Accidents and their Prevention

oPatientPlus articles are written by UK doctors and are based on research evidence, UK and European Guidelines. They are designed for health professionals to use, so you may find the language more technical than the condition leaflets.

Accidents are a major cause of death and disability. About 14,000 people die in the UK, most of them in England and more than 700,000 will be seriously injured in England alone. They cost the UK an estimated £150 billion every year.[1] For children and young people, accidents are the greatest threat to life.[2] 

The prevention of childhood accidents is identified as one of the key indicators in the the 2013-2016 Public Health Outcomes Framework.[3] 

Three published guidance documents from the National Institute for Health and Care Excellence (NICE) outline recommendations for all those with a strategic role to play in injury prevention, including clinical commissioning groups (CCGs), local authorities and their partners.[4][5][6][7] 

Unlike safeguarding, there is currently no requirement for primary healthcare teams to undergo training in unintentional injury prevention. This is an important recommendation of the NICE guidance.[7] 

  • Primary prevention: removal of circumstances causing injury - eg, traffic speed reduction, fitting stair gates for young children, reducing alcohol consumption.
  • Secondary prevention: reduces severity of injury should an accident occur - eg, use child safety car seats, bicycle helmets, smoke alarms.
  • Tertiary prevention: optimal treatment and rehabilitation following injuries - eg, effective first aid, appropriate hospital care.

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Clinical roles for health professionals in accident prevention
These include:

  • Advice to patients: health workers are well placed to identify accident risks or medical conditions conferring risk and to advise accordingly - for example:
    • Child accident prevention:
      • Identify hazards (on home visits or if treatment sought for accidental injury).
      • Advise about prevention - eg, stair gates, keeping chemicals out of reach, etc.[2] 
    • Patients with medical conditions:[9] 
      • Identify and treat accident-causing conditions - eg, obstructive sleep apnoea, visual or balance disorders.
      • Give appropriate advice on fitness to drive.
      • Advise patients on how to minimise accident risks from their medical condition.
  • Identify unacceptable risks and intervene where appropriate - for example:
    • Identify vulnerable children and adults with recurrent injuries or at high risk. This includes those who are experiencing neglect and may require child protection procedures.[2] 
    • Consider reporting to the Driver and Vehicle Licensing Agency (DVLA) patients who fail to comply with medical driving regulations, if they are a serious risk to the public.
  • Accident surveillance: health professionals and their organisations can monitor injury rates and report preventable accidents; it has been suggested that A&E departments could play a key role.[10] NICE recommends establishing local protocols to alert health visitors, school nurses and GPs when a child or young person repeatedly needs treatment for unintentional injuries at an emergency department or minor injuries unit.[7] On a national basis, NICE recommends ensuring that all hospital trusts are made aware of the data collection requirements for the universal and mandatory A&E (minimum) commissioning dataset.[7] 

Non-clinical interventions
These include:[7] 

  • Advocacy and policy making.
  • Collaboration with other agencies.
  • Promoting accident prevention education and training.
  • Research.

How effective are interventions by health professionals?

Research into child safety practices suggests that safety advice for families can be effective. Cochrane reviews found that:

  • Home safety education (usually given in a face-to-face setting), particularly with the provision of safety equipment, is effective in increasing safety practices.[11] 
  • Parenting interventions (usually home-based) may be effective in preventing childhood injury.[12] 

How well do health workers perform in the role of accident prevention?

Health professionals could improve their awareness and involvement in accident prevention. For example:

  • A 2003 survey of primary care organisation (PCO) board members, including GPs, found limited knowledge of and low prioritisation of accident prevention compared with other health promotion activities.[13]
  • Health professionals are generally positive about their involvement in child accident prevention but legislative and engineering measures may need to be addressed in order to make their role more effective.[14] 
  • A study assessing the impact of child injury prevention training of midwives and health visitors suggested this had a positive effect on parental safety behaviours, the adoption of safety practices and injury reduction but that large-scale studies were required.[15] 

This section is intended to outline the major causes of accidents in the UK and to give health professionals some knowledge of how these can be prevented. Advice tips can be found under headings 'Safety advice for carers of young children', 'Home accident prevention' and 'Road accident prevention advice', below.

