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Noncommunicable diseases and their risk factors are important for all aspects of outbreak preparedness and response, affecting a range of factors including host susceptibility, pathogen virulence, and health system capacity. This conceptual analysis has 2 objectives. First, we use the Haddon matrix paradigm to formulate a framework for assessing the relevance of noncommunicable diseases to health security efforts throughout all phases of the disaster life cycle: before, during, and after an event. Second, we build upon this framework to identify 6 technical action areas in global health security programs that are opportune integration points for global health security and noncommunicable disease objectives: surveillance, workforce development, laboratory systems, immunization, risk communication, and sustainable financing. We discuss approaches to integration with the goal of maximizing the reach of global health security where infectious disease threats and chronic disease burdens overlap.

The aim of this study is to establish an effective early intervention mechanism for construction engineering to prevent electrocution while improving labor safety and reducing the casualty risk. This study used narrative text analysis and the Haddon Matrix for data collection, and analyzed the causes from the 113 electrocution deaths among in the construction industry, the exhaustive chi-square automatic interaction detector algorithm was employed the segmentation of the correlations. Based on the theory of inventive problem solving, through IDEF0 (ICAM DEFinition) for function modeling was designed the early intervention mechanism. This study revealed the operating features related to electric shock hazards. Early intervention was introduced to reduce the relevant risks and establish safety mechanisms. The first contribution of this study is the determination of hazard correlations between operating features and conductive media, and entry point for the prevention of electrocutions. The second contribution is the suggestion of the establishment of inspection stations for electric tools, thereby ensuring that the portable power tools are safe. The final contribution is the joint application of TRIZ (Teoriya Resheniya Izobreatatelskikh Zadatch) and IDEF0, which establishing the pre-entry testing, strengthening safety mechanisms.

IntroductionInjury is a major public health issue in the USA. In 2017, unintentional injury was the leading cause of death for ages 1 through 44. Unfortunately, there is evidence that the sciences of injury prevention and control may not fully and widely integrated into medical school curriculum. This paper describes a novel injury prevention and control summer programme that was implemented in 2002 and is ongoing.MethodsThe main component of the Series includes at least seven injury-related lectures and discussions designed to provoke students’ interest and understanding of injury as a biopsychosocial disease. These lectures are organised in a seminar fashion and are 2–4 hours in duration. Kirkpatrick’s four-part model guides evaluation specific to our four programme objectives. Trainee satisfaction with the programme, knowledge and outcome (specific to career goals) is evaluated using several mixed-methods tools.ResultsA total of 318 students have participated in the Series. Evaluation findings show an increase in knowledge of injury-related concepts as well as an increase in interest in pursuing injury-related research topics in the future.ImplicationsThe Series is a novel and innovative programme that provides training in injury and injury prevention and control-related topics to medical students, as well as undergraduate, graduate and pharmacy students. We hope that by increasing students’ knowledge and understanding of injury prevention and control we are contributing to a physician workforce that understands the importance of a public health approach to injury prevention, that implements public health principles in practice and that advocates for policies and practices that positively impact injury prevention and control to help make our communities healthier and safer.

Since its 1960s origins, the Haddon matrix has served as a tool to understand and prevent diverse mechanisms of injuries and promote safety. Potential remains for broadened application and innovation of the matrix for disaster preparedness. Hospital functionality and efficiency are particularly important components of community vulnerability in developed and developing nations alike. Given the Haddon matrixʼs user-friendly approach to integrating current engineering concepts, behavioral sciences, and policy dimensions, we seek to apply it in the context of hospital earthquake preparedness and response. The matrixʼs framework lends itself to interdisciplinary planning and collaboration between social and physical sciences, paving the way for a systems-oriented reduction in vulnerabilities. Here, using an associative approach to integrate seemingly disparate social and physical science disciplines yields innovative insights about hospital disaster preparedness for earthquakes. We illustrate detailed examples of pre-event, event, and post-event engineering, behavioral science, and policy factors that hospital planners should evaluate given the complex nature, rapid onset, and broad variation in impact and outcomes of earthquakes. This novel contextual examination of the Haddon matrix can enhance critical infrastructure disaster preparedness across the epidemiologic triad, by integrating essential principles of behavioral sciences, policy, law, and engineering to earthquake preparedness.

Urban rail transit has become one of the indispensable modes of public transportation in large cities. Escalators are ubiquitous in metro stations, as passengers typically use escalators when entering or leaving a metro station. Thus, escalators have become an accident-prone location. To develop suitable prevention strategies, it is necessary to understand the risk factors that affect the severity of escalator accidents. This study analyzed 967 escalator passenger accidents that occurred in the Guangzhou Metro from 2013 to 2015. The Haddon matrix was used to evaluate the interaction of humans, escalators, and environmental factors before, during, and after accidents. Then, the contributing factors associated with the severity levels were determined based on chi-square tests. Passengers aged 66 years and older are more vulnerable to serious injuries (p &lt, 0.001), and previous health conditions are significantly related to the severity of the passenger&rsquo, s injuries (p = 0.002). The weather conditions (rainy days) are also significantly related to the severity of escalator accident injuries (p = 0.039), and injured people with head injuries are at greater risk of being severely injured (p &lt, 0.001). The analysis results of these risk factors can provide theoretical support for the metro operators to develop reasonable and effective preventive measures to reduce the escalator risk.

All-terrain vehicle (ATV) crashes are one of the leading causes of death and injury in agriculture across the United States. Use of ATVs is highly prevalent in rural areas and has seen an increase in their application for a variety of agricultural work tasks. Empirical research on the use of these vehicles for agricultural tasks and associated injuries is limited, especially in the United States. Moreover, little is known about the risk factors associated with ATV-related injuries while doing farm work. A comprehensive review was conducted to evaluate the current injury burden of ATV use in agriculture, the need for future research, and possible solutions related to agricultural ATV safety. Potential injury prevention approaches are evaluated based on the hierarchy of control, including elimination or substitution (using side-by-side vehicles instead of ATVs or modifying ATV design), engineering control (operator protection devices), administrative authority (regulations and standards in the United States and around the world), training, and use of personal protective equipment. In addition, vehicle nomenclature, risk factors, and crash mechanisms are reviewed. Recommendations to decrease the likelihood of ATV crashes and injuries are provided.

