Injuries are an important public health concern in the UK: they are a recognised public health priority within the white paper Saving lives. Our healthier nation. (1) The multi-agency nature of effective action is reflected in the many places accident and injury prevention appears within government and local policy. This includes, transport, fire health and safety, and many other specific strategies as well as within the National service framework for older people. (2)

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The LHO has recently published a report, commissioned by London's Directors of Public Health for the Health of Londoners Programme (HOLP). Too high a price. Injuries and accidents inLondon is the first report of its kind to give a comprehensive view of injury and accidents in London. The key findings from this report are summarised in:
Too high a price. Injuries and accidents in London. Executive summary.

The main points include:

• Every year in London there are around 2000 deaths from injuries or accidents and nearly 70,000 admissions to hospital.
• Hospital admission rates for most types of accidental injury, as well as for assault and self-harm, are lower for Londoners than for England as a whole.
• Half of hospital admissions for injuries and accidents follow accidental falls - many among older people.
• London has lower mortality from accidents, road traffic accidents and suicide than other European cities.
• Londoners have lower death rates than the England average for most accidents, but higher rates from injuries due to accidental fires, poisoning and homicide. The biggest causes of death from injury are: suicide which accounts for over 700 deaths per year; falls, which kill nearly 400; and road traffic accidents (almost 300 Londoners every year).

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We also commissioned specific research into the economic costs of injury and the events that cause injury in London. The results of this are summarised in Too high a price. Injuries and accidents in London. Executive summary. The full Report On Costs is also available.

The work has identified an estimated annual cost of £19.7 billion, mostly the human costs and the costs of lost outputs. Direct costs are estimated at £290m for medical and social care, and £17m criminal justice system costs. The health and social care costs of fires, falls, poisoning and other accidents are together far greater than the costs of road traffic accidents. Known omissions from this short study mean that these are underestimates. This is the first time we have had an estimate for London, based on the wide range of information sources about injury and accident events and victims. (3)

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Accident and emergency attendances - The Department of Trade and Industry operates two linked databases: the Home Accident Surveillance System (HASS) and the Leisure Accident Surveillance System (LASS). The HASS and LASS databases record details of home and leisure accidents that were serious enough to cause an injury warranting a visit to hospital. Accidents where death occurs are excluded from this analysis (although different HASS and LASS data concerning fatalities are collected). They contain information from a sample of Accident and Emergency (A&E) departments across the UK. The London hospitals included in the study are Kings College Hospital and St. Helier Hospital.

Data are collected primarily to gain understanding of how, why and where home and leisure accidents occur and enable he development of effective consumer safety policies to prevent them in the future.

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Ambulance call outs - The London Ambulance Service (LAS) NHS Trust records details of every ambulance call out. Information is not recorded for every person, just for each incident. However, it is possible to determine how many patients were taken to hospital for each call out. The ambulance crew at the scene assigns the incident type. The injury incident type categories are:

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Hospital Admissions - All NHS acute hospital admissions should be recorded on computer systems that link detailed information on diagnoses and surgical procedures with patient characteristics such as age, sex and area of residence. The Department of Health's Statistics Division collates records into national data sets, and summary tables are available via their website or upon application. Extracts of patient level records are also available upon application for specific analyses.

The analysis of diagnostic codes for accident and injury is complicated by a system of dual classification that is used. Primary diagnosis codes record the nature of the injury to the individual (in ICD 10 these codes begin with S or T). They record things such as fractures, concussion or burn. In addition there should also be a code (starting with W, V, X or Y in ICD 10) pointing to the cause of the injury, in terms of things like road traffic accident, drowning or accidental fall. The recording of these external causes is often incomplete.

