Deborah Friedman has served as Director of Trauma at the Montreal Children’s Hospital Trauma Centre, McGill University Health Centre, since 2000. In 2011, she was appointed Director of the hospital’s Canadian Hospitals Injury Reporting and Prevention Program (CHIRPP), a Public Health Agency of Canada initiative. She is an Associate Professor in the Departments of Pediatrics and Pediatric Surgery in the Faculty of Medicine and Health Sciences at McGill University, where she also served as Assistant Dean of Student Affairs from 2016 to 2023.
How did you find your way into the injury prevention field? What attracted you?
My journey into trauma care and ultimately injury prevention began more than three decades ago when I started my career as a physiotherapist at the Montreal Children’s Hospital. Inspired by the opportunity to take on leadership positions in both Trauma Care and Injury Prevention, I pursued graduate studies in International Health Management. Along the way, I discovered a passion for teaching and a deep commitment to mentoring the next generation of health professionals. Those interests culminated in my appointment as Assistant Dean of Student Affairs in the Faculty of Medicine and Health Sciences at McGill University, where I had the opportunity of supporting students’ professional and personal development by encouraging critical thinking, reflection, and problem solving.
Early in my clinical practice, I worked with children and adolescents recovering from traumatic brain injuries, spinal cord injuries, complex orthopedic trauma, burns, and other life-threatening injuries. The experience left me with several enduring lessons: the critical importance of coordinated, collaborative inter-professional care and clear communication; the extraordinary resilience of patients and their families; the profound losses that can occur in an instant; and the privilege and responsibility of caring for those affected by trauma. I witnessed not only the physical consequences of these injuries, but also their far-reaching emotional, educational, psychosocial, and economic impact on children, adolescents, families, and communities. Many of these injuries were devastating and life altering, moreover, in many cases, entirely preventable.
From the outset, I came to see trauma care and injury prevention as inseparable—two parts of the same continuum. Over time, I learned to think in terms of primary prevention, reducing risk before injury occurs; secondary prevention, ensuring early recognition and timely intervention to limit harm; and tertiary prevention, optimizing recovery and long-term outcomes. This framework became the foundation of my clinical practice, teaching, research, knowledge translation, and advocacy. Energized by the opportunity to intervene before a child or adolescent ever became a patient, my focus expanded from treating injuries to understanding why they occurred, identifying modifiable risk factors, and developing strategies to reduce their incidence through education, system improvement, advocacy, and evidence-informed policy. For me, trauma care and injury prevention have always gone hand in hand.
Trauma is a team sport and I continue to be drawn to the field’s inherently inter-professional and interdisciplinary nature. Likewise, injury prevention cannot be the work of any one profession, it requires collaboration among clinicians, researchers, educators, policymakers, governments, community organizations, and families. That collective effort was intellectually stimulating and, more importantly, offered the opportunity to improve outcomes far beyond the individual patient.
A defining moment in my career came in 1989 with the opportunity to establish and lead Quebec’s first pediatric Neurotrauma Program. We developed an interprofessional program that integrated medicine, surgery, nursing, rehabilitation, psychosocial services, and administration, to provide collaborative coordinated care for children with severe neurotrauma. That experience reinforced a lasting lesson: the best outcomes come not from isolated expertise, but from systems designed around the needs of patients and families. The program became a model for pediatric trauma care across Canada and marked the beginning of my work in trauma systems development.
In 2000, building on the foundation I had established in pediatric neurotrauma I assumed the role of Director of Trauma at the Montreal Children’s Hospital. In this role, I advanced trauma systems, built teams and programs, strengthened injury prevention initiatives, and integrated clinical care with quality improvement and a population health perspective. My work expanded to encompass concussion awareness and management, injury surveillance, education, advocacy, and trauma system design. Whether in the clinical areas, the learning environments, or the regional, provincial or national policy arena, my focus remained constant: preventing injuries improving outcomes, and advocating for the individualized trauma needs of children and adolescents.
Why did you stay in the injury prevention field?
I stayed because I never saw injury prevention and trauma care as separate fields—they are fundamentally connected. One informs the other continuously. The more I worked in trauma care, the more convinced I became that prevention must be embedded within it, not positioned alongside it.
