The Research Center for Safe and Secure Society, Nagaoka University of Technology (NUT) is working in collaboration with the Digital Human Research Center (currently the Artificial Intelligence Research Center, or AIRC), National Institute of Advanced Industrial Science and Technology (AIST) to conduct research and development on “An Evidence Information Base for Advanced Risk Management in Living Spaces”; this project was selected to receive a research grant in FY2014 by the Research Institute of Science and Technology for Society (RISTEX), Japan Science and Technology Agency (JST). By linking known injury information with data on the various types of risks associated with living spaces, this project aims to establish a consolidated information base to facilitate the extraction of risk-related information, as well as to develop methodologies for the utilization of this information base in risk management.

The objective of this manual is to explain the framework for describing known injury information, as well as to specify unified coding criteria for the reorganization of data from existing injury information databanks.

The initial version of the manual was published in March 2015, and this second version includes various additions and improvements. As research and development efforts progress, further additions and improvements will be made as required.

Detailed descriptions of examples where this manual was utilized will be included in the final version of the manual.

According to the World Health Organization (WHO), an injury refers to the physical damage that results when a human body is suddenly or briefly subjected to intolerable levels of energy by an agent, which can include mechanical energy, heat, electricity, chemicals, and ionizing radiation. In this definition, there are four elements in the occurrence of an injury: the host (i.e., the person who is injured), the agent (i.e., the force, energy, or chemical that causes the injury), the vector (i.e., the person or thing that applies the force, transfers the energy, and causes the injury), and the environment (i.e., the situation or conditions under which the injury occurs). While the epidemiological model proposed by the WHO comprises these four elements, the outcomes of an accident (degree of injury) are important for determining the relative priority of countermeasures. Different accident outcomes require correspondingly different countermeasures, and the responses will vary depending on whether an accident results in fatalities, severe injuries, or light injuries. As a consequence, this manual proposes the Injury Information Description Framework (IIDF) as a description framework for injury information databanks. The IIDF comprises five elements, with the addition of an accident’s “consequence” to the four elements of the WHO epidemiological model. In order to establish this description framework, it is necessary to characterize each element in the conceptual model and to define the vocabulary set used to describe each of these attributes. This content is provided in Table 1.

