Prevention - SpeedyLook encyclopedia

Prevention of the accidents

Accident, factors and sensitizing

A Accident is always the meeting of several factors, of which at least a negligence and a chance. Indeed, if there is no Négligence or of chance, it is then about a Crime, in the broad sense of the term: a deliberately harmful action, Ill will, Sabotage… When there are not negligence but only one chance, one speaks about Calamité.

The prevention thus consists in initially trying to envisage the factors being able to lead to the accident. When an accident occurs, it is necessary to analyze these factors (Arbre of the causes) in order to prevent that a similar accident does not reproduce (Capitalisation of the experiment).

One of the principal means of preventing the accidents consists in informing the people subjected to the risk. Indeed, since there is always at least a negligence, it is necessary to try to influence the behaviors in order to reduce this factor. The first stage of information is in general sensitizing: to render comprehensible with the people which is the risk and why it is necessary to change (or to control) its behavior.

Accident, danger and risk

Definitions

; Accident

the Accident can be defined like a sudden event having for consequence of the damage on the people, the material or the environment.

; Danger

the accident being the consequence of several factors, if only one factor is removed, one can avoid the accident, but this one remains always probable: one is in situation of Danger. One could define a danger as a situation in which it misses one factor so that there is an accident.

For example, so that there is an gas explosion, one needs an explosive mixture and an energy source (spark, flame…). If one is in the presence of an explosive mixture which did not explode yet, there is no yet accident, but there is a danger.

; Risk

the Risque could be defined like an action being able to lead to a danger, i.e. the action is a factor which can lead to the accident, while carrying out the action, one approaches the accident; but one is not sure that will lead to the accident: the behavior at the risk leads only seldom to an accident, one thus has frequently the impression that this behavior is inoffensive.

Example of a person who crosses a way of Railroad apart from a right of way. There is danger only if one train approaches; even in this case, there is not necessarily accident , the person being able to succeed in crossing accuracy or to have the reflex to throw itself behind. If there is no train with the approach, there is no danger , but there is a risk all the same, because the train running quickly and sees it being visible only on a few hundred meters, one cannot know if there is danger.

Example of an traffic accident. There is a two-track simple road in coast and a car doubling another car while assembling the coast. If car circulates in opposite direction, one has danger which is not seen (since this car is hidden by the top of the slope), danger which can be transformed into accident (frontal shock), but which can be also solved without damage (for example the car doubling succeeds in being folded back thanks to the brake application of the doubled car and the car coming from face). If no car comes opposite, there is then no danger, but the doubling driver does not have any means of knowing it, it takes a risk.

The risk is thus a potential danger which itself is a potential accident ; so the risk is often not perceived like such, but it can indeed lead to the accident. It is there that is all the difficulty of sensitizing…

Analyzes benefit/risk and forced protection/

The human behaviors make following a decision making (if one excludes the Réflexe S). This decision making rests in general on an analysis cost/profit (in the broad direction and not financier), or rather cost estimated / profit awaited , the cost estimated and the profit awaited being more or less far away from the cost and profit realities.

If a behavior at the risk is considered, the person decides to take the risk because in its opinion the benefit (profit) is worth the incurred risk (the cost being here probability and the gravity of the possible accident). If the behavior is at the risk, it is precisely that the estimate made by the person is false , it is not a question of a rational analysis but of a priori , generally accepted ideas, impressions.

Exemple of a driver which with the impression that while accelerating beyond the speed limit, it will arrive earlier at its destination all while not increasing the accident risk. The estimate of the profit (of time) and the cost (accident risk) are both distorted.

In the same way, the respect of a security measure is a constraint (a cost) which provides a protection (profit). If a person does not respect a security instruction, it is that in its opinion, protection brought does not justify the constraint.

Exemple of the cyclist who with the impression which the port of the helmet is constraining (heat) and is not necessary (speed weak is compared with the motor cycles). There still, the estimate of the profit (protection against the cranial traumatisms) and of the cost (presumedly uncomfortable helmet) are distorted.

To lead people to respect safety regulations, one thus can:

to reduce the cost of the safety measure
to decrease the constraint, for example by supporting the acquisition of the safety device financially, by studying a more comfortable device (Ergonomics);
to increase the perceived benefit of the safety measure
for example by developing the responsible attitude (considers to self), by accompanying acquisition by a “gift” (for example reduction in the premium of insurance);
to increase the cost and to decrease the profit of the imprudent attitude
to sanction the failures with the obligations of prudence (for example amends and withdrawal of points on the license in the event of going beyond of the speed limits or lapse of memory of the port of the helmet, malus on the premium of insurance in the event of responsibility in a disaster); to make the products harmful less available or more expensive (for example raising of prices of the cigarettes, removal of the distributers of delicacies in the schools);
to support the reflection on the analysis cost/profit
to sensitize, to educate in order to show the errors of analysis, and that the imposed proposed measure/is justified.

