cmretac prevention report 2014 - 2015

Central Mountains RETAC PO Box 5055 Frisco, CO 80443 Web: www.cmretac.org

Prepared by: Caring Anne Consulting, LLC Anne Robinson-Montera, RN, BSN PO Box 5973 Eagle, CO 81631 Email: [email protected]

PREVENTION NEEDS

ASSESSMENT

December 2014

CENTRAL MOUNTAINS RETAC

Table of Contents

I. Executive Summary ....................................................................... 1

II. About Central Mountains RETAC ............................................... 1

III. Participating Agencies ................................................................ 2

IV. The Prevention Needs Assessment .......................................... 4 INTRODUCTION ........................................................................................................... 4 PRIMARY DATA COLLECTION .............................................................................................. 4 SECONDARY DATA COLLECTION ........................................................................................... 6

Background on Trauma Data ...................................................................................... 6 Background on EMS Data .......................................................................................... 6 Frequency of Injury ................................................................................................ 6

V. The CMRETAC’s Prevention Profile ........................................... 8 CAUSES OF INJURY ....................................................................................................... 8 DEMOGRAPHICS .......................................................................................................... 10

Total Injury by Gender ........................................................................................... 10 Top 3 Causes of Injury by Age for Trauma .................................................................... 10 Top 3 Causes of Injury by Age for EMS ......................................................................... 12

RESIDENTS VERSUS VISITORS ............................................................................................. 13 Chaffee County .................................................................................................... 14 Eagle County ....................................................................................................... 15 Lake County ........................................................................................................ 16 Park County ........................................................................................................ 17 Pitkin County ....................................................................................................... 18 Summit County .................................................................................................... 19 Central Mountains RETAC ........................................................................................ 20

PREVENTION RESOURCES ................................................................................................ 21 CURRENT PREVENTION ACTIVITIES ....................................................................................... 22

Teen Seat Belt Challenge ........................................................................................ 23 PREVENTION NEEDS ..................................................................................................... 24

VI. Recommendations and Next Steps ......................................... 25

VII. End Notes .................................................................................... 26

CENTRAL MOUNTAINS RETAC Page 1

I. Executive Summary

The Central Mountains Regional Emergency Medical and Trauma Advisory Council (CMRETAC) has conducted a Injury Prevention Needs Assessment as directed by the Board Members. The CMRETAC completed the Systems Development Biennial Plan in early 2013 as required by the Colorado Department of Public Health and Environment’s Emergency Medical and Trauma Services Division. Aligning with priorities and goals from the Biennial Plan, the Board Members contracted with a Prevention Coordinator to coordinate, collaborate, and promote the prevention efforts throughout the region. One of the first goals of the position was to conduct a Prevention Needs Assessment. This report is the first of its kind conducted by the CMRETAC and represents the beginning of forming a Prevention Committee, aligning goals and efforts based on the needs identified.

II. About Central Mountains RETAC The Central Mountains Regional Emergency Medical and Trauma Advisory Council (CMRETAC) region is primarily rural, stretching over 6,883 miles in the mountainous continental divide area of Colorado. The region is almost the size of the State of New Jersey and has unique passenger safety challenges that range from tens of thousands of travelers that do not reside in the region, to the risk taking teen population, and the non-English speaking service working population. Additional challenges include access to medical care due to the rural designation and weather constricting mountainous roads. Within the region, people travel up to 65 miles one way to be seen in a hospital. Image 1 is a map of Colorado outlining the 11 Regional Emergency Medical and Trauma Advisory Councils.

Image 1

CMRETAC is made up of 6 counties: Chaffee, Eagle, Lake, Park, Pitkin, and Summit. All of which have unique characteristics and challenges. Table 1 outlines the demographics of each county according to the 2014 Problem Identification Report published by the Colorado Department of Transportation (CDOT)i, with the demographic data based on 2012 results.

