury PreventionVIBRANTCOMMUNITIES in which all people achieve their best health and well-being where they live, work, learn and play.Adapted from BC’s Guiding Framework for Public HealthHealthy Living & Healthy CommunitiesCommunicable Disease PreventionCommunities NGOs Private Sector Health Care Providers / Primary CarePopulations/Individuals Whole of Government Photo: Leonardo da/Shutterstock8 | The BC Casebook for Injury Prevention03 Injury Patterns in BCCHAPTERUnderstanding the group or population that is most affected by specific causes of injuries informs where to focus our injury prevention efforts.Injury PatternsThere are many different causes of injury, including falls, motor vehicle crashes, drowning, assaults, and sport or recreation injuries.There are also patterns in injury that we can identify. These relate to age, sex, gender, alcohol and drug use, geography, and socioeconomic factors. For example, while transport related hospitalizations peak among young adults and then decrease with age, fall-related hospitalizations increase with age, peaking among those in their mid- to late eighties.1 Looking at suicide patterns, there are more suicides among males than females across all ages.2Known Patterns » The three leading causes of injury are transportation, falls and suicide.1, 2 » Injury mortality rates are higher for males than females at all ages; elderly males have the highest rates of injury mortality.2 » Injury hospitalization rates are higher for males than females up to age 65; elderly females have the highest rates of injury hospitalization.1 » Injury hospitalization rates increase more dramatically among pre-teen and teenaged males than among females.1 » Injury hospitalization rates decline among children, youth and adults as household income increases; however injury hospitalization rates are high across all income ranges among older adults.3 » Injury mortality and hospitalization rates are generally lower in urban areas and higher in rural and remote areas; this tendency is less pronounced for mortality than for hospitalizations.3SUICIDE DEATHS BC, 2005 - 20102AgeAverage Annual Number0102030405060708098+908070605040302010n Males n FemalesFALLS-RELATED HOSPITALIZATIONSBC, 2005/06 - 2010/111AgeAverage Annual Number01002003004005006007008009585756555453525155TRANSPORT-RELATED HOSPITALIZATIONSBC, 2005/06 - 2010/111AgeAverage Annual Number0501001502009585756555453525155Injury patterns can be identified because different causes of injury can have varying effects on different groups of people. Chapter 3: Injury Patterns in BC | 9Geographic DifferencesEach health authority has its own patterns. Understanding factors related to age, sex, gender, level of education, income, urban/rural, etc., for local populations will inform how to approach injury prevention in each region.This informed approach along with the use of collaborative and evidence-based solutions can decrease deaths and hospitalizations due to injury.INJURY HOSPITALIZATION BY FAMILY INCOMEBC, 2006/07 - 2010/113, 405001,0001,5002,0002,5003,0000-14 15-24 25-64 65+Average Annual Rate per 100,000 PopulationAge Groupn $49,000 - $65,350 n $65,351 - $70,750 n $70,751 - $79,150n $79,151 - $92,300 n $92,301+Family Income QuintilesINJURY DEATH RATES BY HEALTH SERVICE DELIVERY AREABC, 2006 - 20103NortheastNorthernInteriorNorthwestThompsonCaribooEastKootenayKootenayBoundaryOkanaganNorthVancouver IslandNorth Shore/Coast GaribaldiNorth Shore/Coast GaribaldiCentral VancouverIslandSouth Vancouver IslandFraserEastLower Mainland18 - 2728 - 3637 - 4546 - 5455 - 62 (BC Average: 36.2/100,000 persons)5-Year Rate per 100,000 PopulationPhoto: David Maska/Shutterstock10 | The BC Casebook for Injury Prevention04 The Injury Burden in BCCHAPTERInjury is the leading cause of death1 and the 2nd leading cause of hospitalization among 1-44 year olds in BC.2Injuries in BCEach day, approximately 1,300 people in BC are injured.3 Of these, five die, making injuries the 4th leading cause of death across all age groups in BC, but the leading cause of death for ages 1-44 years.4 Injury is the 2nd leading cause of hospitalization for the under 45 years of age population in BC, after digestive system diseases.2PYLL as a Proportion of All Injury DeathsPotential Years of Life Lost (PYLL) is an estimate of the average numbers of years a person would have lived if he or she had not died prematurely (i.e. deaths before age 80).5 Injury accounts for 40% of the PYLL in BC for those who die at ages 1-44 years.4Burden of InjuryInformation is readily available on the number of people who die or are hospitalized due to injury. Limited information is available regarding the number people seen in emergency rooms, and it is not known how many are seen in clinics and physicians offices or go untreated by a health care provider.injuries treated in walk-in clinics2,0093fatal injuriesinjuries treated in physicians officesinjuries untreated/treated at home34,9983injuries treated in hospital456,3903injuries treated in emergency roomsLEADING CAUSES OF DEATH, ALL AGESBC, 20114Malignant Neoplasms0% 10% 20% 30% 40% 50%Cardiovascular DiseaseCerebrovascular DiseasesInjuriesChronic Pulmonary DiseaseCause of DeathProportion of All DeathsDeaths28.7%18.8%7.0%5.6%4.6%LEADING CAUSES OF DEATH, AGES 1-44BC, 201140% 10% 20% 30% 40% 50%Malignant NeoplasmsCardiovascular DiseaseCertain Infectious and Parasitic DiseasesOther Disorders of the Nervous SystemInjuriesCause of DeathProportion of All Deaths38.5%16.2%4.8%3.0%2.4%DeathsPOTENTIAL YEARS OF LIFE LOST BY LEADING CAUSE OF DEATH, AGES 1-44BC, 20114CancersCirculatory System DiseasesCertain Infectious & Parasitic DiseasesDigestive System DiseasesInjuriesCause of DeathProportion of All Deaths0% 20% 40% 60% 80% 100%25,1729,7834,0521,7901,740PYLLChapter 4: The Injury Burden in BC | 117,94880kilometres long,HOSPITALIZED for serious injuries,3average-sized hospitals34,998filled to capacity to accommodate this number of injured peopleHope to Whistler,people3 required456,390278people suffered a permanentPARTIAL DISABILITY**Permanently disabled, but able to return to some type of employment.waiting to get into the emergency room to be treated for their injuryrequiring...for their injuries...the equivalent of a line upmore HandiDart buses to accommodate these people794EVERY DAY634people3 suffered a permanent TOTAL DISABILITY‡...2or almost‡Permanently disabled and unable to work.people,the distance frompeople wererequiring3...EMERGENCYMEDICAL ATTENTIONPreventable Injury in BC, in just one year (2010)32,0094hours andthe equivalent of...DEATHSone death every3There were24minutes12 | The BC Casebook for Injury Prevention05 Preventable Years of Life Lost (PrYLL)CHAPTERPrYLL is a powerful metric of premature and preventable loss of human potential.What is Preventable Years of Life Lost?Preventable Years of Life Lost (PrYLL) is an epidemiologic measure used to estimate the average number of years a person would have lived if s/he had not died prematurely due to a preventable cause of death.1 As an indicator of premature mortality, PrYLL is closely related to Potential Years of Life Lost (PYLL) in that it gives more weight to deaths that occur among younger people.2 Both PYLL and PrYLL represent the total number of years NOT lived by an individual who died prematurely, or before average life expectancy. Unlike PYLL, PrYLL excludes causes of death that aren’t deemed to be preventable. PrYLL allows for a comparison of preventable injuries to other preventable causes of death, essentially comparing ‘apples to apples’. The majority of intentional and unintentional injuries are included and compared to behaviour-related or lifestyle-related cancers (e.g., skin, lung and stomach cancer), preventable heart disease, preventable infections, and more. Other cancers (e.g., leukaemia and Hodgkins Disease) and congenital diseases are excluded as they are not considered preventable. Prostate cancer is not included as part of preventable cancers. There is insufficient evidence regarding preventable ways to avoid this form of cancer.Asthma is deemed to be amenable to treatment, for example with the use of inhalers, but not preventable, although it may be influenced by environmental factors or access to good quality health care.PYLL helps us to understand which injuries and diseases contribute to the largest number of years not lived due to the premature death of children, youth and adults.PrYLL allows for a direct comparison of those injuries and diseases resulting in premature death that are deemed to be preventable. Preventable conditions and ICD-10 codes3Condition Group and Cause ICD-10 Codes4Alcohol and illicit drug use F10-F16, F18-F19, G31.2, G62.1, I42.6, K29.2, K70, K73, K74 (excl. K74.3-K74.5), K86.0 Behaviour related cancers: cancer of lip, oral cavity, pharynx, oesophagus, stomach, colon and rectum, liver, trachea, bronchus and lung, skin, mesothelioma, breast, and cervix uteri C00-C16, C18-C22, C33-C34, C43, C45, C50, C53Cardiovascular diseases: ischaemic heart disease, DVT with pulmonary embolism, aortic aneurysm and dissectionI20-I25, I26, I80.1-I80.3, I80.9, I82.9, I71Diabetes E10-14Infections: tuberculosis, hepatitis C and HIV/AIDSA15-19, B90, B17.1, B18.2, B20-24Respiratory diseases: influenza and chronic obstructive pulmonary disorderJ09-J11, J40-J44Injuries: unintentional and intentional V01-V99, W00-X59, X60-X84, Y10-Y34, X85-Y09 Photo: oliveromg/ShutterstockChapter 5: Preventable Years of Life Lost (PrYLL) | 13From birth to retirement, injuries are the leading cause of Preventable Years of Life Lost (PrYLL).“A death is preventable if, in the light of current understanding of the determinants of health, all or most deaths from that cause (subject to age limits if appropriate) could be avoided by public health interventions in the broadest sense”. - The United Kingdom’s Office for National Statistics3Comparing Preventable Injuries to Preventable DiseasesWhen we compare only preventable causes of death, ones where initiatives and policy aimed at the general public can make a difference, injuries lead for ages 1-44 years. Based on a life expectancy of 80 years,6 injuries drop to second place for women after age 60. Injuries remain the leading cause of PrYLL for men up to age 80.7How is Preventable Years of Life Lost Calculated?Developed in 2012 by Errol Taylor at the Royal Society for the Prevention of Accidents1, preventable years of life lost is calculated in the same way as PYLL.8 Causes of death that are considered to be preventable are selected and preventable years of life lost are calculated using an upper age reference. Age 80 has been used here to correspond with the average life expectancy in BC6, however, age 75 is traditionally used in PYLL calculations and could be used instead.For example, a person who died at age 20 would contribute 60 preventable years of life lost, using 80 as the upper age reference. Preventable years of life lost correspond to the sum of the PrYLL contributed for each individual.Why this is Important for BCInjury is the cause of death with the highest PrYLL, accounting for 74% of the PrYLL in BC for those who die at ages 1-44 years. As such, it should attract the greatest share of research and funding for prevention campaigns.Supporting the prevention of injuries in BC will save lives and reduce the number of people living with disability. For those people who may have been injured at younger ages, the prevention of injuries also ensures increased societal and economic productivity.“Injuries are a huge burden to society, they are easy to prevent and appropriate risk management enables rather than constrains economic activity.” - Errol Taylor, Deputy Chief Executive, Royal Society for the Prevention of AccidentsPREVENTABLE YEARS OF LIFE LOST BY PREVENTABLE CAUSES OF DEATH,3 AGES 1-44BC, 20115Preventable CancersIschaemic Heart DiseaseAlcohol & Illicit Drug UseInfectionsInjuriesCause of DeathProportion of All Deaths0% 20% 40% 60% 80% 100%24,8073,9901,4001,2121,200PrYLLPhoto: Monkey Business Images/Shutterstock14 | The BC Casebook for Injury Prevention06 Children, Youth and Young AdultsCHAPTERWhile injury has a significant effect on all age groups, it has a profound impact on children, youth, young adults and their families.Why Should Children, Youth and Young Adults be a Priority?While injury has a significant effect on all age groups, it can have a profound impact on children, youth and young adults as the quality of life lost for young people who are hurt or disabled affects not only them, but also their families and communities, potentially for their whole lives. Their ability to become educated, to enter the work force, to engage in sports and recreational activities and life’s milestones can all be compromised by injury and disability. Adults have a societal responsibility to promote safety and protect children as children are unable to control the environments in which they live, learn and play. The United Nations Convention on the Rights of the Child stipulates that children have the right to live a full life, and that governments should ensure that children survive and develop healthily.Ages and StagesUnintentional injuries among children and youth are related to ages and stages—where they are and what they are doing. For example, young children spend a lot of time at home, while older children have increasing engagement in sports and recreational activities. Also, children spend more time on the road as they get older, commuting to and from school and activities and potentially learning to drive. There is a marked increase in injury death and hospitalization rates during the adolescent period.1, 2The Burden of Injury to Children, Youth and Young AdultsDeathsInjuries that cause death to children, youth and young adults should be made a priority when deciding which injuries to prevent. The #1 cause of death for ages 0-24 is transport-related injuries.1 It is most often head injuries due to motor-vehicle crashes that lead to these deaths.1 The second leading cause of death varies by age. For ages 0-4, asphyxia caused by suffocation or choking is the second leading cause.1 For ages 5-9, it is burns and asphyxia due to fires. For ages 10-24, the second leading cause is death by suicide.1INJURY DEATH RATESBC, 2006 - 20101Average Annual Rate per 100,000 PopulationAge Group051015202530354020-2415-1910-145-90-4INJURY DEATH RATE BY LEADING CAUSEBC, 2006 - 201010-4 Years5-9 Years10-14 Years15-19Years20-24Years#1 1.9 1.0 2.2 13.0 14.4#2 0.8 0.5 0.7 6.6 9.8#3 0.5 2.6 5.8Average Annual Rate per 100,000 Population¢ Transport-Related ¢ Suicide ¢ Unintentional Poisoning ¢ Suffocation-Choking ¢ Fire, Flame and Hot Substance ¢ FallsChapter 6: Children, Youth and Young Adults | 15Injury prevention resources need to be directed at preventing injuries among children, youth and young adults.HospitalizationsFalls are the #1 cause of hospitalization for children and youth of all ages.2 These falls cause fractures that are serious enough to require at least one night’s stay in hospital. The #2 cause of hospitalization varies by age. For ages 0-4 it is foreign body entering into or through an eye or natural orifice, or an object entering through the skin.2 For ages 5-24, transport-related injuries are the second leading cause of hospitalization.2 This information is valuable for informing injury prevention efforts. » BC Children’s Hospital developed a ‘Too Hot for Tots’ campaign to prevent burns among young children.14Awareness campaigns and the enforcement