Final report from the Commission to the European Parliament, the Council and the Economic and Social Committee on the Ehlass programme
Date: 1998-09-04
Institutions: European Commission
Subjects: EU programme, accident in the home, data collection, information system, leisure

COMMISSION OF THE EUROPEAN COMMUNITIES 

Brussels, 04.09.1998 
COM0998) 488  final 

Final Report from the Commission to the European Parliament, 
the Council and the Economic and Social Committee on the EHLASS programme 

The  purpose  of  the  European  Home  and  Leisure  Surveillance  System  -  EHLASS  -is  to 
collect  data  on  home and  leisure accidents.  The number  of  these  accidents  exceeds  more 
than  83.000  deaths  a  year,  compared  to  45.000  fatal  road  accidents  and  6.000  fatal 
accidents  at  the  workplace  The  types  of  accidents  covered  by  EHLASS  are  the  most 
important  causes  of  death  for  European  citizens  under  34  years  of  age.  The  system  is 
based  on  data-collection  at  hospital's  emergency  units  except  in  three  Member  States 
where data are collected by household  surveys. The latest decision ended by 31 December 
1997. EHLASS is the only general source of information  on this kind of accidents. 

EHLASS  was  set  up  in  19861  as  a  pilot  project  to  collect  data  in  order  to  identify 
products  causing  accidents.  The  system  has been  continued  through  decisions  in  19902, 
19933and  19944. 

The  Commission  has  had  an  external  audit  made  to  provide  a  background  for  a  more 
general  assessment  report  on  the  operation  of  the  system  and  for  proposals  for 
amendments. The executive summary of this report is joined as annex. 

On  the  basis  of  the  external  report  it  is  the  Commission's  general  assessment,  that  the 
fundamental  idea behind  the system  is correct  and  that  it has been  of considerable  use  for 
the  Member  States.  However,  the  use  of  the  data  on  Community  level  has  not  been 
satisfactory.  It  is evident  that  the  potential  of  the  system  and  the  Community's  financial 
investment  in data collection  is by far  not  sufficiently  exploited.  One of the  main  reasons 
for  this  has been  that  the  present  reporting  system  where  Member  States  only  transmit 
aggregated  data  in the form  of tables and  graphics to  the  Commission.  The  Commission 
does  not  receive  data  on  the  individual  accidents,  which  has  the  consequence  that 
European  or  transnational  inquiries  on  specific  problems,  for  example  questions  on  the 
dangerosity  of  a  certain  product,  can  only  be  made  by  asking  the  Member  States  for 
information. 

The  Commission  proposes  to  solve this  problem  by  easing  the  access  to  information  by 
establishing a European  Database integrated  in the telematic network  EUPHIN (European 
Union  Public  Health  Information  Network)  which  will provide the  technological  support 
so  that  all  data  would  be  available  to  the  Commission,  the  Member  States  and  other 
interested  parties.  Work  has  already  been  undertaken  as  regards  a  data  structure  and  a 

1  Decision N° 86/138/EEC of 22 April  1986 by the COUNCIL concerning a demonstration project  with a 
view to introducing a Community  system of information  on accidents involving consumer  products, 
OJ N° L 109/23 of 26 April  1986. 

2  Decision  N°  90/534/EEC  of  22  October  1990  by  the  COUNCIL  amending  decision  N°  86/138/EEC 
concerning a demonstration project with a view  to  introducing  a Community  system of  information 
on accidents involving consumer products, and fixing  the financial  allocation  for  the last two years 
of its operation, OJ  N° L 296/64  of  27 October 1990. 

3  Decision  N°  93/683/EEC  of  29  October  1993 by  the  COUNCIL  introducing  a  Community  system  of 

information  on home and leisure accidents, OJ N° L 319/40 of 21 December  1993. 

4  Decision  N° 3092/94/EC of the  PARLIAMENT  and  the  COUNCIL  of 7 December  1994 introducing  a 
Community  system  on  home  and  leisure  accidents,  OJ  N°  L  331/1,  of  21 December  1994.  This 
Decision  has  been  amended  by  Decision  95/184/EC  of  the  COUNCIL  of  22  May  1995,  OJ  N° L 
120/36 of  31 May  1995 in order to include the new Member States. 

A 

data  dictionary.  It  is expected  that  all  data  on  home and  leisure accidents  from  1986 till 
1997 would be fed  into a telematic tool before  the end of  1998. 

The  (Commission  has  the  following  proposals  to  mend  the  weaknesses  of  EHLASS 
disclosed by the evaluation  report: 

•  Représentaivity:  The  Commission  proposes  to  improve  representativity  by  ensuring 
that Member States choose more representative hospitals in terms of geographical and 
demographic  distribution  and  of  urban  and  rural  areas.  First,  it  is  the  intention  to 
assure representativity by collecting a set of demographic variables. In a second phase 
these  demographic  data  would  be  used  to  measure  the  representativity  of  the 
participating  hospitals  to  allow  a  better  choice,  where  needed.  Ad-hoc  household 
surveys could be a useful  tool to enhance representativity. 

©  Comparability:  (Common definitions,  classifications  and coding rules are a prerequisite 
for  achieving  Community-wide  comparable  data.  The  work  for  keeping  the  existing 
coding  manual  from  1986 up  to  date  by  adjusting  to  new  developments  -  especially 
concerning  the  classification  for  products  and  sports  -  must  continue.  It  would  be 
useful  to  abandon  household  surveys  as  the  basic  data  collection  in  some  Member 
States. 

•  The  data  quality  is  in  general  good,  but  could  be  improved.  The  external  report 
proposes  a method  for  the  measurement  for  quality,  which  could  be implemented  to 
follow  the  development  of  data  quality.  The  Commission  intends  to  develop  this 
measurement  of data quality further  in co-operation  with the Member States. It would 
be  useful  to  that  national  EHLASS  officials  met  to  co-ordinate  a  more  uniform 
interpretation  of the coding manual. 

•  The timeliness of Member  States to deliver their results has been a problem, as delays 
at one hospital postpone the national  report,  which again influences  the production  of 
the  European  summary  report  foreseen  by the  EHLASS  Decisions.  The  Commission 
proposes  the abandon  of this reporting  system  and  that  data  in the  future  should  be 
transmitted  directly  to  the  aforementioned  database  at  intervals  of  three  months  or 
shorter  or  a  shorter  period  according  to  provisions  to  be  agreed  upon  with  the 
Member States. 

•  The European  synthesis reports have a volume prohibitive  to  a distribution  in bigger 
numbers, which was a problem for  the accessibility to  information.  This problem  has 
been  solved  as the European  synthesis of the  national  EHLASS  reports  for  1990-95 
was  published  on  Internet  in  May  1997.  With  the  proposed  database  this  kind  of 
reports will be superfluous. 

•  The  coding  manual  needs  amendments,  especially  for  products  and  new  sports. 
Preparatory work  has been done, and the Commission  proposes that  priority be given 
to finalising and implementing this work. 

