INJURY PREVENTION Volume 7 Number 3 Winter Issue, 1997 ACCIDENTS WAITING TO BE PREVENTED by Peter McFarlane [Unintentional Injuries] [Motor vehicle Accidents ] [Alcohol and Injuries] [Drownings] [Fires] [Injuries in the Home] [Poisoning/overdose] [Scalds/burns] [Falls] [Firearms] [Mapping Trouble In Northern Saskatchewan] [Bibliography] UNINTENTIONAL INJURIES Unintentional injuries are those we commonly refer to as accidents: a house fire, a car crash or boating or firearm mishap. In the past, the tendency was to dismiss them as unavoidable, as "acts of God," or the result of momentary thoughtlessness which we cannot hope to prevent in a systematic way. But as with all other types of injuries, common risk factors surround injury events and preventative measures can be employed to reduce or eliminate them. The pattern of unintentional injuries among Aboriginal people is similar to the overall Canadian one. Yet the rate is significantly higher, with fatalities three times greater for Aboriginal people than the Canadian average. The leading causes of unintentional injury deaths for Aboriginal people are motor vehicle accidents, poisoning/drug overdoses, drownings, fire, falls, and to a lesser degree, suffocation, exposure and work-related accidents. It also is important to keep in mind when designing injury prevention programs, that certain injuries cluster around certain ages. Young children are more susceptible to injuries from falls and household accidents like scaldings; elders have an increased risk of injuries from falls. Teenagers and young adults have a high rate of motor vehicle accident injuries and fatalities, as well as an extremely high risk for intentional injuries like suicide and homicide.   Motor vehicle Accidents Motor vehicle accidents, which include skidoo and ATV accidents, account for 40 per cent of unintentional injury fatalities among Aboriginal people. In Canada as a whole, automobile-related deaths are several times higher than in the general population. A recent study in British Columbia showed that Natives were 4.3 times more likely to die due to motor vehicle accident injuries than other residents of the province. The high fatality figures for teenagers and young adults can be attributed to a number of factors. First, there are the higher motor vehicle risks affecting all Aboriginal people. They tend to have to drive much farther to carry out daily or weekly activities, for example, and when they are in an accident, they are usually much farther away from emergency facilities. Aboriginal people are also heavy users of the riskier vehicles like ATVs and skidoos, particularly in the north. ATVs are dangerous because of their high centre of gravity, a design flaw that makes them roll over easily. Skidoo accidents are often caused by unsafe ice conditions and by the fact that skidoos are difficult to manoeuvre and to see on public roads. Important factors for younger drivers include poor training, the fact that they spend more time driving at night and that many young males engage in high risk behaviours (speeding, careless driving). Alcohol also appears to play a major role. Young drivers, males in particular, are more likely to drive after consuming alcohol. The National Survey on Drinking and Driving reported that in fatal crashes involving young Aboriginal males, more than 80 per cent of the drivers had been drinking. Alcohol was also a significant factor in pedestrian deaths (68 per cent of the pedestrians and 28 per cent of the drivers had been drinking). The contribution of alcohol documented by these studies is twice as great as that seen for all Canadians (42 per cent in 1985).   Alcohol and Injuries Good News, Bad News The good news about alcohol abuse and injuries is that, as alcohol dependency declines in Aboriginal communities, so does the rate of injuries, both intentional and unintentional. In this sense, the National Native Alcohol and Drug Addiction Program (NNADAP) and the spiritual health movements have made valuable contributions to injury prevention. Their continued success in reducing alcohol dependency will no doubt further reduce the injury toll. The bad news is that alcohol use is still a major contributor to both intentional and unintentional injuries. Health and Welfare advises that information campaigns and legislation on alcohol consumption should be part of any injury control program. This doesn't mean that injury prevention cannot continue on a parallel track. In Western Australia, an Aboriginal community concerned about motor vehicle injuries with a strong alcohol component produced a television commercial showing a non-drinker taking responsibility for buying food and providing safe transportation for his friends who had been drinking. The message showed that even if someone has been drinking, injury prevention is still possible by trying to keep them out of harm's way. The commercial was positively received by aboriginal people, who responded to its appeal to comradeship -- one of their most important cultural values.   Drownings Drowning is either the second or third most common cause of death among Aboriginal people everywhere in the country except Alberta and the Far North. It is also the largest cause of fatal unintentional injuries among children, although in Canada no thorough study has been done on specific risk factors for Aboriginal children. In Alaska, which has the highest drowning rate of any American state, the large numbers of drownings have been attributed to the swiftness of its rivers, their cold temperature, and the fact that many of its residents are employed in jobs exposing them to water. In Canada, many reserve communities are situated on the shores of rivers and lakes, frequently with important services (stores, health centres, airstrips) located across the body of water. The single greatest preventer of drowning deaths is the regular use of personal floatation devices when on or near the water. But as with other personal protective devices, their effectiveness is diminished by the requirement that they be used all of the time. One promising information campaign in this area is the Manitoba Red Cross Society video on boating safety specifically designed for First Nations people. The script was written by a Native staff worker with active community consultation, and was translated into the four major aboriginal languages of the region. Filming was done on a reserve using local residents as actors. The completed video is brought to native communities each spring and summer by the Medical Services Branch and the Red Cross as part of the community water safety programs (see Resources list for how to acquire the video). Other obvious methods are ensuring that children are taught to swim and information campaigns on the dangers of mixing alcohol and water activities.   