Estimate of the risk

The estimate of the risk is thus distorted by the generally accepted ideas. This shift between the estimate and reality can have several factors, in particular:

the gravity of an accident, the horror of a situation, will increase the real importance of the risk; for example, the air crashes are particularly mortals and the situations all the more shocking when it acts tourists (one identifies easily with the victims), however, the risk is weak (the number of died in the world is ten times lower than the number of died on the road in France);
the resonance of the Media : for example, one can test an impression of insecurity when the media report Homicide S, whereas those represent in France only approximately 400 dead per annum (0,7 deaths for 100 000 inhabitants against 17,5 for the suicides and 12,9 for the road accidents).

In addition, the estimated risk is compared with the “acceptable Risque”: being obvious that the “Risque zero” does not exist on the one hand, and on the other hand that a benefit can be acquired only while running a risk, each person implicitly evaluates an acceptable risk, which is the danger that it agrees to run, the accident that it finds normal to undergo, for example like sanction of failure or fate. This concept of acceptable risk comprises social dimensions and psychological. For example, for a great number of French citizens, the road accidents are acceptable whereas they cause many deaths and that one can act by an individual behavior; contrary, a flood on which one cannot act and who makes few victims appears unacceptable.

There is thus a double source of irrationality which induces the taking risk: irrationality in the estimate of the risk, and irrationality in the reference (acceptable risk).

To estimate in a more precise way the risks without a priori , it is thus necessary to refer to the statistics. In France, the deaths are mainly due:

Note: the figures come from several sources and can correspond to different years, it thus should be regarded only as orders of magnitude; to refer to the references for more details

This analysis depends of course on the way in which one distributes the causes of death. If one not considers for example pathology leading to the death but the behavior having supported pathology, one sees that

the Obésité causes 178 000 per annum dead (287 for 100 000 hab.),
what would thus make of it the first cause of death;
the cigarette causes 60 000 per annum dead (97 for 100 000 hab.),
of which 25 000 per lung cancer (either 90 % of lung cancers), 15 000 with 40 000 by chronic Bronchitis (obstructive chronic Broncho-pneumonopathy or BPCO);
the Alcoolisme causes approximately 45 000 deaths per annum (73 for 100 000 hab.):
23 000 direct deaths (11 000 cancers of the lips, the mouth, the pharynx and the larynx, 9 000 Cirrhosis S, 2 500 by Alcoolo-dependence), and 22 000 indirect deaths (turbid mental, cardiovascular diseases, accidents…) ; every year, 5 000 with 7 000 babies are born in France with serious malformations because of the alcoholism of the mother.

Prevention of the diseases

The problem is more complex for various reasons:

the causes are less obvious: the relation between Tobacco and cardiovascular diseases could be proven only after many epidemiologic studies including several tens of thousands of people followed during many years.
the effectiveness of the prevention is less, being often only one reduction of the risk and not its abolition (put aside, can be, the Vaccination which sometimes makes it possible to exclude the disease concerned).
the evaluation of the results of the prevention is also more difficult to realize (interventionnelles studies). It is necessary and can reveal surprises sometimes: in the Years 1980, some Drug S anti-asynchronous, given in prevention of the sudden death of the adult (cardiorespiratory Stop), finally involved more death than at a group of untreated patients.
It is sometimes more expensive, at the point to present public health problems: It is known that the plantable Défibrillateur is effective in the prevention of sudden death among certain well targeted patients, but the high costs of this technique obstruct its current diffusion.
information is sometimes skewed by with dimensions financier: the interest of the Alicament S, which profit from a broad publicity, is only however seldom proven.

One distinguishes the primary prevention classically aiming at avoiding the disease at the patient not having never been sick, of the secondary prevention intended to decrease the continuations and the gravity of the affection at a patient having declared the disease or aiming at earlier detecting the disease in the populations presenting a big risk of declaration of the latter. The tertiary prevention , finally, seeks to prevent the complications or the relapses.

The Preventive medicine belongs to the Public health.