•  Statistical  assistance  for  the  data  collection  and  for  the  evaluation  of  the  EHLASS 
data is also a part  of the  Statistical  Programme  1998-2002.  Specific  attention  will be 
given  to  assist  in  adapting  the  methodology  taking  into  account  codes  and  models 
already existing at Community or international level. 

) 

^ 

The  Commission's  subvention  to  the  data  collection  has  been  necessary  to  assure 
participation from  all Member  States, as from  when the first pilot  project  was launched in 
1986.  The  experience  gained  is  that  Member  States  benefit  from  the  reduction  of 
accidents and the economic consequences hereof,  which should be a sufficient  motivation 
for Member  States to carry the economical burden  of data collection themselves,  whereas 
it  would  be  natural  for  the  Commission  to  ensure  co-ordination  of  the  action  and  the 
maintenance of a European database within the EUPHIN network. 

The  Commission  will  take  steps  to  ensure  the  implementation  of  the  improvements 
the 
mentioned  above  towards  the  future  programme.  For  1999  and 
Commission  has  proposed  the  integration  of  the  EHLASS  system  in  the  Community 
action  Programme  on injury  prevention  in the field of public health  (COM  (98) 229  final 
of  15 April  1998). The Commission accepted to this end, 23 of the 28 amendments of the 
European  Parliament  in the first reading  of  its  proposal  for  this  programme  (COM  (97) 
178  final). 

thereafter, 

1 lr 

EN/24/97/17380000. WOO (FR) 

Evaluation study of the EHLASS system 

for the European Commission -  Directorate-General XXIV 

Contract No AO-2600/96/000262 

Summary chapters from the final report 

of 20 August 1997 

DG XXIV  commissioned  us  to  carry  out  a  general  evaluation  study  of  the  EHLASS 
system.  The following  pages  set out  what  we regard  as the  main  features  of  the  study. 
These two chapters are extracts from our draft  final  report and cover: 

-  the operational conclusions 

-  the salient points 

Report prepared by: 

Mr Marc Nectoux 
Dr Luc-Henri Barthélémy 
Dr Henning Bay-Nielsen 
Dr Christine Duval 
Dr Birthe Frimodt-Moller 

A  c 

I'xlrnct  from  Ihc final report of the 1.1II,ASS cvaliialion  study  - PSYTEL docuincnl 

THK OPERATIONAL CONCLUSIONS (SYNTHESIS) 

1. 

THE  STATISTICS 

Our  study contains the following  conservative estimates for the annual figures  relating to 
home and leisure accidents (HLAs) in the states of the European Union: 

-  20 million HLAs resulting in medical care 

2 million hospital admissions as a result of HLAs 
83 000 fatalities resulting from HLAs 
3.9 billion ECU as the minimum cost of hospital admissions resulting from  HLAs 
23 billion ECU as the total cost  (direct  medical costs and social costs of absence  from 
work). 

These  figures  are to be set against  the Commission's  annual  subsidy  of 2.5  million ECU 
for  the operation  of EHLASS  and an overall  total  operating  cost  of 3.2 million  ECU in 
1995. 

2. 

THE  RATIONALE  OF THE EHLASS  SYSTEM 

A  specific  information  system  on  HLAs  is  necessary  since  such  accidents  represent  a 
major  public  health  problem  and  involve  considerable  costs.  Moreover,  the  aim  of 
achieving a high  standard  of consumer  protection  is enshrined in the Treaty on European 
Union. The Commission has also been given the task of promoting public health activities, 
which  encompass  accidents  and  injuries.  HLAs  are  thus  a  two-fold  concern  of  the 
Community.  In  addition,  the  need  to  reduce  the  number  of  HLAs  is  clearly  stated  in 
objective No 11 of the World  Health Organisation for its overall public health strategy up 
to the year 2000. 

Two lines of reasoning have led to the EHLASS system: 

-  Operational  considerations:  an upstream  data  collection  system  on HLAs is necessary 
to take stock of the situation, establish priorities, set targets for action and assess how 
far they are attained. 

-  Contextual  considerations: because of the single market, the free movement  of goods, 
the need to coordinate legislation and prevention policy on consumer  safety and public 
health, Community action on HLAs is necessary in view of the scale and effects  of the 
problem. 

This justification  for the system's existence does not merely have continuing validity but is 
indeed  strengthened  by the convergence of the Commission's very clear aims in the fields 
of consumer  safety  (DG XXIV) and of public health  in the Community  injury  prevention 
programme now in course of preparation (DG V). 

z 

DG 

EN/24/97/17380000.WOO (FR) 

Extract  from  the final report of the EHLASS evaluation  study  - PSYTEL  document 

3. 

THE ACHIEVEMENTS OF THE SYSTEM 

The  main  uses  of the  EHLASS  data are to  identify  risk-related  forms  of  behaviour  and 
population  groups (by sex, age, activity, location, etc.) and dangerous products. It is thus 
possible to select  areas for  legislative  action  and to target prevention  activities. In many 
countries, targeted prevention has led to a significant  drop in accident rates and severity. 

In Denmark,  for  example, a significant  reduction  (40%) was achieved  in the  number  of 
eye  injuries  resulting  from  the  recreational  use  of  squibs  and  fireworks.  An  analysis  of 
the  EHLASS data revealed to the authorities that many young boys suffered  eye  injuries 
when  playing  with  fireworks.  Subsequently,  accidents  were  cut  by  a  targeted  safety 
campaign  encouraging  the  use  of  protective  goggles  and  manufacturers  decided  to 
package safety  goggles with fireworks  sold to the general public. 

This  is  only  one  of many  examples  of  national  legislative  or  preventive  action.  Others 
are: 

-  reduction in accidental ingestion of household products by requiring the use of "child 

proof  caps and the addition of malodorous ammonia; 

-  changes in the surfacing of children's play areas to reduce cases of bruising; 
-  a  new  standard  for  folding  furniture  closure  systems,  which  has  cut  the  number  of 

crushed-finger  accidents; 

-  changes in the closing system for automatic garage doors; 
- 
introduction of new safety  standards for pressure cookers; 
-  adoption of standards for hang-gliding; 
-  recommendation that safety helmets be worn when mountain biking; 
- 
-  signing of ski pistes. 

introduction of warning pictograms for the packaging of high-risk products; 

Overall, these  measures  have  led to  a measurable  drop  in certain  types  of  accidents.  In 
France, for example, a substantial and steady decline in the number of fatalities  has been 
observed  for  young persons under the age of  15: 789 deaths from  HLAs in  1986, 526 in 
1992, i.e. a fall of over 33% in six years (source: INSERM SC8). 

In its present  form,  EHLASS thus functions  effectively  at the  level  of detailed  accident 
analysis:  identification  of  high-risk  product  categories,  types  of  activity  and  sub-
populations.  The  system  cannot  yet  be  used  to  produce  general  statistics  and  health 
indicators for HLAs. 

4. 