Specific medical conditions

Doctors are well placed to advise patients on accident risks relevant to their medical problems. For example:

  • Sleep disorders:[16]
    • These may be under-recognised and underdiagnosed.
    • Tools such as the Epworth Sleepiness Scale and expertise such as sleep disorder clinics are valuable.
  • Diabetes:
    • Hypoglycaemia is an important cause of driving mishaps in those with type I diabetes.[17] It is a risk where hypoglycaemic agents are used. Drivers should take precautions such as checking their blood glucose before driving, taking meals and snacks and not ignoring symptoms of hypoglycaemia.[18]
    • Research suggests that people with diabetes at highest risk are those with a history of mismanagement of hypoglycemia, lower limb neuropathy or greater exposure, ie high-volume driving.[19] 
  • Epilepsy:
    • People with poorly controlled epilepsy can be advised how to minimise their risks of injury during a seizure - eg, take a shower instead of a bath, do not iron when alone and other tips. Identified risk factors for injuries include the number of anti-epileptic drugs, history of generalised seizures and seizure frequency.[20] 
  • Attention deficit hyperactivity disorder:
    • ADHD has been shown to be associated with an increased risk of serious transport accidents. There is evidence that this risk is reduced by medication in male patients but not in females.[21] 

Accidents and children

Accidents are one of the main causes of death among children aged 1-5 years. About 100,000 children are admitted to hospital annually in the UK and 2 million attend emergency departments. In a typical CCG with a population of 100,000, this equates to approximately 3,300 emergency departments visits and 200 hospital admissions for child injuries.[4] 

For health workers, important points when advising on child accident prevention are:[22][23] 

  • Offer practical advice, not just general education - eg, advise about car seats or home safety equipment.
  • Use an evidence-based approach where possible and dispel myths - eg, some parents wrongly believe that cooker guards and baby walkers are safe.
  • Promoting safety does not require overprotection ('wrapping children in cotton wool') - this would delay development and increase the risk of obesity.
  • Promote sensible precautions in line with the child's level of development.

Safety advice for carers of young children

The NHS choices website provides clear guidance on preventing accidents in young children.[24] Key points covered are prevention of the following injuries:

Falls

  • Use stair gates until the child is aged 2; teach older children how to climb stairs but supervise them (even 4-year-olds may need some help).
  • If the gaps between banisters or balcony railings are more than 6.5 cm (2.5 in) wide, cover them with boards or safety netting.
  • Change your baby's nappy on the floor; don't leave your baby unattended on a bed, sofa or changing table, even for a second.
  • Don't put baby seats on tables (a baby's wriggling could tip it over the edge).
  • Take care to avoid tripping when carrying a baby.
  • Don't let children under the age of 5 sleep in the top of a bunk bed.
  • Keep low furniture away from windows. Fit windows with safety catches (and ensure adults know where the keys are kept in case of fire).
  • Use a five-point harness with a highchair.
  • Don't use a baby walker.
Choking, strangulation and suffocation

  • Keep all ties and cords short (eg, on curtains, blinds and switches) to avoid a child being strangled by the cord.
  • Do not tie or hang things to babies' cots, and keep all toy ribbons short.
  • Cut food up small enough for a child's mouth; don't give young children hard food such as boiled sweets or nuts.
  • Don't leave children alone when eating; encourage them to sit still while they are eating.
  • Keep small objects such as coins and buttons away from babies and toddlers.
  • Keep plastic bags out of reach.
Burns and scalds

  • Put cold water in a bath before hot water, check the temperature carefully; consider fitting thermostatic mixing valves.
  • Keep hot drinks, teapots, matches, irons and hair straighteners out of reach.
  • Use fireguards and spark guards.
Drowning

  • Children can drown in a few inches of water; they must be supervised at all times when bathing and near ponds, water containers or pools.
  • Garden ponds or pools must be properly fenced.
Poisoning

  • Keep chemicals and medicines out of sight and reach.
  • Children can often open 'child-proof' containers.
Cuts and bumps

  • Use safety glass in low doors/windows, or cover with safety film.
  • Keep scissors, knives and razors out of children's reach.
  • Cover sharp corners; use door stoppers to prevent trapped fingers.
Home safety

  • For general home safety advice, see 'Home accident prevention', below.
Car safety

  • Use correct child seats.
  • Put children in a rear seat of a car whenever possible.
  • Do not put a rear-facing baby seat in a front car seat with an active airbag (forward-facing seats in the same position, while not illegal, are also not ideal for toddlers).
  • Never leave children alone in a car.
Outdoor safety

  • Find safe places to play.
  • Use a harness or hold hands with small children in the street.

