Reducing the child accident toll: education concerning accidents risks, and their circumvention

Much controversy has surrounded the question ”Can childhood accidents be prevented, and their effects reduced, by an educational thrust?” It is important to re-ask this question, because the answer changes as disease patterns change1m2, and knowledge increases. Recognition that accidents are the major cause of death in childhood and young adult life334 has led to several analyses of the various strategies available for their reduction5. There are various ways of approaching this problem, all different, but none mutually exclusive. Detailed studies of specific accident scenarios (such as drowning, or motor vehicle accidents) have revealed up to sixteen separate identifiable causes7, which may be grouped as predisposing causes on the one hand, and acute triggers on the others. Haddon, from the United States Insurance Institute for H i g h w a y S a f e t y , r e c o g n i s e s t e n s e p a r a t e countermeasuresg to prevent accidents; his paper “On the escape of tigers: an ecologic note””J, is now a medical classic. A modified summary of these countermeasures, with some personal specific examples of ways in which child trauma might be reduced, is shown in Table 1. One countermeasure is education; to acquaint people that tigers are afoot, and to teach people how the tigers might be prevented from eating individuals. It is my personal experience, especially in the fields of drowning, road trauma and sporting injuries, that education is a valuable and complementary tool, among the several preventive options possible. By education is meant three things (a) that accidents are preventable, and not a predestined part of the lot of modern man and his children; (b) that by informing the target population of the risks, they (and their children and those who treat them) might be the forewarned and hence better prepared; and (c) that by the specific teaching of preventive skills and modified lifestyles, individuals will not be injured through ignorance. These things are obvious, but broader educational themes permeate much more deeply throughout all aspects of accidental injury. Education requires to be ongoing and the accident-prevention curriculum constantly revised; accident profiles may be State-specific11v12 and the secular trend of accidents is changing constantly. Accident profiles differ from place to place (e.g. gunshot injuries are rare among Australian childrenl3 but are relatively common in the United States14). Accidents are not the result of a single event, but the end feature in a series of l inked sequential causes15. In turn, the accident forms the first part of a new chain with further links which include rescue, resuscitation and first-aid, and