Introduction: We seek to characterize unhelmeted injured cyclists presenting to the emergency department (ED): demographics, cycling behaviour, and attitudes towards helmet use. Methods: This was a prospective cohort study in a downtown teaching hospital, from May 2016 - Sept 2019. Injured cyclists presenting to the ED were recruited if they were not wearing a helmet at time of injury and over age 18. Exclusion criteria included intoxication, inability to consent, or admission to hospital. A standardized survey was administered by a research coordinator. Descriptive statistics were used to summarize the data, and survey responses reported as percentages. Results: We surveyed a convenience sample of 68 unhelmeted injured cyclists (UICs) with mean age of 33.6 years (range 18 to 68, median 29.5 years). Ratio of males to females was 1:1. The majority of UICs cycled most days per week or every day in non-winter months (89.6 %, n = 60). Cycling in Toronto was perceived as somewhat dangerous (45.6%, n = 31) or very dangerous (5.9%, n = 4) by most, and very safe (2.94 %, n = 2) or somewhat safe (19.12%, n = 13) by few. Almost a third (29.4 %, n = 20) had been in a cycling accident in the prior year, some of these (15.0%, n = 3) prompting an ED visit. All cyclists were riding their personal bike (100 %, n = 68) at time of injury, and most (98.5%, n = 67) had planned to cycle when they departed home that day. Purpose of trip was primarily for commuting to work (50%, n = 34), social activities (19.1%, n = 13), school (7.4%, n = 5), and recreation (7.4%, n = 5). Bicycle helmet ownership was low (41.2 %, n = 28). UICs reported rarely (10.3%, n = 7) or never (64.7%, n = 44) wearing a helmet when cycling. Reported factors discouraging helmet use included inconvenience (33.8%, n = 23), lack of ownership (32.4%, n = 22), discomfort (29.4%, n = 20), and ‘messed hair’ (14.7%, n = 10). Few characterized helmets as unnecessary (10.3%, n = 7) or ineffective (1.5%, n = 1). The majority had a college diploma or more advanced education (77.9%, n = 53), and spoke English at home (85.3%, n = 58). Conclusion: Unhelmeted injured cyclists surveyed were frequent commuter cyclists who do not regard cycling as safe, yet choose not to wear helmets for reasons largely related to convenience rather than perceptions regarding safety or necessity. Initiatives to increase helmet use in this subgroup should address the reasons given for not wearing a helmet, potentially using principles of adult education and behavioral economics.

Using post-colonial theory, we sought to determine what current falls prevention recommendations are offered by local falls prevention programmers (LFPPs) to reduce fall rates among Inuvialuit Elders in Inuvik, Northwest Territories, Canada, and to understand how falls prevention programs for Inuvialuit Elders can be co-created with participants to be culturally safe. The findings showed that Inuvialuit Elders and LFPPs in Inuvik recommend adding environment assessments and modifications, physical activity, and education for Elders and caregivers to existing programs. They also felt that for culturally safe falls prevention programs to occur, LFPPs must include the following strategies: establishing trust and rapport within the community, including both Indigenous and non-Indigenous interventions in falls prevention programs, and training others on cultural safety practices.

Parents’ perspectives on their children’s outdoor risky play behaviours influence their children’s adoption of safety strategies and their children’s approach to risky and dangerous situations (Brussoni & Olsen, 2011). Over the past decade, researchers have explored many Canadian mothers’ and fathers’ perspectives on this topic; however, to date, there has been a lack of research on Indigenous parents’ perspectives, particularly those of Inuit parents. This lack of research means that Inuit families are unaccounted for in research used to create and promote safety policies and practices in Canada. The present research commentary is the first to address the urgent need for research on northern Canadian Inuit parents’ perspectives on outdoor risky play. Specifically, outdoor risky play is defined, and Inuit children’s outdoor play experiences are compared to non-Inuit children’s experiences. Further, Inuit children’s experiences of injury are discussed to further situate the dire need to work with the most vulnerable population in Canada – Inuit – in child injury prevention research.