The causes of admission related to injury are the same as for mortality and are listed here with the associated ICD10 codes:

• All accidents and adverse effects (ICD10: V01-X59, Y40-Y84)
• Transport accidents (ICD10: V01-V99)
• Motor vehicle traffic accidents (ICD10: V01-V79), further broken down into 6 mode of transport groups (motor vehicle drivers, motor vehicle passengers, motor cycle drivers, motor cycle passengers, pedal cyclists, pedestrians)
• Accidental poisonings (ICD10: X40-X49)
• Accidental falls (ICD10: W00-W19)
• Accidents caused by fire and flames (ICD10: X00-X09)
• Medical misadventure and adverse effects (ICD10: Y40-Y84)
• Other accidents (ICD10: X10-X39, X50-X59)
• Self harm (ICD10: X60-X84)
• Assault (ICD10: X85-Y09)
• Undetermined injury (ICD10: Y10-Y34)

Mortality - Annual mortality statistics published by the Office for National Statistics give numbers of deaths by cause by area of residence. Numbers of deaths from all 'external causes of injury and poisoning' (ICD9 E800-E999) can be further broken down by a number of sub-groupings:

• All accidents and adverse effects (ICD9: E800-E949)
• Transport accidents (ICD9: E800-E848)
• Motor vehicle traffic accidents (ICD9: E810-E819), further broken down into 6 mode of transport groups (motor vehicle drivers, motor vehicle passengers, motor cycle drivers, motor cycle passengers, pedal cyclists, pedestrians)
• Accidental poisonings (ICD9: E850-E869)
• Accidental falls (ICD9: E880-E888)
• Accidents caused by fire and flames (ICD9: E890-E899)
• Medical misadventure and adverse effects (ICD9: E870-E879, E930-E949)
• Other accidents (ICD9: E900-E929)
• Suicide & self-inflicted injury (ICD9: E950-E959)
• Homicide (E960-E969 and E988.8)
• Undetermined injury (ICD9: E980-E989 excluding E988.8)
• Inquest adjourned (E988.8)

Road traffic accidents - Road traffic collisions reported to the Police are recorded in STATS19 reports. These forms are collated and analysed by the London Accident Analysis Unit (LAAU). This group is now located within Transport for London. The legal requirement on the reporting of road traffic collisions to the police is limited, and means that if details are exchanged at the scene of a collision, and the police do not attend, the event can go unrecorded. There is a substantial literature on the under-reporting, for this and other reasons, of road traffic accidents and injuries in the STATS19 reports. (4) One suggestion is that 'slight' casualties are under-reported by a factor of 1.7, while 'serious' casualties are under-reported by a factor of 2.76. (5)

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Crime - The Metropolitan Police Service crime statistics are available on a borough basis and published on the internet (www.met.police.uk/crimestatistics/index.htm). The police statistics record where a crime is reported, which is usually, but not always, where the crime occurred. (See Crime section).

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Fire - Official statistics about the causes and injuries resulting from fire can be found in annual publications produced by the Department of Transport, Local Government and the Regions (DTLR).(6) Before the year 2000, these data were produced by the Home Office. These official statistics include all those fires where the Fire Brigade is in attendance. The London Fire Brigade also presents information on its website, particularly on the number of non-accidental fires, by borough and also by ward of occurrence. However the Fire Service does not attend all fires. The British Crime Survey (BCS) also collects information on dwelling fires in England and Wales (7) including those fires that the Fire Service did not attend. The BCS estimates that only approximately 13% of all fires in England and Wales are attended by the Fire Service.

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Real Fire Library - The London Fire Brigade Fire Investigation Unit attends all large fires, fires where the cause requires specialist investigation and all fires where fatalities or serious injuries have occurred. Information from these fires is entered into the Real Fire Library. The Real Fire Library contains very detailed information on all significant fires in London, approximately 25% (5000 incidents of fire per year). Currently the database holds data on over 27,000 fire incidents. This data is significantly more detailed than that collected by the DTLR. The data from Real Fire Library relates to fires that occurred in the London Fire Brigade's area and therefore will include injuries and deaths to some people who are not London residents, and excludes deaths and injuries to London residents that occurred outside London.

