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Preventing unintentional injuries among under-15s: police, fire and rescue services – home, off-road cycle and firework safety

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Unintentional injuries among under-15s

About

What is covered

This interactive flowchart covers recommendations on preventing unintentional injuries among children and young people aged under 15 including those who belong to vulnerable groups. In some cases, they may also benefit parents, carers and the wider population.
The recommendations cover:
  • strategy, regulation, enforcement, surveillance and workforce development to prevent such injuries in the home, on the road and in outdoor play and leisure environments
  • home safety assessments and the supply and installation of home safety equipment, either delivered separately or together, plus any supporting education and advice
  • road design and modification to encourage 20 miles per hour (mph) speed limits and other engineering measures to reduce speed generally or make routes safer.
The recommendations are for all those involved in preventing unintentional injuries among under-15s including those working in the public, private, community and voluntary sectors.

Updates

Updates to this interactive flowchart

13 January 2016 Preventing unintentional injury in under 15s (NICE quality standard 107) added.

Unintentional injuries

The term 'unintentional injuries' is used rather than 'accidents' as: 'most injuries and their precipitating events are predictable and preventable'Davis R, Pless B (2001) BMJ bans 'accidents'. Accidents are not unpredictable. BMJ 322: 1320-21.. The term 'accident' implies an unpredictable and, therefore, unavoidable event.

Outdoor play and leisure

Children and young people learn, develop and mature when playing and taking part in activities that challenge them. Their participation in regular physical activity and outdoor play and leisure is important for their growth, development and general health and wellbeing – in both the short and long term. (For example, it can help reduce the risk of obesity and cardiovascular disease.)
The type of hazards encountered during outdoor activities will vary for different age groups and according to where they take place. Likewise, the factors to be considered when addressing and balancing risks and benefits will also differ. For example, where children and young people go off-road cycling will vary, depending on their age and experience: younger children are most likely to cycle in gardens and parks, while older children and young people may get involved in activities such as BMX racing or mountain biking.
This recommendation covers preventive activities at the strategic level. This does not imply that they are the only actions that could be taken to prevent unintentional injuries outdoors and during play and leisure.

Short Text

Everything NICE has said on preventing unintentional injuries among children and young people aged under 15 in an interactive flowchart

What is covered

This interactive flowchart covers recommendations on preventing unintentional injuries among children and young people aged under 15 including those who belong to vulnerable groups. In some cases, they may also benefit parents, carers and the wider population.
The recommendations cover:
  • strategy, regulation, enforcement, surveillance and workforce development to prevent such injuries in the home, on the road and in outdoor play and leisure environments
  • home safety assessments and the supply and installation of home safety equipment, either delivered separately or together, plus any supporting education and advice
  • road design and modification to encourage 20 miles per hour (mph) speed limits and other engineering measures to reduce speed generally or make routes safer.
The recommendations are for all those involved in preventing unintentional injuries among under-15s including those working in the public, private, community and voluntary sectors.

Updates

Updates to this interactive flowchart

13 January 2016 Preventing unintentional injury in under 15s (NICE quality standard 107) added.

Sources

NICE guidance and other sources used to create this interactive flowchart.
Preventing unintentional injury in under 15s (2016) NICE quality standard 107

Quality standards

Preventing unintentional injury in under 15s

These quality statements are taken from the preventing unintentional injury in under 15s. The quality standard defines clinical best practice for preventing unintentional injury in under 15s and should be read in full.

Quality statements

Coordinating action to prevent unintentional injuries

This quality statement is taken from the preventing unintentional injury in under 15s quality standard. The quality standard defines clinical best practice in preventing unintentional injury in under 15s and should be read in full.

Quality statement

Local authority areas have a person responsible for coordinating action to prevent unintentional injuries in children and young people (under 15) in the home.

Rationale

Coordinated action across all relevant local agencies, including the development and delivery of local strategies, can be more effective when supported by a lead person in the local area. Coordinated action can prevent duplication of activity, improve record keeping and information sharing, and achieve better use of resources. In practice, risks identified by staff in one sector may be reduced more effectively by another sector if there is coordinated action.

Quality measures

Structure
a) Evidence that there is a designated person responsible for coordinating action among local authority departments, local NHS organisations and other local agencies to prevent unintentional injuries in children and young people (under 15) in the home.
Data source: Local data collection.
b) Evidence that local authority departments, local NHS organisations and other local agencies work in collaboration with a person responsible for coordinating local action to prevent unintentional injuries in children and young people (under 15) in the home.
Data source: Local data collection.

