Accidents and their prevention

Accidents are a major cause of death and disability. About 14,000 people die in the UK, most of them in England and more than 700,000 will be seriously injured in England alone.¹

They cost the UK an estimated £150 billion every year. For children and young people, accidents are the greatest threat to life.

Three published guidance documents from the National Institute for Health and Care Excellence (NICE) outline recommendations for all those with a strategic role to play in injury prevention, including integrated care systems (ICSs), local authorities and their partners.^{2 3 4}

There is no requirement for primary healthcare teams to undergo training in unintentional injury prevention.

Concepts in accident prevention

• Primary prevention: removal of circumstances causing injury - eg, traffic speed reduction, fitting stair gates for young children, reducing alcohol consumption.

• Secondary prevention: reduces severity of injury should an accident occur - eg, use child safety car seats, bicycle helmets, smoke alarms.

• Tertiary prevention: optimal treatment and rehabilitation following injuries to minimise long-term consequences - eg, effective first aid, appropriate hospital care.

Role of clinicians in accident prevention

Clinical roles for health professionals in accident prevention
These include:

• Advice to patients: health workers such as health visitors can sometimes be well placed to identify accident risks or medical conditions conferring risk and to advise accordingly - for example:

  • Child accident prevention:
    

    • Identify hazards (eg, if a family is being seen by a health visitor at home or if treatment is being sought for accidental injury).

    • Advise about prevention - eg, stair gates, keeping chemicals out of reach, etc .

  • Patients with medical conditions :
    

    • Identify and treat accident-causing conditions - eg, obstructive sleep apnoea, visual or balance disorders.

    • Give appropriate advice on fitness to drive.

    • Advise patients on how to minimise accident risks from their medical condition.

• Identify unacceptable risks and intervene where appropriate - for example:
  

  • Identify vulnerable children and adults with recurrent injuries or at high risk. This includes those who are experiencing neglect and may require child protection procedures.

  • Consider reporting to the Driver and Vehicle Licensing Agency (DVLA) patients who fail to comply with medical driving regulations.

• Accident surveillance: health professionals and their organisations can monitor injury rates and report preventable accidents. NICE recommends establishing local protocols to alert health visitors, school nurses and GPs when a child or young person repeatedly needs treatment for unintentional injuries at an emergency department or minor injuries unit.² On a national basis, NICE recommends ensuring that all hospital trusts are made aware of the data collection requirements for the universal and mandatory A&E (minimum) commissioning dataset.

Non-clinical interventions
These include:

• Advocacy and policy making.

• Collaboration with other agencies.

• Promoting accident prevention education and training.

• Research.

How effective are interventions by health professionals?

Research into child safety practices suggests that safety advice for families can be effective. Reviews have found that:

• Home safety education (usually given in a face-to-face setting), particularly with the provision of safety equipment, is effective in increasing safety practices.⁵

• Parenting interventions (usually home-based) may be effective in preventing childhood injury.⁶

Accident prevention advice

This section is intended to outline the major causes of accidents in the UK and to give health professionals some knowledge of how these can be prevented.

Advice tips can be found under headings 'Safety advice for carers of young children', 'Home accident prevention' and 'Road accident prevention advice', below.

Specific medical conditions

Doctors are well placed to advise patients on accident risks relevant to their medical problems. For example:

• Sleep disorders:
  

  • These may be under-recognised and underdiagnosed.

  • Tools such as the Epworth Sleepiness Scale and expertise such as sleep disorder clinics are valuable.

• Diabetes:
  

  • Hypoglycaemia is an important cause of driving errors.

  • People with diabetes at highest risk are those with a history of mismanagement of hypoglycaemia, lower limb neuropathy or greater exposure, ie high-volume driving.

• Epilepsy:
  

  • People with poorly controlled epilepsy can be advised how to minimise their risks of injury during a seizure - eg, taking a shower instead of a bath, not ironing when alone and other tips. Identified risk factors for injuries include the number of anti-epileptic drugs, history of generalised seizures and seizure frequency.

• Attention deficit hyperactivity disorder (ADHD):
  

  • ADHD has been shown to be associated with an increased risk of serious transport accidents.

Accidents and children⁷

Accidents are the main cause of death among children aged 1-5 years. About 100,000 children are admitted to hospital annually in the UK and 2 million attend emergency departments.

For health workers, important points when advising on child accident prevention are:

• Offer practical advice, not just general education - eg, health visitors or midwives may be able to advise about car seats or home safety equipment.

• Use an evidence-based approach where possible and dispel myths - eg, some parents wrongly believe that cooker guards and baby walkers are safe.

• Promoting safety does not require overprotection ('wrapping children in cotton wool') - this would delay development and increase the risk of obesity.

• Promote sensible precautions in line with the child's level of development.

Safety advice for carers of young children

Elderly or disabled people and accident prevention

Frailty and health problems make the elderly, particularly those over the age of 75 years, at increased risk of accidents, usually occurring in the home.

Falls are the most common cause. Inability to get up after falling puts the person at risk of hypothermia and pressure sores. Hip fractures after falls are a major cause of morbidity and mortality.

