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Collaborative Approach to Effecting National Building Code Change - - PowerPoint PPT Presentation

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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 T HIS WEBINAR IS BEING RECORDED . S TAY IN THE L OOP ! T HE SLIDE

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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

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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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

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
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Preventing Paediatric Window Falls

A COLLABORATIVE APPROACH TO EFFECTING NATIONAL BUILDING CODE CHANGE

  • DR. MICHELLE SIMONELLI, MD, FRCPC
  • MR. BRUCE SCHULTZ, CODES OFFICER
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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

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Identifying The Problem

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▪ The Building Code is less restrictive for single and two family houses than for multifamily houses

▪ Wind ndow w sills for for

  • pe

penabl ble wi windo dows ws can n be be at at fl floo

  • or

r level vel

Identifying The Problem

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▪ Building Code not treating similar hazards the same

Identifying The Problem

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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

  • pening 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 able wind ndow in a singl gle e or two r two family ly re residenc dence e to be the same e as fo for r multi-famil family dwell llin ings gs re requiri ring: ng:

  • Guard
  • Limiter (permanent)

rmanent)

  • Minimum 900mm (35”) openable sill

above floor OR OR

  • Maximum 1800mm (70”) openable sill

above grade

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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

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Pedi diatric tric Inj njur ury y in n Cana nada: da: Le Leadi ding ng Cause se of

  • f Death
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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

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Pediatric Window Falls

In 2016, 23% of ACH Major Trauma Patients were injured in a fall

➢ 56% of these falls were multi-storey falls from windows ▪ Why does it happen? ▪ How big is the problem nationally?

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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)

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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

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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

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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 ADMIT ITTED D AFTER FALL FROM M BUIL ILDING

  • EST. ADMITTED

D AFTER FALL FROM M WIN INDOW EST. . ED VIS ISIT ITS S AFTER FALL FROM WIN INDOW 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 742 520 520 2599 2599

AVERA RAGE GE 124 87 87 433 33

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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

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Limitations of the Data

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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

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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

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Admission Rates and Injury Patterns

▪ 28% admitted to Alberta Children’s Hospital or Stollery

▪ Skul kull l fra ractu tures es & tra rauma matic tic bra rain in inj njur uries es (TBI)* BI)* ▪ 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

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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 an and have a TBI

The younger er the patien ent, t, the higher er the costs

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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

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The Journey to Change the National Building Code:

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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 community Provincial process in parallel

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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

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Responses

Supportive of change as proposed 103 Supportive of change with minor potential modifications 9 Non supportive/ request modifications 2

The Journey to Change the NBC

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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)

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Next Steps: Existing Dwellings

▪ After market devices available that meet recognized standards

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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

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Next Steps: Existing Dwellings

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Next steps: Public Awareness

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Next Steps: Public Awareness

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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.

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Building Partnerships: The NRC Framework

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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

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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

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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

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Lessons Learned

▪ Health Care voices are amplified when we take them outside of

  • ur natural domain
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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

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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