Levels of prevention

The World Health Organization (WHO) defines three levels of prevention:

the primary prevention : Together of the acts intended to decrease the incidence of a disease, therefore to reduce the appearance of the new cases. While acting as Amont this prevention prevents the appearance of the Maladie S, it uses education and information near the population.
the secondary prevention : Together of acts intended to decrease the Prevalence of a disease, therefore to reduce its duration of evolution. Intervenes in the tracking of all the diseases and includes/understands the beginning of the treatments of the disease.
the tertiary prevention : Together of the acts intended to decrease the prevalence of the chronic incapacities or the Repetition S in the population, therefore to reduce functional disabilities due to the disease. Acts as Aval of the disease in order to limit or to decrease the consequences of the disease and to avoid the relapses. In this stage of prevention the professionals deal with the rehabilitation of the person and her reintegration professional and social.

It should be noted that another prevention exists:

the quaternary prevention : Consists of the accompaniment of dying, it is the whole of the treatments and palliative care given by the health professionals. Because any person has the right to die with dignity and without suffering.

Hygiene of life

The behavior at the risk solely does not consist in making dangerous actions; when the leading causes of death are considered, it is seen that the daily behavior (the food, the Sédentarité…) can be regarded as the first cause of death.

One can reduce the disease risks cardiovascular and of cancers, a relatively simple way and without danger, by adopting these behavior:

by eating fruit and vegetables, at least 800 G per day (either approximately five portions per day): they contain antioxydants which reduce the cancer risks, they “fill the belly” without excessive contribution of greases and sugars; the the World Health Organization estimates that a sufficient contribution out of fruit and vegetables would make it possible to reduce by 3 million the deaths due to the cardiovascular diseases and cancers. In the nonsmokers, the cancer which has the most important potential of prevention is the Cancer colorectal: it is estimated that the 3/4 of the Cancer of the colon could be avoided by a better hygiene of life.
by preparing oneself its meals: the agro-alimentary industrialists tending to put additives not expensive to increase the weight of their products (salt, greases, sugar), it is thus preferable to prepare oneself its meals starting from fresh produce;
by having a minimal physical-activity equivalent to half an hour of walk per day, or better as a practitioner a sport regularly;
while not smoking and while drinking only moderately;
by avoiding the excessive exposures to the Sun in summer, especially in the young children (risk of development of cancers of the Skin).

Prevention of health

In France, the Cancer S are the first cause of mortality and the infectious illness the third.

This mortality concerns especially the elderly, except for the AIDS; one is thus tempted to think that it is a “normal” phenomenon concerning the people at the end of the lifetime. That would be to forget that the infectious illness was during millenia the first cause of infant mortality as adult - it is besides always the first cause of mortality in the world, primarily in the Pays in the process of development - and than their regression is due certainly to progress of the medical care, but also with the prevention: Hygiene and Vaccination S.D'ailleurs, the young populations of the developed countries having lost these concepts are particularly exposed, like the Without fixed residence.

In addition to a good hygiene of life (food, exercise, to avoid the behaviors at the risk, cf section above) which makes it possible to have a better general health condition (thus to better resist the infections) and to avoid cancers, it is also necessary to insist on:

personal hygiene: to wash, in particular to wash the hands before a meal and after being gone with the toilets, to brush the teeth twice a day;
domestic hygiene: storage of the refuse in dustbins dedicated and collected regularly by the municipal services, worn drainage towards a Septic tank drained regularly or towards the sewer S, arrangement and cleaning of the dwelling, ventilation to avoid interior pollution (Acarina S, material organic volatile) and thus the Allergy S and the respiratory diseases;
the Vaccination S: so certain diseases almost disappeared in France (like the Tétanos, or the Rougeole which continues to cause 900 000 died per annum in the world), it is thanks to vaccinations; the vaccination of the elderly against the Grippe is recommended;
tracking: the early detection of a disease makes it possible to start its treatment earlier and thus to reduce mortality; the weather is recommended to be at least a medical visit per annum; for the sexually transmitted diseases, there exists in France of the center anonymities and free of tracking;
disease prevention: under certain conditions, it is possible to take precondition measures to reduce the risk to contact a disease, for example to use a Préservatif to reduce the risk to contract a Sexually transmitted disease, to take drugs against the Paludisme at the time of a voyage in a country impaludé…

It is also necessary précautionneusement to take the drugs prescribed by a doctor, by systematically reading the accompanying notes, rich in information (side effects, interactions with other drugs, recommendations…) and not to hesitate to question the doctor or the Pharmacist in case of doubt. The effects can not be immediate, and it is necessary to continue the treatment until the end even in the event of improvement and disappearance of the Symptôme S, in particular in the case of the Antibiotique S: the disappearance of the symptoms means the reduction in the number of germ S, but not their disappearance, if one stops the treatment too early, those can Re-develop, and become resistant to antibiotic.