Elderly or disabled people and accident prevention

Frailty and health problems make the elderly, particularly those over the age of 75, at increased risk of accidents, usually occurring in the home. Falls are the most common cause. Inability to get up after falling puts the person at risk of hypothermia and pressure sores. Hip fractures after falls are a major cause of morbidity and mortality.

NICE and Clinical Knowledge Summaries (NICE CKS) have issued guidelines on the assessment and prevention of falls in older people.[25][26] They state that older people should be asked routinely if they have fallen in the previous year. Those who have fallen, or those considered at risk of falling, should have a multifactorial falls risk assessment and should be considered for interventions, including those to improve their strength and balance and removal of any home hazards.

Environmental interventions have a role in safety for disabled or elderly people living at home - this has led to the concept of 'smart homes', which incorporate alarm or monitoring devices and other safety features.[27] However, safety for those needing home care has many aspects; this includes not only physical safety but social and emotional well-being.[28]

Accidents in the home

In the UK annually, home accidents cause almost 5,000 deaths and 2.7 million A&E department attendances.[29]

Home accident prevention[30] 

See also 'Safety advice for carers of young children', above.

Fire and electrical safety

  • Fit smoke detectors on every floor and renew batteries regularly.
  • Plan your fire escape route.
  • Use fireguards.
  • Keep portable heaters and candles away from furniture, clothes and curtains.
  • Fat friers and 'chip pans' are a serious fire risk. If there is a chip pan fire, turn off the heat (if safe to do so) and call 999. Do not move the pan and do not pour water on it (this can cause a fireball).[31]
  • Do not overload circuits, including using multiple adapters in sockets.
  • Have your wiring checked regularly.
  • Do not use equipment with cracked plugs or worn cables.
  • Always ensure electrical equipment that you buy has been safety tested.
  • Do not touch electrical equipment with wet hands and do not take it into the bathroom.
  • Do not smoke in bed.
  • Keep matches and lighters away from children.
  • Outdoors, use a residual current device (RCD) with electrical power tools.
  • Keep bonfires and barbecues away from buildings, fences and trees and ensure children are supervised.
Heating and cooking

  • Never block air vents. Service heating appliances and sweep chimneys annually.
  • Be alert to the symptoms of carbon monoxide poisoning (drowsiness and flu symptoms).
  • When cooking, use the back rings of the cooker; turn the handles of pots and pans inwards on the cooker so that they can be less easily grasped by small children.
Medicines and cleaning fluids

  • Always ensure containers are clearly labelled and out of children's reach.
Other measures

  • Stairs should have banisters or rails.
  • Avoid loose rugs and flooring. Clean up spills to avoid slipping.
  • Only climb up on something firm and strong.
  • When using power tools, use adequate protection including gloves, goggles and sturdy shoes.
  • Improve lighting in halls and stairways.
  • With DIY, always work within your ability, follow instructions, check equipment and keep tools and chemicals away from children.

Road accidents

In terms of numbers of people killed or injured, this is an important area for accident prevention in the UK and worldwide. Although the figures are still high, statistics for Great Britain suggest that the situation is gradually improving. For the year ending June 2013:[32] 

  • 1,730 people were killed, a 3% drop from 1,785 in the previous year.
  • 185,540 people were injured, 7% fewer than the previous year.
  • Total reported child casualties (ages 0-15) fell by 12% to 15,920 for the year ending June 2013 with those killed or seriously injured down 11% to 2,080.