of injury prevention policies, as well as continued partnerships between government, communities, health authorities and researchers, will enhance the effectiveness of injury prevention initiatives. For more examples of effective injury prevention in action, please see the Case Studies on pages 24-41.What Can Be Done?Everyone can participate in building a culture that values child, youth and young adult wellness. For example: » Changes to policy such as booster seat regulations and immediate roadside prohibition have contributed to a decrease in motor vehicle crash deaths and injuries (chart at right).3-6 » Consider enhancing hand-held cell phone legislation to include other types of distracted driving and address issues of enforcement.7-9 » Hockey Canada banned body checking at the Peewee level starting in the 2013-14 season in an effort to decrease concussions and other serious head and neck injuries in children up to age 12.10-12 » At a local policy level, some municipalities are mandating the use of helmets by children and youth at skating rinks.13Hospitalization Rate per 100,000 Population by Leading Cause, BC, 2009/10-2013/1420-4Years5-9Years10-14Years15-19Years20-24 YearsFalls 148.0 201.6 177.4 176.3 179.9Transport 13.8 44.3 101.5 172.7 171.0Unintentional Poisoning 34.0 4.9 9.9 28.3 29.8Struck by Object 21.0 25.8 80.9 139.6 92.3Foreign Body 57.3 26.6 11.4 10.5 11.3Attempted Suicide 35.4 135.8 103.2Homicide 6.1 69.3 104.3Average Annual Rate per 100,000 PopulationMOTOR VEHICLE CRASH DEATHS BY LEADING CONTRIBUTING FACTORS, AGES 0-25BC, 2004 - 201315Rate per 100,000 PopulationYear0246810122013201220112010200920082007200620052004n Distraction n Impaired n Speed n TotalPhoto: BlueSkyImage/Shutterstock16 | The BC Casebook for Injury Prevention07 The Cost of InjuryCHAPTERInjuries cost British Columbians $3.7 billion dollars in 2010, the equivalent of $422,479 per hour, 24 hours per day, 7 days per week.1There were 2,009 lives lost in 2010 due to injury.1 In addition, 34,998 people were hospitalized and 456,390 were treated in emergency departments as a result of injury.1 In total, 8,582 people suffered injuries that resulted in permanent disabilities.1 These injuries cost BC $3.7 billion dollars in 2010, the equivalent of $829 for each and every British Columbian.1Direct & Indirect Costs of InjuryDirect costs refer to the load on the health care system, including diagnosis, treatment, continuing care, rehabilitation and costs of injury related death. Indirect costs are defined as the value of economic output lost because of illness, injury-related work disability, or premature death.2-5Unintentional injuries accounted for $2 billion or 88% of the direct costs, and $1 billion or 74% of the indirect costs of all injuries.1 Intentional injuries accounted for $239 million or 10% of the direct costs, and $343 million or 24% of the indirect costs of injuries.1Beyond these documented costs, there are also significant indirect costs assumed by families, friends, neighbours and private insurers that result in financial hardship and lost societal productivity in many cases. Preventing injuries will preserve the economic productivity of individuals, families and communities.Which Injuries Cost the Most?This chapter presents direct costs, referred to as health care costs, by cause of injury in two different ways: by age group and per person, also known as per capita. As injury data are available for age groups, the health care cost of injuries for each cause by age group is presented (bottom right table). However, to determine the ages that incur the most health care cost due to injury, it is valuable to break these costs down per person, also known as per capita. Both ways demonstrate that falls were the single greatest contributor of injury costs, making up over one-third of direct injury costs in BC in 2010.1The majority of the injury health care costs per capita are spent on older adults and youth (pie charts on next page). When the health care costs are broken down by cause of injury among older adults, most of the health care costs are spent on fall-related injuries (table at top of next page.) Ages 15-24 years have the highest per capita health care costs associated with transport injuries (such as motor vehicle or ATV crashes, hit while cycling, etc.), suicide/self-harm, injuries due to violence and unintentional poisoning, when compared to other age groups.1 When considering Preventable Years of Life Lost (from chapter 5) along with cost, it is clear that injury prevention policies, environmental modification, education and programming need to target ages 15-24 years.Contributors to the total cost of injury, BC, 20101Number $ MillionsInjury Deaths 2,009 $649Hospitalized Treatment 34,998 $682Non-Hospitalized Treatment 456,390 $615Permanent Disability 8,582 $1,756Total Cost $3,701Total direct & indirect costs of injury by intent, BC, 2010 ($ millions)1Total CostsDirect CostsIndirect CostsUnintentional $3,062 $2,018 $1,044Intentional $581 $239 $343Undetermined Intent/Other$57 $32 $25Total Cost $3,701 $2,289 $1,412Photo: val lawless/ShutterstockChapter 7: The Cost of Injury | 17Health care costs△ spent on injury per person, BC, 20101Children (0-14 yrs)Youth(15-24 yrs)Adults(25-64 yrs)Older Adults (65+ yrs)Falls $127.69 $114.54 $126.60 $729.39Transport Incidents $36.03 $125.99 $89.42 $67.93Suicide/Self-Harm $5.78 $64.00 $41.75 $11.59Violence $3.58 $47.81 $20.15 $3.73Unintentional Poisoning $9.82 $17.48 $16.32 $15.12Other* $127.10 $202.28 $140.40 $137.31Total $310.01 $572.10 $434.63 $965.07△Health care costs are the direct costs. *Includes drowning, fire/burns and other as defined in the table below.△Health care costs are the direct costs. **Includes struck by object (excluding sports equipment); exposure to animate mechanical forces; other accidental threats to breathing; exposure to electric current/radiation/extreme air temperature and pressure; contact with venomous animals and plants; exposure to forces of nature; overexertion and strenuous/repetitive movements; and accidental exposure to other and unspecified factors.Health care costs△ by age group and cause of injury, BC, 2010 ($ millions)1Children(0-14 yrs)Youth(15-24 yrs)Adults(25-64 yrs)Older Adults(65+ yrs) TotalFalls $88 $67 $320 $485 $960Transport Incidents $25 $74 $226 $45 $370Suicide/Self-Harm $4 $37 $106 $8 $155Violence $2 $28 $51 $2 $84Unintentional Poisoning $7 $10 $41 $10 $68Fire/Burns $5 $3 $14 $3 $25Drowning $1 $1 $2 $0 $3Other** $82 $115 $340 $88 $624Total $213 $335 $1,099 $642 $2,289¢ Falls ¢ Transport Incidents ¢ Suicide/Self-Harm ¢ Violence ¢ Unintentional Poisoning ¢ Other*△Health care costs are the direct costs. *Includes drowning, fire/burns and other as defined below.HEALTH CARE COSTS△ SPENT ON INJURY PER PERSONBC, 20101Children$310Youth$572Adults$434Older Adults$965Falls among older adults were the single greatest contributor of injury costs. Injuries to youth cost the most for all causes other than falls.Photo: Toa55 /Shutterstock18 | The BC Casebook for Injury Prevention08 Potential Return on Investment/Business CaseCHAPTERInvesting in prevention provides an opportunity for positive change: we can save lives, reduce disabilities and save health care resources.The Office of the BC Provincial Health Officer, the Canadian Public Health Association and the US Centers for Disease Control argue that investments “upstream”, in programs and interventions that focus on prevention and health promotion, will result in decreased demand for “downstream” acute care health facility-based services, reducing the need for costly treatment.1-3 Investing in prevention and keeping people healthy can save health care resources.1,3Forecasted Cost SavingsParachute, Canada’s national charitable organization dedicated to preventing injuries and saving lives, developed a report in 2015 titled The Cost of Injury in Canada.4 Parachute worked with The Conference Board of Canada to provide forecasts outlining the proportion of injuries that will not occur if specific preventative interventions are in place.Example #1: Falls Intervention for Community-Based Older AdultsIt is conservatively estimated that interventions which include a multifactorial falls risk assessment and a management program tailored to an individual’s risk factors and setting will result in a 20% reduction in falls among older adults by 2035.4 Increasing the number of older adults who receive environmental assessments from health care professionals that include: a) modifications of fall risks identified in the home, b) an evaluation of daily activities, and c) an intervention to promote safe performance of those activities is forecasted to reduce injury due to falls.5 Over 5 years, this will result in a savings of over $28 million.6 Over 20 years, this will result in a savings of well over $146 million.6Example #2: Alcohol Consumption InterventionsPersons under the influence of alcohol are more likely to be injured, and when injured are more likely to sustain serious injuries.7 There are many best practice interventions, such as regulating the cost of alcohol and the hours of sale, that have an impact on the opportunity for excessive alcohol consumption.7, 8 Data to support alcohol cost savings is currently unavailable, however based on the evidence, it is conservatively forecasted that an investment in alcohol-related injury prevention will reduce alcohol-related injury by 9%, also resulting in cost savings.6, 9, 10Example #3: Helmet UseHelmets used when cycling or engaging in snow sports reduce the risk of head injury.11-13 There is a forecasted 25% reduction 20%can reduce4 falls by$146 millionFalls riskinterventiongenerating a savings over 20 years ofPhoto: Tom Wang/ShutterstockChapter 8: Potential Return on Investment/Business Case | 19Upstream investment in injury prevention translates to injury costs avoided and financial resources available for reallocation to other important health care areas.in risk of head injury if bicycle helmets are worn correctly.11, 12 There is a forecasted 35% reduction in risk of head injury if ski and snowboard helmets are used.6, 13 Over 5 years, this will result in a savings of over $28 million.6 Over 20 years, this will result in a savings of well over $125 million.6Example #4: Traffic Speed ControlSpeed-cameras, speed calming such as lowered speed limits, and environmental modifications such as road bumps are effective at reducing speed-related injury and death.14-20 It is forecasted that speed calming efforts will result in 30% fewer transport-related deaths and 50% fewer injuries.20, 21 Speed cameras result in a forecasted reduction of 15% of speed-related injury and death.17, 19 These reductions rely on an investment in environmental modifications and enforcement of road safety laws, however the benefit of lives saved and injuries avoided is more than four times the cost of enforcement.18 Over 5 years, over $61 million will be saved with these investments.6 Over 20 years, well over $266 million will be saved.6Why Invest in Injury Prevention?There is clear evidence that these interventions can reduce the number of people requiring health care services for the treatment of injuries. Prevention reduces the load on the health care system. Upstream investment in injury prevention translates into injury costs avoided and financial resources available for reallocation to other important health care areas.1-3 Investing in prevention provides a potential solution to the rising costs of health care.35%or snowboardhelmetWearing a skican reduce4 head injury by$125 milliongenerating a savings over 20 years ofover 20 years4$266 millionspeed calmingReducing death and injury througheorts will result in a savings ofEstimated cost savings by select child injury intervention, 200922Every dollar spent on: ...saves societyChildproof Cigarette Lighter $80Booster Seat $71Bicycle Helmet $45Child Safety Seat $42Zero Alcohol Tolerance, Driver Under 21 $25Smoke Alarm $18Poison Control Centre $8Photo: altanaka/Shutterstock20 | The BC Casebook for Injury Prevention09 Injury Prevention Links with Public Health IssuesCHAPTERInjury is not an isolated problem. Injury is associated with many of the same determinants that lead to chronic diseases, communicable diseases, mental illness, substance abuse, and is part of a complex puzzle within public health.BC’s Guiding Framework for Public Health identifies seven visionary goals for the public health system. Together, these goals support the vision of “Vibrant communities in which all people achieve their best health and well-being where they live, work, learn and play.” The visionary goals are largely influenced by and aligned with service lines in the Public Health Strategic Framework, which identifies core public health functions as part of the public health system renewal that began in BC in 2003.Injury prevention efforts complement and benefit from work on other public health issues and need to be considered as part of the overall solution to improving the health of individuals, families and communities in BC. Information in the table below demonstrates that supporting injury priorities also has a positive impact on public health and healthy family priorities. Investments in injury prevention support healthy choices and behaviours across the lifespan and across a host of public health issues, in addition to specific injuries.Goal: Healthy Living & Healthy Communities Relevant connection to injury prevention:Physical Activity (Healthy Families BC)Tobacco Control StrategyChronic Disease » Designing communities where children, youth and adults can easily and safely travel on foot and by bike increases physical activity and decreases injuries.1-3 » By addressing injury prevention and control strategies within physical activity initiatives, barriers for participation due to injury can be eliminated and maximum satisfaction and health benefits through participation of physical activity can be achieved.4 » Implementing proven injury prevention initiatives in sport and physical education classes (e.g. FIFA 11+, delayed body checking in hockey, personal protective equipment, quality training for coaches, parents and officials) keeps people injury free, able to remain playing and active, and reduces the burden on the health system.5-8 » BC’s Tobacco Control Strategy aims to decrease the number of people who smoke. As many deaths and injuries from fires are attributable to smoking and smoking-related materials, supporting this strategy may decrease burn injuries and deaths.9 Motor vehicle, falls and job related injuries are also significantly higher among smokers and can be reduced with increased tobacco control and smoking cessation efforts.10 » There is an association between several chronic diseases and injury. Supporting interventions that decrease chronic disease may also decrease injuries:a) Those with type 1 or 2 diabetes have an increased risk of suicidal ideation, attempts and deaths.11-15b) Those with myocardial infarction have an increased risk of depression and suicide.16c) Those with asthma and chronic obstructive pulmonary disease (COPD) have an increased risk of depression and suicide.17, 18d) Older drivers with heart disease are more likely to be involved in motor vehicle crashes.19-21e) Diabetes, obesity and cardiovascular disease are all associated with an increased risk of falling.22-24, 25-28, 29-31f) Long-term immobility due to brain and spinal cord injuries give rise to medical complications such as pneumonia, deep vein