Self-driving or highly automated vehicle (HAV) technologies, now undergoing public trials in major cities,1 are positioned to bring about transformative change to the entire transportation system. Far from being a distant innovation, retail autonomous vehicles have already been announced by various manufacturers for release as early as 2018, complementing estimates that on-road HAVs will reach market ubiquity as part of a US$7 trillion passenger economy by 2055.2 Transportation planners and policymakers are welcoming HAVs for their potential to positively impact traffic safety by fundamentally changing the interaction and relationship between drivers and vehicles, and how drivers and vehicles collect and process information from their environment. HAVs will not, however, offer safety in every possible condition. As HAV technology will have limits, manufacturers and lawmakers suggest vehicles have an operational design domain (ODD) which specifies under which conditions an autonomous driving mode can perform safely.3 ODDs may require HAVs to avoid mixed vehicle routes, inclement weather conditions or unmarked roads; in general, ODDs reflect the limits of HAV technologies. In engineering terms, these are known as ‘edge conditions’: situations that go beyond the reliable and accurate capability and limits of HAV technology. The injury prevention community must understand how these edge conditions could lead to crashes in order to formulate crash countermeasures which ultimately inform vehicle development standards and training. The Haddon Matrix, the long-established safety paradigm for injury prevention, has a rich history of helping those focused on transportation safety explicitly separate roles and responsibilities of all drivers, technologies and environmental factors involved in a crash event.4 A new framework and modification of the Haddon Matrix is needed as man–machine–environment interactions will be facilitated by technology and roles in preventing a crash event will be much more shared. While one could argue that the Haddon Matrix was …

Objective: According to the European Union, fatal road accidents involving Vulnerable Road Users (VRUs) are equal in proportion to fatal car road accidents (46%). VRUs include individuals with mobility challenges such as the elderly and Powered Wheelchair (PWC) users. The aim of this interdisciplinary qualitative study was to identify obstacles and risks for PWC users by exploring their behaviour and experiences in traffic environments. Methods: Videos and in-depth interviews with 13 PWC users aged 20–66 were analysed for this study. The interviews and videos, which include real-life outdoor observations, originate from a qualitative study exploring experiences of PWC use on a daily basis in Sweden. Underlying causal factors to identified risks and obstacles were identified, based on human, vehicle (PWC) and environmental factors in accordance with the Haddon Matrix. Results: The results show significant potential for improvement within all three perspectives of the Haddon Matrix used in the analysis. Participants faced and dealt with various obstacles and risks in order to reach their destination. For example, this includes uneven surfaces, differences in ground levels, steep slopes, as well as interactions with other road users and the influence of weather conditions, resulting in PWC users constantly accommodating and coping with the shortcomings of the vehicle and the environment. Conclusions: There are still major challenges with regard to preventing obstacles and risks in the traffic environment for PWC users. To discern PWC users in traffic accident and injury data bases, a start would be to register type of aid used for persons involved in an accident. Furthermore, to emphasise PWC users’ role as VRUs, it may also be advantageous to describe them as drivers rather than users when navigating the traffic environment. Given the limited sample, further research covering more data from a broader perspective would be beneficial. By incorporating emerging knowledge of PWC users’ prerequisites and needs, and including them in research and traffic planning, the society will grow safer and more inclusive, and become better prepared for meeting future demands on accessibility from an aging population.

Objectives: The aim of this paper is to present the Child Safety Reference Frameworks (CSRF), a policy advice tool that places evidence-based child safety interventions, applicable at the sub-national level, into a framework resembling the Haddon Matrix. Method: The CSRF is based on work done in previous EU funded projects, which we have adapted to the field of child safety. The CSRF were populated following a literature review.Results: Four CSRF were developed for four domains of child safety: road, water and home safety, and intentional injury prevention.Conclusion: The CSRF can be used as a reference, assessment and comparative tool by child safety practitioners and policy makers working at the sub-national level.

Introduction BASE (buildings, antennae, span, earth) jumping involves jumping from fixed objects with a parachute. This practice is associated with fatal events. Despite considerable evolution in BASE jump practice over the past years, fatalities have increased. Identifying the main causes of fatal events and recommending processes to reduce fatalities is vital for safe BASE jumping practice. Methods In an effort to capture worldwide cases between 2007 and 2017, we identified and classified on a Haddon matrix each fatal event from the BASE jumping fatality list. Although not devoid of limitations, this is the most comprehensive list of BASE jumping fatal events and the main source of information on BASE-related fatalities for BASE jump participants. Results The report noted 223 fatalities, 197 of them being cliff jumps. In addition, 137 fatal jumps were wingsuit jumps. Impact and object strike were the main cause of fatal event (96%). Human factors leading to fatality were mostly low pull/no pull (64%) and bad exits (15%). Equipment factors included off-heading openings, twists, and pilot chute entanglement. Environmental factors included strong wind, poor visibility, and water. Conclusions BASE jump practice has undergone radical transformations in the last 10 y, especially linked to the mountain environment and the use of wingsuits. These factors were linked to most fatal events. Key recommendations are basic practical measures, such as ground preparation and equipment checks, and deep technical and personal knowledge that involves regular engagement and significant introspection.

Automated driving systems (ADS) have the potential for improving safety but also pose the risk of extending the transportation system beyond its edge conditions, beyond the operating conditions (operational design domain (ODD)) under which a given ADS or feature thereof is specifically designed to function. The ODD itself is a function of the known bounds and the unknown bounds of operation. The known bounds are those defined by vehicle designers; the unknown bounds arise based on a person operating the system outside the assumptions on which the vehicle was built. The process of identifying and mitigating risk of possible failures at the edge conditions is a cornerstone of systems safety engineering (SSE); however, SSE practitioners may not always account for the assumptions on which their risk mitigation resolutions are based. This is a particularly critical issue with the algorithms developed for highly automated vehicles (HAVs). The injury prevention community, engineers and designers must recognise that automation has introduced a fundamental shift in transportation safety and requires a new paradigm for transportation epidemiology and safety science that incorporates what edge conditions exist and how they may incite failure. Towards providing a foundational organising framework for the injury prevention community to engage with HAV development, we propose a blending of two classic safety models: the Swiss Cheese Model, which is focused on safety layers and redundancy, and the Haddon Matrix, which identifies actors and their responsibilities before, during and after an event.