It is also necessary on sale to limit self medication to the only drugs free, after council of the pharmacist and reading of the note; a drug should not be taken again prescribes by the doctor even if the symptoms seem the same ones, for example, a Angine can be viral or Bactérie, the symptoms are similar but the different treatment. In particular, the antibiotics are without effect on the Virus. Also let us note that the medicamentous intoxications cause 600 per annum dead.

The role of the community (the state) is paramount, to organize collective hygiene, the follow-up of health, information and sensitizing.

Prevention of infant mortality in the countries in the process of development

It is estimated that six million children of less than five years dies per annum. According to Bryce and coll, one could easily reduce the Infant mortality in the Pays in the process of development by a preventive program to low cost (estimated at 1,23 USD by child, 4,6 billion USD per annum for the 42 countries concentrating 90% of the cases of infant mortality), including/understanding twelve measurements:

antenatal treatment antipaludéen,
Vaccination anti Tetanus of the pregnant women ,
delivery the antirétroviraux one before the childbirth and programs artificial recharge for the newborns of mothers positive HIV,
improvement of the néonataux care (childbirth by a professional trained, monitoring of the temperature, antibiotics in the event of rupture premature of the membranes or sepsis, corticoid administration so necessary),
incentive with the breast-feeding,
delivery of mosquito nets treated with the Insecticide S,
vaccination against the Haemophilus influenzae of the type B (Hib),
supplementation in Zinc and Vitamine has,
food supplements between 6 and 9 months,
cleansing of water
vaccination against the Rougeole.

This preventive step would be done during 18 contact in the first five years, whereas the curative treatment of these diseases and deficiencies requires on average 35 contacts over this period.

Particular cases

Specialized prevention

Prevention of the accidents of work

In certain countries, the legislation obliges any employer to carry out an analysis of risks; in France, this analysis must be synthesized in a single Document.

The risks are evaluated according to two criteria: probability of the event not desired and revolved of the damage caused of which the accidents which make parties of the most serious damage. It from there thus in order to avoid these accidents for the first and/or will decrease from the responsibility for the employer will take adequate preventive measures and/or protection grièveté of those for the second.

See the article Industrial accident.

Prevention of the domestic accidents

Each year in Metropolitan France, the accidents in the home cause approximately 20 000 dead (either 3,6 % of the deaths), 80 000 died in the European Union and several million died in the world. One also speaks about accident of the everyday life (AcVC).

The leading causes are (the number of deaths indicated is for France in 1999):

falls (10 520 died, of which 95 % are people of more than 65 years)
suffocation (3 543 dead)
intoxication (758 died, 600 by drugs, 158 by other substances and gas)
drowning (547 dead)
fire (460 dead)

See the detailed article Accident in the home.

Prevention of road accidents

In France, the road accidents make approximately 7 000 per annum dead and more 100 000 wounded. In 2001, they represented 61,2 % of the industrial accidents mortals (chance mishaps included/understood), with 836 accidents, according to the data of the National bank of health insurance.

See the detailed article Traffic control.

Prevention of the suicide

In 1999 in France, the Suicide because death of: 12000 people, that is to say more than the traffic accidents.

The prevention is complex and delicate, the situations are not always obvious to detect. Generally, one can say that committing suicide it (that which makes an suicide attempt) is very frequently in a state of depression.

It is thus necessary to take care to support a close relation in difficult situation (separation, loss of a close being, job loss, adolescence, school failure, sentimental failure, loss of autonomy…), i.e. to listen to it without judging it and making psychoanalytical analyzes pseudo , to even stimulate the dialog with a sentence of the type “I do not feel well in this moment”. One can try to stimulate the person to be left and divert oneself in spite of a loss of desire, but to avoid the sentences of the type at all costs “make an effort! ” or “takes a little on you! ”: the person makes already enormous efforts to try to leave itself its depresses. One can finally invite it to consult a general doctor.

When it is felt that the passage to the act is imminent, it is necessary to prevent the helps (112 in the European Union, 15 or 18 in France). See the detailed article Suicide.

Formation with first aid

The formation with first aid is a measurement of forecast (to act after occurred of the accident), but it is also a preventive measure: indeed, a trained person is more conscious of the risks, it pays more attention to the other people, it thus adopts spontaneously a more careful behavior. Sensitizing with the risks is besides one of the explicit goals of these formations.

References

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