Regional Emergency Medical and Trauma Advisory Councils

Central MountainsCentral Mountains RETACRETAC

Foothills RETACFoothills RETAC

Northeast ColoradoNortheast Colorado RETACRETAC

Southeastern ColoradoSoutheastern Colorado RETACRETAC

SouthwestSouthwest RETACRETAC

Plains to PeaksPlains to Peaks RETACRETAC

San Luis ValleySan Luis Valley RETACRETAC

MileMile--HighHigh RETACRETAC

WesternWestern RETACRETAC

Northwest RETACNorthwest RETAC

Southern ColoradoSouthern Colorado RETACRETAC


Table 1: CMRETAC 2012 Demographics

County Square Miles Population Traffic Fatalities Serious Injuries in Traffic Crashes

Chaffee 1,015 18,066 4 45 Eagle 1,692 51,944 7 142 Lake 384 7,299 0 12 Park 2,211 16,063 3 77

Pitkin 973 17,206 1 57 Summit 608 28,167 3 83

CMRETAC Totals 6,883 138,745 18 416

With a population of 51,944, Eagle County covers over one-third of the region’s total population of 138,745. The smaller rural counties of Chaffee, Lake, Park and Pitkin’s population are less than 20,000, where Summit is more densely populated than any other county. The region had 18 traffic fatalities and 416 serious injuries in traffic crashes during 2012, making this a priority for the future.

III. Participating Agencies The CMRETAC’s mission statement is OPTIMIZING THE CARE OF SICK AND INJURED PATIENTS, AND PREVENT INJURY THROUGH THE INTEGRATION OF HEALTH CARE FACILITIES AND EMERGENCY MEDICAL RESOURCES; UTILIZING COMMUNICATIONS, DATA, PROTOCOLS, CQI AND SYSTEMS DEVELOPMENT. This mission could not be possible without the contribution from the Board Members and participating agencies in each county. There are also agencies that are not currently participating in the RETAC Board meetings, but through this assessment process were identified. A recommendation is to start expanding participation in the regional Prevention Coalition in order to ensure all stakeholders are involved so all of the needs of the communities will be met. Below is a list of agencies by county, separating out current and future members. Chaffee:

§ Buena Vista Fire Department, Buena Vista, CO § Chaffee County EMS, Salida and Buena Vista, CO § Chaffee County Emergency Manager, Salida, CO § Chaffee County Fire Protection District, Buena Visita, CO § Chaffee County Public Health, Salida, CO § Heart of the Rockies Regional Medical Center, Salida, CO § Salida Fire Department, Salida, CO

Eagle:

§ Bond/McCoy Fire, Bond, CO § Colorado Mountain College, Edwards, CO (Regional Educational Institution) § Eagle County Airport Fire Department, Eagle, CO § Eagle County Emergency Manager, Eagle, CO § Eagle County Paramedic Service, Edwards, CO


§ Eagle County Public Health, Eagle, CO § Eagle River Fire Protection District, Edwards, CO § Greater Eagle Fire Protection District, Eagle, CO § Gypsum Fire Protection District, Gypsum, CO § Vail Fire, Vail, CO § Vail Valley Medical Center, Vail, CO

Lake:

§ Lake County Emergency Manager, Leadville, CO § Lake County Fire Department, Leadville, CO § Lake County Public Health, Leadville, CO § St. Vincent Hospital and Ambulance Service, Leadville, CO

Park:

§ North-West Fire Protection District, Fairplay, CO § Park County Emergency Manager, Fairplay, CO § Park County Public Health, Fairplay, CO § Platte Canyon Fire Department, Bailey, CO § South Park Ambulance District, Fairplay, CO § Southern Park County Fire Protection District, Guffey, CO § Ute Pass Ambulance District, Woodland Park, CO

Pitkin:

§ Aspen Fire Protection District, Aspen, CO § Aspen Valley Hospital, Aspen, CO § Aspen Ambulance District, Aspen, CO § Basalt Fire, Basalt, CO § Pitkin County Public Health, Aspen, CO § Pitkin County Emergency Manager, Aspen, CO § Snowmass Fire Department, Snowmass, CO

Summit:

§ Breckenridge Medical Center, Breckenridge, CO § Copper Mountain Fire Department, Copper Mountain, CO § Copper Mountain Medical Clinic, Copper Mountain, CO § Keystone Medical Clinic, Keystone, CO § Lake Dillon Fire Department, Silverthorne, CO § Red, White, and Blue Fire Protection District, Breckenridge, CO § St. Anthony / Summit Medical Center, Frisco, CO § Summit County Ambulance Service, Silverthorne, CO § Summit County Emergency Manager, Frisco, CO § Summit County Public Health, Frisco, CO


IV. The Prevention Needs Assessment

INTRODUCTION: The Prevention Needs Assessment provides an analysis of the current prevention programs, services, and injuries treated for in the CMRETAC. This information compares survey findings regarding perceived prevention efforts among CMRETAC Board members and analyzed results from county level EMS and Trauma data collected over a specific time range. The methodology of collecting primary and secondary data identified prevention priorities in the CMRETAC to help further the work and build on best practices in the future.

