As a trauma centre, we at the Montreal Children's Hospital are continually faced with the challenge of finding an effective way of conveying the message of balancing activity and fun with safety. According to the World Health Organization, prevention strategies should be developed through a combination of education, environmental measures and, in some cases, enforcement. Endless legislation is not always the most well-received and effective strategy.
Likewise, the message of preventing injuries should also not lead to a generation of overweight couch potatoes.
Therefore, our message is: "Be active and play, but be informed and play safely." The objective is to make kids, teens, parents, coaches, teachers, municipalities etc. aware of the potential hazards, make them familiar with the recommendations, and encourage smart choices.
There is nothing more tragic than standing at the bedside of a permanently injured or dying child following a preventable traumatic injury, with a family laden with guilt telling you they never thought of or realized the potential risks. The devastating effects of traumatic injuries have an impact on the entire family. As experts in trauma care, we see first-hand the results of lack of knowledge, poor judgment, limited allocation of governmental resources and, of course, immature attitudes of invincibility.
It is discouraging when I hear people express the sentiment that children are not allowed to take sufficient risks in their developing years and that their environment is being made too safe. If you look up the term "accident" in the dictionary, you will find that it implies "an act of fate." In reality, most traumatic injuries are not "accidents" — at least 90 per cent of them are preventable. Frankly, it seems irresponsible to conveniently ignore the fact that trauma is the leading cause of death and disability in children and teens.
Many skeptics only realize the importance of using a seatbelt, wearing a sport-appropriate helmet, not buying a backyard trampoline, upholding a baby walker ban, or installing a fence with a locked gate around a home pool after experiencing a close call. Unfortunately, when it comes to trauma, not everyone gets a second chance to make a smarter choice.
As a trauma centre, our reality includes seeing:
-- A toddler badly burned while in a baby walker on wheels;
-- A 5-year-old with a severe brain injury as the result of falling from a bunk bed;
-- The faces of most participants in a car-seat verification clinic who find out the car seats are installed incorrectly;
-- A teen sustaining a spine fracture and coming within two millimetres of being a paraplegic while using a backyard trampoline;
-- A baby dying in a car crash because he was in his mother's arms, not in a car seat;
-- Kids out tobogganing ending up with life-threatening brain injuries or leg fractures or abdominal trauma after colliding with an obstacle in an area that should not have been designated for this activity;
-- A 10-year-old boy sustaining a serious eye injury while playing paintball at a friend's birthday party.
I could go on. The point is, all of the injuries we see on a regular basis could have been prevented. It should not take hundreds and, in some cases, thousands of cases to identify the risks involved. It is important to find intelligent ways to address the problem while still ensuring that kids are not denied a healthy, active childhood.
Not all serious trauma, of course, results in death. With the excellent care available today, many of those injured are left with lifelong disabilities, and require costly long-term interventions. Let's face it: The Department of Public Health does not wait for 1,000 cases of meningitis before developing a vaccination program. It is time for preventable traumatic injuries to be treated seriously and not be simply dismissed as unfortunate "accidents." Awareness, education, environmental changes, resources and — yes, in some cases — even legislation are important.
Debbie Friedman is director of Trauma Care and Injury Prevention Programs at the Montreal Children's Hospital of the McGill University Health Centre.
