Page 120 - Journal of Special Operations Medicine - Fall 2017

An Ongoing Series

Tools to Assess and Reduce Injury Risk (Part 1)

Joseph J. Knapik, ScD

ABSTRACT
Many injuries are preventable. Useful tools are available that developed that can aid in assessing injury risks and developing
can aid in assessing injury risks and developing methods to methods to reduce these risks.
reduce these risks. This is part 1 of a two-part article that
will discuss these tools, which include the Haddon Matrix, This is the first of a two-part article that will review these
the 10 Countermeasure Strategies, the Injury Control Process, tools and provide examples to illustrate how they can be
and the Army Risk-Management Process. The Haddon Ma- used. Part 1 will outline the Haddon Matrix and the 10
trix is 3 × 3 table that, across the top (columns), provides an Countermeasure Strategies. Part 2 (to be published in the
approach to conceptualizing injury prevention and control next edition of the Journal of Special Operations Medicine)
through modifications of the human, equipment, and environ- will cover the injury control process, and the U.S. Army risk-
ment; and, across rows, thinking about injury prevention and assessment tool.
control before, during, and after the injury-producing event.
The basic premise of the 10 Countermeasure Strategies is that The Haddon Matrix
injuries are largely due to energy exchanges between a person
and the external environment in such a way that body cannot The traditional epidemiology triad considers the transmission
properly avoid or absorb the energy and anatomic structures of diseases as an interaction between a human host, an infec-
are damaged. The Countermeasure Strategies are (1) elimi- tious agent, and an environment that encourages the disease.
2
nating the hazard altogether, (2) reducing the amount of the As applied to injuries, this triad can be seen as the interaction
hazard, (3) preventing release of the hazard, (4) modifying between a human host, an agent that involves an energy ex-
the rate or spatial distribution of the hazard, (5) separating in change, and an environment that makes the injury possible.
space or time the hazard and the individual, (6) separating the Figure 1 is an example involving a Soldier (the host) exiting
individual from the hazard using a barrier, (7) modifying the a building down a set of stairs. The agent of the injury is the
basic qualities of the hazard, (8) strengthening the individual Soldier’s movement and distance between the top and bottom
to make them more resistant to damage, (9) countering the of the stairs (i.e., potential energy, in the sense used in physics,
damage done, and (10) stabilizing, healing, and rehabilitating is inherent in the Soldier’s movement and stairway vertical dis-
the individual. Part 2 of this series will discuss the injury con- tance). The environment includes the stairs, which lack a hand
trol process and the Army risk management process. rail, do not have nonslip treads, and are slick due to recent
coat of a glossy paint. In this case, there is risk of the Soldier
Keywords: injuries; injury prevention; Haddon Matrix; Counter- falling and becoming injured, largely because of the configura-
measure Strategies tion of the stairway.
The Haddon Matrix is a modification of the traditional epi-
3,4
demiologic triad involving the host, agent, and environment. In
Introduction
addition, the matrix adds a time dimension. The 3 × 3 Haddon
In the past, injuries were often associated with “accidents” Matrix is shown in Table 1. Columns at the top of the matrix
that were viewed as random, unpredictable, and unavoidable are the traditional host, agent, and environment factors, but
events. When injuries occurred, they were often ascribed to in- these are relabeled as human, equipment, and environment,
dividual carelessness and the individual was told to pay more respectively. In terms of injury prevention and control, the hu-
attention to what they were doing. However, research has man aspect considers possible changes to Soldier behaviors or
shown that, to a large extent, injuries can be prevented by un- factors related to the Soldier. The equipment aspect largely
derstanding not only the individual but also the environmental considers engineering and structural changes. The environ-
context in which the individual is operating, and assessing ment aspect considers changes to external setting, location,
1
ways of altering those factors. Several useful tools have been and surrounds.
Correspondence to joseph.j.knapik.ctr@mail.mil
MAJ (Ret) Knapik was a Medic and Medical Service Corps officer in the U.S. Army. He is a senior epidemiologist/research physiologist with the
Henry M. Jackson Foundation and is an adjunct professor at Uniformed Services University (Bethesda, Maryland) and Bond University (Robina,
Australia).

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