The recruitment and retention of health professionals in rural Australia is well documented. The COVID-19 pandemic has further exposed the precariousness of human healthcare resources within small rural communities. The external disaster of the COVID-19 outbreak described in this case analysis exacerbated the frail balance of sustaining adequate staffing levels and skill mix, which exposed behaviours of presenteeism within rural healthcare teams. An analysis of the complex of factors that led to the first nosocomial outbreak of COVID-19 within a healthcare environment in Australia demonstrates how rural healthcare environments are ill-equipped to meet the demands of unexpected external disasters. Using the Haddon Matrix to examine the factors that led to this outbreak provides us with the opportunity to learn from the case analysis. Health professional presenteeism contributed to the North West Tasmania COVID-19 outbreak and affected the hospital and health service provision within the region. Recommendations to mitigate risk for future disaster planning in rural healthcare environments include improved infection control strategies and a whole-community approach.

ObjectiveTo (i) identify person, vehicle and environmental risk factors for injury among children using motorcycles, and (ii) identify and appraise studies of interventions designed to reduce the occurrence or severity of injury among children using these vehicles.MethodA systematic approach was used to collate data from published and grey literature globally on risk factors for motorcycles injury, and studies reporting evaluation of interventions to counter this injury. Academic data sets and public search engines (including Google and Yahoo!) were used. Websites of major conferences, organisations and networks were also searched. Finally, researchers and units working in this area were also contacted by email or phone seeking relevant research. All study types were eligible, excluding clinical case studies. The Haddon Matrix was used as a framework for synthesising the data.ResultsThe review revealed that robust investigations of risk factors for injury among children using motorcycles are relatively scarce, and there are few interventional studies reporting effectiveness of countermeasures to this problem. Epidemiological literature is generally limited to discussion of human factors, and less attention has been given to vehicle and environmental factors. Furthermore, much of the literature is commentaries and descriptive studies. There has been little rigorous study of risk factors unique to children riding motorcycles.ConclusionsThis first attempt at extensively reviewing literature related to risk factors and interventions for children and motorcycles using the Haddon Matrix as a framework clearly highlights need for more rigorous study as information is lacking in all cells of this matrix.

Accident Analysis & Prevention (AA&P) is a leading academic journal established in 1969 that serves as an important scientific communication platform for road safety studies. To celebrate its 50th anniversary of publishing outstanding and insightful studies, a multi-dimensional statistical and visualized analysis of the AA&P publications between 1969 and 2018 was performed using the Web of Science (WoS) Core Collection database, bibliometrics and mapping-knowledge-domain (MKD) analytical methods, and scientometric tools. It was shown that the annual number of AA&P's publications has grown exponentially and that over the course of its development, AA&P has been a leader in the field of road safety, both in terms of innovation and dissemination. By determining its key source countries and organizations, core authors, highly co-cited published documents, and high burst-strength publications, we showed that AA&P's areas of focus include the "effects of hazard and risk perception on driving behavior", "crash frequency modeling analysis", "intentional driving violations and aberrant driving behavior", "epidemiology, assessment and prevention of road traffic injuries", and "crash-injury severity modeling analysis". Furthermore, the key burst papers that have played an important role in advancing research and guiding AA&P in new directions - particularly those in the fields of crash frequency and crash-injury severity modeling analyses were identified. Finally, a modified Haddon matrix in the era of intelligent, connected and autonomous transportation systems is proposed to provide new insights into the emerging generation of road safety studies.

Background Each year, over 15,000 preschoolers die from unintentional injuries in China. Many interventions proven to work in other nations have not been implemented nationwide in China. The rapid popularity of smartphones offers an opportunity to overcome this limitation and disseminate evidence-based interventions to the large population of China. This study aims to assess the effectiveness of an app-based intervention for caregivers of preschoolers to prevent unintentional injury among young Chinese children. Method A single-blinded, 6-month, parallel-group cluster randomized controlled trial with 1:1 allocation ratio will be conducted in Changsha, China. In total, 2626 caregivers of preschoolers ages 3–6 years old who own a smartphone will be recruited from 20 preschools. Clusters will be randomized at the preschool level and allocated to either the control group (routine education plus app-based parenting education excluding unintentional injury prevention) or the intervention group (routine education plus app-based parenting education including unintentional injury prevention). The app-based injury prevention program was developed based on the Theory of Planned Behavior, the Haddon Matrix, the Mobile Learning framework, and a needs assessment. Data collection will be conducted at baseline, 3-month, and 6-month follow-up via app-based survey plus printed questionnaire survey. The primary outcome measure is unintentional injury incidence among preschoolers in the past 3 months. Secondary outcome measures include economic losses due to unintentional injury in the past 3 months, the Incremental Cost-Effectiveness Ratios (ICERs), and parent’s attitudes and behaviors concerning supervision to prevent preschooler unintentional injury in the past week. An intention-to-treat approach will be used to evaluate outcome measures. Chi-square tests will examine differences for outcome measures between groups at each time point and generalized estimation equations (GEE) will test the overall effectiveness of the app-based intervention. Missing outcome data will be imputed using the Expectation Maximization algorithm (EM). Discussion This trial will examine evidence concerning the effectiveness of an innovative app-based intervention for caregivers of Chinese preschoolers. If effective, the app-based intervention could offer an effective population-based intervention option to cost-effectively promote unintentional injury prevention in countries and regions where injury control is under-supported. Trial registration ChiCTR-IOR-17010438. Registered 15 January 2017. Electronic supplementary material The online version of this article (10.1186/s12889-018-5790-1) contains supplementary material, which is available to authorized users.