1. Host
   The host refers to the person who has sustained an injury. The injury information system does not require the inclusion of personally identifiable information. In fact, the inclusion of information that could potentially identify individuals would limit the range of injury information that can be provided. However, attribute information such as age may be needed for investigations into the causes of accidents and the review of possible countermeasures. In ISO 12100:2010 Safety of machinery -- General principles for design -- Risk assessment and risk reduction, Chapter 5.3.2 (Use Limits) states that risk assessments should take into consideration the full utilization range of machinery (e.g., industrial, non-industrial, and domestic) by persons identified by sex, age, dominant hand usage, and limiting physical abilities (visual or hearing impairment, size, strength, etc.). Accordingly, information on the sex, age, and limiting physical abilities of each host are required items for risk assessment in our framework.
   The ISO/IEC Guide 50:2014 Safety aspects -- Guidelines for child safety in standards and other specifications states the need to consider the cognitive and motor development of children when evaluating risks. In particular, children aged 1–2 years have under-developed cognitive abilities, and their motor skills can change on a daily basis. Therefore, it is ideal for age to be provided in units of months for hosts aged below two years.
   Furthermore, some injuries may be concentrated in specific geographical regions. As a result, the region where an accident occurred should be included as a basic item. Cultural differences among ethnic groups can also give rise to disparities in awareness and perceptions. Therefore, each host’s race, region, and nationality should also be included as required items in injury information.
2. Vector
   The vector—which is the cause of an injury—is not limited to a product, but can also include other entities such as persons, plants, and animals. This manual describes “initiating vectors” (causes of the injury), “intermediate vectors” (associated with the accident, but are not the main cause), and “direct vectors” (directly related to the injury). While the initiating vector may also be the direct vector in some cases, these vectors are distinct in other cases. It is critical to include information on the origin and condition of the initiating vector and the cause and responsibility of the direct vector in this injury information system. It would also be beneficial to include information on the model and unit type of products, associated businesses (including manufacturers, importers, and retailers), and utilization duration prior to accident, as these can inform the risk assessment process.
3. Agent
   An agent can refer to a mechanical force or energy that induces a result, as well as an element in a mechanism that causes injury to a person. This manual proposes the description of agents using the following four items: hazard source (e.g., mechanical or thermal source of hazard), mechanism (e.g., falls, impact with an object, and contusions), cause of injury (e.g., design flaw, time-related deterioration, and improper use), and presence/absence of fire. As the effects of fires are far-reaching, it was determined that fire-related agents should be addressed separately.
   With regard to the mechanism of accident occurrence, we predict that the standard descriptive vocabulary lists are insufficient in cases involving complicated injuries or novel accidents. The system should therefore allow the inclusion of relatively free descriptions to supplement the characterization of mechanisms in such cases. To this end, the system will include an “accident summary” item in the remarks column to allow unstructured descriptions.
   In this description framework, injuries are categorized into one of two classifications from the WHO Family of International Classifications (WHO-FIC): the International Classification of Diseases and Related Health Problems (ICD) and the International Classification of External Causes of Injury (ICECI). ICD is already used in a variety of applications in Japan, ranging from population vital statistics to medical statistics. In contrast, the ICECI has yet to be widely implemented in applications throughout the world. However, as the name indicates, this classification system was designed specifically for injuries, and a short list has been developed to facilitate its use in the US Centers for Disease Control and Prevention (CDC). The ICECI is expected to be employed in a wider set of applications in the future, and was therefore included in this system. As there is no official Japanese translation currently available, we have independently worked on its translation for our purposes.
   As classifications are based solely on the ICD and ICECI, there are many cases that will not be indicated in a complete coding system. It should therefore be noted that the codes provided in this manual are independently assigned by the manual’s authors.
4. Environment
   An injury environment is composed of factors such as the time of injury, place of injury, and the injured person’s actions at the time that the injury occurred. The classifications of traffic accidents and occupational accidents define injuries according to the actions of the injured person at the place or time of the injury. In other words, the classification of injuries uses environment-related information that is extracted from available injury information. This is also applicable to other types of accidents, such as medical accidents and school accidents.
   In this manual, information on injury environment is categorized into either natural environment factors or artificial environment factors. Natural environment factors include four items: date of injury, time of injury, weather conditions, and natural disasters; artificial environment factors include eight items: action classification, place of injury, utilization frequency of the initiating vector, location of the initiating vector, implementation of safeguards, stage of utilization, product condition at the time of occurrence, and residential environment. The first four items address natural environment factors such as date and time, weather, and natural diseases; the latter eight items are artificial environment factors that describe the actions of the injured person at the time of the injury, the place, and the initiating vector. Social environment factors, such as the watchfulness of guardians, may also affect the occurrence of injuries.
5. Consequence
   Information on consequences is obtained from the severity of injuries borne by the host and the extent of damage to objects. Information on the extent of harm is crucial for determining the priority of accident countermeasures, and is also a necessary element for evaluating the magnitude of risks. In order to prevent accidents, actions that utilize the investigation status and official announcements of measures are valuable resources for societal risk management. In this research, information on consequences will include the following six basic items: extent of harm (injury severity and extent of damage), injured body part, type of injury (e.g., burn, poisoning, and fracture), treatment classification (e.g., no treatment, additional treatment, and hospitalization), number of injured persons, and implementation of countermeasures.
6. Remark
   In order to manage the accident information, remarks on the following seven types of information will also be included: ID number, date of report, information source, investigation status, clarification of the accident cause, recall date, and accident details (unstructured description).

A wide variety of injuries occur in everyday life, and these are caused by a multitude of intricately intertwined elements. Accordingly, there is a need to allow the systematic description of these conditions. As stated earlier, this manual specifies a description framework involving five elements based on the WHO epidemiological model. However, the epidemiological model is unable to clarify the unsafe behavior (if any) of the injured person, which would constitute a causal factor of the injury. To resolve this issue, the second version of the manual includes an expansion to allow the precise description of human behavior that could be a hazard source with reference to Roudousaigai Bunrui no Tebiki (A Guide to Occupational Accident Classification; Published 19xx) by XX. This guide describes both the unsafe behavior of the injured person and the unsafe situation of the thing/object as causes of injuries. As a result, an attribute was also included to allow the precise description of the host (one of the five elements) as a possible hazard source. Therefore, “human action” is provided as an attribute alongside the hazard source under descriptions of the agent (Refer to Figure 1).

Figure 1. Injury occurrence model and injury information attributes
(Note: * denotes attributes that are essential items used in international statistical standards, such as those used by the WHO; the other items are optional.)

The second version of the manual includes substantial revisions to the description method for initiating vectors, intermediate vectors, and direct vectors. The process of injury occurrence can involve a large number of factors, such as the product being used, the influence of the surrounding environment, factors that directly harm the injured person, or human actions that were the trigger for accidents. In accordance with the WHO’s ICECI, this second version of the manual classifies vectors into initiating, intermediate, and direct vectors. Information on each of these attributes should be included in the framework.