A pivotal step in that direction came in 2011 when I became Director of the Canadian Hospitals Injury Reporting and Prevention Program (CHIRPP) at the Montreal Children’s Hospital. One of my priorities was to fully integrate injury surveillance into the trauma centre’s clinical environment. By bringing together our CHIRPP coordinator, injury prevention team, trauma clinicians, and research staff, we created a model where real-time data simultaneously informed clinical insight and prevention strategies. We were able to become leaders at provincial, national and international levels. This integration allowed us to identify emerging injury trends earlier, evaluate interventions more effectively, and respond rapidly to new risks. It also reinforced core beliefs: prevention is only as strong as the quality of data that informs it, and clinical understanding gives that data meaningful context.
What sustained my commitment was seeing the tangible impact of this approach. I witnessed how changes in systems, policy, and education, could directly reduce harm. Concussion management is a strong example. Over time, awareness shifted dramatically—from seeing concussion as a minor or expected sports injury to recognizing it as a type of brain injury requiring careful management and recovery. Concussion education changed how athletes, families, coaches, schools, and clinicians approached return-to-play and return-to-learn decisions.
Building programs was another source of motivation. I was fortunate to work with dedicated colleagues who shared a common belief: the best trauma care is prevention. Among the initiatives I am particularly proud of is the development of the inter-professional Emergency Trauma Code Response system, which improved coordination and response time for critically injured children.
I also worked extensively on strengthening communication between pre-hospital services and trauma centres, improving transfer efficiency and ensuring that children received specialized care more quickly. These system-level changes, while less visible than clinical interventions, often have the greatest impact on outcomes.
Over time, the field itself evolved. New challenges emerged—cannabis ingestion in young children following legalization, drowning risks, playground equipment safety and standards, minor hockey injuries, ATV and recreational vehicle trauma, and more recently the impact of innovation on safety with the rise in popularity of e-scooters and e-bikes. Each new issue reinforced the same lesson: injury prevention is never static. It requires continuous adaptation, curiosity, and collaboration.
What has kept me in the field is not only its impact, but moreover its philosophy. Children need to move, play, learn to be part of a team, and explore. It is important for their physical, psychological, social and emotional development. Our responsibility is not to restrict or discourage activity, but to educate and advocate for environments where activity can occur safely. That elusive balance between protection and participation has always been central to my work in injury prevention. The message is key, be active and be aware of the risk, and always make informed choices!
What do you feel have been some of the successes in injury prevention?
One of the most important successes in injury prevention over the past several decades has been a fundamental shift in mindset: injuries are no longer viewed as unavoidable accidents, but as events that are predictable and often preventable.
A major area of progress has been concussion recognition and management. I consider myself to be a pioneer in the field. Early in my career, concussion was frequently underestimated. Many children, adolescents and athletes returned to activity too soon, often prior to full recovery. Working with colleagues, we created, developed and expanded the Montreal Children’s Hospital Concussion Program and produced important resources like the MCH Concussion KiT. First introduced in 2007 and now in its fourth edition, it has been widely adopted and referenced nationally and internationally, including by INESSS, Health Canada and the CDC. Our program was a living lab where the work we did contributed to significant changes in youth concussion management.
Another key advancement has been the development of integrated trauma systems. The pediatric Neurotrauma Program established in 1989 demonstrated the value of coordinated inter-professional patient and family focused trauma care. Over time, this model evolved into broader trauma system development, integrating medical, surgical, rehabilitation, nursing, and psychosocial expertise into a single coordinated approach. These systems improved outcomes and influenced trauma care beyond our institution.
The integration of injury surveillance through CHIRPP was another major step forward. By linking surveillance data directly to clinical practice, we were able to identify patterns in real time and respond quickly. For example, we were among the first to detect an increase in cannabis ingestion among young children following legalization. Working with public health partners and the media, we helped raise awareness, contributing to policy changes including restrictions on candy-like cannabis products in Quebec.
During the COVID-19 pandemic, surveillance again proved essential, identifying increases in backyard drowning and sledding injuries and allowing timely public health messaging.
