Ch03 Public Health.docx

Chapter 3 Public Health Unit Summary Public health is a field that encompasses health promotion and disease prevention for groups of people. Public health-related issues can include disasters such as hurricanes and wildfires, or illness outbreaks such as the H1N1 flu. Federal, state, and international rules, regulations, guidelines, and laws govern public health. EMS providers hold an important place in the public health arena through prevention and education efforts. National EMS Education Standard Competencies Public Health Applies fundamental knowledge of principles of public health and epidemiology including public health emergencies, health promotion, and illness and injury prevention. Knowledge Objectives Define public health and explain the goal of the public health field. (p 61) List the major public health laws, regulations, and guidelines in place in the United States, and list the purpose of each. (pp 65-66) Explain the paramedic’s role in promoting public health, both in terms of illness and injury. (p 66) Define primary prevention and secondary prevention, and give examples of each. (p 67) Explain why EMS providers are in a unique position to promote public health. (pp 67-68) Discuss the detrimental effects of injuries as related to public health. (pp 61-62) Define intentional injuries and unintentional injuries. (pp 72-73) Discuss the principles of injury prevention, including education, enforcement, engineering/environment, and economic incentives. (pp 68-69) Discuss the concept of injury surveillance and how it relates to EMS. (pp 70-71) List ways a paramedic can promote injury prevention in his or her community. (pp 71-72) Discuss pediatric injuries and risk factors for them. (pp 73-74) Describe the steps involved in organizing a community prevention program. (pp 74-76) Define and explain the relevance of a teachable moment in EMS. (pp 77-78) Skills Objectives There are no skills objectives for this chapter. Readings and Preparation Review all instructional materials including Chapter 3 of Nancy Caroline’s Emergency Care in the Streets, Seventh Edition, and all related presentation support materials. For a detailed review of public health issues consult Injury Prevention and Public Health: Practical Knowledge, Skills, and Strategies, Second Edition, available at www.jblearning.com, ISBN: 9780763733926. Support Materials • Lecture PowerPoint presentation • Case Study PowerPoint presentation • Any information obtained from local, state, or national public health providers Enhancements • Direct students to visit the companion website to Nancy Caroline’s Emergency Care in the Streets, Seventh Edition, at http://www.paramedic.emszone.com for online activities. • Consider inviting someone from the local health department to give a presentation to your class. Health departments usually provide abundant information and written materials for distribution. • The National Centers for Disease Control and Prevention (CDC) offers a great deal of information on their website at http://www.cdc.gov. Check the “Healthcare Providers” section for a number of excellent resources. • Content connections: Students will find the information on communicable disease processes and immunology useful in discussion of public health. Additionally, injury prevvention activities can easily be discussed during the traumatic injury chapters. • Cultural considerations The CDC offers a special section on ethnic and cultural information relating to public health concerns. You can access it here: http://www.cdc.gov/omhd/Topic/MinorityHealth.html Teaching Tips There is a tendency among public safety providers to assume they have no role in the provision of public health. This is far from the truth. Utilize local, state, and national resources to enhance materials presented in this chapter. Unit Activities Writing activities: Have students research the location of local public health agencies in your area. Students should provide a written summary of resources available to the public as well as define any deficiencies they may note. Student presentations: Have students research public health-related presentations offered by local patient care providers and/or provider agencies. Students should obtain handouts or other educational materials used in these presentations and use them during a presentation of public health-related concerns. Students should develop their own materials and present them to the class as a comparison. Group activities: After dividing students into appropriate teams, have them discuss and develop a Haddon matrix for the injury type you select. Students should prepare to present their matrix to the class. Visual thinking: Have students find public service announcements from any media source and display them in a PowerPoint presentation (for written materials) or YouTube, Facebook, or similar venue (for video materials). The student should be prepared to lead a discussion on identification of the target audience and whether the announcement is effective in your local area. If time permits, this could lead to discussion of how to improve a poor announcement. Pre-Lecture You are the Provider “You are the Provider” is a progressive case study that encourages critical-thinking skills. Instructor Directions Direct students to read the “You are the Provider” scenario found throughout Chapter 3. • You may wish to assign students to a partner or a group. Direct them to review the discussion questions at the end of the scenario and prepare a response to each question. Facilitate a class dialogue centered on the discussion questions and the Patient Care Report. • You may also use this as an individual activity and ask students to turn in their comments on a separate piece of paper. Lecture I. Introduction A. EMS providers have an important role to play in injury and illness prevention. B. Injury and illness prevention are an important part of public health. II. Role of Public Health A. The American Public Health Association (APHA) defines public health as “the practice of preventing disease and promoting good health within groups of people.” 