4th Annual Injury in Alberta Conference : final report

Supported by
the Occupational
Health and
Safety Heritage
Grant Program

Heritage Fund

A PROJECT FUNDED BY THE
OCCUPATIONAL HEALTH AND SAFETY
HERITAGE GRANT PROGRAM

4TH ANNUAL INJURY IN
ALBERTA CONFERENCE

[

Digitized by

the Internet Archive

in 2015

https://archive.org/details/4thannualinjuryi00inju

4TH ANNUAL INJURY IN ALBERTA CONFERENCE
FINAL REPORT

Submitted to:
Occupational Health & Safety
HERITAGE GRANT PROGRAM

By:

Injury Awareness & Prevention Centre

EXECUTIVE SUMMARY

The 4th Annual Injury in Alberta Conference was attended by approximately 220 participants.
Positive feedback from the participants and the number of conference registrants were both
indicators of the conference's success. Conference strengths as identified by conference
participants were:

• the networking possibiUties

• the quality of the speakers

• the format and quality of the organization of the conference

• the action oriented focus of the conference.

Seventy percent of respondents from the Occupational Health and Safety workgroup rated their
workgroup facilitators very good to excellent.

Major presentations were provided by Ms. Maureen Shaw, Dr. Herb Buchwald, Dr. Hugh Walker
and Mr. Dave Gibson. Conference participants were given the opportunity for a question and
answer session following each of the major presentations. A general discussion was then
conducted to assist participants in identifying and priorizing injury objectives as outlined in the
document "A Safer Canada, Year 2000: Injury Control Objectives for Canada". Subsequent to this
discussion the workgroup divided into three smaller workgroups to address individual objectives.
Workgroup facilitation was provided by the aforementioned as well as Ms. Susan Ruffo, Ms.
Deborah Smith, Ms. Ruth Nielson and Ms. Carol Eamer. The focus of each workgroup was as
follows:

Group 1 : the development and implementation of health and safety programs at workplaces with
six or more workers - using social marketing as a major strategy.

Group 2: the reduction of occupational injuries in Alberta by 30% by the year 2000 - using social
marketing as a major strategy.

Group 3: the development of health and safety programs at workplaces with six or more workers -
using information sharing, incentive programs and networking/coalition building strategies.

Action plans were developed by each of the three workgroups.

* The final report details workshop activities, highlights from the keynote speakers and action
plans developed during the course of the conference. A copy of the participants' evaluation,
participant materials and a final budget summary is also enclosed.

4th ANNUAL INJURY IN ALBERTA CONFERENCE
OCCUPATIONAL HEALTH AND SAFETY WORKSHOP SESSIONS

REPORT OF WORKSHOP ACTIVITIES

Thursday, October 22: 09:45 - 12:00 Noon: Concurrent Workshops:

(All Occupational Health and Safety Workshop Session Registrants together)

SPEAKERS/RESOURCE PERSONS:

Ruth Nielsen, Moderator
Maureen Shaw
Herb Buchwald
Vem Millard
Hugh Walker
Dave Gibson

PROCESS:

Presentation: What's New Internationally (Maureen Shaw)
Presentation: The Canadian Scene (Herb Buchwald)

Presentation: Occupational Health and Safety Initiatives in Alberta (Vem Millard)
Presentation: The Alberta Situation (Hugh Walker)

Presentation: Review the OH&S Objectives in the Year 2000 Report (Dave Gibson)
Identify a sub-set (4-6) of the Year 2000 Objectives relevant to Alberta and achievable
in the near future and of particular interest to the participants (discussion of potential
strategies will start)

Identify participants willing to work on each of the selected objectives

PRESENTATION: What's New InternationaUy

MAUREEN SHAW: Maureen is a past Chair of the Alberta Minister's Advisory Council
on Occupational Health and Safety and is the past chairman of the Council of Governors of
the Canadian Centre for Occupational Health and Safety. She is now the principal of MCS
International. Maureen has been active in increasing public awareness of occupational health
and safety across Canada and has been appropriately described as "an agent for change" and
"a lady with a vision."

TEXT OF THE PRESENTATION:

Internationally, as in Canada, we are in a period of awakening that is very exciting , while at
the same time we are faced with crisis.

Page 1

The awakening is the recognition of the need for, and benefits of, INTEGRATION at the
levels of policy development, legislation, program development, training and education.
AWAKENING means the recognition of the need for the transference of POWER to
community (community being individuals, groups, organizations). Hence, the increasing
emergence of volunteer organizations and coalitions. There is growing recognition that we
can no longer rely upon government, which will further facilitate the growth of non-
government organizations.

The crisis internationally is no different that what we are facing in Canada:
Lack of clear focus and direction

Constant downsizing as a reflection of the global recession, and
Lack of funds for current programs-never mind new ones.

Everywhere, people are scanning beyond their borders to see what others are up to. Is there
anything new?

What seems to me to be very exciting is the interest world-wide in sharing information,
learning from each other. Clearly, however, while many exciting discussions are taking
place, we are at a point where money~or lack of it-is going to make the difference in the
near future.

In Alberta, I have a real concern that soon we will wake up and realize that the recession
has taken its toll on organizations and its people and equipment. For example, the Junior Oil
Companies seem to be flourishing by acquiring de-valued equipment from the Majors which
are eager to divest themselves of these liabilities. Unless we manage to bring these
companies along, we will see the results in another five years.

What's happening around the world? Despite the current stresses there are positive things
happening.

In Europe, the European Commission has set 1992 as the European Year of Safety, Hygiene
and Health Protection at Work. The year is being used as an opportunity to raise awareness,
to educate, to commit to the future.

The European Foundation for the Improvement of Living and Working Conditions has

as its Guiding Principals the following:

The "working environment" includes not only the physical setting but also the
organizational and social surroundings.

Health is not merely the absence of accidents and illnesses but the presence of a
complete state of physical , mental and social well-being.

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preventive action is preferable to corrective action, is easier and less expensive, and
must be taken at the design stage of work systems, building, equipment and work-
stations.

Improvement of health and safety at work demands changes in behaviour as well as
changes in the environment.

The involvement of workers/users in introducing change is indispensable.

Improving working conditions pays.

For a start, I would like to see Canada fully commit to a similar set of principals that have
been developed and agreed to by the governments, business and labour.

International Harmonization of Chemical Hazard Communication requirements and the
development of International Standards is on the agenda of the I.L.O./W.H.O. and
discussions are taking place. These discussions will take some time. A colleague with one
of the principal international organizations told me that unless they can receive more support
they will take considerable time. These changes that surely must take place are being done
with existing resources only.

Dorothy Struck, Acting head of the U.S. Occupational Safety and Health Administration

(OSHA), stated in a recent presentation in Australia that OSHA is actively working towards
this end and views world harmonization as beneficial to worker and public protection as well
as facilitating chemical trade. The U.S. is also talking about continental harmonization and
co-operation.

The co-ordination of the activities of various international organizations is to be undertaken

by the International Program on Chemical Safety (IPCS).

IPCS - Created in 1980, is a joint venture of the United Nations Environment
Programme, the International Labour Organisation and the World Health
Organization. Its main objective is to assess the risks to human health and the
environment posed by chemicals, thus providing internationally evaluated
scientific information which countries can base their chemical safety measures.

INTOX - a computerized database management system for poison information
centres, has been developed by the International Programme on Chemical
Safety (IPCS) in association with the Canadian Centre for Occupational Health
and Safety (CCOHS) and the Centre de Toxicologie du Quebec (CTQ). It is
an outcome of the international IPCS/IDRC/CCOHS/CTQ project of the same
name.

Page 3

The INTOX package is directed towards the needs of the information room of
a poisons information centre, particularly in developing countries. It was soon
realized that developed countries did not have that information either.

As well, from IPCS, now on CD ROM, through CCOHS
International Chemical Safety Cards (MSDS)
Environmental Health Criteria Documents

Australia: The Australian approach has standards and the framework for handling
occupational health and safety issues established nationally through the National Commission.
The Commission is tripartite, involving state, territorial and commonwealth governments,
employers and unions- Work Safe Australia.

In November, 1991, the Premiers and Ministers of Labour set December, 1993 as the target
for uniform occupational health and safety standards and standards relating to dangerous
goods. Following the position of the European Community, there was mutual agreement that
recognition alone as a principle did not satisfy occupational health and safety needs.

The National Commission and Worksafe Australia have four complementary and coordinated
processes to seek the maximum degree of uniformity with respect to:

the harmonization of existing standards;

the development of new standards;

general occupational health and safety legislation; and

dangerous goods legislation.

Australia has developed a "World's First" -the National Data Set~a uniform, national coding
and classification system for W.C.B. systems. The system includes definitions of scope,
collection methods and data, a coding system with consistent training and guidelines, and a
central decision making system/register provided by Worksafe. The outcome, according to
Ted Emmett, C.E.O. of Worksafe, will be comprehensive national data covering all worker'
compensation, allowing a variety of valid comparisons. Implementation if well on its way.

Another interesting model in Australia is emerging for delivery of services. It has Workers'
Compensation authorities and the authorities responsible for prevention and enforcement
located within one agency (not unlike the British Columbia model). It is seen to enhance
communication and collaboration and is paid for through the W.C.B. assessment system. I
did not sense the same intensity of concern that I do here regarding the potential loss of
focus and identity of occupational health and safety to its more powerful brother
"compensation".

We (Canada) are seen as leaders in a number of areas by our Australian cousins. Namely:
WHMIS (our system along with the U.K. system provided the models for their new system).
While in Australia, I participated in a round table discussion-most of the questions centred
on WHMIS. "Is it working?" "What changes would you make?" They are also very

Page 4

interested in MIACC, the Major Industrial Accident Council^ as a model for multi-sectorial
approach to preparedness, prevention and mitigation of major industrial disasters. MIACC is
the world-leading model. (The whole question of the prevention of major industrial disasters
is also being discussed by the I.L.O. with the draft International Code under discussion at
this year's I.L.O. Convention. Next year MIACC is playing a major role.)

Australia is also very interested in our work in injury prevention and in the creation of a
social movement. Following one of my keynote presentations where I discussed the lAPC
and Injury Prevention Foundation and the "Hero's" program, I was besieged with questions
and was invited to be the guest on a morning radio talk show.

I find it a sad irony that as we are reducing our national facilitation work by organizations
such as CCOHS, other countries are taking the model (particularly our information/enquiries
service) and using it for developing their systems.

Thailand: In Thailand, the CCOHS National Inquiry Service is being used to develop their
system. They have until now focused the efforts of their National Centre on engineering
approaches.

Japan: In Japan, they are very interested in our MIACC approach, "Hero's", and our
communications systems. Japan is probably leading the world in making safety an integral
component of the cultural and values of organizations on the job and off. Dr. Kiyotsuigu
Saka, of the Japan Chemical Industry Association and Mitsubishi Kasei Corporation, says
that the key to improvement is the whole person and that we must use all the strengths of
psychology, behavioral science, and human engineering. Dr. Saka says that we must work
to reach HIYARI-HATTO: more and more eyes and minds watching, identifying.

Indonesia: I will just mention one last country, and that is Indonesia. Indonesia has a major
transformation in its health problems along with the industrial, transformation of the past few
years. While we think we have challenges, and we do, imagine the magnitude of the
challenges facing our colleagues in developing nations. We are exporting our industrial
system, and with them, problems that the local culture is unequipped to deal with. I recently
had the opportunity to discuss this transformation with Dr. Unar Achmadi, Professor and
Chairman of the Department of Environmental Health and Occupational Health, Faculty of
Public Health, University of Indonesia. Certainly, there have been marked improvements in
the incidence and prevalence of many acute communicable diseases. At the same time they
are seeing the emergence of what they call "new health risks." Occupational health problems
are becoming very prominent among the general population~not just the workers. Infant
mortality has been reduced from 142/1,(X)0 live births in 1971 to 54/1, (XX) in 1990.
However, injuries are now the fourth leading cause of childhood deaths (technology).
Poisoning alone accounts for more infant deaths than diphtheria, pertussis and tuberculosis
combined. Pesticide poisoning amongst children accounts for a high percentage of the
deaths. The plea from Dr. Achmadi was real, emotional and clear. "We must have a global
strategy for health problems related to industrialization." The rapid development in industrial

Page 5

activities in Indonesia is directly related to foreign investment and technology." He says that
we have a tendency to be concerned about the environment because it has become a global
issue. Occupational health and safety on the other hand is "another" issue. "Exported
technologies as part of package of investment from developed and rich countries to the
developing countries also means spreading occupationally-related disease. " We do have a
responsibility to be "responsible and accountable" in our trading and investing policies in less
developed countries as well as at home. Often, however, there is much to learn from their
approaches. This is one of the reasons we need to have shared systems to gather and
disseminate information.

The AWAKENING that is taking place provides us with the opportunity to meet the crisis
for a while, but we are going to face the music down the road as a result of the lack of
resources we have committed. It is time to go back and take a hard look at what we are
doing. I would like, as a start, to see Canada develop a set of guiding principals similar to
those of the European Commission that I mentioned earlier. This should be developed
jointly by labour, business, governments and the public, and adopted by all the provinces—
again with the multi-sectoral commitment. Then we can start again to build, based on a
shared vision for the future. Based on recent discussions in Australia and Europe
representing the Canadian Centre for Occupational Health and Safety, Maureen Shaw will
provide insight into projects and directions taking place. She will touch on such areas as the
International Program on Chemical Safety (IPCS-a project of the I.L.O., W.H.O., AND
U.N.E.P.) and approaches to injury prevention in Australia and Japan. She will also discuss
how Canadian approaches such as the Major Industrial Accident Council, Canadian Centre
for Occupational Health and Safety, the Injury Prevention Foundation and Alberta's
Partnerships Program are having an impact and generating interest internationally.

PRESENTATION: The Canadian Scene

DR. HERB BUCHWALD: Herb Buchwald, or "Dr. B." as he is known to many
occupational health and safety people in Alberta, recently returned to Alberta after spending
more than three years as General Manager of the Health Care Occupational Health and
Safety Association in Ontario. He is one of the first occupational health professionals to
come to Alberta, being recruited in 1964 to set up the occupational hygiene service and the
laboratory for the fledgling government program. From 1975 to 1988 he was the Assistant
Deputy Minister, then Managing Director of Alberta Occupational Health and Safety. He is
now an Adjunct Professor with the Occupational Health Program, Faculty of Medicine at the
University of Alberta. He counts activities with the Canadian Standards Association, the
Canadian Council on Protective Equipment and several professional groups among his many
interests.

Page 6

HIGHLIGHTS OF THE PRESENTATION:

Canadian occupational health and safety is a "mosaic of mosaics" and finds itself is
competition with other issues, including the volatile economy, the national debt and the
Canadian Unity debate.

During the past few years, the Canadian annual workplace death rate has dropped by more
than 35 percent to about 7 per 100,000 workers, and compensable injuries have gone down
by more than 20 percent to less than 9.5 per 100 workers. Can this trend continue? Some
current issues that relate to, and must be addressed in parallel to, this trend include:

WHMIS and the future of chemical hazards;

Economic pressures and competing priorities;

Quality improvement, stress and the ageing population;

Multiculturalism, multilingualism, literacy and worker rights; and

New technologies and societal expectations.

With respect to occupational injury and illness statistics, the National Work Injury Statistics
Division of Statistics Canada produces a compilation of Workers' Compensation statistics
across Canada. There is a need for greater harmonization of this data and for it to be
adaptable to changing needs. It is particularly deficient in the statistics on work-related
illness. To overcome some of these present limitations, a project has been established with
the Canadian Standards Association to establish a code for reporting work injury and illness
statistics.

WHMIS is a good example of a joint federal/provincial/ territorial initiative which has
standardized one aspect of occupational health and safety law across Canada. There is a
need to evaluate the effectiveness of WHMIS.

The Canadian jurisdictions have embarked on a process of further harmonizing occupational
' health and safety standards. Regulations respecting confined space entry and personal
protective equipment are the first to be examined.

The Conference on Protective Equipment will be combining with the Canadian Standards
Association to ensure ongoing attention to protective equipment.

Training of Occupational Health and Safety Officers (of government regulatory authorities) is
seen as an important issue, as the nature of workplace hazards changes, new standards
emerge and roles evolve.

The effectiveness of Joint Workplace Health and Safety Committees continues to be an issue,
with the need for training of committee members being recognized as a critical issue.

Page 7

PRESENTATION: Occupational Health and Safety Initiatives in Alberta

VERN MILLARD: Formerly the Chairman of the Energy Resources Conservation Board,
Vem is the author of the "Millard Report" on the Alberta Workers' Compensation Board,
Following acceptance of report, he was appointed as Chairman of the Board of the Alberta
WCB. His vision has led the WCB into a new era of programs to reduce workplace injuries
and has pioneered preventive programs, including innovative partnerships and incentives.

HIGHLIGHTS OF THE PRESENTATION:

Analysis of Workers' Compensation Board claims data reveals that a disproportionate number
of claims come from some industry sectors.

For several years, the lost time injury rate in Alberta has been near 5 per 100 man years
worked.

One of the most important initiatives adopted by the WCB in 1989 was the decision to play a
role in promoting the reduction of workplace injuries.

A target of 3.5 lost time injuries per 100 man years worked has been established for the year
2000.

In partnership with Alberta Occupational Health and Safety, employers, workers and safety
associations, the WCB has developed pilot work injury reduction programs.

Currently, there are some 450 employers, 120,000 workers and four safety associations
participating in this program.

PRESENTATION: The Alberta Situation

DR. HUGH WALKER: Hugh has been the Managing Director of Alberta Occupational
Health and Safety for the past three and one half years. Under his leadership, AOHS has
developed bold new programs, including the "Partnership" program with Alberta industries
and new ties with the Workers' Compensation Board. With a background in economics and
a particular interest in the economics of the health care system, Hugh has championed the
cause that "occupational injuries must come to be regarded as socially unacceptable, and has
led AOHS in the development of coalitions which are moving toward this objective.

HIGHLIGHTS OF THE PRESENTATION:

The most important occupational health and safety issue before us is social change. We
must make work-related injuries socially unacceptable to Albertans.

Page 8

Creating safe communities is one way of achieving that goal.

In Alberta, there are about 2.4 million people, and over one million of those are in the
workforce.

Recent progress has been made in reducing occupational injuries in Alberta. Based on the
most recent Workers' Compensation claims statistics, lost time injuries have decreased from
5.0 per to 4.4 per 100 man years worked. This is a 12 percent reduction over the previous
year or a reduction from 45,000 lost time claims to 38,000 claims. Of those, about 3,000
resulted in workers becoming disabled.

This human toll and economic cost cannot continue. New approaches are required. Public
awareness and social change will be the moving forces behind additional improvements.

Partnerships and joint ventures, with the leverage they can provide will become increasingly
important. Recent initiatives such as safe community projects, partnerships with stakeholder
groups and coalitions to deal with specific injury prevention are noteworthy.

In response to these changing times, the role of government regulatory authorities is
changing with more emphasis on voluntary compliance, incentives and education and less on
enforcement and prosecution, except in cases of flagrant violations. Limited resources in the
future will also require increased workplace responsibility.

Health and safety has traditionally been considered to be a "blue collar" issue. Often, the
victim was blamed for the injury-its their own fault, they were not responsible enough, did
not wear protective equipment, etc. There has been little perception of the cost of the
problem, the sources of injury, or the remedies available, including training and participation
by workers. These attitudes have to change.

Our goal must be to raise occupational health and safety on the public agenda.

In the future, how will be deliver occupational health and safety services?

Traditional approaches have been:
one on one inspections,
enforcement,

a focus on safety rather than health.

Occupational Health and Safety Officers selected from the trades,
reactive priorities, and
focus on fatalities.

Future strategies must include:
one on many/education,
promotion and consultation,

Page 9

health,

community and family focus,

getting the message into schools and shopping centres,

incentives,

pro-active,

disability related to injuries becoming a social issue, and
partnerships/leverage.

Partners in the future will be:
business and labour,
industry associations,
safety equipment manufacturers
medical/health care,
fire/police,

other government agencies, and

people in the business of health and safety.

We will need to push harder- to find some non-traditional partners:
safe community groups,
communities/families/women ,
libraries/schools/community centres, and
children influencing their parents.

How can we get these partners to work with us? By social marketing.

PRESENTATION: Review of the Occupational Health and Safety Objectives
in the Year 2000 Report: "A Safer Canada- Year 2000:
Injury Control Objectives for Canada"

DAVE GIBSON: After 25 years with Alberta Occupational Health and Safety, Dave
recently left government to set up a consulting practice. He specializes in helping worksites
deal their health and safety issues through the development of occupational health and safety
programs and the evaluation of the effectiveness of those programs. While with the
government he was the Director of the Occupational Hygiene Branch for 12 years and the
Director of Education and Promotion Services for four years. He was the chairperson of the
national working group which last year developed the workplace injury reduction objectives
for the document: "A Safer Canada- Year 2000: Injury Control Objectives for Canada.

Page 10

HIGHLIGHTS OF THE PRESENTATION:

In a series of teleconferences and a two day symposium in May, 1991, the Occupational
Injuries Working Group developed the workplace injury reduction objectives which have now
been published in the document: "A Safer Canada- Year 2000: Injury Control Objectives for
Canada." The following is a summary of those objectives:

Issues Related to Setting Objectives:

1. Inappropriate Attitudes

OH&S separate from "real" lives

Injury is a natural/expected part of work

Purpose of health care system is to respond to injury

2. Lack of information about injuries, illnesses, deaths, and their causes.

3. Well informed workers are less likely to be injured.

4. Health also needs to be protected.

5. OH&S programs needed.

Establishment of statistical baselines in a number of areas is a necessary requirement to:

measure current levels, and
track changes in performance.

Objectives: A. Data Improvements

1. Optimize the use of current Canadian data sources by improving standardization.

2. Identify and develop additional data systems for occupational diseases and cumulative
trauma disorders.

Objectives: B. Education and Information Improvements

3. Increase coverage of occupational injuries and illnesses in educational programs for
all health care practitioners.

4. Increase training opportunities for health and safety practitioners.

5. Include recognition of OH&S hazards in engineering and business curriculae.

6. Make OH&S information available at workplaces.

Page 11

7. Increase availability of low literacy and second language OH&S materials.

8. Establish high school "work-proofing" programs.

9. Establish baseline data for items 3 to 8.
Objectives: C. Occupational Exposure Standards

10. Establish baseline exposure for occupational hazards where Occupational Exposure
Limits exist.

11. Reduce exposure to known occupational health hazards.

12. Review existing Occupational Exposure Limits.

13. Develop uniform national Occupational Exposure Limits.

14. Adopt the uniform national Occupational Exposure Limits.

15. Develop Health and Safety Programs for workplaces with 6 or more workers.

16. Develop back injury prevention programs.

17. Develop baseline data for 15 cind 16.
Occupational Health and Safety Objectives

1. Reduce the national rate of deaths from work-related causes by 30%.
(8.2 to 5.7 per 100,000 workers per year) '

2. Reduce the number of lost-time injuries from all work-related causes by 30%.
(613,836 to 429,685 injuries per year)

3. Reduce jurisdictional rates of injuries by 30% in high risk and 15 % in low risk
industries.

4. Reduce the jurisdictional rate of work-related back injuries by 30%.

GROUP PROCESS:

Following questions and discussion, participants identified objectives that they were
particularly interested in working on. Participants were divided into three small groups for
detailed examination of one of the objectives during the following two workshops periods.

Page 12

Thursday, October 22: 14:45 - 16:30: Concurrent Workshops:

FACILITATORS FOR SMALL GROUPS:

Susan Ruffo
Deborah Smith
Ruth Nielsen
Carol Earner

RESOURCE PERSONS:

Maureen Shaw
Herb Buchwald
Dave Gibson

GROUP PROCESS:

Occupational Health and Safety Workshop Registrants allocated to smaller groups
Each small group to work on goals specific to its selected Year 2000 Occupational
Injury Reduction Objective

Goals must be relevant to Alberta, achievable in the near future (next 1-2 years), and
observable/measurable (discussion of potential strategies will continue)

RESULTS:

Each of the three small groups met and started discussion of its occupational injury reduction
objective.

Page 13

Friday, October: 09:15 - 11:15: Concurrent Workshops:

FACILITATORS FOR SMALL GROUPS:

Susan Ruffo
Deborah Smith
Ruth Nielsen
Carol Earner

RESOURCE PERSONS:

Maureen Shaw
Herb Buchwald
Dave Gibson

GROUP PROCESS:

Occupational Health and Safety Workshop Registrants allocated to smaller groups
Each small group to work on activities specific to its selected goals for its Year 2000
Occupational Injury Reduction Objective

Activities must be relevant to Alberta and must be demonstrably supportive of the
Year 2000 Objective (discussion of potential strategies will firm up)
Each activity must have a leader, contact, focus group or champion identified to
implement the activity

Each small group to report back to the Occupational Health and Safety Workshop at
the end of the session with formalized action plan, including identification of key
stakeholders, overall timeline for the activities and outline of measurement approach
(All Occupational Health and Safety Workshop Registrants together)

RESULTS:

Each of the three small groups continued discussion of its occupational injury reduction
objective, and developed an action plan for achieving the goals the group had established for
the injury reduction objective.

Each small group reported back to the Occupational Health and Safety Workshop with its
plan.

Page 14

Friday, October 23: 11:15 - 12:00: Presentations from Workgroups:

(Conference Plenary)

RAPPORTEUR:

Dave Gibson

GROUP PROCESS:

A report from the Occupational Health and Safety Workgroup to the whole Conference.

RESULTS:

GROUP I:
Objective:

Develop and implement health and safety programs at workplaces with six or more
workers.

Goals:

Get a commitment from workers and employers:

want to develop and change the community "culture" to a safe community
culture. We see safe and healthy workplaces as an integral part of a safe
community.

occupational health and safety practitioners can no longer work in isolation, so
welcome the safe community concept.

Strategies:

Among many, we highlight:

changing attitudes and behaviours of "workplaces" (includes all those involved
ate workplaces).

need to measure - we* will be asking the Injury Awareness and Prevention
Centre to:

include workplace health and safety programs as a component of the
measurement of safe community effectiveness and evaluation,
we* will provide the technical input into this measurement tool

* "we" includes:

staff of Alberta Occupational Health and Safety
staff of the Workers' Compensation Board- Alberta
Alberta Workers' Health Centre
program managers at worksites
etc.

Page 15

GROUP n:

Objective:

Reduce occupational injuries in Alberta by 30% by the year 2000.

Goal:

Increase the number of people who say that they are aware of Alberta Occupational
Health and Safety legislation to 80%.

Strategy:

Social marketing: public awareness/change a social value

Activities:

Advertising - specific age groups Doris and Tee

- positive approach
Education - schools - high

- junior high

- via curriculum

- Specific-employer based (high risk industries) AOHS'^

- Employer association-based

- AOHS, unions, Apprenticeship Board,
Advanced Education, School Boards, Home
and School Associations, Workers' Health
Centre

Displays - at public events Kathy/IAPC^"^

- safe community network

Game - use at displays Lynda/Brian/Tom

- computer-based

- interactive video

- board

- make safety fun

- development: incentive to kids

- problem-solving approach

- students, computer companies, teachers,
video companies, AOHS*, Canadian Centre
for Occupational Health and Safety

* AOHS
** lAPC
italics

Alberta Occupational Health and Safety
Injury Awareness and Prevention Centre
Names of persons with follow-up responsibility

Page 16

GROUP ni:

Objective:

Develop and implement health and safety programs at workplaces with six or more
workers.

Stakeholders:

Industry Associations

Workers' Compensation Board- Alberta

Alberta Occupational Health and Safety

Safe Communities

Workers' Health Centre

Injury Awareness and Prevention Centre

Strategies:
1.

2.

3.

dentify a Central Clearing House
list partners
resources
data

guidelines
programs
media/ videos, etc.

Forum For Action on Workplace Health and Safety, Injury Awareness and
Prevention to help identify.

Universal Incentive Programs

Workers' Compensation Board- Alberta and Alberta Occupational
Health and Safety exchange existing criteria

Innovative Networking and Coalition of Partner Groups
Associations partnering with each other
Schools

Community Organizations
In order to foster attitude/behaviour changes, to pool resources, and to share
information.

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APPENDIX 1

4th Annual Injury in Alberta Conference
Executive Summary

Received 57 completed evaluation forms out of a possible 190 (pre-conference registration count). A
response rate of 30%.

• 97.9% of responses indicated a rating of very good to excellent for the overall
program.

• 90.4% of responses indicated a very good to excellent rating for Dr Leif Svanstrom's
presentation at the open lecture, Creating Safe Communities.

• 98.1% of responses indicated a rating of very good to excellent for Dr Robert Conn's
presentation at the opening plenary, Safe Communities: The Canadian Perspective.

