"In choosing among potentially useful preventive measures, priority should be given to the ones most likely to effectively reduce injuries. In general, these will be measures that provide built-in, automatic protection, minimizing the amount and frequency of effort required of the individuals involved." (Haddon, 1974)

There are as many different prevention and control strategies as there are problems. One of the best ways to investigate potential strategies is to use "Haddon’s Matrix." The matrix looks at 12 different "boxes" in which any injury event can be examined. The matrix was designed by William Haddon, Jr., the first head of the National Highway Traffic Safety Administration (NHTSA). During his directorship at NHTSA (1966-1970), Haddon and his colleagues were directly responsible for research into fatalities caused by the unsafe and unforgiving structure of automobiles at that time. Their investigations and the vehicle modifications that resulted led directly to a reduction of approximately 50% in motor vehicle crash fatalities. Safety glass, collapsible steering columns, padded interiors, and lap/shoulder belts are all results of their research.

Haddon’s Matrix allows you to look at variables in the Human, the Vehicle (Vector of injuring energy), and the Environment (Physical and Socio-cultural), before, during, and after an injury event. Identifying these variables can help identify strategies to prevent an injury event from occurring, or control the severity of the injuries during the event. The trick to using Haddon’s Matrix is to think up as many different possible causes and solutions to a specific injury event as possible. Even bizarre ideas can sometimes lead to innovative strategies, so stretch your imagination! Without innovative thinking, we wouldn’t have the "Wiffle Ball", "Nerf" toys or breakaway baseball bases that prevent leg fractures during slides, (all excellent examples of effective injury control strategies).

The following is an example of Haddon’s Matrix as used to investigate the problem of motor vehicles leaving the roadway and rolling over down steep and high embankments. This is a real problem that our EMS dealt with in the Hoopa EMS district of Northern California.

In addition to his matrix, Haddon went on to identify ten strategies that, when combined with the matrix, can be used to help us zero in on the best possible interventions for any given injury event. (Haddon), Hazard Prevention 16: 8-12

1. Prevent the creation of the hazard in the first place.
1. Yard darts
2. Cop-killer bullets
3. Three-wheel ATV’s
2. Reduce the amount of the hazard that exists.
1. Reduce horsepower in vehicles
2. Restrict motorcycle licensing to older drivers
3. Prevent the release of the hazard.
1. Gun safes
2. Trigger locks
3. Childproof medicine containers
4. Modify the rate of spatial distribution of release of a hazard from its source.
1. Breakaway baseball bases
2. Ski bindings

 

5. Separate people in time or space from the hazard and its release.
1. Bicycle and pedestrian pathways
2. Avalanche release during non-skiing hours
6. Separate people from the hazard by interposing a material barrier
1. Raised median strips
2. Guardrails
3. Energy-absorbing barriers on fixed objects
7. Modify the relevant basic qualities of the hazard.
1. Safer playground equipment
2. Softer playground surfaces
3. Hot tap water settings of below 120 degrees
8. Make the person more resistant to damage.
1. Physical conditioning of athletes
9. Counter the damage already done.
1. EMS
10. Stabilize, repair, and rehabilitate the injured person.
1. Reconstructive surgery
2. Physical therapy

Ask yourself this: Given all the variables of this particular situation, what can you most easily change, control, or modify that will prevent this crash from occurring? What will reduce the severity of any crash that occurs here so that it will not result in serious or fatal injuries?  Consider which of these protects every other user of the road with no action on the part of the protected person.  That strategy is the most likely to be the most effective one.