ACCI

DENTSANDI
NJURI
ES

Anacci
denthasbeendef
inedas:
"anunexpect
ed,

unpl
annedoccur
rencewhi
chmayi
nvol
vei
njur
y"(
1).A

WHOAdvi
soryGroupin1956def
inedaccidentasan
"
unpr
emedi
tatedeventr
esul
ti
ngi
nr ecogni
zabledamage"

(
2).Accor
dingt
oanot
herdef
ini
ti
on,
anacci
denti
sthat

"
occur
rencei
nasequenceofev
ent
swhi
chusual
l
ypr
oduces

uni
ntendedi
njur
y,deat
horpr
oper
tydamage"
.

Acci
dent
srepr
esentamaj
orepi
demi
cofnon-

communi
cabl
edi
seasei
nthepr
esentcent
ury
.Theyar
eno

l
ongerconsi
der
edacci
dent
al.Theyar
epar
toft
hepr
icewe
payf
ort
echnol
ogi
cal
progr
ess.

Acci
dent
shav
ethei
rownnat
ural
hist
oryandf
oll
owt
he

sameepi
demi
ologi
cal
pat
ter
nasanyot
herdi
seaset
hati
s,

t
heagent
,thehostandt
heenv
ironmenti
nter
act
ingt
oget
her

t
opr
oducei
njur
yordamage.Theyoccurmor
efr
equent
lyi
n

cer
tai
nage-
groups,
atcer
tai
nti
mesofdayandweekandat

cer
tai
nlocal
i
ties.Somepeopl
ear
emor
epr
onet
oacci
dent
s

t
hanot
her
sandsuscept
ibi
l
ityi
sincr
easedbyt
heef
fectof

al
cohol
andot
herdr
ugsaswel
lasphy
siol
ogi
cal
stat
esuchas

f
ati
gue.Last
ly,
amaj
ori
tyofacci
dent
sar
epr
event
abl
e.
Measur
ementoft
hepr
obl
em

a.MORTALI
TY

Thef
oll
owi
ngepi
demi
ologi
cal
indi
ceswi
l
lbeusef
uli
n

assessi
ngt
hemagni
tudeoft
hepr
obl
em :
(i)Pr
opor
ti
onal

mor
tal
i
tyr
ate:
Thati
s,t
henumberofdeat
hsduet
o

acci
dent
sper100(
or1000)t
otal
deat
hs.(
ii
)Numberof

deat
hspermi
l
li
onpopul
ati
on:
Thet
erm"
kil
l
ed"(
inar
oad

t
raf
fi
cacci
dent
)isdef
inedasanyper
sonwhowaski
l
led

out
ri
ghtorwhodi
edwi
thi
n30day
sasar
esul
toft
he

acci
dent(
3).(
ii
i)Deat
hrat
eper1000(
or100,
000)
r
egi
ster
edv
ehi
clespery
ear
.(i
v)Numberofacci
dent
sor

f
atal
i
tiesasar
ati
ooft
henumberofv
ehi
clesperki
l
omet
reor

passenger
sperki
l
omet
re.(
v)Deat
hsofv
ehi
cleoccupant
s

per1000v
ehi
clespery
ear
,et
c.

b.MORBI
DITY

Mor
bidi
tyi
smeasur
edi
nter
msof"
ser
iousi
njur
ies"and

"
sli
ghti
njur
ies"(
4).Theser
iousnessoft
hei
njur
yisassessed

byascal
eknownas"
Abbr
evi
atedI
njur
yScal
e"(
3).

Mor
bidi
tyr
atesar
egener
all
ylessr
eli
abl
ebecauseofunder
-

r
epor
ti
ngandmi
s-r
epor
ti
ng.
c.DI
SABI
LITY

Ani
mpor
tantout
comeoft
heacci
dentpr
ocessi
s

di
sabi
l
ity
,whi
chmaybet
empor
aryorper
manent
,par
ti
alor

t
otal
.Measur
ementofdi
sabi
l
ityi
nter
msofi
tsdur
ati
oni
sa

l
i
mit
edconcept
;itdoesnott
akei
ntoconsi
der
ati
ont
he

psy
chol
ogi
cal
orsoci
alaspect
sofanacci
dentori
njur
y(5)
.

TheI
nter
nat
ional
classi
fi
cat
ionofi
mpai
rment
s,di
sabi
l
iti
es

andhandi
caps"i
sanat
temptbyWHO(
6)t
oest
imat
ethe

di
sabi
l
ityofi
ndi
vi
dual
satagi
venmoment
.
Thepr
obl
em

WORLD

I
njur
iesconst
it
uteav
ari
abl
eepi
demi
c.Dur
ing2008r
oad

t
raf
fi
cinj
uri
esr
ankedf
our
thamongt
hel
eadi
ngcausesof

deat
hsi
nthewor
ld.I
njur
iesar
eresponsi
blef
or

·
appr
oxi
mat
ely9percent{
about{
5.12mi
l
li
on)ofal
lcauses

ofdeat
hsi
nthewor
ldandabout16percentoft
he

di
sabi
l
iti
esar
erepor
tedduet
oinj
uri
es.Theyar
e.al
sot
he

maj
orcauseofdeat
hamongper
sonsaged10-
24y
ear
s.I
n

t
hedev
elopedr
egi
ons,
57percentofmal
edeat
hsand43per
centoff
emal
edeat
hsi
nthi
sagegr
oupar
eduet
oinj
uri
es,

mai
nlyt
raf
fi
cacci
dent
s.About

3.
6mi l
l
ionpeopl
edieofunint
enti
onali
njur
iesandabout1.
5
mil
li
ondieofi
ntent
ional
inj
uri
es.Roadtr
afficacci
dent
s

cl
aim 1.
2mi
l
li
onl
i
ves,
sel
finf
li
ctedi
njur
iesandv
iol
encear
e

becomi
ngi
mpor
tantcausesofl
ossofl
i
ves.

I
NDI
A

Acci
dent
sar
edef
ini
tel
yonani
ncr
easei
nIndi
a.

I
ncr
easi
ngmechani
zat
ioni
nagr
icul
tur
eandi
ndust
ry,

i
nduct
ionofsemi
-ski
l
ledandunski
l
ledwor
ker
sinv
ari
ous
oper
ati
onsandr
api
dincr
easei
nvehi
cul
art
raf
fi
chav
e

r
esul
tedi
nani
ncr
easei
nmor
bidi
tyandmor
tal
i
tyduet
o

acci
dent
s.Ov
ercr
owdi
ng,
lackofawar
enessandpoor

i
mpl
ement
ati
onofessent
ial
saf
etypr
ecaut
ionsr
esul
tinan

i
ncr
easi
ngnumberofacci
dent
s.Consumpt
ionofpoi
sonous

subst
ancesacci
dent
all
yori
ntent
ional
l
yisal
soont
her
ise.

Deat
hs,
disabi
l
iti
esandhospi
tal
i
zat
ion.duet
oinj
uri
es

cont
inuet
ohav
eimpactofsoci
o-economi
closst
o

.i
ndi
vi
dual
s,f
ami
l
ies,
soci
etyandi
nfr
ast
ruct
ure.The

t
radi
ti
onal
viewofi
njur
yasanacci
dent
,hasr
esul
tedi
nthe
negl
ectoft
hisaspectofpubl
i
cheal
th.Todayi
njur
iesar
elow

i
npr
ior
it
yforpol
i
cymaker
s,andonl
yfewpl
ansar
edr
awn

f
ori
njur
ypr
event
ion.

TYPESOFACCI
DENTS

1.Roadt
raf
fi
cacci
dent
s

I
nmanycount
ri
es,
mot
orv
ehi
cleacci
dent
srankf
ir
st

amongal
lfat
alacci
dent
s.Ev
eryy
earal
most1.
24mi
l
li
on

peopl
edi
efr
om r
oadacci
dent
sint
hewor
ld.I
naddi
ti
on,
for

ev
erydeat
h,t
her
ear
easmanyas20-
50non-
fat
ali
njur
ies

and10-
20ser
iousi
njur
iesr
equi
ri
ngl
ongper
iodsof
expensi
vecar
e,nur
singandt
reat
ment
.Roadt
raf
fi
cfat
ali
ti
es

r
atei
shi
gheri
nyoungeragegr
oups.Chi
l
drenandy
oung

peopl
eundert
heageof25y
ear
saccountf
orov
er30per

centoft
hoseki
l
ledandi
njur
edi
nroadacci
dent
s.

.Fr
om ay
oungage,
mal
esar
emor
eli
kel
ytobei
nvol
ved

i
nroadt
raf
fi
ccr
ashest
hanf
emal
es.Amongy
oungdr
iver
s,

mal
esundert
heageof25y
ear
sar
eal
most3t
imesasl
i
kel
y

t
obeki
l
ledi
nacarcr
ashasy
oungf
emal
es(
9).