PRIMARY DATA COLLECTION: In conducting the Prevention Needs Assessment for the CMRETAC, information was gathered from the primary data collection source in the form of a Prevention Survey using SurveyMonkey®. All CMRETAC Board Members were asked to fill out the survey and specify what type of agency they represented: EMS, Hospital, Police/Fire, or Public Health. The Board Members were also asked to pass on the survey link to anyone in their community that wasn’t included in the initial contact list. In total, the survey was emailed to 42 respondents, with a response rate of 48 percent. Individuals surveyed included local EMS administrators, Trauma nurse coordinators, prevention and outreach coordinators, fire department administrators, public health officials, sheriff deputies and administrators, police administrators, and emergency managers. Actual respondents to the survey included representation from the following agencies or organizations by county as seen in Table 2:

Table 2: Responses by Agency Type

County EMS Hospital Police/Fire Public Health

Chaffee 1 1 1 1

Eagle 1 1 Lake 1 1 1 Park 3 1

Pitkin 1 Summit 4 2

Methodology

Primary

Survey of Board Members

Secondary

County Level EMS Data County Level Trauma Data


Chart 1 shows the break down by type of agencies that responded to the survey. Hospital and Fire/Police accounted for 65 percent of all responses.

Chart 2 shows the responses by County, with Summit and Park accounting for 50% of responses. Note that some counties had multiple responses from the same type of agencies.

EMS 25%

Fire/Police 30%

Hospital 35%

Public Health

10%

Chart 1: Agency Type Response

Chaffee 20%

Eagle 10%

Lake 15% Park

20% Pitkin 5%

Summit 30%

Chart 2: Responses by County


SECONDARY DATA COLLECTION: The CMRETAC conducted secondary data collection by asking The Colorado Department of Public Health and Environment (CDPHE)’s Trauma and EMS division to run specific statistical reports for 2009-2013. The reports were run in the Trauma and EMS reporting systems, inquiring about the top 5 causes for injuries at the county and regional level. Additional demographic data was collected including age, sex and home residence for each of the patients. Since not every county within the CMRETAC has a hospital and injury types vary by county, it was important to run the reports from both of these databases. Background on Trauma Data: Trauma data is collected at designated Trauma facilities throughout the state. Only Level I, II, and III facilities are required to report Trauma data and Level IV and V facilities have the option to contribute. The data is collected on patients that meet the Inclusion Criteria as defined by the State of Colorado Department of Public Health and Environment Health Facilities and Emergency Medical Services Divisionii and are listed in Table 3.

Background on EMS Data: EMS data is collected by air and ground ambulance transport agencies that are licensed by CDPHE. As stated in Chapter 3 Rulesiii, “All agencies licensed in Colorado shall report the required data elements on all responses that resulted in patient contact. Although not required, agencies may also report the required data elements on responses that did not result in patient contact or transport (all calls)”. The required data and information on patient care is based on the National Emergency Medical Services Information System (NEMSIS) released and recommended by the National Highway Traffic Safety Administration (NHTSA) in 2008. Background on Frequency of Injury: All of the data received from the state’s EMS and Trauma departments has been evaluated and prioritized for this publication by state and regional data experts and regional Trauma nurse coordinators. It was concluded that the data will be presented separately as EMS and Trauma, but then evaluated together as

Table 3: INCLUSION CRITERIA: ALL Trauma patients who:

1. Die anywhere in the hospital (deaths in the emergency department, DOA deaths, deaths in the OR, deaths as an inpatient).

OR 2. Are transferred into or out of an acute care facility, regardless of injury severity, length of stay at the

transferring facility, or mode of transfer (by EMS or by private vehicle). Information should be downloaded to the state registry from both the transferring facility and the receiving facility for any patient transferred (even if the patient is discharged from the ED of the receiving facility).