thrombosis , chronic pain, incontinence, etc. By preventing injuries, the drain on the health care system for these issues can be reduced.32, 33Goal: Maternal, Child & Family Health Relevant connection to injury prevention:Provincial Perinatal Depression FrameworkHealthy Minds, Healthy PeopleFetal Alcohol Spectrum Disorder StrategyHealthy Start » Smoking is a known cause of low birth weight.34 Low birth weight is associated with higher crying, which is associated with shaken baby syndrome.35-38 Support for BC’s Tobacco Control Strategy may contribute to more infants born at healthy weights. » Promoting Canada’s Low-Risk Alcohol Drinking Guidelines is a way to address the hazardous drinking that is associated with higher injury rates.39, 40 » Contributing to actions focused on reducing family poverty, increasing access to affordable housing, and decreasing socio-economic inequalities may achieve health gains in injury and disease prevention.41-44 » Safe recreation and play enhance family relationships and bonding with fathers.45, 46Chapter 9: Injury Prevention Links with Public Health Issues | 21Goal: Positive Mental Health & Prevention of Substance Harms Relevant connection to injury prevention:Healthy Minds, Healthy PeoplePromoting a culture of moderation related to alcohol usePolicies and programs that address specific social, environmental and individual risk and protective factors » There is an association between injury and emotional well-being among Canadian youth. Creating a school and community culture that fosters inclusiveness and respect and discourages bullying will help to improve feelings of belonging and safety.47 » The association between traumatic brain injury and psychiatric disorders is well established and evidence suggests that these disorders can be partially prevented by preventing head injuries.48, 49 » Depression is a major consequence of falls among older adults. The burden of depression can be reduced by preventing falls among older adults.50 » Evidence indicates that physician education in depression recognition and treatment, restriction of means, as well as gatekeeper education are promising components of suicide prevention strategies as they impact suicide rates.51 » Working with public health on community-based health promotion initiatives, including local government policies to promote a culture of moderation related to alcohol use will also address the injuries that are associated with hazardous drinking.39, 40 » Services, regulations and programs that address the use and abuse of alcohol, prescription and illicit drugs can contribute to decreasing injuries47 and disease.52Goal: Communicable Disease Prevention Relevant connection to injury prevention:Harm Reduction: A British Columbia Community GuidePublic Health Act » Communicable disease prevention requires a comprehensive public health approach, among a variety of systems and sector partners including primary care.53 The same approach works for injury prevention. There is an opportunity to provide injury prevention information at the same time as communicable disease information, e.g. during child vaccinations.Goal: Injury Prevention Relevant connection to injury prevention:Provincial Health Officer’s ReportsSeniors Action PlanSeniors Healthy Living FrameworkBC Injury Research and Prevention Unit reports » There are often opportunities to combine injury prevention messaging and initiatives. For example, Surrey Fire Service offers free smoke alarm installation along with a home inspection that includes information on a variety of fire and general safety topics.54 They give priority to homes with children or seniors residing in them.Goal: Environmental Health Relevant connection to injury prevention:Licensed Community Care Facility InspectionsBuilt Environment » Includes health protection and ensuring safe living environments.53 » Inspections of licensed care facilities include inspecting for hazards to ensure the safety of the residents of those facilities. » BC’s Guiding Framework states that “Coordinated data analysis is a best-practice approach to determining which policies will drive improved health outcomes and the protection or development of healthy community environments. This will also inform injury prevention policies and programs.Goal: Public Health Emergency Management Relevant connection to injury prevention:Public Health Act » Good emergency response plans keep workers from being injured in an emergency or disaster. » When workers are not injured, they can help keep other staff and the public safe in an emergency or disaster. » Using surveillance to monitor hazards to health and reporting on risk can inform injury prevention as well as emergency or disaster response.53 » Injury prevention information can be disseminated at the same time and in the same way as emergency/disaster response information.22 | The BC Casebook for Injury Prevention10 Taking ActionCHAPTERIt is time to take action in BC so that full lives are lived free of injuries and disabilities.Injuries have a devastating impact on the physical, psychological and economic health of people living in BC. Injuries take a significant toll in terms of lives lost, lost economic productivity and costs to the healthcare system. However, there is much that can be done to prevent injuries.The key messages in each chapter provide the rationale for why action is needed, as well as outlining potential actions that can be taken. Selected injury prevention programs currently operating in BC are outlined in the following case studies. Parachute’s Horizon solutions website http://horizon.parachutecanada.org/en/ also provides evidence-based examples of injury prevention work in action.Injury prevention organizations such as the BC Injury Research and Prevention Unit and Parachute Canada are available to provide more information and guidance for injury prevention action in your jurisdiction.Why Action is Needed » Injury is the leading cause of death1 and the 2nd leading cause of hospitalization among 1-44 year olds in BC.2 » From birth to retirement, injuries are the leading cause of Preventable Years of Life Lost (PrYLL).3 PrYLL is a powerful metric of premature and preventable loss of human potential. » In just 1 year in BC, there were 2009 deaths due to injury, 34,998 people hospitalized for serious injuries and a further 456,390 people were treated in emergency departments and 8,582 people suffered injuries that resulted in permanent disabilities.4 » Injuries cost British Columbians $3.7 billion dollars in just 1 year, the equivalent of $422,479 per hour, 24 hours per day, 7 days per week.4 » The public health system, including government, health authorities, communities and researchers, is ideally situated to reduce injury in BC. Injury prevention efforts complement and benefit from work on other public health issues and need to be considered as part of the overall solution to improving the health of individuals, families and communities in BC. » There is a forecasted savings of $117 million in 5 years and $537 million in 20 years when specific injury prevention interventions are implemented (see Chapter 8). » Injury prevention prevents death and reduces the need for medical treatment so British Columbians can live long lives to the fullest. » Supporting injury priorities will have a positive impact on public health and healthy family priorities. » Investing in prevention provides an opportunity for positive change: we can save lives, reduce disabilities and save health care resources.What You Can Do1. Focus on injury prevention. Consider the role of injury prevention within the scope of your current position, and determine if this role can be expanded.2. Work collaboratively to implement evidence-based solutions that will save lives and prevent disabilities. Everyone has a role in injury prevention.3. Develop an understanding of the groups or populations that are most affected by specific causes of injuries to inform where to focus injury prevention efforts.4. Gain an understanding of the injury patterns within your target population.5. Build partnerships that use sustained, multi-faceted and reinforcing strategies to conduct injury prevention initiatives.6. Follow the public health approach when implementing and evaluating injury prevention interventions.7. Commit resources for evidence-based solutions to prevent falls among older adults as they are the single greatest cause of direct injury costs.8. Commit resources for evidence-based solutions to prevent injuries among children, youth and young adults as injury has a profound impact on children, youth, young adults and their families. Injuries to youth cost the most for all causes other than falls.49. Address the social determinants of health to reduce injury rates and influence other public health issues.10. Determine the upstream investment for injury prevention as it translates to injury costs avoided and financial resources available for reallocation to other important health care areas.5-724 | The BC Casebook for Injury PreventionShaken Baby SyndromeCASE STUDY 1Shaken Baby Syndrome or Abusive Head Trauma (SBS/AHT) are terms used to describe the constellation of signs and symptoms resulting from violent shaking or shaking with impact to the head of an infant or small child. Among shaken infants, mortality rates range from 15% to 38% with a median of 20% to 25%.1, 2 It has been recognized that crying is an important stimulus for SBS. Feature: The Period of PURPLE Crying® ProgramThe ProgramIn 2007 Prevent Shaken Baby Syndrome BC, a program of BC Children’s Hospital, developed a shaken baby syndrome and infant abuse prevention program called the Period of PURPLE Crying. The program title describes the time in a newborn’s life when he or she cries more than any other time in infancy. It begins at about two weeks of age and continues until they are about three to four months old. PURPLE stands as an acronym for “Peak of crying/Unexpected/Resists soothing/Pain-like face/Long-lasting/Evening”. It’s a normal part of every infant’s development and all babies go through this period.The program has three aims:1. To change the way parents and caregivers are educated about normal infant crying.2. To improve awareness around the dangers of shaking infants.3. To reduce the incidence of SBS/AHT and infant abuse in British Columbia.DeliverySince February 2009, the Period of PURPLE Crying Program® has been delivered to parents of BC’s 42,000 annual births at all 49 birthing hospitals and 112 public health units. This includes exposure to the program through maternity units and midwife-assisted home births; public health materials; and since 2010, through a public education campaign. The public education campaign was launched through various media and every year the program hosts a province-wide grass-roots campaign called CLICK for Babies where purple newborn caps are collected and distributed with the program during the months of November and December.To date almost 9,000 health practitioners, early childhood educators, childcare providers and healthcare students across the province have completed the PURPLE program training and are administering the program. Thirteen post-secondary institutions have incorporated the program into their curriculum and/or course assignments as well.95%The Period of PURPLE Crying Program®PROVINCE-WIDEwithhas been implementedof BC parents of newborns receiving the program from maternity & public health“I read a lot of books but this is the only one that explained that a baby’s crying is normal.”- Mother of four month old infantCase Study 1: Shaken Baby Syndrome | 25PartnershipsPrevent SBS BC is a program of BC Children’s Hospital and is funded by the BC Ministry of Children and Family Development, the BC Ministry of Health, Provincial Health Services Authority and the Canada Research Chair in Community Child Health Research.MaterialsParents of newborns receive crying education as well as an informational package which includes a 10-minute crying film, a 17-minute research-based soothing film and a 10-page booklet.In 2015, the crying film and booklet will be offered in 12 languages: English, French (Canadian), Punjabi, Cantonese, Spanish (Mexican), Korean, Vietnamese, Japanese, Portuguese (Brazilian), Somali, Farsi and Hebrew. The soothing film is available in English, French and Spanish. EvaluationThe Period of PURPLE Crying Program® is currently being evaluated through quality improvement process measures as well as active and passive surveillance.Quality improvement measures include: public health nurse administrative forms (February 2009 to September 2011), maternity nurse surveys (September 2009 to March 2014), parent surveys when their infants are 2-4 months of age (January 2010 and ongoing) and public health nurse surveys (October 2012 and ongoing). For active and passive surveillance, incidence rates of shaken baby syndrome and other forms of physical abuse in 0-2 year olds are collected from the Neurosurgery Department at BC Children’s Hospital, Child Protective Services, the BC Coroners Office and Canadian Institute for Health Information and compared pre/post PURPLE program implementation.cost 18%The program resulted in aofover the years 2009-2011based on ongoing surveillancesavingsreduced the numbercrying casespresenting at the BC Children’s Hospital Emergency Room429%The program hasofbyWould you like more information on this case study? Email: cyambao@cw.bc.caResources » For professionals: www.dontshake.ca » For parents: The Period of PURPLE Crying Program® » www.clickforbabies.org26 | The BC Casebook for Injury PreventionInjury Prevention MessagingCASE STUDY 2Injuries kill more Canadian children than all other causes combined.1 Some consider injuries as ‘accidents’, a childhood right-of-passage, or something that happens to other people. The truth is that injuries happen at an alarming rate and a vast majority of injuries are preventable.1, 2While there has been a positive downward trend in the rates of childhood injuries over the last decade, serious trauma and life-long disability continues to create hardship for children, families and communities across BC. Preventable childhood injuries remain a leading cause of hospitalization and death.3Evidence-based injury prevention strategies, such as child restraint seats, stair gates and window guards along with broad-based public education on these strategies, are required to support behaviour change.3Feature: A Million Messages (AMM)The ProgramA Million Messages (AMM) is a childhood injury prevention program designed to support families, parents and caregivers, and to avoid feeling overwhelmed with ‘a million messages’ on child health and wellness. Northern Health provides AMM through Public Health Nursing by delivering simple, consistent and routine messaging to parents and caregivers on injury risk appropriate to their child’s age and developmental milestones.DeliveryAMM is distributed by public health nurses as part of their regular contact with families, parents and caregivers with children between 0-6 years of age. Embedded into routine public health contact, the program is delivered to families during maternity home visits and regular immunization appointments. With each interaction, parents and caregivers discuss and learn about their child’s developmental stage, associated injury risk factors, and key injury prevention strategies. Written resources specific to injury prevention messages are shared to supplement the verbal discussion. The goal of AMM is to promote optimal childhood development by decreasing childhood injuries in the home through a consistent, simple education and awareness program. Any setting in which services are provided to families caring for young children will find success with this program.PartnershipsAMM was developed by Capital Health, Alberta (now Alberta Health) and is recognized by the Public Health Agency of “Because of the program, I am reminded to speak about safety at every interaction with parents.”