1. Health and wellness have become a focus of the U.S. health care system due to: a. Skyrocketing health care costs b. Incidence of chronic disease c. Health care reform B. Injuries as public health threats 1. Injuries a. Defined by the National Center for Injury Prevention and Control as “the intentional or unintentional damage to the person resulting from acute exposure to thermal, mechanical, electrical, or chemical energy or from the absence of such essentials as heat or oxygen” b. Historically, injuries were reported under distinct umbrellas. c. Grouping injuries makes it possible to consider the breadth and depth of the problem. 2. May be intentional or unintentional a. Intentional i. Included in the definition of injury ii. Examples: Assault, suicide b. EMS usually has a greater effect on preventing unintentional injuries. 3. Many health experts consider injury the largest problem facing the United States today. a. The National Center for Health Statistics reported 81.4 million injury-related health care visits in 2007. 4. A review of the top 10 causes of injury-related death in 2007 is important to understand how injury affects different age groups. a. For the first 44 years of life, unintentional injuries are the leading cause of death. b. Unintentional injuries are the fifth leading cause of death for all ages. c. Injuries requiring medical treatment cost society $406 billion annually. d. Years of potential life lost i. Assume a productive work life until age 65, and deduct the year of death from that age. ii. Example: An 18-year-old who dies in car crash loses 47 years of potential productive work life. iii. This allows a comparison of years of productive work life lost, disease by disease. iv. Teaches member of the community that prevention of childhood death is of great importance to the community. e. It is easier to measure death rates than nonfatal (morbidity) injury rates. i. Morbidity rates from clinics, emergency departments, etc., are stored by a number of agencies and professional groups. C. Illness and disease as public health threats 1. Each year, 7 out of 10 Americans die from a chronic disease. a. Cancer, heart disease, and stroke cause more than 50% of these deaths. 2. Causes of chronic disease include: a. Poor nutrition b. Excessive alcohol intake c. Tobacco use d. Sedentary lifestyle 3. In 2007, asthma was the primary diagnosis for many children and adults presenting to the ED. 4. In April 2009, the HINI influenza was first detected. a. The United States declared a public health emergency. b. The World Health Organization (WHO) declared a global pandemic in June 2009. c. In September 2009, the Food and Drug Administration (FDA) approved four vaccines to prevent the disease. d. As a result of vaccination and communication from the CDC, by June 2010 the health emergency expired. 5. Other public health threats include water supply or seafood contamination, radiation leaks, lack of sanitary conditions following a natural disaster, and increased incidence of cancer after major incidents. D. Public health efforts 1. The APHA recommends three reforms focused on wellness and illness/injury prevention. We must: a. Provide consistent, robust policy leadership that advocates for and funds multifaceted approaches to prevention and wellness. b. Strengthen the ability of the public health system to facilitate and, as appropriate, provide community-based prevention, health promotion, and early detection of disease. c. Assume that all Americans must have access to recommended preventive services. 2. Public health efforts can affect many levels of society, from city to community, state, or national levels. a. Example: Local health department providing vaccines to members of a community i. People stay well, use fewer health care resources, and are more productive. 3. Preventing adverse outcomes is a major goal of public health programs. a. Examples: Education campaigns to promote disease screening, injury prevention, and prenatal care i. Early cancer detection has led to better outcomes. ii. In 2008, preterm birth weights increased because more infants reach 37 weeks gestation. iii. Laws that prohibit smoking in indoor facilities and promotion of smoke-free environments led to a decrease in adult smoking. III. Public Health Laws, Regulations, and Guidelines A. Many rules, regulations, guidelines, and laws govern public health. 1. May be mandated by the federal or state government 2. Refer to Table 3 for a list of public health laws, regulations, and guidelines enacted to improve safety and prevention. B. The federal Health Insurance Portability Accountability Act (HIPAA) 1. Enacted in 1996 2. First national standards established to protect the confidentiality of patient information 3. Outlines various conditions and situations in which a covered entity can use and disclosed protected health information (PHI) a. PHI is the data that contains the patient’s name, address, and specific identifiers. 4. HIPAA also addresses two other forms of data: a. Limited data set i. Information necessary for public health and research purposes, such as some geographic information, birth dates, and dates of treatment b. Data in which common identifiers are removed C. Smoking is considered a serious public health hazard in the United States. 1. Has been addressed by multiple legislative efforts at the state, national, and international levels 2. The World Health Organization created the first global public health treaty on tobacco control in 2005. a. Framework Convention on Tobacco Control (FCTC) b. 168 countries have joined . c. Collaborative effort to reduce demand and supply of tobacco d. Treaty helps members by providing tools for governments to develop policies on the tobacco industry i. WHO Framework Convention on Tobacco Control, 2010 e. United States has yet to ratify this treaty. However: i. In June 2010, the FDA enacted regulations to restrict the sale, distribution, and marketing of cigarettes and smokeless tobacco products to youth in the United States. ii. Many states have also imposed local smoking restrictions. IV. EMS Interface with Public Health A. In November 2001, three organizations created a joint agreement on the emergency medical and public health response to terrorism. 