Hazard (Edition No

Hazard (Edition No. 25) V.I.S.S. December 1995 Victorian Injury Surveillance System Monash University Accident Research Centre

Translating injury surveillance to prevention: an update As VISS is moving to a new system of data collection in 1996 it is timely to review our achievements over the past eight years. This edition of Hazard highlights some VISS success stories and outlines some of the challenges that face us in 1996 and beyond.

Erin Cassell or more significant injury issues and progress has been made by VISS and Virginia Routley Joan Ozanne-Smith a discussion of actions that need to be other bodies but where there is good taken to reduce or eliminate the potential for further gains. In these Summary potential for injury. areas a modest increase in human and financial resources applied to the The first edition of Hazard was As background to this (the 25th) problem could be repaid by significant published in July 1988, the year in edition of Hazard, progress on all the reductions in the number and/or the which the Victorian Injury recommendations to reduce injuries severity of injuries. Surveillance System was established. made in Hazard was reviewed. The The quarterly publication of Hazard review not only covered follow-up Enclosed in this edition is a client is one of the major methods VISS action undertaken by VISS alone or in survey. In 1995 VISS received a uses to disseminate information. The collaboration with other Monash small grant from the Victorian selection of topics forHazard is based University Accident Research Centre Health Promotion Foundation to on the relative severity, frequency (MUARC) projects but also included support the implementation of and the potential preventability of significant action on VISS findings from VISS data analyses injury problems that emerge from recommendations taken by other and research. This grant included analyses of VISS hospital emergency bodies. VISS intends to continuously funds for a survey of VISS clients department presentations data and update this review as an ongoing and potential clients on their data reference to other relevant data Working Report. and other needs for progressing the sources. This edition of Hazard highlights recommendations for action Each Hazard edition includes the some VISS success stories. It also published in Hazard. findings from the data analysis on one focuses on injury issues where some

VICTORIAN INJURY SURVEILLANCE SYSTEM HAZARD 25 page 1 Introduction Media coverage of injury issues in Hazard - 1995 Table 1 The Victorian Injury Surveillance System (VISS) was established in No. of 1988 to collect and analyse injury Injury Issue media Media coverage in 1995 data from hospital emergency requests departments and to disseminate Domestic 22 Print: AAP, Canberra Times, Herald Sun, information for the purposes of injury violence IPA Review, Shepparton News, Sunday prevention. VISS is currently funded Herald Sun, Sydney Morning Herald, The Age, The Australian, The Independent by the Victorian Health Promotion Monthly, Warrnambool Standard, Waverley Foundation. Gazette, Women's Day. The size and nature of the data Radio: ABC Sydney, SBS, Triple M collection has changed over the Television: A Current Affair (Channel 9), lifetime of VISS. It was initially a GP (ABC TV) collection of child injuries reported Dog 12 Print: Fairfax Suburban Newspapers, through the emergency department of bites/attacks Herald Sun, National Dog Magazine, the Royal Children’s Hospital under Sunday Age, Sunday Herald Sun, Sterling Media the directorship of Associate Professor Television: A Current Affair (Channel 9), Terry Nolan. MUARC took over Burke's Backyard (Channel 9) VISS management in 1990 and Horse related 8 Print: Herald Sun, Warrnambool Standard, developed the all age injury collection. injuries Weekly Times By 1992 VISS had expanded to five Radio: Country Hour (ABC Radio) hospitals on seven campuses. Television: Midday Show (Channel 9), Channel 9 VISS is currently in transition from Sports injuries 8 Print: Australian Golf Digest, Fairfax the manual collection of injury data in Newspaper Group, Herald Sun, Sunday selected emergency departments to a Age, Sydney Morning Herald statewide routine electronic collection Radio: 3BA using the National Minimum Dataset Television: Today Tonight (Channel 7) (Injury Surveillance). Smoking 5 Print: AAP, Herald Sun, The Age related injuries Radio: 3MP, 5DN VISS has also expanded to access In-line skating 3 Print: Shepparton News data and information from a wider injuries Television: The Today Show (Channel 9), range of sources so that a more News Channel Pay TV complete picture of injury issues is Escalator- 3 Print: Australian Doctor, Parents obtained. The other sources frequently related injuries (Australian Parenting Magazine), Herald accessed are the Australian Bureau of Sun Statistics (ABS), the Coroner’s Home injuries 3 Print: The Age Facilitation System (mortality) and Television: Better Homes (Channel 7), the Victorian Inpatient Minimum Channel 7 Dataset. Tractor-related 2 Print: Herald Sun, Weekly Times injuries Radio: The Country Hour (ABC radio), There are currently 166,137 cases of Country Roundup (Ace Network) injury on the VISS hospital emergency Shopping 2 Print: Herald Sun department database. VISS data are trolley injuries used to identify injury problems, Snake bites 2 Print: Sunday Herald Sun support research and, most import- Television: Burke's Backyard antly, to underpin the development of Farm injuries 2 Print: Warrnambool Standard, Weekly injury prevention strategies and Times Chainsaw- 1 support their implementation and Print: Gippsland Farmer evaluation. related injuries VICTORIAN INJURY SURVEILLANCE SYSTEM HAZARD 25 page 2 The latter is achieved by bringing hazards and potential solutions to the Progress on selected issues attention of the public and those who share the responsibility for Prevention of suicide - reducing car exhaust gas poisoning safeguarding Victorians - government [reported in Hazard 11, June 92; Hazard 20, Sept 94] departments and statutory authorities, manufacturers, retailers, insurers, Recommendations consumer and injury prevention groups, educators, researchers and • reduce access to the means of suicide, especially firearms and carbon specialist medical practitioners. monoxide gas [Hazard 11, June 92] • design modifications to motor vehicles to impede common methods of The media play an important and carbon monoxide poisoning, eg. modify/re-design car exhaust systems to responsible role in reporting VISS reduce or eliminate carbon monoxide emission, and mandate these design data and often follow up the injury changes by incorporating them into the Australian Design Rules (ADRs) issues highlighted in Hazard. Table 1 [Hazard 20, Sept 94] shows the media attention given to injury issues in 1995 that are directly • mandate, through changing ADRs, the incorporation of a sensing device attributable to the publication of in motor vehicles which monitors carbon monoxide levels and shuts down Hazard. The issue that excited the the motor when levels become life threatening [Hazard 20, Sept 94] most media attention was domestic • improve motor engine designs and catalytic conversion techniques to violence. complete the combustion process and thereby virtually eliminate carbon Over time, increasing emphasis has monoxide emissions [Hazard 20, Sept 94] been given by VISS to the vigorous • improve the identification and treatment of those who are most at risk of pursuit of the implementation of suicide [Hazard 11, June 92] recommendations based on VISS data and available research. Hazard 20 highlighted that carbon Cars built after 1986 have catalytic monoxide poisoning from car exhausts converters fitted which convert VISS is a major program of Monash was a major means of suicide in harmful carbon monoxide gas University Accident Research Centre Victoria, ranking second to hanging/ emissions to carbon dioxide gas. (MUARC) and Dr Joan Ozanne- strangulation. In 1994 carbon However, ongoing surveillance of the Smith, a Senior Research Fellow with monoxide gas was used by 98 trend in suicides in Victoria and MUARC, is the Director of VISS. Victorians and 447 Australians Australia by VISS shows no clear (source-ABS microfiche data) to evidence of a decline in the proportion commit suicide. of suicides from carbon monoxide poisoning in recent times. In fact, There is some research evidence which Victorian Inpatient Morbidity data suggests that restricting access to the indicate that hospital admissions for means of suicide can contribute to a carbon monoxide suicide attempts fall in overall suicide rates. For have steadily increased from 15 in example, a fall in suicides among 1989-90 to 56 in 1993-94. women in Australia occurred when access to barbiturates was tightened Information from the Victorian in the late 1960’s and in the U.K. Institute of Forensic Medicine also when natural gas replaced coal gas. confirms that gassings are still There is preliminary evidence that occurring in post-1986 vehicles, tighter firearm legislation in Victoria probably because catalytic converters may be having a similar beneficial do not work efficiently at a cold start. effect. VISS therefore recommended the consideration of other design

