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Preventing Paediatric Window Falls: A Collaborative Approach to Effecting
National Building Code ChangeDecember 3, 2019 12:00 PM EST
Dr. Michelle Simonelli and Mr. Bruce Schultz
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Preventing Paediatric Window Falls: A Collaborative Approach to Effecting National
Building Code Change
December 3, 2019 12:00 PM EST
Dr. Michelle Simonelli and Mr. Bruce Schultz
Preventing PaediatricWindow Falls
A COLLABORATIVE APPROACH TO EFFECTING NATIONAL BUILDING CODE CHANGE
DR. MICHELLE SIMONELLI, MD, FRCPC
MR. BRUCE SCHULTZ, CODES OFFICER
Objectives
▪ Identifying The Problem
→ City of Calgary
▪ Collecting The Data:
→ Numbers
→ Injury Patterns
▪ Journey To Change The National Building Code
▪ Next Steps
▪ Building Partnerships Outside The Health Care/IP community
Identifying The Problem
▪ The Building Code is
less restrictive for
single and two family
houses than for
multifamily houses
▪ Window sills for
openable windows
can be at floor
level
Identifying The Problem
▪ Building Code not
treating similar
hazards the same
Identifying The Problem
Proposed Change to National Building Code
Existing Code with Proposed Change:5) Windows need not be protected in accordance with Sentence (4),
where the bottom edge of the openable portion of the window is
a) more than 900 mm above the finished floor, or the window serves a dwelling unit that is not located above another suite,
a) the window serves a house with a secondary suite,
b) the only opening greater than 100 mm by 380 mm is a horizontal opening at the top of the window,
c) the window sill is located more than 450 mm above the finished floor on one side of the window, or
d) the window is located in a room or space with the finished floor described in Clause (d) b) located less than 1 800 mm above the floor or ground on the other side of the window.
(See Note A-9.8.8.1.(4).)
Effectively:
▪ Openable window in a single or two
family residence to be the same as for
multi-family dwellings requiring:
• Guard
• Limiter (permanent)
• Minimum 900mm (35”) openable sill above floor OR
• Maximum 1800mm (70”) openable sill above grade
But Where’s the Data?: The Beginning of an Intra-Professional Alliance
▪ City of Calgary approached ACH Trauma Director
▪ Required data to demonstrate severity of problem
▪ Required assistance from the medical community to advocate for urgent change
Pediatric Injury in Canada: Leading Cause of Death
Canadian Pediatric Falls
▪ As with adults, falls are the leading cause of injury admissions & ED visits in Canadian children
▪ 42% of injury related hospitalizations
▪ 36% of injury related ED visits
Pediatric Window Falls
In 2016, 23% of ACH Major Trauma Patients were injured in a fall
➢ 56% of these falls were multi-storeyfalls from windows
▪ Why does it happen?
▪ How big is the problem nationally?
Problem Scope: National Data Sources
I. Canadian Institute for Health Information (CIHI)
➢National Ambulatory Care Reporting System (NACRS)
➢The Hospital Morbidity Database (HMD)
➢The Discharge Abstract Database (DAD)
II. Canadian Hospital Injury Reporting and Prevention Program (CHIRPP via PHAC)
CHIRPP
▪ 19 national CHIRPP ED sites
▪ Front of form collects descriptive data by pt
➢Date, location, sport/MVC (protective equipment), free text description of injury
➢Rich descriptive qualitative data
▪ Back of form injury data by HCP
➢Nature of injury, body part, disposition, follow up
▪ Entered into eCHIRPP database
▪ Site or nationwide queries
CIHI National Data: Pediatric Falls from Buildings
▪ Annually, 124 children ages 0-9 admitted for falls from buildings
▪ PQ: 31*
▪ BC:31
▪ ON:27
▪ AB: 14
▪ SK: 5
▪ MB: 5
▪ NS: 3
▪ NB:3
▪ NWT, NFLD, Nunavut: 1 each
National Pediatric Window Falls Ages 0-9 Years
▪ 70% of falls from buildings were falls from windows
▪ 20% of children seen in ED were admitted
Year ADMITTED AFTER
FALL FROM
BUILDING
EST. ADMITTED
AFTER FALL
FROM WINDOW
EST. ED VISITS
AFTER FALL FROM
WINDOW
2011 138 97 483
2012 120 84 420
2013 112 78 392
2014 124 87 434
2015 128 90 450
2016 120 84 420
TOTAL 742 520 2599
AVERAGE 124 87 433
Limitations of the Data
▪ Robustness of NACRS and DAD
▪ Provincial annual counts less than 5 are suppressed
▪ “Jurisdictions that choose to participate”
▪ NACRS & DAD data indicate Ontario has less 2 x the number of window falls of Alberta despite having 3.3 times the population
Limitations of the Data
Windows and Balconies Falls related Pediatric Injuries in Northern Alberta, Kundra M. and Craig, W.