Near
lyhal
f{46percent)ofthosedyingonr
oadsar
evul
ner
abl
e
r
oadusersli
kepedest
ri
ans,cycli
stsand

mot
orcy
cli
sts.Compar
edt
ocar
sthet
wo-
wheel
ersar
e
unst
abl
eandpr
ovi
del
i
ttl
epr
otect
ionf
ort
hei
rri
der
sin

acci
dent
s.I
ndev
elopedcount
ri
es,
fourwheel
ersar
emor
e

f
requent
lyi
nvol
vedi
nacci
dent
s.

Mor
ethan90percentdeat
hst
hatr
esul
tfr
om r
oadt
raf
fi
c

acci
dent
soccuri
nlowandmi
ddl
e-i
ncomecount
ri
es.Ev
en

wi
thi
nhi
gh-
incomecount
ri
es,
peopl
efr
om l
owersoci
o-

economi
cbackgr
oundsar
emor
eli
kel
ytobei
nvol
vedi
n

r
oadt
raf
fi
cacci
dent
s(9)
.

I
NDI
A

Dur
ingt
hey
ear2011,
atot
alof4.
43l
acr
oadt
raf
fi
c
acci
dent
swer
erepor
tedi
nthecount
ry.Ther
ateofdeat
hper

1000v
ehi
cleshasdecr
easedf
rom 1.
6in2007t
o1.
2in

2011.Ther
ateofacci
dent
aldeat
hsper1000v
ehi
cleswas

hi
ghesti
nBi
harandSi
kki
m at1.
6,f
oll
owedbyWestBengal

at1.
5(10)
.

24.
9percentofv
ict
imsofr
oadt
raf
fi
cacci
dent
swer
e

occupant
soft
wowheel
ers.Maxi
mum number(
73,
001)

ofacci
dent
soccur
redbet
ween6PM and9PM t
ime

per
iod(
10)
.Maxi
mum numberofr
oadacci
dent
swer
e

r
epor
tedi
nthemont
hofMay(
43,
064)f
oll
owedby
Januar
y(39,
185)
.

Ri
skf
act
ors(
9)

Speed

Ani
ncr
easei
nav
eragespeedi
sdi
rect
lyr
elat
edbot
hto

t
hel
i
kel
i
hoodofacr
ashoccur
ri
ngandt
othesev
eri
tyoft
he

consequencesoft
hecr
ash.Someot
herf
act
sar
easbel
ow.

-Pedest
ri
anshav
ea90%chanceofsur
viv
ingacarcr
ash

at30km/
horbel
ow,
butl
esst
hana50%chanceof

sur
viv
ingani
mpactof45km/
horabov
e.

-30km/hspeedzonescanr
educether
iskofacrashandar
e
recommendedi
nareaswher
evulner
abl
eroadusers
ar
ecommon{
e.g.r
esi
dent
ial
areas,
aroundschool
s).

-Apar
tfr
om r
educi
ngr
oadt
raf
fi
cinj
uri
es,
lowerav
erage

t
raf
fi
cspeedscanhav
eot
herposi
ti
veef
fect
sonheal
th

out
comes(
e.g.byr
educi
ngr
espi
rat
orypr
obl
ems

associ
atedwi
thcaremi
ssi
ons)
.

Dr
ink-
dri
vi
ng

Dr
inki
nganddr
ivi
ngi
ncr
easesbot
hther
iskofacr
ash

andt
hel
i
kel
i
hoodt
hatdeat
horser
iousi
njur
ywi
l
lresul
t.

-Ther
iskofbei
ngi
nvol
vedi
nacr
ashi
ncr
eases

si
gni
fi
cant
lyabov
eabl
oodal
cohol
concent
rat
ion(
BAC)
of0.
04g/
dl.

-Lawst
hatest
abl
i
shBACsof0.
05g/
dlorbel
owar
e

ef
fect
iveatr
educi
ngt
henumberofal
cohol
-r
elat
ed

cr
ashes.

-Enf
orci
ngsobr
iet
ycheck-
poi
ntsandr
andom br
eat
h

t
est
ingcanl
eadt
oreduct
ionsi
nal
cohol
-r
elat
edcr
ashes

byabout20%,
andhav
eshownt
obev
erycost
-ef
fect
ive.

Mot
orcy
clehel
met
s

-Wear
ingamot
orcy
clehel
metcor
rect
lycanr
educet
he

r
iskofdeat
hbyal
most40%andt
her
iskofsev
erei
njur
y
byov
er70%.

-Whenmot
orcy
clehel
metl
awsar
eenf
orcedef
fect
ivel
y,

hel
metwear
ingr
atescani
ncr
easet
oov
er90%.

Requi
ri
nghel
met
stomeetar
ecogni
zedsaf
etyst
andar
d

i
simpor
tantt
oensur
ethathel
met
scanef
fect
ivel
yreduce

t
hei
mpactofacol
l
isi
ont
otheheadi
ntheev
entofa

cr
ash.

Seat
-bel
tsandchi
ldr
est
rai
nts

Wearingcarseat
-beltr
educestheri
skoff
atal
i
tyamongf
ront
-seat
passenger
sby40- 503andofrear-
seat
passenger
sbybet
ween25-
753.

-Mandat
oryseat
-bel
tlawsandt
hei
renf
orcementhav
e

beenshownt
obev
eryef
fect
iveati
ncr
easi
ngseat
-bel
t

wear
ingr
ates.

-I
fcor
rect
lyi
nst
all
edandused,
chi
l
drest
rai
ntsr
educe

deat
hsamongi
nfant
sbyappr
oxi
mat
ely703,
anddeat
hs

amongsmal
lchi
l
drenbybet
ween54%and803.

Di
str
act
eddr
ivi
ng

Ther
ear
emanyt
ypesofdi
str
act
ionst
hatcanl
eadt
o

i
mpai
reddr
ivi
ng,
butr
ecent
lyt
her
ehasbeenamar
ked
i
ncr
easear
oundt
hewor
ldi
ntheuseofmobi
l
ephonesby

dr
iver
sthati
sbecomi
ngagr
owi
ngconcer
nforr
oadsaf
ety
.

Thedi
str
act
ioncausedbymobi
l
ephonescani
mpai
rdr
ivi
ng

per
for
mancei
nanumberofway
s,e.
g.l
ongerr
eact
iont
imes

(
not
abl
ybr
aki
ngr
eact
iont
ime,
butal
sor
eact
iont
otr
aff
ic

si
gnal
s},
impai
redabi
l
ityt
okeepi
nthecor
rectl
ane,
and

shor
terf
oll
owi
ngdi
stances.

-Textmessagi
ngal
sor
esul
tsi
nconsi
der
abl
yreduced

dr
ivi
ngper
for
mance,
wit
hyoungdr
iver
satpar
ti
cul
arr
isk

oft
heef
fect
sofdi
str
act
ionr
esul
ti
ngf
rom t
hisuse.
-Dr
iver
susi
ngamobi
l
ephonear
eappr
oxi
mat
elyf
our

t
imesmor
eli
kel
ytobei
nvol
vedi
nacr
asht
hanwhena

dr
iverdoesnotuseaphone.Hands-
fr
eephonesar
enot

muchsaf
ert
hanhand-
hel
dphoneset
s.

Whi
l
ether
eisl
i
ttl
econcr
eteev
idencey
etonhowt
o

r
educemobi
l
ephoneusewhi
l
edr
ivi
ng,
gov
ernment
s

needt
obepr
oact
ive.Act
ionst
hatcanbet
akeni
ncl
ude

adopt
ingl
egi
slat
ivemeasur
es,
launchi
ngpubl
i
c

awar
enesscampai
gns,
andr
egul
arl
ycol
l
ect
ingdat
aon

di
str
act
eddr
ivi
ngt
obet
terunder
standt
henat
ureoft
his
pr
obl
em.

Dev
elopi
ngcount
ri
esar
ever
ydi
ff
erentf
rom t
he

i
ndust
ri
ali
zedcount
ri
eswi
thr
egar
dtot
heenv
ironmentand

t
hemi
xofv
ehi
clesi
nthet
raf
fi
cst
ream.Thef
oll
owi
ngar
e

t
hemor
eimpor
tantdi
ff
erences(
11)
:

1.Lar
genumber
sofpedest
ri
ansandani
mal
sshar
e

t
her
oadwaywi
thf
ast
-mov
ingandsl
ow-
mov
ing

(
e.g.
,bul
l
ockcar
ts)v
ehi
cles.Ther
eisal
mostno

segr
egat
ionofpedest
ri
ansf
rom wheel
edt
raf
fi
c

2.Lar
genumber
sofol
d,poor
lymai
ntai
nedv
ehi
cles
3.Lar
genumber
sofmot
orcy
cles,
scoot
ers,
and

mopeds

4.Lowdr
ivi
ngst
andar
ds

5.Lar
genumber
sofbuses,
oft
enov
erl
oaded

6.Wi
despr
eaddi
sregar
doft
raf
fi
crul
es

7.Def
ect
iver
oads,
poorst
reetl
i
ght
ing,
def
ect
ive

l
ay-
outofcr
ossr
oadsandspeedbr
eaker
s

8.Unusual
behav
iourofmenandani
mal
s.

