Injury Prevention Flashcards
Which of the following statement is true?
a) drowning is the leading cause of non intentional injury and death in age 1-4 year olds Canada
b) no evidence that swimming lessons lead to long term improvement in swimming skills and deck behaviour
c) significant evidence that swimming lessons prevent drowning in age 2-4 age group
d) children can master water skills by 3 years of age
e) personal flotation devices do not need to be used routinely
b) is true
rest false
a) second most, in this group more than 1/5 of deaths in this age group. drownings in this group occur mostly around the home.
c) no evidence that it prevents drowning in this age group.
d) earliest is age 4 for mastery of water confidence and basic locomotive skills, regardless of when the lessons started, front crawl by age 5.5, few studies have looked at effectiveness of swimming lessons in infants only a few months of age.
e) PFDs should be used by all young children and those who cannot swim, not a substitute for supervision
no young child (especially preschool) should ever be considered water wave.
Which of the following is a requirement of a safe home pool?
a) 4 sided fence
b) self latching gate
c) self closing gate
d) pool alarms
d) pool alarms may give parents a false sense of security
the rest are requirements
height and fencing type, as well as other requirements, should be checked with the municipality.
parents should have CPR training, first aid and an emergency action plan
Which of the following is not an increased risk from swimming?
a) hypothermia
b) otitis externa
c) hypernatremia
d) infections including hepatitis A, gastroenteritis, skin infections
c) in fact water intoxication hyponatremia and seizures,
the rest are true for young children
constant arms length supervision for toddlers and infants near water, infants placed in water need to be held by an adult at all times
Which of the following age groups has the highest restraint use in cars?
a) 4-8 year old
b) 9-14 year olds
c) infants
b) 9-14 year old, 98.9% seatbelt use
4-8 year old - 28% in forward facing seat or booster seat
infants - 63% restrained
when used properly, child seat reduce fatality by 71% and significant injury by 67%
booster seat instead of seatbelt alone reduces chance of injury by 59%
Which of the following statements is true?
a) children are able to be restrained by a seat belt alone by age 6
b) most car seats and booster seats are used correctly
c) demerit points or fines rarely occur for using car seats incorrectly
d) all Canadian provinces and territories have legislation in place requiring the use of child safety seats
d) true
more than 53% of parents believe that kids can be restrained by seat belt alone (no booster seat) by age 6
misuse rates - 44-81% for car seats, 30-50% for booster seats
c) incorrect, can get these fines/demerit points
Which of the following is the most common error regarding infant child seat misuse?
a) incorrect seat for weight/height of the child
b) seat too loose - can move >1 inch in each direction
c) harness straps too loose, more than a finger width between the strap and the baby
d) chest clip not at armpit level
a) is the top error, mostly in the form of premature graduation
the other 3 options are the next 3 most common errors
other common errors:
- not anchoring the tether strap for forward facing seats
- rear facing seat in front of an airbag
- wrong angle of infant seats (should be 45 degrees)
- not using a locking clip on the vehicle seat belt
- routine seat belt/harness straps through an incorrect slot of the infant/child restraint
- using recalled or otherwise unsafe seats (>10 year old, beyond expiry date, previously in an accident)
- failure to restrain a child
Which of the following children can ride in a forward facing car seat?
a) 13 month old who weighs 11 kg and able to walk
b) 1.5 year old who weighs 8.5 kg and able to walk
c) 11 month old who weight 11 kg and able to walk
d) 1 year old who weights 10 kg and not yet able to walk
a) can ride in a rear facing car seat
criteria - at least 10 kg, age 1, and can walk
if doesn’t meet one of these criteria, need to continue using rear facing
should continue using rear facing as long as the height/weight limits on the seat allow it, they are safe, encourage parents to continue using rear facing as long as the equipment allows
after graduation from the infant seat (rear facing), move to infant/child seat
Which of the following is not an appropriate way to secure a rear facing infant seat?
