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Monday, 27 February 2012

Safety promotion - reducing injuries on the road and at play.

Tragedy struck on the weekend with the derailment of a passenger train, the deaths of 3 engineers and 46 injured persons. The headlines will be filled for days and considerable time and resources will be spent on determining what happened and how to prevent a similar incident. At the same time, take a moment to remember that on any given day in Canada an average of 7 people die in motor vehicle collisions.  Just think what a difference we could make if the train derailment mitigation and investigative money were matched in dollars directed at further reductions in motor vehicle collisions.

While injury mortality and hospitalization rates continue to creep downwards (use the PHAC injury surveillance tool to explore national/provincial rates http://dsol-smed.hc-sc.gc.ca/dsol-smed/is-sb/c_time-eng.php ), progress in preventing injury has not happened with the same rapidity as it has for other illnesses.  Motor vehicle crash mortality rates have decreased over 50%, other causes of unintended injury have not been so dramatically reduced. In the embedded graphic, the green line represents Motor vehicle crashes which have decreased by almost 2/3rds.   All other unintentional injuries have only reduced by about ¼.  The red line represents all unintentional injuries including motor vehicle crashes. 

There are newer ways of protection from injury that have been and are being implemented.   Health Evidence has recently posted several and primary sources are included in this field that needs to be further padded.

Graduated licensing reduces crashes by 15.5 – 22%  Graduating licensing . The effect seems to be sustained beyond just the first year of driving as well.   The effect is similar for fatal,  injury and non-injury type of crashes.  There is a higher impact on night time and alcohol associated crashes, with benefits of 20-40%. Implemented in all provinces now (Nunavut has yet to take the plunge), it takes drivers through three phases of preparedness starting with accompanied driving; then limited numbers of passengers, no night time driving, no alcohol; before receiving full licensure.  The Cochrane review is well worth reading for the rigour and style if you have access Cochrane review - link may not work from some work sites and outside of Canada .

Speed cameras are not implemented in all provinces, having been subjected to political interference in an injury protection endeavour.   Resistance was based on the perception that speed cameras were merely an easy way of generating fine based income.  This review should provide further evidence for those jurisdictions that need proof that speed cameras save lives as they are associated with a 8-50% reduction in collisions, 11-44% reduction in fatal and serious collisions, and overall reductions in road speeds and proportion of speeders.  Speed cameras .    The full review is also in the Cochrane database. 

Bicycle helmet legislation increases usage, but impact on actual outcomes hard to measure  thought suggestive of benefit.   Bicycle helmet legislation   Not surprising given the relative infrequency of serious events and the methodological challenges in doing comparative studies.  

Speaking of safety helmets, helmet use in skiing and snowboarding showing a 35%-40% reduction in head injuries  amongst helmet users (full reference for those with library access CMAJ 2010, 182(4) pp 333-340)  .  This increased to up to 60% for studies looking specifically at children.   The effect is greatest for beginners and males, lacking significance with expert skiers and females.   

Protect yourself - buckle up and wear the gear....

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