I
nSout
h-EastAsi
aRegi
oncount
ri
es,
semi
-ur
banand

r
ural
areascont
ri
but
e60-
80percentofr
oadacci
dent
i
njur
ies,
alt
houghal
lmedi
aat
tent
ioni
sfocussedonur
ban

r
oadacci
dent
s.

Roadt
raf
fi
cinj
uri
escauset
heconsi
der
abl
eeconomi
closs

t
ovi
cti
ms,
thei
rfami
l
ies,
andt
othenat
ionasawhol
e.These

l
ossesar
isef
rom t
hecostoft
reat
ment(
incl
udi
ng

r
ehabi
l
itat
ionandi
nci
denti
nvest
igat
ion)aswel
lasr
educed/

l
ostpr
oduct
ivi
ty(
e.g.i
nwages)f
ort
hoseki
l
ledordi
sabl
ed

byt
hei
rinj
uri
es,
andf
orf
ami
l
ymember
swhoneedt
otake

t
imeof
fwor
k(orschool
)tocar
efort
hei
njur
ed(
9).

Mul
ti
plecausat
ion
Acci
dent
sar
eacompl
exphenomenaofmul
ti
ple

causat
ion(
Fig.1}
.Theaet
iol
ogi
cal
fact
orsmaybecl
assi
fi
ed

i
ntot
wobr
oadcat
egor
ies-humanandenv
ironment
al.

Upt
o90percentoft
hef
act
orsr
esponsi
blef
oracci
dent
sar
e

at
tri
but
edt
ohumanf
ail
ure.Manyoft
hepsy
chol
ogi
cal

ci
rcumst
ancesi
nwhi
chacci
dent
soccurar
est
il
lpoor
ly

known(
5).

PREVENTI
ON

Acci
dent
sdon'
tj
usthappen;
theyar
ecaused.Thecauses

i
nagi
vensi
tuat
ionmustbei
dent
if
iedbyepi
demi
ologi
cal
met
hods.Si
nceacci
dent
sar
emul
ti
fact
ori
al,
theycal
lforan

i
nter
sect
oral
appr
oacht
obot
hpr
event
ionandcar
eoft
he

i
njur
ed.Thev
ari
ousmeasur
escompr
iset
hef
oll
owi
ng:

1.Dat
acol
lect
ion

Ther
eshoul
dbeabasi
crepor
ti
ngsy
stem ofal
lacci
dent
s.

Thenat
ional
dat
ashoul
dbesuppl
ement
edbyspeci
al

sur
vey
sandi
n-dept
hst
udi
es.Thesest
udi
eswi
l
lbr
ingoutt
he

r
iskf
act
ors,
theci
rcumst
ancesandchai
nofev
ent
sleadi
ng

upt
otheacci
dent
.Thesedet
ail
sar
erar
elypr
ovi
dedbyt
he

basi
crepor
ti
ngsy
stem.Det
ail
edenv
ironment
aldat
arel
ati
ng
t
other
oad,
vehi
cle,
weat
her
,et
cmustal
sobecol
l
ect
ed.The

pol
i
cehav
east
atut
orydut
yinmanycount
ri
est
oinv
est
igat
e

acci
dent
s,f
orl
egal
aswel
laspr
event
ivepur
poses;
thedat
a

col
l
ect
ingsy
stemsshoul
drecogni
zet
hisandt
akepol
i
ce

r
ecor
dsast
hei
rst
art
ingpoi
nt(
3).Wi
thoutadequat
edat
a

col
l
ect
ion,
anal
ysi
sandi
nter
pret
ati
ont
her
ecoul
dbeno

ef
fect
ivecount
er-
measur
es,
eval
uat
ionsandst
rat
egi
esf
or

pr
event
ion.

2.Saf
etyeducat
ion

Ther
eisawi
despr
eadbel
i
eft
hatacci
dent
sar
einev
itabl
e;
t
hisf
atal
i
sti
cat
ti
tudemustbecur
bed.Saf
etyeducat
ionmust

begi
nwi
thschool
chi
l
dren.Thedr
iver
sneedt
obet
rai
nedi
n

pr
opermai
ntenanceofv
ehi
clesandsaf
edr
ivi
ng.Young

peopl
eneedt
obeeducat
edr
egar
dingr
iskf
act
ors,
traf
fi
c

r
ulesandsaf
etypr
ecaut
ions.Theyshoul
dal
sobet
rai
nedi
n

f
ir
stai
d.I
thasbeenapt
lysai
dthat"
ifacci
denti
sadi
sease,

educat
ioni
sit
svacci
ne"
.

3.Pr
omot
ionofsaf
etymeasur
es

(
a)Seatbel
ts:
Theuseofseatbel
tsr
educest
henumberof

f
atal
i
tiesandnon-
fat
ali
njur
iesbyappr
oxi
mat
ely50percent
each.Theyshoul
dbemadecompul
sor
yforcar
s,l
i
ghtt
rucks

andsi
mil
arv
ehi
cles(
3).(
b)Saf
etyhel
met
s:Theyr
educet
he

r
iskofheadi
njur
yby30percentonanav
erageandt
hatof

f
atal
i
tiesby40percent(
5).Theypr
eventl
acer
ati
onoft
he

scal
ptoagr
eatext
ent
.Recent
ly,
thef
ull
-f
acei
ntegr
alhel
met

hasbecomev
erypopul
ar.{
c)Chi
l
dren:
Anot
hersaf
ety

measur
eist
oensur
ethatchi
l
drenr
emai
nseat
edwhent
hey

ar
einav
ehi
cle.Theyshoul
dbepr
ohi
bit
edt
otaket
hef
ront

seat
sofcar
s(5)
.Af
ewcount
ri
eshav
eint
roducedl
awswhi
ch

r
equi
ret
hatchi
l
drenofunder12-
15y
ear
sincar
stobei
n
t
her
earseat
sonl
y.(d)Ot
her
s:Thesecompr
iseuseofdoor

l
ocks,
properv
ehi
cledesi
gn,
useofl
ami
nat
edhi
gh-

penet
rat
ionr
esi
stancewi
ndscr
eengl
ass,
etc.

4.Al
coholandot
herdr
ugs

Al
cohol
impai
rsdr
ivi
ngabi
l
ityandi
ncr
easest
her
iskofan

acci
dentaswel
last
hesev
eri
tyofi
tsconsequences.

Concl
usi
onsofsur
vey
scar
ri
edouti
nsev
eral
count
ri
eshav
e

shownt
hatal
cohol
ist
hedi
rectcauseof30t
o50percentof

sev
erer
oadaccident
s.Dr
ugssuchasbar
bit
urat
es,
amphet
amines,
andcannabi
s

i
mpai
rone'
sabi
l
ityt
odr
ivesaf
ely
.Theyshoul
dbeav
oided
t
otal
l
y.

5.Pr
imar
ycar
e

Pl
anni
ng,
organi
zat
ionandmanagemen.
toft
rauma

t
reat
ment
,andemer
gencycar
eser
vicesshoul
dbea

f
undament
alel
ementofheal
thser
vicemanager
ial
process.

Emer
gencycar
eshoul
dbegi
natt
heacci
dentsi
te,
cont
inued

dur
ingt
ranspor
tat
ion,
andconcl
udei
nthehospi
tal

emer
gencyr
oom.Atanyoft
hesest
agesal
i
femaybesav
ed

orl
ost
,dependi
ngupont
heski
l
loft
heheal
thcar
ewor
ker

andt
heav
ail
abi
l
ityofneededemer
gencyequi
pment
.To
achi
evet
heseends,
ther
eshoul
dbeanAcci
dentSer
vices

Organi
zat
ionandoneful
lyequi
ppedspeci
ali
zedt
raumacar
e
hospit
ali
nall
majorci
ti
es.

6.El
i
minat
ionofcausat
ivef
act
ors

Thef
act
orswhi
cht
endt
ocauseacci
dent
smustbesought

outandel
i
minat
ed,
e.g.
,i
mpr
ovementofr
oads,
imposi
ti
on

ofspeedl
i
mit
sandmar
kingofdangerpoi
nts.

