Injury Prevention and Control

Osama A Samarkandi, PhD, RN

BSc, GMD, BSN, MSN, NIAC

EMS 313; Public Health for EMS Professionals

Public HealthApplies fundamental knowledge of principles of public health and epidemiology including public health emergencies, health promotion, and illness and injury prevention.

National EMS Education Standard Competencies

Introduction• EMS providers have an important role to

play in injury and illness prevention.• Injury and illness prevention are an important

part of public health.

Role of Public Health• Public health

• Practice of preventing disease and promoting good health within groups of people

Injuries as Public Health Threats• Injuries

• Intentional or unintentional damage to the person resulting from exposure to energy or absence of essentials

• Injuries historically reported under distinct umbrellas

© Ryan McVay/Photodisc/Getty Images

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Injuries as Public Health Threats

• May be intentional or unintentional• EMS usually has a greater impact on preventing

unintentional injuries.

Injuries as Public Health Threats• Years of potential life

lost• Assume a productive

work life until age 65.• Deduct the year of

death from that age.

• It is easier to measure death rates than morbidity rates.

Injuries as Public Health Threats• Many health experts

consider injury the largest problem facing the World today.

• It is important to understand how injury affects different age groups.

Illness and Disease as Public Health Threats• Each year, 7 out of 10

Americans die from a chronic disease.

• Causes include:• Poor nutrition• Excessive alcohol

intake• Tobacco use• Sedentary lifestyle

Public Health Efforts• The APHA

recommends three reforms:• Policies/funding• Strengthen public

health system• All-access system

• Public health efforts can impact many levels of society.

© Capifrutta/ShutterStock, Inc.

Public Health Efforts• Preventing adverse outcomes is a major

goal of public health programs.• Education campaigns have promoted:

• Disease screening• Injury prevention• Prenatal care

Public Health Laws, Regulations, and Guidelines• Public health laws or regulations include:

• Law from Government and Ministry of Health• Sharia laws• Saudi Drug Regulation• WHO

EMS Interface With Public Health• Joint agreement on medical and public

health response to Mass Gathering Event: • Ministry of Health• Saudi Red Crescent Authority

EMS Interface With Public Health• September: National

Preparedness Month• Get Ready Day

• H1N1 safety• Floods• Heat waves• Power outages• Winter storms• Earthquakes Courtesy of the American Public Heath Assocation.

Photographed by David Fouse.

Injury and Illness Prevention and EMS

• EMS providers can lead or support interventions.• EMS is an advocate

and practitioner.

• Illness and injury prevention have similar techniques.© Dewitt/ShutterStock, Inc.

Common Roots• “Accidental Death

and Disability: The Neglected Disease in Modern Society”

• Injury prevention always included EMS.• Primary• Secondary

• There is a role for every provider.

© Steven Townsend/Code 3 Images

Why EMS Should Be Involved• There are a number of reasons EMS is

especially suited to be involved. Providers:• Reflect community composition• Are medically sophisticated• Are high-profile role models• Have access to community

Principles of Injury and Illness Prevention• Risk

• A potentially hazardous situation in which the well-being of people can be harmed

• Four E s of Prevention

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Courtesy of Captain David Jackson,

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The 4 Es of Prevention• Education

• Inform people about potential dangers, persuade them to change behaviors

• Effective messages are: • Tailored to specific

groups• Reinforced with

meaningful rewards

• Enforcement• Legislation and

regulation• Formulates rules that

require people, manufacturers, and governments to comply with safety practices

• Litigation can also lead to enforcement.

The 4 Es of Prevention• Engineering/environment

• Passive interventions• Can be social, legal, political, or cultural

• Economic incentives• Economic self-interest provides monetary

incentives to reinforce safe behavior.

The Value of Automatic Protections• Passive interventions are often the most

successful.• Provide constant protection without conscious

action from user• A combination of approaches is still the

most effective strategy.

Models for Injury and Illness Prevention• Visual models

describe a health problem and how to approach it. • Focuses on:

host, agent, environment

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The Haddon Matrix• Added factor of time to previous models to

address causes of injury• The host, agent, and environment interact

over time to cause injury and correspond to:• Pre-event• Event• Post-event

The Haddon Matrix• Matrix uses nine components to analyze

the injury• Encourages creative thinking

• Injury prevention requires broad and innovative thinking to be most successful.

ExamplePhase Human Factors

Vehicles and Equipment

Factors

Environmental Factors

Pre-event

•Information•Attitudes•Impairment•Police Enforcement

•Roadworthiness•Lighting•Breaking•Speed Management

•Road design and road layout•Speed limits•Pedestrian facilities

Event•Use of restraints•Impairments

•Occupant restraints•Other safety devices•Crash-protective design

•Crash-protective roadside objects

Post-Event•First-aid skills•Access to medics

•Ease of access•Fire risk

•Rescue facilities•Congestion

Injury and Illness Surveillance • Data are collected,

disseminated to people/ organizations that can effect change• Applied to

interventions

• Strong surveillance is fundamental to effective programs.

