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On preventing all injuries
  1. Ivan Barry Pless
  1. Correspondence to Dr Ivan Barry Pless, Retired, 434 Lansdowne, Westmount, Quebec H3Y2V2, Canada; barry.pless{at}mcgill.ca

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The arguments put forward by Langley and Cryer1 are interesting, thoughtful, but entirely wrong. This means that some of the views put forward by Molcho and Pickett2 are also wrong. Langley and Cryer assert that ‘it is unrealistic and counterproductive to try and prevent all childhood injury.’ They add that this ‘prevent all’ so-called ‘paradigm’ should extend to all age groups. I agree with the all age point but reiterate that the proponents of this paradigm (of whom I am one) are indeed seriously suggesting that we must seek to prevent even the ‘mildest’ of injuries. We do so simply because it is impossible to accurately predict the outcome of most injury events.

Langley and Cryer give the example of ‘a child tripping over and sustaining a barely visible abrasion to the arm.’ Ordinarily this should be little cause for concern and we need not move heaven and earth to try to stop this specific trip. But consider this: a child tripping causes the injury. This means that some part of the body strikes some surface. Now let us suppose that the body part is the head and the surface is concrete. Or that the tripping occurred on an elevated surface such that the distance fallen is greater. The result is likely to be much more serious than a scratched arm; it could just as well be a concussion, or worse.

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