VICTORIAN INJURY SURVEILLANCE SYSTEM HAZARD 25 page 3 modifications to cars to make carbon Youth Suicide, comprising the (Harrison & Cripps 1994; Harrison & monoxide emissions a less accessible Commonwealth Department of Dolinis 1995). During 1996 VISS means of suicide. One intervention, a Human Services and Health, the will step up its efforts to bring together carbon monoxide sensing device Attorney General’s Department and a coalition of interested parties to which turns off the engine when the the Commonwealth Department of push for action on the problem of car carbon monoxide reaches a dangerous Transport, and the Youth Suicide exhaust gassings and pursue the level, has been assessed as cost Prevention Advisory Group, which opportunities afforded to progress this effective in terms of lives saved. VISS has also been set up by the issue through its representative on the also made suggestions for engineered Commonwealth Department of working group of the Commonwealth design changes to car exhaust systems Human Services and Health. Youth Suicide Prevention Advisory and these have been sent to experts in Group. the field for comment. The latter has been established to provide the Commonwealth with Scalds prevention - hot drinks VISS circulated copies of Hazard 20, expert and consumer advice on youth [reported in Hazard 3, June 1989; which highlights the problem and suicide prevention activity. MUARC Hazard 11, June 92, Hazard 12 possible solutions, to senior staff in (through action by VISS) has been September 1992] car manufacturing companies, invited to be represented on a working automotive bodies, government group of this committee which will Recommendations-hot departments of transport, engineering explore issues around access to the drinks academics and members of the various means of suicide and possible options suicide prevention working parties for a national project or legislative • develop new designs for cups, that have been set up by government activities. mugs, some electric kettles and and other bodies. In December 1995 coffee makers which incor- updated and comprehensive Awareness raising among health and porate the use of heavier material information was sent to these and injury professionals has also been part and a lower centre of gravity to other interested organisations seeking of the VISS implementation agenda. prevent tipping over [Hazard 3, their co-operation and advice on how Information on the use of carbon June 1989] to progress action on the issue. monoxide poisoning as a common means of suicide was a major • introduce a spill-resistant mug The national arm of the Australian component of a paper presented at the onto the Australian market Medical Association (AMA) has also 1994 Public Health Association [Hazard 12, Sept 92] publicly stated its interest in pursuing (PHA) Conference - ‘Non-traffic • educate carers to keep hot drinks this suicide prevention initiative. In motor vehicle injury’ (Routley V.). out of reach of children and to use 1995 the AMA wrote to Members of Posters on the topic have been accepted placemats instead of tablecloths Parliament and automotive manu- for the Third International Conference [Hazard 12, Sept 92] facturers urging action and the AMA’s on Injury Prevention and Control to Ethics, Science and Social Issues be held in Melbourne in February • design kitchens to eliminate Committee and policy officer intend 1996 and the associated Fourth dangerous pathways between key to pursue this matter in early 1996. International Conference on Product work areas, and kitchen benches Safety Research. with a rounded lip to catch spills VISS has provided information on its [Hazard 12, Sept 92] activities to the AMA and offered to The challenge Follow-up action support the AMA’s efforts to restrict The prevention of suicides is a access to the means of suicide. In complex task and restriction of access • media: Herald Sun 1992, 1996 VISS will continue to com- to the means of suicide is one Montage April 1994, Bayside municate and co-operate with the intervention where there appears to Times April 1995, Colac Herald AMA on this issue. be good potential to save lives. Since June 1995 1991 suicides have surpassed motor In late 1995 VISS established contact • information requests: 18 general vehicle traffic accidents as the major with the Commonwealth Inter- scalds requests, including two cause of injury deaths in Australia departmental Working Group on regarding spill-resistant mugs

