Injury prevention program for youthful traffic offenders Author: Christine Byrd , RN, MSN, CNRN, Cape Girardeau, M i s s o u r i

R i s k - t a k i n g b e h a v i o r s p l ay a k e y role in t h e i n c r e a s e d i n c i d e n c e of d e a t h a n d injur ies in ado-

l e scen t s a n d y o u n g adul ts . Young dr ivers are s ignif i - can t ly o v e r r e p r e s e n t e d in alcohol- a n d d rug - r e l a t ed c rashes , s p e e d more often, and f requent ly do no t w e a r s ea t bel ts . ~, 2

In 1990 w e b e g a n an injury p reven t ion p r o g r a m at Sa in t F r anc i s M e d i c a l Cen te r in C a p e Girardeau, Missouri , to t a r g e t th is h igh- r i sk popula t ion . The pur- pose of the p r o g r a m w a s to e d u c a t e y o u n g drivers, a g e s 16 to 25 yea r s old, a b o u t the poss ib l e conse - q u e n c e s of the i r d r iv ing behaviors . T h e s e y o u n g traf- fic offenders a re " s en t enced" to s p e n d a day in t h e hospi ta l . The p rogram, ca l led the Traffic Offender P rogram (TOP), is a coope ra t i ve effort of a c o m m u n i - ty traffic sa fe ty organiza t ion , law e n f o r c e m e n t a g e n - cies, and staff a t Sa in t F ranc i s Med ica l Center.

Program design The p r o g r a m is spec i f ica l ly d e s i g n e d for 16- to 25- year -o lds w i t h traffic offenses, such as d r iv ing whi le in tox ica ted , s p e e d i n g , or ca re less and i m p r u d e n t dri- ving. Two a r ea j u d g e s enroll t he offenders in the pro- g r a m as par t of thei r s e n t e n c e . P rogram enro l lment is l imi ted to s e v e n p a r t i c i p a n t s a t one t i m e b e c a u s e of t h e in t e rac t ive na tu re of t h e p rog ram des ign . The pro- gram, he ld once a month , is coo rd ina t ed b y the neu- ro sc i ence c l in ical nu r se spec ia l i s t a t Sa in t F ranc i s Med ica l Center .

A tota l of 141 p a r t i c i p a n t s have b e e n enrol led in t h e p rog ram from S e p t e m b e r 1993 to Ju ly 1996; t he a ve r age age of p a r t i c i p a n t s is 19. Of these , 72% w e r e ma le dr ivers and 28% w e r e female drivers; 52% of t hose s u r v e y e d s t a t e d t h e y h a d a t t e n d e d a dr iver e d u c a t i o n course , a n d 42% repor t ed a pr~evious dri- v ing offense (Figure 1). The h i g h e s t p e r c e n t a g e (28%) w e r e t i c k e t e d for d r iv ing u n d e r the inf luence of alco- hol, w h e r e a s t he s e c o n d h i g h e s t p e r c e n t a g e (21%) w e r e t i c k e t e d for s p e e d i n g . A var ie ty of o ther offens- es a c c o u n t for t he r e m a i n d e r of the g roup (Figure 2).

Dur ing t h e d a y the p a r t i c i p a n t s v is i t var ious a r eas of t he hosp i ta l t ha t ca re for t r a u m a vic t ims. The a g e n d a for t he d a y is d e s c r i b e d in F igure 3. In e a c h

Christine Byrd is neuroscience clinical nurse specialist, Saint Francis Medical Center, Cape Girardeau, Missouri. J Emery Nurs 1997;23:326-9. Copyright © 1997 by the Emergency Nurses Association. 0099-1767/97 $5.00 + 0 18/1/83620

area, p a r t i c i p a n t s ta lk to staff m e m b e r s involved in t r a u m a care, and w h e n e v e r poss ib le , v i ew ac tua l pa t i en t s . In a reas s u c h as cr i t ica l ca re a n d t h e neuro- s c i e n c e unit , p a r t i c i p a n t s go to t he p a t i e n t ' s b e d s i d e and r e c e ive an exp lana t ion of t he p a t i e n t ' s condi t ion and ca re involved.