1. APHA, the National Association of EMS Physicians (NAEMSP), National Association of state EMS directors 2. Met to discuss ways EMS and public health agencies could work more closely to improve community health 3. They agreed to a set of principles that outline how multiple organizations agree to certain standards. a. Included leadership roles, the definition of EMS providers’ roles, communication strategies, allocation of EMS resources, best practices, educational efforts, rural EMS systems, and the need for joint position statements B. September is designated National Preparedness Month by the APHA. 1. Helps people prepare for potential health emergencies 2. Get Ready campaign a. Encourages citizens and their communities prepare for hazards and disasters b. Get Ready Day is one component of this campaign. i. Third Tuesday of every September ii. Provides tips to help people prepare for: (a) H1N1 safety (b) Floods (c) Heat waves (d) Power outages (e) Winter storms (f) Earthquakes (g) Emergencies at work c. Activities like Get Ready Day are opportunities for EMS personnel to be involved with public health initiatives. C. Programs can be conducted year round to create awareness about safety and health issues. 1. Examples: Bike safety workshops in the spring, safe driving and how and when to shovel snow in winter, flu clinics before and during flu season D. The Division of Emerging Infections and Surveillance Services at the CDC 1. Builds national and international partnerships to detect and respond to emerging infections 2. Epidemiology and Laboratory Capacity for Infectious Diseases Program provides funding in all 50 states. 3. Check with your local/state health department to see how you can participate. V. Injury and Illness Prevention and EMS A. EMS providers can take the lead or support interventions. 1. Interventions: Specific prevention measures or activities designed to increase positive health and safety outcomes 2. EMS is a strong advocate and practitioner of injury and illness prevention. a. Examples of injury prevention activities: Bike helmet rodeos, car seat checks, swimming safety b. Examples of illness prevention initiatives: Flu inoculation programs, blood pressure monitoring 3. Illness and injury prevention have similar principles and techniques. a. Check with your local health department to learn what: i. Programs exist ii. Opportunities are available to start something new B. Common roots 1. Like EMS itself, injury prevention emerged from “Accidental Death and Disability: The Neglected Disease in Modern Society.” 2. Broader definition of injury prevention has always included EMS. a. Primary prevention: Keeping an injury from ever occurring b. Secondary prevention i. Traditional focus of EMS ii. Reducing the effects of an injury, illness, or other existing health problem 3. The Consensus Statement on the EMS Role in Primary Injury Prevention was published in 1996. a. The authors marked primary injury prevention as an “essential” activity. 4. Your priority is to respond to and treat illness and injury in your community. a. However, there is a role for every provider in primary prevention. b. Includes teaching colleagues and the public why you see an injury recurring or how an illness can be prevented C. Why EMS should be involved 1. EMS providers should be involved in community prevention programs because they: a. Are widely distributed in the population b. Usually reflect the community they serve c. May be the most medically sophisticated person in a rural community d. Can be a formidable resource for reducing the overall burden of injuries e. Are high-profile role models f. Are perceived to be champions of their patients g. Are welcome in environments conducive to delivering a preventative message (like schools) h. Are perceived as authorities on prevention VI. Principles of Injury and Illness Prevention A. The 4 Es of prevention 1. Risk: Potentially hazardous situation in which peoples’ well-being might be harmed 2. The 4 Es of prevention are a combination of interventions to prevent illness and injury. 3. Education a. Citizens do not always know that certain behaviors put them at risk. i. Examples: Putting baby seat in front passenger seat, not getting a flu shot b. You can inform people about potential dangerous and persuade them to change their behavior. c. To be effective, messages should be: i. Tailored to specific groups ii. Reinforced with meaningful rewards d. Effective techniques include: i. Contracts or participant commitment ii. Incentives iii. Behavioral feedback iv. Modeling e. Even if some members of the community do not change their behavior, your educational effort may lead to legislative or environmental/technological changes. 4. Enforcement a. Legislation/regulation formulates rules that require people, manufacturers, and governments to comply with safety practices. b. Legislation: Laws enacted by elected government bodies c. Regulation: Made by bureaucracies or agencies that set policies and establish procedures that control products d. Litigation: Sets policy when lawsuits are brought against manufacturers or distributors of hazardous products 5. Engineering/environment a. Passive interventions: Changing the design of products or spaces to offer automatic protection i. Often, without conscious behavior change b. Approaches can be social, legal, political, or cultural c. Modifications usually happen once awareness is raised. 