7.Enf
orcementofl
aws

Legi
slat
ionembodi
escodi
fi
edsetofr
ules.Thesear
e

enf
orcedbyt
heSt
atet
opr
eventacci
dent
s.Thesei
ncl
ude
dr
ivi
ngt
est
s,medi
cal
fit
nesst
odr
ive,
enf
orcementofspeed

l
i
mit
s,compul
sor
ywear
ingofseat
-bel
tsandcr
ash-
hel
met
s,

checki
ngof.
bloodal
cohol
concent
rat
ion,
road-
sidebr
eat
h

t
est
ingf
oral
cohol
,regul
ari
nspect
ionofv
ehi
cles,
per
iodi
c

r
e-exami
nat
ionofdr
iver
sov
ert
heageof55,
etc.

8.Rehabi
li
tat
ionser
vices

Rehabi
l
itat
ionconsi
stsofanumberofel
ement
swhi
ch

eachi
njur
edper
sonshoul
dbenef
itf
rom.Thesear
emedi
cal

r
ehabi
l
itat
ion,
soci
alr
ehabi
l
itat
ion,
occupat
ional

r
ehabi
l
itat
ion,
etc.Theai
m ofr
ehabi
l
itat
ioni
stopr
event
,

r
educeorcompensat
edi
sabi
l
ityandt
her
ebyhandi
cap.
9.Acci
dentr
esear
ch

Thef
utur
eofacci
dentpr
event
ion1sm r
esear
ch.Such

r
esear
chwi
l
lbeconcer
nedwi
thgat
her
ingpr
eci
se

i
nfor
mat
ionaboutt
heext
ent
,ty
peandot
herchar
act
eri
sti
cs

ofacci
dent
s,cor
rel
ati
ngacci
dentexper
iencewi
thper
sonal

at
tri
but
esandt
heenv
ironment
sinwhi
chacci
dent
soccur
,

i
nvest
igat
ingnewandbet
termet
hodsofal
ter
inghuman

behav
iour
;seeki
ngway
stomakeenv
ironment
ssaf
er;
and

ev
aluat
ingmor
epr
eci
sel
ytheef
fi
ciencyofcont
rol
measur
es.

Thi
sar
eai
snowt
ermedacci
dent
ology
.
 2.Domest
icacci
dent
s

By"
domest
icacci
dent
"ismeantanacci
dentwhi
cht
akes

pl
acei
nthehomeori
nit
simmedi
atesur
roundi
ngs,
and,

mor
egener
all
y,al
lacci
dent
snotconnect
edwi
tht
raf
fi
c,

v
ehi
clesorspor
t(16)
.Themostf
requentcausesofdomest
ic

acci
dent
sar
e:

1.dr
owni
ng

2.bur
ns(
byaf
lame,
hotl
i
qui
d,el
ect
ri
cit
y,cr
acker
s

orf
ir
ewor
ks,
chemi
cal
s)

3.f
all
s
-4.poi
soni
ng(
e.g.
,dr
ugs,
insect
ici
des,
ratpoi
sons,

ker
osene)

5.i
njur
iesf
rom shar
porpoi
ntedi
nst
rument
s

6.bi
tesandot
heri
njur
iesf
rom ani
mal
s.

Dr
owni
ng(
12)

Dr
owni
ngi
sthepr
ocessofexper
ienci
ngr
espi
rat
ory

i
mpai
rmentf
rom submer
sion/
immer
sioni
nli
qui
d.

Vi
cti
msofdr
owni
nghav
eav
erysl
i
m chanceofsur
viv
al

af
teri
mmer
sion.Thev
ict
iml
osesconsci
ousnessaf
ter

appr
oxi
mat
ely2mi
nut
esofi
mmer
sion,
andi
rr
ever
sibl
e
br
aindamagecant
akepl
aceaf
ter4-
6mi
nut
es.Ther
efor
e,

pr
event
ionst
rat
egi
esar
ever
yimpor
tant
.

I
n2011,
anest
imat
ed359,
000peopl
edi
edf
rom

dr
owni
ng,
maki
ngdr
owni
ngamaj
orpubl
i
cheal
thpr
obl
em

wor
ldwi
de.I
njur
iesaccountf
ornear
ly10%oft
otal
global

mor
tal
i
ty.Dr
owni
ngi
sthe3r
dleadi
ngcauseofuni
ntent
ional

i
njur
y/deat
h.I
taccount
sfor7%ofal
li
njur
y-r
elat
eddeat
hs.

I
tisacommonmet
hodofsui
cide.

Thegl
obal
bur
denanddeat
hfr
om dr
owni
ngi
sfoundi
n

al
leconomi
esandr
egi
ons,
howev
er;
lowandmi
ddl
e-i
ncome
count
ri
esaccountf
or95%ofuni
ntent
ional
drowni
ng

deat
hs;
over50%oft
hewor
ld'
sdr
owni
ngoccur
sint
he

WHOWest
ernPaci
fi
cRegi
onandWHOSout
h-EastAsi
a

Regi
on;
Chi
naandI
ndi
ahav
epar
ti
cul
arl
yhi
ghdr
owni
ng

mor
tal
i
tyr
atesandt
oget
hercont
ri
but
e43%oft
hewor
ld'
s

dr
owni
ngdeat
hsand41%oft
het
otal
global
DALYs

(
disabi
l
ity
-adj
ust
edl
i
fey
ear
s)l
ostr
elat
edt
odr
owni
ng.

Ther
eisawi
der
angeofuncer
tai
ntyar
oundt
heest
imat
e

ofgl
obal
drowni
ngdeat
hs.I
tisi
mpor
tantt
opoi
ntoutt
hat

t
hegl
obal
probl
em i
smuchgr
eat
ert
hant
heabov
efi
gur
es
r
eveal
;duet
othewaydat
aar
ecl
assi
fi
ed,
global
number
s

excl
udedr
owni
ngduet
ofl
oods(
cat
acl
ysms)
,boat
ingand

wat
ert
ranspor
tmi
shaps.Non-
fat
aldr
owni
ngst
ati
sti
csi
n

manycount
ri
esar
enotr
eadi
l
yav
ail
abl
eorar
eunr
eli
abl
e.

Ri
skf
act
ors(
12)

1.Age:
Agei
soneoft
hemaj
orr
iskf
act
orf
ordr
owni
ng.

Thi
srel
ati
onshi
pisof
tenassoci
atedwi
thal
apsei
n

super
visi
on.I
ngener
al,
chi
l
drenunder5y
ear
sofagehav
e

t
hehi
ghestdr
owni
ngmor
tal
i
tyr
ateswor
ldwi
de.Canadaand

NewZeal
andar
etheonl
yexcept
ions,
wher
eadul
tmal
es
dr
ownathi
gherr
ates.

2.Gender:
Mal
esar
eespeci
all
yatr
iskofdr
owni
ngwi
th

t
wicet
heov
eral
lmor
tal
i
tyr
ateoff
emal
es.Theyar
emor
e

l
i
kel
ytobehospi
tal
i
zedt
hanf
emal
esf
ornon-
fat
aldr
owni
ng.

St
udi
essuggestt
hatt
hehi
gherdr
owni
ngr
atesamongmal
es

ar
eduet
oincr
easedexposur
etowat
erandr
iski
erbehav
iour

suchasswi
mmi
ngal
one,
dri
nki
ngal
cohol
bef
oreswi
mmi
ng

al
one,
andboat
ing.

3.Accesst
owat
er:
Incr
easedaccesst
owat
eri
sanot
her

r
iskf
act
orf
ordr
owni
ng.I
ndi
vi
dual
swi
thoccupat
ionssuch
ascommer
cial
fishi
ngorf
ishi
ngf
orsubsi
stence,
usi
ngsmal
l

boat
sinl
ow-
incomecount
ri
es,
aremor
epr
onet
odr
owni
ng.

Chi
l
drenwhol
i
venearopenwat
ersour
ces,
suchasdi
tches,

ponds,
irr
igat
ionchannel
s,orpool
sar
eespeci
all
yatr
isk.

4.Ot
herr
iskf
act
ors:
Ther
ear
eot
herf
act
orst
hatar
e

associ
atedwi
thani
ncr
easedr
iskofdr
owni
ng,
suchas:

a.i
nfant
slef
tunsuper
visedoral
one,
orwi
thanot
her

chi
l
dinabat
htub;

b.unsaf
eorov
ercr
owdedt
ranspor
tat
ionv
essel
s

l
acki
ngf
lot
ati
ondev
ices;
c.al
cohol
use,
nearori
nthewat
er;

d.medi
cal
condi
ti
ons,
suchasepi
l
epsy
;

e.t
our
ist
sunf
ami
l
iarwi
thl
ocal
wat
err
isksand

f
eat
ures;
and

f
.fl
oodsandot
hercat
acl
ysmi
cev
ent
sli
ket
sunami
s.