BackgroundIn the decades since the landmark report-America Burning-was published in 1973, the number of home fire deaths has shrunk from >5500 per year to 2650 in 2015. This paper: (1) describes how science and practice in injury prevention and fire and life safety contributed to successful interventions, and (2) identifies emerging strategies and future opportunities to prevent home fire-related deaths.MethodsThe aims are addressed through the lens of population health research, with a focus on the work of selected Centers for Disease Control and Prevention-funded Injury Control Research Centers. Results are organised using the Haddon Matrix and an ecological model.ResultsWe found evidence to support interventions that address all components of both the matrix and the model, including: reduced ignition propensity cigarettes, stop smoking campaigns, housing codes, residential sprinkler systems, smoke alarms, community risk reduction, school-based educational programmes, and fire and burn response systems. Future reductions are likely to come from enhancing residential sprinkler and smoke alarm technology, and increasing their utilisation; expanding the use of community risk reduction methods; and implementing new technological solutions. Despite the successes, substantial disparities in home fire death rates remain, reflecting underlying social determinants of health.ConclusionMost of the evidence-supported interventions were focused on changing the policy and community environments to prevent home fires and reduce injury when a fire occurs. Future prevention efforts should give high priority to addressing the continued disparities in home fire deaths.

ObjectiveUnderground mining is associated with obvious risks that can lead to mass casualty incidents. Information about such incidents was analyzed in an integrated literature review.MethodsA literature search (1980-2015) identified 564 modern-era underground mining reports from countries sharing similar occupational health legislation. These reports were condensed to 31 reports after consideration of quality grading and appropriateness to the aim. The Haddon matrix was used for structure, separating human factors from technical and environmental details, and timing.ResultsMost of the reports were descriptive regarding injury-creating technical and environmental factors. The influence of rock characteristics was an important pre-event environmental factor. The organic nature of coal adds risks not shared in hard-rock mines. A sequence of mechanisms is commonly described, often initiated by a human factor in interaction with technology and step-wise escalation to involve environmental circumstances. Socioeconomic factors introduce heterogeneity. In the Haddon matrix, emergency medical services are mainly a post-event environmental issue, which were not well described in the available literature. The US Quecreek Coal Mine incident of 2002 stands out as a well-planned rescue mission.ConclusionEvaluation of the preparedness to handle underground mining incidents deserves further scientific attention. Preparedness must include the medical aspects of rescue operations. (Disaster Med Public Health Preparedness. 2018;12:138–146)

Driver, vehicle, public road, and farm enterprise characteristics were examined for their combined association with farm vehicle public road crash group membership. North Carolina farms experiencing a public road crash from 1992 to 2003 (n = 200) were compared with a non-crash control group (n = 185) for a 1:1 case:control ratio. Five characteristics were associated with increased odds of crash group membership in the combined model (likelihood ratio = 175.95; d.f. = 15; p < .001): use of non-English speaking drivers (OR = 3.71); use of non-family hired help drivers (OR = 4.25); types of non-farm vehicle public road use (OR = 1.39); farm injury history (OR = 1.33); and, use of younger farm vehicle drivers (OR = 1.02). Farms reporting older farm vehicle drivers (OR = 0.97), and low farm income (OR = 0.29) were less likely crash group members. Recommendations are discussed for incorporating findings into farm vehicle crash prevention research and interventions.

Aims: Adopting effective injury prevention practices continues to be problematic within snowboarding and the participation of older individuals is associated with an appreciable injury burden. The Haddon Matrix provides an important framework for developing injury prevention interventions. Since prevention behaviour must `fit' within individual aspirations, our study investigated the meanings and behaviours associated with snowboarding and injury prevention and then applied the findings to the established Haddon Matrix approach. Methods: Nine, older adult recreational participants living in south-west England each contributed two interviews. These progressively focused on experiences and reflections. Verbatim transcripts were analysed and interpreted using the hermeneutic phenomenological themes of time, space, body and human relations. A further wave of analysis reinterpreted the findings in relation to the Haddon Matrix. Findings: Snowboarding was conducted within a holiday when participants were seeking happiness by positively re-evaluating their lives. In a frame of connection-and-disconnection , beginners ( time) were concerned with being- on the slopes ( body and space), while more experienced ( body and time) participants blended this with being-in the mountains ( space). Snowboarding is a bumps-and-bruises activity and this guided the limited prevention practices. Importantly, all prevention practices were time- limited, due to a concern for learning-by-doing within a holiday. At home, more experienced boarders paid careful attention to fitness, whereas in the resorts they actively selected the soft, off-piste areas and wore protective clothing to cushion their inevitable falls. Group experiences were associated with heightened injury risks. Being seen and judged by others helped to determine the quality of the snowboarding experience. Treatment was avoided for all but the most severe injuries. Conclusion: The findings confirm the exploratory value of mixing van Manen's four-dimensional approach with Haddon's well-established injury prevention framework. The diverse subjective meanings associated with snowboarding limit the potential for prevention approaches and suggest that resort-based `injury control' may be more appropriate for addressing the spectrum of prevention in older snowboarders.

William Haddon Jr developed his conceptual model, the Haddon matrix, more than two decades ago applying basic principles of public health to the problem of traffic safety.1 ,2 Since that time, the matrix has been used as a tool to assist in developing ideas for preventing injuries of many types. As such, it provides a compelling framework for understanding the origins of injury problems and for identifying multiple countermeasures to address those problems. However, users then must decide for themselves among the alternatives. This paper adds a third dimension to the matrix to facilitate its use for making decisions about which countermeasures to apply. The matrix of four columns and three rows combines public health concepts of host-agent-environment as targets of change with the concepts of primary, secondary, and tertiary prevention.3 ,4 More specifically, the factors defined by the columns in the matrix refer to the interacting factors that contribute to the injury process (see tables 1 and 2). The host column refers to the person at risk of injury. The agent of injury is energy (for example mechanical, thermal, electrical) that is transmitted to the host through a vehicle (inanimate object) or vector (person or other animal). Physical environments include all the characteristics of the setting in which the injury event takes place (for example a roadway, building, playground, or sports arena). Social and legal norms and practices in the culture are referred to as the social environment. Examples include norms about child discipline or alcohol consumption or policies about licensing drivers or sales of firearms. View this table: Table 1 Haddon matrix applied to the problem of residential fires caused by cigarettes igniting upholstered furniture View this table: Table 2 Haddon matrix applied to the problem of school violence by firearms The phases in Haddon's initial configuration referred to rows in the matrix. These …