VICTORIAN INJURY SURVEILLANCE SYSTEM HAZARD 25 page 4 Preventing hot drink scalds - spill resistant mugs Spill-resistant mug Figure 1 In 1992 VISS identified that the major cause of scald injuries to children was hot drinks being pulled or knocked onto young children. An updated analysis of all cases of child scalds on the VISS database to June 1995 (Table 2) reveals that this is still the case, 39% of scald injuries to children aged under 15 years are tea and coffee scalds. For this reason VISS has concentrated much of its efforts on getting an attractive and well designed spill resistant tea/coffee mug onto the Australian market. The availability of a safe, attractive spill-resistant mug the essential features of a safe spill All of the products that were assessed would facilitate the promotion of this resistant mug to be a narrow mouth, a had some of the design characteristics countermeasure to child scalds to wide, high friction base for maximum required but none appeared ideal, for parents and carers of young children. stability and a sip-through lid which example, they had a wide base but no It is especially important to safeguard stays on (with minimum spillage) lid or had the safety features but were one to two year olds as they are the when the mug is in use or tipped over. too large, too ugly or too expensive. highest risk group for hot drink scalds. As a first step, VISS collected samples VISS subsequently approached a The spill resistant mug was first of spill resistant mugs from companies number of Australian design and mug identified as a promising counter- in Australia and the USA where the manufacturing companies who were measure to child scalds in Hazard 12 use of this mug is promoted to coffee all very helpful but their ultimate (Sept 1992). As shown in the drinking commuters (not a practice response was not encouraging. The accompanying sketch, VISS considers we want to encourage among cost of developing prototypes and Australian drivers!). tooling up for production appears prohibitive because of the small Scald injuries to children aged <15 years Table 2 volume domestic market. NSW Health experienced a similar reaction from the cup and mug manufacturers Mechanism factor N % they approached. hot drinks - tea, coffee 672 39 hot water - cooking 372 21 VISS also followed up a mug design that was recently patented in the USA. hot water - bath, tap, shower 241 14 An interesting design feature is that hot water - other 104 6 the mug can only be used if the lid is cooking oil, fat 89 5 in place. The US health product hot water - n/s 88 5 company that sought the patent is soup, gravy 81 4 currently at the stage of seeking other 103 6 finance for tooling for production. VISS has supplied contacts for the Total 1750 100% manufacturer to follow up and will VISS data: RCH, WH, PANCH 1989-93, meet the designer for discussions in LRH 4 years July 1991 to June 1995. Update of table in Hazard 12 September 1992. February 1996.