a) UAS system
b) LATCH system
c) tether strap
d) seat belt
c)
the other 3 are appropriate, tether strap is for booster seats onwards
UAS (vehicles after Sept 1 2002) and LATCH system are the same thing
prems/small infants should not use any restraints with abdominal pads, shields, arm rests, since could cause injury, for prems, need to find car seat that works for kids <5 lbsAAP statement/special guidelines for this
Which of the following is false?
a) a forward facing car seat can be used until 30 kg (65 pounds) with a tether strap
b) the use of child restraint systems falls under national jurisdiction
c) the maximum height of forward facing car seats is 48 inches (122 cm) depending on the manufacturer
d) forward facing car seats should be secured by tether strap, as well as UAS or seatbelt
b) provincial jurisdiction
the rest are true
the new laws allow child restraint systems with harness and tether strap that accommodates until 30 kg (65 pounds) and therefore increases the capacity of these restraint systems
tether strap limits forward yea emotion in a sudden stop/crash
integrated car seats may be an option for forward facing riders >9 kg
Which of the following is correct regarding who can use a booster seat?
a) at least 4 feet 9 inches and 36 kg
b) at least 10 kg and 30 inches
c) at least 4 years old
d) at least 18 kg - 36 kg
d)
and who have passed the requirements of their infant seats
always check since the requirements vary considerably for different models
**see the chart of different seats as there is considerable overlap
Which of the following is not a criteria for seatbelt use?
a) at least 8 years old
b) at least 36 kg (80 pounds)
c) at least age 6
d) at least 145 cm (4 feet 9 inches)
C) is the answer
more than age or any of the other criteria, the fit of the child in the adult seat belt (based on proportions, etc) must be looked at before graduating from booster seat to seat belt
Please match the car/ booster seat with the name for it (look at figure 2 in statement)
a) high back booster
b) low back/backless booster
c) infant/child/booster seat
d) infant seat
high back - provides head and neck restraint
low back/backless - can be used when the car has adjustable head/neck support, must have shoulder/lap belt and adjustable head/neck support
abdominal shield booster no longer available in Canada
Which province was the first to implement booster seat legislation?
a) Ontario
b) British Columbia
c) Quebec
d) Nova Scotia
c) Quebec was the first in 2002, after that Ontario, BC, Nova Scotia, Newfoundland, PEI, New Brunswick passed laws recently, the rest of the provinces do not have specific laws or laws which are pending
between 1997-2001, death in children < 8 year old very common, include internal injuries and spinal cord injuries from ill fitting seat belt
Ontario - no sales tax for seats
aftermarket products not approved, need to have booster seat for proper securing, may increase lap belt syndrome, not approved
Which of the following statements is false?
a) rear seat positioning decreases risk of death by 36% independent of restraint use
b) the rear middle seat is the safest position in a vehicle
c) rear seating reduces the chance of fatal/severe injury 1.7 x
d) children should be seated in the rear of the vehicle until age 11
d) false, age 13
the rest are true
the exception is for extended pick up trucks, safer in the front (but remember that car seat should never be in front of airbag), only exemption where rear centre is safest
booster seat, shoulder portion not in contact with neck, should keep shoulder belt over middle of clavicle and chest, and lap belt over pelvic bone/below abdomen, bend knees over edge of vehicle while sitting straight (so that they don’t slouch to get comfy)
At what age to the majority of choking and suffocation related deaths occur?
a) 9-11 months
b) <6 year olds
a) is the answer
greatest chance of death 9-11 months
greatest hospitalizations < 3 year old
increased hospitalization until 6 years of age
age<3 greatest chance of choking
choking and suffocation is 40% of unintentional injuries in Canadian children
death occur in the home environment in 85% of cases, more risk if older siblings present
Which group of children was most at risk of strangulation in one study?
a) infants
b) >1 year old
c) school age children
d) teenagers
b) >1 year old were at greatest risk of injury from strangulation, infants at risk for other injury types
in this study (Australia) of children 0-14
38% - strangulation
31% - head and neck entrapment
19% - FB
12% - facial occlusion
non fatal injures were majority for aspiration, food and non food equal for hospitalization, food and coins for ED visits
Which non food item is related to the most choking deaths?