State and local health departments continue to face unprecedented challenges in preparing for, recognizing, and responding to threats to the public's health. The attacks of 11 September 2001 and the ensuing anthrax mailings of 2001 highlighted the public health readiness and response hurdles posed by intentionally caused injury and illness. At the same time, recent natural disasters have highlighted the need for comparable public health readiness and response capabilities. Public health readiness and response activities can be conceptualized similarly for intentional attacks, natural disasters, and human-caused accidents. Consistent with this view, the federal government has adopted the all-hazards response model as its fundamental paradigm. Adoption of this paradigm provides powerful improvements in efficiency and efficacy, because it reduces the need to create a complex family of situation-specific preparedness and response activities. However, in practice, public health preparedness requires additional models and tools to provide a framework to better understand and prioritize emergency readiness and response needs, as well as to facilitate solutions; this is particularly true at the local health department level. Here, we propose to extend the use of the Haddon matrix--a conceptual model used for more than two decades in injury prevention and response strategies--for this purpose.

Objective: The aim of the study was to use the Haddon matrix to analyse crash and injury mechanisms in a severe coach crash, to investigate if a safety belt would have reduced injuries, and highlig...

This study surveyed the knowledge, attitude, and behavior regarding radiation safety of radiation managers and workers in fields of research and education in South Korea.

Most people who have worked within or studied injury prevention have been introduced to the Haddon matrix,1 ,2 a tool to assist in understanding injury problems and identifying possible countermeasures. Potential targets of change are captured within the public health triangle (host–agent (social and physical)–environment) across three event phases referring to primary, secondary and tertiary prevention. Each matrix cell allows identification of possible interventions that would effect change, thus providing a structured way to identify potential prevention strategies. In 1998, Carol Runyan published the seminal paper “Using the Haddon matrix: introducing the third dimension” that expanded on the matrix and its utility by adding a decision-making dimension based on principles of policy analysis.3 This paper made an important contribution to the injury prevention field as it provided straightforward and useful guidance on how to apply and use an already familiar tool to better support evidence-based decision-making. Given the current challenges decision makers face in translating research into action, this framework remains relevant today. Carol Runyan was introduced to the Haddon matrix in 1980 while working on her PhD at the University of North Carolina during an injury course led by Susan Baker, Leon Robertson and William Haddon as part of the Epidemiology Summer Session at the University of Minnesota. She was immediately struck by the elegant simplicity of the matrix as a tool to …

Phenomena of trauma to be dealt with scientifically must be based not on descriptive categorizations, but on etiologic ones. How this is happening and what it means are discussed in this paper. Approaches to the phenomena of trauma, which are of interest here, are rapidly becoming more rational and scientific. None the less, the field still includes the only substantial, remaining categories of human morbidity and mortality still viewed by most laymen and professionals alike in essentially prescientific terms. The traditional wisdom perpetuates terms and concepts formerly applied to much of human experience. “Luck”, “chance”, “accident”, and other extrarational notions still survive from the times when scientific explanations for plagues, earthquakes, “natural disasters”, and other terrifying phenomena scourged a mankind that had no rational understanding, either of their sources or of the means for dealing with them. Unfortunately, because of their automatic subscription to the traditional, prescientific wisdom of the field, many professionals—physicians, behavioral scientists, and others—in coming to this field for the first time, still merely translate the traditional wisdom and its terms into their own scientific framework and jargon. Building on the result, they assume they have contributed something. This, however, is likely to occur decreasingly because of the accelerating transition in concepts and research now taking place. What then, is the essence of this transition? Very broadly and importantly, it is part of the increasing awareness of the relationships between man and his environment, of human ecology, especially of man's relationships with certain potentially or actually hazardous physical and chemical attributes of his environment. At the beginning of the nineteenth century, man was equally ignorant of both the physical and chemical hazards of his environment, on the one hand, and of the biological hazards on the other. In the 150 years that followed, he moved disproportionately rapidly …

Background In 2013 the London Mayor committed to increasing cycling levels by 400% (from 2001) by 2026. Although the numbers of deaths per year are relatively low cycling in London has become highly politicised with significant media focus on every cycle death in the capital. This study was commissioned by Transport for London to explore contributory factors to cyclist deaths and implications for interventions. Methods This study involved an in-depth case review of 53 pedal cycle fatalities in London between 2007–2011. Police fatal reports were used in the analysis. The method involved application of a Haddon matrix approach to data analysis and a case by case review by a multidisciplinary team to explore the multifactorial nature of contributory factors from a safe systems perspective. Results Over half the crashes involved a truck (>3.5 tonnes) as the primary collision partner, most happened during daylight and the commute period, on low speed (30 mph) urban roads and at a junction, particularly at a complex junction. A notable finding was the involvement of trucks in fatalities, particularly for female cyclists, where the truck was turning left. For these crashes contributory factors were identified as poor visibility of the cyclist to the truck driver related to cab design and lack of mirrors, poor positioning by the cyclist and infrastructure issues such as lane narrowing creating a conflict point between cyclist and trucks. Conclusions Potential countermeasures to mitigate risks for cyclists include the design of trucks to create greater visibility of vulnerable road users, training of both drivers and cyclists to raise awareness of visibility and designing infrastructure and managing traffic to reduce the opportunities of conflicts arising in the first place. Few well designed intervention studies were identified. The overrepresentation of female cyclists in collisions with left turning trucks is an issue that warrants further investigation.