VICTORIAN INJURY SURVEILLANCE SYSTEM HAZARD 25 page 5 Another avenue of investigation that been accepted for presentation to the Burns prevention - was implemented concurrently was a Fourth International Conference on cigarettes/lighters/matches field assessment of consumer attitude Product Safety Research to be held in [reported in Hazard 11, June 92; to a spill-resistant mug. In 1995 the Canberra in February 1996. Hazard 12, Sept 92; Hazard 21, 7 Eleven spill-resistant mug was Dec 94] market tested for VISS in a research A VISS staff member is also co- project conducted by Carmelo Caputo, ordinating the Spill-Resistant Mug Peter Liodakis, Vicki Psihogios and Working Party of the Victorian Recommendations Prevention of Child Injury Committee Livia Rivera, students of Monash • consider installing sprinklers in (established by the Department of University Medical School. This institutions housing elderly project examined the effectiveness Health and Community Services). smokers [Hazard 11, June 92] and acceptability of the spill resistant The challenge • consider the introduction of mug (donated by 7 Eleven) among a The recent progress on the legislation for the mandatory group of 50 family day care workers development of the design and manufacture of low fire risk (self employed by the City of Dandenong prototype of a spill-resistant mug will extinguishing) cigarettes Council. influence the steps that will be taken [Hazard 12, Sept 92; Hazard The researchers reported that the in 1996. VISS intends to approach 21, Dec 94 ] potential sponsors if the prototype caregivers responded positively. The • develop a low cost child- design satisfies VISS specifications. product was found to be acceptable resistant cap for cigarette Kidsafe has indicated a strong interest and convenient to use but the lighters and a child-resistant in assisting in marketing the product researchers recommended that matchbox (or import from USA. when it becomes available. awareness raising education on scalds and U.K. respectively) and prevention should accompany its More than three years have elapsed mandate their use in Australia introduction. The caregivers since VISS identified scalds from cups [Hazard 12, Sept 92; Hazard suggested a number of changes in of tea and coffee as the major risk for 21, Dec 94 ] terms of size, shape and material to thermal injury among young children improve the mug’s consumer appeal • support initiatives to reduce and recommended the development smoking [Hazard 21, Dec 94] and safety. of an acceptable spill resistant mug. These research findings were used to In this period three hundred more As reported in Hazard 12 and 21 burn refine VISS design specifications for Victorian children have presented with injuries to children resulting from a spill resistant mug. VISS recently scalds from hot cups of tea and coffee playing with cigarette lighters, interested a South Australian mug to the four hospital emergency although uncommon, are severe. and lid manufacturing company in departments covered by VISS. Cigarette lighters were the cause of the design and, possibly, the The time and persistent effort that 16% of the 31 smoking related deaths manufacture of the product. The were required to progress thisHazard recorded on the Victorian Coroner’s company is currently engaged in recommendation exemplifies the need Facilitation System database during exploring the best design, in terms of for more infrastructure and project the period 1989/90 to 1991/92. effectiveness and aesthetics. Their specific funding to increase the Almost all of the cigarette lighter first concept sketches will be capacity of VISS to pursue interven- cases involved a child under 5 years submitted to VISS in January 1996. tions that arise from its research old playing with the lighter. The issue was raised nationally in a findings. VISS Hospital Emergency paper presented to the First National Department database shows that over Conference on Injury Prevention and half the children under five years who Control held in Sydney in 1995 suffer burns from cigarette lighters (Commonwealth Department of require admission to hospital. Human services and Health 1995) and a paper on the research Hazard 21 called for governments to underpinning these developments has regulate that all cigarette lighters on VICTORIAN INJURY SURVEILLANCE SYSTEM HAZARD 25 page 6 sale in Australia should have child- its higher price acts as a disincentive Child falls prevention - resistant catches. To date there has for the wider implementation of this babywalkers been no positive response from the safety measure. [reported inHazard 14, Mar 93 (home Commonwealth or any State injuries); Hazard 16, Sept 93 (the government, despite the introduction Another burn prevention recommen- safety of babywalkers); Hazard 20, of this safer product onto the dation in Hazard 21 was the intro- Sept 94 (an update)] Australian market. duction of a child resistant matchbox such as Matchguard, which is Cricket, and to a lesser extent Bic, manufactured in the U.K. Recommendations child resistant cigarette lighters are Efforts by VISS to interest local • impose an Australian product now sold in major supermarket chains. ban on babywalkers or, less Cricket lighters are currently promoted manufacturers in the production of a similar product (designed to hold the preferably, change the design to by Bryant and May through media incorporate a broad base that is advertising and a lighter swap scheme. standard size Australian small cardboard match box) have not been wider than household doorways At the suggestion of VISS, Kidsafe successful. The high cost of tooling [Hazard 14, Mar 93] has arranged for a display pack of 25 and low volume local market are again • raise public awareness of the cigarette lighters to be donated by given by manufacturers as reasons for risks associated with baby- Bryant and May to every Maternal their lack of interest in manufacturing walkers and the necessity of and Child Health Centre in Victoria. this safety product. stair guards and supervision These centres will promote a lighter [Hazard 16, Sept 93] The challenge swap scheme to parents of young • encourage retailers to refuse to More active intervention by the children as a means of raising sell babywalkers [Hazard 16, relevant government authorities is awareness of the availability of this Sept 93] product among one of the highest risk required to decrease these burn Follow-up action groups This promotion will expose injuries. Child resistant cigarette some 25,000 parents across Victoria lighters are mandatory in the USA • media: The Sunday Age, to this safer product. and Canada so there is a persuasive Townsville Bulletin, Herald- precedent for similar regulatory action Sun, Sunday Herald Sun, Similar exchange schemes operate at in Australia. The Melbourne Waverley Gazette, Channel 7, the Child Safety Centre at the Royal Metropolitan Fire Brigade and other ABC Regional TV. Children’s Hospital (RCH), fire prevention bodies are major • information requests: nine, Melbourne and, for families whose protagonists for regulations in this including invited submission children are fire lighters, through the area. VISS will continue its efforts to from the Federal Minister for Psychiatry Department of the RCH. stimulate government regulatory Consumer Affairs. action in 1996. Despite the initiatives to educate the • research study, based on VISS consumer taken by Bryant and May data, on facial injuries sustained and child injury prevention bodies, Child resistant Figure 2 by small children in baby child resistant lighters currently make cigarette lighter walkers or prams. up only four percent of the Australian • exposure data provided through cigarette lighter market share. This the Australian Bureau of poor uptake by consumers indicates Statistics (ABS) “Safety in the that more stringent measures are Home” survey conducted in required. Melbourne in November 1992 enabled VISS to calculate The Cricket child resistant disposable relative risk compared to other lighter retails at more than double the nursery items [Hazard 20, Sept price of regular disposable lighters 94] which further supported the ($1.95 v. 89-95 cents). While need for a product ban or increased production would reduce changed design. the cost of the child resistant lighter, VICTORIAN INJURY SURVEILLANCE SYSTEM HAZARD 25 page 7 Babywalkers are an injury hazard. In earlier adverse media reports and a high padded back or wheels that Victoria each year there is a risk that generated by VISS. can be locked). The retailers regarded 1 in every 192 babywalkers will cause these models as comparatively safe, a significant injury resulting in a The Minister’s action through the indicating that they also had some hospital emergency department Federal Bureau of Consumer Affairs awareness of the injury issue. presentation to a child less than one and the media attention given to the year of age. Babywalkers have been issue as a result of reports in three The issue has been raised by VISS in shown to be of no benefit to the baby, issues of Hazard appear to have had a conference papers given at the Second in fact there is evidence that their use beneficial effect in Victoria. World Conference on Injury Control, may hinder child development. Atlanta USA, 1993; the Public Health A VISS survey of 13 major retail Association Seminar ‘The Health of VISS and other Australian and outlets in a cross section of Melbourne Mothers and Children’, Melbourne overseas data have consistently shown suburbs in November 1995 found that 1993; the Children’s Nursery that babywalker use is associated with other major general retail chains Furniture Seminar, Royal Children’s serious injury, for example, stairway (Target, K-Mart and Toys R Us) had Hospital, Melbourne, 1994; and the falls and burns. In the US in 1993 withdrawn babywalkers from sale Health and Community Services babywalkers were associated with “because they were unsafe or Conference, ‘Healthy Families, 25,000 hospital emergency depart- dangerous”, as had some specialist Healthy Children’, Melbourne, 1994. ment presentations among children nursery furniture retailers. The challenge aged 5-15 months and the deaths of Two of the five specialist nursery In 1996 VISS will continue to work 11 children in the period from 1989 furniture retailers that still sold through 1993 (Murray 1995). with other child injury prevention babywalkers reported that they only agencies to pressure the Federal stocked models which they perceived VISS has maintained continuous Bureau of Consumer Affairs to review to have special safety features (for pressure on Commonwealth and State its position and place a product ban on example, models with eight wheels Consumer Affairs bodies to have babywalkers. babywalkers banned, or, less preferably, the Australian standard revised (as was done in Canada) to demand a broader and more stable base. This latter approach to the problem would limit the mobility of Shopping trolley fitted with child seat Figure 3 babies using babywalkers, preventing them getting through doorways. The Federal Bureau of Consumer Affairs (FBCA) has declined to place a product ban on babywalkers citing legal impediments as it is the use, rather than the product itself, that is unsafe. However, in 1995 the Federal Minister for Consumer Affairs, The Hon. Jeannette McHugh wrote to 350 retailers of babywalkers asking them to voluntarily withdraw this product. This action was influenced by the decision of the Myer group of department stores to withdraw babywalkers from sale following

