indian health service aberdeen area division of environmental health services molly patton, mph rehs...
TRANSCRIPT
Indian Health Service Aberdeen Area Division of
Environmental Health Services
Molly Patton, MPH REHS Presentations from those of Myrna J. Buckles and John Weaver
Aberdeen Area IHS DEHS
Leadership Staff
• Director DEHS (vacant)
• Area Injury Prevention Specialist & Deputy– John Weaver (Retired October 2008) & Kathey Wilson
• Institutional Environmental Health Officer– Curt Smelley, MSEH, HEM, REHS,
• Three District Environmental Health Staff– Chris Allen, MS, REHS, Sioux City
– Myrna Buckles, MSEH, REHS, Pierre
– Molly Patton, MPH, REHS, Minot
Field Staff IHS
• Crow Creek– Marcel Felicia, REHS
• Lake Traverse – Vacant
• Lower Brule– Terrold Menzie, REHS
• Pine Ridge– Joe Amiotte, REHS– Jennifer Franks– Dawn Holguin
• Rosebud– Charles Mack
• Turtle Mountain– Jennifer Malaterre
• Yankton/Wagner– Tim Balderrama
Field Staff Tribal
• Cheyenne River – Randolph Runs After,
REHS
• Omaha– Carroll Webster, SR.
• Spirit Lake– Chris Helgesen
• Standing Rock– Bill Sherwood
– Le Ray Skinner *
– Jeannette Cluett
– Mary Brunelle
• Three Affiliated– Verlee White Calfe-
Sayler
• Winnebago– Mona Zuffante
Performance Improvement Indicators – CY 2008
• Severe Injury Profile
• High Priority Facility Surveys
• Other Facility Surveys
• Occupant Protection
• Present Injury Data & Effective Strategies
• Continuous Quality Improvement
Severe Injury Profile
• Three years of local data
• Provided to tribal & IHS leaders
• Develop an Area Severe Injury Profile
Priority Facility Surveys
• Custodial/Residential Care
• Substance Abuse Centers
• Jails• Schools• Head Starts• Day Care Centers
• Senior Citizen Centers• Café/Restaurant• Gaming Facilities• Celebrations• Food Service
Operations
Facility Survey DataIHS Direct Service Sites
0
200
400
600
800
1000
1200
1400
1600
1800
Surveys Other Jan 2003-Sept 2005
Oct 2005-June 2008
Facility Survey DataTribal Sites
0
50
100
150
200
250
300
350
400
450
500
Surveys Other
Jan 1, 2003 -Sept 30 2005Oct 1, 2005 -June 30, 2008
Occupant Protection
• Seat Belt Observation Surveys
• Plan to Implement a Proven Effective Strategy – with community partners
• Implement Strategy
• Evaluate
Action Steps for Injury Intervention
• Presentation of data & interventions
• Coalition formation
• Selection of an effective strategy
• Implementation of an effective strategy
• Evaluation plan of implementation
Continuous Quality Improvement
• “Deep Look” type survey of a high-risk facility
• Project to address critical items identified in a high-risk facility
• Formalized technical assistance project
• Plan reviews and prevention activities
The DifferenceThen & Now
• Focused DEHS Program
• IHS & Tribal Staff Input
• Improved EH Services to tribal members
• Reduction to injury and/or illness exposure for high risk individuals
• Increased local injury prevention activity
• Increased local injury data available
• Increased local injury knowledge & advocacy.