- Public Health Nurse, BCResources » A Million Messages, Northern Health [Link →] » Public Health Agency of Canada’s Canadian Best Practices Portal [Link →] » Safe Kids Canada’s Child Safety Good Practice Guide: Good investments in unintentional child injury prevention and safety promotion- Canadian Edition, at Parachute Canada [PDF →] Would you like more information on this case study? Email: prevent.injury@northernhealth.caCase Study 2: Injury Prevention Messaging | 27Canada as a Canadian Best Practice program.4 Northern Health partnered with Capital Health and their graphic designer to adapt AMM to reflect the population across northern BC.MaterialsAMM tools support those delivering childhood injury prevention messaging by providing staff with standardized reference guidelines, handouts and displays. The resources are easy to understand and give parents and caregivers clear suggestions on how to keep their children safe and injury-free. Northern Health modified the AMM materials to include appropriate literacy levels and up-beat, colourful graphics and caricatures representing the multicultural demographics of northern BC.EvaluationSeveral evaluations, comprehensive literature reviews, and expert and parent consultations support AMM as a childhood injury prevention program that is simple to implement and meets the needs of the families, parents and caregivers working to keep their children safe.Process and outcome evaluations of AMM were completed in the Alberta Capital Health region from 2003-2005. These evaluations identified:5 » Repeated AMM messages are simple and reach the targeted audiences. » 94% of parents/caregivers surveyed reported receiving injury prevention messages during their previous clinic visit. » 60% of parents/caregivers who received AMM messages indicated they had learned something new and 46% reported that this information led to behavior changes. » 93% of nurses trained to implement AMM reported it to be an easy to use tool that allowed them to be more efficient in delivering consistent injury prevention messages. » 83% of parents/caregivers indicated they noticed information and materials about child injury prevention, especially in the clinic setting. » Operations managers did not experience difficulty implementing or operationalizing AMM.AMM is an evidence-based and best-practice program that successfully delivers injury prevention strategies to families, while streamlining the work process for staff.4-628 | The BC Casebook for Injury PreventionConcussion PreventionCASE STUDY 3Once seen as just a knock to the head or ‘getting your bell rung’, concussion is now considered an invisible epidemic and recognized as a traumatic brain injury that requires immediate recognition and management for full recovery. Every day this preventable injury takes people away from school, work and play, costing BC $2.4 million in hospitalizations alone in 2010.1 » In 2011, the leading cause of concussion was falls (32.5%), followed by sports and recreational activities (18%).2 » Children and youth up to age 19 represented 22% of head injury hospitalizations and almost 40% of concussion emergency department cases across BC.2 » Children and youth take longer to recover from concussion than do adults.3How a concussion is handled in the minutes, hours and days following an injury can significantly influence the extent of damage and recovery from that injury.Feature: The Online Concussion Awareness Training Tool (CATT)The ToolBC’s CATT combines public education and awareness for parents, players, coaches and educators, along with resources and support for health care professionals and school professionals. The CATT is available online 24/7 and is updated every two weeks providing free, evidence-based education, tools and resources to help prevent, recognize, and properly manage a concussion.It has been designed to be learner-centered and is based on the International Consensus Statement on Concussion in Sport.CATT is designed to help standardize concussion recognition, diagnosis and management. Good concussion management decreases the risk of brain damage and reduces long-term health issues.Three specialized concussion toolkits can be found at cattonline.com: » The Medical Professionals Clinical Toolkit » The Parents, Players, and Coaches Awareness Toolkit » The School Professionals Toolkit These toolkits provide quick and easy access to numerous resources including online learning modules (physicians can claim CME Mainpro-M2 credit/parents and coaches receive a downloadable certificate of completion), journal articles, handouts, videos, the online concussion response tool, recommended websites and Sport Concussion Assessment Tool (SCAT) 3 assessment tools (both adult and child).Concussions matter! Know more aboutthe need for properprevention withconcussion,management andVisit www.cattonline.com for free up-to-date education, tools and resources.leading cause2 offallsconcussionfollowed by32.5%isatThesports & recreational activities at18%“I am very pleased at the level of interest the CATT has seen on concussion awareness and training, provincially, nationally and internationally.” - Dr. Shelina Babul, BCIRPU Associate Director / Sports Injury SpecialistResources » www.cattonline.comWould you like more information on this case study? Email: concussion@cw.bc.caCase Study 3: Concussion Prevention | 29DeliveryIn February 2015, the Canada Winter Games came to Prince George and northern BC. Northern Health recognized this multi-sport event would place a spotlight on athletes and provide an opportunity to leave a legacy of knowledge and expertise around concussion.The Concussions matter! campaign was created to build the capacity of Northern Health physicians, staff, community members, parents, players, coaches and educators to prevent, recognize and appropriately manage concussion. In order to achieve this goal and standardize concussion knowledge and care throughout the north, the CATT was chosen as the heart of the campaign.Concussions matter! was divided into two phases. Phase one focused on increasing the knowledge and expertise of concussion among Northern Health physicians and staff. Phase two concentrated on regional community partners as well as participants and visitors of the Canada Winter Games. Both phases encouraged the completion of the CATT online training tool.PartnershipsNorthern Health partnered with the creators of CATT at the BC Injury Research and Prevention Unit and preventable.ca in the creation of Concussions matter! Northern Health also partnered with SportMedBC, Pacific Sport North, and Wellness in Northern BC (WINBC) to bring the Northern Safe Sport Tour (NSST). The NSST offered subsidized, in-person concussion management supporting the CATT and sport injury prevention workshops to over 200 athletes, coaches and sport leaders from 15 communities across northern BC.MaterialsResources were promoted and made available across the North. Posters, bookmarks, return-to-learn/return-to-play information cards, stickers, magnets and banners were shared at the Games venue blitzes and mailed out to regional hospitals, public health units, physician offices, pharmacies, health clinics, municipalities and First Nations communities. Social media platforms (blog, Facebook and Twitter) and articles drew daily attention to concussion awareness and the CATT.EvaluationGood concussion management reduces the risk of further brain damage and decreases health care costs related to long-term associated health issues.4 Based on established international principles, CATT has undergone extensive review, both provincially and nationally. Evaluation of the CATT for medical professionals revealed that physicians have a statistically significant positive change in practice and an increase in knowledge for those who reported seeing more than 10 concussions per year. Nurses also demonstrated statistically significant positive change in practices and attitudes.5 Evaluation of the CATT for parents, players and coaches found that parents had a statistically significant positive change in concussion knowledge.6 Evaluation of CATT for School Professionals is currently in progress.30 | The BC Casebook for Injury PreventionInjury Surveillance & PreventionCASE STUDY 4Injury surveillance is the ongoing and systematic collection, analysis, interpretation, and dissemination of health information. The objective to collecting this information is to detect trends in incidence, identify risk factors or causes, develop preventive and control measures, and evaluate the impact of prevention.Feature: Secwepemc Injury Surveillance & Prevention ProgramThe ProgramThe Secwepemc Nation Injury Surveillance & Prevention Program is a program in which injury data is collected and analyzed at a community level to determine the trends in injuries happening in each of the participating communities. With the information collected, strategies can be developed in order to prevent many of these injuries from recurring in the future.The Injury Surveillance Program was started in 2003, when eight Health Directors representing 12 of the Secwepemc communities in the Interior Region, came together to explore the possibility of collecting community specific injury data. They recognized that for prevention strategies to be effective, the strategies needed to be matched to relevant injury problems. The group moved forward with the implementation of the Aboriginal Community Centered Injury Surveillance System (ACCISS). This system collects data on injuries occurring in the community and uses this data to plan prevention activities in the community. This electronic database system was developed to track who, what, when, where, why, and how injuries happen.DeliveryThe goal of the program is to gather as much information as possible while keeping the identity of those injured completely anonymous. In order to accomplish this goal, an Injury Surveillance form was developed to record the age, gender, date of injury, time of injury, what happened, etc. and information about the injury itself. Forms are completed by staff and/or other relevant parties such as nurses, RCMP, Home Support, and Community Health Representatives. Completed forms are then given to the Injury Prevention Data Clerks to enter into the ACCISS database.At the end of each fiscal year, the data collected is summarized and evaluated. The evaluation process allows the clerks and Health Directors in each of the communities determine which areas require prevention initiatives for the next fiscal year. For example, when one community identified that over two thirds of their reported injuries were occurring in and around the home, a Home Safety program was initiated. This included a home safety checklist and support to community members to improve home safety.HOW & WHYare injuries happening?WHEREare the injuries happening?WHENdo injuries happen?WHOis getting injured?WHATare the circumstances leading to an injury?WHATare the circumstances leading to poor health?Injury prevention relies on knowing...Promoting health & well-being relies on...“This project has provided a tool to collect data to inform further program resource and capacity needs at the community level.”- Secwepemc HUB ResourcesInformation regarding the Secwepemc Injury Surveillance and Prevention Program can be found at any of the following Health Centres: » Esketemc, Splats’in, Simpcw » Three Corners Health Services Society (Williams Lake, Soda Creek, Canoe Creek) » White Feather Family Centre (Canim Lake) » Q’wemtsin Health Society (Tkemlups, Skeetchestn, Whispering Pines/Clinton) » Sexqeltqin (Adams Lake) » Skwlax Wellness Centre (Little Shuswap Lake)Information can also be found online by visiting: » Three Corners Health Services Society [Link →] » Q’wemtsin Health Society [Link →] » Adams Lake Indian Band [Link →] » Aboriginal Community-Centered Injury Surveillance: A Community-Based Participatory Process Evaluation [Link →]Would you like more information on this case study? Email: kjasper@threecornershealth.orgCase Study 4: Injury Surveillance & Prevention | 31PartnershipsSecwepemc Injury Surveillance and Prevention Program is comprised of Esketemc, Three Corners Health Services Society, Q’wemtsin Health Society, Adams Lake Indian Band, Canim Lake Indian Band, Little Shuswap Lake Indian Band, Simpcw First Nation, and Splats’in First Nation. The program’s largest supporting partnership is with First Nations Health Authority. There has also been a partnership developed between the Injury Surveillance Program and Interior Health, where the hospitals associated with the Northern Shuswap communities complete the surveillance forms and the data clerks from each community are responsible for collecting the forms from the hospitals. Without the support of the partners, the program would not be able to develop prevention strategies for their community members.EvaluationSince the program’s official start-up in 2005, hundreds of Injury Surveillance forms have been collected from each of our communities. The increase in the numbers of forms that are collected allows the communities to provide more accurate data; this data then leads to more specific prevention initiatives. Some of the initiatives that have been provided include Falls Prevention Workshops, Car Seat Safety, and Bike Rodeos, to name a few.The Secwepemc Nation Injury Surveillance & Prevention Program continues to actively collect injury surveillance forms from communities and partnering hospitals throughout the year to ensure that the data collected is as accurate as possible.The use of promotional products will also help to familiarize the program amongst community members.Photo: Cyclelicious (c) Richard Masoner, CC 2.032 | The BC Casebook for Injury PreventionSeniors’ Falls PreventionCASE STUDY 5Falls are the leading cause of injury-related deaths and hospitalizations for BC seniors.1, 2 Due to an aging population, falls-related hospitalizations have been steadily increasing in BC since 2000 for those aged 65 and over.2 When an older person falls, it can come at a devastating cost resulting in loss of mobility, a reduced quality of life and in severe cases, death. The cost for seniors to the BC health system is also very high with more than $485 million in direct health care costs in 2010.3Feature: The SAIL Adaptation ProjectThe ProgramThe Strategies and Actions for Independent Living (SAIL) is a comprehensive fall prevention program for home support service providers in BC. The SAIL Adaptation Project is a modification of this program to be culturally appropriate for fall and fire prevention in First Nations communities for elders who live on reserves and receive home support services. Through the development and implementation of a train-the-trainer education program for home support leaders, the goal of the program is to create a critical mass of providers that can help to reduce the risk of falls or fire affecting Elders on First Nations reserves.DeliveryIntegrating the SAIL materials into existing home support practice in First Nations communities is challenging due to different service delivery methods, lack of available staff and of time, as well as limited resources for home modifications. However, the project aims to work closely with the First Nations Health Authority (FNHA) and local Bands to focus on integrating the newly adapted program into routine home support.Workshops are facilitated by trained instructors with expertise in fall and fire prevention for older adults from the BC Injury Research and Prevention Unit; the Centre of Excellence on Mobility, Fall Prevention and Injury in Aging (CEMFIA) at the Centre for Hip Health and Mobility; and locally trained Canadian Falls Prevention Curriculum (CFPC) facilitators. The workshop, refreshments, and course materials are offered at no charge—participants are responsible for their own travel and accommodation when needed. Funding for this project is provided by the BC Ministry of Health to the Centre for Hip Health and Mobility.Instructors have found that the integration of falls prevention programming with other healthcare add-ons, such as a foot care program, to be effective. Referring to it as a “full service health prevention teaching opportunity through foot care,” this example demonstrates a unique way to engage people on a variety of healthcare issues in an effective and culturally competent way.PartnershipsThe program is operated by (CEMFIA)—within the Centre for Hip Health and Mobility—in partnership with the FNHA, the Aboriginal Healthy Living Activities (AHLA) program, the BC Injury Research and Prevention Unit and home support leaders working in First Nations communities across BC. reduced44%Trainees of the SAIL programover six months4their clients’ falls by“Fall-related injuries among Elders in First Nations communities require culturally appropriate solutions that reflect proven prevention strategies.”