Child Injury Prevention

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Haddon's Matrix

Dr. William Haddon, Jr. is widely considered as the father of modern injury epidemiology. Dr Haddon was a physician as well as an engineer who worked in the USA on the design of safer roads in the late 1950's. He combined his skills to develop a framework for analysing injury based on the host (i.e. the person injured), the agent (i.e. what caused the injury e.g. electrical energy) and the environment (i.e. the physical and social context in which the injury occurred). [4]

These aspects are looked at over the time / phases leading up to the injury event, the injury event itself and directly after the event.

Analysing injury in this way helps to develop a three tiered approach to injury prevention which includes behavioural, environmental and policy changes. [12] [13] [14] [15] [16] From this work he developed a tool called Haddon's Matrix, which can be used to assess injury and identify methods of prevention. [14] [15] [16]

Structure

Haddon's Matrix consists of the following four columns and three rows.

Columns

1. The Host refers to the person at risk of injury (eg. child). [4] [12] [14] [16]
2. The Agent of injury is energy (e.g. mechanical, thermal, electrical) that is transmitted to the host through a vehicle (inanimate object) or vector (person or other animal). [4] [12] [14] [16]
3. The Physical Environment includes all the characteristics of the setting in which the injury event takes place (e.g.roadway, building, playground, or sports arena). [4] [12] [14] [16]
4. The Social Environment refers to the social and legal norms and practices in the culture and society at the time (e.g. norms about child discipline, usage of child restraints, alcohol consumption, policies about licensing drivers, sales of firearms. [4] [12] [14] [16]

Rows

1. Pre-injury event phase / Primary prevention
   This is about stopping the injury event from occurring by acting on its causes (e.g. pool fences, divided highways, and good road or house design).
2. Injury event phase / Secondary prevention
   This is when there is an attempt to prevent an injury or reduce the seriousness of an injury when an event actually occurs by designing and implementing protective mechanisms (e.g. wearing mouth guard, a seatbelt or helmet).
3. Post injury event phase / Tertiary prevention (Treatment and Rehabilitation)
   This is where there is an attempt to reduce the seriousness of an injury or disability immediately after an event has occurred by providing adequate care (e.g. the application of immediate medical treatment such as cardio pulmonary resuscitation (CPR) or First Aid with a prompt response time), as well as in the longer term working to stabilise, repair and restore the highest level of physical and mental function possible for the injured person.

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Example of Haddon's Matrix as applied to child injury prevention (child restraints)
Table based on [4] [14]

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