Keep your head!: preventing traumatic brain injuries in Eeyou Istchee

May 27, 2016
TBI pie-chart

by Patrick Mcdonagh

This story was originally published October 31, 2015. Update to this story (May 27, 2016): A paper containing results of Dr. Lasry's research was published in the prestigious scientific journal CMAJ Open. Read the paper.

Physical assaults, falls, accidents when driving motor vehicles, all-terrain vehicles (ATVs) and snowmobiles: these are the main causes of traumatic brain injury in Eeyou Istchee, according to a recent study. Traumatic brain injuries, or TBIs, include concussions, fracture, or even internal bleeding that can result when an individual experiences a head injury. A recent collaboration between the Cree Health Board and Oliver Lasry, a neurosurgeon and epidemiologist with the Montreal General Hospital, has shown not only that TBI rates in Eeyou Istchee and Nunavut are much higher than the Quebec average, but also that its causes are different from both Quebec in general and other northern but non-native communities. 

“Our study aimed to describe who was at highest risk and what the causes of TBIs were, and then to identify what risk factors in communities we could address with different interventions,” says Lasry. What they discovered was eye-opening: in Eeyou Istchee a stunning 26% of reported head injuries were caused by assaults, 22% by falls, 21% by motor vehicle accidents, 10% from ATV accidents, 6% from snowmobile crashes, and the remaining 15% by assorted other causes. “There is a big difference in who gets affected by head injuries in Eeyou Istchee compared to the rest of Quebec,” says Lasry. “In the rest of Quebec, over half of head injuries are caused by falls, and usually the victims are the elderly and the very young; in Eeyou Istchee there are more injuries among adolescents and young adults, and the main mechanisms of injury are related to assaults, or physical aggressions, off-road vehicle collisions, and motor vehicle collisions.”

TBI rates and causes even vary within the Cree territory. Whapmagoostui, Eeyou Istchee’s most remote community, has no provincial roadways and people rely more heavily on ATVs, so ATV accidents are the main cause of TBIs in that community; in other communities, physical aggression was most often the primary cause. “So even within Eeyou Istchee there are differences, which makes planning the most helpful ways of targeting dangerous activities more complicated, because they vary from community to community.”

Another challenge is simply keeping track of injuries. This survey is the first attempt to describe the rates of TBI in Eeyou Istchee, and relied on statistics from hospitals and clinics. “But I think quite a few injuries are unreported, and that is a concern,” says George Diamond, the Cree Health Board’s program officer for Healthy Communities. “Another concern is that some parents hit their children on the head to discipline them. We don’t know how severe these hits are and they aren’t reported. But we do know that repeated hits to the head can cause problems.”

The study is leading to efforts to target the three main causes of TBIs: violence, off-road vehicle collisions and motor vehicle collisions. The study’s team, including Lasry and Diamond, has looked at strategies used elsewhere and has brainstormed new ideas to share with all those who could play a role in prevention strategies. 

“We need to work together for a solution,” says Diamond. “All the different entities and departments involved in promoting safety need to combine if we are to see positive results.” 

 For instance, addressing the problem of TBIs caused by violence could involve input from schools (though anti-bullying programs), band councils (such as shelters for victims of domestic violence and reduced availability of alcohol), the justice system (through prevention programs and campaigns to have people report violence); and from the Cree Health Board (through access to rehab programs and psychological support for victims of violence). As for TBIs caused by ATV and motor vehicle accidents, local safety departments could launch driving and safety courses for ATVs and snowmobiles; road maintenance departments might develop clearer trails for ATVs and snowmobiles, and could provide guardrails at difficult sections of highway; and recreational departments could promote the use of helmets and other safety gear.

Individuals can play a role, as well. “As parents and grandparents, when our children ask us to use ATVs or snowmobiles, we always let them but we don’t often give them very close supervision,” says Diamond. “So we need to take the responsibility of teaching them to ensure they wear helmets and follow safe practices.” In addition, Diamond points out, alcohol is a factor in many TBIs. “As individuals or family members we have to emphasize to whoever is operating a motor vehicle, ATV, or snowmobile that they must not drink and drive,” he says. “I think taking it down to this more personal level might be even more effective than a global campaign.”

At this early stage, the strategizing to reduce TBIs has just begun; individuals and entities must now work to identify and implement the best approaches. “Because we don’t need to have this problem,” says Diamond. “We can live without head injuries.”

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