THE  MAIN OPERATIONAL SHORTCOMINGS 

The  system  is  widely  used  at  national  level  in  many  countries,  but  it  is  of  little  direct 
value to the Commission since the way it operates at present does not allow quick, direct 
access to information  which is sufficiently  representative and reliable. 

The  Commission  has  direct  access  only  to  the  standard  national  annual  reports,  which 
give a picture of how the system is working and provide general findings  for the various 
countries but do not yield detailed data for use in specific, short-term projects. 

.  3/21 

Extract  from  (he final report of the EHLASS evaluation  study - PSYTEL document 

5. 

THE  POTENTIAL  OF THE  SYSTEM 

However, the system has enormous potential: 

The  information  collected  in  the  various  countries  are  already  structured  in  national 
databases.  If this information  were  pooled  in a  European  base  accessible  on  Internet,  the 
ease  and  speed  of  consultation  and  dissemination  of  results  would  be  immeasurably 
increased. 

Data quality could be improved by 

combining  ongoing  data  collection  within  the  emergency  services  with  periodic  (e.g. 
five-yearly)  EHLASS  surveys,  which  are  representative  in  terms  of  households,  to 
ensure that the data obtained  is more representative; 
instituting the new coding system which has already been devised; 

- 
-  establishing a standard validation program including consistency checks. 

Use of the data could be improved by networking  experts to disseminate the new  methods 
of  information  processing  already  used  in  various  countries:  calculation  of  a  compound 
severity rating, automated alert system, typology,  data mining, etc. 

The  cost  of  these  measures  would  be  very  modest  and  could  be  financed  by  linking  the 
subsidies  received  by  the  various  states  more  closely  with  the  work  they  actually 
undertake.  A  slight  reduction  in  the  subsidy  for  simple  collection  of  data  would  release 
resources  to  finance  these  essential  shared  tools.  These  improvements  can  therefore  be 
made without  increasing overall  operating costs. 

6. 

O UR  CONCLUSION 

We  firmly  recommend  supporting  the  EHLASS  system  and  improving  the  way  it  works 
rather  than  abandoning  it.  The  foregoing  measures  alone  could  enormously  increase  its 
usefulness.  Given  that  the  estimated  average  direct  cost  of  an  HLA  is  368  ECU  and  the 
EHLASS  operating  costs  are  2.5  million  ECU  per  year,  an  annual  reduction  of  7 000 
HLAs over all the countries or 0.03% of the incidence rate for such accidents would mean 
that  the  investment  was  "self-financing"  at  the  macro-economic  level  in  terms  of  the 
budgets of the EU Member States. 

i 

THE SALIENT POINTS (SYNTHESIS) 

1. 

BASIC DATA 

Our study contains the following conservative estimates for the annual figures relating to 
home and leisure accidents (HLAs) in the countries of the European Union: 

-  20 million HLAs resulting in medical care 
-  2 million hospital admissions as a result of HLAs 
-  83 000 fatalities resulting from HLAs 

-  3.9 billion ECU as the minimum cost of hospital admissions resulting from HLAs 
-  23 billion ECU as the total cost (direct medical costs and social costs of absence  from 

work). 

These figures  are to be set against the Commission's annual  subsidy  of 2.5 million  ECU 
for the operation  of  EIILASS and an overall  total  operating  cost  of  3.2  million  ECU  in 
1995. 

2.  WHY IS THE EHLASS SYSTEM NEEDED? 

As  just  explained,  a  specific  information  system  on  HLAs  is  desirable  since  such 
accidents  represent  a  major  public  health  problem  and  involve  considerable  costs. 
Moreover,  the aim of achieving  a high  standard  of consumer protection  is  enshrined  in 
the Maastricht Treaty on European Union. The Commission has also been given the task 
of promoting public health activities, which encompass accidents and injuries. HLAs are 
thus a two-fold  concern of the Community. In addition, the need to reduce the number of 
HLAs is clearly stated in objective No 11 of the World Health Organisation for its overall 
public health strategy up to the year 2000. 

Not enough  is yet known about  HLAs and their  importance  is underestimated.  In many 
countries, there  is  insufficient  awareness  of them  as  a policy  issue. There  is thus  good 
reason  to  promote  a  European  system  to  remedy  this  lack  of  knowledge  and  the  wide 
discrepancies in the national means available to combat HLAs. 

Free movement of goods within the states of the Union leads to heightened  problems of 
consumer  safety:  any  product  which  is  legally  manufactured  and  placed  on  the  market 
must  be  allowed  access  to  the  markets  of  all  Member  States.  A  major  effort  of 
harmonisation  and  concertation  between  the  Member  States  has  proved  necessary  to 
establish Community product safety standards. 

The  risks  associated  with  HLAs  and  the  products  involved  in  such  accidents  must 
therefore  be investigated on a European scale a using a standard data collection tool. The 
EHLASS  system  has  a  special  relationship  with  the  European  standardisation  bodies, 
which  consult  it  regularly.  The  information  obtained  through  the  system  is  taken  into 
account in the drafting, acceptance and recognition of European standards. 

Two lines of reasoning have led to the EHLASS system: 

Extract from  the final report of the EHLASS evaluation study - PSYTEL document 

Operational  considerations: a data collection  system  on HLAs is needed  to take stock 
of the situation, establish priorities and assess the action taken. 

-  Contextual  considerations: because of the single market, the free  movement of goods, 
the need to coordinate legislation and prevention policy on consumer safety  and public 
health, Community  action on HLAs is necessary in view of the scale and effects  of the 
problem. 

The following  schematic is intended to illustrate these two requirements: for  a system to 
collect  information  on HLAs  and  for  a European  approach  to  accidents.  They  logically 
imply  the  creation  and  retention  of  EHLASS  as  a  homogeneous  European  system  for 
collecting  information  on  HLAs.  This justification  for  the  system's  existence  does  not 
merely remain valid but is indeed strengthened by the convergence of the  Commission's 
aims in the fields of consumer safety and public health. 

Operational  considerations 

Need for  a collection  system 

Collection of 
data on HLAs 

Analysis of 
situation 

Determination 
of priorities 

Prevention 
activities 

Evaluation of 
activities 

Assessment of the usefulness of the 
collection system in these phases 

Need for a 
European 
approach 

Rationale  of  the  information  system  as  a 
basis for  a prevention  policy 

Coordinated prevention activities in the fields  of: 
- consumer safety 
- public health 
European  framework  of  product  legislation  and 
standards 

o 
o 
3 

& 
C 
SL 
o 
o 
3 

(A a o 
3 
o 
3 
(A 

European dimension 
of the context 

Occurrence of HLAs 

Movement of goods and persons 

Single Market 

6/21 

DG 

EN/24/97/17380000.W00  (FR) 

Extract  from  the final report of the EHLASS evaluation  study  - PSYTEL  document 

3.  WHAT CAN EHLASS  BE USED FOR? 

The EHLASS system in its current form should not be expected to provide 

reliable incidence rates and public health indicators for all HLAs in Europe; 

- 
-  strikingly  novel accident analyses at the general  level: it is clear that falls  will  always 
be  the  main  accident  mechanism,  that  the  population  groups  at  greatest  risk  will  for 
many years to come be children and the elderly, etc. 

