Safe Community Kouvola

City Hall Kouvola

Country: Finland
Number of inhabitants: 31,000
Programme started year: 2001
International Safe Communities Network Membership: Designation year : 2008
Info address for the community: www.kouvola.fi
Full application available: http://www.phs.ki.se/csp/pdf/safecommunities/kouvola2008.pdf

For further information contact:
Pertti Vanhala
The City of Kouvola
Torikatu 10
FI- 45100 Kouvola
Finland
Phone : +358 05 829611
Fax: +358 05 3752 197

e-mail: pertti.vanhala@kouvola.fi

The programme covers the following safety promotion activities:

The pedestrian street in Kouvola is a symbol for Kouvola safety work in which pedestrian and cyclist safety, providing public places for citizens activities and involving the association of City Centre entrepreneurs in joint safety work are among key issues.

Children 0-14 years:

Children and the youth are an important focus group in Kouvola's traffic safety work. A web-based traffic safety game has been developed especially for primary schools and traffic safety events are organized on yearly basis. A useful tool for traffic safety education is the traffic park where children can practice traffic rules in a realistic environment.

The improvement of planning for child safe environment is one central focus area of Kouvola's Safe Community work. In order to reach this target, a pilot project was carried out in Kouvola in the spring 2007 for improving the participation of the children in planning for their living environment. In this pilot project children from the daycare and school were photographing their environment and after that explaining their pictures freely following a “tell tale” –methodology. This pilot project served as a basis for development of the methodology which will be applied in other environments in a more systematic way in the future.

Web-based TAPE©-software for injury prevention is used in children's day care (all kind of municipal and private day care facilities). The information of TAPE can be reviewed in real time and used for injury prevention in day care facilities. Injuries of all children needing medical attention are followed at the emergency departments of special and primary health care. This information is basically used for research to describe the profile of these injuries and to identify risk groups in order to develop preventive interventions.

Events/measures targeting children 0-14 years:

• Safe Daycare program, implementation and monitoring
• Developing the planning praxis so that children are involved in the planning of their safe environment. Pilot study will be carried out and its results will be evaluated.
• Policy program for children and families, implementation and monitoring.

Youth 15-24 years:

Good practices have been created to improve the safety of the youth. One such is the organization of street patrolling to safeguard the youth in the city center during weekend evenings and nights. The running of this activity is organized in co-operation between city of Kouvola youth office, Red Cross of Kouvola and the Kouvola Parish. Those doing the foot work are voluntary persons, including professionals as well as ordinary people like parents. The method is to offer presence of adults, discussion partners and help to those in trouble. This has been experienced to be very effective way of preventing violence and crime.

The meeting and information point for the youth “Majakka” is situated in the city center, at Hansakeskus Shopping Mall. In Majakka youth can meet freely and also get advice and information from the worker in duty. A special project is to organize support for the youth to help them finalize their educational duty. This project is organized in co-operation between social work, youth work and school.

Events/measures targeting youth 15-24 years:

• Safe school program for all schools, implementation and evaluation of progress.
• Involving the parliament of youth in the safety work, creating the working model, implementation and evaluation of progress
• Campaign for safe evenings and weekends including prevention of intoxicant abuse

Adults 25-64 years:

Among the adults especially problematic are men's injuries in free time, both deliberate self-harm and unintentional accidents. In this age-group alcohol plays a clear role in accidents among both sexes. To decrease home-, leisure time and sports injuries, well focused campaigns are needed, this should also address alcohol abuse. A part of the solution in decreasing home accidents is to develop and effectively market safety equipments for home renovation.

The safety of public places in Kouvola is a central focus of Kouvola's safety promotion work. Special effort has been put to improve safety both at parks and in street environment. Work to develop “Lively city centre” and to improve the pedestrian area in the centre of Kouvola plays an important part in this. Practical actions include improving the prevention of slippery conditions in the streets and lighting as well as improving the playground safety and safe structures at sports places. As part of the traffic safety program, the traffic environment is improved especially by improving the safe circumstances for pedestrians and cyclists. For this, long-term development work, Kouvola has received a nomination for cycling city of the year in 2005.