a) buttons
b) coins
c) balloons
d) examination gloves
c) balloons
non-food item related to the most choking deaths
food is related to significant number of choking deaths, especially when < 4 cm that are round and smooth (hot dogs, grapes, carrot slices, peanuts, seeds and hard candy)
latex balloons - 29% of non food choking deaths in USA between 1972 and 1992
coins are leading non food product in foreign body ingestion, but doesn’t usually lead to death, usually go to hospital to have it removed
anything that can pass through an empty toilet paper roll is a choking hazard
Which of the following is a not a risk for strangulation/suffocation or choking?
a) plastic bags
b) apples
c) grapes
d) 6 inch pull cord
d) risk if over 8 inch (20 cm)
the rest are risk, see table for details
entrapment risk is spaces between 9-22.9cm between rails
Which of the following foods does not need to be avoided for children < 4 years of age?
a) kabobs
b) sunflower seeds
c) grated carrots
d) fish with bones
c) is okay
avoid - candy, chewable vitamins, peanuts, sunflower seeds, fish with bones, snacks on toothpicks or skewers
special preparation - grapes slice lengthwise, hot dogs - slice length wise, raw carrots/apples - grate/chop
small parts standards identify toys that are choking risks, although can still choke on objects that pass these tests . 3.17 cm x 2.54-5.71cm (approx toilet paper roll)
Which of the following is the most common mechanism of unintentional suffocation in infants?
a) wedging
b) facial occlusion
c) overlying
d) hanging
a) most common infants suffocate in te sleeping environment -wedging 40% -facial occlusion - 24$ -overlying 8% -entrapment with suspension 7% -hanging 5%
older kids - hanging
toys that are hemispherical are very dangerous.
Which of the following is not true of strangulation hazards?
a) blinds sold since 1995 don’t have outer cord that forms a loop
b) blinds sold since 2000 have been redesigned so inner cord cannot form a loop
c) companies are legally required to follow guidelines regarding drawstrings on children’s clothing
d) pull cords >8 inch (20 cm) are the greatest risk
c) false
CPSC published guidelines in 1996 for drawstring and closures on children’s outerwear, incorporated into a VOLUNTARY, american society for testing and materials (standard) but variable compliance, no regulated in Canada
window blind cords and drawstrings on children’s clothing are prominent causes of strangulation
parents need to cut cord short and anchor the remaining
(pull cords longer than 8 inch (20 cm) or any dangling cords
older children - hanging, getting drawstrings caught
CPS recommends amending the Hazardous Products Act to include product that are associated with near misses - i.e. drawstrings, bunk beds, toddler beds, window covering cords
Which of the following is not a regulation in Canada?
a) bags that have an opening of 14 inches or larger must have a warning and not be made of flexible film
b) any toy box large enough for a child to enter must have openings on 2 adjacent sides
c) any toy used on
d) false, 9kg for 5 minutes
warnings needed for toys on crib/playpen
federal regulations have lead to decrease in deaths from choking, suffocation, might also be related to increase in supervision etc.
provincial - daycare should implement safety guidelines to prevent strangling choking suffocating
local - should implement standards for playground equipment (which are now voluntary)
Which of the following is false?
a) consumers are more likely to avoid buying a toy when a specific hazard (i.e. choking) is on the label, rather than a recommended age of use
b) a Canadian multi centre trial showed long term adoption of home safety behaviours after home visits implemented
c) parental education by physicians can improve safety practices, especially when combined with strategies to change behaviour
d) general childproofing education doesn’t seem to be as effective as physician parental education
b) false
this trial showed that RCT of home visit, coupons and counselling showed decrease injury visits, but didn’t result in long term adoption of safety measures
the rest true
c) shown to improve MV restraint use, hot water temperature regulation in faucets, instal smoke alarms
d) although individual studies have shown benefit
CPS recommends that manufacturers use iso Guide 50 which summarizes risks associated with different products
Which of the following is not an appropriate safety measure?
a) keeping a bicycle helmet on when playing on playground equipment
b) switching to a teething ring if baby starts chewing on pacifier
c) t be on top bunk of bunk bed
d) remove crib toys when baby is 4 months old
e) tie plastic bags in a knot and remove out of sight
a) false, remove it, risk of getting caught on equipment
the rest are true
see table for details
bunk beds should meet safety standards - ASTM and 16 CFR
children 4 cm
toy box with air holes and light weight lid with supporting hinges
crib - 1986, and permanent label with the manufacturer’s name, the model number or name, date of manufacture, instructions for assembly, and a warning statement about mattress size and proper crib use, are not safe to use.
