Safety and Injury Prevention

The three leading causes of accident-related death are: unintentional falls, unintentional poisoning deaths and motor vehicle traffic deaths.

Injuries

The home is a common place for many unintentional injuries. Unintentional injuries are injuries that happen accidentally and are not on purpose. Over 11,000 people die each year in the United States from unintentional injuries, such as falls, drownings, poisonings, and fires (CDC, 2014a). The most common household injuries include: falls, burns, cuts, poisoning, and choking. We will discuss each of these common injuries and focus on how to prevent them.

Falls

A fall is a situation in which a person accidentally and suddenly moves from a higher to a lower position, in which injury may or may not occur (Leahy, Fuzy & Grafe, 2013). Worldwide falls are the second leading cause of accidental injury (WHO, 2012). Each year approximately 424,000 people die from a fall globally, with about 80% of these falls occurring in low to middle income countries (WHO). Falls can be caused by many different things. Poor mobility, cognitive impairment, the ingestion of alcohol or drugs, poor balance and coordination, vision loss, and unsafe environments are some of the many possible causes of falls. Side effects from medications, neurological and cardiovascular diseases, and physical disabilities are other reasons why people may fall in the home. Confusion and improperly using assistive devices, such as walkers and canes, also put people at risk for an unintentional injury from a fall.

Developmental changes that occur as children grow and as adults age are also important contributing factors for unintentional injuries from falls. Deaths from falls are highest for adults over the age of 60 years across the globe (WHO, 2012). Adults over 65 years, young adults aged 15-29 years, and children 15 years and younger have the highest morbidity rates across the world (WHO).

Injuries from falls can range from relatively mild (such as a bruise) to life-threatening (such as suffering from a hip fracture or brain injury). Fall prevention strategies are the best way to prevent accidental injury from falls. 

Guidelines for Fall Prevention:

  • Keep walkways free of clutter, throw rugs, and loose cords.
  • Wipe or mop up spills immediately. Close off areas with wet floors until dry to prevent people from walking on wet areas.
  • Do not use wax or use other floor cleaners which will leave the floor slippery.
  • Ensure all carpeting is tacked down securely and all rugs have non-skid backing.
  • Use non-skid mats in the tub.
  • Ensure handrails and grab bars are installed in the shower. Home Health Aides/Personal Care Aides should teach patients how to use them.
  • Use good lighting in all rooms of the home. Replace light bulbs that have dimmed or are no longer working.
  • Ensure stairwells are properly lit and stairs are sturdy.
  • Have patients wear non-skid shoes with tied laces.
  • Ensure clothing fits and that pant or dress hems are not so long as to possibly cause the patient to trip.
  • Teach patients how to properly use ambulatory devices, such as walkers and canes.
  • Have patients use glasses and hearing aids in order to better see and hear what is going on in their surroundings.
  • Check for disorientation frequently and report any concerns to a supervisor immediately.
  • Allow the patient to slowly rise to a standing position by first sitting at the edge of the bed to prevent falls that result from dizziness due to rapid changes in position. This is called orthostatic hypotension.
  • Always lock wheelchair, chair, and bed brakes before completing transfers.
  • Keep beds in their lowest position and ensure side rails are up in proper position.
  • Frequently ask the patient if they need to use the bathroom and stay close while they are in the restroom to quickly respond to requests for help.
  • Assist the patient with muscle strengthening exercises and walking as prescribed by the Care Plan to improve balance, coordination, and strength.
  • Keep the home picked up and do not allow shoes, toys, or other items to be left on the floor.
  • Keep items such as tissues, the phone, remote controls, and drinks within close reach of the patient so they do not have to reach far to retrieve them.

 

Poisoning

There are many hazards in the home which put people at risk for accidental poisoning. Poisoning can occur any time a harmful substance is intentionally or unintentionally ingested. Poisons come in many forms including plants, cleaning supplies, spoiled food, and medications. Children, who are naturally curious and like to explore, are in particular at risk for poisoning. Adults who may be confused or who have vision problems are also at risk for accidentally ingesting a substance that could potentially be poisonous. Never allow children or confused adults to have access to potentially harmful chemicals or medications.

Guidelines to Prevent Poisoning:

  • Keep all cleaning supplies and chemicals locked.
  • All medications should be kept in a locked storage area, out of reach.
  • Check medications periodically for expiration dates and properly dispose of expired medications. Some medications become toxic when they are past their expiration date.
  • Do not tell children that medication is “candy” as this makes it look more attractive to them.
  • Ensure all medications and chemicals are properly labeled. Childproof caps should be on medicine bottles.
  • Ensure the patient uses visual aids, such as glasses, when taking their medications and any time they use a household cleaner or chemical.
  • Check the refrigerator weekly and dispose of spoiled, moldy, or otherwise compromised food.
  • Never use cans that have bulges or deep dents in them.
  • Keep poisonous plants out of reach of children and pets.
  • Keep the number for Poison Control near a telephone and ensure the family knows who to call in case of an emergency.

 

Factors Contributing to Injuries among Older Adults

As people age, they may experience physical, sensory, and cognitive changes that make them more likely to suffer an injury.Adults over the age of 65 are the most likely age group to fall (WHO, 2012).Older adults tend to have more physical diseases and take more medications. The more medications a person takes, the more they are at risk for potential medication interactions and side effects. Muscle weakness, injury, disability, coordination, or balance problems also put older adults at risk for falls. Home Health Aides/Personal Care Aides should teach patients to properly use ambulatory aids such as walkers and canes. Encourage good non-skid footwear while ambulating.