OR 3. Have an ED disposition = OBS and either (a) and Injury Severity Score (ISS) ≥ 9 or (b) a hospital stay of ≥ 12

hours from the time of arrival at the emergency department. OR

4. Have an ED disposition = FLOOR, ICU, TELE, ADMIT, OR, or DIRECT. OR

5. Are admitted for missed diagnoses, complications, failed conservative management or iatrogenic injuries identified after a previous hospital encounter. For these unplanned returns, the original ED visit or admission could have been at your facility or at another facility. Patients who are readmitted as part of standard or planned care for a given injury (e.g., removal of hardware after an orthopedic procedure) should NOT be included as a readmission. The readmission should occur within 30 days of when the patient was last discharged.


recommendations have been made for future regional prevention efforts. With the Trauma data, the results are based on the location where the injury occurred versus the location where the patients were treated. Where with the EMS data, the results are based on where the call for care originated. In addition, Trauma data is based on one patient’s medical record where EMS data is based on each incident or call. For example, a patient can be transported by EMS to a hospital, treated, and transported again to another facility. This would account for two transports and one patient visit to the hospital. At first glance, the Chart 3 below shows the frequency of Injury by county for the 2013 Trauma data set. Summit and Eagle Counties account for almost 70% of the regional’s 2604 recorded Trauma injuries. Where the four other counties, Chaffee, Lake, Park and Pitkin make up the remaining 30% of total injuries in 2013.

Looking at Chart 4 below, the 2013 EMS Frequency of Injury by County, Eagle County accounts for 48% of the total 2213 EMS regional calls, where the other five counties together make up the remaining 52%.

Comparing both charts shows that both Pitkin and Summit Counties see more patients in their Level III and IV Trauma Centers, but more than 50% of their patients are transported to their facility by non-licensed transport agencies. Where in Chaffee, Lake, and Park Counties, EMS transports more non-Trauma patients then higher-level Trauma patients.

40

734

348 83

318

1081

0

500

1000

1500

CHAFFEE EAGLE LAKE PARK PITKIN SUMMIT

Chart 3: 2013 Trauma Frequency of Injury by County

244

1065

77 218 168

441

0

500

1000

1500

Chaffee Eagle Lake Park Pitkin Summit

Chart 4: 2013 EMS Frequency of Injury by County


V. The CMRETAC’s Prevention Profile CAUSES OF INJURY: To help identify and prioritize regional prevention efforts, the top causes of injury needs to be identified based on Trauma and EMS data. In Chart 5, the top 5 Trauma causes of injury throughout the region over the past 5 years shows Falls as the number one and primary injury accounting for 80% of all injuries. The other 20% of injuries comes from motor vehicle traffic occupants, pedal cyclists, other transports, and struck by/against.

In order to understand the causes of injury, the Trauma definitions are cited below from the Center for Medicare and Medicaid Services ICD-9 codesiv Fall accounts for over 100 ICD-9 codes including a wide range of activities as well as skiing, snowboarding, falls from a standing height, and falls from trains, ladders, rafts, stairs, scaffolding, wheelchair, skateboard, etc.*

9981

829 664 538 440 0

5000

10000

15000

FALL MVT OCCUPANT

PEDAL CYCLIST, OTHER

TRANSPORT, OTHER

STRUCK BY, AGAINST

Chart 5: CMRETAC Trauma's Top Causes of Injury 2009 - 2013

• Injuries relating to how a patient falls. Accounts for over 100 ICD-9 codes* Fall

• Injuries that Involve both motor vehicle collisons and single car accidents (rollovers) and accounts for 20 ICD-9 codes

Motor Vehicle Traffic Occupant

• Injury involving a pedal cyclist Pedal Cyclist,

Other

• Injury caused by transport device other than a motor vehicle including snowmobiles, ATV, etc Transport, Other

• Refers to several different mechanisms like striking a tree while skiing, colliding with another person while skiing, a tackle in football or hit by a puck in hockey

Struck by, Against


In Chart 6, the top 5 EMS causes of injury throughout the region from the past 5 years, also shows falls as the number one injury accounting for 58% of all injuries. Motor vehicle traffic accident is second at 29% followed by bicycle accident, motor vehicle non-traffic accident, and motorcycle accident.