On the other hand, the pragmatic and operational approach of EHLASS has made a major 
contribution to specific regulatory or preventive action, such as 

-  reduction  in accidental ingestion of household products by requiring the use of "child 

- 

proof" caps and the addition of malodorous ammonia; 
inducing  pharmaceutical  manufacturers  to  package  medication  in  multi-blister  packs 
to prevent ingestion of large doses by young children; 
-  requiring more stable footing  and fastenings for ladders; 
-  changes in the surfacing of children's play areas to reduce cases of bruising; 
-  making mountain biking safer by recommending that safety helmets be worn; 
- 
introduction of warning pictograms for the packaging of high-risk products; 
-  recommendation  that  safety  barriers  be  provided  around  private  swimming  pools  to 

reduce the risk of children's drowning; 

-  signing of ski pistes; 
- 
-  a  new  standard  for  folding  furniture  closure  systems,  which  has  cut  the  number  of 

requirement  for adequate safety rails on bunk beds to prevent falls; 

- 

crushed-finger  accidents; 
requirement  for  instructions  for  use  to  be  provided  on  the  packaging  of  toxic 
gardening products; 

-  supplementing of the current standard on the safety  of playground equipment  installed 

- 

on private premises; 
improvements  and  compliance  requirement  for  automatic  garage  door  closing 
systems; 
introduction of new safety  standards for pressure cookers; 

- 
-  encouraging children to wear safety helmets while skiing, to reduce head  injuries; 
-  approach to manufacturers  on general use of key-opening cans; 
-  recommendation  to manufacturers  that non-heat-conducting  materials  be used  for  the 

external coverings of oven doors; 

-  adoption of standards for hang-gliding; 
-  preventing  of  severe  scalding  by  domestic  hot  water  by  lowering  the  temperature  in 

the distribution system (a measure under consideration in France). 

Used  retrospectively,  EHLASS  thus  provides  answers  to  precise  questions  which  are 
already  formulated  or,  used  prospectively,  provokes  questions  which  lead  on  to 
preventive  or  legislative  measures  for  specific  product  categories,  sub-populations  or 
activities. 

•?  -  2 

Extract  from  the final report of the El ILASS evaluation  study - PSYTEL  document 

»; \* u  u u v. 

In  its  present  form,  El ILASS thus  functions  effectively  at  the level  of detailed  accident 
analysis:  identification  of  high-risk  product  categories,  types  of  activity  and  sub-
populations.  The  system  cannot  yet  be  used  to  produce  general  statistics  and  health 
indicators for HLAs. 

4.  WHAT ARE THE SYSTEM'S STRENGTHS? 

This  system  for  ongoing  collection  of  data  is  one  of  the  most  important  sources  of 
information  on HLAs - an area about which not enough is yet known. In  11 out of the 15 
countries there are no other collections which are both continuous in time and specific  to 
this  topic.  The  other  collections  are  either  of  a  general  nature  (e.g.  hospital  morbidity 
surveys, death certificates), making it very difficult  to determine what relates to HLAs as 
such,  or  they  are  partial  sources  giving  only  a  very  fragmented  picture  (e.g.  poison 
centres, fire services, burns treatment units, CO poisoning, etc.). 

Since  there  have  long  been  dedicated  information  systems  for  road  and  occupational 
accidents, it is reasonable for there to be a single source bringing together information  on 
HLAs. 

We  estimated  the  lower  limit  of  the  range  of  economic  cost  of  hospital  admissions 
resulting from  HLAs at 3.9 billion ECU and the total cost of HLAs (direct medical  costs 
plus  social  costs arising  from  absence  from  work) at 23 billion ECU. Even though  they 
are  approximate,  these  figures  clearly  show  how  great  these  costs  are.  In  European 
macroeconomic terms, given annual  subsidies of 2.6 million ECU for EHLASS, a fall  of 
less than 0.07% in the annual number of hospital admissions in the Member States would 
be sufficient  to offset  the Community investment. 

The  system  works  satisfactorily  at  national  level  in  most  Member  States  and  has  been 
used  to  collect  pertinent  observations  for  over  ten  years.  In  France,  for  example,  over 
360 000  observations  have  been  collected  and  validated,  thus  forming  a  database  of 
unmatched size on this topic. 

The  data  and  results  published  are  used  by  many  bodies,  both  public  and  private,  at 
national level: the ministers responsible for consumer affairs, health, the environment and 
the media, consumer safety  watchdogs, consumers' associations, social  services, whether 
at  state,  local  authority  or  municipal  level,  and  the  health  services.  Doctors, journalists 
and  students,  as  well  as  insurance  companies  and  indeed  manufacturers  also  consult 
EHLASS.  We  have  established  that  more  than  1  300  requests  for  information  are 
received  by the national  co-ordinators  annually  and that  more than  350  specific  studies 
per year are carried out on EHLASS data in Europe. 

EHLASS  provides  replies  to  a number  of questions  which  no  other  system  can  answer 
thanks  to  its  coding  system,  which  includes  over  1 100 product  codes:  Do  skateboards 
give  rise  to  more  accidents  than  roller  skates?  How  severe  are  these  accidents?  What 
types of  injury  are  sustained? Is there any record  of accidents  with  disposable  cigarette 
lighters? With folding beds? Under what circumstances?... 

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The  system  has  also  made  the  national  authorities  more  keenly  aware  of  ULAs.  Many 
new  projects  and  new  arrangements  have  been  set  up  or  have  consolidated  their  role  on 
the  basis  of  the  EHLASS  results.  A  few  examples  are  the  establishment  of  the 
in  Belgium,  of  the  Cellule  Nationale 
Commission  de  la  Sécurité  des  Consommateurs 
in  France  and  of  a  Comité 
d'Observation 
d'accompagnement  du système  EHLASS  in  Luxembourg. 

des  accidents  de 

la  vie  courante 

A  large  majority  of  the  teams  running  the  system  are  competent  and  enthusiastic  about 
cooperation.  They  take joint  initiatives  to  launch  transnational  studies  and  devise  shared 
tools  (e.g.  the  Stockholm  meeting  of  the  representatives  of  eight  countries  for  the 
EHLASS  conference  of 2 and  3 June  1997 on roller-blade  accidents). 

As  we  shall  see  later,  there  is considerable  scope  for  improving  the  system.  Under-use  of 
the data  at  transnational  level, by  the  Commission  or  by  consumers  themselves,  could  be 
addressed  by  establishing  a  European  EHLASS  database  accessible  via  Internet,  thus 
vastly  increasing  the usefulness  of the system  at very  modest  cost. 

As  yet,  the  system  has  not  been  much  used  by  other  Directorates-General.  However,  the 
usefulness  of  the  system  to  DG  V  in  connection  with  its  future  "Community  action 
programme  on  injury  prevention  in the  context  of the framework  for  action  in the  field  of 
public  health"  (1999-2003),  approved  by  the  Commission  on  14 May  1997,  and  the 
active  support  of Eurostat  for  an overhaul of the system augur very well  for the  future. 