6. Economic incentives a. Economic self-interest provides monetary incentives to reinforce safe behavior. i. Example: Insurance rate reduction for careful drivers b. The threat of lawsuits can spur companies to make changes. c. Organizations may also offer free or subsidized safety products to encourage use. B. The value of automatic protections 1. Passive interventions are often the most successful. a. Also called automatic protection b. Examples: Sprinkler systems in commercial buildings, airbags in cars c. Provide constant protection without conscious action from user 2. A combination of approaches is still the most effective strategy. a. Education is always an important component. C. Models for injury and illness prevention 1. Visual models describe a health problem and how to approach it. 2. The public health model focuses on three factors: a. The host b. The agent c. The environment 3. Public health model has been applied to a number of problems. D. The Haddon matrix 1. William Haddon, Jr, MD, created a matrix that identified several principles of injury prevention. 2. Added factor of time to previous models to address causes of injury 3. The host, agent, and environment interact over time to cause injury and correspond to three phases of the event: a. Pre-event b. Event c. Post-event 4. Matrix uses nine components to analyze the injury. a. Encourages creative thinking in understanding causes of and potential interventions for injury 5. You can use the Haddon matrix to encourage your colleagues and the community to think about and plan for strategies before 9-1-1 is called. 6. Injury prevention requires broad and innovative thinking to be most successful. a. The Haddon matrix helps you think through which interventions can be effective at certain points in time. i. Can expand problem-solving beyond education ii. Can generate solutions with physical and measurable attributes E. Injury and illness surveillance 1. Surveillance: In prevention, refers to ongoing, systematic collection, analysis, and interpretation of data for planning, implementation, and evaluation of public health practice a. Data are collected and disseminated to people or organizations that can effect change. b. Then, data is applied to interventions. 2. Strong surveillance systems are fundamental to effective prevention programs. a. May show a commonplace injury is a threat to the community VII. Getting Started in Your Community A. Recognizing injury and illness patterns in your community 1. To be effective, you need to understand: a. Injury and illness patterns b. Characteristics of the population and environment c. The types of risks present 2. Your regional or state EMS department or public health office will have the most information. a. Good starting place b. May also find information online c. A wide variety of information is available, including case studies and expert assistance. B. Intentional injuries 1. Intentional injuries include: a. Suicide and suicide attempts b. Homicide c. Nonfatal batterings d. Violent assaults on women (including rapes and spousal abuse) e. Child and elder abuse 2. Assaults are more likely to be fatal in the United States than any other developed country. a. In the United States there are approximately 7 million intentional injuries annually. 3. Factors that are numerically connected with intentional violence: a. Being male b. Access to firearms c. Alcohol abuse d. History of childhood abuse e. Mental illness f. Poverty 4. Risk factors: Characteristics that increase the chance of disease or injury 5. EMS providers play important roles in prevention by carefully reporting data and noting risk factors while on scene a. Can also be taught to identify injuries and risk factors associated with abuse and report them to the proper channels 6. Remember: You are an example to your colleagues. C. Unintentional injuries 1. No premeditation a. Often called accidents 2. Motor vehicle accidents account for most unintentional deaths. 3. Unintentional injuries in children a. Twenty million children annually sustain unintentional injuries that require medical attention, missing school, and/or bed rest. i. At a cost of $17 billion every year for medical treatment b. Children are at higher risk than adults for unintentional injuries and likely to be more seriously affected due to: i. Their developing bodies, including a proportionally larger head, thinner skin, and smaller airway c. Focusing on children’s issues creates the “pass-along effect.” i. Example: Third grader telling a parent to buckle his or her seatbelt d. Many prevention and research programs target children. i. EMS for Children (EMSC) is a federal program that funds a variety of prevention and research programs. ii. National Safe Kids Campaign is dedicated to reducing childhood injuries. iii. Programs like these are excellent resources. D. Risk factors for children 1. Children of lower socioeconomic status are at greatest risk of injury. a. Also at risk of contracting physiologic disease 2. According to the CDC, injuries to children in the home are most likely to occur where there is/are: a. Water, such as the kitchen, bathroom, or a swimming pool b. Intense heat, such as the kitchen or a barbeque c. Toxic agents, such as the kitchen, bathroom, garage, or purse d. High potential “energy,” such as stairwells or loaded firearms 3. Unintentional injuries are still a greater threat to kids than bullying or suicide. 4. School injuries most frequently occur: a. During sports activities b. Industrial arts activities c. On playgrounds 5. Forty-five percent of cases are severe injuries (fractures, amputations, concussions, dislocations). 6. Priority prevention efforts are injuries with highest: a. Mortality (death) rate b. Hospitalization rate c. Long-term disability rate d. Effective countermeasures e. Common, severe, and readily preventable injuries are the highest priority. E. Illness prevention 1. Traditionally, most efforts are on injury prevention. a. Illness prevention is receiving more attention. 2. For example, five behavior categories increase the risk of poor health in adolescents: a. Tobacco use b. Alcohol and other drug use c. Sexual behaviors that lead to STDs and unwanted pregnancies d. Unhealthy dietary behavior leading to obesity e. Physical inactivity leading to obesity (CDC, 2010) 3. EMS providers can organize or participate in programs that diminish high-risk behaviors. 