What the quality statement means for service providers, health, public health and social care practitioners, and commissioners

Service providers (such as local authority public health teams, local children’s safeguarding board, children’s social services and NHS organisations) collaborate with a person responsible for coordinating action across all local agencies to prevent unintentional injuries in children and young people (under 15) in the home. Service providers may also be jointly involved in designating the person responsible for local coordination along with local commissioners.
Health, public health and social care practitioners (such as GPs, health visitors, community nurses and midwives, social workers and health promotion workers) use frameworks and protocols that are led by the person who is responsible for coordinating action in their local area to prevent unintentional injuries in children and young people (under 15) in the home.
Commissioners (such as local authorities and clinical commissioning groups) ensure that they commission services that work in collaboration with a person responsible for coordinating action in their local area to prevent unintentional injuries in children and young people (under 15) in the home. Commissioners may be involved in designating the person responsible for coordinating action jointly with service providers and other local stakeholders.

What the quality statement means for the public

Households with children and young people (under 15) will benefit from locally coordinated action, led by a specially appointed person, to help prevent accidents in the home. This is particularly important for households with children under 5, who are at more risk of accidents in the home.

Source guidance

Definitions of terms used in this quality statement

Home
This term covers the dwelling where children and young people (under 15) live, the garden or yard, communal areas of flats, as well as other family homes where they visit or stay.
[Expert opinion]
Local authority areas
Action to prevent unintentional injuries to children and young people (under 15) is likely to be led by local authorities (including public health, social care and children’s services). In their geographical areas, action should be coordinated with relevant NHS organisations (such as clinical commissioning groups), voluntary sector organisations, fire and rescue services.
Person responsible for coordinating action to prevent unintentional injuries to children and young people
A person with experience and expertise in injury prevention who has responsibility for helping achieve the commitments set out in local plans and strategies. Their responsibilities include:
  • Working with local partnerships that include organisations involved with children and young people, and their parents and carers.
  • Developing a 2- to 3-year injury prevention strategy with local partners that is integrated into all relevant local plans and strategies for children and young people’s health and wellbeing.
  • Networking at a regional and national level with other people responsible for coordinating action to prevent unintentional injuries to children and young people under 15.
  • Raising local awareness about the need for prevention activities. This includes working in line with local safeguarding protocols and acting as a local source of information and advice on prevention.
  • Monitoring progress made on the injury prevention commitments set out in local plans and strategies for children and young people’s health and wellbeing. They should report progress to the director of children’s services and/or the director of public health.
  • Providing and/or coordinating specialist training of anyone undertaking home safety assessments.
The person responsible for coordinating action to prevent unintentional injuries to children and young people does not have to be a full-time post, but may be a role incorporated into the job description of a key worker from a local service.
[Adapted from Unintentional injuries: prevention strategies for under 15s (NICE guideline PH29), recommendation 2]

Identifying households for a structured home safety assessment

This quality statement is taken from the preventing unintentional injury in under 15s quality standard. The quality standard defines clinical best practice in preventing unintentional injury in under 15s and should be read in full.

Quality statement

Households in which children and young people (under 15) are at greater risk of unintentional injury in the home are identified through collaboration between local agencies for a structured home safety assessment.

Rationale

The risk of unintentional injury in children and young people (under 15) is higher in some population groups (for example in lower socioeconomic groups, with parents who are long-term unemployed) than in others. Collaboration between local agencies (including primary, community and emergency healthcare, social services, schools and public health teams) can lead to more effective identification of children and young people who are at risk of unintentional injury in the home. Local awareness of neighbourhoods and population groups with characteristics associated with increased risk can provide important context for the sharing of information about injuries or risks identified for specific children and young people, for example those attending emergency departments.

Quality measures

Structure
a) Evidence of a local strategy to ensure that households in which children and young people (under 15) may be at greater risk of unintentional injury in the home are identified through collaboration between local agencies for a structured home safety assessment.
Data source: Local data collection.
b) Evidence that local authority departments, local NHS organisations and other local agencies collaborate to implement a local strategy to ensure that households in which children and young people (under 15) may be at greater risk of unintentional injury in the home are identified for a structured home safety assessment.
Data source: Local data collection.
c) Evidence that local authority departments, local NHS organisations and other local agencies collaborate to identify households in which children and young people (under 15) may be at greater risk of unintentional injury in the home.
Data source: Local data collection.
d) Evidence that local authority departments, local NHS organisations and other local agencies collaborate to identify neighbourhoods and population groups in which children and young people (under 15) may be at greater risk of unintentional injury in the home.
Data source: Local data collection.
Outcome
Number of households identified in which children and young people (under 15) may be at greater risk of unintentional injury in the home.
Data source: Local data collection.