- Vicky ScottCase Study 5: Seniors’ Falls Prevention | 33Resources » Professional Resources: Fall Prevention Guidelines, Training and Tools: [Link →] » Falls and Related Injuries in Residential Care: A Framework & Toolkit for Prevention » Strategies and Actions for Independent Living (SAIL) » Primary Care Fall Prevention Multimedia Package » Promoting Active Living (PAL): Best Practice Guidelines for Prevention of Falls among Residents of Assisted Living » Ministry of Health Fall Prevention Brochures and Pamphlets [Link →] » Primary Care Fall Prevention Multimedia Training Package [PDF →]Would you like more information on this case study? Email: yasmin.yassin@hiphealth.caMaterialsTwo guides were developed as part of an initial pilot for the SAIL Adaptation Project - (1) the Elder Safety Program (ESP): Program Leader’s Guide and (2) the Elder Safety Program Checklist & Action Plan. The Program Leader’s Guide was created with a focus on training home support staff on safety and prevention as well as how to work with Elders to identify and modify factors that increase their risk of falls and fires. The ESP Checklist & Action Plan was adapted for use in First Nations communities from the SAIL program. It includes fall and fire checklist categories such as clothing and footwear, mobility and equipment and home exercises.EvaluationEvaluation of this project includes a follow up visit to one or two communities in each region. A follow-up workshop for CFPC/SAIL trained leaders in those communities is held to present on their progress. The evaluation process is iterative and ongoing throughout the duration of the project. Along with site visits, focus groups with Elders, and staff interviews are conducted. This process is closely monitored by an advisory committee consisting of FNHA representatives, a First Nations Health Director representative, and the fall prevention leads from all of the provincial health authorities.Community Health Workers and Home Health Professionals trained in fall prevention during the SAIL program were able to reduce their clients’ falls by 44% over six months.4The SAIL Adaptation Project, while still in the pilot stage, has trained over 80 health care professionals and others responsible for the health and safety of Elders, reaching over 300 Elders from Haida Gwaii to Cowichan.The program continues to experience high demand and a wait list has been established. A full evaluation of the project will be completed once the pilot period ends.34 | The BC Casebook for Injury PreventionRoad SafetyCASE STUDY 6Despite improvements in road safety over the past decade, incidents involving transportation are still the number one cause of unintentional injury related deaths in the province.1 Road conditions, weather, speed, vehicle factors, and use of safety devices all influence whether a crash with resulting injuries will happen.2 A driver’s age, health and whether they are distracted, impaired, or fatigued are also important. Strategies for the prevention of transportation injuries are not simple, and require input from many stakeholders with varied backgrounds.Feature: The Capital Regional District (CRD) Traffic Safety Commission (TSC) The ProgramThe Capital Regional District Traffic Safety Commission (TSC) was created in 1985 and continues to be unique in British Columbia as an ongoing community collaborative to enhance road safety. The Commission’s members are stakeholders from multiple sectors in Greater Victoria and its goal is to “prevent injuries, save lives and contribute positively to a safer traffic environment”. The TSC receives annual core funding from the Capital Regional District and undertakes projects that are results-focused, evidence-based, and co-funded on a partnership basis. The TSC was recognized as a valuable road safety partnership by the BC Office of the Superintendent of Motor Vehicles (now RoadSafetyBC).Program Delivery & MaterialsMembers of the CRD meet on a monthly basis and work to create results-oriented, community-wide approaches to traffic safety through enforcement, education, and prevention.The following are a few examples of CRD TSC initiatives:Older & Wiser Driver: In 2003, the TSC co-developed a program with the University of Victoria’s Centre on Aging, titled: “The Older & Wiser Driver: A Self-Assessment Program.” Older drivers attended driving self-assessment education sessions, which were arranged in collaboration with agencies serving seniors on the Saanich Peninsula. Senior drivers were asked what would make them safer drivers, and were given information packages including a 74 minute audio CD produced by the Commission with input from the RCMP and municipal police forces, ICBC, and the Centre on Aging.Summer Malahat Safety Project: The Malahat Drive is a 25 kilometre section of Highway #1 that runs along the west side of Saanich Inlet, and is the only major paved connection between the CRD and the rest of Vancouver Island. The winding, steep route has gained a reputation for an increased risk of crashes, fatalities and collision-related road closures. During the summer of 2011, the CRD Integrated Road Safety Unit, a partner in the CRD TSC, undertook a summer safety project on the Malahat which included a notable increase in police presence, notice signs, and increased enforcement of violations, including speeding.The risk of a2.5 timesgreatercollisionor near collision isfor an experienceddriver when using a cell phone3Photo: Syda Productions/Shutterstock“The Traffic Safety Commission brings regional partners together to reduce traffic fatalities, injuries and crashes in Greater Victoria.”- Office of the Superintendent of Motor VehiclesAwareness and Education Campaigns: Used to raise general road safety awareness among targeted groups. » Be Seen and Not Hurt: Released in the fall of 2010 and aimed at vulnerable road users—pedestrians and cyclists, this campaign includes posters and other promotional materials reminding individuals to wear reflective materials when they are out cycling, walking after dark or out in poor weather. » Stupid Distractions Campaign: Targeted to drivers of all ages, this campaign is comprised of messages delivered on vinyl displays on the side of a variety of vehicles. Partners included the health authority, municipalities, University of Victoria and BC Transit.PartnershipsMembers of the TSC include RoadSafetyBC, Police and RCMP from area detachments, members of the Integrated Road Safety Unit, School Districts, the media, the University of Victoria, ICBC, Regional District elected official, traffic planners, BCAA Community Impact, Public Health, Medical Health Officer, cycling liaison, ambulance, and the Coroner’s Office.EvaluationOlder & Wiser Driver: Participants reported that the information provided in the sessions could be useful in helping older adults talk about driving concerns with their families. Many participants reported that as a result of attending the education session they planned to make changes to their driving behaviours.Summer Malahat Safety Project: Excessive speeding was reduced by 30% and no fatal crashes occurred during this 2011 summer safety initiative.4Awareness and Education Campaigns: Evaluation of the vinyl displays on vehicles with road safety messaging found this to be an effective means of raising awareness among vehicle occupants and vulnerable road users. These displays have been used extensively by the TSC for numerous campaigns.The threeleading causesof motor vehicle fatalities are2SpeedRelated33%Distracted Driving28%Impaired Driving27%Resources » RoadSafetyBC [Link →] » www.icbc.com » Canada’s Road Safety Strategy 2015 [Link →]Would you like more information on this case study? Email: murray.fyfe@viha.caCase Study 6: Road Safety | 3536 | The BC Casebook for Injury PreventionAlcohol-Related InjuriesCASE STUDY 7Alcohol is a leading risk factor for injury.1, 2 Studies repeatedly demonstrate that a large proportion of patients admitted to trauma centers are under the influence of alcohol.1, 3-7 Injuries seen as a result of hazardous alcohol consumption levels include falls, burns, assaults, motor vehicle crashes, pedestrian injuries, drownings and intimate partner violence. Addressing alcohol problems with trauma patients is not currently a routine practice across BC’s hospitals; however evidence shows an increased receptivity to alcohol counselling following a visit to a hospital therefore providing an opportunity for intervention.7, 8Feature: Screening, Brief Intervention and Referral to Treatment (SBIRT)The ProgramThe Screening, Brief Intervention and Referral to Treatment (SBIRT) program is an evidence-based, comprehensive, integrated, public health approach to the delivery of early intervention and treatment services for at-risk substance users before more severe consequences occur.In 2013 Trauma Services at Vancouver General Hospital (VGH), a Level I trauma centre in BC, began an initiative to implement SBIRT to address alcohol as a risk factor for injury with the long-term objective to reduce alcohol-related injuries. This first phase of the implementation of SBIRT rolled out October 7th, 2014 with patients admitted to Trauma Services.DeliveryWhen a trauma patient enters the Emergency Department (ED) at VGH a nurse completes a trauma assessment, which includes an assessment of the patient’s alcohol use using a screening tool called the AUDIT-C. If the patient receives a positive score on the AUDIT-C, the patient is then referred to an ED social worker for a brief intervention.In cases when a patient cannot be screened in the ED and is transferred to a Trauma Unit, alcohol screening is deferred to a nurse on the Trauma Unit. Patients who receive positive scores on the AUDIT-C are then referred to a Trauma Unit social worker for a brief intervention.Using the FLO (Feedback, Listen & elicit, Options for change) framework to engage the patient, the social worker:1. Provides feedback about the patient’s screening results, highlighting the link between their alcohol consumption and injury or risk of future injury.2. Informs the patient about Canada’s Low Risk Drinking Guidelines and assesses the patient’s readiness to change.3. Negotiates goals and strategies for change that are patient-centred and arranges follow-up as appropriate.To enable real-time evaluation of the SBIRT implementation, the patient’s AUDIT-C score and the social worker’s brief intervention notes are faxed directly to Trauma Services.Many of the trauma patients are asked to book an appointment with their Trauma surgeon after discharge to make sure that they are healing well and that there are no outstanding concerns. During these appointments, the surgeon asks the patients who received an intervention how they are doing with their behaviour change goals since returning home.Screening - quickly assesses the severity of substance use and identifies the appropriate level of treatment.Brief Intervention - focuses on increasing insight and awareness regarding substance use and motivation toward behavioral change.Referral to Treatment - provides those identified as needing more extensive treatment with information about supports.Photo: jannoon028/Shutterstock“This program is proven to make a positive difference in people’s lives and to lessen the probability of future alcohol-related injury.”