Systematic reviews have shown all but the following?
a) helmets reduce head injuries in cyclers
b) legislation increases helmet use
c) helmet legislation reduces head injuries in cyclers some recent studies have not found this
d) helmet use leads to increase risk taking
d) very conflicted evidence about whether using helmets increase the amount of risk taken
the rest are true
helmets and head injuries
- Cochrane review - helmets reduce head injuries by 69%, severe brain injuries by 74% and facial injuries by 65%, similar across age groups
-another study - reduce head injuries by 60%, brain injury by 58%, facial injuries by 65%, fatal injuries by 75%, did show increase in neck injuries (but might not apply to lower weight helmets used today), applied to all age groups and different collisions, attenuated when this study reviewed in 2011
helmet legislation
- helmet use increases post legislation - >1/2 of studies showed increase of 30%
-helmet use quadrupled with legislation, same in areas where t show reduction in risk not known if people with head injuries wore helmet, weaker studies
risk compensation - conflicting evidence if bicyclists wearing helmets take /allowed to take more risks
Which of the following is false?
a) there is mixed evidence of reduction in bicycling after implementation of helmet laws
b) bicycle helmet legislation can increase helmet use even without significant enforcement, at least for a few years
c) all Canadian provinces have legislation regarding helmet use
d) Canada-wide legislation for all ages is the best way to legislate helmet use
c) false , varies per province
perfect legislation - all cyclists must wear helmets, with fines for non compliance, parents are responsible for ensuring their child wears a helmet
good - province has legislation that all cyclists
Please order the following provinces in terms of best helmet legislation to worst:
a) Ontario
b) Newfoundland and Labrador
c) Quebec
d) Nova Scotia
d) excellent, all ages
a) good, only < 18
c) no laws, some education programs (poor)
b) no laws poor
Excellent: BC, Nova Scotia, PEI, New Brunswick
Good: (<18 year old) Ontario, Manitoba, Alberta
Poor: Quebec, Yukon, NWT, Nunavut, Newfoundland and LAbrador
should use social marketing to raise awareness of bicycle helmet efficacy, accessibility and importance, sales exceptions and federal tax credits should be adopted
Which of the following sports was related to the most emergency department visits related to snow and ice activities?
a) skiing
b) hockey
c) snowboarding
d) snowmobiling
b) hockey leading, snowboarding and skiing are 2nd and 3rd
however more hospitalizations from skiing(12.6%) and snowboarding (11.3%) than hockey (3.6%)
snowboarding responsible for 25% of nonfatal outdoor recreational injuries needing emergency care
snowboarding injuries are leading cause of hospitalization in winter (18%) and spring (10%) in Ontario, skiing/snowboarding are second
Which of the following is false?
a) skiing is more risky than snowboarding
b) most skiing injuries happen in age 7-17 year olds
c) the risk of TBI and spinal injury in skiing is increasing worldwide
d) lower extremity injuries in skiing is the most common injury
a) opposite, snowboarding is riskier
the rest are true
2-4 injury / 1000 participant days in skiing and snowboarding
more serious injuries these days
deaths 0.5-1.9/1000 participant days head injuries cause most deaths, skiing you collide, snowboarding, falls
alpine skiing - most common injury location is lower extremity (40-60%), more common in younger children
upper extremity (15-25%)
head and neck (10-20%)
thumb (10-20%)
snowboarding:
- upper extremity injuries (50%), wrist (22%)
head injuries more common than in skiers, 10% of ER visits and up to 30-40% of trauma admissions
Which of the following is not a risk factor for ski/snowboarding injury?