What the quality statement means for service providers, health, public health and social care practitioners, and commissioners

Local health and wellbeing boards ensure that their local strategies include identifying neighbourhoods, population subgroups and households in which children and young people (under 15) may be at greater risk of unintentional injury in the home for structured home safety assessments.
Service providers (such as local authority public health teams, children’s social services and NHS organisations) collaborate to ensure that households in which children and young people (under 15) may be at greater risk of unintentional injury in the home are identified for structured home safety assessments.
Health, public health and social care practitioners (such as GPs, health visitors, community nurses and midwives, social workers and health promotion workers) contribute to identifying households in which children and young people (under 15) may be at greater risk of unintentional injury in the home for structured home safety assessments.
Commissioners (such as local authorities and clinical commissioning groups) include within the service specifications for commissioned services the need to identify households in which children and young people (under 15) may be at greater risk of unintentional injury in the home for structured home safety assessments.

What the quality statement means for the public

Households with children and young people (under 15) who are at greater risk of having an accident in the home are identified so they can have an assessment of the safety risks in their home. This is particularly important in households with children under 5 because they tend to have more accidents at home.

Source guidance

Definitions of terms used in this quality statement

Home
This term covers the dwelling where children and young people (under 15) live, the garden or yard, communal areas of flats, as well as other family homes where they visit or stay.
[Expert opinion]
Structured home safety assessment
Structured home safety assessments are carried out by trained assessors and usually involve assessing the risk of the most common causes of unintentional injuries to children and young people (including burns, falls, poisoning, drowning, suffocation and choking) in each room.
The assessment should be tailored to meet the household’s specific needs and circumstances, and its purpose should be thoroughly and clearly explained to members of the household. Factors to take into account include (not in a priority order):
  • the developmental age of children and young people
  • whether a child or family member has a disability
  • cultural and religious beliefs
  • whether there is limited understanding of English language
  • levels of literacy in the household
  • the level of control people have over their home environment
  • the household’s perception of, and degree of trust in, authority
  • living in a property where there is a lack of appropriately installed safety equipment
  • living in a property where hazards have been identified through the Housing Health and Safety Rating System
  • the size of the family
  • families living on low income
  • overcrowded conditions
  • the complexity of the family’s needs.
[Adapted from Unintentional injuries in the home: interventions for under 15s (NICE guideline PH30), recommendation 3, and expert opinion]
Households in which children and young people (under 15) may be at greater risk of unintentional injury in the home
Factors to take into account include (not in an order of priority):
  • the developmental age of children and young people
  • whether a child or family member has a disability
  • cultural and religious beliefs
  • whether there is limited understanding of English language
  • levels of literacy in the household
  • the level of control people have over their home environment
  • the household’s perception of, and degree of trust in, authority
  • living in a property where there is a lack of appropriately installed safety equipment
  • living in a property where hazards have been identified through the Housing Health and Safety Rating System
  • the size of the family
  • families living on low income
  • overcrowded conditions
  • the complexity of the family’s needs.
[Adapted from Unintentional injuries in the home: interventions for under 15s (NICE guideline PH30), recommendation 1]
Identified for a structured home safety assessment
Households in which children and young people (under 15) may be at greater risk of unintentional injury can be identified by using local injury and socioeconomic data. Local data may come from surveys, health services (such as A&E and hospital admission records), joint strategic needs assessments and existing datasets (such as emergency service datasets, local socioeconomic profiles and housing records). Some data may be accessed via local profiles maintained by the Child and Maternal Health Observatory, which is now part of Public Health England.
[Adapted from Unintentional injuries in the home: interventions for under 15s (NICE guideline PH30), recommendation 1, and expert opinion]

Structured home safety assessment

This quality statement is taken from the preventing unintentional injury in under 15s quality standard. The quality standard defines clinical best practice in preventing unintentional injury in under 15s and should be read in full.

Quality statement

Households in which children and young people (under 15) have been identified as being at greater risk of unintentional injury in the home have a structured home safety assessment.

Rationale

A structured home safety assessment for households in which children and young people (under 15) have been identified as being at greater risk of unintentional injury in the home can identify specific risks of injuries (including burns, falls, poisoning, drowning, suffocation and choking), leading to action to reduce the risks identified by the assessment.

Quality measures

Structure
Evidence of local arrangements for households in which children and young people (under 15) have been identified as being at greater risk of unintentional injury in the home to have a structured home safety assessment.
Data source: Local data collection.
Process
Proportion of households in which children and young people (under 15) have been identified as being at greater risk of unintentional injury in the home that have a structured home safety assessment.
Numerator – the number in the denominator that have a structured home safety assessment.
Denominator – the number of households in which children and young people (under 15) have been identified as being at greater risk of unintentional injury in the home.
Data source: Local data collection.

What the quality statement means for service providers, health, public health and social care practitioners, and commissioners

Service providers (such as local authority children’s social services and NHS organisations) ensure that systems are in place for households in which children and young people (under 15) have been identified as being at greater risk of unintentional injury in the home to have a structured home safety assessment. This responsibility can be delivered through the work of a person responsible for coordinating action to prevent unintentional injuries in children and young people.
Home safety assessors (employed specifically to undertake this role or as part of a wider role) carry out structured home safety assessments for households in which children and young people (under 15) have been identified as being at greater risk of unintentional injury in the home.
Commissioners (such as local authorities and clinical commissioning groups) ensure that they commission services in which households in which children and young people (under 15) have been identified as being at greater risk of unintentional injury in the home have a structured home safety assessment.