All of the EMS definitions for cause of injury below were cited from The National Association of State EMS Officials Extended Definition Document NEMSIS/NHTSA 2.2.1 Data Dictionaryv except for Motorcycle Accident* which was not included in the document.

5387

2752

681 269 245 0

2000

4000

6000

Falls Motor Vehicle Traffic Accident

Bicycle Accident Motor Vehicle Non-‐Traffic Accident

Motorcycle Accident

Chart 6: CMRETAC EMS's Top 5 Causes of Injury 2009 - 2013

• Excludes falls which occur in the context of other external causes of injury such as fire, or falling in incidents involving machinery

Falls

• Includes any motor vehicle incident occurring on a public road or highway

Motor Vehicle Traffic Accident

• Includes bicycle-related incidents not involving a motorized vehicle Bicycle Accident

• Includes any motor vehicle incident occurring entirely off public roadways or highways. (ATV, snowmobile)

Motor Vehicle Non-Traffic Accident

• Includes any motorcycle accident occurring on a public road or highway

Motorcycle Accident*


DEMOGRAPHICS: Total Injury by Gender: When combining all injuries throughout the region from the past 5 years, males have a higher prevalence of injuries, both in the Trauma and EMS cases.

Top 3 causes of injury by age for Trauma: When prioritizing prevention activities, it is important to target the population with the most risk and occurrence of injury. The definition of fall can result while skiing or just being in one’s own home. The break down of age can help evaluate what types of falls are occurring in the region. In Chart 9 injuries occur primarily with persons ages 18 – 34 but followed closely behind are persons ages 45 – 64.

Female

Male

0

2000

4000

6000

8000

10000

Total

Chart 7: CMRETAC Trauma's Total Injuries by Gender

2009 - 2013

Female

Male

0

2000

4000

6000

Total

Chart 8: CMRETAC EMS's Total Injuries by Gender

2009 - 2013

0 200 400 600 800 1000 1200 1400 1600 1800

Age 0-4 Years Age 5-12 Years

Age 13-17 Years Age 18-24 Years Age 25-34 Years Age 35-44 Years Age 45-54 Years Age 55-64 Years Age 65-74 Years

Age 75+ Years

Chart 9: #1 Trauma FALL


In Chart 10, patients 18 – 44 years old are involved in more motor vehicle accidents than anyone else.

In Chart 11, 45 – 64 year old patients are involved in more bicycle accidents than any other population.

0 20 40 60 80 100 120 140 160



Age 75+ Years

Chart 10: #2 Trauma MVT OCCUPANT

0 20 40 60 80 100 120 140 160 180



Age 75+ Years

Chart 11: #3 Trauma PEDAL CYCLIST


Top 3 causes of injury by age for EMS: EMS data reflects the Trauma data with the top 3 causes of injuries that are fall, motor vehicle accidents, and bicycle accidents. EMS systems are responding to more falls in the older population, of over the age of 75 as seen in Chart 12. This number will continue to increase as the population ages.

In Chart 13, patients 18 – 34 years old are involved in more motor vehicle traffic accidents any other population.

0 100 200 300 400 500 600 700 800

Age 0-‐4 Years Age 5-‐12 Years

Age 13-‐17 Years Age 18-‐24 Years Age 25-‐34 Years Age 35-‐44 Years Age 45-‐54 Years Age 55-‐64 Years Age 65-‐74 Years Age 75+ Years

Chart 12: #1 EMS FALLS

0 100 200 300 400 500 600

Age 0-‐4 Years Age 5-‐12 Years Age 13-‐17 Years Age 18-‐24 Years Age 25-‐34 Years Age 35-‐44 Years Age 45-‐54 Years Age 55-‐64 Years Age 65-‐74 Years Age 75+ Years

Chart 13: #2 EMS Motor Vehicle Traffic Accident


As with the Trauma data, patients 45 – 64 years old are the population that is involved in more bicycle accidents as seen in Chart 14.