VICTORIAN INJURY SURVEILLANCE SYSTEM HAZARD 25 page 8 Child falls prevention - Finger jam injuries commonly associated with finger jam falls from shopping trolleys from doors injuries to older children. On a recent trip to the U.K. a VISS [Reported in Hazard 10, Mar 92 Consequently, VISS assisted the staff member photographed a (schools); Hazard 14, Mar 93 (home); development of a ‘finger-safe guard’ shopping trolley fitted with a child Hazard 16, Sept 93 (childcare which shielded the hinge side of the seat and harness in a Safeway settings)] door. supermarket (Figure 3). Recommendations Research into injuries in the home The danger posed to children by and child care settings for Hazards shopping trolleys, mostly fall-related • install the safest type of door for issues 14 and 16 found finger jam injuries, was highlighted in Hazard location, door closures, wedges injuries to be frequent and severe 22. VISS hospital emergency and finger safe guards in homes, injuries in both these locations. department data shows that in the schools and child care settings period 1989-1993 shopping trolleys [Hazard 10, Mar 92; Hazard Since 1993 VISS has concentrated on were responsible for 268 injuries, 14, Mar 93; Hazard 16, Sept promoting the finger-safe guard, predominantly to children under five 93] raising community and government awareness of the problem, and years of age. • include measures to prevent implementing preventive measures in Baby capsules are fitted to some finger jam injuries in child care child care settings. shopping trolleys inColes New World settings in the Children’s Supermarkets in Australia. However, Services Centres Regulations In late 1993 and early 1994 VISS as shown in Hazard 22, shopping 1988 [Hazard 16, Sept 93] raised with relevant government trolley injuries peak among 1-3 year Follow-up action departments, Ministers and olds and major causes are young committees the need to include children standing in, climbing in or • media: Herald-Sun (VicHealth countermeasures to finger jam injuries out of, or reaching too far out of regular Monday column), ABC in either the Quality Improvement shopping trolleys. radio and Accreditation System or in the • information requests: 12 National Standards for Centre Based In 1996 VISS will again approach Long Day Care. These approaches including Kidsafe,Civic Mutual Australian supermarkets chains to Plus, Shire of Yarra Ranges, were unsuccessful. convince them of the advantages of Department of Health and taking a responsibe attitude to the In May 1995 VISS again raised the Community Services prevention of these unnecessary door finger jam issue in a submission injuries to young children by providing in response to the ‘Future Legislative In 1989 VISS identified finger jam child restraints in shopping trolleys. and Regulatory Framework for injuries as common in children under Children’s Services Discussion Paper, 5 years. Within the previous year April 1995’. The draft framework (1988-89) 143 injuries occurred as a will be released for comment in 1996. result of a child jamming his/her finger in a door. Finger jams often result in As an interim measure VISS wrote an crushes, fractures and even article on finger jam protection for amputations. Information Update 1/95 (recently re-named ‘Extra’), the newsletter of A follow-up study conducted by the Preschool and Childcare Branch MUARC on a sample of these child of the Primary Care Division of the finger jam cases (Ozanne-Smith et al Department of Health & Community 1992, unpublished) found that the Services, Victoria. most severe finger jam injuries to children, especially to one and two This newsletter was circulated to year olds, involved the hinge side of 3,500 registered or government the door. The opening side was more funded children’s services including

VICTORIAN INJURY SURVEILLANCE SYSTEM HAZARD 25 page 9 childcare, preschool and occasional the media and a Department of Health Prevention of needlestick care centres, school-age services, peak & Community Services publication; injuries bodies and interested associations. and the promotion work undertaken [reported in Hazard 17, Sept 93 by the Child Safety Centre at the (workplace)] Civic Mutual Plus, the insurer of 98% Royal Children’s Hospital among of Victorian Local Government Areas child care bodies seeking government (LGAs) included finger jam protection accreditation. Recommendations in their March 1995 Risk Management • use disposable syringes [Hazard Manual update. Their attention was During 1995 VISS encouraged an 17, Sept 93] drawn to the issue by media reports of educational toy shop Hop, Step and VISS findings published in Hazard Jump to stock finger safe guards as • develop and promote the use of and the information used in this the number of sale outlets for the safer products eg. pliable and manual update was largely from VISS. product was very limited. puncture resistant gloves, low cost retractable needles and In terms of implementation, in 1995 A recent development is the other devices such as rubber the Shire of Yarra Ranges was awarded establishment by the Victorian sheath removers that minimise a grant of $10 000 by the Victorian Prevention of Child Injury Committee contact with a sharp [Hazard Department of Health and Community of the Finger Jam Prevention Working 17, Sept 93] Services to reduce finger jam injuries Party. Its brief is to examine the among children in their own homes issues surrounding finger jam injuries, • educate health care staff about and child care settings. develop prevention strategies and current recommendations on make recommendations on their infection control practices and The Shire incorporated information implementation. VISS is represented ways to reduce exposure from VISS on the prevention of finger on this working party. [Hazard 17, Sept 93] jam injuries, including the use of door • immunise hospital staff against guards, in their training program for The challenge Hepatitis B [Hazard 17, Sept new child care workers and raised In 1996 VISS will continue its efforts 93] awareness of the issue among the to increase community awareness of general public during Children’s Week this issue and push for the use of Accidental needlestick injuries are a 1995. The Shire will produce an products which prevent door finger serious concern because of the risk of educational video on the topic in 1996. jams in homes, child care settings, blood-borne transmission of Hepatitis kindergartens and schools through its Kidsafe has included VISS B and C and HIV. There were 225 work for the Victorian Prevention of information on finger jam injuries in needlestick injuries reported on the Injury Committee and other avenues. its leaflet on outdoor safety in pre- VISS hospital emergency presenta- school centres to be distributed in Community awareness (and sales) of tions database in the period 1991- 1996. the finger-safe guard will need to 1992. Injured workers were pre- increase dramatically for this measure dominantly registered nurses, medical Sales of this door hinge finger jam to have any significant impact on the practitioners, State enrolled nurses protective device have increased at an finger jam injury problem. and cleaners. accelerated rate during 1995. Sales almost doubled from 338 in the second Hazard 17 recommended an holistic quarter of the year to 640 in the third approach to this problem which quarter. includes education of healthcare workers and the development and This jump in sales can be attributed to promotion of safer products. a number of factors: the Risk Management Manual update; a A company that has taken this successful litigation case which drew approach and invested heavily in attention to the issue; greater research and development of safety- awareness through VISS input into engineered products and education programs to minimise the risk from