Several families, particularly of victims with head injuries, have requested to speak to the group personally to give the family's perspective.

The pa r t i c i pa n t s s ign a p a t i e n t conf ident ia l i ty s t a t e m e n t , and p e r m i s s i o n is a s k e d from the p a t i e n t s and /o r the i r famil ies before en t e r ing p a t i e n t rooms. W h e n the p r o g r a m w a s deve loped , w e p r e d i c t e d tha t m a n y p a t i e n t s a n d famil ies wou ld refuse pe rmiss ion . A l t h o u g h the occas iona l refusal occurs , m o s t p a t i e n t s a n d famil ies are very suppor t ive . Severa l families, p a r t i c u l a r l y of v i c t i m s w i t h h e a d in ju r ies , h a v e r e q u e s t e d to s p e a k to t he group persona l ly to g ive the family ' s pe r spec t ive . T h e s e pe r sona l i n t e r a c t i ons add an effect ive d i m e n s i o n to the p rogram.

Role-p laying a n d ac t ive pa r t i c ipa t i on are in tegra l in t h e p r o g r a m des ign . In t h e m o r n i n g the par t ic i - p a n t s r andomly choose a d i sab i l i ty card. A typ ica l d i sab i l i ty ca rd m a y read: "You were involved in an a u tomob i l e crash, in w h i c h you w e r e not w e a r i n g your s e a t belt . You w e r e t h rown from t h e car a n d suf- fered a sp ina l cord injury. You are n o w p e r m a n e n t l y pa ra lyzed a n d m u s t u s e a w h e e l c h a i r to g e t around."

Pa r t i c ipan t s m u s t role-play the i r d i sab i l i ty for the m o r n i n g unt i l af ter lunch. This i nc ludes v i s i t ing the e m e r g e n c y d e p a r t m e n t and cr i t ical ca re unit , and m o s t difficult of all, m a n e u v e r i n g t h r o u g h the hosp i ta l ca fe te r ia line. E x a m p l e s of o ther a s s i g n e d d i sab i l i t i e s a re aphas i a , l imb para lys is , a n d m e m o r y loss.

Dur ing thei r v is i t to t he r ehab i l i t a t ion t h e r a p y area, t h e t he r a p i s t s e n c o u r a g e ac t ive p a r t i c i p a t i o n b y t h e group. The group m a y p a r t i c i p a t e in t h e r a p y rou- t ines , a t t e m p t to u s e a d a p t i v e dev ices , or obse rve ac tua l p a t i e n t s in therapy. The p r o g r a m e n d s w i th a f lank d i s c u s s i o n w i t h a traffic v i c t im from the corn-

326 Volume 23, Number 4

Byrd/JOURNAL OF EMERGENCY NURSING

Traffic Offender Program September '93 thru July '96

DEMOGRAPHICS (141 participants)

Male 72% _ _

Average Age: 19

Median Age: 18

Female 28%

Yes 52%

Had a Driver Education Course Unknown 3%

No 45%

Yes 42%

Had Previous Driving Offense

Unknown 10%

No 48%

Figure 1

D e m o g r a p h i c i n f o r m a t i o n of c o u r s e p a r t i c i p a n t s in t raff ic o f f e n d e r p r o g r a m .

Traffic Offender Program September '93 thru July '96 Driving Offenses (141 participants)

Driving Intoxicated

~ 21% Speeding ,

Careless & Imprudent ~ 13%

Failure to Yield ~ 9%

Hit a Parked Car ~ 5%

Ran Traffic Signal ~ 4%

Other ~ ' ~ : ~ 18%

Unknown ~ 2%

Figure 2

T y p e of d r i v i n g o f f e n s e for c o u r s e p a r t i c i p a n t s .