RESIDENTS VERSUS VISITORS: The CMRETAC has a unique opportunity to provide various health care services to local, state, and out of state residents. The influx of visitors challenges the regional system throughout the year. Each county within the region serves a population with many similarities and differences. Below is a break down by county and region for Trauma and EMS causes of injury based on the patient’s home residence.

CHARTS TO FOLLOW

0 20 40 60 80 100 120 140 160

Age 0-‐4 Years Age 5-‐12 Years

Age 13-‐17 Years Age 18-‐24 Years Age 25-‐34 Years Age 35-‐44 Years Age 45-‐54 Years Age 55-‐64 Years Age 65-‐74 Years Age 75+ Years

Chart 14: #3 EMS Bicycle Accident


Chaffee County: The Trauma program treats 49% of patients that live within the county as seen in Chart 15. The other 51% are visitors, primarily during the warmer months of the year, with 33% live in Colorado, and almost 18% live out of state.

As seen in Chart 16, the EMS agency also provides services to the patients living within the county, accounting for 56%. Almost 10% of patients have an unknown place of residence, 27% live in Colorado, and almost 8% live out of state.

126

85

45

0

50

100

150

Lives in County Colorado Resident Resides Out of State

Chart 15: Trauma: Chaffee County Cause of Injury

Patient Home Residence 2009 - 2013

114

666

315

90

0

200

400

600

800

Unknown Residence

Lives In County Colorado Resident

Non-Colorado Resident

Chart 16: EMS: Chaffee County Cause of Injury



Eagle County:

Chart 17 outlines the patients seen by the Trauma program in Eagle County. Of the 5 year total 3366, 54% of patients are from out of state, 29% live within the county, and almost 17% live within the state.

EMS in Eagle County is more difficult to evaluate due to the 28% of patients have an unknown place of residence. Excluding unknown residence it shows that the services treats 30% of local residents, 24% of Colorado residents, and 17% of non-Colorado residents. In addition, non-transport agencies do bring Trauma patients to the hospital and are not accounted into these results.

23

974

566

1803

0

500

1000

1500

2000

Unknown Lives in County Colorado Resident

Resides Out of State

Chart 17: Trauma: Eagle County Cause of Injury


663 705 554

405

0

200

400

600

800

Unknown Residence



Chart 18: EMS: Eagle County Cause of Injury



Lake County:

In Lake County, the Trauma program treats 70% of local residents that live within the county, where 6% are Colorado residents, and 24% live out of state as shown in Chart 19.

Aligning with the county’s Trauma program, Chart 20 shows that greatest amount of patients treated, 44%, live within the county. In addition, 13% live in Colorado, 20% live out of state, and 22% have an unknown residence.

0

1169

101 400

0

500

1000

1500



Chart 19: Trauma: Lake County Cause of Injury


87

176

52 81

0

50

100

150

200

Unknown Residence



Chart 20: EMS: Lake County Cause of Injury



Park County:

Park County doesn’t have a hospital that treats local patients; so all Park County residents and visitors are treated at other facilities. Of the 365 patients treated over the 5 years, 47% live in the county, 44% are Colorado residents, and 9% live out of state based on the information in Chart 21.

EMS patients treated in Park County as shown in Chart 22 the majority of patients are Colorado residents is 47%, with 25% living within the county, 16% are from out of state, and 12% have an unknown place of residence.

1

172 160

32

0

50

100

150

200



Chart 21: Trauma: Park County Cause of Injury


160

321

599

208

0

200

400

600

800

Unknown Residence



Chart 22: EMS: Park County Cause of Injury



Pitkin County:

Very similar to Eagle County, the majority of patients treated in Pitkin County are non-Colorado residents (53%). In addition, 29% of patients live in the county, and 19% live within the state as shown in Chart 23.

Again, similar to Eagle County, the EMS data in Pitkin County shows in Chart 24 that a large percent of patients have an unknown place of residence (47%). Apart of that, 26% of patients live in the county, 18% in state, and only 9% out of state.

1

433 282

795

0 200 400 600 800

1000



Chart 23: Trauma: Pitkin County Cause of Injury


1055

571 407

201

0

500

1000

1500

Unknown Residence



Chart 24: EMS: Pitkin County Cause of Injury



Summit County:

The Summit County Trauma program treats 50% of patients that live out of state as seen in Chart 25. In addition, only 16% of Trauma patients live in the county and 34% are Colorado residents.