- Sheri Johnson, Social Worker, Ortho-Trauma Unit, VGHCase Study 7: Alcohol-Related Injuries | 37PartnershipsThe planning and implementation of SBIRT could not have been possible without the support of many people. Among those instrumental to the success of SBIRT are: the nurses and social workers in the ED and on the Trauma Units, the Patient Care Coordinators (PCC), the nurse clinical educators, the social work practice leads, the unit clerks, the ED and Trauma Unit managers, the VGH Chronic Pain and Addiction Services team, the Trauma team, the Trauma Registry team, the medical residents, GF Strong’s Alcohol and Drug Worker, the Vancouver Coastal Health (VCH) Regional Trauma Program and VCH Printing Services.MaterialsColourful reminder stickers were created to ensure that the PPC verify the completion of the AUDIT-C by Trauma nurses, and that referrals to the social worker are occurring as needed. Stickers were also created to remind surgeons to ask SBIRT patients about their behaviour change goals during their follow-up appointment.A joint RN-SW (nursing - social worker) form was created to document components of SBIRT, supporting data collection by Trauma Services for evaluation purposes. Trauma residents are responsible for documenting patients’ SBIRT scores during daily patient rounds.There are two brochures on Canada’s Low Risk Drinking Guidelines that the social worker may provide to the patient. A listing of the substance abuse-related supports available in the community is also available.EvaluationThe first phase of SBIRT ran for approximately 6 months. The purpose of this phase was to evaluate the process and ensure that each trauma patient received the right SBIRT process at the right time by the right provider. Neither the PCC stickers nor the practice of faxing the intervention information to the Trauma Offices were initially part of the SBIRT process, but together they significantly improved the frequency by which patients were screened and referred to a social worker for a brief intervention.Between October 2014 and April 2015, 262 patients were admitted to Trauma Services and 171 (65.3%) were screened for alcohol use. Of those screened, 78 (45.6%) received a positive score. Of those with a positive score, 68 (84.6%) were referred to a social worker, and 48 (70.6%) received a brief intervention. The frequency of patients with a positive alcohol use being referred to a social worker and receiving a brief intervention has improved over the course of the implementation. The next step in the evaluation process is to conduct a chart review to identify further opportunities for improvement.The vision of VGH Trauma Services is that the SBIRT protocol will be rolled out to hospitals across VCH and across BC.Resources » Canada’s Low Risk Drinking Guidelines [PDF →] » Alcohol Screening, Brief Intervention and Referral to Treatment: Nurse-led SBIRT Practice with Emergency Department Patients [Link →] » SBIRT Webinar Library [Link →] » Brief Interventions for Heavy Alcohol Users Admitted to General Hospital Wards, Cochrane Review [Link →]Would you like more information on this case study? Email: zahra.hussein@vch.caNurse administering the AUDIT-C Screening Tool38 | The BC Casebook for Injury PreventionSuicide PreventionCASE STUDY 8Suicide continues to be the second leading cause of death for young people in British Columbia following motor vehicle crashes.1 Based on regional data, Interior Health identified youth suicide as one of three injury domains (others were motor vehicle crashes and seniors’ falls) to focus on within its Injury Prevention Program.Feature: Suicide Prevention, Intervention, Postvention (PIP) Community Development WorkshopsThe ProgramIn 2009, the BC Suicide Prevention, Intervention and Postvention (PIP) Report was published providing a Framework and Planning Template to address suicide across the lifespan using evidence-based practice and community development principles. Seizing the opportunity to use this useful tool as a catalyst for strengthening the safety net for suicide, PIP in the Interior, a planning committee comprised of representatives from the SAFER Program (Suicide Attempt Follow-up, Education and Research), the Ministry for Child and Family Development (MCFD) and Interior Health developed a model for delivering knowledge exchange workshops. This included the development of a one-day facilitators training workshop with 20 participants from across the Interior to support delivery and follow-up, and two sub-regional pilot workshops. The planning committee defined the specific goals of the workshops as:1. To bring together those organizations in the region whose work is touched by the issue of suicide;2. To make people aware of existing programs and services in their region/communities as well as resources that might strengthen their work in preventing and responding to suicide and suicidal behaviour;3. To introduce the BC Suicide Prevention Intervention and Postvention Framework and Planning Template and explore how they could serve to strengthen community efforts to address the issue of suicide.DeliveryA significant part of the youth suicide prevention work revolved around community development activities led by a full-time facilitator. There was a strong focus on collaboration and building community capacity to support healthy youth development and suicide prevention for youth.In early 2010, community partners from the Cariboo/Chilcotin and West Kootenay regions expressed high levels of readiness and participated in the planning and implementation of the two pilot Suicide PIP community development workshops. These workshops attracted over 120 participants from 15 surrounding communities. Participants came away with a better understanding about evidence informed practice on programs, services and supports, and had the ability to build upon existing dialogue about stakeholder identified priority areas.Three weeks prior to the workshops, participants were asked to complete a survey identifying existing services and supports, collaborations, and challenges and barriers in addressing suicide PIP. The survey information was collated and presented as part of the workshops. Workshops were designed to include: » A “safety speech” to create a space for the work. » BC and health service delivery area-specific data on suicide death rates and hospitalization rates for self-injury. » A spotlight on local/regional programs and services across the PIP continuum.The Conversation Café format provided participants an opportunity to practice putting the Suicide PIP Framework and Planning Templates into action. It fostered networking with fellow participants and the identification of next steps. Photo: Edyta Pawlowska/Shutterstock“This workshop has shown me that I do have a part to play in preventing suicide, especially with children and youth.”- Ambulance Services StaffCase Study 8: Suicide Prevention | 39By the end of 2012, two more workshops were hosted in the communities of Kamloops and Kelowna, and two smaller workshops were held in North Thompson and the East Kootenays. In total, 382 participants from over 28 communities within the Interior participated in the Suicide PIP community development workshops, resulting in various community actions that continue to this day, including annual World Suicide Prevention Day events, gatekeeper training, and the development of community suicide response protocols for youth.PartnershipsThere was a broad involvement by community stakeholders, including some which might not commonly be identified as having a stake in suicide prevention. Representation included school districts, Child & Youth Mental Health, Adult Mental Health & Substance Use Services, non-profit organizations and community planning committees, First Nations and urban Aboriginal agencies; First Responders, religious leaders, and survivors of suicide.Evaluation & ResultsThe Suicide PIP pilot workshops were well attended and positively received by participants. They resulted in the identification of concrete tasks that could be undertaken by the communities represented at the workshops. It’s believed that the success of the workshops is evidence of the wide-spread recognition of the need for stronger community collaborations and resources to mobilize action around suicide PIP and related mental health issues. Opportunities still exist for evaluation, however capacity and resources remain limited.attempted suicideThe average numbersuicide41271 62511deaths by per year in BC isofHospital admissionsdue toper year on average in BC areAverage number, 2001 - 2011 for ages 0-242Average number, 2001 - 2011 for ages 0-241ResourcesAn online Groupsite was created to further engage workshop participants and to maintain a connection to suicide prevention work throughout the Interior. The Strengthening the Safety Net for Suicide PIP (Interior) Groupsite presently has over 200 suicide prevention stakeholders representing the Interior and provincial partners. The community health facilitator with Interior Health continues to moderate this Groupsite and remains the key contact for this work. » Groupsite [Link →] » Visit www.interiorhealth.ca for more information about Youth Suicide PreventionWould you like more information on this case study? Email: jenny.green@interiorhealth.ca40 | The BC Casebook for Injury PreventionSocial Marketing for Injury PreventionCASE STUDY 9The purpose of social marketing is to change people’s attitudes by suggesting that doing something new will be better for them than what they are currently doing. This powerful marketing strategy and has been successfully used to promote physical activity and reduce smoking.Feature: The Community Against Preventable Injuries (Preventable)The ProgramThe Community Against Preventable Injuries (Preventable) is the first-ever social marketing campaign targeted at reducing the burden of preventable injuries in British Columbia and in Canada. Preventable spent three years researching the attitudes behind the behaviours that lead to preventable injuries, and launched its integrated social marketing campaign in British Columbia in 2009.Preventable’s guiding principles: » The approach is based on sound research and analysis, recognizing that the problem must be understood before it can be solved, and working to achieve results which can be measured. » It cannot be done without help. Preventable relies on its strong network of partners to deliver the message where and when it is most effective. By building relationships, Preventable can leverage the unique tools, skills and resources of its partners. » Preventable targets attitudes. Preventable is striving for fundamental societal change, and recognizes that changing the way that people think takes time.In 2006, British Columbians were relatively unengaged with injury prevention. The initial Preventable campaign aimed to raise injury awareness and to create Preventable as a recognizable and trustworthy brand. Through focus groups, Preventable learned that in general, people know what to do to prevent injuries. They may not always take preventive action because they have not had personal experience with serious injury. Traditional injury prevention social marketing approaches – including scare tactics and lecturing – were largely ignored. Preventable learned that British Columbians do not like being told what to do, or made to feel guilty or stupid about their decisions.For their campaign, Preventable chose to use messages that were personal and relevant; creating opportunities for people to use their imagination and draw their own conclusions.Preventable’s campaign strategy is based upon a continuum that recognizes that changing social attitudes is a long-term process:Low Awareness, No Mass EngagementAwareness, No Mass EngagementConsciousness, Societal PressureSome Behaviour ModificationMore Behaviour Modification Mass Engagement1-3 years 3-5 years 5-15 years 15-30 years 30+ yearsOutdoor Play, Distracted Driving (due to eating, music, etc.), ATV SafetyCell Phone Use While Driving, Concussion, Mental HealthInjury Prevention, Homelessness, Climate Change, Aggressive Driving, Anti-BullyingObesity, Booster Seats, Healthy LivingBike Helmet Use, Recycling, Physical ActivityDrinking/Driving, Anti-Smoking, Seat Belts, Hockey Helmet UseThe Social Marketing ContinuumHealth or Societal IssueEngagement Level“Our brand is a key component of our strategy; it creates an emotional resonance for people, and shapes how they feel when they interact with Preventable.”- Kevin La FreniereResources » www.preventable.caWould you like more information on this case study? Email: info@preventable.caCase Study 9: Social Marketing for Injury Prevention | 41This approach empowers people by allowing them to fill in the blanks. Preventable took a non-paternalistic approach grounded in the idea that this kind of message can come from anyone, not just government or the insurance industry.Preventable launched with a mass media blitz supported by ambient and guerrilla messaging in key locations such as school zones, beaches, workplaces and ski hills. The campaign platform was based on the phrase: “You’re probably not expecting to…” completed by messages such as “…need a helmet today.” “….drown today.” This approach garnered high levels of earned media: in the first year of the campaign Preventable invested $1.5 million and received $3.0 - $3.5 million in total value for a return on investment of between 200% and 233%.Delivery & MaterialsPreventable targets British Columbians between 25-55 years of age, who are also the parents of children and youth, and the children of older adults. The majority of funding for a campaign typically focuses on television and online media buys as these have proven to be the most effective channels to reach the target audience. Other campaign elements such as transit shelter ads, newspaper wraps and posters support the media buys by providing connection points to the target audience in their respective community settings. Through its established media network, Preventable manages and places all media buys for the campaign.PartnershipsPreventable is a collaborative and innovative partnership between business, government and community groups, whose combined energy, effort and resources are focused on building awareness, shifting attitudes and changing behaviours towards the causes of serious preventable injuries. Crown corporations, NGOs and leading organizations in both the private and public sectors have all contributed both talents and resources.EvaluationThe first Preventable campaign reached over 2 million British Columbians between June and December 2009, generated over 100 million media impressions. 50,000 people visited the website within the year following the launch. Monitoring indicated a 5-10% positive shift in attitudes and self-reported precautionary actions, as well as support for the Preventable brand.1 Over and above pre-existing trends showing declining injury rates, a 26% reduction in injury deaths was observed during the 2009-10 campaign period among the target group. Furthermore, a significant reduction in deaths was also seen for the 0-24 year age group during the same period, representing children of the target group.1in injury deaths1During the 2009-10 campaignDECREASEperiod there was a26%42 | The BC Casebook for Injury PreventionFrequently Asked QuestionsWhy are injuries in the home and community increasing in BC?Over the years, continuous resource and collaboration directed towards motor vehicle crash prevention such as improved vehicle safety, legislation restricting cell phone use while driving, and changes to enforcement of drinking & driving legislation have resulted in a steady decline in the number of deaths on BC roads from 2000 to 2013. An equal investment has not yet been directed to injuries at home and in the community. Please see page 4 for more information.What are the advantages of preventing injuries?The benefits of investment in injury prevention are broadly shared. Children grow up in safe homes and play in hazard-free spaces; adults contribute productively within safe work places; communities are connected by safe roads; saving lives and saving health care resources is the ultimate result. Please see pages 18-19 for more information.How can I get data on the magnitude of the injury problem in my community/ municipality?The BC Injury Research and Prevention Unit (BCIRPU) has developed an online injury data tool that provides information on the burden of injury. Please visit www.injuryresearch.bc.ca/resources/injury-data-online-tool-idot/Whom should I consult if I want to initiate an injury prevention program in my community/municipality?Information on how to take action is provided on page 21. In addition, examples of injury prevention initiatives and contact information for each one are provided in the Case Studies, pages 22-39. Evidence-based injury prevention initiatives can also be found at: www.horizon.parachutecanada.org/en/What is the best injury prevention approach? Scientific evidence suggests that the public health approach is the best practice for injury prevention when it concurrently targets: Education, Enforcement, Engineering, Environmental Design and Engagement. Please see page 7 for more information.What is the most cost effective way of preventing injuries?Acting upon injuries before they ever occur (primary prevention) is the most cost effective method of preventing injuries. This involves preventing exposure to hazards that cause injury, altering unsafe behaviors that can lead to injury and increasing resistance to injury if exposure occurs. Primary prevention of injuries can be achieved through the public health approach that addresses Education, Enforcement, Engineering, Environmental