VICTORIAN INJURY SURVEILLANCE SYSTEM HAZARD 25 page 10 hypodermic products is Becton reduce needlestick injuries in hospital References  Dickinson, the world’s largest settings is the Interlink IV Access Chalmers D. “Prevention of arm manufacturer of needles and syringes. System (co-promoted with Baxter fractures in playground falls. Do we Healthcare). This intravenous therapy As shown in the Figure 4, the have the answers?” in Proceedings system introduces an advanced design from The First National Conference B-DSafety Lok Syringe is fitted injection site and safe blunt cannula on Injury Prevention and Control held with a sliding shield that locks over to replace conventional needles. It on 27-28 February 1995, Sydney, the needle and an indicator which eliminates up to 80% of the sharp NSW. Commonwealth Department turns red to green to confirm that the steel needles formerly used for of Human Services and Health . shield is in place and safe for disposal. intravenous administration. AGPS, 1995. This syringe is suitable for widespread general use in place of standard While many hospitals have intro- Harrison JE, Cripps RA (editors). disposable syringes. However, the duced needleless systems for the Injury in Australia: an epidemiological higher cost-per-item (currently more administration of anaesthetics, review. Canberra, AGPS, 1994 than double the cost of a standard Victoria appear to be lagging behind (Chapter 10). disposable syringe) is a barrier to use, other States in adopting hospital-wide Harrison JE, Dolinis J. Injury although the cost differential is needleless systems. From the Mortality Australia 1993. Australian shrinking as the volume of production information supplied to VISS in late Injury Prevention Bulletin 10, August increases. 1995, sixteen NSW hospitals have 1995. introduced a hospital-wide system, Murray T. “US pediatricians urge Another of the company’s products while the Maroondah Hospital is the recall, ban on baby walkers”. Injury that has the potential to significantly only Victorian hospital to do so. Prevention 1995;1: 149-151. The B-DSafety Lok Syringe Figure 4 Ozanne-Smith J et al. “Finger jam injuries to children in doors” in Child accident and injury prevention research in other than road accidents (unpublished). Monash University Accident Research Centre. 1992. Victorian Injury Surveillance System Hazard Volume 1, Editions 1 to 10, Injury data and prevention. Monash University Accident Research Centre. March 1993. Victorian Injury Surveillance System Hazard Volume 2, Editions 11 to 20, Injury data and prevention. Monash University Accident Research Centre. February 1995. Victorian Injury Surveillance System “Smoking-related injuries” inHazard Edition 21, Domestic Violence. Monash University Accident Research Centre. December 1994. Victorian Injury Surveillance System Hazard Edition 22, Product related injury - a selection (domestic architectural glass and shopping trolleys injuries). Monash University Accident B-D is a registered trademark of Becton Dickinson & Company InterLink is a registered trademark of Baxter Healthcare Research Centre. March 1995.

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[Hazard 15] , Jul 93 , Jul

15 uries associatedwith rollerbladin

j Shepparton News; The Age; The Today Show Rollerbladinginjuries have risen from no recorded cases in VISS participating hospitals in 1989 to 113cases in 1992 and 147 cases in 1993. Nearlyhalf ofrollerblading injuries recordedin 1993 were wrist injuries, 80%fractures. Eleven per cent were head injuries. The 10-14year old age group is mostatrisk andinjuries occurmost often on footpathsand publicroads. A small follow-up study in 1992 showed that rollerblading injuriesoccurred when userswere learning or when experienced rollerbladers were trying new stunts (most of the injured were not wearing wristguards). promote* the use of safetyequipment (helmets, wrist protectors, kneeelbow and guards) * create* areas for rollerblading separated from traffic andpedestrians encourage and initial training in a protected environment * children* under5 years old should notuserollerblades rollerblade* hire outlets should alsohire outprotective equipment;and hirers sellers shouldgive adviceon fitting of rollerblades, offerinitial and tuition recommend the use of safety equipment Journal of Paediatrics and Child Health; Kidsafe Magazine. four* including Department of Orthopaedics (Royal Children's Hospital) research* used as Case Study in Report to theAustralian Consumer's Council (1993) (Safety in the Making Product Safety for the Year 2000 - Moller, J. 1994) MUARC* has prepared a research proposal to examine theeffectiveness of wrist guards and investigate their wearing rate by rollerbladers. research* the use and effectiveness of protectiveequipment especially wrist safety guards regarding practice current determine to outlets hire survey * education and measures investigate* whether safety strategies association are promoted/implementedrollerbladers' by the uries In j , Mar 95 Edition:

lass in lass 22 [Hazard 7] g

[Hazard 7] , Sept 93; 93; Sept ,

[Hazard 7 & 22] 16

[Hazard 7] , Mar 93;

[Hazard 7] (trade journal) * O'Brien's Glass

[Hazard 22] , June 1990;

7 22]

