Journal of Emergencies, Trauma, and Shock

: 2020  |  Volume : 13  |  Issue : 1  |  Page : 1--2

What's new in emergencies, trauma and shock? developing competency in injury prevention

Sunil Kumar Raina 
 Department of Community Medicine, DR. RPGMC, Kangra, Himachal Pradesh, India

Correspondence Address:
Dr. Sunil Kumar Raina
Department of Community Medicine, DR. RPGMC, Kangra, Himachal Pradesh

How to cite this article:
Raina SK. What's new in emergencies, trauma and shock? developing competency in injury prevention.J Emerg Trauma Shock 2020;13:1-2

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Raina SK. What's new in emergencies, trauma and shock? developing competency in injury prevention. J Emerg Trauma Shock [serial online] 2020 [cited 2020 Jun 4 ];13:1-2
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Our fundamental understanding about injuries has largely been based on the following few assumptions: (1) that injuries are accidental, (2) the easiest way of measuring the impact of injuries is through measurement of deficit outcomes like mortality, and (3) injuries are random and unpredictable.

However, for a larger part, these fundamental assumptions have not been found to be correct.

Let me begin the narrative with a bit of a brief talk about the concept that has long gained ground in the past few decades. The concept of “Injuries are not Accidents.” This concept is being accepted as the bottom-line in defining policy initiatives on injury prevention and is a slogan commonly spoken by injury research professionals. Its origin, some time ago, was developed as a counter-narrative to the perception that injuries occurred by chance. While accidents are an unexpected occurrence, happening by chance, thereby implying a random and uncontrollable event, an injury is a definable, correctable event, with specific risks for occurrence, and therefore, amenable to intervention.

Injury science has come a long way, and injury research has been shaped by technology, industry, and biomechanics but most importantly by epidemiology and heavily influenced by Haddon. However, the large-scale benefits of injury research will only be felt when the injury-related mortality is brought down to a minimum. This is possible. The epidemiological estimates of mortality from the injury worldwide shows that there has been a decrease in deaths in high-income countries, while the current and projected trends in low-income and middle-income countries show a large escalation in global road traffic mortality over the next 20 years and possibly beyond.[1] This differential decrease though worrisome on account of injury burden also is encouraging as it gives strength to the injury prevention models practiced by the high-income countries. This gains the importance in view of the prediction that a substantial increase in road traffic deaths is expected if present policies and actions in road safety continue and no additional road safety countermeasures are put into place.

Injury research though relatively new, injury prevention interventions have been around for centuries. What is needed is the application of scientific methods to injury control. Epidemiological studies like the one conducted in Karnali, Nepal, will form the basis for future framework for injury research.[2] Although injury epidemiology did see a transition from infectious disease models to chronic disease models largely because of initial works by John Gordon, injury science will continue to be better understood in epidemiologic triad model of the host, agent, environment, a model much closer to infectious diseases largely due to works by James Gibson and William Haddon.

Here, I would pause and take you again to the slogan, “Injuries are not Accidents.” How significant is this slogan? This slogan is in the simplest way to change the public perception of injuries and the general an effort public being the largest stakeholders of injury science, its frequent and widespread use is not only necessary but also imperative as well. Beyond that, this slogan removes all doubts regarding injuries being preventable. We also understand that injuries most often occur to certain risk groups and are fairly predictable epidemiologically (whether it be to certain persons, at certain times, or in common locations), it is time to dispense with the unpredictability of injuries. At the face of it, a beginning has been made with automobile accidents now being referred to as “crashes” rather than “accidents,” but in reality, it does not matter whether crashes or accidents is the most appropriate term. What is important is the recognition that injury events often have identifiable characteristics, and that we may be able to prevent future injuries by intervening on one or more of these characteristics.

Therefore, what will help make injury prevention successful globally? Developing core competency in injury prevention will help, but limiting them to high-income countries will do a disservice. There is an urgent need to develop injury prevention competency across economies with in this stepwise approach with steps running concurrently or one followed by another.

The first step is to conduct injury epidemiology across the regions and create a database valid enough to develop prevention models that can be scaled up. The second step is to make successful injury prevention models universally accessible and accessible at an adequate level, and access without excessive burden. The third step is to build national injury prevention programs with inbuilt provisions for dissemination of information related to injury prevention to the community, other professionals, key policymakers, and leaders through diverse communication networks and focus on prevention through policy, enforcement, advocacy, and education. The fourth step is to strengthen existing and develop newer competency in injury prevention through technological innovation and scientific research. The fifth and the last step is to de-compartmentalize injury prevention as existing in silos concept is not favorable to the development of injury prevention professional.


1Murray CJ, Lopez AD, editors. The Global Burden of Disease: A Comprehensive Assessment of Mortality and Disability from Diseases, Injuries, and Risk Factors in 1990 and Projected to 2020. Boston, MA: Harvard School of Public Health; 1996.
2Sharma D, Panta PP, Amgain K. An epidemiological study of injuries in Karnali, Nepal: A hospital-based retrospective study. J Emerg Trauma Shock 2019;12:30-4.