Haddon's matrix
Background
Dr. William Haddon Jr. is widely considered the father of modern injury epidemiology. Dr. Haddon was a physician as well as an engineer who worked in the United States on the design of safer roads in the late 1950s.
He combined his skills to develop a framework for analysing an injury, based on the:
-
host - the person who has been injured [
16]
-
agent - what has caused the injury [
16]
-
environment - the physical and social context in which the injury occurred [
16].
These aspects are considered during the period leading up to the injury event, the injury event itself and directly after the event.
Analysing an injury in this way may help develop a three-tiered approach to injury prevention, which includes behavioural, environmental and policy changes [20, 43, 44, 45, 46].
From this work, Dr. Haddon developed a tool called Haddon's Matrix, which can be used to assess injury and identify methods of prevention [44, 45, 46].
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Structure
Haddon's Matrix is a table consisting of the following four columns and three rows:
Columns
-
The
host refers to the person at risk of an injury [
16,
43,
44,
46]. For falls prevention, this includes adults aged 65 years and over.
-
The
agent of injury is a type of energy transmitted to the host through a vehicle/ inanimate object / vector [
16,
43,
44,
46]. For falls this may be a pushing crowd or an animal.
-
The
physical environment includes all of the characteristics of the setting in which the injury event takes place [
16,
43,
44,
46]. For falls, this may be a roadway, building, house, bedroom or bathroom.
-
The
social environment refers to the social and legal norms and practices in the culture and society [
16,
43,
44,
46]. For falls, this may be norms about ageing, physical exercise, nutrition and polices or legislation on the built environment.
Rows
-
Pre-injury event phase / primary prevention:
This is about stopping the fall event from occurring by acting on its causes, for example: enhancing an individual's strength and balance or good road/house design.
-
Injury event phase / secondary prevention:
This is when there is an attempt to prevent a fall or reduce the seriousness of a fall when an event actually occurs by designing and implementing protective mechanisms such as wearing a hip protector and installing soft fall surfaces.
-
Post-injury event phase / tertiary prevention (treatment and rehabilitation):
This is where there is an attempt to reduce the seriousness of a fall related injury or disability immediately after a fall has occurred by providing adequate care such as immediate cardio pulmonary resuscitation (CPR) or first aid, effective personal alarms or emergency medical services with a prompt response time. In the long-term, it may involve working to stabilise, repair and restore the highest level of physical and mental function possible for the injured older person.
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Example
Example of of Haddon's Matrix as applied to falls prevention. Table is based on work by McClure, R., Stevenson, M. & McEvoy [20].
| |
Host
|
Vehicle
|
Physical Environment
|
Social Environment
|
| Pre-Fall |
Bone density, flexibility, balance and strength |
Appropriateness of type of shoe (such as slippers) |
Non slip flooring, handrails on all stairs, a number of medications being used |
The 'inevitability' of older people falling over and having 'accidents', discouraging physical activity in older people |
| Event (Fall) |
Human tolerances to crash forces, use of hip protectors |
Proper positioning of the hip protector, quality and durability of the hip protector |
Height of the fall and surface fallen onto, contact with any other objects |
Anti-slip flooring requirements in public spaces, hospitals and residential aged care facilities |
| Post-Fall |
Fall victim's general health status, fractures and other wounds |
Personal alarm systems |
Availability of an effective and timely emergency response |
Public support for trauma care and rehabilitation |
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