Glass Australia

Hazard * promote* the application of special plastic film, bars,rails or warningstickers on existing hazardous glass * eight* including During the period 1989 to 1993 therewere 862architectural glass injuries recorded on the VISS hospitalemergency department database. Mostof them occurred in the home and involved glass doors and windows. The injured were predominantly male and in the younger age groups (under 5 year oldsfor children and20-24 year oldsfor adults aged >15 years). The vast majority of the injuries werelacerations to the upper limbs and face. where annealed glass was previously acceptable replace* annealed glass with safety glass whenever glass is replaced in existing homes reduce* the price level differential between safetyand annealed glass [ CSIRO* conducteda study to determine the nature of the domestic in injuries glassinvolved Editions: * include* the1989 revision of the Australian Standard (AS 1288)on "Glass in Buildings Selection - and Installation"in Victoria's buildingcode whichrequires safety glazing materials in some residential situations * research* study by Drs Nolan and Court (Royal Children Hospital) on a sample of children injured by domestic glass Victoria* adopted the 1989 revision to the "GlassBuildings" in Standardinto its building code, operational from April1991 for new houses and houses undergoing renovation monitor* the effectiveness of the revised AustralianStandard andBuildingcode requirement as an injury preventionmeasure promote* the use of safetyglass whendomestic glass is being replaced to householders,glaziers and insurance companies, with attention to reducing the price differential as* an interim measure promote the application of special plastic film, bars,rails and/or warning stickers on existing hazardous glass coverage Issue Prevention of domestic architectural follow-up Media Information requests Key recommendations Hazard action Further Implementation Future challenges Issues in Brief VICTORIAN INJURY SURVEILLANCE SYSTEM HAZARD 25 page 12 20]

Hazard 12 &20] , March 94 (work-related)

Hazard 18 , Sept 92; 92; Sept ,

12 20] , Nov 89;

Hazard , July 1989;

3 In the five year period 1989 to 1993, 1093 children presented to VISS to presented children 1093 1993, to 1989 period year five the In with dog bites, 26% cases of to hospitals admitted were these participating . risk at most were toddlers, particularly years, 5 under Children hospital. injuries bite dog for child location frequent most the was home at Outdoors adult 516 were there 1991-94, period year three the In cases). of (54% of thecases reported dog VISS in injury bite database. were deflectors magnetic of manufacturer the contact to VISS attempts * market the on longer no is product the - unsuccessful non- of issue the up take should who authority responsible the identify * scalds radiator car including injuries related vehicle motor traffic Editions: * promote the development of a radiator cap that has a safety valve and and valve safety a has that cap radiator of a development the promote * radiator boiling the deflect which deflectors magnetic as such devices [ mechanic or motorist the protect to downwards water/steam * develop a radiator cap which cannot be removed if the water temperature temperature water the if removed be cannot which cap radiator a develop * [ pressure or temperature a designated above is * promote * these rules safety promote cap radiator to wait thefor motorists: vehicle if cap remove and click first the to release touching; before down cool to there is [ no pressure 10 program

Hazard , Mar 92 92 Mar ,

10 Program,

Schoolsafe , Nov 1989;

Herald-Sun, The Sunday Age, Age, The Sunday Herald-Sun,

Better Health Better , Sept 93 (child care settings) care (child 93 Sept , radio, 16 Program, individual local government government local individual Program, , July 1989;

Safe Living Safe Living - 23 including Outdoor Education Department, Shire of Outdoor Department, Education - 23 including Program, Valley Latrobe - five including The Playgrounds and Recreation Association of Association Recreation and Playgrounds The including five - , Mar 93 (home injuries); injuries); 93 (home Mar , , Dec 88 (joy wheels); wheels); (joy 88 Dec ,