NICE and Clinical Knowledge Summaries (NICE CKS) have issued guidelines on the assessment and prevention of falls in older people.⁸

They state that older people should be asked routinely if they have fallen in the previous year. Those who have fallen, or those considered at risk of falling, should have a multifactorial falls risk assessment and should be considered for interventions, including those to improve their strength and balance, and removal of any home hazards.

Environmental interventions have a role in safety for disabled or elderly people living at home - this has led to the concept of 'smart homes', which incorporate alarm or monitoring devices and other safety features . However, safety for those needing home care has many aspects; this includes not only physical safety but social and emotional well-being.

Accidents in the home

In the UK annually, home accidents cause almost 5,000 deaths and 2.7 million A&E department attendances.

Road accidents¹⁰

In terms of numbers of people killed or injured, this is an important area for accident prevention in the UK and worldwide. Although the figures are still high, statistics for Great Britain suggest that the situation is gradually improving. For the year ending June 2023 ¹¹ :

• 1,633 reported road deaths.

• 29,429 people killed or seriously injured.

• 133,443 casualties of all severities.

Common causes of these accidents included speeding, drink driving, driving after taking drugs or careless driving, including using a mobile phone whilst driving. About 10% of those killed were inexperienced drivers.

Driving speed
Higher speed both increases the risk of collision and the risk of serious injury to the driver or others. Even a modest speed reduction helps reduce both the number and the severity of accidents - eg, pedestrians hit at speeds below 30 mph receive mainly survivable injuries but this changes to mainly fatal injuries at speeds of between about 30 mph and 40 mph.

Medical conditions that affect driving
The DVLA issues guidance and regulations with regard to medical conditions that impair safe driving. See 'At a glance fitness to drive'.

Excessive sleepiness

• 20% of accidents on motorways in the UK are caused by sleepiness and >300 people per year are killed by drivers falling asleep while driving. Sleepy drivers perform worse on tests than those over the alcohol limit.

• Increased awareness of sleep disorders and their treatment is needed, by both the public and by doctors.

Car seats and seat belts
The value of seat belts is indisputable. In most vehicles, it is now compulsory for everyone to wear a seat belt, or appropriate child restraint, if available, in the front and back. It is the driver's responsibility to ensure that passengers are correctly restrained.

Alcohol and drugs
Alcohol impairs judgement, reaction times, co-ordination and concentration. Statistics from the Department for Transport (DfT) show that in 2021 an estimated 6,740 people were killed or injured in drink-drive accidents, a rise of 4% from6,450 in 2020, but the second lowest number recorded since 1979. . ¹² The total number of accidents where at least one driver or rider was over the legal alcohol limit rose by 1% to 4,660 in 2021. The final estimate of drink-drive fatalities of 260 for 2021 is higher than in 2020 and this was rise was statistically significant - however the number of accidents in 2020 was reduced because of national restrictions due to the COVID pandemic. 17% of road deaths in 2021 occurred in collisions where at least one driver or rider was over the legal drink-drive alcohol limit.

Legal limits for driving with alcohol in England, Wales and Northern Ireland are :

• 35 μg alcohol per 100 ml of breath; or
  

• 80 mg of alcohol per 100 ml of blood; or

• 107 milligrams per 100 ml of urine

However, most drivers are impaired at a blood alcohol level of 50 mg/100 ml. The Royal Society for the Prevention of Accidents (RoSPA) has called for the legal alcohol limit to be reduced to 50 mg/100 ml blood, as it is in many other countries (including Scotland).

It is difficult for drinkers to know how much alcohol they are consuming, as strength and sizes of drinks can vary considerably. Also, the speed of absorption into the body varies with a person's size, age, weight and gender and whether they have eaten. The same amount of alcohol will give different blood alcohol levels in different people. Therefore, the best and safest advice is not to drink when driving.

Drivers may also be impaired due to the use of drugs, both illicit and prescribed. Any drugs that cause sedation are a problem, including many antihistamines and antidepressants.

Mobile phones and driving
Research has shown that using hand-held or hands-free mobile phones whilst driving increases the risk of drivers crashing, injuring or killing themselves and/or other people, by four times. It is an offence for drivers to use a hand-held mobile phone whilst driving .

Motorcyclists and cyclists
Motorcyclists are extremely vulnerable - despite forming only 1% of road traffic, they account for 20% (one in five) of road deaths and serious injuries. Information on preventing accidents for motorcyclists is available on the RoSPA website. 104 motorcyclists are seriously injured on UK roads per week and 6 are killed.¹³

4,364 UK cyclists were killed or seriously injured in 2021 in reported road accidents, and another 11,994 were slightly injured.¹⁴ Research has shown that bicycle helmet use is associated with reduced odds of head injury, serious head injury, facial injury and fatal head injury.¹⁵ The reduction is greater for serious or fatal head injury. Further is available on the RoSPA website; safety tips for cyclists are also available .

Sports, water and leisure safety

The RoSPA website has information on safety in different sports, activities, environmental hazards and holiday leisure pursuits.

Safety in the workplace

Information and 'safety packs' for employers are available from the Health and Safety Executive.¹⁶ Workplace safety is important. In the UK, there are 600,000 workplace injuries annually and 1.2 million cases of ill health caused or exacerbated by work. Small businesses (employing <50 people) have a rate of serious accidents almost double that of large companies .