4. Learn how you can become involved. a. Talk with your manager before taking on potentially sensitive issues. F. Community organizing 1. To develop a successful prevention program, do the following as you build your team and create an implementation plan: a. Have a designated leader. b. Build as broad a support base as possible. c. Create a realistic timeline. d. Choose SMART (simple, measurable, accurate, reportable, trackable) goals and objectives. i. Build consensus in your community on the need for action. e. Understand the religious, ethnic, cultural, and language challenges you may face. f. Do not reinvent the wheel—seek others with experience. g. Anticipate opposition and some losses. h. When lobbying legislators, be brief. i. Set up your program to measure results and make changes as needed. j. Establish self-sustaining funding sources. k. Keep a sense of humor and persist. i. Change takes time. G. Five steps to developing a prevention program 1. Conduct a community assessment. a. Bring people and groups together to assess what: i. Is already being accomplished ii. Resources potentially available b. Invite people who represent the community at large. i. Include survivors and their families c. Potential partners include: EMS groups, law enforcement, school groups, media, public health officials and health care providers, members of the business community, religious organizations, civic groups, service clubs, sports-related organizations, nonprofit groups, celebrities, community leaders, elected officials, and research groups 2. Define the problem. a. On the basis of community assessment and data you collected, define the problem in specific, quantifiable terms. 3. Set goals and objectives. a. Goals: Make this a broad, general statement about the long-term changes. b. Objectives: Make these specific, time-limited, and quantifiable. Two types: i. Process objectives ii. Outcome (impact) objectives 4. Plan and test interventions. a. Actions you take to accomplish your goals and objectives b. Using the 4Es of prevention and the Haddon matrix, brainstorm options. c. Consider your available resources. d. Be sure you have reviewed what others have already done. e. Be aware of timing and cultural considerations. f. Get a sample group together to test before rolling out the entire program. 5. Implement and evaluate interventions. a. Results must be able to be measured quantitatively. b. A formal evaluation will tell you whether or not you met your goals and objectives. c. This way, your experience can be shared. d. Seek out others with knowledge and experience in this area. 6. Many, if not most, interventions demand ongoing attention to be effective. a. Consider building long-term maintenance into any plan to continue the momentum. H. Funding a prevention program 1. Consider innovative ways to fun programs, including: a. Partnering with the local media b. Seeking grants from regional, state, or national organizations c. Seeking scholarships from local nonprofit service organizations or commercial firms 2. Networking with other organizations often provides greater leverage when seeking grants or sponsorships. VIII. How Every Provider Can Be Involved A. Paramedics can, and should, be involved in prevention to some extent. 1. Starting with prevention of their own injuries and illnesses 2. Be a role model for others. 3. Implement your employer’s policies. a. Take the risks you take every day seriously. B. Responding to the call 1. Very few calls require the use of lights and sirens. 2. Many departments require ambulances to stop at every stop sign or red light on every call and maintain speed control. 3. Prioritized dispatch systems using certified dispatchers can be a valuable resource. 4. Provide leadership by advocating for policies, safety equipment, or a safer environment. C. Education for EMS providers 1. Understand the fundamentals of prevention. a. Consider a continuing education program on the subject. b. Contact your EMS office to see about scheduling a workshop in your area. c. Contact your local health office to see what training sources are available. d. Consider taking an online course. D. The “teachable moment” 1. There are times when people are more receptive to accepting advice than others. 2. Articulate and reinforce safety messages when opportunities arise. a. Use good judgment, and be sensitive to the situation. 3. Teachable moments: a. Injuries or illnesses are such that the patient or family will be receptive i. Ethnic and religious differences must temper the message. b. Scene is conducive to delivering the messaging in a nonthreatening, nonjudgmental way i. You are not intruding inappropriately or causing embarrassment. c. There is a definitive preventative measure that could have helped. i. Vague advice will not be useful. E. Collection and analysis of data and research 1. Vital for: a. Measuring trends b. Validating interventions c. Assessing resources d. Persuading others to act 2. Starts with the prehospital care report. a. Accurately and legibly record all details to supply evidence for the scope of the problem and for monitoring trends. 3. Assess your current prehospital care report to see if it can be modified to be a better tool. 4. Get involved in local, state, or national database systems. a. Information is frequently being gathered, but it may not be being used effectively. 5. Consider participating in local, regional, or national research projects. a. Talk with personnel from local medical command centers, hospitals, or universities. 6. Be a leader by: a. Being a role model b. Reaching out in your community to become involved in a wide variety of prevention programs IX. Summary A. Public health encompasses health promotion and disease prevention for groups of people. Issues in this field can include disasters such as hurricanes and wildfires, or illness outbreaks such as the H1N1 flu outbreak. B. Federal, state, and international rules, regulations, guidelines, and laws govern public health. C. Every September is National Preparedness Month to help people prepare for potential health emergencies. D. Many paramedics have been motivated by their field experience to work actively on prevention. E. 