Common causes of these accidents included speeding, drink driving, not wearing seat belts or careless driving. Around a third involved someone driving during their work. About 10% of those killed were inexperienced drivers.[33] 

Driving speed[34] 
Higher speed both increases the risk of collision and the risk of serious injury to the driver or others. Even a modest speed reduction helps reduce both the number and the severity of accidents, eg pedestrians hit at speeds below 30 mph receive mainly survivable injuries but this changes to mainly fatal injuries at speeds of between about 30 mph and 40 mph.

Medical conditions that affect driving
The DVLA issues guidance and regulations with regard to medical conditions that impair safe driving. See 'At a glance fitness to drive'.[35]

Excessive sleepiness[16]

  • 20% of accidents on motorways in the UK are caused by sleepiness and >300 people per year are killed by drivers falling asleep while driving. Sleepy drivers perform worse on tests than those over the alcohol limit.
  • Increased awareness of sleep disorders and their treatment is needed, by both the public and by doctors.

Car seats and seatbelts[36][37]The value of seat belts is indisputable. In most vehicles, it is now compulsory for everyone to wear a seat belt, or appropriate child restraint, if available, in the front and back. It is the driver's responsibility to ensure that passengers are correctly restrained.

Alcohol and drugs[38]Alcohol impairs judgement, reaction times, co-ordination and concentration. There was a 4% decrease in seriously injured drink drive casualties in 2012, to around 1,200 (5% of all seriously injured road casualties).[39] 

Legal limits for driving with alcohol in the UK are:[40] 

  • 35 μg alcohol per 100 ml of breath, or
  • 80 mg of alcohol per 100 ml of blood

However, most drivers are impaired at a blood alcohol level of 50 mg/100 ml. The Royal Society for the Prevention of Accidents (RoSPA) has called for the legal alcohol limit to be reduced to 50 mg/100 ml blood, as it is in many other countries.

It is difficult for drinkers to know how much alcohol they are consuming, as strength of drinks and size of measures vary considerably. Also, the speed of absorption into the body varies with a person's size, age, weight and gender and whether they have eaten.The same amount of alcohol will give different blood alcohol levels in different people. Therefore, the best advice is not to drink when driving.

Drivers may also be impaired due to the use of drugs, both illicit and prescribed. Any drugs that cause sedation are a problem, including many antihistamines and antidepressants.

Mobile phones and driving
Research has shown that using hand-held or hands-free mobile phones whilst driving increases the risk of the driver crashing, injuring or killing themselves and/or other people, by four times.[41] It is an offence for drivers to use a hand-held mobile phone whilst driving.[42] 

Motorcyclists and cyclists
Motorcyclists are extremely vulnerable - despite forming only 1% of road traffic, they account for 20% (one in five) of road deaths and serious injuries. Information on preventing accidents for motorcyclists is available on the RoSPA website.[43] 

6,000 UK cyclists are killed or injured annually in reported road accidents, including around 2,500 who are killed or seriously injured.[44] A Cochrane review found that bicycle helmet legislation appeared to be effective in increasing helmet use and decreasing head injury rates in the populations for which it was implemented. However, further research was required.[45] Further information is available on the RoSPA website; safety tips for cyclists are also available.[46] 

Road accident prevention advice[46] 

General points

  • Watch your speed when you are driving. Watch your speedometer, know the limits, concentrate and slow down when you are entering villages.
  • Do not use hands-free or hand-held mobile phones whilst driving.
  • Follow DVLA guidance on medical conditions that can affect driving.
  • Do not park on pavements - this affects pedestrian safety.
  • Broken-down vehicles should be moved off the road if possible. Switch on hazard warning lights and wear a high-visibility jacket if possible.
  • If stopping on a hard shoulder is necessary, leave the vehicle and wait on the embankment for assistance. Stationary vehicles on the hard shoulder are at high risk of being involved in an accident. Use motorway emergency phones to aid locating you. If you feel vulnerable, leave the passenger door open and enter your vehicle if someone approaches, then communicate through a narrowly opened window.
Preventing sleepiness while driving[16] 

