Accident preventive work Aims and visions. Challenges and opportunities bases upen a 0-vision Inggard Lereim Professor MD PhD NTNU-Norway

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1 Accident preventive work Aims and visions Challenges and opportunities bases upen a 0-vision Inggard Lereim Professor MD PhD NTNU-Norway

2 The realities load on the society W.H.O.parameters of the load on the medical care: Lives lost Lost years of living Days of hospitalization

3 Load continued 1.Cardiovascular diseases Accidents Malignant diseases(cancer and related diseases)

4 Accidents in Norway Domestic accidentes 28% Leisure time accidents 17% Occupational accidents 16% Sports accidents 15% Street/road accidents-non traf. 10% Traffic accidents 9% Violence 5% Total 100% N=

5 Historical review Descriptions of accidents and injuries from World War 1 Desrictions of occupational accidents in 20.ies and the 30.ies Extensive accidentology and surgical documentation from World War 2 and therafter from military medical sources Start of descriptive accident research in USA early 50.ties

6 Historical.cont. Studies on mechanism of trauma at the Stapp institute,l.a.-usa related to airoplane acidents(start of jet-period) Descriptive studies on traffic accidents in Germany,Sweden,France-later on USA,other European countries. Epidemiology by accidents in Europe Later on in USA and other continents

7 Further background After a medico-technical start;- Other diciplines entered the field,like; Behavioural studies Education Enviromental studies Laws and regulations Protective contructions and euipment Above all;cooperation across diciplines

8 Examples on succesful preventive measures Occupational accidents: Registration followed by intervention: Education and instruction Reduced number of killed by 18% Reduced number of injured by 20% Reduced injury severity(ais 1-6) Reduced days of sick-leave by 30% Reduced number of sequeles by 19%

9 Prevention,cont. Sports accidents in Norway 10 years intervention:reduction to Education-teaching New regulations-rules Technical measures(hills,field etc.) Protective equipment(helmets,suits etc.) Personal behaviour and preparation(trainingstrength,tecknique)

10 Prevention,traffic accidents Fatal accidents reduced from ca 700 in 1971 to ca 250 in 2005 Children injured as car occupants; to : Fatal accidents red.by 50 % Other injured red.by 35% Reasons:research,information,education, new law and regulations - Follow up study prooving to the Ministry of transport that the rules are justified.

11 Accident preventive measures, general and traffic(spec.) Related to person; Mental maturity Physical condition-maturity Education-training- knowledge Environment; Complexity Road structure and and condition Function of technical devices-car-others Speed of the vehicles involved(prev.-low) Safety equipment,technical.

12 Injury reducing measures,contitions Related to person; General condition and preparedness Use of safety equipment,position(front,rear) Strength of the car absolutely and related to impacting car or fixed obstacles Smooth shape of impacting car hitting soft roadusers Emergency medical care Proper transportation Hospital treatment and rehabilitation of to days medical standard

13 Vision- 0 -romance or reality Realistic basic data Face the facts In Norway: Official number of victims to traffic accidents ca Treated for injuries caused by traffic accidents in Norwegian hospitals ca anually

14 Vision 0 Know the real reasons for accidents; Affords continous prospective studies and follow up of accidents and of injured Know the mechanisms of the accidents Know the mechanisms of trauma Realize the resources needed for optimal treatment and rehabititation

15 Vision 0 Close cooperation between ; Behavioural sciences; Road constructors;(and road maintenance) Lawmakers Vehicle contructors Medical personel qualyfied in trauma and in mechanism of trauma ***Multidisciplinary composed accident commissions***

16 0-vision Nordic realities: Scientific situation: Sweden: Among the pioneers in the world Finland:Strong general scientific status Denmark:Long tradition in accident registration and evaluation(odense) Iceland:High acceptance by the national health authorities Norway:High activity in 2 centers(tr.heim,oslo)

17 Vision o- Key question Are the authorities willing to pay the costs? Do they know the real advantage by increased preventive efforts? Example: If Norway reduced the number of accidents necessitating medical operations by 25% there were no ques for for operations using the present resources in the hospitals.

18 Vision 0 Prices on new and safer cars is in 4 of 5 Nordic countries too high due to National import taxes.only Sweden has a desent policy in this field The will to invest in safe road-systems is limited in some parts of the Nordic countries The will to give time for accident preventive education at scools,high scools and universities is limited The national will to give financial support to scientific projects in this field is poor(norway) Example: Support to accident preventive scientific project is 3% of that of cardiovascular deseases and that of cancer.

19 Vision 0 But: You know a lot Others know a lot We have exellent scientific institutions * Projects carried out show us that preventive measures of numerous nature have proved to be efficient New diciplines are joining these efforts

20 O-vision The O-vision is unrealistic It shows however a good will Can be used as an inspiration helping us to do more with the resources we have at disposal Help us work closer together across scientific and practical disiplines Help us create stronger influence on politicians in power WE HAVE TO GO ON CONTIUOUSLY -AND WITH INCREASED EFFORTS!