• 85.1%) of responses indicated a rating of very good to excellent for the Panel Plenary
Session, What works in Preventing Injuries.

• In response to the question, what did you like most about the program?, there were four recurring themes
throughout the evaluations:

• the networking possibilities of this conference

• the quahty of the speakers especially Dr. Svanstrom, Dr. Conn, and Captain Vanderbrink

• the format and quality of the organization of the conference

• the action oriented focus of this conference

There was also several comments on the value of the contact with the native population and the issue
surrounding this population.

•Responses to what delegates would like to see changed for future conferences were very diverse. The
following are the items that there was some degree of agreement on.

• more workshop time/discussion time

• the idea of comprehensive coordination or multisectorial workshops - the challenge to work
together

• ideas for action - moving motivation from an individual level to a community level

• more displays on community based projects

• more networking time - longer breaks

• Native focus

• reports on what we have accomplished since last conference '

• person's affiliation bigger on name tags

• All elements of the conference w^ere rated extremely highly.

• Rating of workgroup facilitator/s were as follows:

•Transportation - 100% of respondents rated this group very good to excellent.
•Sports/Recreation - 100% of respondents rated this group very good to excellent.

• Home & Community - 90% of respondents rated this group very good to excellent.
•Native - 77.7% of respondents rated this group very good to excellent.

• Occupational - 70% of respondents rated this group very good to excellent.

• Violence -66.6% of respondents rated this group very good to excellent.

• 38.6%) or respondents heard about the conference from the lAPC News and 22.8%
from the conference brochure.

The 4th Annual Injury in Alberta Conference
Summary of Evaluations

Received 57 Evaluations out of a possible 190 (Pre Conference registraiton count). Response rate
of 30%.

Transportation - 11

Sports/Recreation - 7
Home and Community - 10

Native - 9

Occupational Health - 10

Violence - 3

Not Specified - 7

Questions 1 to 4, 7 and 8 were responded to according to the four part scale of 1 to 4 with 1 being
poor and four being excellent.

1 . Where on the scale would you rate the overall program?

Responses 48/57 = 84.2% of these
30/48 or 62.5% rated the Conference at 3
17/48 or 35.4% rated the Conference at 4.

2 . The open lecture, Creating Safe Communities? (Dr. L. Svanstrom)

Responses 31/51 = 54.9% of these
14/31 or 45.2% rated the open lecture at 3
14/3 1 or 45.2% rated the open lecture at 4.

3 . The opening plenary, Safe Communities: The Canadian Perspective? (Dr.
R. Conn)

Responses 54/57 = 94.7% of these

10/54 or 18.5% rated the opening plenary at 3

43/54 or 79.6% rated the opening plenary at 4.

4 . The Panel Plenary Session, What works in Preventing Injuries?

Responses 47/57 = 82.4% of these
7/47 or 14.9% rated the panel plenary at 2
29/47 or 61.7% rated the panel plenary at 3
1 1/47 or 23.4% rated the panel plenary at 4.

5 . What did you like most about the program?

In response to this question there were four recurring themes throughout the evaluations:

• the networking possibihties of this conference

• the quality of the speakers especially Dr. Svanstrom, Dr. Conn, and Captain Vanderbrink

• the format and quality of the organization of the conference

• the action oriented focus of this conference

Summary of Evaluations - 4th Annual Conference

2

There was also several comments on the value of the contact with the native population and the
issue surrounding this population.

6 . What would you like to see changed for future conferences?

Responses to what delegates would like to see changed for future conferences were very diverse.
The following are the items that there was some degree of agreement on.

• more workshop time/discussion time

• the idea of comprehensive coordinadon or muldsectorial workshops - the challenge to
work together

• ideas for action - moving motivation from an individual level to a community level

• more displays on community based projects

• more networking time - longer breaks

• Native focus

• reports on what we have accomplished since last conference

• person's affiliation bigger on name tags

7 . How would you rate these elements of the conference?

Registration

Responses 55/57 = 96.5% of these
22/55 or 40.0% rated the Conference at 3
30/55 or 54.5% rated the Conference at 4.

Schedule/Agenda

Responses 54/57 = 94.7% of these
33/54 or 61.1% rated the Conference at 3
21/54 or 38.9% rated the Conference at 4.

Workshops: Length
Responses 53/57 = 93% of these
29/53 or 54.7% rated the Conference at 3
19/53 or 35.8% rated the Conference at 4.

Workshops: Format
Responses 51/57 = 89.5% of these
6/5 1 or 1 1.8% rated the Conference at 2
29/51 or 56.9% rated the Conference at 3
15/5 1 or 29.4% rated the Conference at 4.

Displays

Responses 56/57 = 98.2% of these
30/56 or 53.6% rated the Conference at 3
25/56 or 44.6% rated the Conference at 4.

Summary of Evaluations - 4th Annual Conference

Meeting Rooms/Hotel
Responses 56/57 = 98.2% of these
31/56 or 55.4% rated the Conference at 3
24/56 or 42.9% rated the Conference at 4.

Food

Responses 53/57 = 93% of these

19/53 or 35.8% rated the Conference at 3

33/53 or 62.3% rated the Conference at 4.

Hotel Staff & Service
Responses 49/57 = 86% of these
19/49 or 38.8% rated the Conference at 3
30/49 or 61.2% rated the Conference at 4

The Blame Game

Responses 28/57 = 49.1% of these
9/28 or 32.1% rated the Conference at 3
18/28 or 64.3% rated the Conference at 4

8 . Hov*^ would you rate your workgroup facilitator/s

Transportation

Responses 11/41= 27% of these

2/1 1 or 18.2% rated their facihtator at 3

9/1 1 or 81.8% rated their facihtator at 4

Sports/Recreation

Responses 7/19 = 37% of these

4/7 or 57.1% rated their facihtator at 3

3.7 or 42.9% rated their facihtator at 4

Home & Community
Responses 10/41 = 24.4% of these
5/10 or 50% rated their facilitator at 3
4/10 or 40% rated their facihtator at 4

Native

Responses 9/27 = 34% of these
2/9 or 22.2% rated their facilitator at 2
4/9 or 44.4% rated their facilitator at 3
3/9 or 33.3% rated their facilitator at 4

Occupational Health
Responses 10/36 = 28% of these
1/10 or 10% rated their facilitator at 2
3/10 or 30% rated their facihtator at 3
4/10 or 40% rated their facihtator at 4

Summary of Evaluations - 4th Annual Conference

4

Violence

Responses 3/19 = 16% of these

1/3 or 33.3% rated their facilitator at 2

1/3 or 33.3% rated their facilitator at 4

Additional comments.
Transportation

I feel inspired. Thank you!!

A break at noon for exercise/fresh air would be appreciated. Some of the sessions too long!! ie
Friday a.m. 9:15-11:15 - difficult to stay motivated - no break - comfort important.

Herb Simpson is an extremely intelligent and knowledgeable about his topic, well organized and
humerus as a facilitator.

Thank you for bringing in Herb Simpson - he is excellent. We need his and others expertise to
inspire the group! Please put the names of the participants - first and last name in large print.

Most informative. Excellent content. Dr. Herb Simpson - excellent.

Very knowledgeable, good at perceiving the gist of questions or statements from participants.
Sports & Recreation

A well organized, informative conference. I would have liked more interaction with the keynote
speakers on an informal basis.

The workshop I attended was very helpful in terms on general ideas and response. I felt that there
was a little more emphasis on sport than all recreational pursuits ; like play (unstructured). I think
"hockey" was used as an example for most of "fair play" info which was helpful but a bit too
limiting. "Behaviors" in a recreational or sports setting would have applied to a few more of us -
otherwise quite helpful and informative (all of the sessionsV.

Guy - excellent. 4+ (Workshop 1 & 3) Workshop #2 - Ois physician was informative re: his job
but didn't let workshop members participate till very end. Very poor.

The man from Quebec was very good (Guy). The man from Edmonton was good. Could have
gotten a bit more participation from the group, however very good.

Guy was extremely knowledgeable and an excellent facilitator. He provided lots of useful
information to take away and apply.

Good work - came away with some valuable information plus good contacts. Liked handouts
(great for sharing with other staff). Liked summary booklet (good for finding out about other
areas).

Summary of Evaluations - 4th Annual Conference

5

Home and Community

I was in the home and community group. I was somewhat disappointed in the narrow focus on
burn - however, during the course of discussion, some broader coalition between was touched on.
PADIS presentation somewhat duplicated and repetitive. Could have had more discussion around
home issues.

Posting the burns and poison groups on the 2nd day was not good for the momentum that had
developed in the bums group. The poison lecture (within workshop) was too long and much of
what was presented wasn't necessary for this group or our purpose and was much too long. Not a
good idea to leave 2 groups meeting in the same room. Not quite enough control when discussing
got too long and diverse - otherwise excellent.

For some reason, probably my own oversight, I did not realize that Home & Community was just
going to be fire, burn and poison. Overall, the possibility of coming together with people
interested in injury prevention is valuable and important.

The first workshop sessions on bums should have been worked on in day two I believe, could
have looked for transferrable skills networks, behavior/technology issues. How about more tie in
to national objectives? Poisoning diversion not helpful.

Workshop outlines/reference material manual excellent - one suggestion - leave a few blank pages
for note taking following each section so all information in one place. Thanks Alberta for leading
the way. It's an inspiration to come and see your progress!

International speakers were of lesser caliber than the local (Alberta) and other Canadian presenters.

I was really unclear as to what we were trying to achieve. There was only about one half an hour
to plan and the agenda for that had been set.

Native

Disappointed with Native group sessions. Unable to understand the focus or what can or should
be happening. I enjoyed attending one session of the sports group and obtained good info to assist
us in the Winter Games. I was able to make good contacts with other community people and or
plans to meet soon and work collectively and collaboratively.

Need more of a "Take Charge" attitude.

Focus was not on injury prevention.

It was very stimulating to see a new aspect to Health prevention. I had never thought of the
tremendous expense involved with injuries.

I would like to see the Blame Game actors present a play on Feelings, Caring - to model - how to
give and receive positive feed back, to have an awareness re how to respond when they get
negative feed back when they feel hurt, attacked etc. Although they may be aware of their feelings
and how to express - many people in their viewing public may not. PADIS was too long. I would
rather have worked further in our group.

Handled tactfully.

Summary of Evaluations - 4th Annual Conference

6

Occupational Health

Political comments inappropriate.
Great job Dave and Susan!

The facilitator for our work group was excellent. She had a difficult job to keep everyone on track
and I believe she did this. Also group members come with very diverse backgrounds so having
them reach a common end is a challenge.

That was me. Thumbs down. I wasn't adequately "tuned in" to this group. Had also pre-
conceived a notion of what the participants would be concerned with - and I was wrong.

Violence

I felt the Violence and Injury caused by same, workshop was very good in the first session. It
carried all types of violence. However I was not aware from the registration info that family
violence would be the main topic of discussion. I felt that women's issues took over and there was
not much discussion and expertise on other types of violence. Perhaps if the issue is to be family-
women related you should indicate this in future when advertising your conference. This is not to
say that these issues are not important to myself and society, simply I did not get the type of
experience I was expecting. As a result I shopped around and attended some other very interesting
discussions. I also assumed Linda MacLeod would lead the entire workshop.

But they continually focused on violence and women when I was expecting a broader view.
Concemed that Facilitators presented a tool that they had developed, and we merely previewed it -
had hoped to have more input - come away with more specific ideas.

First speaker very dynamic and interesting. The 2 & 3rd workshops were not quite what I had
expected. Wanted to look more at what violence strategies across the whole sector would be. I
had wished to go further than the level that we had reached.

Not Specified

Guy was excellent. It would have been good to expand on different sports.

Dr. Maria Carey did an excellent job in the injuries to Native group; Leif is an excellent resource
who is practical and clear.

Excellent people but felt they brought their agenda with them - choice of group activities influenced
direction of group.

How did you hear about the conference? (Please check)

From a Friend -

3

3/47 =

5.2%

lAPC Newsletter -

22

22/57 =

38.6%

Conference Flyer -

13

13/57 =

22.8%

Full Conference Brochure -

6

6/57 =

10.5%

Summary of Evaluations - 4th Annual Conference

7

Conference Planning Committee Member -

8

8/57

14%

Other -

3

3/57

5.2%

No Answer -

2

2/57

3.5%

Have you attended a previous Injury in Alberta conference? (Please check)

Yes- 15 15/57 = 26.3%
No- 42 42/57 = 73.7%
How many? 1, 3, 1, 1, 3, 1, 3, 2, 2, all, 1, 2

What topic areas would you like to see addressed next year?

Urban communities i.e. Edmonton/Calgary. - issues/strategies in mobilizing.

Some sort of forum for "generic" discussion. Keep building on what you have - a great job!

Consider a poster session where participants informally exchange information on "what works".

Looking at "Safe Community" concept for small town rural Alberta. More on the violence area -
family societal - etc.

Cross the sector boundaries. Specific planning time for specific objectives.

Theme: Safety Education Through The Ages (Early Childhood - Lifelong). Marketing the Safety
Message. Safety - What's It Mean to You and Me. I'd be most pleased to assist in facilitating next
year's conference and/or participating as a member of a group working toward establishing a
clearing house/coalition to facilitate safety education, awareness and prevendon.

Examples of markedng. Some theory on role of health promodon in injury prevention. Seniors.
Intentional injuries including child abuse.

Notice of the sale of conservative party memberships was inappropriate.
Data management Include consumers real people.

Engaging community agencies. - strategies etc. Schedule presenters and expect them to stay on
time. ie. Ft. McMurray - may have been handled better as a display - did not need to see all ads, a
sample is good enough.

Community Development - 1 heard people express this need. How to take the info, digest it and
start out reasonably so they don't bum out!

Invite the media. Get industry involved.

As I've said - native issues - community issues, use grass roots to help evaluate if our messages
have gotten out and across to our projected audience.

Summary of Evaluations - 4th Annual Conference

8

Focus on workplace safety.

Motor vehicle injuries. Children - injuries - situated areas. Injuries with seniors.

Evaluation of current program - what works? How do we make it work and how to evaluate how
it works.

Re Sports & Recreation Activities: Is anyone addressing the VIOLENCE related to HOCKEY - a
very real issue which is being underplayed in terms of breach of rules. Lets promote fair play and
get through to people like Don Cherrie.

Injuries as result of violence, again but perhaps more focused on children, elders, schools, etc.

Specific strategies for action and change in every front. Discuss concrete action methods.

The same high calibre conference using the leading issues of next year will definitely bring me
back.

More on transportation and issues relating to childhood injuries.

I would like the exchange of new ideas and concepts to continue. I liked the example of a safety
city or community. The only problems I had is only looking in long term for significant changes to
happen. Its difficult for me to think 4 years down the line when you are on a 4 month project. 1
like the idea that "action" can happen without years of analysis. New ideas for action and
implementation were fantastic! !! Keep it. Could "water" safety and electrical safety be added next
year under "home safety" concept.

Perhaps some discussion from individuals who have had an injury of some type, focusing on their
experience ie. How has their life changed, their suggestion on improvement in policy/procedure on
prevention of reoccurrence. It would seem to me that 1st hand info from "survivors" may help to
emphasize the issue.

Evaluation of interventions.

Violence in spectator sport should be addressed since sport stars play a major role in the lives of
our youths. Hero worship is a part of the youth culture and sport stars are influential role models
for the young. Unfortunately the society seems to enjoy and encourage violence in sport.

How to motivate a lethargic community.

Program evaluation strategies. Innovative/creative strategies (at the local level). Collaboration is
the key - how to create coalitions/partnerships for injury prevention. Re motivational strategies for
data collection - perhaps lAPC/planning committee could consider awards at local level for groups
organization making significant contribution (ie. cooperation) toward data collection.

A continuation of resolutions and ideas adopted here this year, so we can see what ideas have
evolved into actions.

Further expansion in the development of strategies to increase injury prevention as a
community/social norm.

Summary of Evaluations - 4th Annual Conference

9

Successes - Collaboration with other groups. Injury prevention in context of WHO view of total
health PROMOTION (includes environmental context - political, cultural, economic etc.).

Discussions specific to Safer Communities - progress reports - what worked, what didn't.

A workshop for people who deal with many of the issues and not just one area - eg. promoting
injury prevention in your community.

More on safe communities - how is Alberta doing. Muludisciplinary groups - discussion around
possibilities roles and process if you are just starting out.

What has been done in the past year.

More info on Safe Communities. More focus on preschoolers. More opportunity to network.

If participants were prepared to commit, we could address surviellance systems and evaluations.

Perhaps hearing from groups who have developed injury prevention programs at a local level.
What were their challenges and obstacles and how did they overcome them. Perhaps a panel from
a Hospital since this is my area of focus. Overall an excellent, well-planned conference with great
speakers.

Playground safety and other child safety issues. Seniors issues - injury prevention.
Home/recreation safety issues and education.

APPENDIX 2

W@rksli@p Outlines

Reference Material

October 21 - 23, 1992
Bdmonton, Alberta

TABLE OF CONTENTS

4th Annual Injury in Alberta Conference
Edmonton Hilton
21-23 October 1992
Edmonton, Alberta

Page

SAFER CANADA INJURY RECOMMENDATIONS

- The Honorable Nancy J. Betkowski i

Health Goals viii

INJURIES AMONG NATIVES WORKGROUP

Workshop Outline 1

Native Injuries* (Article) 2

Native Injury Abstracts 4

Richard Musto Presentation - Canadian Pediatric Society, Sept. '92 5

INJURIES AS A RESULT OF VIOLENCE WORKGROUP

Workshop Outline 16

Introduction 18

Issues Related to Setting Objectives 18

Issues for Active Consideration 19

Injury Control Objectives Violent and Abusive Behaviour 19

Violent and Abusive Behaviour Objectives 20

References 21

INJURIES IN THE HOME AND COMMUNITY WORKGROUP

Workshop Oudine 22

Fire Losses in Alberta 25

Bum injuries in native Canadians: a 10-year experience* (Article) 26

Profile of the pediatric bum patient in a Canadian bum centre* (Article) 3 1

OCCUPATIONAL INJURIES WORKGROUP

Woricshop Outline 37

Overview 39

Provincial Totals 40

Major Industry Sectors 40

Person- Year Estimates and Qaim Rates by Detailed Industry 41

Primary Resource - 1990 versus 1991 41

Manufacturing - 1990 versus 1991 42

Construction - 1990 versus 1991 42

Trade - 1990 versus 1991 43

Transportation and Utilities - 1990 versus 199 1 43

Service - 1990 versus 1991 44

Public Administration - 1990 versus 1991 44

Description of Lost-Time Qaims, 1990, 1991 45

A Safer Canada* (Article) 48

TABLE OF CONTENTS CONTINUED

Page

SPORT AND RECREATIONAL INJURIES WORKGROUP

Workshop Outline 50

Overview 54

Introduction 56

Issues Related to Setting Objectives 57

Data Availability 57

Level of Participation 58

Legislation 58

Risk Management Education 59

Issues for Active Consideration 59

Playground Injury Reduction Strategies 59

Bicycle Injury Reduction Strategies 59

Drowning Reduction Strategies 60

Off-road Vehicles Injury Reduction Strategies 60

Injury Prevention Program Strategies 60

References 61

Sport Medicine Council of Alberta 62

Resources 63

TRANSPORTATION INJURIES WORKGROUP

Workshop Outline 64

Introduction 66

Where we are? 66

Dimensions of the Challenge: 66

Cost Effective Prevention Opportunities: 67
Current Traffic Injury Prevention Initiatives

in Alberta: 67

Alberta Solicitor General Initiatives 68

The Impaired Driving Initiatives Grant Program 68

Checkstop 69

The Suspended Driver Vehicle Seizure Program 69

The Designated Driver Program 70

The Vehicle Immobilization Program 7 1

Ignition Interlock 71

The Administrative Licence Suspension Program 72

The Report on Impaired Driver (RAID) Program 72

The Enhanced Impaired Driving Detection Aogram 73

The Impact Impaired Driving (3>urse 74

The Planning Ahead Impaired Driving Course ' 74
An update from the Solicitor General's Office on

Inq)aired Driving in Alberta 75

Current Alberta Motor Association Traffic Safety Initiatives 77

Driver Education/School Patrol 77

Impaired Driving Programs 78

Child Restraints 79
Alberta Auto Insurance (by Alan Wood, Insurance Bureau

of Canada) 80

ii

TABLE OF CONTENTS CONTINUED

Page

Alberta Transportation and Utilities Initiatives 8 1

I Transportation Safety Branch 8 1

'] Minister's Advisory Committee on Traffic Safety 82

] Where We Want To Be 83

I Year 2000 Injury Control Objectives for Transportation

h Injury Prevention 83

Report of the Transportation Work Group 85

i Transport Injury Control Objectives - Reductions 87

I Transportation Injury Control Objectives - Increases 88

1 References 88

Supplementary References for the Objectives 89

iii

From the Office of the Minister of Alberta Health (September 1992)
The Honorable Nancy J. Betkowski

SAFER CANADA INJURY RECOMMENDATIONS

The recommendations put forward in the document "A Safer Canada" are reasonable and
useful from an Alberta Health perspective. Further, these recommendations support earlier
work done by the department, namely the "Background Paper on Accident and Injury
Prevention - 1990" and "Injury Prevention Program Options for Children and Seniors -
1991." These documents have been widely circulated and are available from the Health
Promotion Branch.

Of particular importance in the recommendations from "A Safer Canada" is the emergence
of a common direction and set of priorities. The challenge is to build local, provincial and
national coordination and support. In Alberta there are many good things happening, but
often in isolation. Building partnerships, clarifying our common agenda, and placing die
community at the center of any injury prevention strategy is fundamental. Also, emphasis
on creating a safe physical environment could be elaborated to include a mental health-
enhancing environment.

The recommendation highlighting the importance of a surveillance system is critical if we
are to ensure accessible information to individuals and communities from which they can
plan to prevent injuries. It is anticipated that deliberate, self induced injuries would be
included in the system. In this regard, the recommendation by the Task Force on Suicide
in Canada to develop a similar system should be reviewed. Further, we must acknowledge
the information currently available and then look at ways to link databases and supplement
current information.

ALBERTA HEALTH INITIATIVES IN INJURY PREVENTION

AN OVERVIEW

As a health department, opportunities for injury prevention spread across the full
continuum of care. These have been identified below and should be read within the context
of the recommendations put forward in "A Safer Canada."

Health Goals and Objectives for Alberta

In 1991, the Minister of Health established a Ministerial Advisory Committee to examine
health goals and objectives for Alberta. As part of this initiative, four work groups were
established to develop objectives and strategies supporting the nine health goals delineated
by the Minister's Advisory Committee on Health Goals and objectives for Alberta.

Ultimately, each of the four work groups addressed a stage or phase of life - infants and
children, adolescents, adults and older adults. Injury related objectives and strategies were
developed for each cohort, as one component of the total health picture. As part of an
expert review, these proposals were forwarded to the Injury Awareness and Prevention
Centre, University of Alberta Hospitals, for comment. These comments have been
received and are under review.

Interdepartmental collaboration and stakeholder consultation will continue. Alberta
organizations and communities will be encouraged to use the provincial health goals and
objectives to guide their local planning activities as part of the major restructuring of the
health system.

Data Systems

In order to begin establishing a comprehensive injury data base, a grant from the Health
Services Research and Innovation Fund has been awarded to the Injury Prevention and
Awareness Centre. They will be working with injury data firom a number of government
departments, including Alberta Health, to identify what information is cuirentiy available
and where there are gaps. The data will also be coded by health unit regions that will be
useful for community planning.

ii

The Emergency Health Services Branch, with the assistance of the Information Technology
Division, has developed the Alberta Ground Ambulance Information System. (AGAIN) and
is in the process of developing an Air Ambulance Information and Payment System
(ALAMO). These information systeins, as well as a new provincial Patient Care Report
(PGR) form, will collect patient, injury and otiier data on pre-hospital care in Alberta.

The Ambulatory Care Component of the Acute Care Funding Plan is involved with the
development and implementation of emergency and outpatient clinic funding systems.
These systems would also address various data collection issues.

The Health Economics and Statistics Branch prepares various status reports on an on- going
basis. For example, they prepared "Accident Incidence In Alberta 1988" to supplement the
national report "Accidents in Canada", and in 1991 published "Mortality in Alberta" which
reviewed specific injury related categories. The branch also publishes Birth and Death
Statistics By Health Units of Alberta, which provides annual mortality data on motor
vehicle collisions and suicides. The branch will be developing a Statistical Compendium
on Hospital Morbidity and wiU be accessing personal risk and accident information from
the next cycle of the General Social Survey. Planning is also underway to contribute to the
National Population Health Survey, a potential source of national injury information.

It is expected that coordinating the above activities will assist in eliminating data gaps and
provide opportunities for linkages within Alberta Health and between the various Alberta
government departments. Efforts to develop local data sets is encouraged.

Pre-Hospital Programs

Emergency Health Services Branch is responsible for pre-hospital programs in Alberta,
They are currentiy working within Alberta Health and with other organizations to develop a
planning framework and process for addressing and coordinating injury related issues.
Current priorities are in the area of information systems.

Trauma Services

A Provincial Advisory Committee on Trauma Services has been established to develop and
recommend operational and practice guidelines for trauma prevention, treatment and
rehabilitation.

iii

The Ambulatory Care Component of the Acute Care Funding Plan will address service
issues for injured persons.

Rehabilitation Services

Currently Rehabilitation Services Branch is doing a comprehensive review of incidence,
prevalence, distribution and service availability to brain injured persons and their families in
Alberta.

Occupational Health and Safety

The purpose of Alberta Health's Occupational Health and Safety Program is to identify,
evaluate and control health and safety hazards, to estabUsh health and safety pohcies and
strategies aimed at protecting and promoting worker health, and ensure the programs
conform to the Occupational Health and Safety Act and Regulations. Current initiatives are
in the area of first aid, emergency evacuation planning. Workers Compensation claims and
follow up prevention measures. Workplace Hazardous Information Systems, office
ergonomics audiometric testing and overall issues management.

Community Health Promotion

Eight health unit regions have been funded to develop community based injury prevention
initiatives, through the Health Research and Innovations Fund These initiatives include:
children's injury prevention in a native community, bicycle safety, recreational injuries,
transportation, and seniors falls. The intent is to demonstrate a number of strategies for
injury prevention that may have applicability in other communities across the province. It
is also hoped that the Injury Prevention Projects will develop a knowledge base and
community infrastructure from which to plan future action.

The Healtii Promotion Branch is currentiy working with other government departments
which support injury prevention, such as Transportation and Utilities, Solicitor General,
Occupational Health and Safety to identify and coordinate common agendas. The Branch
also participates on a number of Injury Prevention Committees with government and non
government organizations to facilitate timely and coordinated action.

The Public Health Division participates on the Meeting of Health Unit Directors Injury
Prevention Committee. This committee has established priorities in developing a program
framework, issue identification, and resource identification for Health Units.

Environmental Health Services is looking at ways to create safe environments through the
Institutions and Housing regulations.

A comprehensive survey of nurses and health care facilities has been completed to identify
the knowledge base pertaining to the occurrence of needlestick injuries among nurses in
Alberta. The findings of this survey suggest that a comprehensive needlestick injury
prevention program would be beneficial in all Alberta health care settings.
Recommendations are being developed.

From a service perspective, there are a number of contemporary initiatives Alberta's health
system is providing leadership in. For example: the PARTY program, SAFE KIDS, the
Grey Nuns bicycle helmet campaign. Safe and Secure preschool initiative, and the
Nobody's Perfect parenting course. Many of these initiatives are well known and if
additional information is required, please contact the Health Promotion Branch.

Alberta Health is involved in on-going consultations regarding the health issues of children,
seniors and native people. Additional injury related projects may be identified in the course
of these consultations.

V

/diberra

HEALTH

PO. Box 2222, 10025 Jasper Avenue, Edmonton, Alberta, Canada T5J 2P4 403/427-6085

October 13, 1992

Ms. Kathy Belton
Injury Awareness and

Prevention Centre
3T1.20 OPR
8440 - 112 Street
University of Alberta Hospitals
Edmonton, Alberta
T6G2B7

Dear Kathy:

RE: HEALTH GOALS AND OBJECTIVES FOR ALBERTA PROJECT

Thank you for inviting me to provide an update on progress toward establishing Health Goals anc
Objectives for Alberta.

The project is one of several health reform initiatives currently underway. The fiscal reality of the 1990'5
is challenging us to make better use of health system resources. We want to ensure that Alberta's healtl
system is sustainable; that the system can continue to provide quality health services that meet the needs
of Albertans. In order to do this, we need to find ways to use available resources more efficiently anc
effectively.

The Health Goals and Objectives Project will specify the vision for the health system, the goals or broac
directions for change and the specific health outcomes we would like to achieve for the people of Alberta
The goals and objectives will provide a general framework for assessing priorities, guide planning anc
mobilize action at the community level and enable us to evaluate progress toward improving the healtl
of Albertans.

With the assistance of the Minister's Advisory Committee on Health Goals, Alberta Health ha
implemented a process for establishing the vision, goals and objectives. The process involves extensivt
consultation with a variety of partners including communities, government departments, organizations anc
individuals.

vi

Ms. Kathy Bel ton
October 13, 1992
Page 2

Several tasks have been completed. They include:
Developing a Health Goals Model.

Establishing the vision and identifying nine health goals for Alberta. (The vision and
goals are attached.)

Forming multidisciplinary work groups to identify preliminary health goals for four life
phases (infants and children, adolescents, adults and older adults).
Communicating and providing opportunities for review of the goals and preliminary
objectives through a stakeholder mailout; meeting with other provincial government
departments; community workshops in Lethbridge, Calgary, Red Deer, and Peace River;
a Provincial Conference in Edmonton and review by technical experts).

The results of the consultations to date indicate the existence of widespread support for the Health Goals
Model, vision and nine health goals. However, consensus has not been achieved regarding the objectives.
Stakeholders have concerns with many of the preliminary objectives, ranging from issues related to cost-
effectiveness, feasibility, duplication and overlap, wording and definition to lack of a clear outcome
focus.

The Minister's Advisory Committee will be meeting in November to consider how the set of objectives
can be reduced and improved. The Minister's Advisory Committee will propose a revised set of
objectives for public review and discussion in 1993.

In closing, I would like to mention that I will be attending the Fourth Annual Injury in Alberta
Conference and would encourage participants who are interested in the project or would like further
information to approach me between sessions or to contact me at 422-9510 (fax 427-2511).

Sincerely,

Judy Evans,

Manager, Plaiming (Health Goals and Objectives Project)
Research and Planning Branch

Attachment

vii

HEALTH GOALS

Our vision is HEALTHY ALBERT ANS LIVING IN A HEALTHY ALBERTA. We see everyone
working together to achieve better health for all. The health goals of Albertans are:

L To attain the best possible physical, mental, emotional and spiritual health.

2. To develop and maintain skills for coping in a healthy way with physical and social
environments.

3. To choose healthy behaviours.

4. To recognize the potentials and limitations of heredity and to minimize limitations, where
practical and ethical.

5. To live in a healthy physical environment.

6. To have the opportunity to live in strong, supportive and healthy families and communities.

7. To have appropriate, accessible and affordable health services.

8. To include a health perspective in public policy.

9. To make decisions based on good information and research.

viii

INJURIES AMONG NATIVES WORKGROUP

WORKSHOP OUTLINE

Workshop 1: Thursday, A.M.

This session will focus on providing a background and overview of the conditions of
safety prevalent among native communities; information will include anecdotal and
statistical data.

Workshop 2: Thursday, P.M.

A discussion circle will explore the strategies needed to meet die targeted challenges.
Utilizing the principles and the matrix of Achieving Health for All, the group will prepare
plans to fit the aims identified, and will review the Injury Control Objectives. The focus
will be on creating safer communities.

Workshop 3: Friday, A.M.

This session is a joint workshop that will be attended by the Home and Community
Workgroup and representatives from the Injury Among Natives Workgroup. It will focus
on poison prevention and effective intervention in poisoning simations. Mr. Rick
Kaczowka, of the Alberta Poison Center, will review the interventional programs offered
by the poison center. The discussion will address prevention techniques, education
strategies, recognition of drug overdose symptoms and correct first-aid choices.

With the participation of the workshop members, the issues of poisonings and
bums will be explored and community-specific interventions and action plans will be
developed.

1

INJURIES AMONG NATIVES WORKGROUP

Native Injuries

Why do we have three
times the number of
injuries among natives
than among the rest of
the population ?

If injuries can be clas-
sified as a disease, in
Canada we have an epi-
demic among our native
population. According to
the Background Paper on
Accident and Injury
Prevention in Alberta,
prepared for Alberta
Health in September
1990, native Canadians
are three times more like-
ly to be injured than other
Canadians. "As well, the
rate of hospital admis-
sions resulting from acci-
dents(sic) and violence
was four times greater for
natives than for all
Canadians," states the paper.
In the United States, the native
injury mortality rate is nearly
double that of the rest of the
American population.

Not to overstate the obvious,
statistics like these make one
ask, "What is being done or
what is not being done?" In
upcoming issues you will read
articles discussing the problem
and what kind of programs are
available to deal with this
epidemic.

The Alberta situation

In Alberta the leading causes
of injuries among natives are:

1 . Motor \fefaicle Collisions

2. Suicide

3. Homicide/Assault

4. Poisoning

5. Drowning

According to information
supplied by Alberta Medical
Services Branch, in 1989 over
one-third (37%) of native

deaths were a result of motor
vehicle collisions and 21'
were due to suicides. Next
was homicide/assault and poi-
soning, which were both 8%.

If one compares the top five
native mortality rates against
that of the total Alberta popu-
lation, there is a definite pat-
tern. This should mean that
the existing programs and
strategies used to reduce
injuries among Albertans

should work for
natives too. In actual
fact, the rates for
natives still remain
three to four times
higher than the rest of
the population.

While concluding
that native injuries are
not being reduced
using existing proce-
dures may seem
rather simplistic, it
points out the fact that
this problem is far
bigger than the tools
we are using to fight
it.

The threat to
native
children

From Alberta
Health's background paper:
"The threat to native children
is apparent. Compared to the
national average, registered
native children have four times
the risk of fatal injury." In
The Health of Canada's
Children: A CICH Profile
(Canadian Institute for Child
Health), the suicide rate (per
100 000) for native Canadians
was compared to that of the
total population. The rate for

Mortality Rates
By Major Causes of injuries
Ages 1-14
Canada and Indian Reserves 1977-82^

All Reserves All Canada
(Rate/100 000)

AH Injuries

66.5

20.5

MV and Traffic injijles

14.0

8.8

inocJveftent FaBs

1.0

0.4

Fires and Flanges

15.2

2.5

Oownlngs

13.5

3.0

' Age Standofdtzed

2 AuMOM

from The Health of Canada's Children: A
CICH Profile

VOL4N0 2 0 MAR 1991

INJURY AWARENESS & PREVENTION CENTRE NEWS

10- to 14-year-old natives was
7.4, but the rate for the total
population of 10- to 14-year-
olds was only 1.5; the native
rate is almost five times higher.

The leading cause of death
for children in Canada is
injuries, and in Alberta the
native population has a high
proportion of young children.
In fact, in 1981 42% of natives
were under the age of 15, com-
pared to only 24% of the total
population in the province.

Contributing factors

Alberta Health's background
paper states best what seem to
be the factors involved in the
high native death rate;

"Many natives live in isolat-
ed areas where roads are poor,
buildings are not safely con-
structed, firefighting equip-
ment is inadequate, or natural
water and animal hazards
abound. In Alberta in 1981.
natives made up 14.2% of the
population of Census Division

No. 12 and 12.7% of Census
Division No.- 15, which togeth-
er comprised the northern half
of the province. This area has
had high rates of both injury
mortality and injury morbidity.
It would not be unreasonable,
then, to look for some correla-
tion between these factors.

Both urban and rural natives
are clustered at the low end of
the socioeconomic scale,
which has been marked by
high injury rates. The family
stresses common in such cir-
cumstances must certamly
affect young natives, as 'non-
intentional injuries (such as
falls and bums) increase
among children when major
intrafamily problems exist.'
Limited access to safe, suitable
recreation areas is another
problem confronting low-
income families and communi-
ties.

What to do?

To address this preventable
health problem satisfactorily, a
number of different interven-
tion strategies will have to be
employed, aimed at resolving
the economic, cultural, politi-
cal and historical factors that
have shaped native society. o
Ian Jackson

VOL 4 NO 2 o MAR 1991

Comparison of Death Rates Due to Injuries
By Age

Registered Native (1984) and Total Canadian
Population (1985)

250

1 -4 years 5-14 years 15-19 years

' from The Health of Canada's Children: A CICH Profile
INJURY AWARENESS & PREVENTION CENTRE NEWS

INJURIES AMONG NATIVES WORKGROUP

Native Injury Abstracts

Burn Injuries in Native
Canadians: A 10-year
Experi^ce

PR. Callegari. J.D. Alton.
HA. Shankowsky, M.G. Grace

Between 1977 and 1986,
1598 patients were admitted to
the Firefighters' Bum Unit of
the University of Alberta
Hospitals in Edmonton,
Alberta. One hundred and
twenty-five (7.8%) of these
patients were Treaty Indians or
Metis, compared to 4.2% of
the general population in the
given area. The data show
native people suffered larger
total body surface area
(TBS A) bums, were hospital-
ized on average 16.9 days
longer and required 0.7 more
operations than their non-
native counterparts. Natives
are also three times more like-
ly to remain within the health
care system as in patients for
rehabilitation after acute bum
management has been com-
pleted. Mortality rates as a
result of these bums were sim-
ilar for natives (4.8%) and
non-natives (4.3%). This
review indicates that the native
population is at higher risk of
suffering bum injury even
after adjusting for certain
demographic variables, conse-
quendy impacdng the utiliza-
tion of the health care
system.o

Bums, Including Thermal
Injury, 1989 Feb;15(l):15-19

Death Styles Among
Canada's Indians

G. K. Jarvis and M. Bold!

Data was examined from a
prospective study of native
mortality on 35 reserves and
colonies in the province of
Alberta. Native Indian deaths
tend to occur at a younger age
than others, to be multiple
events, and to occur in non-

hospital settings with others
present. In almost half the
cases, death resulted from
accident, suicide or homicide.
Though circumstances of
weather carelessness resulted
in some deaths, the majority of
violent deaths were associated
with a heavy use of alcohol.

Social Science Medicine,
1982; 16(14): 1345-52

Alberta Registered Indian Deaths Due to Inadvertent
Injuries, Violence & Poisoning — 1984-1989

134

I Female

Age-Specific Suicide Rates
Registered Native and Total Canadian Population
(Rate/ 100 000)

Age Group

Registered
Native '

Total ,
Canadian

0-9

0.0

0.0

10-14

7.4

1.5

15-19

81.6

12.3

20-24

93.8

18.8

25-29

80.6

17.3

30-34

55.4

17.4

Total: 0-85 yrs

43.5

13.7

Average 1980-84
' 1984

from The Health of Canada's
Children: A CICH Profile

VOL4N0 2 0 MAR 1991

INJURY AWARENESS & PREVENTION CENTRE NEWS

INJURIES AMONG NATIVES WORKGROUP

CHILDHOOD INJURY PRBVEKTIONi CPS MEETING, Sept. '92

1. Childhood injury pr^veption will be best accomplished as a
partnorghip between First Kationft and Inult oomiaunities and
health care worXerg.

Partnership is a word that is in increasing usage and, as such, in
danger of losing its usefulness. However, it is still the best we
have to describe the relationship that many would like to achieve
between First Nations and Inuit communities and health care workers
wherever they are from. I stress that it is an evolving

relationship, and one that, if we sincerely are committed to it,
poses several challenges to both partners.

The first is that, while mutual respect and trust are fundamental
to an effective partnership, it will take time for these essential
characteristics to be earned.

A second is that the community's agenda must have primacy. While
at first hearing this statement appears to unbalance the
partnership, in fact it serves instead to remind the health care
workers, both those from within and those from outside the
community, of the overriding goal of promoting healthful childhood.
For their part, health care workers do have the responsibility to
share their particular perspective, and thereby influence the final
agenda towards which interventions may then be directed and
evaluated.

2 . Thq information baae must be relevant to oommunity priorities
and action oriented.

Here are the data describing the mortality from injuries
experienced by First Nations children. Unfortunately, British
Columbia and the Northwest Territories are excluded because vital
statistics for status Indians and Inuit residents of these regions
have not been available to MSB since the mid-80 's.

Another problem with the coverage is that, of the remaining
provinces and territory, only Manitoba, Saskatchewan, Alberta and
the Yukon report on all status Indians within their boundaries,
regardless of residence on or off reserve. The Atlantic provinces
and Ontario collect data only for those persons living on reserves.
Quebec similarly only includes on-reserve individuals and has the
further exclusions of those communities covered by the James Bay
and Northern Quebec Agreement as well as some others not directly
served by msb. (Bobet)

OH # 2

The first overhead, which covers only the most recently reported
year's data, 1990, serves to remind us that injuries cause most

5

INJURIES AMONG NATIVES WORKGROUP

childhood deaths — more than 7 0% for boys in every age group past
the first year, and for girls after age 4.

OH # 3

The fatal injury rate varies considerably across the country, with
a more or less east to west gradient*

OH # 4

The relative importance of the mechanism of injury also varies
between Regions. Most noticeable is that the ''other' category, is
first in all regions except Alberta, and is especially high in
Ontario. I think that this is first and foremost an artifact of
the groupings used for the data, since the homicides and many of
the suicides are included there. For the two years that I have
information about suicides '89 and *90, the ^other' category drops
nationally to 18% of injuries from 36% and even further to 10% if
homicides are taken out. However, for all Ontario residents, the
suicide rate in recent years has been lower than the national
average^ so unless the reverse is true for Status Indian children
living on-reserves, this anomaly remains without ready explanation.

Motor vehicle crashes clearly require attention, especially in
Alberta. Fires account for nearly 20% of the injury deaths in
Manitoba, followed closely by drownings.

OH # 5

The mechanism of injury of course also varies with the age of the
child. Again, the other category' is predominantly suicide and
homicide, and increases dramatically in the teen years as does
motor vehicle crashes. Fire deaths and drowning victimize
primarily the pre-schoolers.

However, mortality is but the tip of the injury iceberg. In
Canada, for all Canadians, there are 20 hospital admissions for
every injury fatality, and many more outpatient or physician
visits.

At the symposium held last year in Edmonton to develop National
injury prevention objectives, there was not general support for
specifying Inuit or Indian status in surveillauice systems. This
attitude handcuffs specific analysis of the injiiry problem among
this group and perpetuates speculative rather than well informed
planning. As a group, the CPS can join with National and local
Native organizations in calling for more appropriate recognition
of First Nations and Inuit people in the design of surveillance
activities.

In order for the information to be helpful on a local basis, it

6

INJURIES AMONG NATIVES WORKGROUP

must be the kind of information the communities wish to have, and
it must be in their hands. This presents a challenge for health
care workers, particularly those from outside, because it means
that careful discussion must occur with the community partners to
clarify what community activity or change or health outcome is
desired, how information about it can be collected and by whom,
where and how the analysis will be done, and how the feedback will
reach the community. The discussion must also include how
information such as that derived from vital statistics, provincial
health services utilization records and other surveillance
activities such as CHIRPP can be integrated with the locally
derived information. A supplement to the CJPH referenced in the
handout is a good starting point for those of you who are
interested in learning more about this desireable shift in research
methodology.

3. Unintentional and intentional in-iuries must both bo included
in a oomprehenaive approaoh,

OH # 6

I made mention earlier of the large number of suicides reported.
I was surprised as I was preparing this talk just how high the
proportion was, especially since it is generally conceded that
suicides are underreported. Add to this total the 16 reported
homicides in the same two year period, and one is given an awful
glimpse of the intra- and inter-personal violence victimizing
aboriginal children and youth.

There is a wide and persistent chasm between health professionals
who deal with mental health and those who focus more specifically
on physical health or illness. This separation has occurred in
part because of different conceptualization of health and the
causation of illness, and is perpetuated by the general lack of
communication between the various health professionals. Community
members, unless they have been strongly influenced by the
perspectives of the various health professionals available to them,
tend not to make the separation and intuitively both define the
problems and seek solutions in more comprehensive or holistic
terms.

Another factor contributing to the separation is the apparent lack
of evidence for effective community interventions directed against
intentional injury. I commend to you Dr. stanwick*s excellent
review referenced in the handout. However, this situation must not
be a deterrent to action. Instead conscious effort must be made
to continually evaluate initiatives undertaken, and again I suggest
that the development of research methods that are participatory,
action oriented and community centred, must be encouraged.

To return to the matter of the blinkered perceptions of the various

7

INJURIES AMONG NATIVES WORKGROUP

health professionals, one result is that the importance of
intentional injury is either underestimated, or obscured all
together. The type of data categorization used in reports of vital
statistics is one example that we have just seen.

It also means that opportunities for collaboration may be missed.
A legitimate criticism levelled against the Brighter Futures
Initiative by First Nations and Inuit leaders is that it is too
compartmentalized, there being separation of Mental Health and
injury Prevention components for example. While this may have been
necessary during the process of obtaining Treasury Board funding,
the challenge now is to fit the pieces together so that a
comprehensive effort is brought to bear against the conditions that
place children at risk and result more broadly in the disabilities
discussed by Cathy, and more particularly in injuries.

Richard Musto

Regional Coraiuunity Medicine Consultant
Alberta Region, MSB, HWC

8

INJURIES AMONG NATIVES WORKGROUP

Additional Reading

Prevention of Injuries among Canadian Aboriginal People. Final
Report of the Interdisciplinary Working Group on Injury Prevention.
MSB, 1991.

Suicides, Violent and Accidental Deaths among Treaty Indians in
Saskatchewan: Analysis and Recommendations for Change. Health and
Social Development Commission, Federation of Saskatchewan Indian
Nations.

Aboriginal Suicide in British Columbia, Prepared by Mary Cooper,
Anne Marie Karlberg, and Loretta Pelletier Adams for the B.C.
Institute on Family Violence Society. Burnaby, B.C., 1991.

Health Promotion Research Methods: Expanding the Repertoire.
Supplement to the Canadian Journal of Public Health, vol, 83, 1992.

Stanwick, R.J, Prevention of Injuries in Canadian Children Aged
0-14 Years. Health Services and Promotion Branch, HWC, 19 88.

9

INJURIES AMONG NATIVES WORKGROUP

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INJURIES AMONG NATIVES WORKGROUP

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INJURIES AMONG NATIVES WORKGROUP

Overhead #4

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INJURIES AMONG NATIVES WORKGROUP

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9

1 c

INJURIES AS A RESULT OF VIOLENCE
WORKGROUP

WORKSHOP OUTLINE
Workshop 1: Violence is a Universal Concern

The visibility of violence in communities around the world has, in the last decade, become
a universal concern. Rates and patterns of known violence both have shown significant
change. The world-wide incidence of reported assaults skyrocketed form a litde over 150
per 100,000 population in 1970 to nearly 400 per 100,000 population in 1990. The rates
of intentional homicides have also shown an almost threefold increase. Gang-based
violence and political terrorism are both apparentiy on the rise. Knowledge of the
widespread violence in families has grown. Violence perpetrated by people in positions of
authority and trust has also surfaced as a significant problem. Policy makers, social
reformers and the general public are increasingly aware of the devastating social and
economic costs of violence.

This workshop will elaborate on existing knowledge concerning violence internationally
and within Canada. Participants will not only examine rates, types and patterns of
violence, but will explore myths and beliefs we hold about violence and how these myths
match with reality. Questions including: Who is at the greatest risk? Where are we most
vulnerable? will be discussed in an attempt to provide a comprehensive knowledge base for
prevention efforts.

Finally, the workshop will explore briefly a range of approaches to the prevention of
violence being used internationally and nationally. Workshop participants will be
encouraged to discuss the implications of insights and initiatives around violence shared
during this session, for creating safer communities in Canada.

Workshop 2: Methods for Preventing Violence to Foster Community
Health

This workshop is designed to assist participants to examine methods utilized in current
programming to prevent family violence.

16

INJURIES AS A RESULT OF VIOLENCE
WORKGROUP

To meet this aim participants will work together to:

1 . Relate beliefs about the underlying root causes of violence to current program
efforts.

2. Analyze current approaches taken in programming in relation to expected
community health outcomes.

Workshop 3: Prevention of Violence in Alberta

This workshop focuses on the prevention of violence in Alberta.
Participants will be invited to:

1 . develop a vision for a community based approach to eliminating violence.

2. develop a statement of strategies to achieve a safer environment for Albertans.

INJURIES AS A RESULT OF
WORKGROUP

VIOLENCE

REPORT OF THE VIOLENT AND ABUSIVE

WORK GROUP

BEHAVIOUR

1 . Introduction

The Violent and Abusive Behaviour work group, consisting of a small number of individuals who represented
a broad range of professional backgrounds and interests, addressed the problem of injury resulting from
violent and abusive behaviour. Such behaviour includes, but is not limited to, intra- familial and extra-familial
violence, such as homicide, sexual assault, child abuse and neglect, elder abuse and neglect, spousal assault,
suicide and self-injury.

Violent and abusive behaviour is a major cause of injury and death. In addition to the physical injury, it
almost always results in, or is accompanied by, psychological trauma, which may be severe and long-lasting.
It is likely that all injury, regardless of etiology, results in psychological trauma to some degree, but in
situations where the injury is intentional we would expect significant and profound psychological trauma to
occur.

2 , Issues Related to Setting Objectives

The work group discussed the notion of setting quantifiable objectives for the reduction of injury resulting
from violent and abusive behaviour. It was acknowledged that there are several significant problems
associated with such an undertaking. Indeed, it may not be possible nor appropriate to set quantifiable
objectives. First, there is a paucity of research related to the nature and incidence of violent and abusive
behaviour and its associated health problems. Further, there is widespread concern that current inforTnaiiop
regarding the incidence of intentional injury and/or violent behaviour may lack reliability and validity T!ic
problem of family violence, in particular, is subject to under-reponing both by victims and service providers.
Related to the problem of under-reponing is the concern that any progress in anempts to eliminate the problen-;
of family violence would initially be reflected in higher repomng rates as victims become more likely to seen
assistance. The problems associated with the reliability and validity of the information available are further
compounded by the fact that there is no common defmition(s) nor repomng structure for violent and abusive
behaviour. Finally, the setting of quantifiable objectives is a strategy that has not been used in developing
prevention and intervention programs related to violent and abusive behaviour and there is minimal evidence or
its efficacy to support its use.

Notwithstanding the identified problems associated with setting quantifiable objectives, the violent and abusive
behaviour work group recognized that there is considerable merit in defining objectives that could be used tc
monitor the incidence of intentional injury and gaining a better understanding of the magnitude of the problem
However, tiie setting of target objectives was thought to be inappropriate. That is, identifying a desirable rate
of reduction in any one behaviour was thought to implicitly suggest that there was an acceptable level o!
violent and abusive behaviour. Such a position would directly contradict the working group's conclusion tha
societal attitudes that tolerate or sanction violence and abuse contribute to the persistence of such behaviour
Thus, the working group agreed to set objectives ta indicate the desirability of a continuous downward trenc
in the incidence of injury and death resulting from violent and abusive behaviour. It is hoped that thi:

A Safer Canada — YEAR 2000 INTURY CONTROL OBTECnVES FOR CANADA

18

INJURIES AS A RESULT OF VIOLENCE
WORKGROUP

approach implicitly suggests that the ultimate goal is the elimination of violent and abusive behaviour in our
communities and homes. Several issues were addressed by the working group. The group also contemplaied
that it is possibly more appropriate and productive to set "service objecuves" (e.g., treatment and prevention
services) rather than "health status. objectives" (e.g., outcome-focused) in this area of concern. However, it
was recognized that this would necessitate a long-term activity that should involve broader consultation than is
possible within the working group.

3 . Issues for Active Consideration

Violent and abusive behaviour has emerged as a social or criminal justice issue. Health professionals, for the
most part, have only recendy acknowledged the role that they can play and that this must extend beyond the
traditional health care approach. Further, the approach of health professionals has been mostly concentrated ai
a tertiary level of intervention, involving late identification and rehabilitative aspects of care, with little
involvement in primary prevention activities. The importance of primary prevention during the interaction of
health professionals with their clients was well-recognized by tihe working group, who consistentiy noted the
need for attitudinal change.

4. Injury Control Objectives — Violent and Abusive Behaviour

What follows are the objectives (without targets) set by the Violent and Abusive Behaviour work group 1'
should be noted that the baseline rates were obtained from data sources that have considerable limitations, no:
the least of which is the problem of comparability across the range of violent and abusive behaviour. Cautior
is advised when considering these rates; they have only been provided as an estimate of ihs magnitude of tiic
problem of violent and abusive behaviour in Canada today.

A Safer Canada — YFAR 2000 TNHJKY CONTROL OBTF.CTIWS FOR CAM^p^

INJURIES AS A RESULT OF VIOLENCE
WORKGROUP

VIOLENT AND ABUSIVE BEHAVIOUR OBJECTIVES

OBJECTIVES

BA^EUNE
PER
100 000
IN

CANADA

%

CHANGE
OVER
PAST 4

YEARS

TARGET

%

REDUCTION

DATA SOURCES

MONITORING
AGENCIES

1 .0

Reduce homicides

1.71'

(1988)

-20.47

Morialily
Database

Statistics
Canada,
CCHI

2.0

Reduce assaults

45.42'
(1987)
68 "

-2.43

Hospital
Morbidity
Database
Canadian Urban
Victimization
Study (CUVS)
General Social
S u rve y

Canadian
Centre on

Justice
Statistics
(CCJS)
CCHI

3.0

Reduce the incidence of

Unavailable

Hospital

CCHI

injury resulting from child

Morbidi ty

abuse and neglect

Database
Victimization
surveys of adults

4.0

Reduce the incidence of
injury resulting from intcr-
spousal violence

10.3

-14.4^ '

Viciim surveys
Police records

CCJS

5.0

Reduce suicides

12.03'
(1988)

-2.83

.M 0 r I a i 1 1 \
Database

CCHI

6.0

Reduce the incidence of self-
inflicted injuries resulting
in hospitalization

73.43^
(1987)

+ 11. 77

H 0 s 0 1 1 a 1
M 0 r h 1 d 1 1 \
Database

CCHI

7.0

Reduce the incidence of

Unavailable

Hospital

CCHI

injuries resulting from elder

Morbidity

abuse and neglect

Database

8.0

Reduce the incidence of

Unavailable

Police records

cas

sexual assault of adults

Surveys

20

A Saf^ Ca^nda — YEAR 2000 TNnTRY CONTROL QBTFCTTVFq FOT^ r AjMAH A

INJURIES AS A RESULT OF VIOLENCE
WORKGROUP

Baseline Data References:

1. Canadian Mortality Database. Personal Communication. Laboratory Centre for Disease Control, Health and Welfare Canada

2. The largest proportion of homicides take place in the victim's home, with one-half of all victims killed in ihcir own
residence. The proportion of victims killed m their own residence was considerably higher for women than for men (63.8%
vs 42.4%). 78.7% of solved homicides in 1988 involved suspects and victims who were known to each other. Overall,
36.1% of offenders and victims were domestically related, 42.6% were acquainted through business or social situations, while
another 21.3% were total strangers. In 1988. 57.4% of all female victims of homicide were killed by someone with whom
they shared a domestic relationship, whereas only 24.4% of male victims were killed in such a situation.

The most common methods of committing homicide in 1988 were shooting (29.4%) and stabbing (28.7%), followed by
beating (21.2%). Together, these three methods accounted for four out of every five homicides committed.

Although likely an under-representation, police report that nearly one-third of solved homicide incidents involved alcohol or
drug consumption by either the victim or suspect. [From: Statistics Canada, Canadian Centre for Justice Statistics, Law
Enforcement Program (1989). Homicide in Canada 1988: A Siaiisdcal Perspective (Catalogue 85-209). Oiiawa, Ontario:
Minister of Supply and Services.]

3. Canadian Hospital Morbidity Database. Personal Communication. Laboratory Centre for Disease Control, Health and
Welfare Canada.

4. Sacco, V.F. and H. Johnson. Paiierns of Criminal Victimization in Canada. General Social Survey Analysis Series
(Catalogue 11-612E, No. 2), Ottawa, Ontario: Statistics Canada. Housing, Family and Social Statistics Division/Minister of
Supply and Services Canada, 1990.

5. Brinkerhoff, M.B. and E. Lupri. "Interspousal Violence". Canadian Journal of Sociology, 13, t988:407-434

6. Kennedy, L.W. and D.G. Duton. "The Incidence of Wife Assault in Alberta" Canadian Journal of Bchaviourni Science.
21(1), 1989:40-54.

7. Ratner, P.A. The Health Problems and Health Care Uuhzauon Patiems of Wn'c.^ \^'ho Arr Phxsicdliv and-or
Psychologically Abused. Unpublished master's thesis, University of Alberta, Edmonton, 1991

8. Smith, M.D. "The Incidence and Prevalence of Woman Abuse in Toronto". Violence and Victims. 2, 1987:173-187

A Safer Canada — y¥.Ml 2000 nMTimY CONTROL OBTECTIVRS FOR rAM^QA

21

INJURIES IN THE HOME AND COMMUNITY

WORKGROUP

WORKSHOP OUTLINE

Workshop 1

DATE: Thursday, 22nd of October 1992

TIME: 9:45 a.m. - 12 noon

The keynote speaker will be Philip Schaenman of TriData Incorporated, who will
discuss fire and bum prevention from an intemational perspective.

The United States and Canada have had the highest fire death rates in the world for
most of the last two decades. People of Hungarian, Native American, Irish and Scottish
descent living in Canada and the U.S. account the highest fire death rates in these two
countries. The cultures these people come from have many things in common that
contribute to high fire incidence and death rates. On the other hand, people of Dutch,
Austrian, German, Japanese, and Korean descent have much in common that contribute to
their low fire death rates.

TriData's research has focused on why Canada and the U.S. have been less
successful than other nations in public fire awareness and education. The company has
also explored the question of how to overcome the barriers to public fire education,
identified key factors leading to successful fire safety programs and analyzed, methods
which demonstrate the effectiveness of these programs. The company's latest research
concentrates on the hardest-to-reach groups which account for a disproportionately large
part of the fire and bum problem. This research will be summarized.

Two local information sessions wiU precede Mr. Schaenman's presentation. The
format for the workshop is as follows:

22

INJURIES IN THE HOME AND COMMUNITY

WORKGROUP

0945 - 1005 A Review of Alberta Fire Statistics

Presenter

Fire Commissioner Tom Makey

Fire Commissioner's Office, Alberta Labour

1005 - 1025 Profile of Pediatric Bums in the Firefighters Bum Unit,
Edmonton, Alberta

Presenter

Dr. Tony Ryan

Royal Alexandra Hospitals, Edmonton, Alberta

1025 - 1040 Break

1040 - 1 130 International Perspective to Fire and Bum Prevention

Presenter

Mr. Philip Schaenman, Arlington, Virginia

1 130 - 1200 Question Time

Workshop 2

DATE:

Thursday, 22nd of October 1992

TIME:

2:45 p.m. - 4:30 p.m.

This workshop wiU begin with a panel session and will explore the personal and
organizational goals of individuals from various fire and bum prevention backgrounds.
Efforts will be made to identify where individuals and organizations can compliment and
support each other in preventing bum injuries.

1 . Mr, Philip Schaenman, TriData Corporation, Arlington, Virginia

2. Captain Tim Vanderbrink, Edmonton Fire Department, Edmonton, Alberta

3. Mr. Peter Clarke, Bum survivor, Edmonton, Alberta

4. Ms. Audrey Groeneveld, Clinical Nurse Specialist, Firefighters* Bum
Treatment Unit, Edmonton, Alberta

The following issues will be discussed with the panel:

1 . What do you see as your role in fire and bum prevention at the present time?

2 . Where do you think we should go firom here?

3 . How do we get there?

23

INJURIES IN THE HOME AND COMMUNITY

WORKGROUP

Workshop 3

DATE: Friday, 23rd of October 1992

TIME: 9:15 a.m. - 11:15 a,m.

This session is a joint workshop that will be attended by the Home and Community
Workgroup and representatives from the Injury Among Natives Workgroup, It will focus
on poison prevention and effective intervention in poisoning situations. Mr. Rick
Kaczowka, of the Alberta Poison Centre, will review the interventional programs offered
by the poison center. The discussion will address prevention techniques, education
strategies, recognition of drug overdose symptoms and correct first-aid choices.

With the participation of the workshop members, the issues of poisonings and
bums will be explored and community-specific interventions and action plans will be
developed.

24

INJURIES IN THE HOME AND COMMUNITY

WORKGROUP

FIRE LOSSES IN ALBERTA

Annual fire losses in Alberta have averaged 8,702 fires, 63 deaths, 443 injuries and 126.7
million dollars in property damage, during the ten-year period 1981-1990. These losses
accounted for 11 to 12% of the correspondmg fire losses in Canada.

Homes, representing one/two family dweUings, apartments and mobile homes, account for
nearly one-third of all fures in Alberta and are responsible for 68% of fire deaths, 54% of
fire injuries, and 25% of dollar losses in the province (Table 1). Fires per 1000 homes
have declined steadily during the past twenty years despite a continuous increase in the
housing population in Alberta.

Table 1. Average Fire Losses in Alberta and Alberta Homes (1981-1990)

HRES

DEATHS

INJURIES

$ LOSSES

Alberta

8,702

63

443

126,744,301

Alberta Homes

2,534

43

238

32,146,016

Relative to their proportional representation in the population, children five years and
younger, the elderly 61 + years and young adults between 16 and 25 years of age are at the
highest risk for home fire deaths. On the same basis, persons between 16 and 40 years of
age are at the highest risk for home fire injuries. The malerfemale ratio for civilian fure
deaths and injuries in Alberta are 2:1 and 1.7:1.

Fire death rates (per 1(X),(XX) population) for the province and its homes have declined
during the past decade. However, both civilian and firefighter injury rates have remained
fairly stable in the same period. In 1990, fire death and injury rates were 1.3 and 17.6 in
Alberta compared to 1.7 and 14.0 in Canada.

Smoke alarms were not installed in 52% of homes that had fires. Thirty-eight percent of
home fire deaths occurred where smoke alarms were installed and 62% in homes without
smoke alarms. The lack of a battery, dead battery, electricity off or not connected were
responsible for alarm failures in 40% of home fires.

The major known causes of home fires are: cooking (32.1%), home heating (12.0%),
smoking (11.4%), children playing witii fire (7.7%), arson/set fires (7.7%), and electrical
(4.0%). The major known causes of fatal home fires are: smoking (31.4%), home heating
(14.8%), cooking (11.2%), cMldren playing with fire (9.8%), arson/set fires (5.6%), and
electrical (4.0%). The major known causes of fires which inflicted injuries are: cooking
(28.0%), smoking (21.1%), home heating (14.3%), children playing with fire (10.9%),
arson/set fires (6.7%), and electrical (4.3%).

Concluding remarks

With the expectation of Albertans for more efficient allocation of limited resources, a new
appjroach is emerging in the safety arena. Some key features of this ^proach are:

- dispelling the myth that government can single-handedly address siety issues

- emphasizing that the primary roles of government are to educate, inspire, inform,
advocate, assist and facilitate mutually beneficial parmerships among all stakeholders

- die government moving fiiom a role of intervention to one of facilitation, and

- beconodng more relevant and effective in identifying (ex: fire loss statistics) and
responding to safety issues.

SOURCE: Fire Commissioner's Office, Alberta Labour

25

INJURIES IN THE HOME AND COMMUNITY

WORKGROUP

Burn injuries in native Canadians: a
10-year experience

p. R. Callegari, J. D. M. Alton, H. A. Shankowsky and M. G. A. Grace

Firefighters' Bum Treatnaent Unit, University of Alberta Hospital, Edmonton, Alberta, Canada

Between 1977 and 1986. 1598 patients were admitted to the Firefigh-
ters' Bum Unit of the University of Alberta Hospital in Edmonton,
Alberta. One hundred and twenty-fixx (7-8 per cent) of these patients
were Treab/ Indians or Metis compared to 4-2 per cent of the general
population in the same given area. The data show native people suf-
fered larger total body surface area (TBS A) bums, were hospitalized on
average 16-9 days longer and reqmred 07 more operations than their
non-native counterparts. Natives are also three times more likely to
remain within the health care system as inpatients for rehabilitation
after acute bum management has hem completed. Mortality rates as a
result of these bums loere similar for ruitives (4-8 per cent) and non-
natives (4-3 per cent). This review indicates that the native population
is at higher risk of suffering bum injury even after adjusting for certain
demographic variables, consequently impacting the utilization of the
health care system.

Introduction

It is generally held assumption that Canada's native popul-
ation is disadvantaged in its ability to gain access to and
utilize social educatiorul and health-related programs and
facililies. Their life-expectancy is 10 years less than the
national average; the infant mortality rate 60 per cent
higher; and postnatal mortality rate 100 per cent higher
than the national average (Shah and Farkas. 1985). Natives
have higher rates of both infectious and non-infectious
disease than non-natives (Shah and Farkas, 1985; Baker et
al., 1987). Smoking is highly prevalent among native
people in Canada; two recent studies indicate that 55—60
per cent of natives smoked and the majority of smokers
were less than 35 years of age (Thomson. 1983; Mclntyre
aiKl Shah. 1986). The proportion of disabled and handi-
capped natives is higher than any other segment of the
Canadian population (Compilation. 1981; Tervo, 1983),
and mental health disorders and problems resulting from
drug and alcohol abuse are prevalent (Shah and Farkas,
1985). Mortality and morbidity rates have been consist-
ently higher for natives than non-natives. The most stri-
king contrast between the two groups is the natives' high
mortality rate due to accidents and intentiorud violence
(Hislop et aL. 1987). It has been reported that alcohol mis-
use is associated with 25-40 per cent of all native deaths
Garvis and Boldt. 1982; Schmitt et aL, 1966; Young, 1983).

Bums remain a major health problem throughout the
world (DenJing, 1985). In Canada during 1985, 487 people

died in accidents caused by fires and flames, 49 people died
of electrical current, and 15 people died of accidents caused
by hot, caustic or corrosive substances (Statistics, Canada,
1985). A recent study in British Columbia (Hislop et al.,
1987) examining the eight leading causes of accidental
death for registered Indiai\s and non-natives in that pro-
vince, indicated that accidents due to fire were a leading
cause of death for natives, second only to motor vehicle
accidents. This was particularly so for native males whose
mortality rate from accidental death due to fire was 21 per
cent; and for native females the rate was 13 per cent. Death
due to fire was the fifth most frequent cause of death for
non-natives accounting for 5 per cent of all accidental
deaths. Although house fires account for less than 5 per
cent of hospital admissions for bums, they were respon-
sible for more than 45 per cent of bum-related deaths,
which are due largely to smoke-inhalation injury (Demling,
1985).

The trend in the USA has been toward lower numbers of
bum injuries and deaths. This is attributed in part to adop-
tion of smoke detectors, guarding of space heaters and
modificarion of the design and fibre content of sleepwear
and nightwear, particularly among children. Formarion of
service clubs and firefighters associations involved with
programmes for public education and fire prevention, as
well as building codes requiring more fire-resistant
materials and sprinkler systems have also contributed to
lower numbers of bum injuries and deaths. In addition,
progress in this field has been made by the development of
specialized bum treatment centres and the multidisdpli-
nary approach with this type of injury (Feller et al.. 1976,
1980).

The objective of our study was to ascertain if the native
population firom our referral area is at greater risk for
severe bums than the general population and. if so, are
there differences in types of bums experienced subsequent
treatment received, and cost of hospitalization given that
patient management is similar?

Methods

A retrospective, case control study was undertaken with
data relevant to the objectives of our study being extracted
from the Bum Unit Registry which is part of the Firefigh-
ters' Bum Unit at the University of Alberta Hospital
Although it is not absolute that the Registry is populaHon

26

INJURIES IN THE HOME AND COMMUNITY

WORKGROUP

based the Firefighters' Bum Unit cares for the majority of
severely burned patients from northern Alberta, an area of
over 500 000 ian^ (data from Alberta Bureau of Surveying
and Mapping, Edmonton) and serving a population of 14
million people. Referral to the bum centre would include
surviving patients with bum injuries that involve more
than 25 per cent total body surface area (TBSA). full thick-
ness bums involving more than 10 per cent TBSA, and
critical bums to the hands, face, eyes, ears, feet or peri-
neum. This would also include bum patients with inhal-
ation injuries, significant electrical bums and multiple
trauma. The 1981 Statistics Canada Census indicates that
approximately 54 000 native people live in the region
served which accounts for 4-2 per cent of the population
for the area served by the Firefighter's Bum Unit. Approx-
imately 60 per cent of natives remain in rural or isolated
communities in spite of the trend in recent years for natives
to move to urban areas.

The Bum Unit Registry contains data collected over a
10-year period from 1977 to 1986, on all bum patients
admitted to the University of Alberta Hospital Bum Unit
from within the referral area. There are approximately 500
items of iriformation dealing with demographics, epidemi-
ology and medical/surgical treatment entered on each pati-
' ent. This basic set of data is augmented by auxiliary com-
puter files in which more detailed information on certain
aspects of specific patients are stored. The information is a
numerical matiix-type data-base which can be used in con-
junction with many available statistical padcages. Infomi-
ation on each registered patient includes a history with
family and occupational background, items about the aeti-
ology of the bum, where the bum took place, treatment
and outcome, laboratory investigations and reviews of
pathology material The registry is continually monitored
and updated when additional information is forthcoming
and the data-base is reviewed by registry f>ersonneL- nurse,
coder and statistician working in concert with surgeons
and physicians.

Analysis was done on the Amdahl 5870 using an SPSSX
statistical package to compute basic descriptive statistics,
and to detect any significant differences between the
variables using chi-square and t-iests. analysis of variance
and analysis of covariance where applicable. Probability
for all tests was taken at the 0-05 level.

Treaty Indians and Metis were classified as native
people; all other radal groups were classified as non-native
(over 96 per cent of the non-native group were Caucasian).

Results

Table I shows that during the 10-year period of 1977 to
1986 there were 1598 patients registered in the Bum Unit.
One hundred and twenty-five native people constituted
the study group; 1473 non-native people became the con-
trol group. Treaty Indians and MeHs accounted for 7-8 per
cent of ail bum admissions from the referral area. In con-
trast, this group accounts for only 4-2 per cent of tits gen-
eral population in the same given area according to Hie
available census figures.

Within the study group, there are 45 (36 per cent)
females and 80 (64 per cent) males; within the control
group 293 (20 per cent) females and 1180 (80 per cent)
males. A chi-square comparison showed a significant dif-
ference for gender (P< 0-01) between the two groups with
a larger percentage of females being found in the native

The average native age was 19-7 ±18 3 years; non-
native 26-5 ± 19- 1 years which was significantly different
(P<G 05). Fifty per cent of native patients were less than
18 years of age and 4 per cent were greater than 65 years.
Comparatively, 30 per cent of non-natives were less than
18 years and 5 per cent greater than 65 years. This in-
dicates a tendency for the native group to be younger than
the non-native group in the bum population, a trend also
found in the general population. Mortality rates were 4-8
per cent for natives; 4 3 per cent for non-natives, a dif-
ference which was not statistically significant. There was a
significant difference (P<0 05) between the groups for
time spent in hospital with natives spending 16-9 days
more. Natives were less likely than non-natives to be dis-
charged home (natives 76-8 per cent, non-natives 88-6 per
cent) and more likely to be discharged to an auxiliary or
peripheral hospital (natives 18-4 per cent, non-natives 71
per cent).

Table //outlines certain bum descnptors by radal origin:
environment, instigation, contributing factors and mode of
travel. The home environment was the location of the bum
for 75-2 per cent of the natives and 451 per cent of non-
natives. In contrast, the work environment was the site of
injury for 4-0 per cent of natives but 36-5 per cent of non-
natives. Accidental circumstances were the leading cause
of instigating events for all bum patients (92-8 per cent of
native patients and 97-2 per cent of non-native patients).
Native patients were burned in criminal circumstances, e.g.
suicide, child abuse, or as deliberate acts by other people, in
7-2 per cent of cases compared to 2-8 per cent in non-
natives (P<0-05).

Contributing factors specifically involved in the circum-
stances of the bum injury included: consumption of al-
cohol, tobacco smoking, street drug consumption and pre-
viously diagnosed psychiatric disorders. Alcohol was
identified as a contributing factor in 21-6 per cent of the
native bums and 4-2 per cent in non-native bums; smoking
in 4-8 per cent of native bums and 3-9 per cent in non-
natives. Street drug consumption was involved in 2-4 per
cent of native patients and 0-2 per cent of non-native pa-
tients. Contributory factors were examined while control-
ling for racial origin and gender. The major difference
comes in the alcohol category where for both males and
females the natives have a much higher incidence than non-
natives (P<0-05).

The mode of trarxsportation to the Bum Unit was differ-
ent for natives than non-natives. Road ambulance was ut-
ilized by 67-2 f>er cent of natives and 51-3 per cent of non-
natives; air ambulance by 16-8 per cent of natives and 7 0
per cent of non-natives; and private vehicle by 12-0 per
cent of natives and 39-5 per cent of non-natives.

Table III addresses bum aetiology by racial origin and
sex. This has been categorized as fire and flames, hot water
scald explosive gases (propane. lutural gas, gasoliite,
methyl hydrate), electrical current, thermal contact, and
other (steam chemical friction, molten lead, hot tar and
grease). The three major causes of bum injury (fire and
flames, hot water scald, explosive gases) accounted for 82-4
per cent of native and 70-5 per cent of non-native hums.
Hot water scalding with 311 per cent of natives and 35-5
per cent of non^tives was the leading aetiological agent
for bums in females of both radal groups. The leading
cause of bums in native males was fire arkl flames with 46-3
per cent, and the leading cause of bums in non-native males
was explosive gases with 32-9 per cent.

Tabu IV indicates total bum surface area (TBSA) and

27

INJURIES IN THE HOME AND COMMUNITY

WORKGROUP

Table I. Demographic and hospital administration data by ra - ! ongin (x ± SD or n. %)

Probability
Non-nativesX level

Gender (no.)

Male 80(640%) 1180(80 1%) (/'<0 01)

Female 45(36 0%) 293 (19 9%) (^<001)

Age(yT) 19-7± 18 3 26 5±19 1 (P<0 05)

Mortality (no.)

Alive 119(95-2%) 1410 (95 7%) n.s.

Dead 6 (4-8%) 63 (4-3%)

Days in hospital 42 3±39 9 25-4±30 6 (P<0 05)

Type of discharge (no.)

Home 96 (76 8%) 1305 (88 6%) (/'<005)
Other (auxiliary or peripheral

hospital, hostel) 23(18-4%) 105 (7 1%)

Dead 6 (4-8%) 63 (4 3%)

"rj=125 (7-8%).
tn=1473 (92 2%).

Table BL Bum descriptors by radal origin

Natives

Non-

natives

Probability

n

%

n

%

level

Environment

Home

94

(75-2)

664

(45-1)^

Work

5

(4-0)

537

(36 5)

(P<0-05)

Other

26

(20-8)

272

(18-5) J

Instigation

Accident

116

(92-8)

1432

(97-2)]

Oeiit>erate

5

(40)

19

(1-3)

(P<0-05)

Other (suicide, child abuse)

4

(32)

22

(1 5) J

Contributing faaors*

Alcohol

27

(21-6)

62

(4 2)1

Smoking

6

(48)

57

(3-9)

(P<0-05)

Street drugs

3

(2-4)

3

(02)

Psychiatric

1

(0-8)

17

(1-2)^

Mode o< travel

Road ambulance

84

(67-2)

755

(51-3) ^

Air amtxjlance

21

(16-8)

103

(7-0)

Private vehicle

15

(12-0)

582

(39-5)

(/'<0-05)

Other (includes ambulatory.

police transport commercial air)

5

(4-0)

33

(2-2),

'Numbers relate only to those cases where contributing factors were identified.

Table IIL Aetiology by radal origin arul sex

Native Non-native
Male Female Male Female

Aetiology

n

%

n

%

n

%

n

%

Flames and fires

37

(46-3)

18

(40.0)

259

(21-9)

72

(24-6)

Hot water scald

13

(16-3)

14

(31-1)

178

(151)

104

(35-5)

Explosive gases (propane, natural
gas. gasoline, methyl hydrate)

15

(18-8)

6

(13-3)

388

(32-9)

37

(12-6)

Electrical current

4

(50)

1

(2-2)

102

(8-6)

4

(1-4)

Thermal contact •

2

(2-5)

3

(6-7)

76

(6-4)

32

(10-9)

Other (steam, chemical, friction,
molten lead, hot tar, grease)

9

(11-3)

3

(6-7)

177

(150)

44

(150)

INJURIES IN THE HOME AND COMMUNITY

WORKGROUP

Table IV. Bum treatment by racial origin (i ± s.d. or n, %)

Natives '

Non-natives^

Probability
level

Total burn surface area

21

1 ±20 1

17-8

±19-7

(P<0 05)

Treatment

n

%

n

%

Non-of)erative
Surgical with healing
Surgical with death
Palliation

43
76
4
2

(34-4)
(60 8)
(3-2)
(1-6)

691
719
26
36

(46 9)^
(48-8) 1
(1-8) 1
(2-4} J

y (P<0 05)

No. of surgical procedures

1-

7±1 7

10 ±1-4

(P<0-05)

n

%

n

%

Zero
One
Two
Three t

45
35
16

29

(36-0)
(280)
(12-8)
(23-2)

in

447
157
141

(49-4)1
(30-4) 1
(10-7)
(9-6) _

(/'<0-05)

•n=125.
t/7=1472.

tCount does not include one patient remaining in hospital.

cent; whereas it was 17-8 per cent in non-natives (P < 0-05).
Treatment was less likely to be non-operative for natives
(natives 34-4 per cent, non-natives 46-9 per cent) and more
likely to involve 'surgical intervention' (natives 64 per
cent non-natives 50-6 per cent). For natives requiring oper-
ations there was an average of 1-7 svirgical procedures;
non-natives I-O. Of those patients requiring three or more
operations during their stay in hospital for the manage-
ment of bum wounds 23-2 per cent were natives, 9-6 per
cent non-native.

Because there were significant differences between
naHve and non-native groups for sex ratios and ages, the
data v/ere further analysed by adjusting for these factors.
The dependent variables examined were days in hospital
and number of surgical procedures. There was a signficant
difference between native and non-native males in the
number of days in hospital (P< 0-002) when age was con-
trolled. There was no significant difference for males in the
number of surgical procedures. A similar analysis for
females showed a significant difference for days in hospital
(P< 0-001) and number of surgical procedures (P<0-05).

The initial review of discharge mortality, instigation,
aetiology, mode of travel type of bum treatment, type of
disch<u"ge and bum environment showed significant dif-
ferences between natives and non-natives. When compa-
risons were made for males alone, it was found that there
remained significant differences (P < COS) in bum environ-
ment, aetiology, mode of travel and type of discharge, but
no significant dififerences in discharge mortality, instig-
atioru and type of bum treatment. Females retained signifi-
cant differences (P<0^5) in mode of travel type of bum
treatment, and type of discharge, but no significant dif-
ferences for discharge nwrtality, bum environment, instig-
atioa and aetiology.

An examination of the same variables controlling for
age and sex together showed that many of tiie significant
differences remained between the rutive and non-native
groups. For males, with the age controlled there were sig-
nificant differences between groups for days in hospital (P
<0O01). total bum surface area (P<CH)5) and number of
surgical procedures (P<0001). The native group had
higher values for all variables. Using the same analysis for
females, with age controlled, there was a significant dif-

ipTPru^ K#fwA^ l-K* naKvp >r\A nr»n-naHvp ffmiir»« for riavc

in hospital (P< 0-001) and number of surgical procedures
(P<0-05). The native group had higher values for each of
these variables. There was no significant difference be-
tween groups for total bum surface area when controlling
for age and sex.

Discussion

Native people made up approximately 4-2 per cent of the
total population of 1-4 million people served by this Bum
Unit. With an overall incidence of 7-8 per cent of all bum
admissions, native people have accounted for almost twice
as many hospitalized bum victims as would be expected
from that given population.

The trend towards a difference in age at bum between
the two groups may be a result of a higher incidence of
paediatric bums in that native group or simply a reflection
of the fact that the overall age of Canadian natives is
younger than the general population (Statistics Canada.
1981). Fifty per cent of all native bum patients are children
less than 18 years of age, and within this group, accidents,
injuries and violence account for 40 per cent of the deaths
(Bain, 1982). Non-native bum patients less than 18 years of
age make up orJy 30 per cent of the non-native bum
group. The large difference in proportion of bum patients
less than 18 years of age (natives 50 per cent, non-natives
30 per cent) may be a reflection of different demographic
patterns within the two communities.

Overall mortality rates were similar but total bum sur-
face area was larger for natives, perhaps due to the fact that
alcohol and street drugs are used to a greater extent in the
native populatioa leading to an altered level of conscious-
ness at the time of bum and thus a more prolonged ex-
posure to flames and smoke.

Non-accidental causes of bums in natives were double
that of non-natives. Alcohol as a related cause of bums,
was five times more frequent among lutives than non-
rutives; street drugs twelve times more frequent. The latter
should be cautiously interpreted as there were a limited
number of cases and the adequacy of reporting may be
incomplete.

High unemployment and lower average age of the
native population reduces the potential risk of bum injuries

nrnirrina in fh^ wr»rWnlar«» wftprpac nr^n.naKvA< ar<> moro

29

INJURIES IN THE HOME AND COMMUNITY

WORKGROUP

frequently employed in the petrochemical industry, a
source of high occupational risk for bum injury in this area,
leading to an increase for this group.

Over 75 per cent of native bums (compared to 45 per
cent for non-natives) occur within the home leading to
both personal and property damage, thus fewer natives
have homes to be discharged to upon completion of active
treatment. Given this lack of family resources and greater
distance from their residence it is understandable that
native patients would remain in the hospital longer and
require greater support in the form of rehabilitation
services through regional and auxiliary hospitals than non-
natives. In addition, those bum injuries requiring rehabilit-
ation only add to an already higher than average propor-
tion of disabled and handicapped among the native popul-
ation (Shah and Farkas, 1985).

Since, according to Statistics Canada 1981 Census, 61
per cent of natives live in isolated northern communities it
is understandable that there is a higher utilization of the air
ambulance service among native patients. It is also imder-
standable that this may create a delay in initiating appro-
priate treatment to these people while being transported
via fixed wing aircraft to the Bum Unit.

When a more detailed analysis, controlling for age and
sex, was conducted some of the earlier differences noted
between natives and non-natives disapp>eau'ed. Native
males came closer to the results exhibited by non-native
males. A similar trend occurred for females but this was not
as pronounced as in the males. However, there continued
to be marked differences in the number of days spent in
hospital. Natives spent approximately 17 days longer in
hospital than non-natives. Individual patient costs per hos-
pital bed in Alberta Hospital Bum Unit were determined to
be $693 Canadian (£319) per day in 1986. Consequently,
the average stay for natives cost approximately $1 1 000
(£5070) more than for non-natives.

Conclusions

Native people accounted for almost twice as many hos-
pitalized bum victims as would be expected from that
given population. Overall mortality rates were similar but
total bum surface area was larger for natives. Non-
accidental causes of bums in natives were double that of
non-natives. Alcohol, as a related cause of bums, was five
times more frequent among natives than non-natives.
Over 75 per cent of native bums (compared to 45 per cent
for non-natives) occur within the home. There was a sig-
nificant difference in the number of days in hospitaL with
natives spending 17 days longer in hospital than non-
natives. Natives require air or road ambulance transport
more often, receive more operations, and tend to be dis-
charged to auxiliary hospitals more than non-natives.

References

Bain H. W. (1982) Community development: an approach to
health care for Indians. Can. Med. Assoc ]. 126, 223.

Baker F. W.. Findlay S_ Isbtster L et al. (1987) Native health care
an alternative approach (Editorial) Can. Med. Assoc. 136.
695.

Compilation (1981) The Disabled and Handicapped. Follow-up
Report: Native Population, Special Committee on the Disab-
led and the Handicapped. Ottawa: House of Commons.

Demling R. H. (1985) Bums. N. Engl /. Med. 313, 1390.

Feller I., Flora |. D. Jr and Bawal R. (1976) Baseline results of
therapy for burned patients. JAMA 2 36, 1943.

Feller 1., Tholen D. and Cornell R. G. ( 1980) Improvement in bum
care, 1965-1979. /AMA 244, 2074.

Hislop T. G. Threlfall W. J., Gallagher R. P. et al. (1987) Acci-
dental and intentional violent deaths among British
Columbian native Indians. Can. J. Public Health 78. 271.

Jarvis G. K. and Boldt M. (1982) Death style's among Canada's
Indians. Soc. Sci. Med. 16. 1345.

Mclntyre L and Shah C P. (1986) Prevalence of hypertension,
obesity and smoking in three Indian communities in north-
western Ontario. Can. Med. Assoc. ]. 134, 345.

Moncrief I. (1973) Bums. N. Engl. J. Med. 288. 444.

Schmitt N., Hole L W. and Barclay W. (1966) Accidental deaths
among British Columbia Indians. Can. Med. Assoc. J. 94, 228.

Shah C. P. and Farkas C S. (1985) The health of Indians in Cana-
dian cities: a challenge to the health care system. Can. Med.
Assoc. J. 133, 859.

Statistics Canada (1981) 1981 Census.

Statistics Canada (1985) Vital Statistics, Mortality, 1985, Vol. III.
Cat. No. 84-206, Annual. April 1987.

Tervo R. (1983) The native child with cerebral palsy at a
children's rehabilitation centre. Can. }. Public Health 74, 242.

Thomson M. P. (1983) The Smoking Habits of Native Canadians.
In: Forbes W. F.. Frecker R. C. and Nostbakken D. (eds).
Ottawa. Proceedings of the Fifth World Conference on Smoking
and Health. Winnipeg. Canada, vol. 1. Canadian Council on
Smoking and Health, p. 785.

Young T. K. (1983) Mortality pattern of isolated Indians in Nort-
hwestern Ontario: a 10 year review. Public Health Rep. 98.
467

Paper accepted 22 May 1988.

Correspondence should be addressed to: Or M. G. A. Grace, Depart-
ment of Surgery. University of Alberta Hospital Edmonton.
Alberta. Canada.

INJURIES IN THE HOME AND COMMUNITY

WORKGROUP

Profile of the paediatric burn patient in a Canadian
burn centre*

C A. Ryan\ H. A. Shankowsky^ and E. E. Tredget^

'Department of Pediatncs and ^Firefighters' Bum Treatment Unit, Division of Plastic Surgery, Department of Surgery,
University of Alberta Hospitals, University of Alberta, Edmonton, Alberta, Canada

Five hundred and eighty-three children (0-18 years old), caraistjng of 33.4
per cent of all bum inpatients, were admitted to the University of Alberta
Hospitals over an 11-year period (January 1978 to December 1988).
Demographic and outcome variables, in addition to aetiological factors,
were examined. 4S.4 per cent of bums occurred in children < 4 years of
age. with males predonurmting in every age group (P < 0.001). Children
had smaller bums, a higher incidence of scalds, less inhalation mjuries and
a lower mortality compared to adult bum patients admitted over the same
time period (? < 0.05). There was a low incidence of confirmed child abuse
by bums (1.4 per cent). High-nsk environments identified were the home
{74.6 per cent of bums) and recreational settings (12.4 per cent of bumsl.
mainly occurring around campfires. Native children were overrepresented
m the bum population compared to the general population by a factor of
approximately 10 ■ I. Scald prevention, high-nsk environments (home and
recreational), high-nsk populations (male and natives) and unsafe practices
with flammable liquids (petrol in particular) should be emphasized in
paediatnc bum prevention programmes.

Introduction

Thermal injury is the third most common cause of injury-
related deaths in the industrial world, accounting for more
than 1300 childhood (0-14 years old) deaths per year in the
USA (Robinson and Seward 1987) and approximately 120
deaths per year in Canada (Statistics Canada. 1986). In
addition, for every paediatric death there are approximately
50 children viho survive bums which are severe enough to
require admission to hospital (Guzzetta and Holiharv 1988).
While the numbers of deaths reflect the importance of the
subject, its true enomiity is portrayed by expressing these
losses in potenKal years of life lost before the age of 65.
Thus, 101 000 life-years were lost in the USA in 1985 from
1461 bum deaths (0-19 years old) at a cost to society of $3.5
billion (McLoughlin and McGuire, 1990).

Bums are therefore an enormous societal and personal
burden. However, tf>ere is a dearth of information in Canada
concerning paediatric bum injuries. In order to address this
deficiency, we compared the demographics, hospital course
and outcome of paediatric and adult hums and examined the
aetiology of paediatric bums in a provincial bum unit over
an 11-year period

© 1992 Butterworth-Heinanann Ltd
0305-4179/92/040267-06

Patients and methods

A retrospective study of 583 children (0-18 years of age)
with bums admitted to the University of Alberta Hospitals
over an 11-year period (January 1978 to December 1988)
was undertaken. These included patients treated for bums
within and outside the Firefighters' Bum Unit (FBU). The
relevant data were retrieved from the Bum Treatment
Registry, a computerized registry, containing over 500
items of information on each bum patient admitted to the
hospital. The Registry has previously been described in
detail by Callegan et al. (1989). Patients excluded from the
data registry and this study include those admitted for
secondary or reconstruchve surgery and those who suffered
either an inhalation or chemical ingestion injury without a
surface area bum.

This bum unit is the referral center for Northern Alberta
and the North West Temtones, an area of over 500 000 km-,
serving a total population of over 1.4 million people. This
area includes a relatively large native population (Treaty
Indians and Metis were classified as native people) which is
incompletely enumerated but is estimated, from Statistics
Canada data, at approximately 4.3 p>er cent of the total
population, of whom a third are < 19 years of age (i.e. 1.4
per cent).

The distances involved in transporting critically ill
patients to Edmonton are extensive, up to 2000 km from
some outlying communities, many of which have sparse or
no medical facilities. Thus prolonged transportation inter-
vals (up to 24 h in some instances) are not uncommon. Most
physicians who serve the outlying commuruHes and
reserves have Advanced Trauxna Life Support training,
during which it is recommended that bum patients be
referred to the regional bum unit according to the American
Bum Association guidelines. These indude partial and full
skin thickness burns involving more than 10 per cent BSA in
patients under 10 and over 50 years of age; parrial and full
skin Rudeness bums greater than 20 per cent BSA in other
age groups; partial and full skin thickness bums with serious
threat of functional impairment that involve the face, hands,
feet, genitalia, perineum and major joints; full skin thickness
bums greater than 5 per cent in any age group. Bum patients
who do not meet these criteria may be treated in local
medical centres or regional general hospitals.

31

INJURIES IN THE HOME AND COMMUNITY

WORKGROUP

Inhalation injuries were diagnosed according to criteria
reported by Tredget and Shankowsky (1990). A recreational
burn was defined as one occurring outside the 'home'
environment and involving a recreational setting and/or
activity, for example, camping in a park or playing in a
street. Statistical analysis of the data was performed using
the SF*SSX statistical package to compute basic descriptive
statistics, and to detect any significant differences between
the variables using chi-square and /-tests and analysis of
variance where applicable. P values (two-sided) less than
0.05 were considered statistically significant.

Results

Demographic data

The 583 children and young adults (0- < 19 years old) with
bums accounted for 33.4 per cent of all 1744 bum patients

1

<1 1 2 3 14 S 6 7 8 9 10 1 1 12 13 14 IS 16 17 18
Age (yr)

Figure 1. Distribution of ages for 583 children included in the

study.

r

<1 1 2-5 6-12 13-18

Age (yr)

Figure 2- Distribution of age by gender among 583 children. K ,
Male; female.

admitted during the 11 years under study. In comparison.
32.4 per cent of Northem Alberta's population is less than
19 years of age. Almost half of the paediatric burns (48.4 per
cent) occurred in children less than 4 years of age {Figure J ),
with males outnumbering females in every age group
(P< 0.001, Figure!). Most of the children were Caucasian
(80.6 per cent), while Treaty Indians and Metis accounted
for 13.4 per cent of paediatric bum admissions. This is
almost 10 times their representation within the general
population (1.4 per cent). Of the 583 children there were 14
Oriental (2.4 per cent), 16 East Indian (2.7 per cent), three
black-skinned (0.5 per cent) and two Inuit (0.3) per cent
children.

Severity of bum injury

The mean total body surface area (TBSA) burned was
12.3 ± 14.2 per cent (range 1-100 per cent TBSA), which is
significantly lower than the mean TBSA in 1161 adult
patients treated by the FBU over the same time period
(16.4 ± 18.9 per cent, P< 0.01). Nineteen children or 3.3 per
cent of all bumed children suffered injuries greater than 50
per cent TBSA, while nine of these had bums > 70 per cent
TBSA. The percentage TBSA bumed did not vary signifi-
cantly with age or sex (male, 12.5 per cent; female, 1 1.8 per
cent; P<0.05).

Aetiology of bums

Children had a significantly higher incidence of scalds and a
significantly lower incidence of flash injuries compared to
the adult patients (P<0.05, Figure 3). Scalds accounted for
close to half of all bums in children, followed by flame, flash
and contact bums (electric irons, radiators, hot embers).
Children with scalds were younger (mean = 2.7 years) than
children with flame and flash injuries (10.0 and 12.5 years
respectively; P<0.01). Flammable gases, liquids and
matches were identified in 77 per cent of flash and flame

Table i. Combustible agents involved m 219 flame and flash

injuries (percentage calculated on 1

68 known causes)

Combustible agent

No

%

Petrol alone

64

38.1

Petrol and matches

16

9.5

Natural gas

20

11.9

Propane

12

7.1

Lighters

12

7.1

Matches alone

10

5.9

Kerosene

6

3.6

Matches and other

4

2.4

Barbeque fluid

3

1.8

Methyl hydrate

3

1.8

Other

18

10.7

Unknown

51

Total

219

100.0

Scald 41.2

)ther 3.7
Electrical 3.3
'^Crease I.S
Contact 9.8
Children

Flash 311.4

Scald 8.7

Other 13.2

Electrical 8.3
Crease 4.S
Contact S.3

Adults

Figure 3. Aetiology of bums in 583 children compared to that in 1161 adults admitted over the
same timespan.

INJURIES IN THE HOME AND COMMUNITY

WORKGROUP

Flame 23.5

Contact 6.1
Flash 10.3

Contact 27 0

Recreational

Figure 4. Aetiology of bums in the home (429 children) compared to those occurring
recreational settings (74 children).

Table II. Environment: where did the bums ocoir?

Place

No.

%

Home

429

73.6

Recreational

74

12.7

Occupational

30

5.1

Motor vehicle accident

23

3.9

Temporary domicile

16

2.7

Public building

7

1.2

Hospital

1

0.2

Ottier

3

0.5

Total

583

100.0

Table FV. Comparing aetiology and environment of bums in
native (n= 78) and non-native (n= 505) children

Natives Non-natives

No.

%

No.

%

Aetiology

Scald

26

333

214

42 4

Flame

30

38.5

113

22.4

Flasti

9

115

67

13 3

Ttiermal contact

4

5.1

53

10 5

Grease

4

5.1

22

4 4

Electrical

3

3.8

16

3.2

Ottier

2

2 6

20

4 0

Environment

Home

65

83.3

364

72.1

Recreational

4

5.1

70

13.9

Work

0

0.0

30

6.0

Other

9

11.5

41

8.1

(P<0.05)

(P<0.05)

Table III. The circumstances associated with bums occurring in a
recreational setting

Cause

No.

%

Campfires

Walked or fell

24

32.4

Poured petrol

11

14.8

Ottier flammables

3

4.1

Ttirew aerosol can

5

6.8

Scalds

3

4.1

Other

5

6.8

Playing*

12

16.2

Tent fire

4

5.4

Motorcycle

2

2.7

Motor boat (explosions)

2

2.7

Power transformer

2

2.7

Assault (set on fire)

1

1.4

Total

74

100.0

'Unsafe environments or practices (e g

dumps.

irecrackers)

A

/ \

/ \

Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec

Month

Figure 5. Seasonal vanation in recreational bums ( — • — ) com-
pared to all other bums ( — I — )

injuries, with petrol being implicated in close to half of
known cases {Jabk I)-

The vast majority of scalds occurred in the home (91.7 per
cent). A review of 46 childhood scalds that occurred over a
1-year period (1 January to 31 December 1986), showed
that 76 per cent were due to hot liquid spillages (water, tea,
coffee, soups). The remainder (24 per cent) were caused by
children or their caretakers turning on the hot water faucets
of sinks or tubs in error.

Nearly three-quarters of all bum injuries occurred in the
home while 12.7 per cent occurred in recreational settings
(Table U). There was no significant difference in percentage
TBSA and length of hospital stay when comparing home to
recreational bums. However, children who suffered bums in

a recreational setting were significantly older than children
who were injured at home (8.6 ±5.8 years vs 5.5 ±5.4
years; P< 0.01). Scalds predominated in the home, followed
by flame injuries. In contrast, flame injuries were much more
common in the recreational setting, followed by hot solid
contact bums and flash injuries (Figure 4). There was a
marked seasonal variation in reaeationaJ bums compared
with all other bums, with the peak incidence occurring in the
summer months {Figures). Campfires accounted for 68 per
cent (50/74) of recreational bums (Table M). One in three
were associated with inappropriate use of petrol or other
flamnuible agents.

All occupaHonal bums occurred in young fieople
between 16.5 and 19 years of age. Flash and flame injuries

33

INJURIES IN THE HOME AND COMMUNITY

WORKGROUP

accounted for 53 per cent (16/30) of occupational bums
involving petrol (8/16), propane (4/16) and natural gas
(4/16). Other injuries included scalds (5/30), grease (5/30)
and electncal bums (4/30).

The vast majority of bums (96.6 per cent) were uninten-
tional. Eleven children (1.9 per cent) were burned deliber-
ately by other children or siblings, eight were victims of
child abuse (1.4 per cent), and there was one attempted
suicide (0.2 per cent).

Apart from a significantly higher incidence of flame bums
and a lower incidence of recreational injuries (P<0.05), the
aetiology of bums among native children was not substan-
tially different from non-natives {Table IV).

Hospital course and outcome

Almost half of the children (46.5 per cent) had at least one
surgical procedure for bums, mairJy eschar debridement and
split thickness skin grafting. The average number of surgical
interventions was 1.7 per patient (range 1-9). The average
length of hospital stay for all patients was 23.0 ±27.2 days
(median 16 days; range 1-267 days). Although median
lengths of hospital stay were similjir (16 days), children who
required surgery (« = 27I) had almost three times the
average length of stay (35.9 ± 34.4 days) compared with the
312 children who did not require surgery (12.1 ± 9.0 days,
P<0.01), due to the skewed distribution of the former
group.

The incidence of inhalation injuries was significantly
higher among adults compared with children (10.2 per cent
vs 2.9 per cent, P<0.05). Qiildren with inhalation injuries
had significantly greater bums compared with those with-
out inhzilation injuries (57.5 per cent ±28.1 vs 10.9 per
cent ± 11.1). In additioa the presence of an inhalation injury

was significantly associated with death, being present in five
of the eight children who died compared to 12 of the 575
children who survived (P< 0.01). Patients who sustained an
inhalation injury and survived had a significantly prolonged
length of hospital stay (117.9 ±86.1 days; median = 65
days; « = 17) compared with survivors who did not have an
inhalation injury (21.3 ±20.4 days; median = 16 days;
M = 566; P<0.01).

Eight children died giving an overall mortality rate of 1.4
p>er cent (Tabk V), which was significantly lower than the
adult mortality rate of 5.3 per cent (P< 0.05). Mortality was
related to increasing percentage of TBSA burned. No
significant trends in age distribution, percentage of TBS/\.
length of stay or mortality were observed during the study
period.

Discussion

In general bums in children were less severe compared with
bums in adult patients, as indicated by a smaller mean
percentage TBSA, less flash and flame bums and a lower
incidence of inhalation injuries among children. This may
have contributed in part, to the lower mortality rate among
children compared with adults. However, it does not imply
that, hospital admission criteria for children with bums
should be made less stringent. Bum size, depth and location
(as described in the Patients and methods' section), the
circumstances leading to the injury and the ability of the
parents to cope must all be considered when determining
paediatric admission criteria.

The vast majority (98.6 per cent) of bumed children who
reach hospital survive, although the addition of an inhala-

Table V. Demographic data on the eight children who died

Age

Sex

TBSA

Survival time
LOS

Cause/
location

Inhalation
injury

Course

2yr

M

100

3h

Flash

Natural gas
Home

Yes

Palliative care

18yr

M

95

28 h

Flash

Natural gas

Furnace

Home

Yes

Self-extubation
Failure to reintubate

11 yr

M

90

6h

Flame

Matches

Petrol

Yes

Acute renal failure
Cardiac arrest

8mth

F

70

12h

Scald

Tub

Home

No

Hypotensive

Metabolic acidosis (H " = 1 00)
Cardiac arrest

3yr

M

40

72 h

Flame
Lighter
Clothing
Home

No

Hypernatraemia (Na = 1 94 mmol/l)
Rapid correction causing cerebral oedema
and brain death

Syr

M

30

lOh

Flame
Home

Yes

Pulled pulseless from house
Cardiac arrest prior to transfer
Severe acidosis, cerebral oedema
Probable carbon monoxide poisoning

Ayr

M

30

5d

Flame
Matches
Sofa
Home

Yes

Pneumococcal pneumonia
ARDS

17yr

M

40

26 h

Electrical

Pylon

Alcohol

Airway
injury

Bronchoscopy/CXR N on admission
Airway obstruction at 26 h
Failure to intubate

34

INJURIES IN THE HOME AND COMMUNITY

WORKGROUP

tion injury is associated with a higher mortality. A previous
analysis of all bum patients admitted to the University of
Alberta Hospitals, including the children reported here,
revealed that inhalation injury adversely influenced survival
in all patients independent of the TBSA burned and reversed
the otherwise favourable survival rates in children (Tredget
and Shankowsky, 1990). While length of hospital stay was
prolonged in patients with inhalation injuries, this was
related more to the larger bums encountered in patients
with inhalation injuries rather than the inhalation injury per
se. It should be emphasized that children with inhalation
injuries, even with very extensive bums, have an excellent
probability of survival when treated in specicilized bum
units.

The overall mortality in this series was 1.4 per cent, which
is comparable with other repjorts G^homson et al., 1986;
Tomkirts et al., 1988). However, comparisons of simple
mortality rates between centres are misleading because of
differences in patient populations, bum size and type. The
percentage survival related to the percentage TBSA is a
more accurate indicator of the level of care in a bum unit,
although this still does not t<ike into account pertinent
factors such as the incidence of ir\halaHon injury, which has a
major effect on survival independent of age and percentage
TBSA. Nevertheless, our survival rate of 44 per cent for
bums greater than 70 per cent TBSA is compairable with
other reporirs (East et al., 1989).

The low hospital mortality rates should not lead to
complacency since, apart from belying the enormous mor-
bidity associated with bums, they do not include the many
bum victims who do not survive to reach hospital. Between
1980 and 1989 there were 43 deaths from fires in people less
than 19 years of age in Northern Alberta, not including the
North West Territories (Wijayasinghe, 1990). Since only
eight children died having reached this institution (the major
referral hospital for Northern Alberta and the Northwest
Territories), we can deduce that for every hospital death,
there are at least five others who did not survive to reach the
bum unit.

Many of the findings, including the age and sex distribu-
tion, type of bum injury and survival rate, broadly concur
with those of the National Bum Information Exchange
(NBIE) (Feller et al., 1982). The pattem of bum injuries
resembles that seen in other developed countries (Langley
and Tobin, 1983; Green et al., 1984; Lyngdorf et al., 1986;
Gordon and Ramsay, 1986). However some factors, unique
to this area, emerged from the present study. These include
the low incidence of confimied diild abuse, the higher rate of
hospital admission among the native population and the
occurrence of bums around campfires, often associated with
the misuse of petrol and other flammable liquids.

The incidence of confirmed child abuse by bums was low
compared to other series where the incidence varies from 2
per cent (Kumar. 1984), to 4.2 per cent (Stone et al., 1970)
and as high as 16 per cent (Hight et aL. 1979) of all bums.
This low detection rate implies either a low prevalence of
child abuse in our population or a reluctance to make such a
diagnosis. Every child admitted with bums during the study
period was seen by a sodal worker and the circumstances of
the injury were evaluated for possible abuse. Nevertheless,
based on our findings of a lower than average rate of child
abuse, we are instituting a protocol similar to that described
by Gmigan et aL (1988). whid\ weighs the risk factors for
abuse in each bum patient. In rtus way, we hope to be able to
make a more objective assessment of the circumstances of
bum injuries.

In a previous analysis of bums in native Canadians, taken
from the University of Alberta Hospitals Bum Registry.
Callegari et al. (1989) confirmed that native people in
Alberta are at a higher nsk and suffer more severe bums than
non-natives. On closer examination of bums in native
children we observed that they were overrepresented in the
bum unit compared to the general population by a factor of
10 : 1, and that flame injunes were more common among
natives compaired to non-native children. This concurs with
national data, which indicate that the mortality rate of
natives from fire and flames is six times the national average
(15.2 vs 2.5 per 100 000 population; Avard and Hanvey,
1989). Poor housing (60 per cent of native homes are
without rurming water, sewage disposal, or indoor plumb-
ing facilities), a higher incidence of smoking and alcohol
abuse, high unemployment and larger families resulting in
inadequate supervision may all contribute to this problem.
Strategies to prevent bums among native people will have
to arise from the native communities themselves (Bain.
1982). Such strategies should be aimed at resolving the poor
sodal and econonnic factors that have made injuries in
general the prime cause of death among native children.

We used a broader definition of recreation (location and
activity outside of the home) than the International Classi-
fication of Diseases code, where recreation is classified by
locadon alone. Wliile recreational settings have been assoc-
iated with bums in other studies, the contribution of this
factor varies depending on cultural, economic and geogra-
phical backgrounds. In New England, USA. 37 per cent of
paediatric bums were non-residential, with motor vehicles
accounting for a qucirter of such bums among those aged
15-19 years (Rossignol et al., 1990). In contrast, only 2.5 per
cent of paediatric bums in Saudi Arabia were non-residential
Oamal et al., 1990), which is similar to other countries where
leisure activities outside the home are uncommon (Abu
Ragheb et al., 1984; Mabogunje et al., 1987). Increasing
leisure hme and the long tradition of outdoor activities in
Alberta's provincial and national parks, contribute to the
high incidence of campftre bums in this study. Because of
this. Parks and Recreation, Canada, are now incorporating
bum prevention into their school-based programmes.

The misuse of petrol to ignite fires was also associated
with campfire bums. Indeed, petrol, flammable liquids and
matches were concomitant in over three-quarters of all flash
and flame injuries in this study. Petrol-related bums
accounted for 10-23 per cent of annual admissions to the St
Paul, Minnesota Bum Center (Williams et al., 1990). A recent
report from the Shriners Bum Unit in Galveston, Texas
indicated that up to 62 per cent of bum injuries (in children
between 10 and 15 years of age) were petrol related; half of
the injuries were due to petrol being thrown on a fire while a
quarter were associated with petrol sniffing (Cole et al..
1986). a problem also prevalent among Canadian native
youths (Boeckx et al., 1977). The public particularly young
people, need to be alerted to the dangers of petrol misuse
and the need for continued efforts promoting, safety in the
use and storage of these agents is evident.

Although the probability of surviving a major bum in
Alberta is excellent among children who reach hospital
those living in remote areas are at a geographical disadvan-
tage whidi may cost lives. For these communities the need
to prevent bums is all the more imperative. Thus, bum
prevention efforts should be directed at scald preventioa
high-risk environments (home and recreatiorul), high-risk
populations (male and natives) and unsafe practices with
flammable liquids.

35

INJURIES IN THE HOME AND COMMUNITY

WORKGROUP

Acknowledgements

The authors thank Peter Olley, MB, for his thoughtful
comments and the nurses of the Firefighters' Bum Unit
whose commitment to patient care made this study possible.

Supported by the Alberta Heritage Foundation for
Medical Research and by the University of Alberta Hospi-
tals Firefighters' Bum Treatment Fund.

References

Abu Ragheb, Qaryout S. and Al Mohtaseb H. (1984) Mortality of

bums in Jordan. Bums 10. 439.
Avard D. and Hanvey L (1989) Aboriginal children. In: Avard D.

and Hanvey L (eds). The Health of Camda's Children: A CICH

Profile. Ottawa: Canadian Institute of Qiild Health, p. 105.
Bain H. B. (1982) Community development: an approach to health

care for Indians. Cart Med. Assoc. J. 116, 223.
Boeckx R. L, Postl B. and Coodin F. ]. (1977) Gasoline sniffing and

tetraethyi lead poisoning in children. Pediatrics 60, 140.
Callegari P. K Alton J. D. M. Shankowsky H. A. et al. (1989) Bum

injuries in rutive Canadians: a 10-year experience. Bums 15,15.
Carrigan L, Heimbach D. M. and Marvin J. A (1988) Risk

management in children with bum injuries. /. Bum Care Rehabil.

9, 75.

Cole M., Hemdon D. Desai M. H. et al. (1986) Gasoline

explosions, gasoline sniffing: an epidemic in young children.

/. Bum Can Rehabil. 7, 532.
East M. K., Jones C A., Feller 1. et al. (1989) In: Carvajal H. F. and

Parks D. H. (eds). Bums in Children: Pediatric Bum Management.

Chicago: Year Book Medical p. 3
Feller I., Jones C. A. and James M. H. (1982) Bum epidemiology:

focus on youngsters and the aged. /. Bum Care Rehabil. 3, 285
Hight D. W., Bakalar H. R. and Lloyd J. R. (1979) Inflicted bums in

children: recognition and treatment. }AMA 242. 517.
Gordon P. G. and Ramsay G. C (1986) A survey of thermal

injuries to children in Australia. Aust. Fam. Physician 15. 1222.
Green A. R., Fairdough J. and Sykes P. J. (1984) Epidemiology of

bums in childhood. Bums 10, 368.
Guzzetta P. C. and Holihan J. A. (1988) Bums. In: Eichelberger M.

R. and Pratsch G. L. (eds). Pediatric Trauma Care. Maryland:

Aspea p. 153.

Jamal Y S., Ardawi M. S. M.. Ashy A. R. A. ct al. (1990) Pediatric

bur, injuries in the jeddah area of Saudi Arabia: a study of 197

paSi-.-nts. Bums 16, 36.
Kumar P. (1984) Child abuse by thcmial iniury - a relrospective

study. Bums 10, 344.
Langley J. and Tobm P. (1983) Ch.idiiood burns N Z. Med j 96,

681.

Lyngdorf P.. Sorensen B. and Thomsen M. (1986) The total

number of bum injuries in a Scandinavian population: a

prospective analysis. Burns 12, 567.
MabogunjeO., Khawaja M. and Lawrie J. (1987) Childhood bums

in Zaria. Nigena. Bums 13, 298.
McLoughlin E., and McGuire A. (1990) The causes, cost and

prevention of childhood burn injuries. Am. j. Dis. Child. 144,

677.

Robinson M. D. and Seward P. N. (1987) Thermal injury in

children. Pediatr. Emerg. Care 3, 266.
Rossignol A. M.. Locke I. A. and Burke J. F (1990) Paediatric bums

in New England. USA. Bums 16, 41.
Statistics Canada (1986) Vital Statistics. Mortalih/. 1986, Vol. IV.

Cat. No. 84-203. Annual.
Stone N. H. Rinaldo L. Humphrey C. R. et al. (1970) Child abuse

by burning. Surg. Clin. North Am. 50, 1419.
Thomson P. B., Hemdon D. N.. Traber D. L et al. (1986) Effect on

mortality of inhalation injury. /. Trauma 26, 163.
Tomkins R. G.. Remensnyder J. P., Burice J. F. et al. (1988)

Significant reductions in mortality for children with bum

injuries through the use of prompt eschar excision. Ann. Surg.

208, 577.

Tredget E. E. and Shankowsky H. A. (1990) The role of inhalation
injury in bum trauma: a Canadian experience. Ann. Surg. 6, 720.

Wijayasinghe M. (1990) Fire injunes in Alberta. Alberta Fire News
11, 10.

Williams J. B.. Warren B., Arenholz D. H. et al. (1990) Gasoline
bums: the preventable cause of thermal iniury (abstr). Proc. Am
Bum Assoc. 22, 16

Paper accepted 22 December 1991

Correspondence should be addressed to Dr C A. Ryan, Department ot
Pediatrics, 2C300. Walter Mckenzie Center. University of Alberta.
Edmonton. Alberta. Canada T6G 2B7

36

OCCUPATIONAL INJURIES WORKGROUP

WORKSHOP OUTLINE

WORKSHOP 1: (Thursday, October 22: 09:45 - 12:00)

• Presentation: What's New Internationally (Maureen Shaw)
Presentation: The Canadian Scene (Herb Buchwald)

Presentation: Occupational Health and Safety Initiatives in Alberta (V em Millard)
Presentation: The Alberta Situation (Hugh Walker)

Presentation: Review of the OH&S Objectives in the Year 2000 Report (Dave
Gibson)

Participants will identify a sub-set of the Year 2000 Objectives for Occupational
Injury Reduction relevant to Alberta, achievable in the near future and of particular
interest to the participants

Participants will choose one of the selected objectives to work on

WORKSHOP 2: (Thursday, October 22: 14:45 - 16:30)

Participants will meet in the small groups as selected in Workshop 1.
Each small group will work on one occupational injury reduction objective.
Each small group will develop goals specific to the selected Year 2000 Objective.
Goals must be relevant to Alberta, achievable in the near future (next 1-2 years),
and observable/measureable.

Discussion of potential strategies to reach the goals will start.

Each small group will report back to the Occupational Health and Safety

Workgroup at the end of the session with formalized goals.

37

OCCUPATIONAL INJURIES WORKGROUP

WORKSHOP 3: (Friday, October 23: 09:15 - 11:15)

• Participants will meet in small groups as selected in Workshop 1 .

• Each small group will continue to work on its occupational injury reduction
objective.

• Potential strategies will be discussed.

• Each small group will work on activities specific to its selected goals for its Year
2000 Objective. Activities must be relevant to Alberta and must be demonstrably
supportive of the Year 2000 Objective. Each activity must have a leader, contact,
focus group or champion identified to implement the activity.

• Each small group to report back to the Occupational Healdi and Safety Workgroup
at the end of the session with formalized action plan, including identification of key
stakeholders, overall timeline for the activities and outline of measurement
approach.

PLENARY SESSION: (Friday, October 23: 11:15 - 12:00)

• Report from the Occupational Health and Safety Workgroup to the plenary session.

38

OCCUPATIONAL INJURIES WORKGROUP

OVERVIEW

The Alberta lost-time injury rate declined by 12% in 1991, to 4.38, compared to
4.97 in 1990. This is the lowest value ever reported for Alberta.

• Risk of injury declined in all major industry sectors. The largest declines occurred
in: Construction (-22%), Oil Gas and Mines (-16%), Forestry (-15%), and
Manufacturing (-14%).

• The three highest risk industry sectors continue to be Forestry, Construction, and
Manufacturing.

The highest risk sub-industries continue to be; meat and poultry packing (19.3),
geo-seismic exploration (12.9), trucking (12.7), and metal fabrication (12.1).

Sub-industries with considerably lower risk, compared to 1990, were: glass and
windows (-39%), flooring installation (-29%), sheet metal (-28%), geo-seismic
exploration (-27%), well service with rigs (-26%), meat and poultry packing (-
24%), and wood and building products (-24%).

The most frequent types of accident were overexertion (29%), bodily reaction
(15%), and being struck by objects (10%).

• The back was the most frequently injured part of body (29%).

• The most frequent type of injury was sprains and strains (49%).

21% of injured workers were between 15 and 24 years old. 24% had less than 6
months experience with their employer.

• 34% of injuries resulted in from 1 to 5 lost work days. 19% resulted in more than
50 lost work days.

39

OCCUPATIONAL INJURIES WORKGROUP

PROVINCIAL TOTALS

The number of lost-time claims decreased by 13.3% in 1991, while the estimated person-
years worked decreased by 1.6%; the result was an 1 1.9% decrease in the lost-time claim
rate in 1991 compared to 1990.

The following points summarize the lost-time claims and claim rates for the whole province
for 1991.

a) The estimated person-years worked in 1991 decreased by 1.6%.

b) The number of employer WCB accounts decreased by 2.7%.

c) The number of lost-time claims decreased by 13.3%.

d) The lost-time claim rate (per 100 person-years) was 4.38, down about 12% from
1990.

The lost-time claim rate has been declining gradually since 1985, when the rate was 5.54
lost- time clainos per 100 person-years. In 1991 the lost-time claim rate was the lowest ever
recorded in Alberta.

MAJOR INDUSTRY SECTORS

a. The person-years worked estimates declined in several major industry sectors. The
largest percent decreases occurred in construction (-11.3%) and manufacturing (-
3.9%). Person-year estimates increased in the forestry sector (+9.1%) and
agriculture (+8.5%).

b. Lost-time claims decreased in allindustry sectors. The largest percentage decreases
were in construction (-3L3%), oil gas and mines (-18.7%), and manufacturing (-
16.9%).

40

OCCUPATIONAL INJURIES WORKGROUP

c. Lost-time claim rates in all major industry sectors declined in 1991 compared to
1990. The largest declines were in construction (-22%), forestry (-15%), oil, gas
and mines (-16%), and manufacturing (-14%).

Each major industry sector consists of a wide variety of industries having a wide range of
health and safety risks. For example, the oil, gas, and mines sector includes both the high
hazard drilling, exploration, and servicing industries, and the low hazard operation and
processing industries.

PERSON-YEAR ESTIMATES AND CLAIM RATES BY DETAILED
INDUSTRY

Primary Resource

Very large differences in lost-time claim rates occurred between selected sub-
industries within this industry group. Claim rates were high in exploration and
logging, moderate in drilling, and well servicing, and low in the operation and
processing industries. Coal mining and the tar sands had relatively low lost-time
claim rates.

1990 versus 1991

a) Person-year estimates: Person-year estimates decreased slightly in most
primary resource industries. The only large decrease in employment
occurred in oil and gas well drilling (-10%). Logging activity increased
slightly (6%),

b) Lost-time claim rates: Lost-time claim rates decreased or remained
unchanged in all sub-industries. The largest change occurred in oil and gas
exploration (from 17.6 to 12.9; a 27% decline). Lost-time claim rates in
drilling and well servicing continued the downward trend begun in 1988.

41

OCCUPATIONAL INJURIES WORKGROUP

Manufacturing

The meat and poultry packing industry again had the highest claim rate in this sector
(19.3), but has improved considerably over the 1990 rate of 25.4. There were
relatively high claim rates as well in the fabrication and manufacture of metal
products industry, the food and beverage industry, and the wood products
industry. Low claim rates occurred in printing and publishing, and in the petro-
chemical industries

1990 versus 1991

a) Person-year estimates: Person-year estimates decreased in most
manufacturing industries, with the greatest decreases occurring in petro-
chemical (-14%), and meat and poultry packing (-13%).

b) Lost-time claim rates: Lost-time claim rates in 1991 decreased in moot
manufacturing industries. The greatest improvements were in meat and
poultry packing (-6.1), wood and building products (-2.5), metal produ ti
(-2.1) and non-metallic minerals (-2.1).

Construction

Among the major construction industry groups, the highest claim rate in 1990 was
for construction of buildings (7.8), followed closely by construction trades C
The lowest rate was for construction of roads and bridges (6.3). Among the specin
trades, roofing, sheet metal, concrete, and drywall construction trades had the
highest lost-time claim rates.

1990 versus 1991

a) Person-year estimates: Person-year estimates decreased for the construcaor;
of buildings (-14%), and construction trades (-12%).

42

OCCUPATIONAL INJURIES WORKGROUP

b) Lost-time claim rates: The lost-time claim rates in the construction
industries have declined substantially in every major group. Claim rate ^
declined in several special trades; particularly large decreases occurred m
sheet metal (-5.1) and roofing (-2.5).

. Trade

The trade industry includes small retail stores (e.g., jewellery stores) with very low
lost-time claim rates (1.7) and the automobile repair industry, with a claim rate of
5.3. Food stores had the highest claim rate in the trade sector (7.0) in 1991.

1990 versus 1991

a) Person-year estimates: Person-year estimates declined in most trade sub-
industries. The only increases occurred in machine sales and service (+6%)
and food stores.

b) Lost- time claim rates: Claim rates decreased in all trade sub-industries,
especially in food stores (from 9.1 to 7.0); and warehouse/wholesale (from
4.6 to 3.5). These changes, however, can be accounted for in part by the
reclassification of several large employers within the WCB assessment
system.

Transportation and Utilities

The trucking industry was the major source of lost-time claims in this sector, and
has the highest lost-time claim rate (12.7). Within this sector, air transportation
services had a moderate claim rate, and the claim rates within the railway, utilities
and communications industries were quite low.

1990 versus 1991

a) Person-year estimates: The largest increases in activity were evident in
pipeline operations (+14%), while there was a 12% decrease in railways,
and a 7% decrease in radio and television.

■4

OCCUPATIONAL INJURIES WORKGROUP

b) Lost-time claim rates: The lost-time claim rates decreased or reman rl
unchanged in most sub-industries in this sector in 1991 compared to V ->0
levels. The largest decreases were in trucking (from 14.3 to 12.7) and w
gas distribution (from 2.1 to 1.6),

Service

Claim rates for all sub-industries in this sector were relatively low; the care of ^ ^
young, old, and infirm had the highest claim rate in this sector (4.9). Low rate .
this industry sector occurred in the education (1.7) and engineering (0.9) industnes

1990 versus 1991

a) Person-year estimates: Person-year estimates for several sub- industries
increased in 1991; engineering increased 10%, and care of young, old a; .'
infirm increased 3%. Small decreases occurred in hospitals (-4.0%) ojA
hotels/restaurants (-3%).

b) Lost- time claim rates: Lost-time claim rates in the service sub-industn : .
changed only by small amounts in 1991 compared to 1990 levels. LTC
rates increased in building services and personal services, and decrease ] m
care of young old and infirm, hotels and restaurants, business services, and
engineering.

Public Administration

Sub-industries in this sector include the provincial government, provincial boiii ds
and agencies, and the various levels of local government Claim rates in these sab-
industries are generally near or below the provincial average,

1990 versus 1991

a) Person-year estimates: There were very few changes in 1991; loc dl
governments tended to increase slightly, while there was a decrease m
provincial government

44

OCCUPATIONAL INJURIES WORKGROUP

b) Lost-time claim rates: Claim rates in this sector decreased in the cities (from
6.1 to 5.7), and in counties and municipalities (from 5.2 to 5.4). The lost-
time claim rate for the provincial government decreased from 2.6 to 2.4 lost-
time claims per 100 person-year.

DESCRIPTION OF LOST-TIME CLAIMS; 1990, 1991

In this section, lost-time claims are described in terms of (a) source of injury, (b) type of
accident, (c) nature of injury, and (d) part of body injured. The percent distribution of
1991 claims is compared with the distribution of claims in 1990.

In addition, some information regarding the age, sex, and experience of injured workers is
included, as well as statistics on the duration of the disability (days compensation).

Source of Injury

The four most frequent sources of injury in 1991 were working surfaces (12.1%),
bodily motion (14.8%), metal items (9.7%), and boxes and containers (10.8%)
accounting for almost half of all lost-time claims. The distribution of claims
according to source of injury has changed very littie since 1990, except that injuries
due to bodily motion have increased.

Accident Type

The three most frequent types of accidents in 1991 involved overexertion (29.3%),
bodily reaction (14.8%), and struck by an object (10.3%). The distribution of
claims according to accident type has changed very litde in 1991 compared to 1990.

Nature of Injury

Sprains and strains accounted for 49.2% of claims (up from 45.7% in 1990),
followed by bruises and crushing (12.0%), and cuts and lacerations (9.7%).
Occupational disease or illness continues to account for only a small proportion of
lost-time claims.

45

OCCUPATIONAL INJURIES WORKGROUP

Part of Body

The most frequently injured body parts in 1991 were the back (29.0%), fingers
(10.3%), other trunk (10.4%), and ankle or foot (8.6%). The distribution of lost-
time claims by part of body injured changed very litde between 1990 and 1991.

Injured Worker Characteristics

Men accounted for 73% of lost-time claims in 1991, about 3% lower than in 1990.
Conversely, there was a 3% increase in the proportion of claims by women in
1991.

In 1991 about 20% of claimants were young (15-24 years), down from 23% in
1990, and 36% were aged 25-34. Changes from 1990 reflect a gradually aging
labour force. Lost-time claim rates for different age groups show that the 20
year age group had the highest rate (4.2), followed by the 25-34 year age gr- ;
(3.8). Note that these rates are based upon employment data from StatisUv
Canada, and not on AOHS person-years, and therefore cannot be compared direc
with other claim rates in this report

24% of injured workers had worked less than 6 months for their current empUvy i-
down from 29% in 1990, and 48% had worked for more than one year, up fruL j
45% in 1990. The risk of a work injury or illness during the first 6 months on the
job is estimated to be twice the risk faced by experienced workers (those w i th more
than 1 year on the job).

Days Lost

In 1991, 34% of claims were for 5 or fewer work days lost, and 15% were tor
between 6 and 10 days lost Lengthy disabilities (more than 50 days lusti
accounted for almost 19% of all lost-time claims in 1991. Compared to \ 9v<J, ^
were somewhat more long duration injuries and fewer short duration ir ;
reported to and accepted by the WCB in 1991.

46

OCCUPATIONAL INJURIES WORKGROUP

* For detailed figures and tables please refer to "Lost-Time Claims and Claim Rates, 1991
Summary" available through Research and Information Development, Planning and
Research Branch, Alberta Occupational Health and Safety, July 1992.

OCCUPATIONAL INJURIES WORKGROUP

A Safer Canada

Workplace Injuries in Canada

7 lie following is an excerpt
from A Safer Canada — Year
2000: Injury Control Objectives
for Canada. These proceedings
have been edited for this publi-
cation

1. Introduction

Work-related injuries and ill-
ness are an unacceptable part of
work life. In Canada, a com-
pensable work injury occurs
every seven seconds, and a
worker is killed every two hours
of each working day (Bulletin
No. 14, Labour Canada, April
1991). In 1989, provincial
Workers' Compensation Boards
paid "nearly $4 billion in benefits
to workers. The total costs
(including all direct and indirect
costs) of work-related injuries
have been estimated at almost
$20 billion in 1989 (Bulletin No.
14, Labour Canada, April 1991).
Almost 621,000 work-related
time-loss injuries were reported
to Workers' Compensaiion
Boards in 1989. Most frequently,
the injuries were caused by
over-exertion (28 percent) or
workers were struck by objects
(17 per cent). Of all injuries. 27
per cent involved the back
(Work Injuries 1987-89,
Statistics Canada, Catalogue 72-
208, 1991).

2. Issues Related to Setting
Objectives

a) If occupational illnesses
and injuries are to be sig-
nificantly reduced^ three
major inappropriate atti-
tudes that limit the belief
that it is possible must be
changed.

These inappropriate attitudes
are:

• Occupational health and
safety is something separate
from people's "real" lives.
On the contrary, occupational
health and safety has to become
an integral part of everyday life.

Almcsi all Canadians are woik-
er.s. Very few do not work full-
time or part-time, at home or
outside the home. "Safety at
work" is as important a part of
our lives as the use of seat belts,
rails on our basement stairways,
and child-resistant medicine bot-
tles.

• injury is a natural and
expected part of working for
a living.

This attitude has its roots in
beliefs such as "danger pay";
that is, compensating workers
for taking inordinate risks on the
job. The more reasonable expec-
tation is that working will not
result in injury or ill-health.
When Canadians come to realize
this fact, injury on the job will
become socially unacceptable
just like drinking and driving,
and the rate of injuries on the
job will fall accordingly.

• The purpose of the health
care system is to respond to
iiijurv and illness rather
itian to prevent it.

Canada's health care system is'
still based largely on treating ill-
ness and injury once they occur
rather than focusing on the
improvement of health through a
balanced mix of strategies, rang-
ing from health promotion to
disease/injury prevention to
treatment to rehabilitation.
Social marketing campaigns
aimed at increasing the public's
awareness that injuries are pre-
ventable, should also contain
messages that reinforce work-
place safety and health.

b) The lack of information
about injuries^ illness,
deaths and their ceuises is a
major impediment to evalu-
ating occupational health
and safety efforts in
Canada.

Data on work-related injuries
was the subject of considerable
discussion at the symposium.

Wiihout comprehensive and
accuiaie information about the
cuiTcnt situation, it is not possi-
ble to plan and implement opti-
mal programs for protecting the
health and safety of Canadian
workers.

Statistics Canada provides a
National Work Injuries Statistics
Program. It is a cooperative
arrangement under which
provincial and territorial
Workers' Compensation Boards
supply data on accepted time-
loss and permanent-disability
claims for work-related injuries
and illnesses. However,
Workers' Compensation system;
were designed principally for
paying claims, not for providing
mformation on the needs and t.he
effectiveness of health and sate
ty programs. Furthermore,
Workers' Compensation Boards
across the country vary some-
what in their record-keeping sys
lems. which makes it difficuk to
compare statistics between jui in
dictions or to calculate national
injury or illness rates.

As a priority, there is a need i
optimize the use of the existiii^:
system and data while sinvinL; ; .
improve data support for plan-
ning, delivering and evaluating
occupational health and safety
programs. There is also a need
to educate people on the mean-
ing and use of statistics.

In the future, if Canada is to
compare injury data with other
countries, it will also be neces-
sary to identify and obtain die
intemational data sources neces-
sary to make these comparisons,
and where required, to make the
necessary conversions to such
data to compare them to
Canadian data. In the long term,
it is believed that Canada should
adopt injury reduction objectives
aimed at achieving the lowest
death and injury rates of any
country.

INJURY AWARENESS & PREVENTION CENTRE NEWS

VOLS N06 o AUGUST IPPi-

OCCUPATIONAL INJURIES WORKGROUP

c) Workers who are well
informed and knowledge-
able about the recognition
and prevention of work-
related hazards are less
likely to be injured or
develop occupational ill-
nesses.

Education and information
programs are required at several
levels. Programs are required in
high schools to create new,
young workers who are better
equipped to perform work in a
safe and healthful manner.
Programs are required in univer-
sities and colleges to ensure that
future managerial, technical and
professional staff view occupa-
tional health and safety as an
integral part of work.
Educational programs are also
required to train more occupa-
tional health and safety special-
ists to support programs in
workplaces.

Management and workers
need access to accurate, under-
standable and credible occupa-
tional health and safety mforma-
tion. One such data source is
already established in Canada;
the Canadian Centre for
Occupational Health and Safety
(CCOHS).

d) The health of workers, as
well as their safety, needs
to be protected.

Occupational exposure limits,
or their variously named coun-
terparts in each jurisdiction, set
out the maximum exposures to
chemical and physical agents
that are permitted in work-
places. In order to be useful,
compliance with these exposure
limits must be achieved.

To provide consistent protec-
tion to workers across Canada,
uniform standards are needed.
National review, followed by
the development of a single,
national standard for each
chemical or physical agent, and
adoption of these national stan-
dards in each jurisdiction, is
essential.

e) Occupational health and
safety programs are needed
at many levels of society.
These programs provide a
systematic approach to imple-
menting solutions to problems.
Some programs, such as nation-
al public awareness campaigns,
involve the population as a
whole; some involve the effons
of persons at many sites within
the occupational health and
safety infrastructure, such as
those that are geared toward
occupational health and safety
professionals; others operate at
a single location, such as at
individual workplaces.

National or provincial pro-
grams should be encouraged by
the federal and jurisdictional
governments and by labour and
professional associations. They
may be most effective, though,
if they are developed and oper-
ated by industrial associations
or large companies due to their
very substantial influence on
the entire business community.
For example, principal contrac-
tors in the construction industry
could require, as a tender speci-
fication, that potential subcon-
tractors have active and effec-
tive occupational health and
safety programs. Large compa-
nies could stipulate similar

requirements for maintenance
contracts on their sites.

National and provincial pro-
grams could include consulta-
tion on occupational health and
safety programs at workplaces
and assistance in establishing
specific programs. Examples of
such programs include back
care, hearing conservation,
employee assistance programs
and programs for reducing
injuries and illnesses among
"new workers". Establishing
such programs in all workplaces
may become an objective for
injury control for the next
decade. The imponance of
worker involvement in these
programs cannot be over-
emphasized. Expanded use of
joint worker/management occu-
pational health and safety com-
mittees will help with the imple-
mentation of occupational
health and safety programs ai
mdividual workplaces.

3. Issues for Active
Consideration

The Occupational Health and
Safety Work Group identified a
number of issues thai require
lurther development if signil'i-
cant improvements in work-
place health and safety are to be
realized. Unfonunately, many of
the recommended strategies do
not have baseline data sources
to track changes in perfor-
mance. Therefore, the establish-
ment of baselines in a number
of areas was identified as a nec-
essary requirement to measure
current levels of performance as
well as to track changes in per-
formance.O

VOL 5 NO 6 - AUGUST 1 992 INJURY AWARENESS & PREVENTION CENTRE NEWS

49

SPORT AND RECREATIONAL INJURIES
WORKGROUP

WORKSHOP OUTLINE

Workshop 1: Preventing Sport and Recreational Injuries through Better
Design and Maintenance of Facilities

Guy Regnier, Ph.D.

The promotion, over the last 20 years, of sport and physical activity as a means of
improving one's quality of life, has led ironically to an increase in the number of sport and
recreational injuries. Aldiough it is true that any activity involving human movement such
as sport involves a certain degree of risk, sport and recreational injuries are preventable. In
order to do so, sport and recreational injury prevention programs have to: 1) identify the
risk factors; 2) eliminate them if possible; 3) control them if they can't be eliminated; and
4) make sure no new risks are introduced.

One of the challenges facing injury prevention practitioners in the field of sport and
recreational activities is to respect the inherent nature of the activity. How do we make
skiing or playing hockey safer without taking the fun, the health benefits and therefore, the
people, out of it?

The Haddon matrix^ has proven to be a valuable framework to design adapted intervention
strategies in the field of sport and recreational injury prevention. The original matrix can be
adapted to include four major areas of injury prevention in sport and recreational activities:
quality of the facilities, quality of the equipments, quality of the leaders, and attitudes and
behaviors of the participants. The matrix is con^leted by looking at each of the four areas
across time i.e. before, during and after the event that led to the injury. The 12 cells
resulting from the matrix allow one to scrutmize an activity in a multidimensional approach
in search of risk factors and possible intervention measures.

Haddon, W. and S.P. Baker. 1981. Injury control. In Preventive and
Community Medicine. C. Qark and B. MacMahon (Ed.). Boston: Littie,
Brown and Co., pp. 109-140.

50

SPORT AND RECREATIONAL INJURIES
WORKGROUP

This first workshop will use the Haddon matrix as a framework to explore the ways by
which better designed and maintained facilities could help prevent or reduce the severity of
sport and recreational injuries. Participants will seek: 1) to identify what sport or
recreational activities would benefit the most in their conmiunity from such an
environmental intervention, and 2) what actions could be taken at the community and the
provincial levels to facilitate the development and implementation of safety guidelines
regarding sport and recreational facilities. Examples will be taken from voluntary safety
guidelines developed and implemented in Quebec over the last 3 years for ice-rinks, cross-
country skiing trails, backyard swiniming pools, and baseball, Softball and soccer fields.

WORKSHOP 2: "Get Trained": Prevent Injuries In Sport and Recreation
by Being "SMART"

Shelby Karpman, MHA, MD, C.C.F.P.

Many sport and recreation injuries can be prevented by providing trained leaders to
coordinate and supervise the activity. A tremendous amount of information and resources
are available for individuals, teams, and associations to implement into their daily activities
to keep it fun and safe.

This interactive workshop will utilize a safety guideline "checklist" to overview safety
considerations in your sport and recreation activities, and discuss what existing resources
are available to you.

It is the culmination of many small and simple actions that prevent injuries from occurring.
Following is an overview of some of these actions.

- Ensure each athlete completes a medical examination given by a physician at the
start of the season.

- Keep a medical history of athlete(s) on site.

- Develop safety standards for facilities to be used for practices and events.

- Ensure medical and/or paramedical personnel are present at the event

- Keep a first aid kit on site.

- Provide coaches and supervising personnel with athletic first aid training.

- Establish safety standards for equipment used in activity.

51

SPORT AND RECREATIONAL INJURIES
WORKGROUP

- Enforce the use of protective equipment, (ie. mouth guards, helmets, pro;e ^ c
eye wear).

- Provide educational information to athletes and coaches through newsletter:,
workshops, and lectures, (ie. safe training principals, nutrition, drugs in spoi f .

- Complete pre, mid, and post season fitness testing on each athlete.

- Post an emergency protocol and practice it

WORKSHOP 3: Preventing Sport and Recreational Injuries through the
Promotion of Fair Play.

Guy Regnier, Ph. D.

In many contact and collision sports, whether they are played at a competitive '^r a
recreational level, better protective equipment, safer facilities and stricter regulations ar« h
enough to ensure the safety of players. In amateur hockey for instance, it has ^
estimated that two third of injuries result from an illegal action^. What is needed
modification of players' and leader's attitudes and behaviours toward violent ai .
dangerous play.

This conclusion has led to a worldwide movement in favor of the promotion of fair p!;i>'
and sportsmanship as a means of reducing violence-related injuries in sports such as ictf
hockey or European football. The concept of sportsmanship has generally been defined is
to include values such as respect for the rules, respect for the officials, respect for on : ^
opponent and fairness.

This workshop will review the international initiatives to enhance safety in sports through
the promotion of fair play and sportsmanship. Canadian and provincial programs will also
be presented and discussed.

One of the major criticisms frequently addressed to such value-oriented promo lor
campaigns, is their lack of demonstrated effectiveness in changing the behavior oi ^; '

2 Brust, J.D., Leonard, B.. Pheley, A. and Roberts, W.O. 1992. Children's ice
hockey injuries. AJDC, vol. 146, pp. 741-747.

52

SPORT AND RECREATIONAL INJURIES
WORKGROUP

targeted audience. Original and more direct approaches are needed to change playerx
coaches' and parents' attitudes and behaviors toward violent play in sports.

Participants will seek to identify which aggressive behaviors can lead to injuries and whai
actions can be taken to eliminate them. Participants will explore different ways by which
sport and recreational injuries can be prevented through strategies that actively promote a
sense of respect for the rules, for the official and for the opposing players. Two original
programs designed to make fair play part of every game played in any contact or collision
sport, will be presented and discussed with the participants.

Workshop participants will identify what can be done over the next year to put the active
promotion of fair play on the agenda of every sport organisation in Alberta at the provincial
as well as at the community level.

SPORT AND RECREATIONAL INJURIES
WORKGROUP

Overview

JOANNE VINCENTEN, EXECUTIVE DIRECTOR,
Sport Medicine Council of Alberta

Data from the provinces of Quebec, Ontario, and even the country of Australia, tell us that
sport and recreation injuries are by far the leading cause of emergency room attendance. To
date, we in Alberta have no provincial data or even national data to specifically tell us the
true picture of sport and recreation injuries. I can tell you that last year in Alberta six
people died on our ski hills; a two year old gkl died of asphyxiation due to hanging because
her coat caught part of a metal slide at a playground; 12 people died while cycling; 7 people
died while riding an all terrain vehicle; and 43 people drowned. These statistics are a brief
overview from the Alberta Coroner's Report This is just the tip of the iceberg since we
know that for every fatal childhood injury, another 45 injuries require hospital treatment,
and 1,300 require an emergency room visit.

We cannot begin to imagine the number of sport and recreation injuries that do not result in
an emergency room visit but eventually surface in the physician's office or receive self-help
at home.

There are a few small steps underway in Alberta to determine how serious the injury
situation really is, and what actions should be taken to prevent such injuries.

The Hanna Injury Prevention Project (HIPP) conducted a survey in 1991 of emergency
room visits. This small, rural Alberta community has also confirmed that sport and
recreation injuries were the leading cause for tiieir emergency room visits.

The Children's Hospital Injury, Research and Prevention Program (CHIRPP) has also
collected some data on childhood sport and recreation injuries. Investigation of data shows
a yearly increase in trampoline injuries, the largest number of which occur in Calgary and
Vancouver. There is a very low sex ratio in children under the age of thirteen. Even
toddlers are at risk from these injuries which tend to be more severe than the databiiit*
average; as measured by the nature of the injuries and the general nature of the treatmeni.

SPORT AND RECREATIONAL INJURIES
WORKGROUP

Project funding is also in the process of being confirmed for a pilot project of data
collection for sport and recreation injuries. This project has been submitted by the Sport
Medicine Council of Alberta, the Injury Awareness and Prevention Centre, the University
of Alberta Faculty of Physical Education and Recreation, and the Department of Health
Services Administration and Community Medicine. The project will take a sampling of
injury statistics from patient charts at selected hospitals across the province. This will
provide information on numbers, rates, and types of injuries incurred during participation
in various sport and recreation activities in Alberta. It is hoped that through this study an
impetus can be created for ongoing data collection for sport and recreation injuries.

Many injury prevention programs, services, and resources have been developed and are
being delivered in Alberta, which is illustrated by the enclosed resource list. Our
continuing drive to collect data will assist us, not only in determining what injury
prevention priorities need to be addressed, but also how effective they have been. These
efforts will make sport and recreation safer, and ultimately healthier.

I

SPORT AND RECREATIONAL INJURIES |
WORKGROUP

INTRODUCTION ^

In 1987, Statistics Canada conducted a general social survey that revealed spon and ^
recreation activities as having the second most frequent number of injuries. These acti\ ities

were responsible for 29% of injuries to adults. Among people aged 15 to 24, sport and \
recreation incidents were responsible for 42% of all unintentional injuries.!

Sport and recreation injuries accounted for approximately 8.7 million activity-loss da> s and ^

1.5 million bed-disability days in 1987. These injuries also represented 31% of activity- |

loss days and 26% of bed-disability days for people aged 15 to 24. 1 1

A study conducted by the Regie de la securite dans les sport du Quebec reported in 1987

"the overall cost of injuries and deaths resulting from sport and recreational activitie s in

Quebec is estimated at $184 million".^*^ These figures were determined from 239.<>' 0 '

participants who consulted health professionals to attend to their injuries. Tlie si., iy

concluded that sport and recreational injuries accounted for 25% of all injuries in Qu<^

The economic and social costs of sport and recreational injuries are sufficient to v,

special attention to this area.

The Ontario Minister of Tourism and Recreation has conducted a similar study ^ e
assistance of the Canadian Sports Spine and Head Injuries Research Centre.^ A meav re
of the seriousness of the problem can be seen in these facts:

• 1.3 miUion participation-related injuries occurred in 1986.

• Economic costs for sport and recreation injuries exceed $663 million per year.

• 530 catastrophic incidents, including 87 deaths and 48 cases of paraK ms,
occurred in 1986.

• Half of all sCTious school-related injuries are the result of athletic activities

• 25% of all emergency ward cases are sports and recreation related.
A Safa Canada -YFAK 2(X)0IN^mYm^^^tnT,OB^;c^VR«> FCin r^]vj^p^

56

SPORT AND RECREATIONAL INJURIES
WORKGROUP

The trend towards increased participation in sport and recreation activities is expected to
continue as a result of availability of more leisure dme, growing awareness of health
benefits and greater promotion of participation. Unfortunately, the enjoyment of this type
of activity quickly diminishes when the safety and well-being of the participant is at risk.
Each individual must be conscious of what safety precautions to undertake, since a
tremendous number of injuries occur in both unsupervised and supervised settings.

Sport and recreation participants and organizations frequendy neglect to ensure that safety
receives a high priority within the management structure of their events. Injuries can be
categorized as occurring in the following four areas:

• Equipment

• Facilities

• Behavior and attitude

• Quality of leaders

Making individuals aware of the degree of risk of injuries from sport and recreation
activities through national injury control objectives is a start to reducing their incidence.

ISSUES RELATED TO SETTING OBJECTIVES
Data Availability

Specific sport and recreation categories are currently non-existent in the
International Classification of Disease E-code system. A further breakdown of
injuries by sport is necessary for planning prevention interventions. National and
provincial injury data collection systems for sport and recreation need to be
developed. The following actions must be taken to provide adequate data sources
for sport and recreation.

• All Canadian hospitals should be coding injuries by specific sport and recreation
categories for all hospitalizations and emergency department visits. This could
be accomplished by modifying the existilng International Classification of
Disease E-Code (mechanism of injury code) system. This would provide

57

SPORT AND RECREATIONAL INJURIES
WORKGROUP

information primarily concerned with the frequency and diagnosis ot injuries
requiring medical treatment A health care cost estimate could also be asses- *
for acute sport injuries through this data source.

• A national athletic injury registry should be developed tiiat will colleci mjurv
data from all school and community youth sport groups across Canada in a
uniform manner. This may be accomplished by modifying e\. 'i g
injury/accident reporting systems to provide standardized information ali i i,v
frequency, mechanism and anatomical distribution of injuries.

• A national survey should be used to collect data regarding adult recrear.on 1 1 J
sport injuries on a regular basis. This may possibly be conduci-a fi
conjunction with another national survey. Data from this source would ii d ; ate
how much injuries affect sport and recreation participation patterns. Tt ; 1
also capture data concerning adult sports injuries not treated in hospi; '
emergency departments.

Level of Participation

Individual involvement in sport and recreation occurs at many different levei j; j
involves a tremendous diversity of participants. Activities may occur in structured
or unstructured settings, and may be recreational or competitive. In some cases, a
recreational activity such as snowmobiling may be the mode of transportation for
other individuals. The "issues for active consideration" and objectives were sei
with this diversity of participants in mind.

Legislation

There is a need for legislation objectives to assist in the reduction of spon and
recreation injuries involving equipment and facilities. Again, the necessary !
was not available to set measurable objectives and thus became part of our I
for Active Consideration" seciton.

A Safer Canada — YEAR 2000 TNTUR Y CONTRnT. OBTECTTVES FOR TAMA n ^

58

SPORT AND RECREATIONAL INJURIES
WORKGROUP

Risk Management Education

In trying to set measurable objectives to reduce injuries in sport and recreation
activities, all agreed there is a need to develop and promote injury prevention ai 1
safety information to participants. Behavior and attitudes need to be shaped so w e
may participate safely; these include playing fair, handling aggression, controlling
substance abuse, meeting safety standards when using equipment and facilities, and
having quality leaders with appropriate training in the applicable activity. Methods
must be established and agencies identified to monitor the progress in this very
important aspect of injury control.

ISSUES FOR ACTIVE CONSIDERATION

The following points have been raised as areas for concern. Unfortunately, no baseline
data was available to set measurable objectives for these points but they were expressed j s
issues for active consideration and used as strategies to reduce injuries.

Playground Injury Reduction Strategies

• Ensure compliance with CSA playground standards in all public and scho^ol
playgrounds

Bicycle Injury Reduction Strategies

• Make approved bicycle helmets mandatory for both practices and events at the
competitive level

• Make the use of approved bicycle helmets a mandatory condition of
participation at all mass participation cyclethon events.

• Establish/develop legislation to ensure that bicycles are sold or rented only
proof of ownership of a helmet is demonstrated or a helmet is concurrent i
purchased^nted.

A <;afpr Canad" — YF AT? 2000 nsJTURY CONTROL QBTECTTVES FOR CANADA

SPORT AND RECREATIONAL INJURIES
WORKGROUP

Establish/develop legislation for minimum safety standards for bicycle
construction.

Drowning Reduction Strategies

• Increase the number of education and awareness programs about the use of pool
barriers, fences and water safety.

• Increase law enforcement of existing standards, e.g., domestic pool installation.

• Increase the mandatory wearing of personal floatation devices by individuals
when on water through education, legislation and enforcement

Off-road Vehicles Injury Reduction Strategies

• Increase the number of safety programs that address the use of off-road vehicles
in all communities with high use of off-road vehicles and excess mortality and
morbidity rates.

Ensure that the government of Canada include off-road vehicles in the Canadian
Motor Vehicles Safety Act so standards on stability and safety devices for off-
road vehicles will be specified.

Injury Prevention Program Strategies

• Increase the completion of pre-season medical examinations by physicians.

• Increase the conviction of participants medical history cards and have them on-
site.

• Increase the availability of first-aid kits on-site.

• Increase the number of education and awareness programs about sport and
recreation injury prevaition.

• Increase the number of coaches and officials trained in CPR and sports first aid.

• Increase use of effective head, face, eye, mouth and neck protection in sports.

• Develop and use safety standards for facilities and equipment used for practices
and events.

60

A Safprr^nnd^ — yPAR 2000 T>Jn TRY mNTROT. OBTECTIVES FOR TAj^^p^

SPORT AND RECREATIONAL INJURIES
WORKGROUP

• Increase use of emergency protocol at practices and events.

• Promote initiatives to reduce injuries resulting from aggressive (violent)
behavior in sports.

• Increase the use of medical or paramedical personnel at events.

• Increase the completion of injury occurrence forms, maintain yearly statistics,
and use for evaluation.

References:

1. Millar, W.,. and O. Adams. Accidents in Canada. Statistics Canada, February
1991: 68-71.

2 . Economic Costs of Injuries and Fatalities Resulting from the Practise of Sports and
Recreational Activities in Quebec. Regie de la securite dans les sports du Quebec,
April, 1990.

3. Objectif: Sante (Objective: A Health Concept in Quebec). A Report of the Task
Force on Health Promotion, Government of Quebec, 1984.

4 . The Report and Recommendations in Amateur Sport, Personal Fitness and Physical
Recreation in Ontario, Volume II. The Ontario Sport Medicine and Safety Advisory
Board, 1987.

A Safer Canada — YEAR 2(XX) INTURY CONTROL OBJFmVFS FOR r am^hA

61

SPORT AND RECREATIONAL INJURIES
WORKGROUP

Sport Medicine Couricii bf Ajberta :

Th: Sport Medlcirv CouncU of Altxna (SMCA) is a/i
organization of spori physicians, sport physiotherapists, athletic
therapists and sport scientists. The cooperative function of these
individuals is to prornote and coordinate the provision of sport
mecUctne programs and services for the Alberta sport com-
munity. These professional members provide their services to
assist in making Alberta a healthy and safe environment for
sport and recreational aclivides.

The swviccfi of a sport medicine profcssiomil may be required
on and off ihc field; and before, during and after the game. The
most obvious services art a part of on site coverage for games,
ixaining camps, competiilons and U5urs, siich as iho assessmcni
and ireaanem of aihleiic injuries. Behind iho scenes, a gpon
medicine professiontd can carry out prc-season medical cxa-
fninations, physiological and psychological lesiing and consuU-
ing. ongoing medical oure for aihleies including nutrition
assessments, counselling and drug testing.

KDI't A llON I'KtH^KAM

Education courses are available for those individuals interested
in upgrading or developing their knowledge and skills in spon
medicine. Courses include: Aihleiic First Aid. Taping and
Scrapping, Sports Munition, and Drugs in Sport.

MlilHC \l. I.VIIM C<>\ l.K \(

Aisisiance may be provided for ensuring appropriate medical
coverage at events and competitions. An SMCA liaison will act
as a consultant to the Gaines Medical Planning Commiuce;
guidelines are provided in our Games and Competition Medical
Handbook: pre-cvcnt workshops and craining are available for
medical volunteers: and assistance with recruiting medical
personnel.

SI'OIM Ml UK IM. IIJI H'MI.M \ .SMM'I.II S

Coin|»ehenstve prolbssianal medical kits for physicians and
iherq)isu can be borrowed fxom the SMCA. For the coach,
athlete medical information cards are available. Also avail^le
is technical assistance with the development and purchase of
spoft q)ecific medical kits.

DKl t; I IU ( AI JON

Educational infonnatioo on drugs in spon can be obtained
£rom the council. Formats inclode tochnical articles, individual
consulting, drug testtng, qwakers and writers, resource maienals

sport Meaiclne Council of Alberta

for junior high ichool teachers and studcnis. educaiionaJ
woritshops and handbooks and fact sheets on performance
enhancing substances.

si'ORis M ruriioN

A variety of nutrinon services arc available with particular
attention to the athlete's needs. The SMCA offers speakers and
writers, resource information, individual consulmiion and educa-
tional workshops and handbooks.

( <)M i:ki.n( i; smtoui am) .si kvk i:s

The SMCA hosts and promotes spon medical, paramedical
and scientific conferences, symposia and lectures for spon
medicine professionals, spon and rccrcauooal associauons, ajid
the general public.

Sri AKI kS \M> WKII I Its IJI'KI AI'

Medical, paramedical and scientific profwsionals ore available
for spon associations' pubUcaUons, symposia, trairung camps
coachmg clinics and technical seminars Topic axeoi ma-
include: Nutntion. PtiysiOlogy, Psycholo^, Taping & Strao
ping. Emergency Prouxol. ALhlcac Injunc^. Drugs Sport
Scrcngth & Flcxibiliiy, Safecy Standards, and Pnoiccuvc E^^uip
menu

in SOI u( I iM im\i vi i()\

The SMCA Resource Library has a variety of spon medicine
materials available for loan: anatomical joint models, wall
Chans, educational packages, and audio-visual material. Also
available is Pulse, a quoncrly nowsloocr which lughlighus
SMCA activities and current spon medicine informauon

To access any of the programs or services of the SMCA. please
do not hesitate to contact us.

Sport Medicine CouncU of Alberta
11759 Croat Road
Edmonton, Alberta
T5M3K6

Telephone: (403) 453-8636
Fax: (403) 422-3093

62

SPORT AND RECREATIONAL INJURIES
WORKGROUP

RESOURCES

Cost

ATHLETE MEDICAL INFORMATION CARDS

Holds all vital emergency information on each athlete;

Contact name, blood type, etc. (25 cards per pkg.) 5.00/pk:g

ATHLETIC FIRST AID KIT

Perfect for most teams and organizations. Includes tape,

bandages, slings, etc. Kits can be custom designed for your needs. 165.00

A variety of Athletic First Aid supplies are kept on hand

ta restock your own first aid kit; prowrap, Tuf-skin, slings, etc. varies

SPORTS NUTRITION RESOURCE BINDER

Includes a variety of information on all topics of sports nutrition;

pre/post event meals, hydration, travelling tips, etc. 25.00

CROSSING THE LINE PACKAGE

Excellent classroom or lecture package on the straight

facts about drugs in sport. Video appearances by Kurt Browning,

Karen Percy, and Dr. Randy Gregg. 42.00

FLYERS varies
Anabolic Steroids
Exercising with Asthma
Hydration
Pre-Event Eating

Prevention of Physical Activity Injuries

Procedures for Conducting Announced Doping Control

R.I.C.E.

Ride Longer and Stronger
Trampoline Safety

POSTERS 2.50 for

First Aid shipping
Steroids

Recreational Drugs
Nutrition

SMCA

Sport Medicine Council of Alberta
11759 Groat Road, Edmonton, Alberta T5M 3K6
Phone: (403) 453-6636 Fax: 422-3093

TRANSPORTATION INJURIES WORKGROUP
WORKSHOP OUTLINE

Concurrent Workshop 1 - "The Alberta Scene: Who is Preventing
Transportation-related Injuries" (Thurs., October 22, 1992 9:45 a.m. -
12:00 noon)

Purpose: to gain a more complete understanding of the traffic safety initiatives in Alberta
that are currentiy underway or planned for the near future or who's doing what to prevent
death and disability from this leading cause of injury in Alberta.

Description: E>r. Herb Simpson, Executive Director of the Traffic Injury Research
Foundation will moderate a panel of speakers from Alberta who will be presenting a series
of ten minute talks to provide an overview of the current state of traffic safety programs and
initiatives in the Province. The panelists are as follows: Mr. Neil Warner describing the
work of the Alberta Solicitor General's Office; Ms. Jackie Petruk and Mr. Scott Wilson
describing the activities of the Coalition on Child Passenger Restraints; Mr. Ross Hogg of
Alberta Transportation and Utilities presenting an overview of the role of his Department as
well as the work of the Minister's Advisory Committee on Traffic Safety; Dr. Stewart
Hamilton, the Director of Trauma services at University of Alberta Hospitals describing the
work of the Provincial Advisory Committee on Trauma Services; Mr. Rob Taylor of the
Alberta Motor Association discussing the traffic safety initiatives of this large consumer
organization; and finally Ms. Loma Stewart, Director of the University of Alberta Hospitals
Injury Awareness and Prevention Centre, will be providing an update on the status of a
provincial coalition on motor vehicle trauma. Workshop participants will also be given an
opportunity at the end of the panel presentation to describe their work in this field. Time
will be allowed for questions and discussion of the current state of traffic safety in Alberta.

Concurrent Workshop 2 - "What works in Preventing Transportation
Injuries" (Thurs., October 22, 1992 2:45 p.m. - 4:30 p.m.)

Purpose: to gain insights into educational, legislative and technological strategies from
around the world that are known to be effective at preventing traffic-related injuries.

64

TRANSPORTATION INJURIES WORKGROUP

Description: During this session Dr. Herb Simpson, an internationally recognized
researcher in the field of traffic safety, will provide an expanded version of his plenary
session "What Works in Preventing Injuries? Principles of Success". The presentation
will cover the current state of knowledge on what is effective at reducing traffic injuries
including legislative, educational and technological strategies. Dr. Simpson has indicated
that he will allow ample time for workshop participants to seek clearer understanding of
effective traffic injury countermeasures.

Concurrent Workshop 3 - "Creating an Agenda for Action in Alberta" (Fri.,
October 23, 1992 9:15 a.m. - 11:15 a.m.)

Purpose: to create a broadly-based action plan for the next year on how workshop
participants and others might work together to reduce injuries due to motor vehicle crashes
in communities across the province on the journey to the year 2000 objective of a 20
percent reduction.

Description: Using this backgrounder document workshop participants will come
together to develop an action plan for the next year to make some breakthroughs in
reducing traffic injuries. The focus of the discussion will be how can we best use our
limited resources to achieve reductions in traffic injuries. Dr. Herb Simpson will act as
facilitator and consensus builder during this session.

65

TRANSPORTATION INJURIES WORKGROUP

INTRODUCTION

In May, 1991, the first National Symposium to Establish Injury Control Objectives for
Canada for the Year 2000 was held in Edmonton, Alberta. This Symposium was an
attempt to develop consensus around injury prevention priorities for Canada that might be
used by the provinces/territories as a starting point to prepare a more detailed agenda for
action on injury prevention. The Fourth Annual Injury in Alberta Conference has been
organized around the injury control objectives presented in A Safer Canada, the
proceedings of the National Symposium. This background paper is intended to provide the
participants of the Transportation Injury Workshop with an overview of the current state of
affairs in motor vehicle injury prevention in Alberta as well as a tentative action plan for
reducing injury death and disability from motor vehicles. The overall purpose of the
transportation injuries sessions is to build an agenda for action for Alberta around which
people might work together to maximize limited resources and achieve at least a 20 percent
reduction in traffic-related injuries by the year 2000.

WHERE WE ARE?

Dimensions of the Challenge:

Motor vehicle crashes are the leading cause of injury death in Alberta with
approximately 500 Albertans killed each year- on the province's roadways. Motor
vehicles were responsible for 43 percent of all injury deaths in 1989. Injuries
sustained in motor vehicle crashes are the leading cause of injury hospitalization
among the 15 to 34 year old age group. For the year 1987, injuries due to motor
vehicle crashes were the second leading cause of injury-related hospital admission
for both males and females. Motor vehicle deaths and hospital admission rates
decreased markedly between 1979 and 1982, especially among males and especially
between 1981 and 1982. Thereafter the rates have remained stable. (Saunders and
Rowerdew, Alberta Injury Mortality and Morbidity, December, 1991)

(Additional and more recent data on the extent and consequences of these injuries
will be available to participants at the conference registration desk.)

66

TRANSPORTATION INJURIES WORKGROUP

Cost Effective Prevention Opportunities:

The following information, which highlights the cost effectiveness of traffic safety
initiatives, is excerpted from the American document "Position Papers from The
Third National Injury Control Conference - Setting the National Agenda for Injury
Control in die 1990s", April, 1991.

Motor vehicle injury prevention is a sound investment of scarce public health and
highway safety dollars. Health economists have compared the estimated costs per
life (and life year) saved by numerous public health programs. Such studies have
consistently concluded that traffic safety programs are more cost effective than
almost all other kinds of public health interventions. For example, Graham and
Vaupel found that the median cost per life year saved for selected National Highway
Traffic Safety Administration (NHTSA) programs was over 100 times less than for
selected occupational and environmental health programs. (Value of a life: what
differences does it make? Risk Analysis 1981; 1:89-95)

The cost-effectiveness of regulatory actions also varies tremendously, reflecting the
poor allocation of society's resources for reducing risks. An example of this
variation appears in the US Federal Budget for Fiscal Year 1992: on the average,
spending $2 million regulating cancer risks posed by wood preserving chemicals
prevents one cancer case every 2.9 million years, whereas the same amount spent
on highway safety saves at least one life in just a few years. The evidence suggests
that our limited public health resources could lower costs and save more lives if
they were reallocated to favor more traffic safety investments.

Current Traffic Injury Prevention Initiatives in Alberta:

There are many, many initiatives in Alberta that focus on some aspect of the
prevention of injury death and disability due to motor vehicle crashes. Some of the
key organizations and groups are highlighted here. This is not an exhaustive
inventory of who's doing what in this field. However, with the cooperation of
workshop participants it might be possible to compile a more comprehensive
inventory which could be used for identifying gaps and highlighting opportunities
for collaboration among various groups in addressing this issue.

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TRANSPORTATION INJURIES WORKGROUP

ALBERTA SOLICITOR GENERAL INITIATIVES

The Impaired Driving Initiatives Grant Program

The Impaired Driving Initiatives Grant Program, established in 1988, is intended to
facilitate development and delivery of community-based impaired driving
coimtermeasures.

The program is aimed at community groups or non-profit organizations. These
groups, when engaged in volunteer initiatives to prevent impaired driving in their
communities, may receive a one time grant to assist them in the initial stages of
these efforts.

The overall objectives to be met by proposed initiatives are:

1) to reduce the incidence of impaired driving in Alberta and the resulting
deaths and injuries; and

2) to create a higher level of awareness among Albertans of the serious legal,
social and economic impact of impaired driving.

Grant applications are reviewed by the Impaired Driving Countermeasures
Committee and a recommendation for approval or rejection is made to the Solicitor
General, who then makes the final decision.

To date, grants have been awarded for a diverse range of initiatives including
conferences, impaired driving awareness programs for teens. Safe Grad manuals.
Prevent Alcohol & Risk-Related Trauma In Youth (PARTY) programs and a rural
safety essay contest

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TRANSPORTATION INJURIES WORKGROUP

CHECKSTOP

Alberta's Checkstop Program, which has been in operation since 1973, is a combined
enforcement and education program designed to deter people from drinking and driving.
All vehicles passing through a Checkstop location are required to stop for a brief driver
check. The police officer then detennines whether the driver has been drinking, and may
impose a 24-hour suspension or lay Criminal Code charges against the driver.

In addition to detecting impaired drivers as they pass through a Checkstop, the program
provides a visible reminder to the public that impaired drivers will be caught

To increase awareness, Checkstop is extensively advertised on highway signs, billboards,
and banners, and at sporting events and trade shows.

An average of 464,000 vehicles per year were stopped at Checkstop s between 1985 and
1990. During that time, 11,182 24-hour suspensions were issued and 19,689 Criminal
Code charges were laid against impaired drivers.

THE SUSPENDED DRIVER VEHICLE SEIZURE PROGRAM

In December 1991, the Government of Alberta passed legislation to introduce the
Suspended Ehiver Vehicle Seizure Program.

The program is aimed at deterring an increasing number of motorists who continue to drive
while under licence suspension.

Under the program, vehicles driven by a suspended driver will be seized and impounded
for 30 days. In addition, drivers may be fined up to $2,000, or jailed for not .less than 14
days on the accompanying charge of Drive While Suspended. Conviction on this charge
carries a mandatory six month licence suspension.

If a motorist with a suspended licence borrows a vehicle and is caught driving, the vehicle
will still be in^unded. The vehicle owner faces a fine of up to $2,000, or a jail term of up

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TRANSPORTATION INJURIES WORKGROUP

to 14 days in default of payment, if it is shown that the owner knowingly lent the vehicle to
a driver under suspension.

The program provides avenues for the return of a vehicle to the registered owner if he was
not aware that the individual he lent it to was suspended. The registered owner may sign a
statutory declaration to the effect that he unknowingly lent a vehicle to a driver under
suspension.

If a vehicle owner did not realize his own licence had been suspended, he may state his
case before the Driver Control Board. He must prove to the Board's satisfaction that he
could not have known his licence was suspended.

THE DESIGNATED DRIVER PROGRAM

Launched in September 1989, the Designated Driver Program utilizes the theme "Round
Up the Party Animals! Have a Safe Safari Home," to emphasize the separation of drinking
and driving. The Program was developed by the Department of the Solicitor General in
cooperation with a number of Alberta groups and organizations.

The Designated Driver Program is designed to:

• reduce the incidence of impaired driving,

• reduce the incidence of motor vehicle collisions, resulting injuries, property
damage; and most importantly,

• save lives.

The Program puts the onus on groups to plan their outing in terms of getting home safely.
One person from a group of guests at a licensed establishment, social function or private
house party is designated as the group's driver, and does not consume any alcohol before,
during or after the event The designated driver accepts the responsibility for making sure
the other group members arrive hcwne safely.

Licensed establishments that participate in the program agree to provide free non-alcoholic
beverages to the designated driver in each group.

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TRANSPORTATION INJURIES WORKGROUP

The Department of the Solicitor General provides licensed establishments with the posters,
tent cards, server and designated driver badges utilized in the program, at no charge.

THE VEHICLE IMMOBH^IZATION PROGRAM

Mechanical immobilization of vehicles commenced as a pilot project in 1989. Under this
program, police may order the installation of an immobilization device, commonly known
as a "boot", on vehicles driven by an individual charged with impaired driving. The
puipose of the program is to prevent a driver from using the vehicle to commit another
impaired driving offence within a 24-hour period of the initial offence.

In addition to serving as an enforcement method, the impact of seeing an immobilization
device on a vehicle serves as a deterrent to other drivers, since it is a visible reminder that
impaired driving is a crime.

Although some Canadian and American jurisdictions use immobilization to enforce the
payment of parking tickets. Alberta is the only jurisdiction to use the device for impaired
driving offences.

The program was expanded after successful evaluation of the pilot project, and is now
operational in eight Alberta communities: Calgary, Edmonton, Fort McMurray, Grande
Prairie, Lacombe, Lethbridge, Medicine Hat and St Albert.

IGNITION INTERLOCK

This program, which commenced as a pilot project in April 1990, allows the Driver Control
Board to order an alcohol sensing device to be installed on the vehicle of a previously
convicted impaked driver, as a condition of licence reinstatement

Participation in the program may commence after the Court imposed driving prohibition
expires. Participation is limited by law to those convicted under sections 253 and 254 of
the Criminal Code.

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TRANSPORTATION INJURIES WORKGROUP

The interlock technology requires that drivers pass a breath alcohol test before the vehicle
will start, and at variable intervals while the vehicle is being operated Once the vehicle has
been started, if a driver does not provide a breath sample at the required time, the vehicle's
horn will be activated, drawing attention to the vehicle. A computerized log kept by the
interlock device provides notification to the Motor Vehicles Division if a driver tampers
with, or attempts to by-pass, the interlock device.

THE ADMINISTRATIVE LICENCE SUSPENSION PROGRAM

The Administrative Licence Suspension Program has been in effect since August 1989.
Under the program, the Registrar of Motor Vehicles immediately refers all cases where a
driver was charged with impaired driving causing death or bodily harm, to the Driver
Control Board. The Board then determines whether to suspend the driving privileges of
the driver pending the outcome of the court case.

In 1990, the right of the Driver Control Board to take away a licence before a driver is
actually convicted of an offence was challenged in Court. Alberta's Court of Queen's
Bench ruled that the Board was acting within its authority by removing driving privileges
prior to the outcome of the court case.

THE REPORT AN IMPAIRED DRIVER (RAID) PROGRAM

The RAID program was implemented in June 1991. The purpose of the program is to
provide information to private citizens on how to report impaired drivers to the police.

RAID brochures and posters were developed to tell citizens:

• how to spot an impaired driver on the road;

• which telephone numbers to call to inform police; and

• what information the police will require, such as location of die driver, direction
of travel, and the vehicle's licence plate number.

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TRANSPORTATION INJURIES WORKGROUP

The brcx:hures are mailed to vehicle owners with their registration renewals. Arrangements
have been made with retail merchants to display RAID posters in locations throughout
Alberta.

THE ENHANCED IMPAmED DRIVING DETECTION PROGRAM

The Enhanced Impaired Driving Detection Program was implemented as a six month pilot
program in Calgary and Edmonton in December 1991. The Program, the first of its kind in
Canada, uses new technology to assist peace officers in making the determination that a
driver has consumed alcohol. The new technology, in the form of a passive alcohol
sensor, takes a sample of normally exhaled breath with a minimum of intrusion.

If the passive device, together with other observations, provides indications of alcohol use
by the driver, an active breath sample using an Alert or Alco-Sur may be requested. If the
Alco-Sur indicates a green or flashing green reading, the driver would be free to go. In the
case of a yellow reading, the driver would be given a 24-hour suspension. If the Alco-Sur
indicated a red reading, the individual would be asked to be tested on an approved breath
alcohol screening device, commonly known as a breathalyser. If this device indicates a
reading above the legal limit of .08, the driver would be charged under the Criminal Code
of Canada.

Although Alberta's present Checkstop program is working well, research indicates that the
most serious impaired drivers are often the best able to avoid detection in a Checkstop.
Chronic alcohol abusers are accustomed to the presence of alcohol in their bodies. They do
not show the normal signs of impairment corresponding to their actual blood alcohol levels.
In a Checkstop situation, where an officer must make a quick decision on a driver's
condition, these serious alcohol abusers may slip through. Passive alcohol sensors will
help police identify these individuals, as weU as any other who might be tempted to evade
detection.

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TRANSPORTATION INJURIES WORKGROUP

THE IMPACT IMPAIRED DRIVING COURSE

As of July 1, 1992, the Department of the Solicitor General assumed responsibility for the
administration of the IMPACT impaired driving course. Second and subsequent impaired
driving offenders are required to attend the course as a condition of licence reinstatement.
This internationally recognized residential weekend program for repeat offenders was
formerly administered by the Alberta Alcohol and Drug Abuse Commission.

The name IMPACT is an acronym for Insight, Motivation, Progress, Assessment,
Counselling and Treatment. The primary purpose of IMPACT is to foster impaired
drivers' personal exploration of their alcohol and other drug use. The course uses group
dynamics to influence perceptions of alcohol use and the risk involved, thereby increasing
the likelihood that the offender will take action to deal with his alcohol problem. The
impaired driving offence provides an opportunity to intervene in the alcohol use of impaired
drivers before even more serious problems develop.

The program is being delivered under contract with the Alberta Motor Association.

THE PLANNING AHEAD IMPAIRED DRIVING COURSE

As of July 1, 1992, the Department of the Solicitor General assumed the administration of
the Planning Ahead impaired driving course. The one day course is a licence reinstatement
requirement for first time impaired drivers. Previously the course was administered by the
Alberta Alcohol and Drug Abuse Commission.

The course focuses on both attitudes and behaviours in order to help participants avoid
future impaired driving incidents. During the course, participants are provided with
information about the law, impairment, alcohol use and licence reinstatement The course
also provides a context within which participants can evaluate their drinking and driving
and develop ways to personally avoid impaired driving in the future. The course content
promotes responsible use of alcohol, especially in relation to driving.

Planning Ahead is currentiy delivered under contract with the Alberta Motor Association.

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TRANSPORTATION INJURIES WORKGROUP

An update from the Solicitor General's Office on Impaired
Driving in Alberta

I . EXECUTIVE SUMMARY

Impaired driving is a problem which affects all Albertans. In response to
the concerns of citizens, the Department of the Solicitor General initiated a
program of impaired driving countermeasures to reduce the incidence of this
crime.

A. Collision Fatalities and Injuries

1 . In 1984, 33 percent of all traffic collisions in Alberta were alcohol-
related. By 1990, that figure had been reduced to 28 percent. The
number of alcohol-related fatal collisions has decreased by 24.8
percent between 1984 and 1990. Alcohol-related injury collisions
declined by 19.3 percent in the same period.

2. The number of people killed in alcohol-related collisions was
reduced by 27.3 percent between 1984 and 1990, from 154 to 1 12,
respectively.

3 . Involvement of drinking drivers in fatal or injury collisions declined
slightiy between 1984 and 1990. The number of drinking drivers
involved in fatal collisions decreased from 26.4 percent to 22.1
percent, while drinking drivers involved in injury collisions declined
from 11.2 percent to 9.4 percent

4. The 25 to 29 age group accounted for the greatest portion of
drinking drivers in fatality and injury collisions. HovC^ever, when
the number of licensed drivers is controlled, the 18-19 age group
emerges as having the highest rate (3.1) of drinking drivers involved
in fatality and injury collisions per 1000 licensed drivers. This age
group also experienced a 32.6 percent decline in the rate of
involvement, from 4.6 per 1,000 licensed drivers in 1984, to 3.1
per 1,000 licensed drivers in 1990.

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TRANSPORTATION INJURIES WORKGROUP

B . Enforcement Data

1. The number of people charged with impaired driving in Alberta
decreased by 31.6 percent from 1984 to 1990. This decrease was
the second largest in Canada for that period

2. Alberta's rate of persons charged with impaired driving is the
second highest in Canada (excluding the territories), at 689 per
100,000 population.

3. Although the number of vehicles stopped through the Checkstop
Program increased between 1984 and 1990, the rate of criminal code
charges laid as a result of this activity has decreased. The rate of
criminal code charges has declined sharply from 1 14 per 10,000
vehicles stopped in 1990.

4 . The number of driver licence suspensions occurring under the Motor
Vehicle Administration Act declined by 32 percent between fiscal
years 1985-86 and 1990-91. The proportion of drivers whose
licences were suspended for a repeat offence fell from 33 percent in
1988 to approximately 29 percent in 1990.

5. The number of offenders incarcerated in Alberta Correctional
Centres for impaired driving offences increased between fiscal years
1985-86 and 1990-91. Specifically, a 67.8 percent increase in the
number of incarcerated offenders occurred between 1985-86 and
1990-91.

6. Sentence lengths have increased in the "over 1 year" and "less than 1
mondi" categories. The number of drivers receiving sentences in the
remaining categories of "1-3 months", "3-6 months" and "6-12"
months have decreased between 1985-86 and 1990-91.

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TRANSPORTATION INJURIES WORKGROUP

C. What has been Accomplished

1 . The Department of the Solicitor General has taken a leading role in
Alberta in developing and implementing impaired driving
countermeasures. More than 20 initiatives have been introduced in
the past four years to reduce the incidence of impaired driving.
These initiatives are part of a multifaceted approach, involving
prevention, education and enforcement.

2. As part of a continued commitment to reduce impaired driving, the
Department of the Solicitor General will focus on delivering existing
programs that have proven successful in combating this problem.

D. Conclusion

1 . The number of alcohol-related fatal and non-fatal injury collisions
decreased between 1984 and 1990, as did the resulting deaths and
injuries. However, young people are still over-represented in
alcohol-related collisions.

2 . The number of impaired drivers detected through Checkstop activity
has declined, as has the number of charges laid through routine
enforcement. However, the people that are charged face stiffer
penalties, particularly in the form of jail terms.

CURRENT ALBERTA MOTOR ASSOCIATION TRAFFIC SAFETY
INITIATIVES

Driver Education/School Patrol

The Alberta Motor Association offers driver education programs to novice drivers,
senior drivers, and to specialized drivers (oilfield etc.).

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TRANSPORTATION INJURIES WORKGROUP

As well, the AMA offers its school patrol -program. Every year, thousands of
Albertan youngsters participate in this safety program which teaches them
elementary road safety rules.

These patrollers ensure the safety of their fellow students and others at nearby
pedestrian crossings and raise driver awareness of pedestrian safety in these
communities. Since the program began more than fifty years ago, not one person
has been killed or injured at these patrolled pedestrian crossings.

The AMA has and continues to encourage:

1 ) Uniform standards for the examination and licensing of all drivers;

2) Mandatory re-training for all drivers;

3) Expanded curriculum for novice drivers' courses to include alcohol and
drug abuse and impaired driving;

4) Adoption of a zero blood alcohol content stipulation to the conditions for
retention of probationary drivers licenses.

Impaired Driving Programs

The Solicitor General's Department offers two (2) Impaired Driving intervention
programs, both of which are administered and delivered by the Alberta Motor
Association. Approximately 8,500 Albertans participated in these courses in 1991.

Planning Ahead, an eight (8) hour program, is aimed at drivers convicted of their
first impaired driving offence. The course employs a lecture format and includes
group discussion and videos. Participants are taught how to plan ahead to avoid a
situation in which they may drink and then drive.

Impact is a weekend long program aimed at repeat impaired drivers. This program
uses small group dynamics in assisting participants to examine their own behavior,
attitudes, and feelings about drinking and substance abuse. Unlike Planning

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TRANSPORTATION INJURIES WORKGROUP

Ahead, Impact is an intensive, internal learning experience which requires
participants to fully involve themselves in a self examination process. Impact
participants are helped to set realistic goals for themselves and are introduced to
various support agencies and networks.

Additionally, the AMA supports:

1) Increasing the legal drinking age to nineteen (19);

2) Including alcohol/drug education throughout the school curriculum from
kindergarten to grade twelve (12);

(3) Restricting the advertising of beer and wine on television.

Child Restraints

As part of an agreement with Transport Canada, the Alberta Motor Association
distributes information regarding child restraints to the general public and a wide
variety of interested groups; Consumers are informed about selection, installation,
and proper use of child restraints and are kept up to date on public notices
concerning these devices. The AMA provides province wide access to this service
using a toll free phone line. Across the province, this service may be accessed at 1-
800-222-6578; in Edmonton and area consumers may call 430-6800.

The AMA encourages:

1 ) Development of uniform design standards for child restraints;

2) Legislated use of booster seats for children in the 18 kg to 35 kg weight
range;

3) Increased levels of child restraint law enforcement

Additionally, the AMA is involved heavily with the Coalition on Child Passenger
Restraint and its efforts to increase conect usage of child restraints in Alberta.

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TRANSPORTATION INJURIES WORKGROUP

ALBERTA AUTO INSURANCE (by Alan Wood, Insurance Bureau of
Canada)

The automobile insurance industry in Alberta has gone through a difficult period
during the past 5 years, with claims expenses exceeding premium income each year
since 1986. The results of an Insurance Bureau of Canada survey of member
companies indicates that die net industry loss on automobile insurance in Alberta for
1991 was approximately $155 million after operating expenses and investment
income were factored in. The estimated net loss for 1989, 1990 and 1991
combined is at least $330 million.

The poor results are due to three major factors. A serious weather related event has
occurred somewhere in Alberta each year, beginning with the Edmonton tornado in
1987. A significant increase in automobile theft claims has also occurred, with
Edmonton and Calgary both experiencing a 30% plus increase in stolen automobiles
during 1991 as compared to 1990.

Finally, the cost of bodily injury claims has continued to escalate at a pace far
beyond the rate of inflation. In 1990, the average cost of a third party liability claim
(injury or property damage to the innocent driver in a collision) was 47% higher
than the corresponding 1986 cost For comparison purposes, the cost of settiing
collision damage claims increased only 22% during the same period. In recent
years, the average injury claim has been increasing at a rate of about 13% annually,
to the point where the average injury settlement by insurers in Alberta now exceeds
$20,000.

Drivers who consistently cause traffic collisions or who have a poor record of
traffic infractions do pay higher insurance premiums than those who remain
collision free. However, this does not seem to deter them from driving or from
in^roving their driving habits and skills.

The Insurance Bureau of Canada has long been supportive of traffic safety
initiatives designed to reduce collision frequency. We are presentiy promoting the
concept of a graduated licensing system for new drivers as a countermeasure to the
over representation of new drivers in traffic collisions. Under this system, new
drivers would have restrictions placed on their licence that limit where, when and

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TRANSPORTATION INJURIES WORKGROUP

under what circumstances they could drive. These restrictions would gradually be
removed as they obtain driving experience.

We also support increased penalties for non use of vehicle restraint devices, stricter
enforcement of traffic violations that are the leading causes of traffic collisions, a
mandatory vehicle inspection program and other safety initiatives designed to
reduce the frequency and severity of traffic collision.

ALBERTA TRANSPORTATION AND UTILITIES INmATIVES
Transportation Safety Branch

The Transportation Safety Branch, the provincial government's traffic safety coordinating
body, is responsible for reducing the number of motor vehicle collisions, injuries and
deaths in Alberta. Through inspection, legislation and the development of educational and
informational programs, this branch provides direction in the safe transportation of goods
and people on Alberta highways and provincially regulated rail lines.

This branch is also responsible for setting policy and awarding carrier safety ratings for
administering the National Safety Code, a Canada-wide program developed to improve the
mechanical fitness of vehicles, and the driving skills and attitudes of commercial vehicle
drivers.

Through its Safety Policy and Development section, it also provides safety policy
development and highway safety engineering recommendations to improve motorist safety.
This includes on-going policy analysis, development and direction to solve motorist safety
problems, and the enhancement of collision data collection and analysis.

Safety Branch's Safety Standards and Records section works with other groups having
common interests in vehicle safety provincially and nationally; develops technical and
professional standards for vehicle inspection programs such as those required by the
Written-Off Motor Vehicles Program and the Commercial Vehicle Inspection Programs;
and maintaining technical information standards for the carrier and operator profile data
bases.

TRANSPORTATION INJURIES WORKGROUP

The Safety Education and Programming section develops educational and information
programs to promote traffic safety, focusing on program development in a number of areas
such as pedestrian safety, seat belt safety, school bus safety, bicycle safety. This is
accomplished through the provision of a number of programs:

A Mobile Safety City teaching pedestrian safety to ECS and Grade 1 students

A Winter Driving Program;

A School Bus Evacuation Program;

A General School Bus Safety Program;

A Bicycle Safety Program;

A Seat Belt Safety; and

A Child Car Safety Seat Program.

Transportation Safety Branch's Rail Safety section is responsible for developing and
administering a new provincial rail safety program. This follows a recent Supreme Court
decision making provincial governments responsible for railways incorporated under
provincial legislation.

These provincial railways include short-line public carriers (Central Western Railway &
Alberta Railway Excursions), private railways (which include 100 industrial spurs around
the province), and amusement passenger railways (i.e. Fort Edmonton, Calgary Heritage
Park) operating throughout Alberta, Concentrated efforts are being made into updating the
Alberta Railway Act and developing the province's new railway safety program to ensure
public safety.

MINISTER'S ADVISORY COMMITTEE ON TRAFFIC SAFETY

On September 16, 1991, the Honourable Al "Boomer" Adair, Minister of Transportation
and Utilities announced the formation of his Minister's Advisory Committee on Traffic
Safety. This committee is made up of representatives of traffic safety interest groups
including police forces, motor associations, safety councils, the driving school industry
and the automobile insurance industry along with personnel from Alberta Solicitor General
and Alberta Transportation and Utilities. The mission of the committee is "to reconunend

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TRANSPORTATION INJURIES WORKGROUP

specific strategies, policies and program initiatives to the Minister of Transportation and
Utilities related to Highway Safety through consultations with private sector, government
agencies and the exploration of existing programs". The committee is chaired by the
Minister.

Since its inception, the committee has held a number of meetings in Edmonton. Under the
direction of the committee, staff from Alberta Transportation and Utilities have developed a
short range program and a long range program aimed At improving traffic safety in Alberta.
In general terms, these plans include public information programs, enforcement programs
and safety environment improvement programs.

Under the general direction of the committee, staff of the department are now "fleshing out"
these plans, developing specific programs, work schedules and budgets. There will be
announcements by the Minister from time to time in the coming months as these programs
go "on stream".

It is anticipated that the initiatives developed and coordinated by the Minister's Advisory
Committee on Traffic Safety will have a significant impact on road safety in Alberta.

WHERE WE WANT TO BE

Year 2000 Injury Control Objectives for Transportation Injury
Prevention

A key focus of the National Syiiq)osium to Establish Injury Control Objectives for
Canada for the Year 2000 was the area of transportation injury prevention. As
noted in the preamble to the findings of that workgroup, motor vehicle-related
injuries are by far the leading cause of transportation fatality, accounting for 89
percent of all deaths due to transport activities fix)m 1984 to 1988. The objectives
and issues requiring active consideration proposed by the Symposium participants
now need to be taken the next step of developing detailed strategies and action plans
which are appropriate for Alberta to move towards achieving the overall injury
reduction objective of 20 percent less motor vehicle-related injury deaths and
hospitalizations by the year 2000. For the purposes of this background paper and
the Transportation Injury Prevention Workshop at the Fourth Annual Injury in

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TRANSPORTATION INJURIES WORKGROUP

Alberta Conference, Injury prevention for other means of transportation (i.e. rail,
air and marine) will not be addressed. See Attachment 1 for a copy of the Report of
the Transportation Work Group contained in the proceedings of the National
Symposium, A Safer Canada - Year 2000 iniurv Control Objectives for Canada.

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TRANSPORTATION INJURIES WORKGROUP

REPORT OF THE TRANSPORTATION WORK GROUP

1 . Introduction

In Canada from 1984 to 1988, about 38% of the deaths due to injuries took place while people were engaged
in transportation activities.^ Air, rail and marine transportation accounted for about 11% of these
transportation fatalities, while motor vehicle collisions caused the remaining 89%. Because of the
preponderance of motor vehicle deaths, they became the main focus of the symposium's objective-setting
efforts to control and reduce transportation deaths. Each year, over 4000 Canadians die because they were
involved in motor vehicle crashes.^

To place the incidence of morbidity due to motor vehicle collisions into perspective, severity notwithstanding,
motor vehicle collisions accounted for about 12% of all non-fatal injunes in Canada from 1983 to 1987.'
Each year, over 45 000 Canadians are injured in motor vehicle crashes. ^

2. Issues Related to Setting Objectives

A central issue that emerged when trying to set objectives was how best to define "high-risk" situations and
behaviour. Different methods of measuring risk and different perspectives often produce conflicting priorities.
For example, older drivers would be considered a particularly vulnerable group of road users, if risk were
defined in terms of a common transportation index, such as deaths or injuries per unit of distance travelled.
On the other hand, if risk were defined in terms of a common health-care index, such as deaths per 100 000
population, older adults (if grouped as all those over the age of 65 years), would be viewed as a rclativch
low-risk group when compared to young adults. As a further illustration, while children account for a ver.
small proponion of the total road toll, collisions are the leading cause of their death; from one perspective ihc\
are a low prionty, and from another, they are a high priority.

To provide a consistent frame of reference, injury rates per 100 000 population were used to assess the relatn e
imponance of targets for specific population groups. Such an approach leads to the conclusion that soir.c
groups, like children and older adults, are low-risk and this would tend to eliminate them as primary targets
for injury reduction. However, they are included in the list of objectives because the young are largely unable
to protect themselves and road crashes continue to be a leading cause of their death, and because the
representation of seniors in the population is increasing significantly and their contribution to the road toll will
grow. As well, when the age-specific death rates (for motor vehicle deaths including pedestrian deaths) for
the 65+ group are broken down by ten-year age spans, a different picture emerges. The 15-19 and 20-24 age
group rates are higher than the 65-74 and 75-84 group, but the 85+ group has the highest rate of all. After 75
years of age, older adults are not a low-risk population for motor vehicle-related deaths.

Trying to set measurable objectives for reducing the incidence of motor vehicle injuries and deaths among
native Canadians was difficult because there was no known source of information on the rate of injury and
death among non-status Indians. Because data are available for status Indians, only this group is included in
the objectives, even though the intent of the objectives is to reduce death and injury among both status and

A ^aier Canada — YFAR 2000 TNniRY CONTROL OBTF.CTTVFS FOR CANADA

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TRANSPORTATION INJURIES WORKGROUP

non-status native Canadians. If reductions in death and injury are realized among status Indians, it is expected
that there will be similar reductions among non-status Indians.

As there was no known source of reliable data on long-term disabilities m Canada, no rr.c isurablc objectives
were set for minimizing long-term disabilities due to motor vehicle crashes. It was agreed that all injury-
reduction initiatives should focus pnmanly on those injury events that are most likely to have serious long-
[cmi effects, such as head and spinal cord injuries.

In defining motor vehicle, it was decided that bicycles and off-road vehicles should be included in the
definition. However, because these modes of transportation are predominantly used in recreational and
community activities, objectives for reducing injuries caused while riding bicycles and off-road vehicles were
established by the Sports and Recreation and Home and Community work groups.

3 . Issues Requiring Active Consideration

a) Increased educational programming about the risk of injury associated with the
operation of motor vehicles.

Members of the work group identified the significant role that educational programs play in reducing injury
death and disability. The perception of risk of sustaining adverse health consequences associated with
operating a motor vehicle is disproportionately low when compared to more topical health risks such as
AIDS. Educational programs that address this distoned perception of risk are recjuircd and stiouki be
directed towards elementary and secondary school students. Since there arc no baseline data on ihc ciirrcm
level of motor vehicle injury prevention (traffic safety), it will l->e neccssarx lo conduct an invcntor\- o\
current programming. The Canadian As.sociation for School Health (C'ASIh. ;i naiional coalition ili;ii :s
striving for comprehensive school health, was identified as an agency iliat is uicaily posnicMicd to c(vuiuc:
this baseline inventory and to monitor increased programming in this area.

2. Identify and implement effective road user skill development and traininj^ pro^iniins lo
minimize the risk of injury death and disability due to motor vehicle crashes.

Training of road users in the skills required to be effective, safe users is a critical component ol"
comprehensive approach to improving the current level of road safety. Unfonunately, the current level oi
road user skills is unknown, as well as the range and type of programs available across Canada. The
work group identified the need to establish baseline data in these two areas: skill level of road users; and
road user training and skill development programs. It will also be necessar)' to conduct literature review
studies to determine which road user training programs are most effective. The work groups
recommended that the Canadian Council of Motor Transport Administrators (CCMTA) take the le<id in this
activity, in collaboration with the Canadian Automobile Association (CAA), the Health Promotion
Directorate of Health and Welfare Canada, and the Driver Training Association.

References:

1 . Personal Communication, Transport Canada.

2. Canadian Mortality Database. Personal Communication. Laboratory Centre for Disease Conu-ol. Health and Welfare Canada.

A Saf^ Canada — YFAR 2000 INTimY rONTROL OBTECTIVES FOR CAMAO A

86

TRANSPORTATION INJURIES WORKGROUP

TRANSPORT INJURY CONTROL OBJECTIVES — REDUCTIONS

OBJECTIVES

BASELINE
PER 100 000
IN CANADA

TARGET
%

REDUCTION

DATA
SOURCES

MONITORING
AGENCIES

1 .0

Reduce fatal injuries from

Unavailable

Mortality

o I 3 1 1 S I I C S

iransporialion crashes in all

Database

age groups

CCHI

2.0

Reduce injuries requiring

Unavailable

25%

no 5 p 1 1 a I

CCHI

hospitalizaiion from

Morbidity

iransporialion crashes in all

Database

age groups

3.0

Reduce faial injuries caused

1 J . JO

ones.

Mortal ily

CCHI

by moior vehicle crashes.

I, 1 7 0 O j

Database

Groups al risk:

reduce lo

3.1 15-24 years

31.77'

27.02

3.2 0-14 years

J. /o

3.3 65+ years

1 y.j

1 J.O

3.4 siaius Indian/lnuit

Unavai lable

Unavailable

4.0

Reduce injuries requiring

1 99 A 1 J

Z\J /o

Hospital

'^'^n 1

hospilalizalion caused by

(198<S)

Morbidity

moior vehicle crashes.

Database

Groups al risk:

reduce to

4.1 1 5-24 years

392.32-

313.16

4.2 0-14 years

106 >^ 4 ■

85 47

4 3 65+ years

146.55'

117 24

4 4 status Indian/lnuit

Unavailable

Unavailable

5,0

Reduce the proportion of

46.5%'-

I'rali'ic Ini-ry

fatal injuries due to alcohol-

(19 8 9!

Research

impaired drivers

Foundai ion

(TIRF)

6.0

Reduce ilic number of

4 4 9 S ^

; i > ^v.

Road Accidcni

casualty collisions caused by

collisions

reduced to

Statistics :n

deficiencies in design,

(I989>

40 40

Canada

consiruciion and

collisions

mainienance of the road

cnvironmcni

A <;af»- Canada - YFAR 2000 IMUKY CONTROL OBTECTIVFS FOR TAMA DA

87

TRANSPORTATION INJURIES WORKGROUP

TRANSPORTATION INJURY CONTROL OBJECTIVES — INCREASES

BASELINE

TARGET

DATA

MONITORING

OBJECTIVES

PER 100 000

%

SOURCES

AGENCIES

IN CANADA

INCREASE

7.0

increase use of occupani

85.1% use'

Increase lo

Transpori

CCMTA

restraint systems

(1991)

95% by 1995

Canada

8 0

fn^rpac/* fhp mimK/*r C%f

I jurisdiC"

I np r/* a Q ^* in

CCMTA

CCMTA

jurisdictions using

lion*

50% (to 6

administrative licence

(1990)

jurisdictions)

suspension as an impaired

driving countermcasure

9.0

Increase the number of

1 jurisdic-

Increase to

CCMTA

CCMTA

jurisdictions using vehicle

tion*

50% (to 6

impoundment as an impaired

(1990)

jurisdictions)

driving couniermeasurc

10.0

Increase the number of

0 jurisdic-

Increase lo

CCNfTA

CCMTA

jurisdictions that have

tions*

50% (to 6

graduated licensing systems

(1990)

jurisdictions)

1 1.0

Increase the number of

5 jurisdic-

Increase lo

CCMTA

CCMTA

jurisdictions that have

tions*

100% (10 12

mandatory motor vehicle

(1991)

jurisdictions)

inspections for all classes of

vehicles

References:

1 . Canadian Monaliiy Database. Personal Communicaiion. Laboratory Ccnirc for Disease Control. Health and WcKaj-c Canatia.

2. Canadian Hospital Morbidity Database. Personal Communicaiion. Laboratory Ccnirc for Disease Conirol, Hcakh and Wcilarv.-
Canada.

3 Traffic Injury Research Foundation (TIRF). H.M. Simpson, 1989.

4 . Road Accident Siaiisiics in Canada. Transpori Canada. 1989.

5 . Transport Canada.

6. Canadian Council of Motor Transpori Administraiors. Contact Audrey H. Lavoie, Director of Programs, 2323 Si Laurent Blvd.
Ottawa, K1G4K6.

A Safpr Canada — YF AR 2000 INTURY CONTROL OBTECnVES FOR CAM AO A

88

TRANSPORTATION INJURIES WORKGROUP

Supplementary References for the Objectives:

1 . Alberia Solicitor General. Effective Strategies to Combat Drinking and Driving. An cduol collecuon of papers presented at the
InicmaiionaJ Congress on Drinking and Driving, Edmonton, 1990.

2. The Canadian Council of Motor Transport Adminisiraiors. Road Safety in Canada: 1 he Challenge Symposium Proccalings.
Montreal, 1988.

3 . General Accounting Ofncc. Periodic Inspection Programs. G AO/RCED-90- 1 75 , U S .

4. Mayhew, D.R.. H.M. Simpson, and K.N. Wood. Alcohol Use Among Persons Fatally Injured in Motor Vehicle Accidents in
Canada, 1989. The Traffic Injury Research Foundation, March 1991.

5. Provisional Licensing Programs for Young Drivers. Topical Papers by Licensing Experts. Including an Annotated
Bibliography. DOT HS 807 375. February. 1989. U.S.

6. Transport Canada. Background Paper on Motor Vehicle Occupant Protection in Canada. Report TP8087, 1986.

7. Traffic Injiory Research Foundation of Canada. New to the Road: Key Findings and Implications from an International
Symposium. Halifax, 1991.

A Safer Canada — YEAR 2000 INTURY CONTROT. nByFCTTVES FOR T ANIAO A

89

APPENDIX 3

4th Annual Injury in Alberta Conference
21 - 23 October 1992
Budget

General Expenses Actual Variances

Scholarships

2,000.00

Pre-conference flyers

200.00

(40.00)

Conference Brochures

2,185.68

(685.68)

Postage

3,500.00

Faxes/Phones

800.00

Office/Conference Supplies

200.00

Media Coverage

668.97

(468.97)

Planning Meeting

200.00

Speaker/Guest Gifts

876.33

(526.33)

Awards

1,910.24

(410.24)

Staff Support

(5,000.00)

Secretarial Support

832.00

(832.00)

Print Materials for Delegates

971.56

Miscellaneous Supplies (paper
supplies, mailing list, etc.)

358.96

Printing of Open Lecture Tickets

52.00

Sponsors' signs

507.18

Conference Banner

111.00

Alberta Data (Printing)

509.32

Conference Bags

1,667.86

Festival of Trees Tickets

280.00

$17,831.10

Hotel Expenses Actual Variances
Hilton

Meeting Room Rental 2,100.00 (13.50)

Audiovisual 1,185.00 (985.00)

Flip Charts/Easels/Table 550.00

Miscellaneous (Photocopy) 50.25
Catering

Lunch (210 people) (22/10/92) 3,079. 12

Breaks (22/10/92) 1,456.13

Office/Staff 90.27

Lunch (180 people) (23/10/92) 4,481.55

Breaks (23/10/92) 987.85

Reception 1,149.42 (3,405.66)

Goods & Services Tax > 1,070.50

S afe Community Meeting 163,88

Planning Committee Speaker Meal 871.44

Convention Inn - Open Lecture

Room Rental 400.00

Pre Conference Reception 520.98

Coffee Open Lecture 474.24

Audio Visuals 75.00

Goods & Services Tax 102.92

17,235.41

1.573.14
$18,808.55

speaker Expenses Actual Variances

Leif Svanstrom 5,000.00

Robert Conn 685.56 614.44

Philip Schaenman 3,081.26 (1,781.26)

GuyRegnier 1,186.02 113.98

Shelley Karpmen 250.00

Linda MacLeod 2,994.22 (1,694.22)

Herb Simpson 1,705.03 (405.03)

Maureen Shaw 1,500.00
Occupational Health &

Safety Facihtators 3.000.00
Herb Buchwald
Susan Ruffo
Deborah Smith
Vem Millard
Dave Gibson

Total Speaker Expenses

Total Expenses

$19.402.09
$56,041.74

Revenue

Registrations
Kids Care

Fire Fighters Bum Unit
President's Office

Alberta Occupational Health & Safety
Alberta Health

Recreation Parks and Wildlife Foundation

Trauma Association

Alberta Transportation & Utihties

Worker's' Compensation Board
City of Edmonton

Registration fees outstanding
Total Revenue

Total Revenue less expenses

45,860.60 - 56,041.74

14,137,61
2,900,00
600,00
871.44
8,000.00
5,000.00
1,700,00
1,000.00
3.400.00
37,609.05
4,481.55
95.00

3.675.00
$45,860.60

(10,181.14)

The deficit shown is due to costs incurred by the open lecture event. This event was not
budgeted for in the original conference budget.