In  the  course  of  our  interviews,  we  were  often  told  that  "if  EHLASS  did  not  exist  it 
would  have  to  be  invented".  The  system  is  far  from  perfect  but  it  has  the  great  merit  of 
existing  and  operating  on  a routine  basis. If EHLASS  did  not  exist,  more  than  two-thirds 
of the countries  (11/15) would  have no overall  source of information  on  HLAs. 

5.  W H AT  ARE  THE  SYSTEM'S  WEAKNESSES? 

Lack  of  clarity  about  the  aims:  there  still  seems  to  be  confusion  about  the  very  nature  of 
the system  ten  years after  it came  into existence.  It cannot  provide  a complete  measure  of 
the  number  and  severity  of  all  accidents  in  daily  life,  nor  can  it  be  regarded  as  an  alert 
system  or  a  system  measuring  the  consequences  of  such  accidents  in  terms  of  public 
health.  The  current  EHLASS  system  must  be  regarded  as  a  databank  available  to  those 
who  want  to  look  more  closely  into  the  forms  of  behaviour,  sub-populations  or  product 
categories  associated  with risk. EHLASS must be regarded  as a register  of  HLAs. 

The  coexistence  of two  approaches  -  ongoing  collection  by  the  emergency  services  (12 
countries)  and  household  surveys  (three  countries)  -  reflects  the  divergent  views  on  the 
purpose  served  by  the  system.  The  practice  followed  within  each  of  these  approaches  is 
again  not entirely  uniform. 

Representativeness  of  the  data:  the  arrangements  in  three  countries  ensure  overall 
representativeness  of  the  HLA  figures  obtained  by  survey  while  those  in  another  three 
ensure  such  representativeness  for  HLA  figures  obtained  via the emergency  services.  The 
other  (nine)  countries  collect  non-representative  data  and  seven  countries  do  not  ensure 
exhaustive  data collection  at all  collection  sites. 

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Coding  practice: there  are differences  in the way  the product  codes are  used. 

Obsolescence  of  the  coding  system,  which  is  more  than  ten  years  old:  there  are  no 
specific  codes  for  sports  and the product  nomenclature  needs to be  revised. 

Checks:  there  is a great  diversity  of logical  checks. A  standard  validation  program  should 
be established,  including  a check  on data  consistency. 

Poor  availability  of the  data  in temporal  and  spatial  terms: the  annual  file  often  cannot  be 
created  until  the  last  hospital  has  sent  its  last  batch  of data.  This  delays  publication  of  the 
standard  report  and  availability  of  the  data  in  the  national  base.  The  data  from  one 
country  are  not  directly  available  to  the  other  countries  or  the  Commission  and  the 
number  of  transnational  studies  is  therefore 
limited.  Since  there  is  no  accessible 
European  database,  none  of  the  players  can  obtain  direct  and  ready  access  to  all  the  data 
collected. 

Usefulness  of  the  data:  the  value  of  the  data  to  the  Commission  is  slight.  The  standard 
national  annual  reports  do not provide  detailed  information  of direct operational  value. 

Rigidity  of  the  system:  the  system  does  not  adapt  quickly  enough  to  changes  in  the 
objectives  and  requirements  or  to  new  information  technology  as  it  becomes  available 
(networks  and  analysis  techniques). 

Quality  of management:  there  are wide discrepancies  between the countries as regards  the 
main  aim  the  system  is  expected  to  achieve,  the  methods  used,  and  the  quality  and 
average  cost  of  data  collection.  The  average  rating  for  collection  quality  is therefore  low 
and  there  is  a  wide  scatter  of  operating  cost  indices.  We  also  feel  that  at  national  level 
fewer  resources  could  be  devoted  to  data  collection  and  more  to  data  analysis  and 
dissemination  of results. 

Lack  of  institutional  and  financial  stability:  as  one  assessment  report  follows  the  other, 
the  fate  of  EI I LASS  has  often  been  under  discussion  and  has  depended  from  year  to  year 
on  institutional  decisions as to whether  it would  continue to exist.  The question  asked  has 
often  been  "Should  the  system  be  continued  or  not?"  and  this  has  distracted  attention 
from  the other  question:  "How  can the  system  be  improved?". 

On  various  occasions,  the  possibility  that  the  operating  subsidies  would  be  discontinued 
has led to a loss of impetus  in various  countries. 

The  subsidiarity  principle:  its  rigorous  application  may  have  undermined  the  efforts  to 
renew  and  reform  the  system  at European  level,  since  there  was  no  machinery  to  provide 
strong  leadership  and  coordination. 

6.  WHAT  OVERALL  ASSESSMENT CAN  BE  MADE? 

The outcome  of  this  review  of  strengths  and  weaknesses  depends  on  the  point  of  view  of 
the  assessor: 

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For the  statistician,  it  is negative: after  ten  years of existence, the  system  still  docs  not 
provide  sufficiently  reliable  statistics  at  European  level,  although  the  position  in  this 
regard  is very  satisfactory  in certain  countries. 

-  For those  involved  in prevention  (consumer  safety  and public health) or law-making  at 
national  level  in connection with HLAs, it is generally positive  in many  countries. 

-  For  those  involved  in  prevention  or  law-making  at  European  level,  it  is  generally 

negative, since the European  data are not directly  available. 

- 

It  is  very  positive  if one  considers  the potential  of the  system  and  the  scope  for  future 
collaboration  with  Eurostat  on  methodology,  validation  and  publication  of  the  results 
and  with  DG  V  in  connection  with  the  Community  injury  prevention  programme. 
Complementarity  of  the  Community's  projects  could  be  enhanced  by  means  of 
Ell LASS. 

7.  W H AT  ARE  THE  OPTIONS  FOR THE  SYSTEM'S  FUTURE? 

There are  four  options: 

- 
- 
- 
- 

to abandon  the EHLASS  system; 
to suspend  it for one or two years; 
to keep  it up in its present  form; 
to  improve  it. 

We  shall  now  consider  these  four  options  in  turn,  assessing  the  system's  potential  for 
improvement. 

8. 

SUPPOSE  EHLASS  WERE  ABANDONED? 

In  some  countries,  there  are  sources  of  information  on  HLAs  other  than  EHLASS. 
Abandonment  of  EHLASS  would  have  little  effect  on  the  quality  of  the  information 
system  in this area in the Netherlands  or the  United  Kingdom.  In  France, regular  CNAM 
and  INSEE  surveys  provide  an  overall  picture  of  HLAs.  In  the  other  countries, 
abandonment  of  EHLASS  would  severely  affect  the  quality  of  the  information  system. 
As we have already  stressed, all that would then exist in these countries would  be 

-  general  collections  (e.g. hospital  morbidity  surveys, death  certificates),  making  it  very 

difficult  to identify  figures  specific  to HLAs; 

-  partial  sources  giving  a  very  fragmented  picture  (e.g.  poison  centres,  fire  services, 

burns treatment  units, surveys of CO poisoning, etc.). 