Kouvola's program for accessibility is from year 2006. As a basis for this program an extensive evaluation of infrastructure and buildings was carried out in order to find out deficiencies and best practice examples. Program includes timetable and plan for improvement of the city environment from the accessibility point of view.

Kouvola has an active council of the disabled, which has enhanced studies of the urban environment and public places from the point of view of the disabled. Public buildings and outdoor environments have been mapped in 2004 considering persons with impaired hearing and defect of vision. On basis of this work the lighting of the city centre has been improved and public places have been equipped with hearing aid. Salpapuisto park at city centre has been constructed especially to serve the needs of disabled persons. Developments to better serve the needs of the disabled in Salpapuisto and other parks in the city center, are planned for the coming years.

An important part of safety promotion work is carried out via Kouvola city centre association, which members are the entrepreneurs and real estate owners in the city centre. The association is responsible for arrangements of all public events which take place in the city centre and also for their safety. The association follows up the safety developments in the city centre continuously and it plays a crucial role in linking citizens and their needs for safety and nuisance to everyday work of the authorities and other responsible parties. Safety promotion events are organised regularly by the association in the city centre.

Events/measures targeting adults (25-64 years) and families:

• Policy program for children and families, implementation and monitoring
• Action program to prevent domestic violence, implementation and monitoring
• Campaigns to prevent alcohol abuse which includes the constructing and implementing of an intoxicant strategy
• Campaigns promoting safe leisure time renovations
• Suicide prevention including the creation and implementation of working models

The elderly 65+ years:

Prevention of injuries among the elderly is an important target. In older age groups falls are typical injuries. Systematic development of information and advice concerning prevention of injuries at home and prevention of traffic accidents is on-going as part of activities served by the meeting point for the elderly (Ikäasema) at the city centre and as part of the work of the council of the elderly. The elderly participate also to the monitoring of the accessibility program. An important focus area is to develop preventive visits at home to assist the elderly living at home to understand the importance of preventive measures. The TAPE©-software is a crucial tool to collect information and develop follow-up of the injury situation of those living at home as well.

An important way to prevent these injuries is to increase exercise in all age groups. Organizing exercise for the elderly is an important focus of Kouvola's clubs and associations for the elderly. Of crucial importance is to encourage the elderly to move among the other people and to prevent displacement and isolation. In this respect the plans to develop the city infrastructure and especially parks to enhance activation of different age groups is an important approach.

Events/measures targeting the elderly +65 years:

• Monitoring of the accessibility program and continuation of the work
• Campaigns for home safety including planning, realization and monitoring
• Campaigns for exercise planning realization and monitoring
• Creation of 3G parks in Kouvola, participation of stakeholders in the development project and construction of the parks and monitoring
  

At the following environments :

Home:

• Campaigns for home safety of the elderly including planning, realization and monitoring
• Policy program for children and families, implementation and monitoring
• Action program to prevent domestic violence, implementation and monitoring

Traffic:
A new traffic safety plan has been created in 2007, which covers the entire Kouvola region. The targets for traffic safety work by 2015 in the region include:

• decreasing the amount of moped accidents and accidents of the youth
• decreasing the speed to the main target for the planning of the traffic environment
• special attention to the traffic environment planning in protecting the vulnerable groups i.e. children and the elderly
• improving the safety of light traffic by small adjustments
• improving the safety of heavy transports by influencing the driving culture
• increasing the cross sectional co-operation in traffic safety
• improving the respect for traffic safety work

Traffic safety development has been monitored in Kouvola since 1990's by systematic collection of accident information. This information is reported once a year to the city council and to different committees. The report includes a map of all accident locations. The consequences of the long term efforts on traffic safety can be seen e.g. in the decrease of cycling accidents.

Traffic injuries needing medical attention are followed at the emergency departments (ED) in special and primary health care using the ICD-10 classification (external cause of injury).

Occupational:
Occupational injuries needing medical attention are followed at the EDs in special health care and primary health care using the ICD-10 classification (external cause of injury).

