1ST CITY CLINICAL HOSPITAL

Injury to the population is one of the most important problems of public health and healthcare, the relevance of which is determined not only by medical, but also by socio-economic aspects, which are determined by the consequences of injuries, often permanent loss of ability to work and even disability, as well as a high mortality rate from external causes.

Injury is an indicator of primary morbidity, which is characterized by the number of all injuries, including poisoning and some other consequences of external causes, registered in a certain group of the population over a specific period of time. Its highest level is observed in men aged 20-49 years, in women – 30-59 years, and in men it is higher in all age groups.

Damage, or trauma, is usually called the consequence of exposure to an external factor (mechanical, physical, chemical, radioactive, x-ray, electrical, etc.) that disrupts the structure and integrity of tissues and the normal course of physiological processes. Depending on the nature of the injured tissue, skin (bruises, wounds), subcutaneous (ligament ruptures, bone fractures, etc.) and cavitary (bruises, hemorrhages, wounds of the chest, abdomen, joints) injuries are distinguished. Injuries can be single (for example, a fracture of a bone), multiple (several fractures), combined (bone fractures with damage to internal organs) and combined (a bone fracture and, for example, frostbite or burns, etc.). Injuries to tissues and organs can be open, with violation of the integrity of the skin and mucous membranes, and closed without damage to the outer integument.

According to WHO, more than 5 million people die each year worldwide as a result of injuries and other accidents (external causes), which is about 9% of the total number of deaths, and injuries themselves are one of the main causes in the structure of the “global burden of disease” and , accordingly, economic losses. Moreover, it should be noted that more than 70% of mortality from external causes occurs in working age.

Injuries account for about 12% of the total number of diseases, are the third leading cause of death and the leading cause of death in people aged 1-40 years. In countries with a high level of development, for every person who dies from injury, 30 patients are hospitalized in a hospital, and approximately 10 times more people seek medical care at the outpatient level.

Considering the socio-economic importance of the problem of injuries and its role in ensuring the demographic security of the country, measures for its prevention, optimization of specialized medical care with the development of high-tech types of it were included in the State Program “People's Health and Demographic Security of the Republic of Belarus for 2016-2020”.

Over the last 10 years (2007-2016), mortality from external causes decreased by 41% (from 148.0 to 87.4 per 100 thousand population), and in absolute numbers the number of deaths decreased by 6,050 people (from 14,359 to 8,309 ), incl. from drownings - by 59%, suicides - by 23.3%, alcohol poisoning - by 41%, murders - by 40%; as a result of a fatal accident - by 60.4%.

In 2016, injuries, poisonings and other accidents in Belarus took 4th place (7%) in the structure of population mortality after diseases of the circulatory system (55.2%), neoplasms (15%), symptoms and other ill-defined conditions ( 10%).

The structure of mortality from external causes was as follows: suicides (24.6%), alcohol poisoning (17.6%), road traffic injuries (9.3%), accidents associated with fire, flames and smoke (7.5 %), falls (10.1%), other poisonings (4.3%), drownings (5.2%), mechanical strangulation (4.2%), murders (4.8%), etc.

Road traffic injuries are one of the leading causes of direct death from injuries due to road traffic accidents (RTA). According to the World Health Organization, more than a million people die every year in the world, and from 20 to 50 million are injured or become disabled. In the coming years, their growth is predicted, and road traffic injuries will take third place in the structure of the “global burden of disease”, second only to ischemic heart disease and depressive conditions.

Countries that have succeeded in reducing road traffic deaths have achieved this through improved legislation, improved road and vehicle safety, and compliance with traffic rules. Almost half of these global deaths occur among so-called “vulnerable road users” – pedestrians, cyclists and motorcyclists.

Of the victims in road accidents, about 70% require hospital treatment, and the mortality rate is 15-20%, and in 50-55% of cases death occurs at the scene of the accident, in 2.5% of cases - during transportation, in 6% of cases - in emergency departments and in 30-40% of cases - in other hospital departments. The hospital mortality rate of patients injured in road accidents is 4.5 times higher than for other diseases. This is due to the fact that the main injuries in road accidents are bone fractures (30%), multiple and combined injuries (30%), and brain injuries (25%). Of particular note is the high incidence of head injuries - up to 50% in victims.

According to the Ministry of Internal Affairs, from 2007 to 2016, the number of road accidents in Belarus decreased by 51.3% (from 7501 to 3634), during this period the number of deaths decreased by 61.2%, the number of injured - by 50.9%, and the severity of the consequences [ the number of deaths / (number of wounded and dead) x 100] decreased by 19.6% (from 16.3 to 13.1).

The reduction in the number of injured and killed in road accidents in Belarus became possible as a result of intensified interdepartmental cooperation, incl. traffic police departments with road and municipal organizations in matters of maintaining the road network, accident rate analysis with identification of accident concentration areas, monitoring the condition of roads. Medical care for road accident victims is provided by territorial health care organizations; for its prompt provision, certain sections of roads are assigned to organizations. A major role in reducing injuries is played by timely provision of first aid (rescuers, internal affairs officers, flight attendants, flight attendants, persons in high-risk professions).