Compliant flooring aims to prevent fall-related injuries among high-risk older adults in long-term care, but uptake of compliant flooring in this setting is limited. We hosted a one-day stakeholder symposium to identify advantages and disadvantages of implementing compliant flooring in long-term care and the most pressing directions for future research from the perspective of key stakeholders. Twenty-three stakeholders representing health care, industry, and research attended the symposium. Attendees believed the most important advantages of compliant flooring were reducing injuries in residents who have fallen, potential benefits to care staff, and potential increases in quality of life for residents. Attendees perceived the most significant disadvantages of compliant flooring were financial considerations, lack of research evidence, and challenges with installation. Attendees indicated a need for additional research on cost-effectiveness and clinical effectiveness. While stakeholders perceived compliant flooring to add value to long-term care, there are significant informational and financial barriers to uptake.

Introduction: Gun related injuries were last reported by the Canadian Hospitals Injury Reporting and Prevention Program (CHIRPP) in 2005. Since that time, Canadian gun control is less stringent and non-powder guns are increasingly popular. We aim to describe trends in pediatric gun related injuries and deaths since 2005. Methods: This is a retrospective review of CHIRPP data. The dataset included pediatric (age 0-19 years) gun-related injuries and deaths reported by participating CHIRPP emergency departments (ED) from 2005-2013. Variables were tested using Fisher’s exact test and simple linear regression. Results: There were 421 records of gun-related injuries in the database. Three hundred and twenty-nine occurred from use of non-powder guns, 85 occurred from use of powder-guns, and in 7 cases the type of gun was not clear. The number of gun-related injuries per 100 000 ED visits remained stable from 2005-2013 with a male predominance (n=366, 87%). Most injuries resulted from non-powder guns and were unintentional. Injuries most often occurred in the context of recreation (n=181) and sport (n=51). One hundred fifty four eye injuries were reported, 98% of which were from a non-powder gun. Forty-six individuals required admission to hospital and 2 died in the ED. Nine of 10 intentional self-harm injuries were inflicted with a powder gun. Conclusion: This study describes the injuries and circumstances in which pediatric gun-related injury and death occur in Canada. Unintentional injuries caused by non-powder guns were most common. Though less fatal than powder guns, non-powder guns can still cause life-altering eye injuries. This evidence can inform injury prevention programs to target specific circumstances in which the pediatric population is most vulnerable.

Introduction: The Canadian Hospitals Injury Reporting and Prevention Program (CHIRPP) found a significant rise in trampoline-related injuries from 1999-2005, many of which required hospitalization. In 2007 and again in 2013, the Canadian Pediatric Society (CPS) recommended against the recreational use of trampolines at home. The purpose of this study was to evaluate the impact of this policy statement on trampoline-related injuries in Halifax, Nova Scotia. Methods: Trampoline injury data was obtained from the CHIRPP database at the IWK Health Centre, the paediatric referral hospital for the Maritimes. The data was stratified according to the timing of the CPS policy statement (before: 2001-2006, after: 2008-2013 and after reaffirmation 2013-2015). Data variables included mechanism, site, nature and context of injury. The data were evaluated using SPSS and chi-squared tests. Results: Since the 2007 CPS policy statement, an average of 162 per 10,000 ED visits at the IWK Health Centre were the result of trampoline-related injuries compared to 95 per 10,000 pre-policy. The majority of injuries (76-80%) occurred in children 5-14 years of age. Recreational use at home in the yard was the most common location of the accident (78-88%), with most injuries occurring on the trampoline mat itself (83-85%) due to incorrect landing (32-35%), falls (21-27%), or being struck by a person or object (24-25%). Soft tissue injuries (15-17%), sprains (19-22%) or fractures (40-46%) to the elbow (11-12%), forearm (5-9%) or ankle (19-21%) continued to be the most common nature and sites of injuries. The injury data before compared to after the CPS policy statement did not differ significantly in gender, the mechanism of injury, the type of injury, or body part involved (p-value >0.05). There was a significant difference in the number of injuries between age groups post-policy, with more occurring in children less than 4 and between the age of 10-14 (p<0.009). Moreover, where the trampoline injury was located was also significantly different post-policy with more injuries occurring in sports/recreational facilities (p<0.001). Conclusion: Trampolining is a high-risk activity with injuries occurring predominantly in children and youth. Despite the recommendations brought forth by the CPS, trampoline-related injuries remain an important source of pediatric injuries at the IWK Health Centre in Halifax, Nova Scotia.