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. F. The 1996 Consensus Statement on the EMS Role in Primary Injury Prevention emphasized that primary injury prevention is an essential activity of EMS. G. EMS can play a supporting role in preventing intentional injuries and can have an even larger effect in preventing unintentional injuries. H. The years of potential life lost concept is another way to measure the cost of unintentional injury to society. It assumes that an average productive work life continues for 65 years. The age of death is deducted from 65, leaving the years of potential life lost. I. The 4 Es of prevention are: – Education – Enforcement – Engineering/environment – Economic incentives J. Automatic protections do not require a conscious decision to act and include air bags in automobiles. K. The Haddon matrix uses nine separate components to analyze injury. It encourages creative thinking in understanding the causes and potential interventions for injury. L. Surveillance is the ongoing systematic collection, analysis, and interpretation of data essential to the planning, implementation, and evaluation of public health practice. M. Paramedics need to triage their focus on prevention—do not let the headlines be your guide. N. The five steps to developing a prevention program are: – Conduct a community assessment. – Define the problem. – Set goals and objectives. – Plan and test interventions. – Implement and evaluate interventions. O. Primary prevention begins at home by taking care of yourself and presenting a role model for others in your service and in the community. P. The best teachable moments are those that convey positive reinforcement. Q. The importance of collecting data in measuring trends, validating interventions, assessing resources, and ultimately persuading others to act cannot be overestimated. Post-Lecture This section contains various student-centered end-of-chapter activities designed as enhancements to the instructor’s presentation. As time permits, these activities may be presented in class. They are also designed to be used as homework activities. Assessment in Action This activity is designed to assist the student in gaining a further understanding of issues surrounding the provision of prehospital care. The activity incorporates both critical thinking and application of paramedic knowledge. Instructor Directions 1. Direct students to read the “Assessment in Action” scenario located in the Prep Kit at the end of Chapter 3. 2. Direct students to read and individually answer the quiz questions at the end of the scenario. Allow approximately 10 minutes for this part of the activity. Facilitate a class review and dialogue of the answers, allowing students to correct responses as may be needed. Use the quiz question answers noted below to assist in building this review. Allow approximately 10 minutes for this part of the activity. 3. You may wish to ask students to complete the activity on their own and turn in their answers on a separate piece of paper. Answers to Assessment in Action Questions 1. Answer: A. interventions Rationale: Paramedics should take an active role in injury and illness prevention. Paramedics are often the first on scene after an accident has occurred and may have a “teachable moment” when they are able to explain how the injury could have been prevented. EMS providers see the scene as a whole—the physical situation, the possible design flaws in a home or on a roadway, and the stress of trauma. For this reason, EMS personnel are strong advocates of injury prevention programs. Although illness prevention (such as vaccinations or blood pressure monitoring) is common for physicians and public health officials, EMS is in the unique position to recognize and provide education for injury prevention. Hospital personnel do not have the perspective that you do as a paramedic in the field. The principles and techniques of injury prevention are similar to those of illness prevention. Once a need is discovered, you should put a plan into place to address it. 2. Answer: C. primary injury prevention Rationale: Primary injury prevention is designed to keep an injury from occurring. Secondary injury prevention reduces the effects of an injury that has already occurred, which has always been the focus of EMS. Injury prevention initiatives could help reduce the number of incidents. Although your main role is to respond to and treat injuries, you must also pay attention to recurring injuries and teach others in the health care system and the public to recognize and prevent them. 3. Answer: B. unintentional Rationale: Injuries may be classified as intentional (such as a suicide or assault) or unintentional (such as a fall or drowning). There is no premeditation with unintentional injuries, which are the leading cause of death in the 1- to 44-year-old age group. Children make up a large portion of the population that experiences unintentional injuries. Younger children have a disproportionately large head that plays a significant role in serious injuries resulting from falls. Children of lower socioeconomic status are more at risk for injury and disease. They have the least access to medical care or prevention programs and should be a target audience for EMS prevention efforts. The most frequent injuries occur where there is water, intense heat, toxic agents, or high potential energy, such as in stairwells or with loaded firearms. Injuries at school occur most frequently during sports activities, industrial arts classes, and on playgrounds. The highest priority for injury prevention programs is to reduce the number of injuries that are common, severe, and readily preventable. There are many programs in place to help protect children such as free car seat inspections and donations of bike helmets. EMS for Children (EMSC) provides funding for prevention and research programs, and the National Safe Kids Campaign is dedicated to reducing childhood injuries. Both have web sites for more information. 