The Missing Link

In the spring of 1988 I had the honour to serve as the Felton Visiting Professor in Melbourne, Australia. Giving 7 or 8 lectures in 5 days while jet-lagged proved to be a huge ordeal and I don’t think I made a great impression. No, that is not entirely accurate: I was a great hit when I gave an after-dinner speech because most of the audience and I were well ‘into our cups’ (inebriated). In spite of my shortcomings, I left Melbourne with many good ideas.


One of these was that we needed to create an injury surveillance system in Canada. My motivation was that this would provide a far more accurate picture of the magnitude of the injury problem we faced. Naively, I thought that when ER data were added to mortality data policy makers would be sufficiently impressed to take action. Although this never happened, the creation of that system (later called the Canadian Hospitals Injury Reporting and Prevention Program (or CHIRPP) may have been one of my most noteworthy accomplishments. It began with m the huge task of persuading the federal deputy health minister all of its importance and the need to support it financially, I also had to persuade all the pediatric ER directors that it was a good idea. Part of what sold the idea to both parties was that this would a collaborative effort between industry, the hospitals, and the government.


The industry part involved persuading Hewlett Packard Canada (HP) to donate a desktop computer to each of the 10 children’s hospitals to enable data entry at the ER by a coordinator who was paid by Health Canada. At the time HP was the main supplier of mainframe computers for all children’s hospitals so this was not a tough sell. Basically, CHIRPP involved presenting a form to parents of an injured child to complete while they were waiting to be seen. However, the basic idea that made CHIRPP and it’s Australian predecessor (the National Injury Surveillance and Prevention Program) different – and presumably better then other ER-based systems – was the inclusion of a free text field on the forms where parents were asked to describe “what happened”.


As the well-publicized launch date drew nearer, I begin running through a mental checklist of all the items that needed to be in place to make the system work as planned and all that could go wrong. About one week before the actual launch, I discovered that there was, in fact, something I had overlooked: a missing link. Can you guess what it was?


Here is a hint: remember that everything hinged on parents filling out one side of the carefully designed reporting forms. It’s true that on the reverse side the treating physician was supposed to enter basic details about the injury and treatment but I was not foolish enough to assume that most physicians would actually do so. We foresaw this problem and arranged for this task to be performed by a paid coordinator based on the medical record. Far more critical was ensuring that parents provided the information we needed, especially the open text field describing ‘what happened’. Generally most parents were given the forms but still something was missing. What was it?


If you guessed pencils, you deserve a gold star on your workbook. We had wrongly assumed that most parents had a pencil with them. But we did assume that the ER had enough pencils lying around to fill the need and it never occurred to us that many parents would forget to return them. So we needed a large supply on a regular basis.


With little time left I managed to persuade Buros Canada – one of the largest pencil suppliers – to donate large numbers of golf pencils to each hospital each month. They agreed but only if all were sent to one address which turned out to be ‘my’ hospital, the Montreal Children’s. We, in turn, somehow managed to distribute them to all the other hospitals. I honestly don’t know or don’t remember how this problem was solved after I was eased out of my position as CHIRPP’s founder, but somehow it was and the system has survived.


Last word: No, in case you were wondering,  providing more accurate (i.e., much larger) numbers has still not persuaded politicians to provide appropriate funding for injury prevention in Canada.

Reference: Mackenzie S, Pless IB. CHIRPP: Canada’s principal injury surveillance program. Inj Prev. Sep 1999; 5(3): 208–213.

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