A Summary of Two Years of Injury Data Gathered at Seven
Health Care Facilities
John Weaver
Aberdeen Area
Injury Prevention Specialist
Thoughts to Remember
• Trauma and death due to injuries are a major health care problem in the Aberdeen Area
• There are evidence based interventions that can reduce this problem
• Trauma has an impact on IHS direct care and contract health care dollars
OEH&E has developed a Severe Injury Surveillance System (SISS)
• It is a health care facility based data system designed to collect and analyze injury data
• This active surveillance system is maintained by the local service unit or tribal environmental health staff
SISS Objectives
• Identify the leading causes of severe injury at the local level– Identify injury problem – Complete a Severe Injury Profile– Develop a special study– Involve tribal entities to choose interventions
• Generate awareness and provide information to community, IHS, and Tribal Officials
• Combine data for an overview of Area injuries
Data Sources
• Emergency room logs
• Resource Patient management System (RPMS) Visit General Query (VGEN)
• Patient charts
Data Sources
• Contract Health Service Records– Minutes– Logs – Approvals– Denials
• States vital records
• EMS reports • Police reports
Severe Injury is Defined as an Injury Resulting in
– Amputation– Loss of consciousness– Major fracture ( excludes fingers and toes)– Hospitalization for at least one day– Fatality
Severe Injuries are Separated into Seven Main Categories by Cause
• Assaults• Drowning• Falls• Fire/Burns• Motor Vehicle Crashes• Other• Suicide/Self-inflicted
SISS Limitations
• Fatal cases
• Alcohol-related injuries
• Small number of cases
• Compare to national data
Injury Overview Leading Causes of Injury Morbidity (N=3758) and Mortality (189) by Disposition
Ambulatory Patients2005-2006
Inpatients IHS/ Contract2005-2006
Mortality2005-2006
Cause Number Cause Number Cause Number
Falls 1181 Falls 300 Motor Vehicle
93
Assault 600 Motor Vehicle 295 Other 36
Other 386 Suicide 264 Suicide 29
Motor Vehicle
254 Assault 256 Assault 15
Injury OverviewNumber of severe injuries by gender, disposition of patient, intent, and alcohol use, 2005-2006 N = 3758
Gender Frequency Percentage
Male 2222 59.1
Female 1536 40.9
Disposition of patient
Outpatient 2449 65.2
Hospitalized 1273 33.9
Unknown 36 .96
Intent
Unintentional 2598 69.1
Intentional 1160 30.9
Alcohol related*1
Yes 1212 32.3
No 1312 34.9
Unknown 1234 32.8
*Alcohol-related injuries were difficult to assess because data collectors reviewed a subjective assessment of alcohol involvement by health personnel. In very few cases were BACs obtained. Also not all yes’s were confirmed with BACs and not all no’s were tested in the patient population.
Injury Morbidity by CausePercent of Injuries by Cause 2005-2006
Falls40%
Motor Vehicle15%
Suicide8%
Assault23%
Other14%
Drowning.03%
Fire/Burn1%
Motor Vehicle Crash Trauma What Can Be Done ?
• Tribal policy and procedures can have a direct impact on levels of safety belt use
• Tribal efforts can be most effective in establishing and improving safety belt usage levels (NHTSA DOT HS809 921 Oct. 2005)
• Evidence-based research shows that passage of seat- belt use laws, coupled with education and enforcement efforts, are effective tools to increase seat belt use
• Use of seatbelts can reduce the risk of death in a motor vehicle crash by 45% to 60%, and can reduce moderate to critical injury 50% to 65%
Motor Vehicle Crash Trauma What Can Be Done?
• National Highway Traffic Safety Administration (NHTSA) Survey of Native American Tribal Reservations found
– Reservations with primary safety belt laws have 85% of the vehicle occupants belted
– Reservations with secondary safety belt laws averaged 53% seat belt use
– Reservations with no safety belt laws of any kind have a usage rate of 26%.
Aberdeen Area Seat Belt Survey
• A total of 20,927 seatbelt use observations were conducted (n=15,196 drivers and n=5,731 passengers)
• The overall all passengers seatbelt use rate for individual tribes ranged from 8% to 42%.
• Combining seat belt use data for the 10 reservations, the overall seatbelt use rate was 21% for drivers, 16% for passengers, and 20% for all vehicle occupants
Aberdeen Area Seat Belt Survey
• The seatbelt use rate for Americans Indians in the Northern Plains is low
• 2007 observed seatbelt use rate in Aberdeen Area is 20%
• 2007 National use rate was 82%
• 2007 North Dakota use rate was 82%
• 2007 South Dakota use rate was 73%
Injury Mortality by Cause
Leading Cause of Injury Mortality by Cause 2005-2006(Percent of Mortality)
Other19Assault
7.9
Suicide15.3
Falls5.3Fire/Burn
2.6
Motor Vehicle49.2
Drowning0.5
Years of Potential Life LossYPLL Before Age 65, All Deaths, AI/AN, 2005 North Dakota
All Others 20.7%
Diabetes 4%
CongAnom 4.5%
Cancer 5.1%Perinatal 5.9%
Liver Disease 6.7%
Heart Disease 6.7%
All Injuries 46.5%
Leading Cause of DeathLeading Causes of Death,
2005 North Dakota Native Americans, Age 1-44 Years
All Other 13.8%
HIV 1.7%
Heart Disease 3.4%
Diabetes 5.2%
Liver Disease 10.3%
Injuries 65.5%
Conclusion• Intentional & unintentional injury morbidity & mortality
are a major public health problem
• Injuries cause more that 46 % of the YPLL
• In the age group 1 to 44 injuries cause more then 46% of the deaths
• 49% of all injury deaths are cause by motor vehicle crashes
• Seat belt usage rate in our population is 20%
Conclusion
• Alcohol involvement is difficult to assess because limited data
• We have the same injury causes as that of the United States & there are evidence –based interventions that we can use
• IHS has a network of injury prevention specialist, evidence-based interventions, support from our agency – we should act now
*Questions*
Molly Patton
Minot District office100 1st Street Fed Bldg 302
Minot ND 57803(701) 852-0250