The  following  diagram  illustrates  the  central  role  of  the  EHLASS  system  within  the 
overall  arrangements  for  collecting  information  on  HLAs. 

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Partial sources: 

Poison  centres,  fire  services,  burn 
treatment  units, 
surveys  of  CO 
poisoning, etc. 

General  sources: 

hospital  morbidity 
surveys 

death  certificates 

-  health  surveys 

If  EH LAS S  were  discontinued,  there  would  thus  be  a  major  gap  in  the  information 
network. 

A  table  in  our  report  shows  what  general  (but not  exclusive)  HLA  information  sources 
other  than  EHLASS  there  are  in  Europe,  thus  providing  an  indication  of  the 
consequences  if EHLASS  were to be abandoned. These would be 

-  very  serious  in  eight  countries:  Belgium,  Ireland,  Luxembourg,  Austria,  Greece, 

Spain, Portugal  and Finland; 

-  serious in five countries: Denmark, France, Germany, Italy and Sweden; 

-  minor in two countries: the Netherlands and the United  Kingdom. 

In the  course  of  our  interviews,  several  national  experts  spontaneously  commented  that 
"if EHLASS  did not exist  it would have to be invented".  In  11 out of the  15 countries, it 
is the only  dedicated national  system for collecting data on HLAs. 

If  EHLASS  were  not  retained  as  a  coordinated  system  at  European  level,  the  general 
standard  of  consumer  safety  would  be  reduced  and  essential  public  health  information 
forfeited.  This would 

-  be  inconsistent  with the  logic  underlying  the  system,  which is based  on the need  for a 

system  of data collection  on  HLAs and for a European approach to accidents; 
leave  11 countries  with no HLA  information  system  at all; 

- 
-  perpetuate  discrepancies  in  the  status  of  prevention  tools  and  policies  in  the  fields  of 

consumer safety  and public  health; 

-  make  it impossible  to compare the data from  the various  countries; 
-  make  it  impossible  to  identify  rare  accidents  which  may  cumulatively  acquire 

significance; 

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lower the profile  of I ILAs and reduce the national authorities' awareness of this  major 
problem; 

-  reduce the scope for targeting prevention policies; 
- 

forfeit  a long tradition of cooperation and the experience acquired. 

The advantage  of this option would  be to  get rid of a system which  is unsatisfactory  in 
statistical terms and of little direct use to the Commission as it works at present. It is true 
that the present EHLASS system resembles a collection of national systems rather than a 
unified, truly European system. If it were abandoned, funds could be reallocated. 

9. 

SUPPOSE EHLASS  WERE DISCONTINUED FOR ONE OR TWO YEARS? 

This interim solution would have many disadvantages, viz. 

- 

the work on highlighting the importance of HLAs would lose impetus; 
national  and  European  users would  be deprived  of a tool  essential  to the  formulation 
of preventive and legislative policy; 
the arrangements for complementary  funding  would be disrupted; 
the statistical time series would be broken; 
the existing teams would be disbanded; 

- 
- 
- 
-  when  use  of  the  system  was  resumed,  it  would  have  to  be  recommissioned,  with  a 

consequent loss of time and energy to no real purpose. 

The only advantage of this option is that it allows time to plan the introduction of a better 
system. However, it would be a mistake to think that a new system could restart easily at 
European  level.  In  addition,  the  present  study  and  other  work  have  provided  the  main 
elements required to design new methods. What is lacking is not ideas and proposals, but 
decisions and their actual  implementation. 

10.  SUPPOSE EHLASS  WERE RETAINED IN ITS PRESENT FORM? 

The present  system  suffers  less from  a lack of data (not enough observations) than  from 
the  fact  that  data  collection  is  not  always  carried  out  under  optimum  conditions 
(exhaustiveness,  quality  of  validation,  suitability  of  coding,  speed  of  availability,  etc.). 
These  data  are  under-used  at  Community  and  international  level,  and  at  the  level  of 
individual users, because it is not possible to consult the whole corpus of European  data 
simply and quickly. 

Despite the benefits  at national  level, the present  system does not work well  enough. In 
our  view,  this  means  that  EHLASS  cannot  be  retained  as  it  stands,  especially  if  one 
considers the potential of a system adapted to use the most recent technology. 

As matters stand, we consider the choice to be made is between abandoning the EHLASS 
system and improving it. 

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11.  WHAT SCOPE IS THERE FOR IMPROVING THE SYSTEM? 

There is considerable potential: 

Recent  developments  in networking,  WWW applications  and  methods  of using the  data 
contained  in information  systems (e.g. data mining) provide a simple solution to most of 
the shortcomings mentioned. This would not have been the case even two years ago. 

Our  cost/benefit  analysis  leads  us  to  suggest  that  funding  for  collection  as  such  be 
reduced  in  favour  of  funding  for  improvement  of  data  quality,  data  utilisation  and  the 
ease and speed of availability to all users. 

As an immediate step to reduce collection costs, we propose that 

- 
- 

- 

the level of subsidy be more closely matched to the work carried out; 
if  politically  feasible,  one  of  the  collection  sites  should  be  abandoned  in  countries 
which have a high ratio of participating hospitals to population; 
that  an  additional  collection  site  should  be  included  in  other  countries  with  a  low 
participating hospitals-to-population ratio. 

Overall, this would reduce the proportion of subsidies devoted merely to data collection. 
We propose that these savings should be reallocated to 

- 

improving data quality by 

-  conducting  EHLASS  surveys,  if  requested,  to  improve  the  representativeness  of 
data  in  those  countries  which  collect  their  data  on  an  ongoing  basis,  so  that  the 
advantages of the two methods are combined; 

-  recommending  and  promoting  exhaustive  collection  at  the  continuous  collection 

sites; 
introducing the new coding system recently devised; 

- 
-  developing and disseminating a standard program for data consistency checking; 
-  producing and disseminating recommendations on "good collection practice"; 

improving data dissemination and use by 

-  establishing a European EHLASS database accessible via Internet; 
- 
-  using E-mail as a general means of communication between the parties involved in 

feeding this base with input from the collection sites every three months; 

the system; 

-  developing tools for use of the data (severity rating, automatic alert, typology, etc.) 

related to the national and Community alert systems; 

-  promoting cost analysis models; 
-  establishing  a  forum  of  experts  to  develop  and  promote  this  set  of  shared  tools, 

which are of value to all the partners. 

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In the  medium  term,  to  reduce  the  costs  of  local  data  collection  and  depending  on  the 
progress of network development, the following  would be desirable: 

-  on-line data collection; 
-  automatic checks; 
-  electronic transmission to the central site; 
-  on-line training in coding; 
-  on-line standard operation. 

We feel  that  the  system's  performance  and  usefulness  can  be  greatly  enhanced  by  these 
simple steps, without any increase in costs. 

To illustrate the scope for  improving the EHLASS system,  we have produced  a diagram 
plotting its usefulness  against the main categories of user. 