School: The Kouvola's Safe School toolkit and the TAPE©-software for collection of injury data will be taken into operative use in every school in the city during 2008. The matrix for monitoring the development of the safety work will be used to set targets for school safety work in every school on yearly basis. Special attention will be paid to develop methods to increase participation of schoolchildren and their families at safety work.

Sports: The sports associations are an important stakeholder in Kouvola Safe Community work. This involves joint effort to prevent injuries in sports activities as well as programmatic prevention of intoxicant abuse carried out by sports associations.

Leisure: The safety of public places in Kouvola is a central focus of Kouvola's safety promotion work. Special effort has been put to improve safety both at parks and in street environment. Work to develop “Lively city centre” and to improve the pedestrian area in the centre of Kouvola plays an important part in this. Practical actions include improving the prevention of slippery conditions in the streets and lighting as well as improving the playground safety and safe structures at sports places. Campaigns promoting safe leisure time renovations.

Violence prevention:

Program for security planning has been carried out through regional co-operation under the Security working group of Kouvola region. This work, which initiated in 2003, has focused on improving the prevention of crime and violence. The working group has gathered different authorities and stakeholders responsible for the security issues. As a basis of this work a common social worker for police and the municipality is hired to the Kouvola police station. This measure has been invaluable in long term tackling of domestic violence and in enabling early intervention with social problems, thus preventing crime and violence.

According to the Start injury data, males aged 20 to 24 years are at high risk of being victims of violence. Alcohol is strongly associated in violent injuries. This is the most challenging and difficult target group for prevention. All the interventions focused in this group will be planned and performed multiprofessionally in co-operation with social care and several other relevant fields.

• The objective is to prevent violence and crime through stakeholder focused security planning and allocated personnel
  

Suicide prevention:

The prevention of suicide in the Kouvola region is carried out by voluntary actors. Active in this sector are the organizations Surunauha ry, for those those, whose nearest have committed suicide and Kymenlaakson mielenterveysseura, the society for mental health in Kymenlaakso. The research and long term programs for suicide prevention have not been previously established in Kouvola. The mental health care in Kouvola Regional Health Care Center is responsible for preventive work in the municipality.

In schools, in long term perspective, the general safety and the prevention of bullying are also important tools in preventing self harm and suicides. Programmatic work for prevention of suicide needs to be developed in the city of Kouvola . Thus in injury registration the frequency of self harm cases is identified. Subsequently the data analysis and planning of the preventive work based on the analysis, is important in suicide prevention.

The mental health issues need to be developed in Kouvola region addressing especially the youth and the middle aged population to prevent exclusion, self harm and suicide.

In the Start injury data of Kouvola region, persons attending to medical care due to self harm or suicide attempt are identified (ICD-10, external cause of injury), and the psychiatric consultation in these cases has been arranged. According to the Start injury data, young females are at highest risk of self harm and suicide attempts, alcohol and medication intoxication as well as the use of sharp objects being the main types of self injury. In the next stage of the Start project, preventive interventions are to be planned and performed in co-operation with professionals of several fields.

Programmes aiming at "High risk-groups":

Prevention of hazards and injuries caused by alcohol is an important issue in all age groups, including the elderly. The active discussion policy concerning alcohol problems is taken to regular use as an intervention method in Kouvola Region's health centre. It is crucial to develop monitoring methods and evaluation of effects of such interventions concerning alcohol hazards as part of the injury research.

At the moment, we are planning one additional time related structured variable in the TAPE©-software where the actions that have been performed in the facilities on the basis of injury information, are described and can be chosen, and their effectiveness can be evaluated in time. In childrens' day care these are for example: increased the number of staff, removed some furniture, checked and repaired the playground equipments etc. In the care of elderly, correspondingly, these options could be for example: increased the number of staff, changed the shifts of the staff, checked and removed some medication (hypnotics, antidepressives, neuroleptics etc.), removed or changed some furniture/obstacles etc., just to mention some simple possible options. We are working on this variable.

Surveillance of injuries :

Health centre of Kouvola region, Kuusankoski Regional hospital, institutions of the elderly, children's' day care units and schools.