What the quality statement means for the public

Households with children and young people (under 15) who are at greater risk of having an accident in the home have an assessment of the safety risks in their home, which should help to reduce the chance of accidents. This is particularly relevant to children under 5 because they tend to have more accidents at home.

Source guidance

Definitions of terms used in this quality statement

Home
This term covers the dwelling where children and young people (under 15) live, the garden or yard, communal areas of flats, as well as other family homes where they visit or stay.
[Expert opinion]
Structured home safety assessment
Structured home safety assessments are carried out by trained assessors. The assessors may be employed specifically to undertake this role or as part of a wider role. The structured home safety assessment involves assessing the risk of the most common causes of unintentional injuries to children and young people (including burns, falls, poisoning, drowning, suffocation and choking) in each room.
The assessment should be tailored to meet the household’s specific needs and circumstances, and its purpose should be thoroughly and clearly explained to members of the household. Factors to take into account include (not in a priority order):
  • the developmental age of children and young people
  • whether a child or family member has a disability
  • cultural and religious beliefs
  • whether there is limited understanding of English language
  • levels of literacy in the household
  • the level of control people have over their home environment
  • the household’s perception of, and degree of trust in, authority
  • living in a property where there is a lack of appropriately installed safety equipment
  • living in a property where hazards have been identified through the Housing Health and Safety Rating System
  • the size of the family
  • families living on low income
  • overcrowded conditions
  • the complexity of the family’s needs.
[Adapted from Unintentional injuries in the home: interventions for under 15s (NICE guideline PH30), recommendation 3, and expert opinion]

Equality and diversity considerations

The purpose of a structured home safety assessment, and information or advice about the identified risks of unintentional injury to children and young people, should be communicated to members of the household in a way that is easily understood. This may include providing information in a written or verbal form. When information is communicated, services should be aware of the needs of members of households for whom English is not the first language or if those receiving the information have difficulty understanding it for any other reason. For example, assessors should be aware of the needs of a household in which the primary care giver has health or complex needs that may affect their ability to provide adequate supervision to children and young people or fully understand the information provided.

Follow-up actions

This quality statement is taken from the preventing unintentional injury in under 15s quality standard. The quality standard defines clinical best practice in preventing unintentional injury in under 15s and should be read in full.

Quality statement

Households with children and young people (under 15) that have had a structured home safety assessment at which risks have been identified receive tailored advice or support to reduce the risks.

Rationale

The appropriate response to any identified risk will depend on the circumstances of the household, so tailored advice or support is needed to ensure the follow-up actions are effective. The findings of a structured home safety assessment for households with children and young people (under 15) should be reported so that follow-up support can be provided by children’s social services, housing and other appropriate agencies to reduce the risks identified. Awareness of any specific actions carried out at the time of the home safety assessment (such as providing advice for action by members of the household themselves) can prevent duplication of effort.

Quality measures

Structure
Evidence of local arrangements for households with children and young people (under 15) that have had a structured home safety assessment at which risks have been identified to receive tailored advice or support to reduce the risks.
Data source: Local data collection.
Process
a) Proportion of households having a structured home safety assessment of the risk of unintentional injuries to children and young people (under 15) in which risks are identified.
Numerator – the number in the denominator in which risks are identified.
Denominator – the number of households having a structured home safety assessment of the risk of unintentional injuries to children and young people (under 15).
Data source: Local data collection.
b) Proportion of households in which risks of unintentional injuries to children and young people (under 15) are identified by a structured home safety assessment that receive tailored advice to reduce risks identified.
Numerator – the number in the denominator that receive tailored advice to reduce risks identified.
Denominator – the number of households in which risks of unintentional injuries to children and young people (under 15) are identified by a structured home safety assessment.
Data source: Local data collection.
c) Proportion of households in which risks of unintentional injuries to children and young people (under 15) are identified by a structured home safety assessment that receive follow-up support to reduce risks identified.
Numerator – the number in the denominator that receive follow-up support to reduce risks identified.
Denominator – the number of households in which risks of unintentional injuries to children and young people (under 15) are identified by a structured home safety assessment.
Data source: Local data collection.
Outcome
Incidence of unintentional injuries in children and young people (under 15) occurring in the home.
Data source: Local data collection.

