Injury Surveillance
As part of our strategic approach to tackling violence in Scotland, the VRU has adopted the World Health Organisation’s Public Health Model. A key strand of the model is to fully define the existing problem of violence and this can be done through injury surveillance. With the under recording of violence widely accepted as being an issue in Scotland, engagement with the health service and in particular Emergency Departments will help to develop potentially beneficial partnerships. Injury surveillance will undoubtedly improve the Scottish police forces response to violence by providing more accurate data with which to respond to with enforcement and preventative measures.
Under Reporting of Violence
A number of studies have estimated that violence is under recorded by the police by as much as 50 – 70 %. In practical terms these victims are denied access to relevant services and the police are allocating resources based on only a fraction of the necessary information. An independent study carried out in five Glasgow A&E departments cited the following reasons for patients not reporting an assault to the police:
- mistrust of the police or believing they are ineffective
- Cultural issues around group solidarity, which may be underpinned by sanctions such as punishment of “grasses”.
- The time and trouble involved in reporting.
- Not being able to identify the assailants.
Data Collection
The majority of Emergency Departments in Scotland use EDIS information management software. EDIS was primarily intended to record data within the NHS however it is now recognised that a substantial amount of the data recorded may be useful to other public bodies such as local councils, police, traffic and transport authorities and special interest groups which deal with specific areas of injury, as an aid for audit purposes and to develop effective prevention strategies.
A specific Assault Care Plan can be added to EDIS to collect the necessary injury surveillance information. The form below details the assault data that will be captured electronically. These questions are based on the data fields used by Jonathan Shepherd in Cardiff.
Injury Surveillance Dataset
- Date of Assault
- Time of Assault
- Location of Assault
- Bar/pub
- Club
- Street
- Workplace
- Your Home
- Someone Else's home
- Other
- Further Details of Location (Free text field for street name or pub/club details
- Who was the attacker
- Partner/Wife/Husband
- Ex Partner
- Family Member
- Friend Acquaintance
- Bouncer
- Stranger
- Customer/Client
- Other
- Sex of attacker
- Male
- Female
- Both
- Number of attackers
- Weapons Used
- Body Part
- Knife
- Glass
- Bottle
- Firearm
- Blunt Object
- Unknown
- Other
- Motive for attack
- Football
- Gangs
- Territory
- Racial
- Unprovoked
- Drugs
- Robbery
- Religion
- Homophobic
- Other
- Was drugs and/or alcohol involved
- Drugs
- Alcohol
- Both
- None
- Don't Know
- Have you or do you intent to report this to the police?
- Yes
- No
Information Flow
Parntership Analyst
A partnership analyst will be based within Lanarkshire Health board and will have access to both police crime data and hospital patient data to enable accurate comparisons to be made. Patient name and DOB will be used to accurately establish whether or not a crime has been reported to the police however, all patient identifiable information will be removed before the data is passed to the police for action. The anonymised data will be disseminated electronically to police divisions to be incorporated in to the Tasking and Co-ordinating process for prompt action.
Police use of injury surveillance data
The injury surveillance data will be used to enhance existing police data and intelligence. There is huge potential for the data to be used to target police resources and preventative programs more accurately, develop appropriate interventions and address environmental or licensing issues in identified hotspots.
The key to the success of any injury surveillance pilot is ensuring that local police divisions act upon the data promptly and the Partnership Analyst feeds back results to the participating hospitals.
Some examples of the practical uses for the data include:
- Divisional Analysts will incorporate the information into any relevant crime problem profiles they produce as a result of the Tasking and Coordinating Process.
- Divisional Licensing departments will ensure that any licensed premise identified through the survey is visited and counseled with regards to customer safety, security, CCTV, Servwise training and door entry policy etc.
- Licensing Boards can consider the surveillance information if a license is due for renewal.
- Community Safety Departments will carry out safety surveys on any property / premise that is identified as a trouble spot through the surveillance.
- Police divisions can make recommendations with regards to environmental issues such as lighting and CCTV in identified hotspots.
- Operational officers will target identified hotspots.
- Hospital data will help to identify trends in weapon use.
Although the police would be given anonymised data, the health board would have access to the full data set including names and addresses of victims. This would enable them to identify repeat victims and vulnerable communities (through postcode information). This information could be used to refer patients on to Victim Support, Substance Misuse Services, Womens safety units or Community Psychiatric Support etc.
There is also huge potential for this information to be used by the Community Health Care Partnerships to improve the long term health and well being of the local community through the development of interventions that meet the specific needs of each community.
Additional benefits for the health board include
- A reduction in assault patients would contribute towards the NHS HEAT target to reduce overall ED attendance
- A reduction in the number of drunk and aggressive patients attending the ED would undoubtedly help to reduce violence against NHS staff.
- A reduction in assault patients would mean cost savings for the health board. Approximately 3-6% of the Health budget in Scotland goes towards treating victims of violence
- An information sharing project would link in with the forthcoming government plans for routine enquiry for domestic abuse within the ED. (Gender based violence CEL 29/9/08)
- There are clear links between the injury surveillance model and the work of local Alcohol and Drug Action Teams.
If the success of the Cardiff project were replicated in other areas of Scotland then we would hope to achieve a reduction in the number of assault patients presenting at emergency departments. This would help to relieve the burden on emergency departments particularly late at night at the weekend when resources are stretched and alcohol related disorder is common. It would also enable staff to concentrate on other life saving operations. In addition, a reduction in the number of drunk and aggressive patients attending at emergency departments would undoubtedly have an impact on violence against ED staff.
The Future
It is clear that health professionals including those in Emergency Departments have a key role to play in identifying problem areas and at risk groups in relation to violence.
The VRU has gained the support of the Chief Medical Officer in Scotland and has discussed National Injury Surveillance with every Director of Public Heath and a number of A&E Clinical Directors in Scotland. The Lanarkshire pilot will help to identify good practice that can be used in other areas across Scotland.
Spread the Word!