Pr
event
ion(
12)

Dr
owni
ngpr
event
ionst
rat
egi
esshoul
dbecompr
ehensi
ve

andi
ncl
ude:
engi
neer
ingmet
hodswhi
chhel
ptor
emov
ethe

hazar
d,l
egi
slat
iont
oenf
orcepr
event
ionandassur
e

decr
E:!
asedexposur
e,educat
ionf
ori
ndi
vi
dual
sand
communi
ti
est
obui
l
dawar
enessofr
iskandt
oai
din

r
esponsei
fadr
owni
ngoccur
s.

Engi
neer
ingmet
hodst
oel
i
minat
eexposur
etowat
er

hazar
dsar
ethemostef
fect
ivest
rat
egyf
ordr
owni
ng

pr
event
ion.Exampl
esi
ncl
ude:

dev
elopmentandi
mpl
ement
ati
onofsaf
ewat
ersy
stems,

suchasdr
ainagesy
stems,
pipedwat
ersy
stems,
flood

cont
rol
embankment
sinf
loodpr
onear
eas;

bui
l
dingf
our
-si
dedpool
fencesorbar
ri
erspr
event
ing

accesst
ost
andi
ngwat
er;
cr
eat
ingandmai
ntai
ningsaf
ewat
erzonesf
orr
ecr
eat
ion;

-cov
eri
ngofwel
l
soropenci
ster
ns;

empt
yingbucket
sandbat
hs,
andst
ori
ngt
hem upsi
de-

down.

Lawsorr
egul
ati
onswhi
cht
argetr
iskf
act
orsf
ordr
owni
ng

i
ncl
udel
awsr
equi
ri
ngr
egul
arsaf
etychecksoft
ranspor
tat
ion

v
essel
s,andl
awsonal
cohol
usewhi
l
eboat
ingorswi
mmi
ng.

I
ndi
vi
dual
andcommuni
tyeducat
ionondr
owni
ng

awar
eness,
lear
ningwat
ersur
viv
alski
l
lsandensur
ingt
he

pr
esenceofl
i
feguar
dsatswi
mmi
ngar
easar
epr
omi
sing
st
rat
egyt
opr
eventdr
owni
ng.

Bur
ns(
13)

Abur
nisani
njur
ytot
heski
norot
heror
gani
cti
ssue

pr
imari
l
ycausedbyheatorduetor
adi
ation,radi
oacti
vi
ty,
el
ect
ri
cit
y,f
ri
cti
onorcont
actwit
hchemicals.Thermal(heat
)

bur
nsoccurwhensomeoral
loft
hecel
l
sint
heski
norot
her

t
issuesar
edest
roy
edby:

hotl
i
qui
ds(
scal
ds)

hotsol
i
ds(
cont
actbur
ns)
,or

-f
lames(
fl
amebur
ns)
.
Thepr
obl
em

Bur
nsar
eagl
obal
publ
i
cheal
thpr
obl
em,
account
ingf
or

anest
imat
ed265,
000deat
hsannual
l
y.About11mi
l
li
on

peopl
ewor
ldwi
der
equi
remedi
cal
att
ent
ionduet
osev
ere

bur
ns.Themaj
ori
tyoft
heseoccuri
nlowandmi
ddl
e-

i
ncomecount
ri
esandal
mosthal
foccuri
ntheSout
h-East

Asi
aRegi
on.

I
nmanyhi
gh-
incomecount
ri
es,
bur
ndeat
hrat
eshav
e

beendecr
easi
ng,
andt
her
ateofchi
l
ddeat
hsf
rom bur
nsi
s

cur
rent
lyov
ersev
ent
imeshi
gheri
nlowandmi
ddl
e-i
ncome
count
ri
est
hani
nhi
gh-
incomecount
ri
es.

Non-
fat
albur
nsar
eal
eadi
ngcauseofmor
bidi
ty,

i
ncl
udi
ngpr
olongedhospi
tal
i
zat
ion,
disf
igur
ementand

di
sabi
l
ity
,of
tenwi
thr
esul
ti
ngst
igmaandr
eject
ion.

I
tisest
imat
edt
hatov
eronemi
l
li
onpeopl
ear
e

moder
atel
yorsev
erel
ybur
ntev
eryy
eari
nIndi
a.I
n

Bangl
adesh1.73l
acchi
l
drengetmoder
ateorsev
erebur
ns

ev
eryy
earwi
thabout17percentget
ti
ngt
empor
ary

di
sabi
l
ityand18percentper
manentdi
sabi
l
ity
.Bur
nsar
e

t
hesecondmostcommoni
njur
yinr
ural
Nepal
account
ing
f
or5percentdi
sabi
l
iti
es.

Ri
skf
act
ors(
13)

Gender:
Femal
essuf
ferbur
nsmor
efr
equent
lyt
han

mal
es.Womeni
ntheSout
h-EastAsi
aRegi
onhav
ethe

hi
ghestr
ateofbur
ns,
account
ingf
or273ofgl
obal
bur
n

deat
hsandnear
ly703ofbur
ndeat
hsi
nther
egi
on.The

hi
ghr
iskf
orf
emal
esi
sassoci
atedwi
thopenf
ir
ecooki
ng,
or

i
nher
ent
lyunsaf
ecookst
oves,
whi
chcani
gni
tel
oose

cl
othi
ng.Openf
lamesusedf
orheat
ingandl
i
ght
ingal
so

poser
isks,
andsel
f-
dir
ect
edori
nter
per
sonal
viol
encear
e
al
soi
mpor
tantf
act
ors(
alt
houghunder
studi
ed)
.

Age:
Alongwi
thadul
twomen,
chi
l
drenar
epar
ti
cul
arl
y

v
ulner
abl
etobur
ns.Bur
nsar
ethe11t
hleadi
ngcauseof

deat
hofchi
l
drenaged1-
9year
sandar
eal
sot
hef
if
thmost

commoncauseofnon-
fat
alchi
l
dhoodi
njur
ies.Whi
l
eamaj
or

r
iski
simpr
operadul
tsuper
visi
on,
aconsi
der
abl
enumberof

bur
ninj
uri
esi
nchi
l
drenr
esul
tfr
om chi
l
dmal
tr
eat
ment
.

Soci
o-economi
cfact
ors

Peopl
eli
vi
ngi
nlowandmi
ddl
e-i
ncomecount
ri
esar
eat

hi
gherr
iskf
orbur
nst
hanpeopl
eli
vi
ngi
nhi
gh-
income
count
ri
es.Wi
thi
nthecount
ri
esal
so,
bur
nri
skcor
rel
ateswi
th

soci
o-economi
cst
atus.

Ot
herr
iskf
act
ors

Ther
ear
eanumberofot
herr
iskf
act
orsf
orbur
ns,

i
ncl
udi
ng:

occupat
ionst
hati
ncr
easeexposur
etof
ir
e;

-pov
ert
y,ov
ercr
owdi
ngandl
ackofpr
opersaf
ety

measur
es;

pl
acementofy
ounggi
rl
sinhousehol
drol
essuchas

cooki
ngandcar
eofsmal
lchi
l
dren;
-under
lyi
ngmedi
cal
condi
ti
ons,
incl
udi
ngepi
l
epsy
,

per
ipher
alneur
opat
hy,
andphy
sical
andcogni
ti
ve

di
sabi
l
iti
es;
alcohol
abuseandsmoki
ng;

easyaccesst
ochemi
cal
susedf
orassaul
t(suchasi
naci
d

v
iol
enceat
tacks)
;

-useofker
osene(
par
aff
in)asaf
uel
sour
cef
ornon-

el
ect
ri
cdomest
icappl
i
ances;

i
nadequat
esaf
etymeasur
esf
orl
i
quef
iedpet
rol
eum gas

andel
ect
ri
cit
y.

Bur
nsoccurmai
nlyi
nthehomeandwor
kpl
ace.
Communi
tysur
vey
sinBangl
adeshandEt
hiopi
ashowed

t
hat80-
903ofbur
nsoccurathome.Chi
l
drenandwomen

usual
l
ygetbur
nsi
ndomest
icki
tchens,
from upset

r
ecept
acl
escont
aini
nghotl
i
qui
ds,
orf
lames,
orf
rom

cookst
oveexpl
osi
ons.Menar
emor
eli
kel
ytogetbur
nsi
n

t
hewor
kpl
aceduet
ofi
re,
scal
ds,
chemi
cal
sandel
ect
ri
cit
y.