Based on world experience, it can be noted that in the Republic of Belarus the main problems that can reduce the level of injuries and deaths in road accidents are the following.

Firstly, ensuring road safety: compliance with the rules and increasing penalties for violating them (especially in case of failure to comply with the speed limit and driving while intoxicated). It is known that an increase in speed by an average of 1 km/h increases the risk of traffic accidents accompanied by injuries by 3%, and in case of serious accidents – by 5%. The probability of death in an accident at a speed of 80 km/h is 20 times higher than at a speed of 32 km/h, etc.

Secondly, the ability to provide first aid to all road users, i.e. persons of “first contact”.

As is known, timely stopping of external bleeding by arriving police officers and nearby drivers and other persons can save up to 29.4% of victims. Timely immobilization, even with improvised means, can prevent the development of traumatic shock in 25.0% of victims.

The adoption of a number of regulatory legal acts aimed at improving legislation in the field of road safety was of great importance in reducing road accidents in the Republic of Belarus. By Decree of the President of the Republic of Belarus dated October 13, 2014 No. 483, changes were made to the Traffic Rules: an increase in practical driving training to 50 hours, the mandatory use of child restraints (child car seats), the use of winter tires, the introduction of new markings to organize the movement of cyclists. Changes in administrative legislation have come into force, allowing the perpetrator to be held accountable for a violation on the basis of photo and video recording.

Occupational injuries are injuries sustained by workers at work and are usually caused by non-compliance with labor protection requirements. The causes of work injuries are:

1. Organizational, associated with shortcomings in the organization and maintenance of the workplace, the use of incorrect work methods, insufficient supervision of work and compliance with safety regulations, admission to work of untrained workers; poor organization of the labor process, lack or malfunction of personal protective equipment.
2. Sanitary and hygienic: lack of special clothing and shoes or their defects; improper lighting of workplaces; excessively high or low air temperature in work areas; industrial dust, insufficient ventilation, clutter and pollution of the production area.
3. Personal: illness or fatigue of the worker; insufficient qualifications; unsatisfactory living conditions; alcohol intoxication.

Measures to prevent industrial injuries are reduced to eliminating the immediate or contributing causes:

• mechanization and automation of technological processes, elimination of manual operations and reduction of intersecting cargo flows, manual carrying of products and lifting of goods, etc.;
• the presence of special safe places for storing products and semi-finished products, as well as spare parts and equipment, so as not to clutter up working areas and aisles with them;
• that technological equipment and tools comply with their intended purpose and are in good condition;
• fencing moving and rotating parts of machines and units, as well as places of possible contact with hot surfaces, caustic liquids and other substances;
• grounding of all electrical equipment in workshops and its periodic monitoring;
• fencing areas of open contacts with protective shields or casings;
• periodic monitoring of the condition of lifting and transport equipment and devices under pressure;
• good lighting, maintaining cleanliness and order in the workplace and workshop.

To reduce industrial injuries, it is necessary to strictly observe labor safety rules; workers must be provided with proper personal protective equipment and special clothing. To provide first aid, first aid kits with a set of medications, dressings, splints, etc. must be available. All newly hired employees undergo a medical examination and mandatory instruction on labor protection. Increasing competence and replenishing knowledge in this area and testing it must be constant.

Domestic injuries include accidents that occurred outside of the victim’s work activities - at home, in the yard, at the dacha, etc.

Domestic injuries, as a rule, account for the main share of all injuries. The leading cause of these injuries (about a third of cases) is doing household work: cleaning and repairing premises, cooking, etc. Recently, injuries received at the dacha or in the garden have become increasingly common.

Among household injuries, bruises, wounds, burns, etc. predominate. The hand is most often damaged. About a quarter of household injuries occur due to falls in the yard or apartment, etc.

In general, prevention of household injuries includes:

• improvement of living conditions;
• organizing leisure time and holding various cultural events;
• anti-alcohol propaganda;
• promoting a healthy lifestyle and way of life;
• expansion of public services to the population;
• organization of local commissions to combat domestic injuries;
• wide public involvement.

Less commonly, injuries occur in various domestic conflicts. Alcohol intoxication plays a significant role in their occurrence, especially on holidays and weekends. Domestic injuries in men occur 3-4 times more often than in women, and in people 18-25 years old they occur 4-5 times more often than in people 45-50 years old.

In recent years, we have begun to classify injuries resulting from violence and abuse as a separate type of injury. Moreover, in accordance with current legislation, medical workers are required to report such cases to law enforcement agencies.