The web-based TAPE© tool plays an important role in the monitoring and prevention of injuries. Hospital wards, nursing homes, residential homes, kindergartens, schools etc. using TAPE©-software can view and monitor their injury situation in real time as has been described earlier. The main purpose of TAPE©- software is that the information is to be used immediately for future injury prevention. However, TAPE© is also an excellent everyday tool for safety management and promotion for those in charge in the units.

The next stage of the injury prevention project of Kouvola Region is to develop multiprofessional interventions for injury and violence prevention in co-operation with universities and other institutions.  

Numbers of injuries per year: Approximately 2800 and 3000 attendances due to an acute injury in special health care and in primary health care, respectively.
Population base: 90,000 in special health care and 81,000 in primary health care and in TAPE.
Started year: 2001, TAPE 2006

Publications: (Scientific)

Airaksinen Noora (2007). Pyöräilijöiden, mopoilijoiden ja moottoripyöräilijöiden liikennetapaturmat Pohjois-Kymenlaaksossa. Väliraportti ensimmäisen vuoden tutkimustuloksista. Liikenneturvallisuuden pitkän aikavälin tutkimus- ja kehittämisohjelma. LINTU-julkaisuja n/2007 (www.lintu.info.fi)

Kaukonen JP, Nurmi-Lüthje I , Lüthje P, Naboulsi H, Tanninen S, Kataja M, Kallio ML, M.Leppilampi. Acute alcohol use among patients with acute hip fractures: a descriptive incidence study in southeastern Finland. Alcohol & Alcoholism 2006 May-Jun; 41(3):345-348.

Nurmi I, Narinen A, Lüthje P, Tanninen S. Cost analysis of hip fracture treatment among the elderly for the public health services. A prospective study in 106 consecutive patients. Arch Orthop Trauma Surg 2003; 123: 551-554.

Nurmi-Lüthje Ilona. Alkoholi ja vanhusten tapaturmat -voimistuva yhteys. [ Alcohol and injuries among elderly-increasing association ]. Suomen Lääkärilehti , lääketieteellinen pääkirjoitus [ Finnish Medical Journal, editorial] 2006; 35: 3433.

Nurmi-Lüthje I, Karjalainen K, Hinkkurinen J, Salmio K, Lundell L, Salminen M, Pelkonen J, Kajander A, Lüthje P. Tapaturmakäyntien tilastointi paljastaa riskiryhmät [ First attendances due to an acute injury in Regional Hospital Kuusankoski –a two-year prospective study in Kouvola region, Finland ] Suomen Lääkärilehti [ Finnish Medical Journal ] 2007;62:3434-3436 (1-5).

Nurmi-Lüthje I, Kristeri K, Salmio K, Harmoinen M, Puhalainen E, Pelkonen J. Tapaturmatilastointi terveyskeskuksissa: tulokset ja kokemukset Kouvolan seudulta [ Injury registration in health care centres:results and experiences in Kouvola region, Finland ] . Suomen Lääkärilehti [ Finnish Medical Journal ] 2008;63:1630-1632(a-f).

Ilona Nurmi-Lüthje, Peter Lüthje, Kalevi Karjalainen, Kimmo Salmio, Janne Pelkonen, Jari Hinkkurinen, Lasse Lundell, Kirsi-Marja Karjalainen ja Antti Virtanen. Etenevä tutkimus väkivallan uhreista aluesairaalan päivystyspoliklinikalla [ Prospective study on the victims of violence at the casualty department in regional hospital ] Duodecim 2008;128(13)(in press)

Vohlonen I, Bäckmand H, Korhonen J. Menetetyt elinvuodet. PYLL-indeksi väestön hyvinvoinnin mittana. [ Potential years of life lost. PYLL-rate in monitoring the wellbeing of the population ] Suomen lääkärilehti [ Finnish Medical Journal ] 2007; 62: 305-3309.