Older adults who experience confusion, as a result of dementia or illness, may not be completely aware of their surroundings and may not be as cautious while moving about as they normally would. Sensory impairments, such as vision problems and hearing loss, also put older adults at risk for falls as they may not adequately see or hear what is going on in their surroundings.As we age, we also have a reduction in our ability to taste and smell. This makes us more likely to not smell smoke if there is a fire, or to eat food that is spoiled without being aware.

Factors Contributing to Injuries Involving Young Children

Children are another high risk group for falls. Their natural curiosity, and the developmental tasks they are experiencing, in which independence and risk-taking behaviors come about, makes them prone to accidents involving falls. Ensure that stairways are blocked off from small children with gates. Do not allow children to climb stairs, ladders, or other surfaces unsupervised. Teach them to tie their shoelaces and ensure they wear good non-skid shoes.

Children are also especially prone to choking as they like to put items into their mouth as they explore the world. Ensure that toys are age appropriate and that very young children are not allowed to play with toys and games with very small pieces. Keep medications and cleaning solutions locked and out of reach. Use child-proof covers for outlets, child-proof locks for cabinets which hold cleaning supplies, and child-proof caps on medications.

Children are developing their gross motor skills and may not have very good balance and coordination. Teach them to use rails when walking on stairs. Teach children to hold your hand and to look both ways when crossing a street. Supervise children while they are playing outdoors and in activities such as bike riding, skating, or skateboarding. Never allow young children to bathe or swim unsupervised in order to prevent possible drowning.

With infants, keep in mind that they must always be supervised. Never leave a baby unattended. Never walk away from a baby while giving a bath as they do not have the muscle development to keep their head out of water and could potentially drown. Feed babies with their heads higher than their bodies and burp them in between feedings to prevent choking. Do not keep stuffed animals and excessive bedding in a baby’s crib. Keep babies on their backs while sleeping to prevent possible suffocation.

As children tend to lack a sense of fear and have a strong desire to explore their world, Home Health Aides/Personal Care Aides must always be watching for potential hazards in their environment. Keep the environment clutter free and teach children to pick up their toys and shoes.

Where Household Injuries Commonly Occur

Two areas in the home, the kitchen and the bathroom, are the places where most household injuries occur (Leahy, Fuzy & Grafe, 2013). People tend to spend a lot of time in both of these areas in the home. They are also places where many dangers lie.

In the kitchen, using appliances improperly or near water could result in electrical injury. Other hazards in the kitchen include walking on a wet or greasy floor, improperly using knives, fire hazards while using the stove, and ingesting spoiled food or dangerous chemicals.

In the bathroom, potential hazards involve slipping on a wet floor or in the bathtub, using appliances such as hair dryers near water, unsafe use of razors or scissors, and the ingestion of medications and other potentially dangerous substances.

Car and Motorcycle accidents

Motor vehicle crashes are the leading cause of death in the workplace in the United States accounting for 35 percent of all workplace fatalities.[103] In the United States, individuals involved in motor vehicle collisions may be held financially liable for the consequences of a collision, including property damage, and injuries to passengers and drivers.[99] Where another driver’s vehicle is damaged as the result of an accident, some states allow the owner of the vehicle to recover both the cost of repair for the diminished value of the vehicle from the at-fault driver.[104] Because the financial liability that results from causing an accident is so high, most U.S. states require drivers to carry liability insurance to cover these potential costs. In the event of serious injuries or fatalities, it is possible for injured persons to seek compensation in excess of the at-fault driver’s insurance coverage.[105]

The table below shows the motor vehicle fatality rate in the United States by year from 1899 through 2018. It excludes indirect car-related fatalities.

Annual US miles traveled (blue), traffic fatalities per billion vehicle miles traveled (red), per million people (orange), total annual deaths (light blue), VMT in 10s of billions (dark blue) and population in millions (teal), from 1921 to 2017

For 2016 specifically, National Highway Traffic Safety Administration (NHTSA) data shows 37,461 people were killed in 34,436 motor vehicle crashes, an average of 102 per day.[1]

In 2010, there were an estimated 5,419,000 crashes, 30,296 deadly, killing 32,999, and injuring 2,239,000.[2] About 2,000 children under 16 die every year in traffic collisions.[3] Records indicate that there were 3,613,732 motor vehicle fatalities in the United States from 1899 to 2013.

Although the number of deaths, and deaths relative to the total US population, declined over most of the previous two decades, the trend reversed in 2015 and continued to move upward in 2016.[needs update] From 1979 to 2005, the number of deaths per year decreased 14.97% while the number of deaths per capita decreased by 35.46%. The 32,479 traffic fatalities in 2011 were the lowest in 62 years, since 1949. US motor death statistics reported by government only include those on public roads, and do not include parking lots, driveways, and private roads.[4]

Motorcycles

Motorcyclists have little protection other than their clothing and helmets. This difference is reflected in the casualty statistics, where they are more than twice as likely to suffer severely after a collision. In 2005, there were 198,735 road crashes with 271,017 reported casualties on roads in Great Britain. This included 3,201 deaths (1.1%) and 28,954 serious injuries (10.7%) overall. Of these casualties 178,302 (66%) were car users and 24,824 (9%) were motorcyclists, of whom 569 were killed (2.3%) and 5,939 seriously injured (24%).[61]

Sociological factors

Studies in United States have shown that poor people have a greater risk of dying in a car crash than people who are well-off.[62] Car deaths are also higher in poorer states.[63]

Similar studies in France or Israel have shown the same results.[64][65][66] This may be due to working-class people having less access to secure equipment in cars, having older cars which are less protected against crash, and needing to cover more distance to go to work each day.

Other

Other possibly hazardous factors that may alter a driver’s soundness on the road includes: