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Supported  by 
the  Occupational 
Health  and 
Safety  Heritage 
Grant  Program 

Heritage  Fund 




Digitized  by 

the  Internet  Archive 

in  2015 


Submitted  to: 
Occupational  Health  &  Safety 


Injury  Awareness  &  Prevention  Centre 


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 

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. 



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

(All  Occupational  Health  and  Safety  Workshop  Session  Registrants  together) 


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


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." 


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. 

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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 

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- 

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 

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 

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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 

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 

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 

Page  6 


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 

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. 

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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. 


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 

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 

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. 


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 

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, 

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 


community  and  family  focus, 

getting  the  message  into  schools  and  shopping  centres, 



disability  related  to  injuries  becoming  a  social  issue,  and 

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

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 


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 

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


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: 


Susan  Ruffo 
Deborah  Smith 
Ruth  Nielsen 
Carol  Earner 


Maureen  Shaw 
Herb  Buchwald 
Dave  Gibson 


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) 


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

Page  13 

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


Susan  Ruffo 
Deborah  Smith 
Ruth  Nielsen 
Carol  Earner 


Maureen  Shaw 
Herb  Buchwald 
Dave  Gibson 


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) 


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 

Page  14 

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

(Conference  Plenary) 


Dave  Gibson 


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



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


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 

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


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 

Page  15 

GROUP  n: 


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


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


Social  marketing:  public  awareness/change  a  social  value 


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 

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 

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

Page  16 

GROUP  ni: 


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


Industry  Associations 

Workers'  Compensation  Board- Alberta 

Alberta  Occupational  Health  and  Safety 

Safe  Communities 

Workers'  Health  Centre 

Injury  Awareness  and  Prevention  Centre 




dentify  a  Central  Clearing  House 
list  partners 

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 

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

Page  17 


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 

•  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 

•  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 


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? 


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. 


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. 


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. 


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 


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 


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 


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 



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. 

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 

Summary  of  Evaluations  -  4th  Annual  Conference 


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. 


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 


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. 


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  - 


3/47  = 


lAPC  Newsletter  - 


22/57  = 


Conference  Flyer  - 


13/57  = 


Full  Conference  Brochure  - 


6/57  = 


Summary  of  Evaluations  -  4th  Annual  Conference 


Conference  Planning  Committee  Member  - 




Other  - 




No  Answer  - 




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 


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 

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 


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 

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


W@rksli@p  Outlines 

Reference  Material 

October  21  -  23,  1992 
Bdmonton,  Alberta 


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



-  The  Honorable  Nancy  J.  Betkowski  i 

Health  Goals  viii 


Workshop  Outline  1 

Native  Injuries*  (Article)  2 

Native  Injury  Abstracts  4 

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


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 


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 


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 




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 


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 




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 


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


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. 



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. 


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 


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 

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. 




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 

Dear  Kathy: 


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 

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 


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 

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). 


Judy  Evans, 

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




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 

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. 




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 



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 

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 

The  threat  to 

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 



MV  and  Traffic  injijles 



inocJveftent  FaBs 



Fires  and  Flanges 






'  Age  Standofdtzed 

2  AuMOM 

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

VOL4N0  2  0  MAR  1991 


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- 

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) 


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

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


Native  Injury  Abstracts 

Burn  Injuries  in  Native 
Canadians:  A  10-year 

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 

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 


I  Female 

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

Age  Group 

Native ' 

Total  , 



















Total:  0-85  yrs 



Average  1980-84 
'  1984 

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

VOL4N0  2  0  MAR  1991 




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 

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 



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 

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 

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



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 

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 

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 



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 



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 

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. 



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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 

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



To  meet  this  aim  participants  will  work  together  to: 

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

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. 






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 

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: 




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. 

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


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 





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: 




0945  -  1005    A  Review  of  Alberta  Fire  Statistics 


Fire  Commissioner  Tom  Makey 

Fire  Commissioner's  Office,  Alberta  Labour 

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


Dr.  Tony  Ryan 

Royal  Alexandra  Hospitals,  Edmonton,  Alberta 

1025  -  1040  Break 

1040  -  1 130    International  Perspective  to  Fire  and  Bum  Prevention 


Mr.  Philip  Schaenman,  Arlington,  Virginia 

1 130  -  1200    Question  Time 

Workshop  2 


Thursday,  22nd  of  October  1992 


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? 




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 





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) 










Alberta  Homes 





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 




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. 


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, 

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, 

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? 


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 




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). 


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 




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

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 




















(36  5) 






(18-5)  J 













Other  (suicide,  child  abuse) 




(1  5)  J 

Contributing  faaors* 





(4  2)1 







Street  drugs 










Mode  o<  travel 

Road  ambulance 




(51-3)  ^ 

Air  amtxjlance 





Private  vehicle 






Other  (includes  ambulatory. 

police  transport  commercial  air) 





'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 










Flames  and  fires 









Hot  water  scald 









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









Electrical  current 









Thermal  contact  • 









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











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

Natives ' 



Total  burn  surface  area 


1  ±20  1 



(P<0  05) 






Surgical  with  healing 
Surgical  with  death 


(60  8) 


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

y       (P<0  05) 

No.  of  surgical  procedures 


7±1  7 

10  ±1-4 






Three  t 






(30-4)  1 
(9-6) _ 



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. 


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 

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 




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. 


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. 


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. 

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. 

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. 



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. 


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 

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. 




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. 


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     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 



<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 

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 



Petrol  alone 



Petrol  and  matches 



Natural  gas 









Matches  alone 






Matches  and  other 



Barbeque  fluid 



Methyl  hydrate 











Scald  41.2 

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

Flash  311.4 

Scald  8.7 

Other  13.2 

Electrical  8.3 
Crease  4.S 
Contact  S.3 


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



Flame  23.5 

Contact  6.1 
Flash  10.3 

Contact  27  0 


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? 













Motor  vehicle  accident 



Temporary  domicile 



Public  building 












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

Natives  Non-natives 










42  4 










13  3 

Ttiermal  contact 




10  5 





4  4 








2  6 


4  0 
























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





Walked  or  fell 



Poured  petrol 



Ottier  flammables 



Ttirew  aerosol  can 












Tent  fire 






Motor  boat  (explosions) 



Power  transformer 



Assault  (set  on  fire) 






'Unsafe  environments  or  practices  (e  g 




/  \ 

/  \ 

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


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 




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 

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 


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 




Survival  time 









Natural  gas 


Palliative  care 




28  h 


Natural  gas 




Failure  to  reintubate 

11  yr 








Acute  renal  failure 
Cardiac  arrest 










Metabolic  acidosis  (H  "  =  1 00) 
Cardiac  arrest 




72  h 



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







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







Pneumococcal  pneumonia 




26  h 





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




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 

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. 





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. 


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Chicago:  Year  Book  Medical  p.  3 
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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 




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 

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. 



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 

•  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 

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

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




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 

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. 




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 

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. 


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  (- 



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. 


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. 




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). 


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%). 



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 

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. 



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), 


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 

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 



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. 


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. 



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 

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. 



*  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. 


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- 

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 

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 

These  inappropriate  attitudes 

•  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- 

•  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 

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 

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 


VOLS  N06  o  AUGUST  IPPi- 


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- 

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 

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 

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 

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 

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- 





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. 



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. 



-  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. 



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  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. 


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. 




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^ 



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. 

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 



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. 


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 ^ 



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. 


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 

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 

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


Establish/develop  legislation  for  minimum  safety  standards  for  bicycle 

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- 

•  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. 


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


•  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. 


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 



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 

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 

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 

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






Holds  all  vital  emergency  information  on  each  athlete; 

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


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 


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

pre/post  event  meals,  hydration,  travelling  tips,  etc.  25.00 


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 
Pre-Event  Eating 

Prevention  of  Physical  Activity  Injuries 

Procedures  for  Conducting  Announced  Doping  Control 


Ride  Longer  and  Stronger 
Trampoline  Safety 

POSTERS  2.50  for 

First  Aid  shipping 

Recreational  Drugs 


Sport  Medicine  Council  of  Alberta 
11759  Groat  Road,  Edmonton,  Alberta  T5M  3K6 
Phone:    (403)  453-6636    Fax:  422-3093 


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. 



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. 




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. 


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.) 



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. 




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 

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 




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. 


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 



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 

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. 


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. 



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. 


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. 


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. 



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  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  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. 



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 


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 




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. 


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. 



An  update  from  the  Solicitor  General's  Office  on  Impaired 
Driving  in  Alberta 


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 

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, 

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. 



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 

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. 



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. 


Driver  Education/School  Patrol 

The  Alberta  Motor  Association  offers  driver  education  programs  to  novice  drivers, 
senior  drivers,  and  to  specialized  drivers  (oilfield  etc.). 



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 



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 

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. 



ALBERTA  AUTO  INSURANCE  (by  Alan  Wood,  Insurance  Bureau  of 

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 

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 



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. 

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 

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 


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. 


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 



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 

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. 


Year  2000  Injury  Control  Objectives  for  Transportation  Injury 

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 



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. 




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 



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. 


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 





PER  100  000 





1  .0 

Reduce   fatal   injuries  from 



o  I  3  1 1  S  I  I  C  S 

iransporialion   crashes    in  all 


age  groups 



Reduce    injuries  requiring 



no  5  p  1 1  a  I 


hospitalizaiion  from 


iransporialion   crashes   in  all 


age  groups 


Reduce  faial  injuries  caused 

1  J  .  JO 


Mortal  ily 


by  moior  vehicle  crashes. 

I,  1  7  0  O  j 


Groups  al  risk: 

reduce  lo 

3.1        15-24  years 



3.2       0-14  years 

J.  /o 

3.3       65+  years 

1  y.j 

1  J.O 

3.4       siaius  Indian/lnuit 

Unavai  lable 



Reduce    injuries  requiring 

1  99  A  1  J 

Z\J  /o 


'^'^n  1 

hospilalizalion   caused  by 



moior  vehicle  crashes. 


Groups   al  risk: 

reduce  to 

4.1        1 5-24  years 



4.2        0-14  years 

106  >^ 4  ■ 

85  47 

4  3        65+  years 


117  24 

4  4        status  Indian/lnuit 




Reduce   the   proportion  of 


I'rali'ic  Ini-ry 

fatal   injuries  due  to  alcohol- 

(19  8  9! 


impaired  drivers 

Foundai  ion 



Reduce  ilic  number  of 

4  4  9  S  ^ 

;  i  >  ^v. 

Road  Accidcni 

casualty   collisions   caused  by 


reduced  to 

Statistics  :n 

deficiencies   in  design, 


40  40 


consiruciion  and 


mainienance  of  the  road 


A  <;af»-  Canada  -  YFAR  2000  IMUKY  CONTROL  OBTECTIVFS  FOR  TAMA  DA 









PER  100  000 







increase  use  of  occupani 

85.1%  use' 

Increase  lo 



restraint  systems 


95%  by  1995 


8  0 

fn^rpac/*    fhp    mimK/*r  C%f 

I  jurisdiC" 

I  np  r/*  a  Q  ^*  in 



jurisdictions  using 


50%  (to  6 

administrative  licence 



suspension  as  an  impaired 

driving  countermcasure 


Increase  the  number  of 

1  jurisdic- 

Increase to 



jurisdictions   using  vehicle 


50%  (to  6 

impoundment  as  an  impaired 



driving  couniermeasurc 


Increase  the  number  of 

0  jurisdic- 

Increase lo 



jurisdictions   that  have 


50%  (to  6 

graduated   licensing  systems 



1  1.0 

Increase  the  number  of 

5  jurisdic- 

Increase lo 



jurisdictions   that  have 


100%  (10  12 

mandatory  motor  vehicle 



inspections  for  all  classes  of 



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.- 

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 



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 



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

General  Expenses  Actual  Variances 



Pre-conference  flyers 



Conference  Brochures 







Office/Conference  Supplies 


Media  Coverage 



Planning  Meeting 


Speaker/Guest  Gifts 






Staff  Support 


Secretarial  Support 



Print  Materials  for  Delegates 


Miscellaneous  Supplies  (paper 
supplies,  mailing  list,  etc.) 


Printing  of  Open  Lecture  Tickets 


Sponsors'  signs 


Conference  Banner 


Alberta  Data  (Printing) 


Conference  Bags 


Festival  of  Trees  Tickets 



Hotel  Expenses  Actual  Variances 

Meeting  Room  Rental  2,100.00  (13.50) 

Audiovisual  1,185.00  (985.00) 

Flip  Charts/Easels/Table  550.00 

Miscellaneous  (Photocopy)  50.25 

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 



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 



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 




The  deficit  shown  is  due  to  costs  incurred  by  the  open  lecture  event.  This  event  was  not 
budgeted  for  in  the  original  conference  budget.