4. Answer: D. injury risk Rationale: Injury risk is a potentially hazardous situation in which the well-being of a person can be harmed. Injury risks can be greatly reduced through the use of proper safety equipment such as seat belts and bicycle helmets. Education plays a major role in teaching the public about the use of safety equipment as well as other information such as where to safely place a car seat in a vehicle and why it is important to wear a seat belt. Education about potential dangers may persuade people to change their behavior. For those who refuse to comply (ie, will not wear a seat belt), legislation can force behavior to change. Legislation or regulation can require individuals, manufacturers, and governments to comply with certain safety practices. They can also set policies and establish procedures that control the manufacture, sale, and/or use of products. Passive interventions are yet another way to prevent injuries. Changing the design of a roadway, adding a guardrail to a particularly dangerous area, or making child-resistant bottles to reduce poisonings are all forms of passive interventions. Environmental modifications usually happen when the community’s awareness is raised, for example when a traffic light is installed in a dangerous intersection after a death has occurred. Economic incentives such as reducing rates for those who have not been involved in collisions may also serve as a form of injury prevention. This is true as well for manufacturers who improve the safety of products to avoid the threat of lawsuits. Free or subsidized safety products also encourage use. 5. Answer: A. teachable moment Rationale: Teachable moments occur when there has been an injury and you have an opportunity to discuss how this particular injury could have been prevented. There are certain times when people are more receptive to accepting advice and learning. It is appropriate to discuss prevention with someone who was involved in an accident that was a near-miss, but it is not appropriate immediately after a serious injury has occurred. The best teachable moments convey positive reinforcement such as praising a patient involved in an accident for wearing a seat belt. The scene should also be conducive to delivering the message in a nonthreatening, nonjudgmental way. You should not embarrass anyone. There must also be a definitive prevention measure that could have made a difference, such as wearing a seat belt or correct installation of a car seat. Advice that is specific is more likely to have a lasting effect. 6. Answer: B. intentional Rationale: Intentional injuries are injuries that are perpetrated against another; they account for more than 58,000 deaths per year. Intentional injuries include suicides and suicide attempts, homicides, nonfatal batterings, violent assaults on women, and child and elder abuse. Intentional injuries in the United States are more likely to be fatal than in any other developed country. Certain risk factors are connected with the potential for intentional violence. These include male gender, access to firearms, alcohol abuse, history of childhood abuse, mental illness, and poverty. It may seem difficult to find a solution when the cause of the problem seems to be complex. For example, a child who was abused may then become an abuser. Paramedics are taught to identify injuries and risk factors (characteristics that increase the chances of disease or injury) that are associated with domestic violence or child abuse and to report them to the proper channels. Being a conscientious observer sets an example and is the key to preventing further violence. 7. Answer: A. enforcement, engineering/environment, and economic incentives. Rationale: Education, enforcement, engineering/environment, and economic incentives make up the 4 Es of injury prevention. Education is a major component of primary injury prevention. A parent may not realize that putting an infant seat in the front of a vehicle could result in an infant’s death. By informing the public about potential dangers and offering explanations as to how to change the behavior, the number of injuries can be reduced. To be effective, messages about injury prevention need to be tailored to specific events. For example, encouraging someone to wear a seat belt may be accomplished by discussing the consequences of being ejected from a vehicle. Law enforcement of safety measures, such as a fine for not wearing a seat belt, may be enough encouragement for most people to buckle up. Laws also set policies and establish procedures that control the manufacture, sale, and/or use of products. Modifying the environment or creating new products encompasses the engineering/environment portion of the 4 Es. This may be accomplished by adding a guardrail to a particularly hazardous portion of roadway or changing the design of the roadway. Research and development of newer, safer products plays a major role in injury prevention. Economic incentives is the fourth “E.” Saving money is usually a good incentive for most people. Offering rate reductions on insurance for safe driving or decreases in health care costs may be enough to encourage safer habits. Offering free or reduced-cost products such as bicycle helmets may also help to encourage use. Additional Questions 8. Rationale: By using a step-by-step approach, you should start by establishing goals and objectives that have a measurable outcome. Start by conducting a community assessment to determine the needs and to see what has previously been done and what resources are available. Do not reinvent the wheel. Once the needs have been established, define the problem. This should be done in specific quantifiable terms. Use questions such as “What populations are at highest risk?” and “When and where are these injuries occurring?” These questions have