The EMS patient’s place of residence is not very accurate as seen in Chart 26, with 21% unknown. 30% of patients live within the county, 37% within the state, and only 11% reside out of state. As in Eagle County, non-transport agencies do bring Trauma patients to the hospital and are not accounted into these results.

5

831

1787

2661

0 500

1000 1500 2000 2500 3000



Chart 25: Trauma: Summit County Cause of Injury


458 651

804

244

0 200 400 600 800

1000

Unknown Residence



Chart 26: EMS: Summit County Cause of Injury



Central Mountains RETAC: The CMRETAC’s regional Trauma programs together treat 40% of patients that live out of state as seen in Chart 27. In addition, only 25% of patients live in Colorado and 29% live within the region.

The regional EMS patient’s place of residence is not very accurate as seen in Chart 28, with 26% unknown. 32% of patients live within the region, 28% within the state, and only 13% reside out of state. In both Summit and Eagle Counties, non-transport agencies do bring Trauma patients to the hospital and are not accounted into these results.

133

2690 2375

4144

0

1000

2000

3000

4000

5000

Unknown Lives in RETAC Colorado Resident Resides Out of State

Chart 27: Trauma: CMRETAC Cause of Injury


2537 3090

2731

1229

0 500

1000 1500 2000 2500 3000 3500

Unknown Residence

Lives In Region Colorado Resident Non-Colorado Resident

Chart 28: EMS: CMRETAC Cause of Injury Patient Home Residence 2009 - 2013


PREVENTION RESOURCES: It is important not only to identify the causes of injury and demographic data of the regional population, but also what resources are currently available to take care of the population. In the Prevention Survey, the participants were asked, “Do you have a community outreach / injury prevention position in your organization?” Of the 18 respondents, 8 responded with a “Yes”. Chart 29 shows the break down.

Of the 44% that responded “Yes”, the next questions was asked about the total number of hours each individual spent on prevention activities each month. 34% spent 0-5 hours, where the remaining were spread out equally among almost all of the rest of the choices given. Chart 30 outlines the distribution of hours.

Yes 44%

No 56%

Chart 29: "Do you have a Community Outreach/Injury Prevention position?"

0 – 5 hours 34%

6 - 10 hours 0%

11 – 15 hours 11%

16 – 20 hours 11%

21 – 25 hours 11%

26 – 30 hours 11%

31 - 35 hours 0%

36 – 40 hours 11%

41+ hours 11%

Chart 30: Number of Hours per Month


With further evaluation, calculations were made to show the total hours dedicated to prevention activities per month but by agency type. The results show that the majority of time spent on prevention activities comes from resources in the hospitals throughout the region, where only ONE EMS agency in the region dedicates on average 100 hours per month. Chart 31 shows the breakdown.

CURRENT PREVENTION ACTIVITIES: The CMRETAC is well known around the State of Colorado for the prevention efforts and activities conducted in the region. The Prevention Survey asked each respondent to list all of the prevention activities that their agency is currently involved with in the county. This gave participants the opportunity to free text their responses and further provide current and up to date information. After extensive evaluation of the answers, the top five activities were identified in random order.