Pr
event
ion(
13)

Bur
nsar
epr
event
abl
e.Hi
gh-
incomecount
ri
eshav
e

madeconsi
der
abl
epr
ogr
essi
nlower
ingr
atesofbur
n

deat
hs,
thr
oughacombi
nat
ionofpr
event
ionst
rat
egi
esand
i
mpr
ovemet
nsi
nthecar
eofpeopl
eaf
fect
edbybur
ns.Most

oft
heseadv
ancesi
npr
event
ionandcar
ehav
ebeen

i
ncompl
etel
yappl
i
edi
nlowandmi
ddl
e-i
ncomecount
ri
es.

I
ncr
easedef
for
tst
odosowoul
dli
kel
yleadt
osi
gni
fi
cant

r
educt
ioni
nrat
esofbur
n-r
elat
eddeat
handdi
sabi
l
ity
.

Pr
event
ionst
rat
egi
esshoul
daddr
esst
hehazar
dsf
or

speci
fi
cbur
ninj
uri
es,
educat
ionf
orv
ulner
abl
epopul
ati
ons

andt
rai
ningofcommuni
ti
esi
nfi
rst
-ai
d.Anef
fect
ivebur
n

pr
event
ionpl
anshoul
dbemul
ti
sect
oral
.Ther
ear
eanumber

ofspeci
fi
crecommendat
ionsf
ori
ndi
vi
dual
s,communi
ti
es
andpubl
i
cheal
thof
fi
cial
stor
educebur
nri
sk.

FI
RST-
AID(
13)

Do'
s

1.St
opt
hebur
ningpr
ocessbyr
emov
ingcl
othi
ngand

i
rr
igat
ingt
hebur
ns.

2.Usecool
runni
ngwat
ert
oreducet
het
emper
atur
eoft
he

bur
n.

3.Ext
ingui
shf
lamesbyal
l
owi
ngt
heper
sont
orol
lont
he

gr
ound,
orbyappl
yi
ngabl
anket
,orbyusi
ngwat
eror

ot
herf
ir
e-ext
ingui
shi
ngl
i
qui
ds.
4.I
nchemi
cal
bur
ns,
remov
eordi
l
utet
hechemi
cal
agent

byi
rr
igat
ingwi
thl
argev
olumesofwat
er.

5.Wr
apt
hepat
ienti
nacl
eancl
othorsheetandt
ranspor
t

t
othenear
estappr
opr
iat
efaci
l
ityf
ormedi
cal
car
e.

Don'
ts

1.Donotst
artf
ir
st-
aidbef
oreensur
ingy
ourownsaf
ety

(
swi
tchof
fel
ect
ri
cal
cur
rent
,weargl
ovesf
orchemi
cal
s

et
c.)

2.Donotappl
ypast
e,oi
l
,hal
di(
tur
mer
ic)orr
awcot
tont
o

t
hebur
n.
3.Donotappl
yicebecausei
tdeepenst
hei
njur
y.

4.Av
oidpr
olongedcool
i
ngwi
thwat
erbecausei
tmayl
ead

t
ohy
pot
her
mia.

5.Donotopenbl
i
ster
sunt
ilt
opi
cal
ant
imi
crobi
alscanbe

appl
i
ed,
byaheal
th-
car
epr
ovi
der
.

6.Donotappl
yanymat
eri
aldi
rect
lyt
othe'
woundasi
t

mi
ghtbecomei
nfect
ed.

7.Av
oidappl
i
cat
ionoft
opi
cal
medi
cat
ionunt
ilt
hepat
ient

hasbeenpl
acedunderappr
opr
iat
emedi
cal
car
e.
 Fal
ls

Gl
obal
l
y,f
all
sar
eamaj
orpubl
i
cheal
thpr
obl
em.An

est
imat
ed424,
000f
atal
fal
l
soccureachy
ear
,maki
ngi
tthe

secondl
eadi
ngcauseofuni
ntent
ional
inj
urydeat
h,af
ter

r
oadt
raf
fi
cinj
uri
es.Thoughnotf
atal
37.
3mi
l
li
onf
all
sar
e

sev
ereenought
orequi
remedi
cal
att
ent
ion.Suchf
all
sar
e

r
esponsi
blef
or17mi
l
li
onDALYsl
ost
.Ov
er80%off
all
-

r
elat
edf
atal
i
tiesoccuri
nlowandmi
ddl
e-i
ncomecount
ri
es,

wi
thr
egi
onsoft
heWest
ernPaci
fi
candSout
hEastAsi
a

account
ingf
ormor
ethant
wo-
thi
rdsoft
hesedeat
hs.I
nal
l
r
egi
onsoft
hewor
ld,
deat
hrat
esar
ehi
ghestamongadul
ts

ov
ert
heageof60y
ear
s(14)
.

Fal
l
sar
eresponsi
blef
ort
hel
argestnumberofhospi
tal

v
isi
tsf
ornon-
fat
ali
njur
ies,
especi
all
yforchi
l
drenandy
oung

adul
ts.Fal
l
sfr
om r
oof
tops,
bal
coni
es,
windowsandst
air

casesar
ecommon.Fact
orsspeci
fi
ctoSEARcount
ri
esar
e

f
all
sfr
om t
reesofwor
ker
spi
cki
ngf
rui
tsorcoconut
s,t
appi
ng

t
oddy
,chi
l
drenf
all
i
ngf
rom r
oof
topswhi
l
efl
yi
ngki
tes,
high

i
nci
denceoff
all
samongconst
ruct
ionandf
orest
rywor
ker
s.

Asl
i
feexpet
ancyi
ncr
easesi
nthesecount
ri
es,
thei
nci
dence
ofhi
pandot
herf
ract
uresduet
ofal
lamongt
heel
der
lyar
e

al
soassumi
nggr
eat
erpr
opor
ti
ons(
15)
.

Someoft
her
iskf
act
orsi
ncl
ude(
14):

occupat
ionsatel
evat
edhei
ght
sorot
herhazar
dous

wor
kingcondi
ti
ons;

al
cohol
orsubst
anceuse;

-soci
o-economi
cfact
orsi
ncl
udi
ngpov
ert
y,

ov
ercr
owdedhousi
ng,
youngmat
ernal
age;

-under
lyi
ngmedi
cal
condi
ti
ons,
suchasneur
ologi
cal
,

car
diacorot
herdi
sabl
i
ngcondi
ti
ons;
si
de-
eff
ect
sofmedi
cat
ion,
phy
sical
inact
ivi
tyandl
oss

ofbal
ance,
par
ti
cul
arl
yamongol
derpeopl
e;

-unsaf
eenv
ironment
s,par
ti
cul
arl
yfort
hosewi
thpoor

bal
anceandl
i
mit
edv
isi
on.

Pr
event
ion(
14)

Forchi
l
dren,
eff
ect
ivei
nter
vent
ionsi
ncl
udemul
ti
facet
ed

communi
typr
ogr
ammes;
engi
neer
ingmodi
fi
cat
ionsof

nur
ser
yfur
nit
ure,
play
groundequi
pment
,andot
her

pr
oduct
s;andl
egi
slat
ionf
ort
heuseofwi
ndowguar
d.

Forol
deri
ndi
vi
dual
s,f
all
prev
ent
ionpr
ogr
ammescan
i
ncl
udeanumberofcomponent
stoi
dent
if
yandmodi
fyr
isk,

suchas:

scr
eeni
ngwi
thi
nli
vi
ngenv
ironment
sforr
isksf
orf
all
s;

cl
i
nical
int
erv
ent
ionst
oident
if
yri
skf
act
ors,
suchas

medi
cat
ionr
evi
ewandmodi
fi
cat
ion,
treat
mentofl
ow

bl
oodpr
essur
e,Vi
tami
nDandcal
cium suppl
ement
ati
on,

t
reat
mentofcor
rect
abl
evi
sual
impai
rment
;

homeassessmentandenv
ironment
almodi
fi
cat
ionf
or

t
hosewi
thknownr
iskf
act
orsorahi
stor
yoff
all
i
ng;

pr
escr
ipt
ionofappr
opr
iat
eassi
sti
vedev
icest
oaddr
ess
phy
sical
andsensor
yimpai
rment
s;

muscl
est
rengt
heni
ngandbal
ancer
etr
aini
ngpr
escr
ibed

byat
rai
nedheal
thpr
ofessi
onal
;

Poi
soni
ng

Poi
soni
ngwasr
esponsi
blef
oranest
imat
ed252,
000

deat
hsdur
ingt
hey
ear2008wor
ldwi
de.I
nIndi
aabout

28,
012poi
soni
ngdeat
hswer
erepor
teddur
ingt
hey
ear

2010(
7).Themostcommonagent
sresponsi
blef
or

poi
soningar
epest
icides,
kerosene,
prescr
ipt
iondr
ugs,
and
househol
dchemi
cals.Pesti
cidesar
ewidelyusedi
nmany

count
ri
eswher
eagr
icul
tur
eisani
mpor
tantpar
toft
he
economy
.Repor
tsf
rom I
ndi
a,I
ndonesi
a,Sr
iLanka,
and

Thai
l
andi
ndi
cat
ethatcommonav
ail
abi
l
ityanduseoft
oxi
c

pest
ici
desi
sresponsi
blef
ori
ntent
ional
anduni
ntent
ional

mor
bidi
tyandmor
tal
i
ty.