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Accidents at Work - The Health & Safety Executive collects data on workplace injuries under The Reporting of Injuries, Diseases and Dangerous Occurrences Regulations 1995 (RIDDOR 95). The data are based on accident reports from employers and the self-employed to local authorities. The 1995 regulations updated previous legislation, which means that statistics from 1996/97 onwards are not directly comparable with previous years.

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Social Services - Activity data on local authority social services show the number of children placed on child protection registers and why those children have been placed on the register (albeit in broad categories).

Referrals, Assessments, and Children and Young People on Child Protection Registers

Date	Title	Format	View
17 Sep 2002	Presentation - Too High a Price - Injuries and Accidents in London
16 Sep 2002	Accident and Suicide Tables (Supplementary Data)
16 Sep 2002	Estimating the Costs of Injuries and Accidents in London
16 Sep 2002	National and London-wide Policy Initiatives for Injury and Accident Reduction
16 Sep 2002	Too high a price: injuries and accidents in London. Executive summary
16 Sep 2002	Too high a price: injuries and accidents in London. Full report
16 Sep 2002	Too High a Price: Injuries and Accidents in London: Executive Summary - Cover
16 Sep 2002	Too High a Price: Injuries and Accidents in London: Full Report - Cover

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• London Accident Analysis Unit (LAAU)
  Transport for London, Street Management, Windsor House, 42-50 Victoria Street, London SW1H 0TL.
• London Ambulance Service NHS Trust
  London Ambulance Service NHS Trust, 220 Waterloo Road, London SE1 8SD
• London Fire Brigade
  London Fire & Emergency Planning Authority 8 Albert Embankment, London SE1 7SD
• Health and Safety Executive
  Epidemiology and Medical Statistics Unit, Health and Safety Executive, Room 244, Magdalen House, Trinity Road, Bootle. Local office for London: Rose Court, 2 Southwark Bridge, LONDON, SE1 9HS.
• Metropolitan Police Service
  New Scotland Yard, Broadway, London, SW1H 0BG.

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• Department of Health. Saving lives: Our healthier nation. London: TSO, 1999.
• Department of Health. National service framework for older people. London: DoH, 2000
• Department of Trade and Industry. Home accident surveillance system including leisure activities: 23rd annual report. 1999 data. London: DTI, 2001.
• Roadpeace. Under-reporting of road traffic casualties in the UK. London: Roadpeace, 2001.
• Hopkin J, Simpson H. Valuation of home accidents: a comparative review of home and road accidents, Transport Research Laboratory report. Crowthorne: Transport Resarch Laboratory, 1995.
• Watson L, Gamble J, Scholfied R. Fire statistics: United Kingdom 1999. London: The Home Office, 1999.
• Aust R. Fires in the home: findings from the 2000 British Crime Survey. England and Wales. London: Department of Transport, Local Government and the Regions, 2001.

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1. Violence and Injury Prevention
2. Department of Health. Children and young people on child protection registers - year ending 31 March 2001, England. London: Department of Health, 2001.
3. Health & Safety Executive. Safety statistics bulletin 1998/99. Bootle: HSE, 1999.
4. Health & Safety Executive. Safety and enforcement statistics briefing 1998/99: London and the SouthEast. Bootle: HSE, 2000.
5. Holborn P. Fire deaths in London 1996-2000. London: London Fire and Emergency Planning Authority, 2001.
6. Home Office. Home Office Statistical Bulletin. Recorded crime, England and Wales, 12 months to March 2001. London: The Home Office, 2002.
7. London Accident Analysis Unit. Annual report 98. London: London Research Centre, 1999.
8. London Accident Analysis Unit. LAAU topics 2001-1 to 2001-7. London: Transport for London, 2002
9. London Accident Analysis Unit. Casualty targets reduction update. London: Transport for London, 2002.

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