The  degree  of  usefulness  for  the  various  categories  is  represented  by  a  curve,  with  a 
corresponding curve for a future  EHLASS system modified  as recommended above. 

The  area  between  the  two  curves  represents  the  scope  for  improvement  of  the  system, 
depending on the type of user. 

Use full less ot  the 
system 

I  Modified  KHI  ASS 

system 

Present. Kl  ILASS 
system 

Consumers 

Transnational  io< iperation 

Types  of  user 

National  mstkutjonuJ  users 

To  demonstrate  the  feasibility  and  usefulness  of  a  base  accessible  via  Internet,  we 
developed a model server accessible at the French site (with a password  made available to 
DG XXIV  for  tests).  This  model  allows  interactive,  direct  consultation  of  the  EHLASS 

AG 

Extract  from  the final report of the El 1EASS evaluation  study  - PSYTEL  document 

France base by formulating  a query on an input mask including all the EHLASS variables 
(a  clear  text  search  is  also  possible).  It  is  possible  to  consult  the  records  selected,  to 
request standard statistical tables or to download the data. 

The  EHLASS  data  from  previous  years would  be taken  over  into the general  European 
base (base  1) so that  all the existing  national  bases could be used. A reference  database 
(base  2)  could  also  be  set  up, comprising  only  data  from  the  hospitals  which  cover  all 
types of emergency  and ensure exhaustive collection  of cases. This base would be more 
representative. 

12.  OUR CONCLUSION 

In view of 

- 

the strengths and weaknesses of the current system as described above, 

- 

the  major  drawbacks  of  the  options  of  abandonment,  suspension  or  retention  of  the 
current EHLASS system, 

-  our  observations  on  the  scope  for  improving  the  system  by  changes  which  can  be 
made  rapidly,  without  closing  the  system  down  and  losing  impetus, with  technically 
proven means and at constant cost, achieved by a better allocation of funds, 

- 

- 

the  need  for  information  on  HLAs  in  order  to  pursue  consistent  and  effective 
consumer safety policies as part of DG XXIV s activities, 

the  great  value  of  the  system  to  DG V  in  the  context  of  its  1999-2003  injury 
prevention programme and the active support of Eurostat for an improved system, 

we firmly  recommend that the improved  EHLASS system be introduced  as quickly 
as possible. 

How can this be done? 

-  By exploiting the scope for improvement which has been identified  by our operational 

analysis. 

-  By  pursuing  vigorously  the  preparation  of  the  new technical  tools  mentioned  above 

and firmly coordinating their introduction. 

-  By placing much greater stress on cooperation  with the other Directorates-General, in 
particular  Eurostat,  to  obtain  reliable  statistics,  and  DGV,  in  connection  with  the 
injury  prevention programme. 

-  By  placing  the  system  on  a permanent  basis. It has been  noted  that  one  of the  main 
obstacles to the development of the system has been that its future  was not assured. In 
the past, proposed developments were always frustrated  by the fact that a decision was 
pending  on the continued  existence of the system. Today, the system has to be  given 
time (four or five years) for far-rsaching changes to be made. 

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13.  HOW SHOULD THE  FUTURE  EHLASS  SYSTEM  BE  USED? 

The future  EHLASS system is to be seen as a pool of readily accessible data (base  1) for 
use in detailed accident analysis: 

- 

- 

in  an ex-post  mode, to  answer  precise  questions  which  are  already  formulated  (How 
many  accidents  occur  with  supermarket  trolleys  and  are  they  serious?  How  many 
accidents arise from  hang-gliding? etc.); 

in an ex-ante mode, to provoke questions by means of simple statistical tools (such as 
a compound  severity  rating  or automated  alert  system) or by  alert procedures  carried 
out by the coders at the data collection sites. 

With  the  proposed  methodological  improvements,  and  in  particular  the  link  between 
ongoing  data  collection  by  the  emergency  services  and  EHLASS  surveys  which  are 
representative  at  household  level,  a better  sample  of hospitals  and  compliance  with  the 
criterion  of  exhaustive  collection  at  the  site,  it  will  also  be  possible  to  use  the  system 
(base 2) for general accident analysis to provide reliable statistical indicators. 

This pool  of data obviously  must  not be a data graveyard  (the data are currently  under 
used at European and transnational level and the tools employed are obsolete), it must not 
be a depository  for errors (the quality of the data generated must be improved) and must 
not be a bottomless  pit  in  financial  terms  (the race to  include  more  hospitals  must  stop 
and subsidies must be reallocated to optimise the cost-benefit ratio). 

14.  WHY SHOULD THE COM MISSION CONTINUE TO SUPPORT EHLASS? 

Because it is important:  We have already  mentioned  the  importance of  HLAs  in terms 
of consumer safety, public health and economic costs. 

Because  it  is  a  European  responsibility:  Free  movement  of  products  gives  rise  to 
additional  risks  to  consumers.  While  ready  movement  of  products  is  desirable,  better 
protection for consumers and compliance with the requirement for products to be safe are 
also essential. The Commission also has the duty to help ensure a high standard of human 
health protection by illness and accident prevention activities. EHLASS falls  under both 
of these headings. The very existence  of Directorates-General  which are concerned  with 
consumer  safety  (DG XXIV)  and  protection  of  human  health  (DG V)  demonstrates  the 
need to coordinate  and provide  funding  for  accident prevention  activities. It is  therefore 
logical  for  funding  also  to  be  provided  upstream  for  a  source  of  homogeneous 
information which can guide or inform this policy. 

If  the  European  institutions  do  not  finance  the  project,  the  countries  which  are  most 
advanced  in the field  of prevention will continue their efforts,  while the others will  cease 
to  do  so.  This  will  lead  to  a  wider  spread  of  standards  and  greater  inequality  among 
European citizens with respect to the accidents of everyday  life. 

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Because it is difficult:  It has also been mentioned  that there is still little awareness of the 
problem  of  HLAs, which  is underestimated,  and that  it  is difficult  to measure the  direct 
impact  of  prevention  policy  in  this  area.  It  is  therefore  a  subject  which  is  not  fully 
appreciated by national political decision-takers. 

Because  it  would  be  illogical  to  stop  funding  EHLASS:  At  a  time  when  the 
achievement  of  a  high  standard  of  consumer  protection  is  enshrined  in  the  Maastricht 
Treaty  and when the Commission  (DG V) is instituting the  1999-2003  injury  prevention 
programme, it would be perverse to abandon the only European project  which yields the 
essential  information  on HLAs. 

15.  WHY SHOULD THE COMMISSION CONTINUE TO COORDINATE THE SYSTEM? 

Because  it is logical:  Since machinery  in one country  cannot  be expected  to  coordinate 
data  collection  in  other  countries,  it  is  natural  for  this  to  be  responsibility  of  a 
supranational  body,  in  this  case  the  Commission.  Since  the  Commission  already 
coordinates  other  information  systems  in  the  area  (e.g.  the  rapid  information  exchange 
system),  it makes sense  for  it to continue to coordinate  EHLASS, even  disregarding  the 
system's history (it was established at the Commission's instigation and under its aegis). 