Presentations:

Airaksinen Noora, Lüthje Peter. Bicycle injuries treated in emergency department (ED): their consequences and costs in south-eastern Finland in an area of 100 000 inhabitants. 9 th World Conference on Injury Prevention and Safety Promotion in Merida , Mexico March 16, 2008.(poster presentation)

Nurmi Ilona. Injury registration and prevention project (START) in Finland , 27.9.2003. 5 th Safe Community Conference, Helsinki , 26.-29.8.2003. (oral presentation)

Nurmi Ilona. Use of continuous, prospective injury data for injury prevention. Regional injury registration and prevention project in south-eastern Finland . International Seminar on Injury Research Methods, organised by ECOSA, Vienna , Austria , 10.6.2004.(oral presentation)

Nurmi Ilona. Falls among elderly - what can be done to prevent them? The 8th – Japanese-Finnish Seminar on Hospital and Welfare Architecture 11.-14.10.2004. General Theme: ”Take Care- Architectural Means for Risk Management in Care Facilities”. Käpylä Rehabilitation Centre, Helsinki 13.10.2004.(oral presentation)

I.Nurmi-Lüthje, P.Lüthje, J.Hinkkurinen, L. Lundell, K.Salmio, K.Karjalainen, M.Salminen and A.Kajander. One year accident and injury profile among aged in southeastern Finland in an area of 100 000 inhabitants. IOF World Congress on Osteoporosis 2-6 June, 2006, Toronto , Canada (poster presentation).

Nurmi-Lüthje Ilona. TAPE software-a web-based tool for injury prevention in south-eastern Finland . 9 th World Conference on Injury Prevention and Safety Promotion in Merida , Mexico March 16, 2008.(oral presentation)

Vohlonen Ilkka ja Bäckmand Heli. Kouvolan seudun PYLL-tulokset. Esitys Kouvolan seudun seminaarissa: Ennenaikaisesti menetetty elinvuosi maksaa. 8.2.2006 Kuusankoskitalo, Kuusankoski. (oral presentation)

Unpublished data:

Kouvolan seudun tapaturmahanke (Start). Kouvolan kaupungin väestötason tapaturma-aineisto erikoissairaanhoidon potilastietojärjestelmästä ajalta 1.6.2004-31.5.2006 [Injury data (Kouvola population) from the special health care patient record system during 1.6.2004-31.5.2006 ]

Kouvolan seudun tapaturmahanke (Start). Kouvolan kaupungin väestötason tapaturma-aineisto perusterveydenhuollon potilastietojärjestelmästä ajalta 15.6.2005-31.10.2006. [Injury data (Kouvola population) from the primary health care patient record system during 5.6.2005-31.10.2006 ]

Produced information material, pamphlets :
The following publications have been given out in English:

– A description of accident prevention work in Kouvola in the light of the criteria made out for the network of Safe Communities

– Abstract of the TAPE©-software in English

In addition, there is Finnish material

Staff

The leaders: Chairman of the Safe Community co-ordination group major Aimo Ahti, secretary of the safe community coordination group Pertti Vanhala, project manager of START injury prevention work PhD Ilona Nurmi-Lüthje

Number of working groups: 6 + the Safe Community co-ordination group

Professions: council of the elderly, council of the disabled, parliament of the youth, working group for the traffic safety, working group for the child safety, working group for the accessibility

Permanent: Yes
Organization: The city of Kouvola
Specific intersectional leadership group: Yes
General public health/health promotion group: Yes

International commitments:
Study visits: Lidköping 2007
Participation in Safe Community conferences: Helsinki , Finland 2003

Hosting Safe Community Conferences: Not yet.
Hosting "Travelling Seminars": Not yet
Other: 7th World Conference on Injury Prevention and Control in Vienna in 2004; the 8th – Japanese-Finnish Seminar on Hospital and Welfare Architecture in Helsinki in 2004. The first results of the Start injury data have been presented in the IOF World Congress on Osteoporosis in Toronto , Canada , June 2-6, 2006. TAPE©-software and the epidemiology of bicycle injuries, their consequences and costs have been presented recently at the 9 th World Conference on Injury Prevention and Safety Promotion in Merida, Mexico, March 15-18, 2008.