What the quality statement means for service providers, health, public health and social care practitioners, and commissioners

Service providers (such as local authority children’s social services and NHS organisations) ensure that systems are in place (in line with local safeguarding protocols) for households with children and young people (under 15) that have had a structured home safety assessment at which risks have been identified to receive tailored advice or support to reduce the risks.
Home safety assessors ensure that when structured home safety assessments identify the risk of unintentional injury to children and young people (under 15) they report the risks to the appropriate local authority department or other local agency (along with any tailored advice or support provided at the time of the assessment) so that further support can be provided to reduce the risks.
Commissioners (such as local authorities and clinical commissioning groups) ensure that they commission services that offer tailored advice or support to households with children and young people (under 15) that have risks of unintentional injuries in the home identified by a structured home safety assessment.

What the quality statement means for the public

Households with children and young people (under 15) are likely to benefit from tailored advice or support offered by local authority departments and social services to help reduce the risk of accidents in the home. This is particularly important for households with children under 5 because they tend to have more accidents at home.

Source guidance

Definitions of terms used in this quality statement

Tailored advice or support
Advice or support arising from a structured home safety assessment can include installing home safety equipment, advice on obtaining and maintaining equipment, advice or education on home safety, or a combination of these.
[Adapted from Unintentional injuries in the home: interventions for under 15s (NICE guidance PH30), recommendations 3 and 4, and Unintentional injuries: prevention strategies for under 15s (NICE guideline PH29), recommendation 9]

Equality and diversity considerations

The purpose of a structured home safety assessment, and information or advice about the identified risks of unintentional injury to children and young people, should be communicated to members of the household in a way that is easily understood. This may include providing information in a written or verbal form. When information is communicated, services should be aware of the needs of members of households for whom English is not the first language or if those receiving the information have difficulty understanding it for any other reason. For example, assessors should be aware of the needs of a household in which the primary care giver has health or complex needs that may affect their ability to provide adequate supervision to children and young people or fully understand the information provided.

Integrating home safety into other visits

This quality statement is taken from the preventing unintentional injury in under 15s quality standard. The quality standard defines clinical best practice in preventing unintentional injury in under 15s and should be read in full.

Quality statement

Households with children and young people (under 15) receive advice on home safety or are referred for a structured home safety assessment by practitioners providing family support on home visits who identify risks of unintentional injury.

Rationale

Practitioners from various local agencies who provide family support on home visits can assess potential risks of unintentional injury to children and young people (under 15) when visiting households for other reasons. Considering risk during all household visits means that immediate advice can be given or further action can be arranged, including a referral for a structured home safety assessment.

Quality measures

Structure
Evidence of local arrangements to ensure that households with children and young people (under 15) receive advice on home safety or are referred for a structured home safety assessment by practitioners providing family support on home visits who identify risks of unintentional injury.
Data source: Local data collection (evidence of local arrangements may be collected from individual local authority departments, NHS organisations or social care providers whose staff undertake family support on home visits).
Process
a) Proportion of households with children and young people (under 15) that receive advice on home safety from practitioners providing family support on home visits who identify risks of unintentional injury.
Numerator – the number in the denominator that receive advice on home safety.
Denominator – the number of households with children and young people (under 15) in which risks of unintentional injury are identified by practitioners providing family support on home visits.
b) Proportion of households with children and young people (under 15) that are referred for a structured home safety assessment by practitioners providing family support on home visits who identify risks of unintentional injury.
Numerator – the number in the denominator that are referred for a structured home safety assessment.
Denominator – the number of households with children and young people (under 15) in which risks of unintentional injury are identified by practitioners providing family support on home visits.
Data source: Local data collection (information to support local audit against this measure may be more readily available in relation to home visits by certain types of practitioners, such as GPs, community nurses, midwives and health visitors).
Outcome
Number of referrals for structured home safety assessments in households with children and young people (under 15).
Data source: Local data collection.

What the quality statement means for service providers, health, public health and social care practitioners, and commissioners

Service providers (such as local authority children’s social services, local education departments and NHS organisations) ensure that systems are in place so that households with children and young people (under 15) receive advice on home safety or are referred for a structured home safety assessment by practitioners providing family support on home visits who identify risks of unintentional injury.
Practitioners (such as social workers, health visitors, community nurses and midwives, and GPs) who provide family support on home visits give advice or refer for a structured home safety assessment if they identify risks of unintentional injury in households with children and young people (under 15).
Commissioners (such as local authorities and clinical commissioning groups) ensure that they commission services in which households with children and young people (under 15) receive advice on home safety or are referred for a structured home safety assessment by practitioners providing family support on home visits who identify risks of unintentional injury.

What the quality statement means for the public

Households with children and young people (under 15) are given advice or are referred for a detailed assessment of the safety risks in their home by health or care workers providing family support on home visits who identify risks of accidents in the home. This is particularly important for households with children under 5 because they tend to have more accidents in the home.