Because  it  is  essential:  Funding  of  only  part  of  the  system  would  not  be  sufficient  to 
maintain  the  minimum  degree  of  consistency  required  for  a  European  information 
system. The content of the information  collected  in the various countries would  quickly 
diverge. Methods which already differ  too widely  would  lose all comparability.  There is 
a need for a coordinating structure which is sufficiently  strong and enjoys  credibility and 
general  recognition. 

Because  of the strategic  implications: It is not acceptable  for the insurance  companies 
and  manufacturers  to  be  the  only  parties  holding  information  on  HLAs.  Consumers 
associations, 
interests,  the  consumers 
themselves  and  those  active  in  the  field  of  public  health  must  also  have  access  to 
information  on such accidents. To ensure this, the system must be coordinated by a body 
of unquestioned independence: the Commission. 

institutional  bodies  representing  consumer 

16.  HOW CAN THE MOST FREQUENT  CRITICISMS  BE MET? 

"The  data  are  not  representative"  (problem  of  representativeness):  this  question  can  be 
addressed  by  using  information  from  "EHLASS  surveys",  which  are  representative  at 
household  level,  to  correct  the  information  derived  from  the  continuous  collection 
system. Exhaustive collection of data at the individual sites and stability of the sample of 
hospitals must also be encouraged. 

"No overall picture of these accidents is provided" (problem of the scope of the enquiry): 
systematic  cross-referencing  between 
the  EHLASS  surveys  and  complementary 
information  sources  on  the  one  hand  and  the  data  collected  at  the  normal  sites  on  the 
other allows full coverage of the field. 

19/21 

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EN/24/97/17380000.WOO (FR) 

Extract from the final report of the EHLASS evaluation study - PSYTEL document 

"The  data  are  not  comparable  between  countries"  (problem  of  comparability):  this 
problem can be solved by introducing 

the new collection system harmonising coding philosophy and practice; 

- 
-  standard  software  (which  could  be  distributed  on  Internet)  for  input,  validation  and 

coding assistance; 

-  regular meetings of co-ordinators to deal with problems of coding consistency; 
-  arrangements for the data collecting teams to compare notes (by E-mail). 

"EHLASS  is not a genuine alert system" (problem of the diversity of the system's aims): 
this  is  not  is  main  purpose.  However,  it  can  make  a  useful  contribution  to  alert 
arrangements by the introduction of 

-  an automated statistical alert tool; 
-  arrangements  for  transmission  of alert messages between the  national  EHLASS  sites 

and DG XXIV; 

-  greater  cooperation  with  other  alert  systems  (rapid  information  exchange  system, 
safeguard  clauses,  etc.),  allowing  interactive  consultation  of  a  regularly  updated 
European EHLASS base. 

"This  system  does  not  identify  the  products  which  are  really  dangerous":  this  point  is 
linked  to  the  previous  one. It  is  admittedly  fairly  unusual  for  products  to  be  the  direct 
cause  of  HLAs,  and  the  purpose  of  EHLASS  is  thus  to  identify  sequences  of  events, 
forms  of  behaviour  and  sub-populations  associated  with  risks.  However,  it  can  also  be 
effective  in identifying  dangerous products provided that 

the table of product codes is improved; 
the make of product involved is indicated when possible; 

- 
- 
-  accident victims are contacted for post-hoc studies (accident traceability); 
-  a  compound  severity  rating  for  products  is  used,  which  has  been  validated  by  all 

concerned and allows historical and geographical comparisons. 

"There  are  not  enough  variables"  or,  conversely,  "there  are  too  many  variables": 
introduction of the new coding system should deal with this problem by 

the addition of essential variables (coding of sports practised, etc.); 

- 
-  revision and refinement  of the variable nomenclatures (use of logical structures, use of 

the NOMESCO coding tables); 
-  better presentation of coding aids. 

"The data are under-used": this could be addressed by 

-  on-line consultation of the European base on the Internet; 
-  sharing of new tools for data use (typology, data mining, etc.). 

"The  results  are always the  same": one of the aims of the  EHLASS  system  is to  detect 
broad  trends  (general  accident  analysis). There is certainly  little  variation  in the  general 
findings  (high frequency  of poisoning  in young children, of falls  among elderly persons, 
etc.), but it is important to have a basis of reference which is stable over time in order to 

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EN/24/97/17380000.W00 (FR) 

Extract from  the final report of the EHLASS evaluation  study -PSYTEL document 

-  be in a position to construct behavioural and detailed accident analysis approaches; 
-  build  up  a  "pool"  of  data  for  ex-post  and  ex-ante  studies  (a  recent  example  being 

drowning accidents in swimming pools); 

-  provide  a  basis  for  assessing  prevention  policies  by  measuring  changes  in  the 
frequency  (or  compound  severity  rating)  of  types  of  accidents  associated  with 
products which have given rise to action. 

"What  will  be,  will  be":  this  is  an  expression  of  cynicism  rather  than  common  sense. 
Section  3 lists  many examples  of practical  measures taken  on the basis of the  EHLASS 
data.  Only  EHLASS  can  provide  answers  to  many  questions  such  as whether  accidents 
have  been  reported  with  a  new  type  of  firework,  whether  a  horse-rider's  hat  affords 
adequate  protection,  whether there have been  cases of suffocation  with a particular  type 
of toy or how many and what types of fractures  are caused by snowboard accidents. 

"It is not the Commission's job to fund  this system": sections  14 and  15 establish that it 
was  appropriate  for  the  Commission  to  support,  fund  and  coordinate  the  EHLASS 
system. 

=> Our  recommendation  is that three  main  steps  be taken  to support  and  improve 

the EHLASS system: 

-  creation  of  a  European  EHLASS  database  which  can  be  consulted  via 

- 
- 

Internet; 
introduction of the new coding system; 
introduction of new data utilisation tools proposed by a joint panel of national 
experts. 

These  steps  in  themselves,  without  any  increase  in  costs,  should  give  EHLASS  its 
second wind and allow it to take on a new dimension. 

=> The purpose of these changes is 

-  to give EHLASS a much more active Community role, especially at the level of 
the  Commission,  ensuring  greater  collaboration  with  DG XXIVs  alert 
systems, with  EUROSTAT  and with  DG V in  connection  with  the  1999-2003 
Community action programme on injury prevention; 

- 

to  have  better tools  available  so that  practical  steps  can  be taken  to  improve 
consumer safety and the health of European citizens. 

=> The  best  way  of  ensuring  better  data  quality  in  the  various  countries  is  very 
frequent  Community  use of the data from  all countries and the greater ease and 
sophistication of use that will result from the changes proposed. 

21/21 

ISSN 0254-1475 

COM(98) 488 final 

DOCUMENTS 

EN 

05  06  01  17 

Catalogue number  :  CB-CO-98-501-EN-C 

ISBN 92-78-38705-3 

Office  for Official  Publications of the European Communities 

L-2985 Luxembourg 

2  2~