  • Drive when well rested, healthy and not taking sedating medication.
  • Take regular rest breaks (at least 15 minutes every two hours).
  • If feeling sleepy during a journey, stop somewhere safe, take drinks containing caffeine and take a short nap.
  • If necessary, plan an overnight stop. Avoid driving into the time when you would normally be falling asleep, into the small hours (2 am-6 am) or after a full day at work.
  • Be extra careful when driving between 2 pm and 4 pm, especially after a meal.
Alcohol, medicines and drugs[47] 

  • If intending to drive, do not drink alcohol. Never rely on trying to calculate accurately how much alcohol is in your body and whether you are above or below the drink-drive limit.
  • If intending to drink alcohol, either arrange for a non-drinking person to drive, use public transport or stay overnight. Be aware that you may still be impaired the following morning after a drink the night before.
  • Avoid driving while under the influence of medicines. Check for warnings on the packet patient information leaflet AND ask a pharmacist or doctor if the medicine could affect your driving.
  • Do not drive under the influence of drugs.
Seat belt regulations
All passengers should use appropriate seat belts or child restraints; this is the driver's responsibility. Detailed information is available on suitable child seats and current regulations.[36][37]

Sports, water and leisure safety

The RoSPA website has information on safety in different sports, activities, environmental hazards and holiday leisure pursuits. 

Safety in the workplace

Information and 'safety packs' for employers are available from the Heath and Safety Executive and the RoSPA. Workplace safety is important. In the UK, there are 600,000 workplace injuries annually and 1.2 million cases of ill health caused or exacerbated by work. Small businesses (employing <50 people) have a rate of serious accidents almost double that of large companies.[48] 