8:45-9i15AM

9:15-10:00 AM

10:00-10:15 AM 10:15-11:00 AM

11:00-11:30 AM

11:30-12:00 Noon 12:00-1:00 PM

1:00-1:30 PM

1:30-2:15 PM

2:15-2:45 PM

Meet w i t h Program Coordinator - O v e r v i e w of p r o g r a m - P re l iminary q u e s t i o n n a i r e - In jury i n fo rma t ion Social Serv ices - D i s c u s s i o n of family, social,

a n d e c o n o m i c i m p a c t Disabi l i ty a s s i g n m e n t E m e r g e n c y Department - Tour of h e l i c o p t e r / a m b u l a n c e - Tour of E m e r g e n c y

D e p a r t m e n t & T r a u m a R o o m - Desc r ip t ion of e m e r g e n c y ca re I n t e n s i v e Care Unit - O b s e r v a t i o n of i n t e n s i v e ca re

p a t i e n t ca re Lunch Rehabi l i tat ion Serv ices - O b s e r v e p h y s i c a l t he rapy ,

o c c u p a t i o n a l t h e r a p y & s p e e c h t h e r a p y

- Desc r ip t i on of l o n g - t e r m t h e r a p y n e e d s of p a t i e n t s w i t h h e a d & sp ina l cord in jury

Neurosurgical Unit and/or Rehabi l i tat ion Unit - O b s e r v a t i o n of p a t i e n t s w i t h

h e a d a n d / o r sp ina l cord in jury - D i s c u s s i o n w i t h pa t i en t , if

a p p r o p r i a t e Discuss ion w i t h Vict im of Head Injury Wrap-up - R e v i e w of t h e d a y - Fo l low-up q u e s t i o n n a i r e

Figure 3 Typ ica l c o u r s e s c h e d u l e for t raff ic o f f ende r p r o g r a m .

m u n i t y w h o h a s s u s t a i n e d a h e a d i n ju ry . T h i s d i s -

c u s s i o n h a s b e e n h i g h l y r a t e d i n t h e p r o g r a m e v a l u a -

t i o n s .

Participants must role-play their disability for the morning.

P a r t i c i p a n t s a r e r e q u i r e d t o p a y a p r o g r a m f e e

d i r e c t l y t o t h e h o s p i t a l , w h i c h c o v e r s t h e p r o g r a m

e x p e n s e s . S t a f f t i m e i s v o l u n t a r y , a n d i s i n m o s t

c a s e s , i n a d d i t i o n t o t h e i r r e g u l a r d u t i e s . S t a f f

i n v o l v e d i n c l u d e f l i g h t n u r s e s , p a r a m e d i c s , n u r s e s

f r o m t h e e m e r g e n c y d e p a r t m e n t , c r i t i c a l c a r e , n e u r o -

s c i e n c e u n i t , r e h a b i l i t a t i o n u n i t , p h y s i c a l , o c c u p a -

A u g u s t 1997 3 2 7

JOURNAL OF EMERGENCY NURSING/Byrd

Traffic Offender Program September '93 thru July '96

Participant Responses

BEFORE PROGRAM: What % of the time do you wear your seatbelt?

AFTER PROGRAM: How often do you plan to wear your seatbelt?

• BEFORE [ ] AFTER

100%

75%- 100%

- /

!0~1

63%

50%-75%

25%-50%

<25%

12%

b11% '/o

26%

N = 141

Figure 4 Preprogram and postprogram survey of seat belt use among course participants.

tional, speech therapists , and social services. Staff i npu t from all areas involved in the care of t r auma vic- t ims has b e e n extremely valuable. Al though there has not b e e n direct phys ic ian involvement , the neurosur- gical staff has b e e n very support ive of the program.

Survey results Par t ic ipants complete a survey before the program

and immedia te ly after comple t ion o~the prggram. No n a m e s are required and par t ic ipants a r~-encouraged to answer honestly. " *':

Studies have shown tha t younger drivers are less likely to wear seat belts t han older drivers. 1, 2 In the

presurvey, only 22% of our sample said they wore a sea t belt all of the t ime. A total of 54% wore a sea t bel t more t han half the t ime, and 46% wore it less t han half of the t ime. In the postsurvey, 63% s ta ted they p l anned to wear a sea t bel t all of the t ime. Only 12% s ta ted they would wear a sea t belt less t han half of the t ime (Figure 4).