Policy and advocacy efforts have also led to meaningful changes. Some examples include: includes; improvements in playground safety standards; anchoring of soccer nets; removal of trampolines from school physical education programs; a ban on the production of baby walkers in Canada; advocacy for backyard pool fencing; updates to minor hockey regulations following our reporting of a significant increase in injuries; enhanced trauma transport systems; expanded access to pediatric trauma care across Quebec; and safer recreational infrastructure, including toboggan hills.
In 2013 in Quebec, I also contributed to public policy discussions demonstrating that wearing turbans does not increase the risk of soccer-related injury, helping to ensure that decisions made were grounded in evidence rather than politics.
Public education has been another area of success. I have always felt that as a Trauma Centre we had a responsibility to diffuse timely credible information and recommendations. Through hundreds of media engagements, we translated evidence into practical guidance on concussion, drowning awareness and prevention, helmet use, ATV safety, carbon monoxide poisoning, button battery ingestion, dangers of distracted driving, cannabis ingestion, trampoline safety, and emerging high risks such as e-scooters and e-bikes amongst other timely topics.
Perhaps the most enduring success has been cultural. Injury prevention is now more widely recognized as a shared responsibility across healthcare, education, government, and communities. That cultural shift is what allows systems to sustain progress over time. Accurate surveillance and collaboration amongst trauma centres is essential.
How do you feel about the future of the injury prevention field?
I am optimistic about the future of injury prevention, but also mindful of the challenges ahead.
Advances in data science, surveillance systems, and digital technology are transforming how we understand injury. We are moving toward earlier detection of trends, better identification of risk factors, and more targeted prevention strategies. Integrated surveillance systems at provincial, national, and international levels will further enhance our ability to respond in real time. CHIRPP has been essential to the work we have done at our Trauma Centre and should be part of all pediatric and adult centres across the country. It would allow for larger scale reflections on the Canadian trauma profile and guide prevention strategies needed on a national level.
Collaboration will remain central. The most effective initiatives I have seen have always involved partnerships across healthcare, public health, education, government, and community organizations. That collaborative model will become even more important as injury patterns grow more complex.
Education will continue to play a critical role. Future healthcare professionals will be better equipped to integrate prevention into everyday clinical practice. At the same time, we must prepare for new and evolving risks, including those associated with rapidly changing transportation technologies, recreational devices, substance use patterns, and weather related events.
One area of concern is the increasing burden of violence and mental health-related trauma. Issues such as social media–driven bullying, Tik Tok challenges, psychological distress, and community violence are now directly shaping injury patterns in ways that were far less visible earlier in my career. These challenges require a more integrated approach that addresses both physical injury and its underlying social determinants.
Despite these concerns, I remain deeply hopeful. Injury prevention has always evolved in response to new evidence and new realities. The capacity for innovation within this field is strong, and the commitment of those working within it is even stronger.
If you could wave a magic wand and change one thing for injury prevention, what would it be?
If I could change one thing, it would be to make injury prevention a fully embedded priority across every system that influences the lives of children, adolescents, and families.
Prevention should not be an afterthought. It should be built into the design of communities, schools, healthcare systems, transportation networks, recreational environments, and consumer products from the beginning. Safety should be proactive, not reactive. Regulation is important, but it must be paired with education, enforcement, and shared responsibility. Working together to develop national strategies would be ideal.
I would also ensure universal access to robust injury surveillance systems similar to CHIRPP. Data is the foundation of prevention. Without timely and accurate information, we are limited in our ability to identify risks and respond effectively.
Equally important is equity. Children in rural, remote, and First Nations communities should have the same access to prevention programs, trauma expertise, and resources as those in urban centres. This remains an area where continued progress is essential.
Finally, I would reinforce a culture in which injury prevention is everyone’s responsibility. The greatest advances occur when clinicians, educators, policymakers, families, and communities work together toward a shared goal of safety and well-being.
Looking back, I return to two lessons my late parents taught me: choose to do something you are passionate about, and use it to help others. Those principles have guided every stage of my career.
I have been fortunate to work with extraordinary colleagues, a supportive institution, the Montreal Children’s Hospital, McGill University Health Centre and the Montreal Children’s Hospital Foundation, as well as countless partners across Quebec, Canada, and internationally.
Injury prevention is not just a field—it is a commitment to protecting potential. When evidence, collaboration, and compassion come together, we can prevent injuries before they happen and create healthier futures for children and communities.