a) youth
b) female sex
c) beginner skier
d) rented equipment
b) male sex is a risk factor
youth - higher risk of ski and snowboarding injuries, including lower extremity, head and neck, and severe (predominantly head) injuries; majority of injured snowboarders are male (70-80%), males also more risk of severe injury
skill level - 40-50% of injures in young skiers in beginners, often on first day; experts lower risk of injury but higher risk of severe injury
equipment - <13 year old, more chance of being injured with rented equipment , lack of quality control
Which of the following regarding ski equipment is false?
a) improvement in bindings over past several decades has lead to decreased injuries including foot, ankle and lower tibial injuries
b) a professional should adjust children’s binding at the beginning of a lesson
c) studies have shown that youth with poorly adjusted bindings have higher chance of injury
d) changes in equipment have reduced the occurrence of knee sprains and upper extremity injury in skiing
d) false - knee sprains and upper extremity injuries remain common, overall lower extremity equipment related (LEER) injuries have declined with equipment changes
LEER injuries - 40% - most common are knee sprains
youth at risk of LEER injuries - skeletal immaturity, boot design, don’t activate self release technology as well
one adult study - 96% of LEER injuries bindings did not release
the rest are true
grooming of the ski hill - lowest risk of snowboarding injury on deep snow, as grooming hours decreased increased injury rates, more severe injuries/head injuries on runs designed for snowboarding
Which of the following is not supported by research studies?
a) helmets decrease head injuries in skiing
b) skiers are more likely to wear helmets than snowboarders, with increase in younger and older skiers, and more experienced participants
c) helmets increase spinal injuries in skiing/snowboarding
d) helmets don’t lead to riskier behaviour in skiing/snowboarding
c) false - not supported by multiple studies
the rest true
decrease head injuries, most in t support increased risk of cervical spine injury, no evidence that riskier behaviour
so far limited studies about ways to increase helmet use, and no legislation in N.A as of yet.
Which of the following has not been shown to reduce skiing/snowboarding injuries?
a) wrist guards
b) presenting a safety video on buses
c) falls training
c) falls training - inconsistent evidence, one study showed more injuries after falls training (LEER injuries),
wrist guards - snowboarding, mostly wrist injuries, recent systematic review showed that it decreased wrist injuries, low use of wrist guards, some people say it might increase upper arm, elbow, shoulder injury but evidence is conflicted.
presenting an alpine skiing instruction and safety video on buses resulted in fewer injuries (16 vs 23%)
video on ACL injuries reduced them by 62%
Which of the following is false?
a) grass protects against playground injury suffered by falls
b) 5-9 year olds have the highest risk of injury on playground equipment
c) most common cause of playground injury is falls
d) most common playground injury is upper extremity fractures
a)false - sand or pea gravel (impact absorbing) offer better protection than grass for playground injuries, one study showed that it reduces risk of injury 1.7x. fall height (>4 ft 11 inches) 4x the risk of injury
the rest
causes
- falling (75%), impact with obstacle (11%), body part being crushed, pinched or cut (8%), entrapment (1%)
-falls from climbing structure most common (vs from swing/slide)
-head injuries 15% of ER injuries, more likely from swing fall
-fractures is most common injury and also most common cause of hospitalization, head injury 2nd cause of hospitalization
-hospitalizzation rates declined by 27% between 1994-2003 (likely from better safety standards)
- home playground equipment - 20% of injuries, children 1-4 more likely to get injured at home, deaths rare, usually from strangulation
Which of the following about the Canadian Safety Standards is false?
a) requires loose fill around and under play structures to depth of at least 15 cm for preschool equipment and 30 cm for full sized equipment
b) playgrounds legally required to follow them
c) reduce risk of falling with protective guardrails and vertical bars
d) playgrounds modified to meet the CSA standard reduces injuries by as much as 49%
b) not legally required, voluntary standards
loose fill includes - coarse sand or pea gravel, wood chips, synthetic surfaces
the rest true
vertical bars discourage climbing
peaked/curved surfaces for guardrails
active supervision important - kids less likely to take risks when parent is nearby
decrease strangulation - neck warmer (no scarf), no drawstrings
HCP should report playground injuries to playground operators
Which of the following is true for snowmobiling in Canada?