specific measurable answers. Once the problem has been recognized and evaluated, you must set goals for long-term changes and prevention initiatives. Goals are broad, general statements. Objectives are specific and set a time limit and method for meeting that objective. For example, a goal would be to reduce the number of injuries from improperly installed car seats, and the objective would be to provide courses and car seat checks in a particular area during a certain time frame. Interventions are the actions taken to accomplish the goals and objectives. Consider your resources and also what may have worked in other communities that can be implemented in your area. After the program has been implemented, it will need to be evaluated for effectiveness. You must be able to show that you have made a difference. To be effective, interventions must be ongoing. This requires attention and education. You must build long-term maintenance into your plan to continue the momentum of the program. Securing funding may be the biggest obstacle that you face. Partnering with the media; seeking grants from regional, state, or national organizations; or seeking sponsorships from local nonprofit organizations are great places to start. Take advantage of opportunities to network with organizations with similar objectives in seeking grants or sponsorships. It is important to remember that for any program to be successful, the public needs to be consistently reminded of its message. 9. Rationale: Not only should you take care of yourself, you should also be a role model for others in your service as well as the community in general. Primary injury prevention begins at home. Make sure you are wearing your seat belt whether you are in your personal vehicle or in the ambulance. Drive safely. Ensure that you are preparing yourself physically for the job, use safe lifting techniques, and wear appropriate protective equipment. Always make sure the scene is safe before entering, and quickly remove yourself if it changes. Remember that scenes are dynamic, and you must always be alert to protect yourself, your partner, bystanders, and patients. Take measures to avoid becoming involved in an emergency incident. A collision involving an ambulance is not only tragic for EMS personnel and others who may be involved, but it increases the response time for the person who made the 9-1-1 call. Use information provided by the dispatcher as well as current conditions (such as traffic, weather, or construction) to determine response mode. Dispatchers are trained to assess the need for emergency response and to provide prearrival instructions. You can improve your department by being an advocate for wellness programs and a role model by practicing what you preach. Look for education programs that are geared toward EMS providers that may be offered as workshops or online courses. Be proactive in primary injury prevention, whether you are using proper protective gear, driving safely, or explaining the proper use of a car seat. Assignments A. Review all materials from this lesson and be prepared for a lesson quiz to be administered (date to be determined by instructor). B. Read Chapter 4, Medical, Legal, and Ethical Issues, for the next class session. Unit Assessment Keyed for Instructors Many public health officials list this as the largest public health risk. Provide the detailed description from the CDC. Answer: According to the National Center for Injury Prevention and Control, part of the CDC, injuries are “the intentional or unintentional damage to the person resulting from acute exposure to thermal, mechanical, electrical, or chemical energy or from the absence of such essentials as heat or oxygen” (2011). (p 61) According to the American Public Health Association (APHA), public health is defined as__________. Answer: “The practice of preventing disease and promoting good health within groups of people” (p 61) What is the difference between primary and secondary prevention? Answer: Primary prevention is defined as keeping an injury from ever occurring. EMS traditionally has focused on secondary prevention, reducing the effects of an injury, disease, or other health problem that already exists. (p 67) What are the “4 Es” of prevention? Answer: Education, enforcement, engineering/environment, economic incentives (pp 68-69) What is the Haddon matrix? Answer: The Haddon matrix uses the host, agent, and environment as factors that interact over time to cause injury. These factors correspond to three phases of the event: pre-event, event, and post-event. The matrix uses nine separate components to analyze the injury. (p 70) Define surveillance as it relates to prevention. Answer: The ongoing, systematic collection, analysis, and interpretation of data essential to the planning, implementation, and evaluation of public health practice (pp 70-71) List at least five examples of unintentional injuries. Answer: Any five of the following: suicides and suicide attempts, homicides, nonfatal batterings, violent assaults on women (including rapes and spousal abuse), and child and elder abuse (p 72) What are the top four causes of unintentional injuries? Answer: Motor vehicle traffic incidents, poisonings, firearms, falls (p 73) Explain the five steps to developing a prevention program. Answer: Conduct a community assessment, define the problem, set goals and objectives, plan and test interventions, and implement and evaluate interventions. (pp 74-76) Unit Assessment Many public health officials list this as the largest public health risk. Provide the detailed description from the CDC. According to the American Public Health Association (APHA), public health is defined as__________. What is the difference between primary and secondary prevention? What are the “4 Es” of prevention? What is the Haddon matrix? Define surveillance as it relates to prevention. List at least five examples of unintentional injuries. What are the top four causes of unintentional injuries? Explain the five steps to developing a prevention program.