I
nSr
iLanka,
pest
ici
desar
eoneoft
hemai
nagent
sused

i
nat
tempt
edsui
cidei
nrur
alar
eas.Theuseof

or
ganophosphor
ousi
nsect
ici
desi
nsui
cideev
ent
shasbeen

r
epor
tedt
obeashi
ghas20-
30percent
.Par
aquat

i
ntoxi
cat
ioni
sknownt
ocausei
rr
ever
sibl
edamagei
n

pat
ient
s.Manycount
ri
esal
sor
epor
tacci
dent
ali
ngest
ionof
ker
oseneasal
eadi
ngcauseofpoi
soni
ng,
especi
all
yamong

chi
l
dren(
15)
.Ast
udyf
rom Thai
l
andr
eveal
edt
hat54per

centofcasesofpoi
soni
ngamongpr
e-school
chi
l
dren

i
nvol
vedt
her
apeut
icdr
ugs.

Snakebi
te

Snakebi
tei
sanegl
ect
edpubl
i
cheal
thi
ssuei
nmany

t
ropi
cal
andsubt
ropi
cal
count
ri
es.About5mi
l
li
onsnake

bi
tesoccureachy
ear
,resul
ti
ngi
nupt
o2.
4mi
l
li
on

env
enomi
ngs{
poi
soni
ngf
rom snakebi
tes)atl
east94,
000-

125,
000deat
hsandar
ound400,
000amput
ati
onsandot
her
per
manentdi
sabi
l
iti
es.Mostoft
heseoccuri
nAf
ri
ca,
Asi
a

andLat
inAmer
ica.I
nAf
ri
caal
onet
her
ear
eanest
imat
ed

1mi
l
li
onsnakebi
tesannual
l
ywi
thabouthal
fneedi
ng

t
reat
ment
.Thi
sty
peofi
njur
yisof
tenf
oundamongwomen,

chi
l
drenandf
armer
sinpoorr
ural
communi
ti
esi
nlowand

mi
ddl
e-i
ncomecount
ri
es(
18)
.

Theout
comeofsnakebi
tedependsonnumer
ousf
act
ors,

i
ncl
udi
ngt
hespeci
esofsnake,
thear
eaoft
hebodybi
tt
en,

t
heamountofv
enom i
nject
ed,
andt
heheal
thcondi
ti
onof

t
hev
ict
im.Feel
i
ngsoft
err
orandpani
car
ecommonaf
tera
snakebi
teandcanpr
oduceachar
act
eri
sti
csetofsy
mpt
oms

medi
atedbyt
heaut
onomi
c.ner
voussy
stem,
suchasa

t
achy
car
diaandnausea.Bi
tesf
rom non-
venomoussnakes

canal
socausei
njur
y,of
tenduet
olacer
ati
onscausedbyt
he

snake'
steet
h,orf
rom ar
esul
ti
ngi
nfect
ion.Abi
temayal
so

t
ri
ggerananaphy
lact
icr
eact
ion,
whi
chi
spot
ent
ial
l
yfat
al.

Fi
rst
-ai
drecommendat
ionsf
orbi
tedependsont
hesnakes

i
nhabi
ti
ngt
her
egi
on,
asef
fect
ivet
reat
mentf
orbi
tei
nfl
i
cted

bysomespeci
escanbei
nef
fect
ivef
orot
her
s.

Thev
enom ofpoi
sonoussnakesmaybepr
edomi
nant
ly
neur
otoxi
corpr
edomi
nant
lycy
tol
yti
c.Neur
otoxi
nscause

r
espi
rat
orypar
aly
sisandcy
tol
yti
cvenomscauset
issue

dest
ruct
ionbydi
gest
ionandhaemor
rhageduet
o

haemol
ysi
sanddest
ruct
ionoft
heendot
hel
i
all
i
ningoft
he

bl
oodv
essel
s.Themani
fest
ati
onsofr
att
lesnake

env
enomat
ionar
emost
lyl
ocal
pai
n,r
edness,
swel
l
ingand

ext
rav
asat
ionofbl
ood.Per
ior
alt
ingl
i
ng,
met
all
i
ctast
e,

nausea,
andv
omi
ti
ng,
hypot
ensi
onandcoagul
opat
hymay

al
sooccur
.Neur
otoxi
cenv
enomat
ionmaycausept
osi
s,

dy
sphagi
a,di
plopi
a,andr
espi
rat
oryf
ail
ure.Venom emi
tt
ed
f
rom somet
ypesofcobr
as,
almostal
lvi
per
scausenecr
osi
s

ofmuscl
eti
ssue.Muscl
eti
ssuesbegi
ntodi
ethr
oughoutt
he

bodyandi
tresul
tsi
naccumul
ati
onofmy
ogl
obi
nint
her
enal

t
ubul
eswhi
chl
eadst
oacut
erenal
fai
l
ure.

Ear
lycl
uest
hatapat
ienthassev
ereenv
enomi
ng(
19):

Snakei
dent
if
iedasav
erydanger
ousone.

Rapi
dear
lyext
ensi
onofl
ocal
swel
l
ingf
rom t
hesi
teof

t
hebi
te.

Ear
lyt
enderenl
argementofl
ocal
lymphnodes,

i
ndi
cat
ingspr
eadofv
enom i
nthel
ymphat
icsy
stem.Ear
ly
sy
stemi
csy
mpt
oms:
col
l
apse(
hypot
ensi
on,
shock)
,

nausea,
vomi
ti
ng,
diar
rhoea,
sev
ereheadache,

"
heav
iness"oft
heey
eli
ds,
inappr
opr
iat
e(pat
hol
ogi
cal
)

dr
owsi
nessorear
lypt
osi
s/opht
hal
mopl
egi
a.

-Ear
lyspont
aneoussy
stemi
cbl
eedi
ng.

Passageofdar
kbr
own/
blackur
ine.

FI
RST-
AID

TheGov
ernmentofI
ndi
adev
elopedanat
ional
snake-

bi
tepr
otocol
in2007whi
chi
ncl
udesf
oll
owi
ngadv
ice:

1.Reassur
ethepat
ient
.70%ofal
lsnakebi
tesar
efr
om
non-
venomousspeci
es.Onl
y50%ofbi
tesbyv
enomous

speci
esact
ual
l
yenv
enomat
ethepat
ient
.

2.I
mmobi
l
izei
nthesamewayasaf
ract
uredl
i
mb.Use

bandagesorcl
otht
ohol
dthespl
i
nts,
nott
obl
ockt
he

bl
oodsuppl
yorappl
ypr
essur
e.Donotappl
yany

compr
essi
oni
nthef
orm oft
ightl
i
gat
ures,
theydon'
t

wor
kandcanbedanger
ous.

3.Donotgi
veal
cohol
i
cbev
eragesorst
imul
ant
s.Theyar
e

knownv
asodi
l
ator
sandt
heyspeedupt
heabsor
pti
onof

v
enom.
4.Remov
eanyi
temsorcl
othi
ngswhi
chmayconst
ri
ctt
he

bi
tt
enl
i
mbi
fitswel
l
s(r
ings,
bracel
ets,
wat
ches,

f
oot
wear
,et
c.)
.

5.Donoti
nci
seormani
pul
atet
hebi
tt
ensi
te.Donotappl
y

i
ce.

6.Tr
anspor
tthepat
ientt
oamedi
cal
facul
tyf
ordef
ini
ti
ve

t
reat
ment
.

ANTI
VENOM (
19)

Unt
ilt
headv
entofant
ivenom,
bit
esf
rom somespeci
esof

snakewer
eal
mostuni
ver
sal
l
yfat
al.Despi
tehugeadv
ances
i
nemer
gencyt
her
apy
,ant
ivenom i
sof
tenst
il
ltheonl
y

ef
fect
ivet
reat
mentf
orenv
enomat
ion.Thef
ir
stant
ivenom

wasdev
elopedi
n1895byFr
enchphy
sici
anAl
ber
tCal
met
te

f
ort
het
reat
mentofI
ndi
ancobr
abi
tes.Ant
ivenom i
smade

byi
nject
ingasmal
lamountofv
enom "
int
oanani
mal

(
usual
l
yahor
seorsheep)t
oini
ti
ateani
mmunesy
stem

r
esponse.Ther
esul
ti
ngant
ibodi
esar
ethenhar
vest
edf
rom

t
heani
mal
'
sbl
ood.

