Stay On Your Feet® - Haddon's matrix

Background

Dr. William Haddon Jr. is widely considered the father of modern injury epidemiology. Dr. Haddon was a physician as well as an engineer who worked in the United States on the design of safer roads in the late 1950s.

He combined his skills to develop a framework for analysing an injury, based on the:

• host - the person who has been injured [16]
• agent - what has caused the injury [16]
• environment - the physical and social context in which the injury occurred [16].

These aspects are considered during the period leading up to the injury event, the injury event itself and directly after the event.

Analysing an injury in this way may help develop a three-tiered approach to injury prevention, which includes behavioural, environmental and policy changes [20, 43, 44, 45, 46].

From this work, Dr. Haddon developed a tool called Haddon's Matrix, which can be used to assess injury and identify methods of prevention [44, 45, 46].

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Structure

Haddon's Matrix is a table consisting of the following four columns and three rows:

Columns

1. The host refers to the person at risk of an injury [16, 43, 44, 46]. For falls prevention, this includes adults aged 65 years and over.
2. The agent of injury is a type of energy transmitted to the host through a vehicle/ inanimate object / vector [16, 43, 44, 46]. For falls this may be a pushing crowd or an animal.
3. The physical environment includes all of the characteristics of the setting in which the injury event takes place [16, 43, 44, 46]. For falls, this may be a roadway, building, house, bedroom or bathroom.
4. The social environment refers to the social and legal norms and practices in the culture and society [16, 43, 44, 46]. For falls, this may be norms about ageing, physical exercise, nutrition and polices or legislation on the built environment.

Rows

1. Pre-injury event phase / primary prevention:
   This is about stopping the fall event from occurring by acting on its causes, for example: enhancing an individual's strength and balance or good road/house design.
2. Injury event phase / secondary prevention:
   This is when there is an attempt to prevent a fall or reduce the seriousness of a fall when an event actually occurs by designing and implementing protective mechanisms such as wearing a hip protector and installing soft fall surfaces.
3. Post-injury event phase / tertiary prevention (treatment and rehabilitation):
   This is where there is an attempt to reduce the seriousness of a fall related injury or disability immediately after a fall has occurred by providing adequate care such as immediate cardio pulmonary resuscitation (CPR) or first aid, effective personal alarms or emergency medical services with a prompt response time. In the long-term, it may involve working to stabilise, repair and restore the highest level of physical and mental function possible for the injured older person.

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Example

Example of of Haddon's Matrix as applied to falls prevention. Table is based on work by McClure, R., Stevenson, M. & McEvoy [20].

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