Further reading & references

  1. Delivering Accident Prevention at local level in the new public health system; Royal Society for the Prevention of Accidents, 2013
  2. World report on child injury prevention; UNICEF, 2008
  3. Public health and child accident prevention; Making the Link, 2014
  4. Kendrick D, Hayes M, Ward H, et al; Preventing unintentional injuries: what does NICE guidance mean for primary care? Br J Gen Pract. 2012 Feb;62(595):62-3. doi: 10.3399/bjgp12X625012.
  5. Preventing unintentional injuries among under-15s in the home; NICE Public Health Guideline (November 2010)
  6. Preventing unintentional road injuries among under-15s: road design; NICE Public Health Guideline (November 2010)
  7. Strategies to prevent unintentional injuries among under-15s; NICE Public Health Guideline (November 2010)
  8. Fine R et al; Principles of Prevention, Spinal Cord Medicine: Principles and Practice, 2003
  9. Abdel-Aley M et al; Accident Analysis & Prevention, 2014
  10. Jamrozik K, Samarasundera E, Miracle R, et al; Attendance for injury at accident and emergency departments in London: a cross-sectional study. Public Health. 2008 Sep;122(9):838-44. doi: 10.1016/j.puhe.2007.10.011. Epub 2008 Mar 4.
  11. Kendrick D, Young B, Mason-Jones AJ, et al; Home safety education and provision of safety equipment for injury prevention (Review). Evid Based Child Health. 2013 May;8(3):761-939. doi: 10.1002/ebch.1911.
  12. Kendrick D, Mulvaney CA, Ye L, et al; Parenting interventions for the prevention of unintentional injuries in childhood. Cochrane Database Syst Rev. 2013 Mar 28;3:CD006020. doi: 10.1002/14651858.CD006020.pub3.
  13. Kendrick D, Groom L, Hippisley-Cox J, et al; Accidental injury: a neglected area within Primary Care Groups and Trusts? Health Educ Res. 2003 Jun;18(3):380-8.
  14. Woods AJ; The role of health professionals in childhood injury prevention: a systematic Patient Educ Couns. 2006 Dec;64(1-3):35-42. Epub 2006 Sep 29.
  15. Woods A, Collier J, Kendrick D, et al; Injury prevention training: a cluster randomised controlled trial assessing its effect on the knowledge, attitudes, and practices of midwives and health visitors. Inj Prev. 2004 Apr;10(2):83-7.
  16. Sleep SOS report. The impact of sleep on society; Sleep Alliance
  17. Cox DJ, Ford D, Gonder-Frederick L, et al; Driving mishaps among individuals with type 1 diabetes: a prospective study. Diabetes Care. 2009 Dec;32(12):2177-80.
  18. Driving and diabetes; Diabetes UK
  19. Cox DJ, Singh H, Lorber D; Diabetes and driving safety: science, ethics, legality and practice. Am J Med Sci. 2013 Apr;345(4):263-5. doi: 10.1097/MAJ.0b013e31828bf8d7.
  20. Nguyen R, Tellez Zenteno JF; Injuries in epilepsy: a review of its prevalence, risk factors, type of injuries and prevention. Neurol Int. 2009 Nov 16;1(1):e20. doi: 10.4081/ni.2009.e20.
  21. Chang Z, Lichtenstein P, D'Onofrio BM, et al; Serious transport accidents in adults with attention-deficit/hyperactivity disorder and the effect of medication: a population-based study. JAMA Psychiatry. 2014 Mar;71(3):319-25. doi: 10.1001/jamapsychiatry.2013.4174.
  22. Brussoni M, Olsen LL, Pike I, et al; Risky play and children's safety: balancing priorities for optimal child development. Int J Environ Res Public Health. 2012 Aug 30;9(9):3134-48. doi: 10.3390/ijerph9093134.
  23. Accidents to Children; Royal Society for the Prevention of Accidents
  24. How to childproof your home; NHS Choices
  25. Falls: assessment and prevention of falls in older people; NICE Clinical Guideline (Jun 2013)
  26. Falls - risk assessment; NICE CKS, June 2009
  27. Chan M, Campo E, Esteve D, et al; Smart homes - current features and future perspectives. Maturitas. 2009 Oct 20;64(2):90-7. Epub 2009 Sep 2.
  28. Lang A, Edwards N, Fleiszer A; Safety in home care: a broadened perspective of patient safety. Int J Qual Health Care. 2008 Apr;20(2):130-5. Epub 2007 Dec 23.
  29. Home Safety; Royal Society for the Prevention of Accidents
  30. Home Safety Checklist; Royal Society for the Prevention of Accidents
  31. Fire Safety in the Home; UK Fire Service Resources
  32. Personal injury accident statistics on public roads in Great Britain in the year ending June 2013; GOV.UK
  33. Road Safety FAQs; Royal Society for the Prevention of Accidents, 2014
  34. Inappropriate speed; Royal Society for the Prevention of Accidents, 2011
  35. At a glance guide to the current medical standards of fitness to drive; Driver and Vehicle Licensing Agency
  36. Child Car Seats; Royal Society for the Prevention of Accidents
  37. Seat belts: the law; GOV.UK
  38. Drinking and Driving Policy Paper; Royal Society for the Prevention of Accidents, May 2007
  39. Reported road casualties in Great Britain: Estimates for accidents involving illegal alcohol levels: 2012 (provisional) and 2011 (final), 2013; GOV.UK
  40. The drink drive limit; GOV.UK, 2014
  41. Driving for work: Mobile phones; Royal Society for the Prevention of Accidents, 2011
  42. Using mobile phones when driving: the law; GOV.UK, 2013
  43. Motorcycling Safety Advice & Information; Royal Society for the Prevention of Accidents
  44. Cycling Safety Advice & Information; Royal Society for the Prevention of Accidents
  45. Macpherson A, Spinks A; Bicycle helmet legislation for the uptake of helmet use and prevention of head injuries. Cochrane Database Syst Rev. 2008 Jul 16;(3):CD005401. doi: 10.1002/14651858.CD005401.pub3.
  46. Road Safety - Advice, Information & Resources; Royal Society for the Prevention of Accidents
  47. Driving for work: drink and drugs; Royal Society for the Prevention of Accidents, 2012
  48. Occupational Safety and Health; Royal Society for the Prevention of Accidents

Disclaimer: This article is for information only and should not be used for the diagnosis or treatment of medical conditions. EMIS has used all reasonable care in compiling the information but make no warranty as to its accuracy. Consult a doctor or other health care professional for diagnosis and treatment of medical conditions. For details see our conditions.

Original Author:
Dr Michelle Wright
Current Version:
Peer Reviewer:
Dr Helen Huins
Document ID:
1747 (v23)
Last Checked:
28/05/2014
Next Review:
27/05/2019