Reducing and preventing road traffic injuries (RTIs) is a challenge faced by all nations [1]. The manuscript by Naghavi et al. highlights the huge burden of injuries in Iranian children [2], most of which are the result of road traffic injuries. The manuscript revealed a rising death rate from injuries among children from 1971 to 2005. The authors' previous work has documented the fact that Iran has the highest RTI death rate of any country where such data are available [3,4]. The authors described and documented the main reasons for the rapid increase in RTIs. It is not a surprise that Iran's subsidized gas, which is 10 times cheaper than its production cost, and the rapid increase in vehicle production (more than 1 million cars and 1.5 million motorcycles produced every year since 2002) are important contributing factors in Iran's RTI burden [4]. Indeed, when it comes to RTIs, Iran is experiencing one of the downsides of joining the club of countries with rapid economic growth over the past three decades. The manuscript has some limitations. The comparison to previous years is weakened by the limited amount of historical data. Only data on the capital Tehran were available in 1971. In addition, improvements in the quality of data throughout the study period make the data difficult to compare to previous years. The most important limitation is the completeness of the data and whether the increases in RTI rates are due to better statistics about RTIs rather than true rates of increase. As much as the latter is true, it still does not explain all the increases in RTIs in Iran. However, the results of the study and the previous work of the authors provide a clear picture of RTIs in Iran today and their increasing burden. In general, the study shows the importance of the data systems that capture the burden of injuries in Iran and suggests such systems could be a model for other countries with similar economic growth. Strategies to prevent traffic injuries have been discussed and promoted in many publications [1,5]. These measures include designing safer cars and roads and enforcement of speed and weight limits. In addition, enforcing occupant protection through child safety seats, seat belts, and helmet use, to name a few, is essential. Unfortunately, Iran has a long way to go to reach these objectives. Iran is a country with deep cultural roots; however, it is a late bloomer when it comes to modern mechanization. Iran's rapid increase in motor vehicle use may have started in the 1950s, with its first automobile production occurring in the late 1960s. Car production started its peak in 2002 [4]. This would place Iran about 80 years behind the US and much of Europe in motor vehicle use. What Iran is facing now is similar in many ways to what the US once faced. At the beginning of the century, motor travel in the US was a novelty, with an estimated 8,000 automobiles on the road. By 2000, more than 226 million vehicles were registered [6]. As the number of vehicles and drivers in the US increased, so did deaths and injuries - from 1.0 motor-vehicle deaths per 100,000 to 26.7 per 100,000 in 1930 [6]. For the most part, these rates remained very high until 1970 (27.7 per 100,000), except for a brief decline during World War II due to lack of fuel availability [6]. After 1970, rates began to decline. It took the US about 70 years to curb the burden of RTIs. Iran and other countries should not follow this model. The victories of motor vehicle safety in the US are well-documented [7]. Substantial gains in driver education, vehicle safety, and road design were implemented through legislation and public awareness campaigns. Above all, these victories were due to the work of public safety champions. President Herbert Hoover convened the first National Conference on Street and Highway Safety in 1924. President Franklin D. Roosevelt convened an Accident Prevention Conference on vehicle safety in 1936 and called for lower speeds, better lighting, and stronger auto frames. President Lyndon B. Johnson signed the National Traffic and Motor Safety Act and the Highway Safety Act in 1966. Lawyer and activist Ralph Nader led a consumer movement for vehicle safety in the 1960s. His work inspired hundreds of activists who joined together to help with his work (they came to be known as "Nader's raiders"). William Haddon, a public health physician and epidemiologist who became the first director of the National Highway Safety Bureau, revolutionized the scientific approach to preventing motor-vehicle injuries by developing the Haddon Matrix [8]. His work recognized that injuries are like infectious diseases, a result of the interaction between a host (person), an agent (motor vehicle), and the environment (road). The US success story was built upon the hard work of champions who pushed to reduce RTIs and to improve motor-vehicle safety. As in many success stories, many components must come together to achieve the goal of safer roads. However, the essential ingredient is the dedication and vision of the champions who make motor-vehicle safety their cause. Iran is in dire need of champions such as those who have driven road safety improvements in the US. Their contributions will no doubt expedite the time it takes to achieve a success story similar to what the US has experienced. It is time for champions of RTI prevention and control and motor-vehicle safety to step forward in Iran. The manuscript by Naghavi et al. makes a strong case for Iran to follow the US's path, but at much faster pace.

ResumenIntroducciónÚnicamente se deberían implementar las intervenciones de seguridad vial con evidencia científica de su efectividad. El objetivo de este trabajo consiste en resumir la evidencia disponible sobre la efectividad de las intervenciones de seguridad vial para reducir las colisiones, las lesiones y las muertes de tráfico.MetodologíaSe incluyeron todas aquellas revisiones de la literatura publicadas en una revista científica que evaluaran la efectividad de una o más intervenciones de seguridad vial, y cuyas medidas de resultado fueran colisiones, lesiones o muertes de tráfico. Se llevó a cabo una búsqueda exhaustiva en bases de datos de la literatura científica. Las intervenciones se clasificaron según su evidencia de efectividad para reducir las lesiones de tráfico (intervenciones efectivas, insuficiente evidencia de efectividad, intervenciones no efectivas) siguiendo la estructura de la matriz de Haddon.ResultadosSe incluyeron 54 revisiones. Se hallaron intervenciones efectivas antes, durante y después de la colisión, y para todos los factores: a) el individuo: el permiso de conducir gradual (reducción del 31% de las lesiones de tráfico); b) el vehículo: control electrónico de estabilidad (2 a 41%); c) las infraestructuras: pacificación del tráfico (0 a 20%), y d) el entorno social: radares (7 a 30%). Algunas intervenciones no son efectivas, en especial la educación vial, y otras requieren mayor investigación.ConclusiónLas intervenciones más efectivas son aquellas que reducen o eliminan el riesgo y que no dependen del cambio de comportamiento de los usuarios ni de sus conocimientos sobre seguridad vial. Aquellas intervenciones basadas exclusivamente en la educación no son efectivas para reducir las lesiones de tráfico.AbstractIntroductionOnly road safety interventions with scientific evidence supporting their effectiveness should be implemented. The objective of this study was to identify and summarize the available evidence on the effectiveness of road safety interventions in reducing road traffic collisions, injuries and deaths.MethodologyAll literature reviews published in scientific journals that assessed the effectiveness of one or more road safety interventions and whose outcome measure was road traffic crashes, injuries or fatalities were included. An exhaustive search was performed in scientific literature databases. The interventions were classified according to the evidence of their effectiveness in reducing road traffic injuries (effective interventions, insufficient evidence of effectiveness, ineffective interventions) following the structure of the Haddon matrix.ResultsFifty-four reviews were included. Effective interventions were found before, during and after the collision, and across all factors: a) the individual: the graduated licensing system (31% road traffic injury reduction); b) the vehicle: electronic stability control system (2 to 41% reduction); c) the infrastructure: area-wide traffic calming (0 to 20%), and d) the social environment: speed cameras (7 to 30%). Certain road safety interventions are ineffective, mostly road safety education, and others require further investigation.ConclusionThe most successful interventions are those that reduce or eliminate the hazard and do not depend on changes in road users’ behavior or on their knowledge of road safety issues. Interventions based exclusively on education are ineffective in reducing road traffic injuries.