Source guidance

Definitions of terms used in this quality statement

Structured home safety assessment
Structured home safety assessments are carried out by trained assessors and usually involve assessing the risk of the most common causes of unintentional injuries to children and young people (including burns, falls, poisoning, drowning, suffocation and choking) in each room.
The assessment should be tailored to meet the household’s specific needs and circumstances, and its purpose should be thoroughly and clearly explained to members of the household. Factors to take into account include (not in a priority order):
  • the developmental age of children and young people
  • whether a child or family member has a disability
  • cultural and religious beliefs
  • whether there is limited understanding of English language
  • levels of literacy in the household
  • the level of control people have over their home environment
  • the household’s perception of, and degree of trust in, authority
  • living in a property where there is a lack of appropriately installed safety equipment
  • living in a property where hazards have been identified through the Housing Health and Safety Rating System
  • the size of the family
  • families living on low income
  • overcrowded conditions
  • the complexity of the family’s needs.
[Adapted from Unintentional injuries in the home: interventions for under 15s (NICE guideline PH30), recommendation 3, and expert opinion]

Equality and diversity considerations

The purpose of a structured home safety assessment, and information or advice about the identified risks of unintentional injury to children and young people, should be communicated to members of the household in a way that is easily understood. This may include providing information in a written or verbal form. When information is communicated, services should be aware of the needs of members of households for whom English is not the first language or if those receiving the information have difficulty understanding it for any other reason. For example, assessors should be aware of the needs of a household in which the primary care giver has health or complex needs that may affect their ability to provide adequate supervision to children and young people or fully understand the information provided.

Effective interventions library

Effective interventions library

Successful effective interventions library details

Implementation

Pathway information

Unintentional injuries

The term 'unintentional injuries' is used rather than 'accidents' as: 'most injuries and their precipitating events are predictable and preventable'Davis R, Pless B (2001) BMJ bans 'accidents'. Accidents are not unpredictable. BMJ 322: 1320-21.. The term 'accident' implies an unpredictable and, therefore, unavoidable event.

Outdoor play and leisure

Children and young people learn, develop and mature when playing and taking part in activities that challenge them. Their participation in regular physical activity and outdoor play and leisure is important for their growth, development and general health and wellbeing – in both the short and long term. (For example, it can help reduce the risk of obesity and cardiovascular disease.)
The type of hazards encountered during outdoor activities will vary for different age groups and according to where they take place. Likewise, the factors to be considered when addressing and balancing risks and benefits will also differ. For example, where children and young people go off-road cycling will vary, depending on their age and experience: younger children are most likely to cycle in gardens and parks, while older children and young people may get involved in activities such as BMX racing or mountain biking.
This recommendation covers preventive activities at the strategic level. This does not imply that they are the only actions that could be taken to prevent unintentional injuries outdoors and during play and leisure.

Supporting information

What action should they take?

Use emergency department surveillance data to inform local firework injury prevention campaigns.
Conduct local firework injury prevention campaigns (see the Department for Business Innovation and Skills website for details) during the lead up to all celebrations and festivals where fireworks are used. This includes Bonfire Night, New Year and Diwali. Use the principles of behaviour change (see NICE's recommendations on behaviour change for details) to inform campaign planning, delivery and evaluation. Evaluate the effectiveness of campaigns.
Trading standards officers should ensure adults are given the firework safety code when they buy fireworks, as a condition of the licence to store and sell fireworks. The code should be available in a range of languages and formats.
Know which groups of children and young people are at high risk of drowning – and when that risk is increased. For example, children with certain medical conditions may be more at risk and boys are more likely to be at risk than girls. In addition, older children are more likely to drown outside the home.
Provide children, young people, their parents and carers with informationFor example, advice from the National Water Safety Forum, the RoSPA water safety code for children and the Child Accident Prevention Trust leaflets and booklets. and education on water safety in play and leisure environments. This should be appropriate to the age, developmental stage and experience of the child or young person and meet the household's particular needs and circumstances. It should be readily available in a suitable format. It should also be factually correct and consistent.
Ensure the information and education:
  • helps parents, carers, older children and young people identify and address the potential risks from water in the wider environment (this includes lakes, canals, rivers and on the coast)
  • stresses the importance of proper supervision, particularly for younger children, and describes in detail what this means.
Provide timely information and advice, for example, during the holiday season and for dealing with conditions such as heatwaves and extreme cold. (Ice might form on ponds, rivers and lakes during extreme cold spells.) This could include clearly displayed information at appropriate locations.
Encourage children, young people, their parents and carers to become competent swimmers and to learn other water safety skills (for example, so that they know how to effect a rescue).
Ensure swimming lessons include general and specific water safety information. Specific information could include detail on the meaning of different coastal warning flags. It should also raise children and young people's awareness of how difficult it is to assess and manage the hazards posed by water in a range of different outdoor environments.
Know which groups of children and young people are at high risk of drowning – and when that risk is increased. For example, children with certain medical conditions may be more at risk and boys are more likely to be at risk than girls. In addition, older children are more likely to drown outside the home.
Provide children, young people, their parents and carers with informationFor example, advice from the National Water Safety Forum, the RoSPA water safety code for children and the Child Accident Prevention Trust leaflets and booklets. and education on water safety in play and leisure environments. This should be appropriate to the age, developmental stage and experience of the child or young person and meet the household's particular needs and circumstances. It should be readily available in a suitable format. It should also be factually correct and consistent.
Ensure the information and education:
  • helps parents, carers, older children and young people identify and address the potential risks from water in the wider environment (this includes lakes, canals, rivers and on the coast)
  • stresses the importance of proper supervision, particularly for younger children, and describes in detail what this means.
Provide timely information and advice, for example, during the holiday season and for dealing with conditions such as heatwaves and extreme cold. (Ice might form on ponds, rivers and lakes during extreme cold spells.) This could include clearly displayed information at appropriate locations.
Encourage children, young people, their parents and carers to become competent swimmers and to learn other water safety skills (for example, so that they know how to effect a rescue).