Design and Engagement.Can we integrate injury prevention into other public health programs?Yes. Injury prevention efforts complement work being done on other public health issues and vice versa. Please see page 20 for more information.What are the strengths for injury prevention in BC?Injury prevention is one of the seven visionary goals of BC’s Guiding Framework for Public Health. Through the Provincial Health Services Authority, the BC Ministry of Health supports an injury network, injury surveillance system and inter-sectorial collaboration towards injury prevention. These are great strengths for injury prevention in BC.What are the barriers for injury prevention in BC?Poor translation of research knowledge into practice, disproportionate allocation of resources for injury prevention compared to other health issues, poor transfer of provincial level injury prevention efforts to the grass-root level and underutilization of proven preventive strategies are the barriers for injury prevention in BC.Can we learn lessons from others when developing injury prevention interventions and programs in BC? Yes. Evidence-based approaches to setting priorities, designing interventions that can be implemented and evaluating the impact of those interventions are key to success in any injury prevention program.Further ResourcesThe BC Casebook for Injury Prevention | 43Please visit the following links for more evidence-based practices for injury prevention:Parachute www.parachutecanada.orgInjury Prevention Centre www.injurypreventioncentre.caOntario Injury Prevention Resource Centre www.oninjuryresources.caAtlantic Collaborative for Injury Prevention www.acip.caSaskatchewan Prevention Institute www.skprevention.caWinnipeg Health Region www.wrha.mb.ca/community/publichealth/services-injury-prevention.phpBC Injury Research and Prevention Unit (BCIRPU) www.injuryresearch.bc.caCanadian Pediatric Society www.cps.caTrauma Association of Canada www.traumacanada.orgCanadian Collaborating Centres for Injury Prevention www.canadianinjurycurriculum.ca/cccipConcussion Awareness Training Tool (CATT)Online www.cattonline.comMcMaster University’s Health Evidence www.healthevidence.orgHealth Canada www.hc-sc.gc.caPublic Health Agency of Canada www.phac-aspc.gc.caTransport Canada www.tc.gc.caWorld Health Organization www.who.int/violence_injury_prevention/enSafe Kids Worldwide www.safekids.org44 | The BC Casebook for Injury PreventionReferencesChapter 1: Injury Prevention: A Call to Action1. British Columbia Vital Statistics Agency, Ministry of Health, 2013.2. Business Information Warehouse – Traffic Accident System. North Vancouver, BC: Insurance Corporation of British Columbia; 2015.3. World Health Organization [Internet]. 2015 [cited 2015 June 18]. Available from: http://www.who.int/violence_injury_prevention/child/injury/world_report/UK_poisoning/en/4. BC Injury Research & Prevention Unit. Concussion Awareness Training Tool. 2012 [Cited 2015 Aug 12]. Available from cattonline.com5. British Columbia. British Columbia Vital Statistics Agency. Selected Vital Statistics and Health Status Indicators: One Hundred and Fortieth Annual Report 2011. Victoria, BC: Ministry of Health; 2011. Available from http://www2.gov.bc.ca/gov/content/vital-statistics/statistics-reports/annual-reports/20116. Rajabali F, Ibrahimova A, Barnett B, Pike I. Economic Burden of Injury in British Columbia. Vancouver, BC: BC Injury Research and Prevention Unit; 2015.7. Ontario Injury Prevention Resource Centre. Ontario Regional Injury Data Report. Toronto, ON: Parachute; 2013 Available from http://www.oninjuryresources.ca/8. Yanchar N, Warda LJ, Fuselli P, & Canadian Paediatric Society, Injury Prevention Committee. Child and youth injury prevention: A public health approach. Paediatr Child Health [Internet]. 2012 Nov [cited 2015 June 18]; 17(9): 511. Available from http://www.cps.ca/documents/position/child-and-youth-injury-prevention9. Cubbin C, Smith G. Socioeconomic inequalities in injury: Critical issues in design and analysis. Annu Rev Public Health. 2002; 23:349–75.10. Atlantic Collaborative for Injury Prevention. The Social Determinants of Injury. 2012 [cited 2015 June 18]. Available from http://www.parachutecanada.org/downloads/research/reports/ACIP_Report_SDOI.pdf11. Kendall PRW. Investing in Prevention: Improving Health and Creating Sustainability. The Provincial Health Officer’s Special Report. Victoria, BC: Office of the Provincial Health Officer; 2010 [cited 2015 April 12]. Available from http://www.health.gov.bc.ca/library/publications/year/2010/Investing_in_prevention_improving_health_and_creating_sustainability.pdf12. Canadian Public Health Association. Frontline Health Beyond Health Care: Making the Economic Case for Investing in Public Health and the SDH. 2015 [cited 2015 April 12]. Available from http://www.cpha.ca/en/programs/social-determinants/frontlinehealth/economics.aspx13. Centers for Disease Control and Prevention, National Center for Injury Prevention and Control. Protect the Ones You Love: Child Injuries are Preventable. 2012 [cited 2015 April 12]. Available from http://www.cdc.gov/safechild/NAP/background.htmlChapter 2: Injury Prevention in BC1. Yanchar N, Warda LJ, Fuselli P, & Canadian Paediatric Society, Injury Prevention Committee. Child and youth injury prevention: A public health approach. Paediatr Child Health [Internet]. 2012 Nov [cited 2015 June 18]; 17(9): 511. Available from http://www.cps.ca/documents/position/child-and-youth-injury-prevention2. Cubbin C, Smith G. Socioeconomic inequalities in injury: Critical issues in design and analysis. Annu Rev Public Health. 2002; 23:349–75.3. Atlantic Collaborative for Injury Prevention. The Social Determinants of Injury. 2012 [cited 2015 June 18]. Available from http://www.parachutecanada.org/downloads/research/reports/ACIP_Report_SDOI.pdf4. British Columbia. Setting Priorities for the B.C. Health System SUPPORTING the health and well-being of B.C. citizens. DELIVERING a system of responsive and effective health care services for patients across British Columbia. ENSURING value for money. Victoria, BC: Ministry of Health; 2014. Available from http://www.health.gov.bc.ca/library/publications/year/2014/Setting-priorities-BC-Health-Feb14.pdf5. British Columbia. Ministry of Health 2014/15 – 2016/17 Service Plan. Victoria, BC: Ministry of Health; 2014. Available from http://www.bcbudget.gov.bc.ca/2014/sp/pdf/ministry/hlth.pdf6. British Columbia. Promote, Protect, Prevent: Our Health Begins Here: BC’s Guiding Framework for Public Health. British Columbia. Victoria, BC: BC Ministry of Health; 2013. Available from http://www.health.gov.bc.ca/library/publications/year/2013/BC-guiding-framework-for-public-health.pdfChapter 3: Injury Patterns in BC1. Discharge Abstract Database (DAD), Ministry of Health, BCIRPU Injury Data Online Tool, 2013.2. British Columbia Vital Statistics Agency, Ministry of Health, 2013.3. Miller M, Rajabali F, Piedt S, Pike I. BC Injury Atlas, Injuries in British Columbia: 2006-2010. Vancouver, BC: British Columbia Injury Research and Prevention Unit; 2012.4. Canada. Profile of Income and Earnings, 2006 Census – Profile for Canada, Provinces, Territories and Forward Sortation Areas, 2006 Census, Census year 2006. Ottawa: Statistics Canada; 2006. Available from http://www5.statcan.gc.ca/olc-cel/olc.action?objId=94-581-X2006003&objType=46&lang=en&limit=0The BC Casebook for Injury Prevention | 45Chapter 4: The Injury Burden in BC1. British Columbia. British Columbia Vital Statistics Agency. Selected Vital Statistics and Health Status Indicators: One Hundred and Fortieth Annual Report 2011. Victoria, BC: Ministry of Health; 2011. Available from http://www2.gov.bc.ca/gov/content/vital-statistics/statistics-reports/annual-reports/20112. Discharge Abstract Database (DAD), Ministry of Health; 2013.3. Rajabali F, Ibrahimova A, Barnett B, Pike I. Economic Burden of Injury in British Columbia. Vancouver, BC: BC Injury Research and Prevention Unit; 2015.4. VISTA electronic download, BC Vital Statistics Agency, Ministry of Health, 2015.5. Canada. Statistics Canada, Demography Division, BC Life Expectancy at Birth, 2009-2011.Available from http://www.statcan.gc.ca/pub/84-537-x/84-537-x2013005-eng.htmChapter 5: Preventable Years of Life Lost (PrYLL)1. The Royal Society for the Prevention of Accidents. Delivering Accident Prevention at local level in the new public health system. Birmingham: The Royal Society for the Prevention of Accidents; 2013. Available from http://www.rospa.com/public-health/delivering-accident-prevention/2. Last JM. A Dictionary of Epidemiology. New York: Oxford University Press; 1995.3. Office for National Statistics: Definitions of Avoidable Mortality; c2011 [cited 2015 July 1]. Available from: http://www.ons.gov.uk/ons/about-ons/get-involved/consultations/archived-consultations/2011/definitions-of-avoidable-mortality/consultation-on-definitions-of-avoidable-mortality.pdf4. International Classification of Diseases, 10th Revision, World Health Organization. Available from: http://www.who.int/classifications/icd/en/5. VISTA electronic download, BC Vital Statistics Agency, Ministry of Health, 2015.6. Canada. Statistics Canada, Demography Division, BC Life Expectancy at Birth, 2009-2011.Available from http://www.statcan.gc.ca/pub/84-537-x/84-537-x2013005-eng.htm7. BC Cancer Registry [Internet]. Provincial Health Services Authority; 2015 [cited 2014 Aug 13]. Available from: http://www.bccancer.bc.ca/health-professionals/professional-resources/bc-cancer-registry8. Taylor Errol. PRYLL definition [email communication]. Message to Fahra Rajabali. 2014 July 11 [cited 2015 July 1].Chapter 6: Children, Youth and Young Adults1. British Columbia Vital Statistics Agency, Ministry of Health, 2013.2. Discharge Abstract Database (DAD), Ministry of Health, 2015. 3. Durbin DR, Elliott M, Winston FK. Belt-positioning booster seats and reduction in risk of injury among children in vehicle crashes. JAMA. 2003;289(21):2835- 2840.4. Elliott MR, Kallan M, Durbin DR, Winston FK. Effectiveness of child safety seats vs seat belts in reducing risk of death in children in passenger vehicle crashes. Arch Pediatr Adolesc Med. 2006;160:617- 621.5. Winston FK, Kallan MJ, Elliott MR, Xie D, Durbin DR. Effect of booster seat laws on appropriate restraint use by children 4 to 7 years old involved in crashes. Arch Pediatr Adolesc Med. 2007;161(3): 270-275.6. Beirnessa DJ, Beasleya EE. 2014. An evaluation of immediate roadside prohibitions for drinking drivers in British Columbia: Findings from roadside surveys. Traffic Inj Prev. 2014;15(3):228-233.7. McCartt AT, Hellinga LA, Bratiman KA. Cell phones and driving: review of research. Traffic Inj Prev. 2006;7(2):89-106.8. Wilson FA, Stimpson JP. Trends in fatalities from distracted driving in the United States, 1999 to 2008. Am J Public Health. 2010:100(11): 2213-2219.9. Klauer SG, Guo F, Simons-Morton BG, Ouimet MC, Lee SE., Dingus TA. Distracted driving and risk of road crashes among novice and experienced drivers. N Engl J Med. 2014;370(1):54-59.10. Regnier G, Boileau R, Marcotte G, Desharnais R, Larouche R, Bernard D, et al. Effects of Body-Checking in the Pee Wee (12 and 13-years-old) Division in the Province of Quebec. In: Castaldi CR, Hoerner EF, editors. Safety in Ice Hockey. Philadelphia: American Society for Testing Materials; 1989. p. 84-103.11. Cusimano MD, Taback NA, McFaull SR, Hodgins R, Bekele TM, Elfeki N. Effect of bodychecking on rate of injuries among minor hockey players. Open Med. 2011;5(1):e57.12. Emery CA, Kang J, Shrier I, Goulet C, Hagel BE, Benson BW, et al. Risk of injury associated with body checking among youth ice hockey players. JAMA. 2010;303(22):2265-2272.13. McGeehan J, Shields BJ, Smith GA. Children should wear helmets while ice-skating: a comparison of skating-related injuries. Pediatrics 2004;114(1):124-128.46 | The BC Casebook for Injury Prevention14. BC Children’s Hospital. Child Safety; 2015 [cited 2015 July 1]. Available from http://www.bcchildrens.ca/KidsTeensFam/SafeStart/default.htm15. Business Information Warehouse – Traffic Accident System. North Vancouver, BC: Insurance Corporation of British Columbia; 2015.Chapter 7: The Cost of Injury1. Rajabali F, Ibrahimova A, Barnett B, Pike I. Economic Burden of Injury in British Columbia. Vancouver, BC: BC Injury Research and Prevention Unit; 2015.2. Rice DP, Hodgson TA, Kopstein AN. The economic costs of illness: A replication and update. Care Finance Rev. 1985;7:61-80.3. Kirschstein R. Disease-specific estimates of direct and indirect costs of illness and NIH support: Fiscal year 2000 update. Washington, DC: National Institutes of Health, Department of Health and Human Services; 2000.4. Hodgson TA, Meiners M. Cost-of-illness methodology; A guide to current practices and procedures. Millbank Q. 1982;60(3):429-62.5. National Health Expenditure Trends (NHEX), 1975-2014. Ottawa, ON: Canadian Institute for Health Information; 2014. Available from https://www.cihi.ca/en/nhex_2014_report_en.pdfChapter 8: Potential Return on Investment/Business Case1. Kendall PRW. Investing in Prevention: Improving Health and Creating Sustainability. The Provincial Health Officer’s Special Report. Victoria, BC: Office of the Provincial Health Officer; 2010 [cited 2015 April 12]. Available from http://www.health.gov.bc.ca/library/publications/year/2010/Investing_in_prevention_improving_health_and_creating_sustainability.pdf2. Canadian Public Health Association. Frontline Health Beyond Health Care: Making the Economic Case for Investing in Public Health and the SDH. 2015 [cited 2015 April 12]. Available from http://www.cpha.ca/en/programs/social-determinants/frontlinehealth/economics.aspx3. Centers for Disease Control and Prevention, National Center for Injury Prevention and Control. Protect the Ones You Love: Child Injuries are Preventable. 2012 [cited 2015 April 12]. Available from http://www.cdc.gov/safechild/NAP/background.html4. Parachute. The Cost of Injury in Canada. Toronto, ON: Parachute; 2015. Available from http://www.parachutecanada.org/downloads/research/Cost_of_Injury-2015.pdf5. Public Health Agency of Canada. (2014) Falls in Canada: Second Report.6. Parachute. Economic Burden of Injuries in Canada Forecasting Scenarios [Internet]. 2015 March 24 [cited 2015 July 6]. [13 pages].7. Atlantic Collaborative on Injury Prevention. Alcohol & Injury in Atlantic Canada: creating a culture of safer consumption. Halifax: Atlantic Collaborative on Injury Prevention; 2010.8. Community Preventative Services Task Force [Internet]. Atlanta: Community Preventative Services Task Force; 2015 [cited 2015 July 6]. Available from: http://www.thecommunityguide.org/alcohol/index.html9. Gray D, Saggers S, Atkinson D, Sputore BA, Bourbon D. 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Calverton, MD: Pacific Institute for Research and Evaluation; 2014. Available from http://www.childrenssafetynetwork.org/sites/childrenssafetynetwork.org/files/InjuryPreventionWhatWorks2014Update%20v9.pdfChapter 9: Injury Prevention Links with Public Health Issues1. Jackson RJ. The impact of the built environment on health: An emerging field. Am J Public Health. 2003;93(9):1382-1384.2. Cummins SK, Jackson RJ. The built environment and children’s health. Pediatr Clin North Am. 2001;48(5):1241-1252.3. McCormack GR, Shiell A. In search of causality: A systematic review of the relationship between the built environment and physical activity among adults. Int J Behav Nutr Phys Act. 2011;8(1):125.4. Finch DF, Owen N. Injury prevention and the promotion of physical activity: What is the nexus? J Sci Med Sport. 