Getting Started in Your Community• To be effective, you need to understand:

• Injury and illness patterns• Characteristics of the population, environment• The types of risks present

Getting Started in Your Community• Intentional injuries

• There are risk factors connected with intentional violence.

• EMS providers:• Reporting data• Note risk factors

© Mikael Karlsson/On Scene Photography

Getting Started in Your Community• Unintentional Injuries

• “Accidents”

• In Children:• 20 million annually• Children are:

• At higher risk• More likely to be

seriously affected

• “Pass-along effect”

© SuperStock/age fotostock

Getting Started in Your Community• Risk factors for children

• Lower socioeconomic status• Injuries are more likely to occur where there

is:• Water• Heat• Toxic agents• High potential “energy”

Getting Started in Your Community• Risk factors for

children (cont’d)• Unintentional injuries

are greatest threat• School injuries are not

uncommon.• 45% of cases are

severe injuries.

• Priority prevention efforts are injuries with highest: • Mortality rate• Hospitalization rate• Long-term disability

rate• Effective

countermeasures

Getting Started in Your Community• Illness Prevention

• Illness prevention is gaining attention.

• Example: poor health in adolescents• Tobacco/alcohol/other

drugs• STDs• Unhealthy diet• Sedentary lifestyle

• Community Organizing• Implementation plan,

should include: • Identify a leader.• Build support base.• Create a timeline.• Gather data, facts.• Choose goals.• Establish funding.• Be positive, persist.

Getting Started in Your Community• Five steps of a

prevention program• Conduct community

assessment.• Bring people and

groups together.• Represent the

community at large.• Include survivors, their

families.• Identify partners.

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Getting Started in Your Community• Five steps of a prevention program

(cont’d)• Define problem.

• In specific, quantifiable terms

• Set goals and objectives.• Goals: broad, general, long-term• Objectives: specific, time-limited, quantifiable

• Process or outcome

Getting Started in Your Community• Five steps of a prevention program

(cont’d)• Plan and test interventions.

• Actions to accomplish your goals, objectives

• Implement and evaluate interventions.• Must be able to measure results quantitatively

Getting Started in Your Community• Funding a prevention program

• Consider innovative ways to fund programs.• Partner with the media.• Look for grants and sponsorships.• Network with other prevention programs.

How Every Provider Can Be Involved• Paramedics can, and should, be involved

in prevention to some extent.• Be a role model.

• Responding to the call• Very few calls require the use of lights and

sirens.• Dispatchers can be a resource.

How Every Provider Can Be Involved

• Education for EMS providers• Understand the

fundamentals of prevention

• “Teachable moment”• Articulate and reinforce

safety messages.• Use good judgment.• Be sensitive.

© Craig Jackson/IntheDarkPhotography.com

How Every Provider Can Be Involved• Collection/analysis of data and research

• Vital for:• Measuring trends• Validating interventions• Assessing resources• Persuading others to act

How Every Provider Can Be Involved• Collection/analysis of data and research

(cont’d)• Starts with prehospital care reports• Be a leader by:

• Being a role model• Reaching out in your community

• Public health encompasses health promotion and disease prevention for groups of people.

• Kingdom rules, regulations, guidelines, and laws govern public health.

Summary

• Many paramedics have been motivated by their field experience to work actively on prevention.

• The 1966 National Academy of Sciences/National Research Council study, “Accidental Death and Disability: The Neglected Disease of Modern Society,” noted that EMS could help with trauma after an event, and injury prevention could help prevent an accident before it happens.

Summary

• The 1996 Consensus Statement on the EMS Role in Primary Injury Prevention emphasized that primary injury prevention is an essential activity of EMS.

• EMS can play a supporting role in preventing intentional injuries and can have an even larger impact in preventing unintentional injuries.

Summary

• The years of potential life lost concept is another way to measure the cost of unintentional injury to society.

• The 4 Es of prevention are education, enforcement, engineering/environment, and economic incentives.

• Automatic protections do not require a conscious decision to act; an example is including air bags in automobiles

Summary

• The Haddon matrix uses nine separate components to analyze injury.

• Surveillance is the ongoing systematic collection, analysis, and interpretation of data essential to the planning, implementation, and evaluation of public health practice.

• Paramedics need to triage their focus on prevention—do not let the headlines be your guide.

Summary

• The five steps to developing a prevention program are: conduct a community assessment, define the problem, set goals and objectives, plan and test interventions, and implement and evaluate interventions.

• Primary prevention begins at home by taking care of yourself and presenting a role model for others in your service and in the community.

Summary

• The best teachable moments are those that convey positive reinforcement.

• The importance of collecting data in measuring trends, validating interventions, assessing resources, and ultimately persuading others to act cannot be overestimated.

Summary