The Haddon matrix is a potential tool for recognizing hazards in any operating engineering system. This paper presents a case study of operational hazards at a large construction site. The fish bone structure helps to visualize and relate the chain of events, which led to the failure of the system. The two-tier Haddon matrix approach helps to analyze the problem and subsequently prescribes preventive steps. The cybernetic approach has been undertaken to establish the relationship among event variables and to identify the ones with most potential. Those event variables in this case study, based on the cybernetic concepts like control responsiveness and controllability salience, are (a) uncontrolled swing of sheet contributing to energy, (b) slippage of sheet from anchor, (c) restricted longitudinal and transverse swing or rotation about the suspension, (d) guilt or uncertainty of the crane driver, (e) safe working practices and environment.

Despite pesticide self‐poisoning causing around 300 000 deaths each year in the rural Asia Pacific region, no comprehensive public health response has yet been formulated. The authors have developed a Haddon matrix to identify factors that increase the risk of fatal rather than non‐fatal pesticide self‐poisoning in Sri Lanka. Many important host factors such as age, gender, and genetics are not alterable; factors that could be changed—alcohol use and mental health—have previously proved difficult to change. Interventions affecting agent or environmental factors may be easier to implement and more effective, in particular those limiting the human toxicity and accessibility of the pesticides, and the quality, affordability, and accessibility of health care in the community. Controlled studies are required to identify effective strategies for prevention and harm minimization and to garner political support for making the changes necessary to reduce this waste of life. Lessons learnt from Sri Lanka are likely to be highly relevant for much of rural Asia.

Accident investigations influence public perceptions and safety management strategies by determining the amount and type of information learned about the accident. To examine the factors considered in investigations, this study used a content analysis of 100 consecutive media reports of amusement ride accidents from an online media archive. Fatalities were overrepresented in the media dataset compared with U.S. national estimates. For analysis of reports, a modified “Haddon matrix” was developed using human-factors categories. This approach was useful to show differences between the proportions and types of factors considered in the different accident stages and between employee and rider accidents. Employee injury accounts primarily referred to the employee's task and to the employee. Rider injury reports were primarily related to the ride device itself and rarely referred to the rider's “task”, social influences, or the rider's own actions, and only some reference to their characteristics. Qualitatively, it was evident that more human factors analysis is required to augment scant pre-failure information about the task, social environment, and the person, to make that information available for prevention of amusement ride accidents. By design, this study reflected information reported by the media. Future work will use the same techniques with official reports.

Objective: The purpose of this study was to assess the range of information relevant to bicyclist injury research that is available on routinely completed emergency department medical records. Methods: A retrospective chart review of emergency department medical records was conducted on children who were injured as bicyclists and treated at an urban level I pediatric trauma center. A range of variables relevant to bicyclist injury research and prevention was developed and organized according to the Haddon matrix. Routinely completed free text emergency department medical records were assessed for the presence of each of the targeted elements. In addition, medical records of seriously injured patients (for whom a more structured medical record is routinely used) were compared to free form records of less seriously injured patients to identify differences in documentation that may be related to the structure of the medical record. Results: Information related to previous medical history (96% of records), diagnosis (89%), documentation of pre-hospital care (82%), and child traumatic contact points (81%) were documented in the majority of medical records. Information relevant to prevention efforts was less commonly documented: identification of motor vehicle/object involved in crash (58%), the precipitating event (24%), the location of the crash (23%), and documentation of helmet use (23%). Records of seriously injured patients demonstrated significantly higher documentation rates for pre-hospital care and child traumatic contact points, and significantly lower documentation rates for previous medical history, child kinematics, main body parts impacted, and location of injury event. Conclusions: Routinely completed free text emergency department medical records contain limited information that could be used by injury researchers in effective surveillance. In particular information relating to the circumstances of the crash event that might be used to design or target prevention efforts is typically lacking. Routine use of more structured medical records has the potential to improve documentation of key information.

Many host factors that have been defined as “unalterable” from the biological or clinical point of view might actually be “alterable” from a sociological or cultural point of view The Haddon matrix has been used both to conceptualize etiologic factors for injury and to identify potential preventive strategies.1,2 In this issue, the matrix has been used by Eddleston et al to identify strategies to prevent death after pesticide self-poisoning (see page 333) .3 I certainly agree with the authors of this paper that intentional pesticide self-harm is an important but neglected public health problem, not only because of its size but also because of its preventability. I do not, however, entirely agree with some of the depictions of host factors in their matrix. In this editorial, I want to illustrate how, compared with traditional epidemiologists, social epidemiologists might have different depictions of the same host factor or identify different host factors. I argue that many of the so-called “unalterable” host factors can be viewed as “alterable”, depending on how the theoretical conceptual framework is used. These differences have great implications for injury prevention. Any host factor defined as “unalterable” or “not modifiable” will never be a candidate in the agenda of prevention strategies. Eddleston et al appear to be pessimistic about the primary prevention of self-poisoning using pesticides. They suggest that strategies to prevent deaths by restricting access to toxic pesticides may be effective but that there are considerable economic and regulatory barriers to their implementation. They repeatedly state that the substantial delay after the act of self-harm offers several opportunities to minimize damage. Accordingly, they invest most attention on event and post-event phases of prevention. Taiwan, a newly industrializing country, also experienced many unnecessary pesticide poisoning …