Ant
ivenom i
sinj
ect
edi
ntot
heper
soni
ntr
avenousl
y,and

wor
ksbybi
ndi
ngt
o,andneut
ral
i
zingv
enom enzy
mes.I
t
cannotundodamageal
readycausedbyv
enom,
so

ant
ivenom t
reat
mentshoul
dbesoughtassoonaspossi
ble.

Moder
nant
ivenomsar
eusual
l
ypol
yval
ent
,maki
ngt
hem

ef
fect
iveagai
nstt
hev
enom ofnumer
oussnakespeci
es.

Phar
maceut
ical
compani
eswhi
chpr
oduceant
ivenom

t
argett
hei
rpr
oduct
sagai
nstt
hespeci
esnat
ivet
oa

par
ti
cul
arar
ea.Al
thoughsomepeopl
emaydev
elopser
ious

adv
erser
eact
ionst
oant
ivenom,
suchasanaphy
laxi
s,i
n

emer
gencysi
tuat
ionst
hisi
susual
l
ytr
eat
abl
eandhencet
he

benef
itout
wei
ghst
hepot
ent
ial
consequencesofnotusi
ng
ant
ivenom.

3.I
ndust
ri
alacci
dent
s

Ther
ear
eappr
oxi
mat
ely580mi
l
li
onwor
ker
sint
he

Sout
h-EastAsi
aRegi
on.Appr
oxi
mat
ely60-
80percentof

t
hesewor
ker
sar
eempl
oyedi
nagr
icul
tur
e,f
isher
ies,
home

i
ndust
ri
es,
andsmal
l
-scal
euni
ts.I
njur
iesduet
othese

occupat
ionsr
esul
tinanest
imat
ed120mi
l
li
oni
njur
iesand

200,
000deat
hspery
ear(
15)
.

Thoughrel
i
ableest
imatesforworkr
elat
edinj
uri
esanddeat
hsi
n
theRegi
onarenotavai
l
able,par
tl
ybecausea

maj
ori
tyoft
hewor
ker
sar
eempl
oyedi
nunor
gani
zed
sect
ors,
fewst
udi
esi
ndi
cat
ethatnear
lyonepercentof

deat
hsand10percentofper
manenti
mpai
rmentr
esul
tfr
om

agr
icul
tur
ali
njur
ies.Agr
icul
tur
ewor
ker
sar
eexposedt
owi
de

v
ari
etyofphy
sical
,chemi
cal
(pest
ici
deandf
ert
il
izer
s),

bi
ologi
cal
(ani
mal
bit
esandani
mal
rel
atedi
njur
ies)and

mechani
cal
inj
uri
es.Theest
imat
esf
rom agr
icul
tur
einj
ury

v
aryf
rom 22-
29per1000wor
ker
s.Thei
nci
dencer
ateof

i
njur
yamongagr
icul
tur
ewor
ker
sinI
ndi
aisest
imat
edt
obe

116per100,
000wor
ker
s.I
nast
udypopul
ati
onof23,
000i
n

r
ural
Har
yana,
near
ly31percentoft
hei
njur
ieswer
erel
ated
t
oagr
icul
tur
alact
ivi
ty(
17)
.Oft
hese,
ser
iousi
njur
ieswer
e

causedbymechani
zedequi
pmentandt
ract
ors(
15)
.

Rapi
dindust
ri
ali
zat
ionhasal
sor
esul
tedi
nmor
tal
i
tyand

mor
bidi
tyofmanywor
ker
sinhazar
dousi
ndust
ri
es.

Theuni
quef
eat
urescommont
othewor
kpl
acei
nthi
s

r
egi
onar
ethatt
hemanual
labourcont
enti
shi
ghandt
he

man-
machi
nei
nter
act
ioni
sunsaf
e.I
naddi
ti
on,
ther
eis

gr
eat
eremphasi
sonat
tempt
stochanget
hewor
ker
's

behav
iour
,butdesi
gnst
hatpr
ovi
deaut
omat
icpr
otect
ionar
e

i
gnor
ed.Chi
l
drenandpeopl
ewhoar
echal
l
engedphy
sical
l
y
aswel
lasment
all
yar
eatagr
eat
err
iskofencount
eri
ng

occupat
ional
inj
uri
es(
15)
.

4.Rai
lwayacci
dent
s

Wi
tht
hei
ncr
easei
nnumberoft
rai
nsandpassenger
s,t
he

i
ncr
easei
nthenumberofacci
dent
sandcasual
ti
esr
esul
ti
ng

t
her
efr
om i
snotunexpect
ed.Dur
ing2010,
about30,
576

peopl
edi
edofr
ail
wayacci
dent
sinI
ndi
a(8)
.Themai
n

f
act
ori
nvol
vedi
nrai
l
wayacci
dent
sishumanf
ail
ure.

5.Vi
olence

Anest
imat
ed1,
510,
000per
sonsdi
edi
n2008duet
o
v
iol
enceori
ntent
ional
inj
uri
es(
homi
ci
de,
sui
cideandwar
)

wor
ldwi
de,
ofwhi
ch420,
000wer
einSEARcount
ri
es(
7).

Theaccur
atest
ati
sti
csar
enotav
ail
abl
e,asnotal
lthose

i
njur
edgot
othehospi
tal
orst
atet
hatt
hei
njur
yisbecause

ofv
iol
ence.Vi
olencebehi
ndcl
oseddoor
sar
egr
ossl
y

unr
epor
ted.

Vi
olencei
srepor
tedt
obei
ncr
easi
ngr
api
dly
.Ital
sof
oll
ow

t
hesameepi
demi
ologi
cal
pat
ter
nasanyot
herdi
sease(
host
,

agentandenv
ironment
),i
.e.amot
ivat
edper
sonwho

i
njur
es;
asui
tabl
etar
get
;andasui
tabl
eenv
ironmentort
he
absenceofaguar
dian,
all
coi
nci
dingi
nti
meandspace.

Of
ten,
itmayonl
ybepossi
blet
oini
ti
atest
epsf
orpr
event
ion

af
teranepi
sodeofv
iol
encehasal
readyt
akenpl
ace.

Someoft
her
iskf
act
orsf
orv
iol
entbehav
iourar
e(15):

-Exposur
etov
iol
enceandsoci
etal
accept
abi
l
ityof

v
iol
enceasameanst
osol
vepr
obl
ems.Thei
mageof

v
iol
enceasanaccept
abl
eandef
fect
ivet
ool
forsol
vi
ng

pr
obl
ems,
whet
heracr
ossi
nter
nat
ional
bor
der
s,on

t
hest
reet
,orar
oundt
hehome,
mayspi
l
lov
eri
ntor
eal

behav
iour
;
-Av
ail
abi
l
ityofl
ethal
weaponsl
i
kef
ir
e-ar
ms

si
gni
fi
cant
lyi
ncr
easest
hepossi
bil
i
tyofbot
hfat
aland

non-
fat
ali
njur
ies;

-Consumpt
ionofal
cohol
andot
herdr
ugsi
sli
nkedt
o

al
most2/
3ofcasesofv
iol
enceaccor
dingt
osev
eral

st
udi
es.

Vi
olenceduet
owarandpol
i
tical
unr
esti
sfai
rl
ycommon

i
nsev
eral
count
ri
es.Or
gani
zedandunor
gani
zed,
ethni
cand

communalvi
olencear
ewel l
knowninsomepl
aces.Sui
cideshav
e
beeni
ncr
easi
ngatanal ar
mingrat
ein
SEARcount
ri
es.I
nci
dencer
atesof11perl
acpopul
ati
oni
n

Bangl
adesh,
36perl
acpopul
ati
oni
nIndi
a,8perl
aci
nSr
i

Lanka,
and22perl
aci
nThai
l
and;
pery
earhav
ebeen

r
epor
ted.Near
ly70percentofsui
cidesi
nal
lcount
ri
eshav
e

beenr
epor
tedi
ntheagegr
oupof15-
34y
ear
swi
thmal
e-

f
emal
erat
ioof1:
1.2t
o1:
3fr
om di
ff
erentcount
ri
es.

Poi
soni
ng,
hangi
ng,
sel
f-
immol
ati
onanddr
owni
ngar
ethe

mostcommonl
yrepor
tedmet
hodsofsui
cide(
17)
.

I
nIndi
a,anav
erageof369sui
cidest
akepl
aceev
eryday
,

outoft
hese248ar
ecommi
tt
edbymal
esand121by
f
emal
es(
62ar
ehousewi
ves)
.Fami
l
ypr
obl
ems(
89)and

i
l
lness(
72)ar
ethemai
ncauseofsui
cides.Maj
ori
tycasesar
e

bel
ow29y
ear
sofage(
136)f
oll
owedby30-
44y
ear
sofage

gr
oup(
125}(
10)
.