Advanced Trauma Life Support ATLS Student Course Manual 2018

INJURY PREVENTION
Injury should not be considered an accident, because
that term implies a random circumstance resulting
in harm. In fact, injuries occur in patterns that
are predictable and preventable. The expression “an
accident waiting to happen” is both paradoxical and
premonitory. There are high-risk behaviors, individuals,
and environments. In combination, they provide a
chain of events that can result in traumatic injury.
With the changing perspective in today’s health care
from managing illness to promoting wellness, injury
prevention moves beyond promoting good health to take
on the added dimension of reducing healthcare costs.
Prevention is timely. Doctors who care for injured
individuals have a unique opportunity to practice effective,
preventive medicine. Although the true risk takers
may be recalcitrant about considering any and all prevention
messages, many people who are injured through
ignorance, carelessness, or temporary loss of self-control
may be receptive to information that is likely to reduce
their future vulnerability. Each doctor–patient encounter
is an opportunity to reduce traumatic injury or recidivism.
This is especially true for surgeons and physicians who
are involved daily during the period immediately after
injury, when there may be opportunities to truly change
behavior. This document covers basic concepts of
injury prevention and strategies for implementing them
through traditional public health methods.
Classification of
iNjury Prevention
Prevention can be considered as primary, secondary,
or tertiary. Primary prevention refers to elimination of
the trauma incident completely. Examples of primary
prevention measures include stoplights at intersections,
window guards to prevent toddlers from falling, fences
around swimming pools that keep out nonswimmers
to prevent drowning, DUI laws, and safety caps on
medicines to prevent ingestion.
Secondary prevention recognizes that an injury may
occur but serves to reduce the severity of the injury
sustained. Examples of secondary prevention include
safety belts, air bags, motorcycle and bicycle helmets,
and playground safety surfaces.
Tertiary prevention involves reducing the
consequences of the injury after it has occurred. Trauma
systems, including the coordination of emergency
medical services, identification of trauma centers,
and integration of rehabilitation services to reduce
impairment, are efforts to achieve tertiary prevention.
Haddon Matrix
In the early 1970s, William Haddon described a useful
approach to primary and secondary injury prevention
that is now known as the Haddon matrix. According
to Haddon’s conceptual framework, injury occurrence
involves three principal factors: the injured person
(host), the injury mechanism (e.g., vehicle, gun), and
the environment where the injury occurs. There are
also three phases during which injury and its severity
can be modified: the pre-event phase, the event phase
(injury), and the post-event phase. n TABLE 1 outlines
how the matrix serves to identify opportunities for
injury prevention and can be extrapolated to address
other injury causes. The National Highway Traffic
table 1 haddon’s factor-phase matrix for motor vehicle crash prevention
PRE-EVENT EVENT POST-EVENT
Host Avoidance of alcohol use Use of safety belts Care delivered by bystander
Vehicle Antilock brakes Deployment of air bag Assessment of vehicle characteristics that
may have contributed to event
Environment Speed limits Impact-absorbing barriers Access to trauma system
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