Background From 2009 to 2010, drowning prevention interventions were implemented in two pilot sites in the cities of Dagupan and Lingayen. With the support of the local leadership, these initiatives proved to be worthwhile endeavours in support of the Child Injury Prevention Programme of the Department of Health (DOH), Philippines. With the successful implementation of interventions in the pilot sites, the DOH embarked on an expansion project to another community in the City of Dagupan. It is hoped that this will contribute to the decrease in the incidents of drowning in the expansion site. Objective To develop and implement evidence-based interventions for drowning prevention in the community. Methods Qualitative data collection techniques such as Key Informant Interviews, Focus Group Discussions, Review of Records, and Community Walk-throughs were used. Results Using the Haddon Matrix, findings revealed several factors that may have led to incidents of drowning in the community. Results were presented to the village members and priority interventions were implemented from September to December 2011. Village Drowning Prevention Committee was formed, capability-building activities were done, barriers were constructed and open dug wells were reconstructed and covered. It is hoped that these interventions will address drowning incidents in the community. Significance/Contribution to the Field Different community drowning prevention strategies were implemented such as formation of drowning prevention committee, barriers (door, house, backyard), training programmes, reconstruction and covering of wells.

(1994). Using the Haddon Matrix in Injury Prevention Education. Journal of Health Education: Vol. 25, No. 2, pp. 112-113.

The prevailing opinion in the public health community is that the use of the word"accident" is detrimental to the efforts to describe, understand, analyze, and prevent the complex person-environmental interactions that lead to bodily injury. This is due to the connotations of faith, chance, and unpredictability associated with the word "accident", and even more so with the adjective, accidental. As a result, the public health, pediatric, and medical literature over the past decade has increasingly replaced the word accident with the term"injury", which is neutral with respect to causation, intentionality, and predictability. While this shift may have contributed to the increased scientific interest in the phenomenon, it is left substantial conceptual and linguist of problems in its wake. Put quite simply, an injury is not an accident. To paraphrase Haddon, an injury results from the transmission of energy from the environment to the human body when the quantity or nature of the energy is sufficient to cause damage to tissues. If the transmission of energy occurs over a relatively brief time, as in, for example, a fall from a height or a motor vehicle collision, it can be considered a discrete event that can be easily distinguished from the resulting injury or injuries. The major conceptual model used to assess etiology and identify targets for countermeasures, the Haddon Matrix, clearly distinguishes between the human-environmental event and resulting injury. Haddon dropped the term accident in his later work; however, he insisted on addressing the person environmental interchange in its full complexity, with the practical aim of identifying the phases of the process most amenable to intervention. Just as the single word, accident, did not adequately convey the complexity of the phenomenon, and in fact added a misleading etiologic assumption, the word injury only represents the outcome of a process in which an event, previously referred to as an accident, plays a central part. Banishment of the word accident from the injury researcher's lexicon has resulted in some practical difficulties, in addition to the conceptual problem of conflating the event and the outcome. When referring to multiple injuries that occur from a single human-environmental interaction, some term needs to be substituted for the old "A" word. When referring to events with injury producing potential that do not result in injury, some other term is needed. When referring to prevention of the events that lead to injury, we can list specific types of events(For example, a motor vehicle crashes, fires, poisonings, salts), but we have no time that encompasses them all. In seeking a solution to the loss of the a word we need to distinguish between scholarly usage and popular usage. The word accident is deeply ingrained in the public mind and its use has remained untouched by the academic substitution of the word injury. Much as injury researchers may emphasize the continuing between intentional and unintentional injuries, the media and the public clearly make a distinction between injuries for home no one is held directly responsible our accidents, and the intentionally inflicted injuries. And, While decades of research have made it clear that there are seasonal, geographic, academic, and demographic very nations in the occurrence of the events leading to injuries, these events are still perceived as largely random. The us, those who worked at the interface of academia and the public are likely to need to continue using the word accident, while hammering home the point that they are also put that a ball and predictable. For the academic community, it would be advantageous to adopt a common term for the events that resulting injury, or have the potential friend treat. Given caught occasions of the word accident, the animosity to it over the past 10 to 20 years, and the inclusion of clearly intentional injuries the public health field of injury control, it is inadvisable to resurrect the term. One solution would be to use one of the multi word phrases that describe the phenomenon "energy exchange". Acronyms, such as IPE (injury producing event) and PIPE (potentially injury producing event) may serve the purpose. Although new terms are inherently unfamiliar and awkward, they have been successfully adopted in other fields (for example, CAT, MRI, EEG). Prevention of events leading to injury may be an integral component of injury prevention, but ultimately it is the adverse impact of these events on the human body that is of paramount importance. (term-accident-vs-injury)

Fires cause over 300,000 deaths annually worldwide and leave millions more with permanent injuries: some 95% of these deaths are in low- and middle-income countries. Burn injury risk is strongly associated with low-income and informal (or slum) settlements, which are growing rapidly in an urbanising world. Fire policy and mitigation strategies in poorer countries are constrained by inadequate data on incidence, impacts, and causes, which is mainly due to a lack of capacity and resources for data collection, analysis, and modelling. As a first step towards overcoming such challenges, this project reviewed the literature on the subject to assess the potential of a range of methods and tools for identifying, assessing, and addressing fire risk in low-income and informal settlements; the process was supported by an expert workshop at University College London in May 2016. We suggest that community-based risk and vulnerability assessment methods, which are widely used in disaster risk reduction, could be adapted to urban fire risk assessment, and could be enhanced by advances in crowdsourcing and citizen science for geospatial data creation and collection. To assist urban planners, emergency managers, and community organisations who are working in resource-constrained settings to identify and assess relevant fire risk factors, we also suggest an improved analytical framework based on the Haddon Matrix.