Amber teething necklaces supposedly provide analgesia for teething infants. Their use is becoming more widespread, despite lack of peer-reviewed evidence and warnings from Health Canada that they pose a strangulation and aspiration risk. To date, there have been no published reports of strangulation secondary to amber teething necklaces. In this report we present a case of non-fatal infant strangulation from the first time use of an amber teething necklace. We will also discuss the role of physicians as advocates in reporting similar cases and educating families. Finally, we will comment on the responsibility of all professionals and professional organizations that work with infants and toddlers to advocate for children by raising concerns and counselling parents.

Introduction: Head injury is a major cause of bicycling-related disability and death, and more likely to occur in unhelmeted riders. Legislation regarding helmet use varies by province. In Ontario, helmet use is not mandatory for cyclists >= age 18, and approximately 50 % of adult cyclists do not routinely wear helmets. Non-legislative approaches to increase helmet use have included education, public health campaigns, and helmet giveaways, but sustained effect is typically limited. The goal of the HEADSTRONG Behaviour Study is to identify injured adult cyclists who do not regularly wear helmets, and effect sustained helmet use. The strategy incorporates evidence-based elements of health behaviour change, including: reducing barriers, education and modelling, providing necessary materials, and social support. Methods: Prospective cohort study in downtown Toronto teaching hospital, launched Nov 2015. ED clinician (EP or NP) will recruit injured cyclists (consecutive, convenience sample) who report not regularly wearing a helmet nor owning a suitable one. Study endpoint: 100 enrolled (to estimate prevalence of usage of +/- 10%, alpha 0.05, power >90%, assuming 80% study completion and 50 % helmet wearing at 12 months). Exclusion criteria: unable to consent, admitted to hospital, age <18. Each element of the HEADSTRONG Behaviour Strategy is intended to facilitate patient adoption and maintenance of the desired behaviour, including: 1) enrolment/education by research associate while still in the ED; 2) provision and fitting of a free bicycle helmet; 3) social contract commitment and tailored reminders to document ongoing helmet use: participant agrees to respond to brief electronic survey follow-ups at two weeks, two months, six months, and twelve months; 4) social media engagement with participation in the HEADSTRONG Twitter group, which engages other enrolees and cycling advocacy groups; 5) peer nomination: the participant who is complying with the social contract is encouraged to nominate an uninjured non helmet-wearing colleague to enrol in the study. Results: Primary outcomes include: recruitment rate, enrolment, and sustained participation through follow-up period. Secondary outcomes include age, gender and social demographics of helmet recipients, and participation of peers. Conclusion: Discussion of strategy and interim results at six month interval will be presented at CAEP.

The purpose of this phenomenological study was to explore the everyday experience of community-dwelling elders, with particular attention to seniors' perceptions of safety, fear of falling, independence, and quality of life. We also aimed to identify contextual factors that influence the health of elders who had fallen and/or had a fear of falling. Data from in-depth interviews with a purposeful sample (n = 9) of elders were analysed using interpretative analysis procedures. Both individual and team analysis was undertaken until interpretations of the experiences of the participants were inductively developed and crystallized into a holistic interpretation of the participants' shared experience. The holistic experience was comprised of two opposing, dynamic life forces: exercising precaution and striving for independence. Within each life force, participants used five major strategies that simultaneously constrained and expanded their life space. Health-promoting practice and policy implications, as well as areas for further research, are discussed.

This paper reports the process outcomes of a randomized trial of a one-session Motivational Interviewing (MI) intervention conducted with youth (12–20 years) in a hospital emergency department (ED) while undergoing medical care for an injury. The interventions targeted six behaviors placing youths at high risk for injury. Those youth whose counselors perceived their readiness to increase between the start and end of the MI session were 4.5 times more likely to have improved their use of seat belts 6 months later compared with youth who were not perceived to have increased in readiness during the session.