100

208

35

343

0 50

100 150 200 250 300 350 400

EMS Hospital Fire/Police Total Prevention Hours Per Month

RETAC

Chart 31: Hours Per Month Injury Prevention by Agency Type

Ski and Bike Helmets

Seat Belts

Car Seats

Fall Prevention

Health Promotion


Teen Seat Belt Challenge: Every year, The Colorado Department of Transportation (CDOT) conducts multiple seat belt use surveys throughout the State of Colorado. Only 3 of the CMRETAC’s 6 counties have been observed in the studies over the past 5 years showing a seat belt use rate lower than the state average of 80.7%vi. To respond to lack of data and results, the CMRETAC Prevention Coalition was created in 2011 to address the seat belt usage problems in all 6 counties of the region. These efforts resulted in a grant partnership with CDOT over the past 5 years. There is at least one high school in each county, which became the only consistent target for the CMRETAC to capture data and create an opportunity for improvement within the region. Also, according to NHTSA, “belt use rates for occupants 16 to 24 years old tends to be lower than the use rates of all other age groupsvii”. So during the first grant cycle in 2011 it was identified that the CMRETAC would need to start collecting seat belt use data due to the limited resources in the mountainous rural setting. Since that time, four seat belt use surveys have been consistently and accurately conducted each year at the local high schools throughout the region. The data collected has been used to justify the need for continued grant support in the past and is the only consistent source of data available to show what is truly going on in the rural mountain communities in Colorado. Built on the best practices established during the first 3 Teen Seat Belt Challenges, the CMRETAC Prevention Coalition will continue to engage partners and grow the stakeholder groups throughout all of the 6 counties in order to ensure the most effective strategies for behavior change. The communication and outreach strategies are the core activities during the CMRETAC’s Teen Seat Belt Challenge. This student lead project has demonstrated amazing results with a variety of activities. From school and community wide signage, to kick-off events including community stakeholders and great educational opportunities, to t-shirt design contests that push the safety message, to pledge banners, this six week long event is focused on influencing and changing life long behaviors. This program sets up young drivers with the skill and expertise to make educated decisions about wearing their seat belts for the rest of their lives. During the spring of 2014, the third annual CMRETAC Teen Seat Belt Challenge was held. Over 5,000 students participated from six high schools from around the region with the goal to increase seat belt usage. The six high schools were as follows: Aspen HS in Aspen, CO; Buena Vista HS in Buena Visita, CO; Eagle Valley HS in Gypsum, CO; Salida HS in Salida, CO; South Park HS in Fairplay, CO, and Summit HS in Frisco, CO. The data collected in the fall of 2013 was used at the starting point of the “Challenge”. The studies not only observed students, but parents and school staff as well. The activities of the Teen Seat Belt Challenge proved to be successful. Summit HS held the highest ending buckle up rate at 98.5% and tied for first place. The most improved and also tied for first place was Salida HS with a rate increase of 38.1%. They went from 55.5% to 93.6% in seat belt use compliance. There was improvement in all six schools and the CMRETAC as a region increased seat belt usage to 86.3%. The state average is 80%. CDOT has awarded the CMRETAC a fifth grant to host the fourth annual Teen Seat Belt Challenge in the spring of 2015.


PREVENTION NEEDS: The assessment of current prevention activities is one thing, but identifying the needs in the community and region is another. Each participant of the Prevention Survey was asked to list out what prevention needs have been identified in his or her county. This gave each respondent the opportunity to list where the prevention activities should be focused in the future. The following needs were identified and made as recommendations for the focus of activities in the future.

#1 Fall Prevention

#2 Older Adult Injury Prevention

#3 Ski Injuries

#4 Seat Belt Use

#5 Motor Vehicle Safety


VI. Recommendations and Next Steps TO BE DEVELOPED BY THE CENTRAL MOUNTAINS RETAC’s PREVENTION COALITION


VII. End Notes

i FY 2014 Problem Identification Report, March 2014, Colorado Department of Transportation.

ii Level III Trauma Center Designation Application, State of Colorado Department of Public Health and

Environment Health Facilities and Emergency Medical Services Division, Revised 2012.

iiiChapter Three – Rules Pertaining to Emergency Medical Services Data and Information Collection and Record

Keeping, Section 3 Reporting Requirements, Department of Public Health and Environment, Health Facilities

and Emergency Medical Services Division 6 CCR 1015-3.

iv ICD-9 Code Lookup, Centers for Medicare and Medicaid Services website, http://www.cms.gov/medicare-

coverage-database/staticpages/icd-9-code-lookup.aspx.

v Extended Definition Document NEMSIS/NHTSA 2.2.1 Data Dictionary, The National Association of State EMS

Officials and EMS Data Managers Council, Version 1 – 6-2008.

vi 2012 State of Colorado STATEWIDE Seat Belt Survey, Colorado Department of Transportation, Seat Belt Study conducted by the Colorado State University, Institute of Transportation Management. vii Countermeasures That Work: A Highway Safety Countermeasure Guide For State Highway Safety Offices, Seventh Edition, 2013, section 2-24.

Acknowledgments:

cmretac prevention report 2014 - 2015

Documents

causes of injury

eagle county

chaffee county

lake county

park county

pitkin county

summit county

central mountains retac