Fires Fires also affect children disproportionately. In fact, 31 per cent of all fire deaths in the Aboriginal population occur among children aged 1-14, which is almost double the Canadian average (16 per cent). In most studies of fatal fires, cigarette smoking is given as the cause about 50 per cent of the time. Recent information on the smoking habits of Aboriginal people indicates a significantly higher rate than other Canadians. Alcohol is also frequently cited either as a co-factor with cigarette smoking or independently in about half of fire deaths. Fires also contribute significantly to the fatal injuries of persons over 65 years. Diminished capacity to flee may be a common factor for both them and the very young. Wood-frame house construction and a low prevalence of smoke detectors contribute to the high injury rate.   Injuries in the Home Unintentional injuries in the home, which include poisoning/overdoses, falls, scalds, burns, and many firearms accidents, take their highest toll on children. A recent study of the reasons children were hospitalized found that 29 per cent were due to falls, 22 per centwere due to poisoning and another 7 per cent were from burns, mainly due to scalds from hot water. A small number of young children (2 per cent ) suffocated. The very old also suffer an inordinate number of home-based injuries. In some cases, this is caused by a lower capacity to avoid hazards or escape dangerous situations, in others it may simply be a reflection of the fact that young children and elders spend much more time in the home environment. One active approach to making a home safer is to organize an Annual Safety Round, where the injury prevention message and methods are brought into each home in the community. A checklist on home safety might look at the following areas: Poisoning/overdose: Young children experience ten times more poisoning than children of school age and elders often have difficulty administering correct amounts of prescription medication. During the Safety Round, the CHR might ensure that dangerous chemicals/drugs are locked away from small children, and ensure that elders, particularly those who have difficulty reading the language of the prescription, are using their medication correctly.   Scalds/burns Burns are a major cause of injuries in young children and most happen in the kitchen. They are caused by scalds from heated food and water or contact with hot surfaces on stoves, radiators and irons. During the Safety Round: Stress the importance of not leaving children unattended in kitchens or where other appliances like irons are being used. Suggest the use of a child gate to prevent very young children from coming into contact with dangerous appliances. Check that water heaters are turned down to safe temperatures.   Falls Falls are so common that one out of every 12 children under 6 requires hospital treatment for a fall. Most falls happen in the home when a child falls from furniture or stairs. Prevention involves encouraging closer supervision of children and removing or modifying obvious hazards.   Firearms Children under 6 years old should have no access to firearms in any circumstances and older children should have access to them only under close adult supervision. All firearms should have safety devices to make them unusable for children. One of the most effective ways of preventing home injuries is to educate parents about home safety. Injury prevention in the home should be an important part of programs for new parents and of workshops designed to increase parenting skills.   MAPPING TROUBLE IN NORTHERN SASKATCHEWAN The first step in designing an injury prevention program is to determine exactly what a community's needs are. In Northern Saskatchewan, three communities -- Shoal Lake, Red Earth and Cumberland House -- with a total population of about 1,600 people, have launched an extensive Aboriginal Injury Surveillance System pilot project. Anne Acco, who is directing the project in Cumberland House, says they are just completing the process of putting together the injury prevention teams, which consist of an injury prevention coordinator, CHRs, NNADAP worker, mental health worker, home care worker, nurses, and school representative from each community as well as a representative from the local RCMP detachment. Once the teams are in place, they will conduct a survey that will yield a detailed picture of the injury problems in the three communities. "Basically," Anne Acco says, "what we are doing at this stage is mapping trouble." Since her community is situated on an island and many people still pursue the traditional economy, she expects most injuries will involve ATVs, skidoos, boating and chainsaw accidents. "Firearm accidents," she says, "are rare. People here know how to handle guns. It's in the cities where they are a problem." As far as intentional injuries, Ms. Acco says in Cumberland House they are "almost all alcohol-related." When the injury surveillance data is collected and analyzed, priorities will be set and prevention programs put in place. "If one of the communities finds the problem in motor vehicle accidents is a certain curve in a road," Anne Acco explains, "they can do roadwork or put up warning signs. If we find that there are a number of home accidents involving children during Bingo hours, we will look into improving childcare services for parents who play Bingo." The program will also have mechanisms to continuously evaluate and, if necessary, alter the prevention programs after they are put in place. Anne Acco predicts the programs will make a big difference in the health of her people. "All we've had up until now," she says, "is crisis management." The program is being carried out in cooperation with the Alberta Injury Prevention Centre and Medical Services Branch in Ottawa. If you are interested in more information, please call:  Anne Acco at 306-888-2184 in Cumberland House  Annel Bear at 306-768-3457 in Shoal Lake  Raymond Head at 306-768-3617 at Red Earth  You can also call Yingmei Ding of Prince Albert Grand Council at 306-953-7248     Bibliography 1. Health and Welfare Canda statistics for 1993 show that First Nations had 1.69 deaths from injuries per 1,000 population and the general Canadian population had 46 deaths per 1,000 population. 2. Death Rates Due to Unintentional Injury and Poisoning, Trends in First Nations Mortality: 1979-93. 3. Injury Prevention Programs in First Nations Populations, prepared by the Institute of Health Promotion Research, University of British Columbia, March 1995, p.2. 4. Ibid. 5. The nationwide statistics on childhood drownings place backyard swimming pools as the leading danger. 6. Prevention of Injuries Among Aboriginal People, Final Report, p.30. 7. In Touch, Vol. 6 No. 2. 8. Prevention of Injury Among Canadian Aboriginal People, Final Report, September 1990, p.20. copyright © 1997 NIICHRO 05/01/98