injury prevention and ems

CHAPTERCHAPTER

Management of EMS

Injury Prevention

and EMS

4

Bruce E. Evans • Jeff T. Dyar — Management of EMS Copyright © 2010 by Pearson Education, Inc. Upper Saddle River, NJ 07458

Learning Objectives

4.1 Describe the extent of the injury- prevention problem.

4.2 Establish what constitutes an injury.

4.3 Define the CDC injury-prevention model.

4.4 Describe the EMS manager’s role in the public-health model.


Learning Objectives (Cont.)

4.5 Explain the implementation process for injury-prevention programs.

4.6 Identify resources available for EMS agencies to conduct injury-prevention activities.

4.7 Design and implement prevention activities.

4.8 Evaluate prevention activities.



4.9 Build and manage a prevention program to disseminate information.

4.10 Stimulate change through policy, enforcement, engineering and education.

4.11 Define and describe concepts of attributable risk and explain how injuries are preventable.



4.12 Describe general approaches to prevention and demonstrate how conceptual models are used to describe multiple risk factors.


History of Injury Prevention

• Injury is still the leading cause of death and disability in the United States

• As health-care costs continue to increase, there remains a need to allocate more money toward preventing injury

• Injury prevention should be integrated into EMS operations


History of Injury Prevention (Cont.)

• EMS has spent approximately 80% of its time, money, and expectations on advanced life support “upgrades” to provide high-end services such as cardiac and trauma resuscitation, promising to resuscitate expired victims– EMS has not increased survival rates


Injury-Prevention Programs

• National Training Institute (NTI) for injury and violence prevention – Draft set of core competencies, or essential

skills and knowledge– Fundamental understanding of injury as a

public-health problem


Injury-Prevention Programs (Cont.)

– NTI objectives for injury prevention: Define and describe concepts of intentionality Explain how injuries are preventable Describe general approaches to prevention Demonstrate how conceptual models are used

to describe multiple risk factors


Intentional Injuries and Crime

• Intentional injuries are also a leading cause of death

• Homicide and suicide are the 2nd and 3rd leading causes of death for 15- to 24-year-olds

• Suicide is the 3rd leading cause of death for 10- to 14-year-olds


Intentional Injuries and Crime (Cont.)

• Homicide is the 4th leading cause of death

• Homicide is the 4th leading cause of death for 1- to 4-year-olds and 5- to 9-year-olds


National Initiative

• Healthy People 2010– Benchmarks give EMS leadership goals to

work toward – Reduce numbers by targeting specific injuries– Reduce hospital emergency department visits– Reduce the incidence of drowning – Reduce the incidence of hip fractures in fall-

related injuries


TABLE 4.1


Databases and Injury Prevention

• Web-Based Injury Statistics Query and Reporting System (WISQARS)– CDC database– Provides customized reports of

injury-related data– Query information by state and cause of

death and injury

• State EMS systems or department of highway safety

• NFERS


Databases and Injury Prevention (Cont.)

• Disease management coordinators– Employed by HMOs– Look at how to reduce medical costs and

provide cost-effective activities such as injury prevention

• Injury-prevention surveillance– Used to identify the greatest risk to the public,

as well as to monitor the progress of EMS activities as they relate to injury prevention


FIGURE 4.3Example of WISQARS Data on Injuries.


Opportunities for EMS

• Adjust from a primarily reactive service to one of injury prevention

• Community-wide approach to healthy living

• Must accept responsibility for providing health services beyond emergency response to citizens

• Bicycle helmets, child safety seats, smoke detectors, poison-control services


Science of Injury Prevention

• Epidemiology– Study of distribution and determinants of

health-related states and events in specified populations, and the application of this study to control health problems

– Focus on description or analysis

• Attributable risk– Assesses the ways in which a particular

type of injury is associated with a particular exposure within a population


Science of Injury Prevention (Cont.)

• Predictors of injury– Developmental age

Rapid and unexpected motor development Drive for autonomy Need to explore environment Cannot control impulses Cannot understand consequences of behavior Unable to comprehend causality or assess

danger and multiple aspects and risks of a situation


Public-Health Model

• A public-health approach to injury prevention is an effective way to proceed

• Looking at causes and solutions in the community as a whole

• Requires looking at the multiple causes of an injury and devising multiple solutions


FIGURE 4.5The Public-Health Model.