Who should take action?

Local authority children's services and their partnerships, in consultation with local safeguarding children boards.
Local highway authorities and their road safety partnerships.
Other local authority services that may have a remit for preventing unintentional injuries such as education, environmental health and trading standards.

What action should they take?

Ensure there is a child and young person injury prevention coordinator. The aim is to help achieve the commitments set out in local plans and strategies for children and young people's health and wellbeing. The coordinator could be someone in the local authority, an NHS organisation or another local partner organisation (such as the fire and rescue service or a housing association). Alternatively, the coordinating role could be jointly funded by several local partners.
Ensure the coordinator:
  • Works with local partnerships that include organisations involved with children, young people, their parents and carers.
  • Develops a 2 to 3-year injury prevention strategy with these partners which is integrated into all relevant local plans and strategies for children and young people's health and wellbeing.
  • Networks at regional and national level with other child and young person injury prevention coordinators.
  • Raises local awareness about the need for prevention activities. This includes sitting on the local safeguarding children board. It also includes acting as a local source of information and advice on prevention.
  • Monitors progress made on the injury prevention commitments set out in local plans and strategies for children and young people's health and wellbeing. They should report progress to the director of children's services.
Ensure the coordinator understands the range of preventive measures available and is trained – and has the skills – to carry out the above activities. Provide them with both informal and formal learning opportunities. (The former could include using peer support and 'cascade learning' within placements. The latter could include the acquisition of qualifications at different stages of a formal career pathway.)
Ensure specialist learning and training is monitored and evaluated to see what effect it has on the coordinator's performance. Revise approaches that are found to be ineffective.
These national recommendations have been made to support local action. The decision on whether these recommendations are taken forward – and how they are prioritised – will be determined by government and subject to statutory regulatory and cost-impact assessments.
This national recommendation has been made to support local action. The decision on whether it is taken forward – and how it is prioritised – will be determined by government and subject to statutory regulatory and cost-impact assessments.

Making the prevention of unintentional injuries among children and young people a local priority

The prevention of unintentional injuries among children and young people may not be a priority among local organisations. To ensure prevention activities are accorded the importance they deserve, they need to be incorporated into national objectives aiming to improve the population's health. Local injury prevention coordinators could promote a strategic framework for action and encourage local agencies to work together.
Professional standards are needed to set out the knowledge and skills (or 'competencies') required for a range of injury prevention roles within and outside the NHS. Funding to develop these standards and curricula – and the provision of accessible training – is also required.
Injury surveillance is needed to monitor unintentional injuries among children and young people locally, regionally and nationwide. The data gathered could be used as the basis to plan preventive initiatives. Such initiatives may need to take a particular type of injury into account locally or regionally – even though it may not be a major problem nationwide.

Home safety

Ensuring permanent safety equipment is fitted in homes and the provision of home safety assessments should help prevent unintentional injuries among all under-15s. However, groups facing a higher than average risk of an unintentional injury need to be prioritised. Home refers to the home, garden and boundaries of a property.

Background information on outdoor play and leisure

Children and young people learn, develop and mature when playing and taking part in activities that challenge them. Their participation in regular physical activity and outdoor play and leisure is important for their growth, development and general health and wellbeing – in both the short and long term. (For example, it can help reduce the risk of obesity and cardiovascular disease.)
The type of hazards encountered during outdoor activities will vary for different age groups and according to where they take place. Likewise, the factors to be considered when addressing and balancing risks and benefits will also differ. For example, where children and young people go off-road cycling will vary, depending on their age and experience: younger children are most likely to cycle in gardens and parks, while older children and young people may get involved in activities such as BMX racing or mountain biking.
This recommendation covers preventive activities at the strategic level. This does not imply that they are the only actions that could be taken to prevent unintentional injuries outdoors and during play and leisure.
This recommendation proposes that those responsible for road safety should focus on the needs of local children and young people. This includes helping drivers to reduce their speed in areas where children and young people are present.
These recommendations propose that those responsible for road safety should focus on the needs of local children and young people. This includes helping drivers to reduce their speed in areas where children and young people are present.
This recommendation should be implemented as part of a broader strategy that includes driver and public education and enforcement activities.
These recommendations should be implemented as part of a broader strategy that includes driver and public education and enforcement activities.