14 2

Safe Living Safe Victoria, of Bulla Victoria, Shire Editions: mostly occurred in school playgrounds and other childcare settings (47%), (47%), settings childcare other and playgrounds school in occurred mostly commercial or private and public and (18%) homes private by followed resulted injuries of 80% Over (17%). areas amusement and playgrounds sets swing and swings boards, sliding or slides bars, Monkey falls. from to injuries in involved frequently most equipment play of pieces the were of study follow-up Victoria of Association Recreation and Playground * and by site VISS, investigations identified including injuries playground [ recommendations with published victims/carers with interviews Mar 92] a over Council Kilda St by playgrounds from removed wheels joy nine * 2, VISS Dec 88] report[Hazard following three month period by * under has review a Standards theStandard been 1982 Australian been has revisions on agreement no but 1986 since Committee Australia to date reached NSW the of adoption the considering currently is Australia Standards * Playgrounds Safe on Guidelines Kidsafe * reported toFirst further research at and refine confirm findings the David Dr by 1995 Control and Prevention Injury on Conference National and heights fall regarding NZ) Unit, Research Prevention (Injury Chalmers 1.5 from falls 1.5 of than excess in heights injury from falls that (i.e. in injury equipment result playground to likely more times four over were metres less) or metres a of introduction the over developed has that impasse the break to action * undersurfacing which for includes Standard playgrounds revised There were 4,237 cases of play equipment-related injury under to children injury were cases There equipment-related 4,237 of play 1989- period the in hospitals participating VISS by reported age of years 15 93. The was year most age group 5-9 at risk Injuries injuries. of these Bulla councils * address design factors that are associated with play equipment injuries * injuries factors with that play address equipment associated design are bars, between distance and size rails, safety equipment, of height including Standards and revise ofand layout equipment Australian stability of proposed Parents and Citizens; Council Queensland (schools); 3, 14,[Hazard 16] the to undersurfacing absorbing impact effective maintain and install * 250mm) of 200mm (community depth playgrounds recommended conformance in Children's Services Centres Regulation Centres Services Children's in conformance 3, 14,[Hazard 16] * and conformance new toto attend Australian the maintenance design, the and for equipment (AS undersurfacing available, play Standard 2155), when (include child settings schools, care in primary all ABC Advertiser, Adelaide Herald-Sun, 60 Minutes Playgrounds play areas School coverage Issue injury equipment-related Play bites Dog Information requests Further action Further Implementation Challenges Future Key Key recommendations Hazard Mediafollow-up VICTORIAN INJURY SURVEILLANCE SYSTEM HAZARD 25 page 13 - INDEX - Subject Edition Pages Babywalkers, update ...... 16,20 ...... 1-4,12-13 Bunkbeds ...... 11 ...... 12 Bicycles - Bicyle related injuries ...... 6 ...... 1-8 - Cyclist head injury study ...... 2, ...... 2 - Cyclist head injury study updates ...... 7,8,10 ...... 8,13,9 Burns - Scalds ...... 3 ...... 1-4 - Burns prevention ...... 12 ...... 1-11 Chainsaw injuries ...... 22 ...... 13-17 Child care settings ...... 16 ...... 5-11 Data base use, interpretation & example of form ...... 2 ...... 2-5 Deaths from injury (Victoria) ...... 11 ...... 1-11 Dishwasher machine detergents - Update ...... 18 ...... 11 Dogs - Dog related injuries ...... 3 ...... 5-6 - Dog bite injuries ...... 12 ...... 12 Domestic architectural glass ...... 7,22 ...... 9-10,2-5 Domestic Violence ...... 21 ...... 1-9 Drownings/near drownings - Immersions ...... 2 ...... 3 - Pool fencing leglislation, update ...... 2,7 ...... 3,7 - Drownings & near-drownings at home ...... 5 ...... 1-4 Escalator and elevator injuries ...... 24 ...... 9-13 Exercise bicycles, update ...... 5,9 ...... 6,13-14 Home injuries ...... 14 ...... 1-16 Horse related injuries ...... 7,23 ...... 1-6,1-13 Infants - injuries in the first year of life ...... 8 ...... 7-12 Intentional injuries ...... 13 ...... 6-11 Latrobe Valley - The first three months ...... 9 ...... 9-13 - Latrobe Valley injuries ...... * March 1992 ...... 1-8 - Injury surveillance & prevention in the L. V...... *Feb 1994 ...... 1-14 Lawn mower injuries ...... 22 ...... 5-9 Martial arts ...... 11 ...... 12 Motor vehicle related injuries, non-traffic ...... 20 ...... 1-9 Needlestick injuries...... 11 ...... 12 Older people, injuries among...... 19 ...... 1-13 Off-street parking areas ...... 20 ...... 10-11 Playground equipment ...... 3 ...... 7-9 Poisons - Child resistant closures ...... 2 ...... 3 - Drug safety and poisons control ...... 4 ...... 1-9 - Dishwasher detergent, update ...... 10,6 ...... 9-10,9 Roller Blades ...... 15 ...... 11-13 School injuries...... 10 ...... 1-8 Shopping trolley injuries...... 22 ...... 10-12 Skateboard injuries...... 2 ...... 1-2 Smoking Related injuries ...... 21 ...... 10-12 Sports - Sports related injuries...... 8 ...... 1-6 - The 5 most common sports ...... 9 ...... 1-8 - Adult sports injury...... 15 ...... 1-10 Tractor injuries ...... 24 ...... 1-8 Trampolines...... 13 ...... 1-5 VISS: early overview ...... 1 ...... 1-5 VISS: how it works ...... 1 ...... 6-8 Work Related Injuries ...... 17,18 ...... 1-13,1-10 * Special edition VICTORIAN INJURY SURVEILLANCE SYSTEM HAZARD 25 page 14 Editorial Board How to Professor Peter Vulcan, Monash University Accident Research Centre Access VISS Dr Joan Ozanne-Smith, Monash University Accident Research Centre Assoc. Professor Terry Nolan, Department of Paediatrics, Melbourne University Data: Mr. Jerry Moller, National Injury Surveillance Unit VISS collects and tabulates information on injury problems in order to lead to the development of prevention strategies and their implementation. VISS analyses are publicly available for teaching, research and prevention VISS Staff purposes. Requests for information should be directed to the VISS Co- Director: Dr Joan Ozanne-Smith ordinators or the Director by Co-ordinators: Virginia Routley contacting them at the VISS office. Graeme Watt Research Assistant: Karen Ashby Administrative Assistant: Christine Chesterman VISS is located at: Building 70 Data Processor: Julia Palmer Latrobe Regional Hospital Accident Research Centre Associate Director: Dr Terry Nolan Monash University (Child Injuries) Wellington Road Clayton, Victoria, 3168 Postal address: General As above Phone:

Acknowledgements Reception (03) 9905 1808 Participating Hospitals Co-ordinators (03) 9905 1805 Latrobe Regional Hospital (Traralgon and Moe) (03) 9905 1815 The contributions to the collection of VISS data by the director and staff of the Director (03) 9905 1810 Emergency Departments of these hospitals, other particpating clinicians, Medical Records Departments, and ward staff are all gratefully acknowledged. The Fax (03) 9905 1809 surveillance system could not exist without their help and co-operation. Coronial Services Access to coronial data and links with the development of the Coronial Service’s statistical database are valued by VISS. National Injury Surveillance Unit The advice and technical back-up provided by NISU is of fundamental importance to VISS.

VICTORIAN INJURY SURVEILLANCE SYSTEM HAZARD 25 page 15 Project Funded by Victorian Health Promotion Foundation

VISS is a project of the Monash University Accident Research Centre.

Hazard was produced by the Victorian Injury Surveillance System with the layout assistance of Glenda Cairns, Monash University Accident Research Centre. Illustrations by Jocelyn Bell, Education Resource Centre, Royal Children’s Hospital and Ann James, Books Illustrated.

ISSN-1320-0593

Printed by Sands and McDougall Printing Pty. Ltd., North Melbourne

VICTORIAN INJURY SURVEILLANCE SYSTEM HAZARD 25 page 16