2001;4(1):77–87.5. Steffen K, Emery CA, Romiti M, Kang J, Bizzini M, Dvorak J, et al. 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Ahmed LA, Joakimsen RM, Berntsen GK, Fonnebo V, Schirmer H. Diabetes mellitus and the risk of non-vertebral fractures: The Tromso study. Osteoporosis Int. 2006; 17:495-500.23. Brown AF, Mangione CM, Saliba D, Sarkisian CA. Guidelines for improving the care of the older person with diabetes mellitus. J Am Geriatr Soc. 2003;51:S265-80.24. Berlie HD, Garwood CL. Diabetes Medications Related to an Increased Risk of Falls and Fall-Related Morbidity in the Elderly. Ann Pharmacother. 2014; 44:712-717.48 | The BC Casebook for Injury Prevention25. Fjeldstad C, Fjeldstad A, Acree L, Nickel K, Gardner A. The influence of obesity on falls and quality of life. Dyn Med. 2008;7:4.26. Himes CL, Reynolds SL. Effect of obesity on falls, injury, and disability. J Am Geriatr Soc. 2012;60(1):124-129.27. Colne P, Frelut ML, Peres G, Thoumie P. Postural control in obese adolescents assessed by limits of stability and gait initiation. Gait Posture. 2008; 28:164-169.28. Freidmann JM, Elasy T, Jensen GL. 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Ko TJ, Tsai LY, Chu LC, Yeh SJ, Leung C, Chen CY, et al. Parental smoking during pregnancy and its association with low birth weight, small for gestational age, and preterm birth offspring: A birth cohort study. Pediatr Neonatol. 2014;55(1):20-27.35. Wolf MJ, Koldewijn K, Beelen A, Smith B, Hedlund R, de Groot IJM. Neurobehavioral and developmental profile of very low birthweight preterm infants in early infancy. Acta Paediatr. 2002:91:930–938.36. Korja R, Huhtala M, Maunu J, Rautava P, Haataja L, Lapinleimu H, et al. Preterm infant’s early crying associated with child’s behavioral problems and parents’ stress. Pediatrics. 2014;133(2):e339-e345.37. Reijneveld SA, van der Wal MF, Brugman E, Sing AH, Verloove-Vanhorick SP. Infant crying and abuse. Lancet. 2004;364:1340–1342.38. Stewart TC, Polgar D, Gilliland J, Tanner DA, Girotti MJ, Parry N, et al. Shaken baby syndrome and a triple-dose strategy for its prevention. J Trauma Acute Care Surg. 2011;71(6):1801-1807.39. Rehm J, Room R, Graham K, Monteiro M, Gmel G, Sempos C. The relationship of average volume of alcohol consumption and patterns of drinking to burden of disease: An overview. Addiction. 2003;98:1209–1228.40. Taylor B, Irving HM, Kanteres F, Room R, Borges G, Cherpitel CJ, et al. The more you drink, the harder you fall: A systematic review and meta-analysis of how acute alcohol consumption and injury or collision risk increase together. Drug Alcohol Depend. 2010;110:108–116.41. Faelker T, Pickett W, Brison RJ. Socioeconomic differences in childhood injury: A population based epidemiologic study in Ontario, Canada. Inj Prev. 2000; 6(3):203-208.42. Kendrick D, Marsh P. How useful are sociodemographic characteristics in identifying children at risk of unintentional injury? Public Health. 2001;115(2):103-107.43. Capewell S, Maclntyre K, Stewart S, Chalmers JW, Boyd J, Finlayson A, et al. 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A neuropsychological comparison of psychotic disorder following traumatic brain injury, traumatic brain injury without psychotic disorder, and schizophrenia. J Neuropsych Clin Neurosci. 2004;16(3):306-14.49. Schwarzbold M, Diaz A, Martins ET. Psychiatric disorders and traumatic brain injury. Neuropsychiatr Dis Treat. 2008;4(4): 797–816.50. Scaf-Klomp W, Sanderman R, Ormel J. Depression in older people after fall-related injuries: a prospective study. Age Ageing. 2003;32:88–94.51. Mann JJ, Apter A, Bertolote J, Beautrais A, Currier D, Haas A, et al. Suicide prevention strategies: A systematic review. JAMA. 2005;294(16):2064-2074.52. Rehm JUR, Room R, Monteiro M, Gmel G, Graham K, Rehn N, et al. (2003). Alcohol as a risk factor for global burden of disease. Eur Addict Res. 2003;9(4):157-164.The BC Casebook for Injury Prevention | 4953. British Columbia. Promote, Protect, Prevent: Our Health Begins Here: BC’s Guiding Framework for Public Health. British Columbia. Victoria, BC: BC Ministry of Health; 2013. Available from http://www.health.gov.bc.ca/library/publications/year/2013/BC-guiding-framework-for-public-health.pdf54. City of Surrey. Free Smoke Alarm Installation Program. Accessed 23 June 2015 from http://www.surrey.ca/city-services/4640.aspxChapter 10: Taking Action1. British Columbia. British Columbia Vital Statistics Agency. Selected Vital Statistics and Health Status Indicators: One Hundred and Fortieth Annual Report 2011. Victoria, BC: Ministry of Health; 2011. Available from http://www2.gov.bc.ca/gov/content/vital-statistics/statistics-reports/annual-reports/20112. Discharge Abstract Database (DAD), Ministry of Health, 2013.3. VISTA electronic download, BC Vital Statistics Agency, Ministry of Health, 2015.4. Rajabali F, Ibrahimova A, Barnett B, Pike I. Economic Burden of Injury in British Columbia. Vancouver, BC: BC Injury Research and Prevention Unit; 2015.5. Kendall PRW. Investing in Prevention: Improving Health and Creating Sustainability. The Provincial Health Officer’s Special Report. Victoria, BC: Office of the Provincial Health Officer; 2010 [cited 2015 April 12]. Available from http://www.health.gov.bc.ca/library/publications/year/2010/Investing_in_prevention_improving_health_and_creating_sustainability.pdf6. Canadian Public Health Association. Frontline Health Beyond Health Care: Making the Economic Case for Investing in Public Health and the SDH. 2015 [cited 2015 April 12]. Available from http://www.cpha.ca/en/programs/social-determinants/frontlinehealth/economics.aspx7. Centers for Disease Control and Prevention, National Center for Injury Prevention and Control. Protect the Ones You Love: Child Injuries are Preventable. 2012 [cited 2015 April 12]. Available from http://www.cdc.gov/safechild/NAP/background.htmlCase Study 1: Shaken Baby Syndrome 1. Ludwig S, Warman M. Shaken baby syndrome: A review of 20 cases. Ann Emerg Med. 1984;13:104–107.2. Alexander R, Sato Y, Smith W, Bennett T. Incidence of trauma with cranial injuries ascribed to shaking. Am J Dis Child. 1990;144:724–726.3. Christian CW, Block R. Abusive head trauma in infants and children. Pediatrics. 2009;123(5):1409-1411.4. Barr RG, Rajabali F, Aragon M, Coulbourne M, Brant R. Education about crying in normal infants is associated with a reduction in pediatric emergency room visits for crying complaints. J Dev Behav Pediatr. 2015;36:252–257.Case Study 2: Injury Prevention Messaging1. Parachute. The Cost of Injury in Canada. Toronto, ON: Parachute; 2015. Available from http://www.parachutecanada.org/downloads/research/Cost_of_Injury-2015.pdf2. Ontario Injury Prevention Resource Centre. Ontario Regional Injury Data Report. Toronto, ON: Parachute; 2013 Available from http://www.oninjuryresources.ca/3. Scime G, Rajabali F, Turcotte K, Jivani K, Babul S, Pike I. 2010. Children and Youth in British Columbia: Injury by Ages and Stages 2003-2007. Vancouver, BC: BC Injury Research and Prevention Unit; 2010. Available from http://www.injuryresearch.bc.ca/wp-content/uploads/2014/08/Child-Youth-Ages-Stages-Nov-2010.pdf4. A Million Messages. Public health Agency of Canada’s Canadian Best Practices Portal. Available at http://cbpp-pcpe.phac-aspc.gc.ca/interventions/a-million-messages/5. Volpe R, Lewko J. Science and Sustainability in the Prevention of Neurotrauma: An Ontario Neurotrauma Foundation Review of Best Practice. Toronto, ON: Ontario Neurotrauma Foundation; 2008, pp 181-207.6. King WJ, LeBlanc JC, Barrowman NJ, Klassen TP, Bernard-Bonnin A-C, Robitaille Y, et al. Long term effects of a home visit to prevent childhood injury: Three year follow up of a randomized trial. Inj Prev. 2005;11:106–109.Case Study 3: Concussion Prevention1. Discharge Abstract Database (DAD), Ministry of Health, BCIRPU Injury Data Online Tool, 2013.2. Rajabali F, Ibrahimova A, Turcotte K, Babul S. The Burden of Concussion in British Columbia. Vancouver, BC; BC Injury Research and Prevention Unit: 2012.3. McCrory P, Meeuwisse WH, Aubry M, Cantu B, Dvořák J, Echemendia RJ, et al. Consensus statement on concussion in sport: the 4th International Conference on Concussion in Sport held in Zurich, November 2012. Br J Sports Med. 2013;47:250–258.4. Halstead ME, Walter KD, The Council on Sports Medicine and Fitness. Sport-related concussion in children and adolescents. Pediatrics. 2010;126(3):597 -615.5. Turcotte K, Karmali S, Babul S. Concussion Awareness Training CATT for Health Practitioners: CATT Pilot Study and Evaluation. Vancouver: BC Injury Research and Prevention Unit, 2014.50 | The BC Casebook for Injury Prevention6. Babul S, Turcotte K. Concussion Awareness Training Tool for Parents, Players and Coaches: Evaluation Report. Vancouver: BC Injury Research and Prevention Unit, 2015.Case Study 5: Seniors’ Falls Prevention1. British Columbia Vital Statistics Agency, Ministry of Health, 2013.2. Discharge Abstract Database (DAD), Ministry of Health, 2013.3. Rajabali F, Ibrahimova A, Barnett B, Pike I. Economic Burden of Injury in British Columbia. Vancouver, BC: BC Injury Research and Prevention Unit; 2015. 4. Scott V, Votova K, Gallagher E. Falls prevention training for community health workers. J Gerontol Nurs. 2006:32(10):48-56. Available from: http://www.coag.uvic.ca/resources/publications/reports/FallsPrev-GerontolNursing.pdfCase Study 6: Road Safety1. British Columbia Vital Statistics Agency, Ministry of Health, 2013.2. Business Information Warehouse – Traffic Accident System North Vancouver, BC: Insurance Corporation of British Columbia; 2015.3. Klauer SG, Guo F, Simons-Morton BG, Ouimet MC, Lee SE, Dingus TA. (2014). Distracted driving and risk of road crashes among novice and experienced drivers. New Engl J Med. 2014;370(1): 54–59. 4. British Columbia. Vancouver Island Health Authority Motor Vehicle Collision Report 2012: Health Impacts of Traffic Mishaps and Opportunities for Road Safety. Victoria, BC: Vancouver Island Health Authority & Office of the Chief Medical Health Officer, 2012. Available from: http://www.viha.ca/NR/rdonlyres/BBE6759F-01C3-4F73-816E-E9991214AEB3/0/VIHAMVCReport2012.pdfCase Study 7: Alcohol-Related Injuries1. Alcohol Screening and Brief Intervention (SBI) for Trauma Patients. COT Quick Guide. Available from https://www.facs.org/trauma/publications/sbirtguide.pdf2. Cherpitel CJ, Borges G, Giesbrecht N, Hungerford D, Peden M, Poznyak V, et al., editors. Alcohol and Injuries: Emergency Department Studies in an International Perspective. Geneva: World Health Organization; 2009. Available from http://www.who.int/substance_abuse/msbalcinuries.pdf3. Schermer CR, Moyers TB, Miller WR, Bloomfield LA. Trauma center brief interventions for alcohol disorders decrease subsequent driving under the influence arrests. J Trauma. 2006;60:29 –34.4. Gentilello LM, Ebel BE, Wickizer TM, Salkever DS, Rivara FP. Alcohol interventions for trauma patients treated in emergency departments and hospitals: A cost benefit analysis. Ann Surg. 2005;241(4):541.5. Rivara FP, Koepsell TD, Jurkovich GJ, Gurney JG, Soderberg R. The effects of alcohol abuse on readmission for trauma. JAMA. 1993;270:1962–1964.6. Nilssen O, Ries RK, Rivara FP, Gurney JG, Jurkovich GJ. The CAGE questionnaire and the Short Michigan Alcohol Screening Test in trauma patients: Comparison of their correlations with biological alcohol markers. J Trauma. 1994;36: 784–788.7. Gentilello LM, Rivara FP, Donovan DM, Jurkovich GJ, Daranciang E. Dunn CW, et al. Alcohol interventions in a trauma center as a means of reducing the risk of injury recurrence. Ann Surg. 1999;230(4):473. Available from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1420896/8. Nilsen P, Baird J, Mello MJ, Nirenberg T, Woolard R, Bendtsen P, et al. A systematic review of emergency care brief alcohol interventions for injury patients. J Subst Abuse Treat. 2008;35(2):184–201. Available from: http://www.sciencedirect.com/science/article/pii/S074054720700298XCase Study 8: Suicide Prevention1. British Columbia Vital Statistics Agency, Ministry of Health, 2013.2. Discharge Abstract Database (DAD), Ministry of Health, 2013.Case Study 9: Social Marketing for Injury Prevention1. Pike, I. Preventable – Social Marketing for Injury Prevention in BC. Presented at the Canadian Injury Prevention and Safety Promotion Conference, Vancouver, November 16–18, 2011.The BC Casebook for Injury Prevention | 51The Ambulance Down in the ValleyJoseph Malins (1895)‘Twas a dangerous cliff, as they freely confessed, Though to walk near its crest was so pleasant; But over its terrible edge there had slipped A duke and full many a peasant. So the people said something would have to be done, But their projects did not at all tally; Some said, “Put a fence ’round the edge of the cliff,” Some, “An ambulance down in the valley.”But the cry for the ambulance carried the day, For it spread through the neighboring city; A fence may be useful or not, it is true, But each heart became full of pity For those who slipped over the dangerous cliff; And the dwellers in highway and alley Gave pounds and gave pence, not to put up a fence, But an ambulance down in the valley.“For the cliff is all right, if you’re careful,” they said, “And, if folks even slip and are dropping, It isn’t the slipping that hurts them so much As the shock down below when they’re stopping.” So day after day, as these mishaps occurred, Quick forth would those rescuers sally To pick up the victims who fell off the cliff, With their ambulance down in the valley.Then an old sage remarked: “It’s a marvel to me That people give far more attention To repairing results than to stopping the cause, When they’d much better aim at prevention. Let us stop at its source all this mischief,” cried he, “Come, neighbors and friends, let us rally; If the cliff we will fence, we might almost dispense With the ambulance down in the valley.”“Oh he’s a fanatic,” the others rejoined, “Dispense with the ambulance? Never! He’d dispense with all charities, too, if he could; No! No! We’ll support them forever. Aren’t we picking up folks just as fast as they fall? And shall this man dictate to us? Shall he? Why should people of sense stop to put up a fence, While the ambulance works in the valley?”But the sensible few, who are practical too, Will not bear with such nonsense much longer; They believe that prevention is better than cure, And their party will soon be the stronger. Encourage them then, with your purse, voice, and pen, And while other philanthropists dally, They will scorn all pretense, and put up a stout fence On the cliff that hangs over the valley.Better guide well the young than reclaim them when old, For the voice of true wisdom is calling. “To rescue the fallen is good, but ’tis best To prevent other people from falling.” Better close up the source of temptation and crime Than deliver from dungeon or galley; Better put a strong fence ’round the top of the cliff Than an ambulance down in the valley.52 | The BC Casebook for Injury Prevention
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Vancouver : University of British Columbia Library
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Children and youth (0-19)
Adults (20-64)
Older adults/seniors (65+)
Economic burden of injury
Injury outcomes
Injury policy and prevention
The British Columbia Casebook for Injury Prevention
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