Putting this recommendation into practice

This recommendation should be implemented as part of a broader strategy to reduce unintentional injuries in the home. This would include the use of regulations and the provision of safety education to prevent such injuries.
Implementation should ensure a systematic approach can be adopted. This involves prioritising households at greatest risk of unintentional injuries and establishing partnerships to ensure coordinated delivery and follow-up on home safety assessments and home safety equipment interventions.
Home safety issues should be considered as part of routine practice for all practitioners visiting children and young people at home.

Putting these recommendations into practice

These recommendations should be implemented as part of a broader strategy to reduce unintentional injuries in the home. This would include the use of regulations and the provision of safety education to prevent such injuries.
Implementation should ensure a systematic approach can be adopted. This involves prioritising households at greatest risk of unintentional injuries and establishing partnerships to ensure coordinated delivery and follow-up on home safety assessments and home safety equipment interventions.
Home safety issues should be considered as part of routine practice for all practitioners visiting children and young people at home.
Consider opportunities to develop engineering measures to provide safer routes commonly used by children and young people, including to school and other destinations (such as parks, colleges and recreational sites). This should be done as part of the development of a broad package of measures to address travel, for instance when developing school travel plans.
Include school governors and head teachers in discussions about changes relating to school travel.

Who should take action?

Strategic planners and leads with responsibility for child health.
Fire and rescue services.
Housing associations.
Local authorities: leads for children's services, environmental health, accident prevention and home safety and housing.
Sure Start and children's centres.

Measures to reduce speed

Local highways authorities and local strategic partnerships should introduce engineering measures to reduce speed in streets that are primarily residential or where pedestrian and cyclist movements are high. These measures could include:
  • speed reduction features (for example, traffic-calming measures on single streets, or 20 mph zones across wider areas)
  • changes to the speed limit with signing only (20 mph limits) where current average speeds are low enough, in line with Department for Transport guidelines.
Implement city or town-wide 20 mph limits and zones on appropriate roads. Use factors such as traffic volume, speed and function to determine which roads are appropriate.
Consider changes to speed limits and appropriate engineering measures on rural roads where the risk of injury is relatively high, in line with Department for Transport guidance.
Take account of the factors identified in needs assessment and planning when introducing measures.
The term 'vulnerable' is used to refer to children and young people who are at greater than average risk of an unintentional injury due to one or more factors. As an example, they may be more vulnerable if they:
  • are under the age of 5 years (generally, under-5s are more vulnerable to unintentional injuries in the home)
  • are over the age of 11 (generally, over-11s are more vulnerable to unintentional injuries on the road)
  • have a disability or impairment (physical or learning)
  • are from some minority ethnic groups
  • live with a family on a low income
  • live in accommodation which potentially puts them more at risk (this could include multiple occupied housing and social and privately rented housing).
a home safety assessment is the process of systematically identifying potential hazards in the home, evaluating the risks and providing information or advice on how to reduce them. Other terms commonly used to describe the same process include 'home risk assessment' and 'home safety check'. It may be carried out by a trained assessor or by parents, carers and other householders using an appropriate checklistHome safety assessment tools are available from The Royal Society for the Prevention of Accidents and SafeHome.

Glossary

engineering measures to reduce speed or make routes safer comprise physical features such as speed humps, chicanes or changes in traffic priority (that is, changes in the right for traffic to proceed). These may be used on single roads or across a larger area. 20 mph limits are imposed using signs at the start and end of roads covered by the limit and reminder signs at points in between (terminal and repeater signing). 20 mph zones are areas where engineering measures must be used to slow traffic
home refers to the inside of the dwelling itself. It does not include the garden or outbuildings
home safety equipment is any device used to prevent injury in the home. This includes door guards and cupboard locks, safety gates and barriers, smoke and carbon monoxide alarms, thermostatic mixing valves and window restrictors
permanent home safety equipment is defined as a device that needs to be fitted and cannot easily be modified or removed by the householder. Examples include hard-wired or 10-year battery operated smoke and carbon monoxide alarms, thermostatic mixing valves and window restrictors
surveillance of any health issue is defined as the: 'systematic, ongoing collection, collation and analysis of health-related information that is communicated in a timely manner to all who need to know which health problems require action in their community'. Last JM (2007) A dictionary of public health. Oxford: Oxford University Press

Paths in this pathway

Pathway created: November 2012 Last updated: June 2017

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