In order to provide specific examples of the items described in the preceding paragraph and Figure 2, unstructured descriptive sentences from the items of “accident notification content” and “accident cause” in the National Institute of Technology and Evaluation (NITE) database were reorganized using the framework conceptualized in this manual. The results are shown below.

As indicated above, when codifying injury information based on the ICECI, descriptions of the two attributes of “mechanism” and “object/substance” were categorized into three stages: Initiating (involved at the start of the injury event) → Intermediate (involved in the injury event) → Direct (producing the actual physical harm).

In order to explain this description method from a different angle, we can use a two-dimensional matrix involving the ICECI’s three stages of injury processes (Initiating, Intermediate, and Direct) and the NITE database’s damage classifications (No damage, Object damage, and Injury). Here, the “object” is the key, and we use three examples of baby carriage accidents selected from the NITE database (shown in Fig. 3). Through the establishment of databases that include incidents without damage and accidents with damage to objects and property (but no injuries to humans), we may be able to elucidate the reasons that explain how an incident progressed to an accident. This will provide highly important evidence for advanced product safety management and the actualization of risk management.

Figure 2. Examples of applications of injury information reorganization using NITE data

Although there are existing information databases concerning injuries in daily life in various fields, the lack of a unified format in data entry means that even if there is valuable information stored in these databases, it may not always be possible to adequately re-utilize this information to benefit society. This manual uses the IIDF format to consolidate and summarize the injury information databases currently managed by various government ministries and agencies within Japan. In this way, we provide a novel approach for the future development of new technology to utilize injury information.

Table 1. Organization of recorded items in various domestic databases concerning risk information in living spaces based on the Injury Information Description Framework (IIDF)

(note: ※: With the standard items; It isn't separated every standard item, but it's sometimes included in describing.; ×: Without the standard items.) 2. About an abbreviation: NITE ADB: National Institute of Technology and Evaluation Accident information data base; NITE RDB: National Institute of Technology and Evaluation accident Announcement by company and recall information database; KDDB: National Institute of Advanced Industrial Science and Technology design data base of kids; -: The contents in detail can't be checked.; ※△: In case of death by an external cause, an injury was done or the related information as of the death is asked. *Used product: In the event of a dangerous incident, the information of product will be primarily taken into account. However, the product being used at the time may serve as a product occurred at start, product involved, or the role of product causing injury. *Guardian: It's sometimes purchased about those behavior details in case of occurrence of the occasion of the child and the person who needs nursing and a dangerous event. *: Detailed information about a thing is chosen after post enumeration and cause revealing with a person in case of a fire investigation, it'll be often reported;)

Standardizing and codifying information enables us to maximize the use of injury information. Accordingly, this manual uses, where possible, vocabulary lists that comply with international standards (e.g., WHO and ISO) and domestic standards for the individual items presented in Figure 2. However, there is currently a lack of international standards for several attributes that are thought to be required for the elucidation of injuries and the improvement of product design. As a result, we have independently developed classification codes for these attributes.

Table 2. Information sources of the standardized vocabulary list used in the IIDF

Through the development of the aforementioned designs, the injury data in this manual exhibit the following distinctive characteristics:

• Enable international comparisons;
• Reduce operation time for data mining;
• Enable objective and quantitative risk assessments;
• Reduce costs through the integrated management of various data;
• Improve convenience for all users through the use of logical hierarchical data expressions;
• Form the foundation of public-private shared information exchange.

While this manual incorporates the results of various projects conducted by research group members from NUT and AIST, authorship of this manual centered around Dr. Kun Zhang (a member of the AIST’s AIRC and a research fellow [JSPS Postdoctoral Fellow] at NUT’s Research Center for Safe and Secure Society) and Prof. Yoshiki Mikami, Principal Investigator. The standardized vocabulary list was independently developed by Mr. Yuki Iizawa, Ms. Junko Sato, and Ms. Yukari Yokota. Mr. Yuki Iizawa organized the printed materials.

The integrated hazard source list attached to the Appendix was developed by Prof. Takabumi Fukuda and Mr. Yuki Iizawa from the Department of System Safety, NUT, as part of a research project funded by a Grant-in-Aid for Scientific Research entitled “Surveillance of Injury Information in the Era of Market Surveillance” (FY2013 to FY2015; Principal Investigator: Prof. Yoshiki Mikami).