a) near drowning events from falling through the ice are common in youth
b) associated with the highest rate of injury of all winter sports
c) there has been a significant decline in snowmobile injuries in the last 10 years
d) girls are more likely than boys to be victims
b) is true
- head injuries and injuries from being towed on snowmobile are the most significant, often after running into things
the rest are false
c) false - no decline in injury in the last 10 years
in US study 10% in younger than 15 and 25% 15-24 year old, young people very likely to be injured
d) false - boys are more likely to be victims
a) false - not common in youth, more likely in older people, frostbite is infrequent hazard
in CHIRPP data: some kids also while being towed, mechanism of injury from running into things or flipping over , children
Which of the following provinces does not have a minimum age for snowmobiling?
a) British Columbia
b) Alberta
c) Newfoundland and Labrador
d) Yukon
a) B.C. is the answer, no minimum age, need license to cross the highway
the others:
Alberta - private property no age restriction, public, need to be with adult
Saskatchewan - 12-15 year old need to do safety course, be with someone with driver’s license, ; > 16 year old safety course
Manitoba - <14 need adult supervision, remote exception
Ontario -
etc etc - read the table in the statement
all provinces say that snowmobiles need to be registered
Which province requires the use of helmets?
a) British Columbia
b) Alberta
c) Newfoundland
d) Ontario
d) Ontario, the other 3 are the only provinces that don’t require helmet use
other rules
all provinces need head lights, tail lights and stop lamps, most need mufflers, a few need breaks, only Ontario needs a mirror, only 3 provinces have drug and alcohol limits, PEI is the only one with rules about snowmobiling on private property
Which of the following is not consistent with CPS recommendations about snowmobiling?
a) should not snowmobile
c) SHOULD consider graduated licensing, but no evidence for snowmobile accidents, more an extrapolation from MVC accidents
helmets should be approved by Snell,
shouldn’t tow people, if necessary should attach sled or cutter attached by rigid bar to reduce risk of injury
Which of the following statements is false?
a) child death reviews don’t identify specific children but rather identify common themes that lead to death
b) in Canada, death investigation is chartered by the Canadian federal courts
c) unintentional injuries are the leading cause of death of children in Canada
d) Canada doesn’t have a formalized child death review process
e) For children in care or receiving services from a child welfare agency, all death and serious injuries must be investigated
b) false - Provincial courts and the Canadian criminal law
america has standardized child death review
canada doesn’t have that yet
typical case review process includes the relevant history, discussion of the death or injury investigation, and an examination of services and systems involved before death. Consideration is then given to: 1) identifying potentially modifiable risk factors, both specific to the case and systemic; and 2) reviewing agency policies and practices to prevent the occurrence of similar events in future.
goals are to help with prevention, identify problems, advocate for children etc.
provincial death review include safe sleep advocacy, youth suicide prevention initiatives and the safer operation of motor vehicles
Which of the followingCanadian Provinces does not have a formal child death review processes?
a) Ontario
b) British Columbia
c) Manitoba
d) Newfoundland
e) Alberta
d) Newfoundland
the other provinces do
Ontario and BC - chief coroner report
Alberta all death<18 year old evaluated by committee chaired by medical examiner
Manitoba - Children’s Inquest Review Committee and the Child Health Standards Committee under the provincial College of Physicians and Surgeons.
CDR has lead to safe sleep recommendations, etc some others
things incorporated into the CDR should include:
- broad representation, structured process, linkable databases, evaluative mechanism, financial support from all levels of government
Ideally, review processes should be developed with provincial/territorial chief coroners or medical examiners.
What is the leading cause of injury related deaths in <1 year olds in Canada?
a) falls
b) MVC
c) drowning
d) threat to breathing
d)in <44 years old