There is a s t rong associa t ion b e t w e e n alcohol use and i nc idence of motor vehicle injury in young dri- vers. 3 In our survey 48% reported they often, some-

t imes, or rarely drink and drive, whereas only 52%

Traffic Offender Program September '93 thru July '96

Participant Responses

B E F O R E P R O G R A M :

Do you dr ink and dr ive?

A F T E R P R O G R A M : Wil l you dr ink and dr ive?

[ ] BEFORE [ ] AFTER

3%

Often 1%

Sometimes P 14%

3% N = 141

Rarely

31%

Never

52%

Figure 5 Preprogram and postprogram survey of alcohol use among course participants.

reported they never drink and drive. In the postsur- vey, 12% sta ted they would drink and drive rarely, somet imes , or often, and 88% s ta ted they would never drink and drive (Figure 5).

Adolescen ts have a need to ga in a nd m a i n t a i n control over their e nv i r onme n t and can often rebel aga ins t authori ty and control. Before and after the pro- gram, par t ic ipants were asked to respond to the state- ment : "I feel sea t belts are a personal choice a nd no one should be forced to wear them." In this survey, those who strongly agreed wi th the s t a t e m e n t did no t c h a n g e their opinion in the postsurvey. However, the n u m b e r of those who strongly d i sagreed with the s t a t e m e n t a lmost doubled after the program (Figure 6).

We recognize that these results are reported i n t en t i ons of par t ic ipants , and we do not know whe the r any actual behavior c ha nge s took place. Al though changes in knowledge and a t t i tude can be

328 Volume 23, Number 4

Byrd/JOURNAL OF EMERGENCY NURSING

Traffic Offender Program September '93 thru July '96

Participant Responses

I feel seatbelts are a personal choice and no one should be forced to wear them.

• BEFORE

Strongly Agree

Agree

Not Sure

Disagree

Strongly Disagree

Figure 6

• AFTER

12%

12%

31%

17% N = 141 Yo

23%

~/o

33%

Attitudes of course participants regarding seat belt use.

precursors to changes in behavior, long- term follow- up of the par t ic ipants would be n e e d e d to de t e rmine whe ther changes in dr iving behavior did occur.

Discussion The National Center for Env i ronmen ta l Health and Injury Control, a division of the Centers for Disease Control and Prevention, r e c o m m e n d s that "Hospitals should act ively work wi th EMS personnel , s tate and local heal th depar tments , h ighway safety agen- cies, and other gove rnmen ta l and non -gove rnmen ta l agenc ies in developing a nd promot ing injury pre- ven t ion programs. ''~ In this era of scarce heal th care

dollars, motor vehicle injury programs have proved to be more cost-effective t han almost any other k ind of publ ic heal th in tervent ion. Motor vehicle injuries accoun t for 22% of all in jury-associa ted hos- pi tal izat ions and more t h a n 25% of all u n c o m p e n - s a t e d hosp i t a l i za t ion charges . ~ Dollars alone, however, canno t express the devas t a t ing costs to individuals , families, and society in te rms of pain, suf- fering, and loss of product iv i ty tha t can occur with

motor vehicle injury. More s tudies need to be done related to effect iveness of motor vehicle injury pre- v e n t i o n p rograms in c h a n g i n g high-r isk dr iv ing behaviors.

References

1. Setting the national agenda for injury control in the 1990s (position papers from The Third National Injury Control Conference). Atlanta: US Department of Health and Human Services, Centers for Disease Control and Prevention; 1992. 2. Grossman DC, Rwara FR Injury control in childhood. Pediatr Clin North Am 1992;39:471-85. 3. Sommers MS. Alcohol and trauma: the critical link. Crit Care Nurse 1994;14:82-92.

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