Retrospective review & 2 year prospective study at Stollery 2009-2017
▪ 107 falls (15.2 per year) <17 yrs
▪ Mean age 5.14, Median age 4, Mean height 110.8cm
▪ 63.2% boys
▪ 55.7% fell in own home
▪ 50.5% through window screen
▪ Only 20% had sills higher than ‘knee height’
▪ 28.6% had furniture pushed up to the window
▪ 28.3% were admitted
Demographics of Pediatric Window Falls ACH
▪ 66% are 4 years of age or less
▪ 78% are 5 years of age or less
▪ Majority are boys
▪ Majority fall from their own homes
Admission Rates and Injury Patterns
▪ 28% admitted to Alberta Children’s Hospital or Stollery
▪ Skull fractures & traumatic brain injuries (TBI)*
▪ Cervical spine fractures
▪ Facial and long bone fractures
▪ Splenic or liver lacerations
▪ 53% of Stollery admissions required surgery
▪ 72% treated & discharged from ED
▪ 13% ACH ED discharges required specialist follow up
Costs of Pediatric Window Falls
Human Cost
Health Care Costs
▪ Direct and Indirect Costs
▪ In 2010, falls for children 0-9 years cost $1,000,000,000
▪ Multi storey falls are the most severe pediatric falls
▪ Most children admitted after multi storey falls are <5 and have a TBI
The younger the patient, the higher the costs
The Journey to Change the National Building Code:
▪ Why change the National Building Code?
▪ The National Building Code is the model code for Canada
▪ Each province chooses how to adopt the code in their jurisdiction
The Journey to Change the National Building Code:
The Journey to Change the National Building Code
Formulate Proposal
Submit Code Change Request
(CCR) to NRC
NRC forwards to Standing
Committee (SC)
SC forwards to Task Group
(TG)
TG Recommends to SC
To public review
TG reviews public review
comments
TG Recommends to SC
SC recommends to
Commission (CCBFC)CCBFC approves inclusion
in code
09/2012-09/2015
11/2016
04/2017
12/2016
05/2018
10/2018
04/2019
05/2019
06/2019
Gather support from medical
communityProvincial
process in
parallel
The Journey to Change the Building Code
▪ What needs to be addressed in a code change request
▪ What is the problem?
▪ What is the proposed solution and how does it address the problem
▪ Which of the stated objectives and functional statements of the code
will the proposed solution assist in achieving?
▪ What are the cost benefit implications
▪ What are the enforcement implications
Responses
Supportive of change as proposed 103
Supportive of change with minor
potential modifications9
Non supportive/ request
modifications2
The Journey to Change the NBC
Slow road to change
▪ 14,072,080 Canadian dwellings
▪ 8,000,000 (60%) single or duplex dwellings
▪ In 2018: 80,000 single & duplex housing starts
▪ New Code for new construction→
▪ 1% of current single & duplex housing inventory
▪ Not all provinces will adopt NBC immediately
▪ Not all the current housing stock has non conforming windows
▪ New Code also applies to renovations
▪ Architectural changes with new National Energy Standards (smaller windows)
Next Steps: Existing Dwellings
▪ After market devices
available that meet
recognized standards
Next Steps: Existing Dwellings
▪ Install guards or limiters restricting opening to 4” (10 cm)
▪ Close & lock windows with low sill heights when small children in house
▪ Don’t push furniture up against windows
▪ Understand that screens are NOT safety devices
Next Steps: Existing Dwellings
Next steps: Public Awareness
Next Steps: Public Awareness
Next Steps: More Codes to Be Changed..
▪ It’s long. It’s complicated. It’s unwieldy. YEARS.
▪ It takes an expert with the seat at the table, like Bruce.
Building Partnerships: The NRC Framework
Building Partnerships: How to Become Involved?
▪ How can you participate in the process?
▪ Participate in public reviews
▪ Opportunity for the public to take a detailed look at proposed changes and to comment on
each one
▪ Attend a Codes Canada meeting
▪ Meeting schedules posted on NRC Website https://nrc.canada.ca/en/node/344
▪ Volunteer for committee membership
▪ Participate in national codes development on a standing committee or as a CCBFC member
▪ Request a code change
Building Partnerships: How to Become Involved?
▪ How can you participate in the process?
▪ Get to know your local and provincial authorities
▪ Make it known as a group when you have a concern and that you have data to
support it
▪ When you have a concern approach the provincial authority for assistance in
the provincial and national process
▪ Make it known to authorities that you have data available on the effects of
safety related issues
▪ Be ready when the authorities come calling
Lessons Learned
▪ You need an inside expert
▪ It’s a team sport
▪ High level and committed City of Calgary staff
▪ An “in” with committees that make the changes (TG, SC)
▪ 20 different institutions across Canada providing letters of support
Lessons Learned
▪ Health Care voices are amplified when we take them outside of our natural domain
Acknowledgements
▪ Mr. Bruce Schultz
▪ Mr. Marco Civitarese
▪ Mr. Steven McFaull, CHIRPP, PHAC
▪ Ms. Trudi Senger
▪ Dr. Manu Kundra, Dr. William Craig and Ms. Neelam Mabood
▪ Dr. Jonathon Guilfoyle and Ms. Sherry McGillivray
▪ IP Professionals across Canada who helped advocate for this change
Questions?
Type your questions into the Q&A box.
THIS WEBINAR IS BEING RECORDED.THE SLIDE DECK AND RECORDING WILL BE
EMAILED AFTER THE WEBINAR.
STAY IN THE LOOP!WWW.FALLSLOOP.COM
WWW.JR.FALLSLOOP.COM
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