Epidemiological Model

• Looks at the environment, the host or human, and the agent or vector, and how the three interrelate

• Central to the evaluation of public- health problems, uncovering multiple causes, and devising multiple solutions to prevent injury


Epidemiological Model (Cont.)

• The host– The person or people who are injured

• The agent– Products people use

• The environment– Physical and social environment


Haddon Matrix

• Conceptual model for developing injury-prevention strategies

• Took the public health model a step further by looking at injuries in terms of casual and contributing factors

• Haddon believed that injuries occur with a certain time sequence, consisting of pre-event, event, and post-event phases


Haddon Matrix (Cont.)

• Buildup of uncontrolled energy is released in the pre-event phase, energy is transferred in the event phase, and factors about the state of the person, agent, or environment affect what the energy does in the post-event phase

• Points out different areas in which interventions can be applied


Access, Interpret, Use, and Present Injury Data

• Access to good injury data makes it possible to identify and understand the local-community injury problem

• Helps to prioritize a list of problems and determine how large specific problems are

• Enables you to note patterns of when and how injuries occur, and to monitor trends to determine if injuries have increased or decreased over time


Access, Interpret, Use, and Present Injury Data (Cont.)

• Data can help assess emerging injury issues and identify behavioral and environmental risk factors so you can design, implement, and evaluate an effective injury-prevention program

• Data can help answer the who, how, where, what, and when questions that are important to selecting a cause of injury to address, a target population, and other issues related to choosing an appropriate intervention


Federal Cost Tracking

• International Classification of Diseases– ICD-9 codes– World classification system of medical

conditions, diseases, and injuries– Billing for Medicare and Medicaid– (N) code

Nature of injury

– (E) code External cause Required on all death certificates


Models for Prevention Strategies

• Haddon’s Matrix– Three Es of prevention

Educational interventions• Attempts to initiate behavioral changes by

informing a target group about potential hazards, explaining risks, and persuading people to adopt safer behavior


Models for Prevention Strategies (Cont.)

Enforcement activities and enactment of laws• Enforcement through legislation and

enforcement of that legislation Environmental interventions

•Make changes to the environment– Child-resistant pill bottles, soft surfaces for

playgrounds


Models for Prevention Strategies (Cont.)

• The Spectrum of Prevention– Describes seven levels at which prevention

activities can occur: Strengthening individual knowledge and skills Promoting community education Training EMS providers Fostering coalitions and networks Changing organizational practices Mobilizing communities and neighborhoods Influencing policy and legislation


A Systematic Approach to Injury Prevention

• Learn as much as you can about the problem

• Select your injury priorities

• Define prevention strategies

• Identify resources and potential partners

• Clarify objections for evaluation


Four Approaches for Behavioral Change

• Educational approach– Individuals will do the right thing if they

understand why and how to carry it out

• Persuasion approach– People are motivated after a careful

argument triggering of and motivational hot buttons


Four Approaches for Behavioral Change (Cont.)

• Behavioral modification approach– People do what they do because they find it

rewarding

• Social influence theory– Social pressure to conform


Best Practices in Injury Prevention

• Safe communities

• The EPIC Medics story: a local paramedic initiative

• Frisco Fire Safety Town Project

• Seattle bike helmet program


Resources for Prevention Activities

• National Center for Injury Prevention and Control (NCIPC)

• National Institute of Occupational Safety and Health (NIOSH)

• Maternal and Child Health Bureau (MCHB)

• Health Resources and Services Administration (HRSA)

• EMS for Children (EMS-C)


Evaluating Injury- Prevention Programs

• Formulative evaluation– Can be used to refine a program’s

implementation before full-scale implementation

• Process evaluation– Whether or not program activities and their

delivery are being carried out as planned• Outcome evaluation

– Whether or not objectives of a particular injury-prevention program have been achieved


Program Evaluation

• Three questions for program evaluation:– What is the program designed to do?– Is this the program doing it?– Is the intervention making a difference?


Summary

• Injury-prevention efforts give EMS an opportunity to shift from a reactive to proactive nature

• EMS professionals should be actively involved in safety and injury-prevention programs

• Educate the public and encourage widespread dissemination of the information and public advocacy

injury prevention and ems

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