Street injuries. One of the important measures to prevent street injuries is the fight against domestic drunkenness, since street injuries are often caused by people intoxicated. Prevention of injuries in pedestrian traffic includes:

• planning and improvement of streets and pavements, proper care of them (using sand during icy conditions, filling potholes, etc.), lighting streets and squares, fencing buildings under construction and repairs;
• organization and regulation of street traffic, strict control over compliance with traffic rules;
• ensuring the proper technical condition of street transport, its safety, for example, the serviceability of automatic doors on buses);
• constant supervision of children and their leisure time;
• conducting educational and explanatory work with the population (print, radio, television, lectures, reports, etc.).

In winter, ice injury is a particular concern . The main rule is to be extremely attentive and careful and to avoid danger you must:

• look carefully at your feet;
• do not step wide, walk slowly;
• step on the entire sole, but not on the toe or foot;
• avoid unimproved streets and avoid slippery places;
• walk where the sidewalks are covered with sand;
• attach a strip of sandpaper or regular adhesive tape to the sole of the shoe;
• use shoes with grooved soles;
• girls should forget about high heels.

When you fall, it is very important to correctly assess your condition. The main signs of a fracture or dislocation: sharp pain, increasing swelling, shortening of the injured limb and the inability to move it normally. A concussion is manifested by loss of consciousness (sometimes literally for a few moments), nausea, and headache.

The victim, at all costs, must attract the attention of passers-by and ask for help. You need to call an ambulance or help get to the nearest emergency room. You can do without the help of a doctor only in case of a slight bruise: just apply something cold to the sore spot, this will reduce swelling and pain, and treat it with ointment or gel that resolves bruises. You can’t heat a sore spot; the effect will be exactly the opposite.

In recent years, special attention has been paid in our country to the prevention of children's domestic injuries. The main types of injuries that children can get at home and their causes are:

• burns from a hot stove, dishes, food, boiling water, steam, iron, electrical appliances and even open fire;
• falling from bed, window, table and steps;
• suffocation from small objects (coins, buttons, nuts, etc.);
• poisoning with household chemicals (insecticides, detergents, bleaches, etc.);
• Electric shock from faulty electrical appliances, exposed wires, or sticking needles, knives, or other metal objects into outlets and wall wiring.

Burns , including steam burns, are the most common injuries in children. Severe burns leave scars and can sometimes be fatal. Burns can be avoided if:

• keep children away from hot stoves, food and irons;
• install the stoves high enough or unscrew the burner handles so that children cannot reach them;
• keep children away from open flames, candle flames, bonfires, and firecracker explosions;
• hide flammable liquids such as gasoline, kerosene, as well as matches, candles, lighters, sparklers, and firecrackers from children.

Falls are a common cause of bruises, broken bones and serious head injuries. They can be prevented by preventing children from playing in dangerous places; install fences on steps, windows and balconies.

Broken glass can cause cuts, blood loss and infection. Glass bottles should be kept away from children and infants. Young children should be taught not to touch broken glass. Knives, blades and scissors must be kept out of the reach of children. Older children should be taught how to handle these objects carefully.

Many injuries can be avoided if you explain to children that throwing stones and other sharp objects, or playing with knives or scissors is very dangerous. Sharp metal objects and rusty cans can become a source of wound infection. Such items should not be on children's playgrounds.

Choking from small objects. Young children should not be given food with small bones or seeds. Children should always be supervised while eating. Feed your baby crushed food. Recently, coins have become one of the common causes of foreign bodies entering the respiratory tract. Small used batteries are very dangerous and can cause serious complications if swallowed.

Coughing, noisy rapid breathing, or an inability to make sounds are signs of breathing problems and possibly suffocation, which can lead to death. You should make sure that everything is fine with the child. If he has difficulty breathing, the possibility of small objects entering the child's respiratory tract cannot be ruled out, even if no one saw the child put anything in his mouth.

Poisoning from household chemicals. Toxic substances, medicines, bleaches, acids and fuels such as kerosene should not be stored in food bottles as children may drink them by mistake. Such substances should be kept in tightly closed, labeled containers out of the reach of children. Poisons for rats and insects, kerosene, acids and alkaline solutions, and other toxic substances can cause severe poisoning, brain damage, blindness and death. The poison is dangerous not only if swallowed, but also if inhaled, gets on the skin, in the eyes and even on clothing.

Medicines intended for adults can be fatal for children. Medicines should be given to a child only as prescribed by a doctor and in no case should you give him medicines intended for adults or children of a different age. Medicines must be stored out of the reach of children. Misuse and overdose of antibiotics can lead to deafness in young children.

Electric shock. Children can be seriously injured by sticking their fingers or objects into electrical outlets; they must be covered to prevent electric shock. Electrical wires should be kept out of the reach of children - exposed wires pose a particular danger to them.

Injuries can and should be prevented. There is ample evidence to suggest that the way forward is through a combination of approaches and specific measures: environmental change, designing and manufacturing safe products, legislation requiring these changes, education.

A successful solution to the problem of reducing injuries and mortality from external causes is possible only through joint actions of government agencies at the interdepartmental level, support of ongoing activities (to promote a healthy and safe lifestyle) by public organizations and, very importantly, the general public.