Gloria Salazar, RN, MSN, MA, CP-CA SANE, LPC Manager, Trauma Education &

1. Injury Prevention at a Trauma Level 1 Center Gloria Salazar, RN, MSN, MA, CP-CA SANE, LPC Manager, Trauma Education & Injury Prevention Division

2. “Injury Not An Accident” • Predictable and Preventable • High risk individuals • High risk environments • Third leading cause of death nationally • Ages one to 44 years • One person dies every three minutes • Generates $406 billion lifetime costs (U.S. Center for Disease Control & Prevention 2010)

3. Injury Prevention Deaths Injury Deaths Compared to Other Leading Causes of Death for Persons Ages 1-44, United States, 2007* ACS. 2008

4. Trauma a Disease Lacking Public Awareness • Trauma Level I Centers • Identify specific injuries, patterns, risk factors • 50% of patients who die do not reach a Trauma Center • Injury prevention programs can reduce morbidity and mortality • Reduce trauma recidivism

5. Distribution of Global Injury Mortality ACS, 2008

6. Injury Prevention Programs are Data Driven • Emergency Nurses Association (ENA) • Society Trauma Nurses (STN) • American Academy of Pediatrics (AAP) • Many others • Trauma Registry • Regional Registry • Law-Enforcement • DSHS • Safe Kids World Wide

7. Injury Prevention Strategies • Lessen morbidity & mortality • Using principles of patient family centered care • Age specific evidenced-based programs

8. Development of a Prevention Program • Define and focus • Effective • Systematic and organized approach • Appropriateness of steps (individualized) • Supported by data • Existence of many modules

9. Injury Prevention Collaboration Efforts • Local level: Inspections, presentations, events, classes • State level: Safe Riders, Shattered Dream Program, CPS Week • Regional level: Fall Prevention Program, Bicycle Helmet Safety • National level: Safe Kids Coalition, (ACS-COT, 2006)

10. Classification of Injury Prevention • Primary: elimination of injuries (stoplights, window guards, safety caps, car crash) • Secondary: injury occurred but reduces severity injuries (seat belts, airbags, helmets) • Tertiary: reducing the consequences of injury (trauma centers, rehabilitation)

11. Haddon’s Matrix a Conceptual Framework

12. Example of Haddon's Matrix as Applied to Child Injury Prevention (child restraints)

13. The Four Es’ of Injury Prevention • Education: provides public awareness and education • Enforcement: Mandates behavioral changes • Engineering: Advance technology as air bags, highway designs • Economics: Incentives/non as financial support and insurance discounts

14. Trauma Centers: Developing an Injury Prevention Program • Defining the problem: population-based data. • Defining the causes/risk factors: kind of injuries, where, when, why? • Implement strategies: cost effective, simple, culturally sensitive, and group/age specific. • Evaluate impact: successful change in behavior.

15. Internal Trauma Registry Data UMC Trauma Registry: Araceli Camacho

16. UMC Injury Prevention Programs • Motor Vehicle Crashes (MVA or MVC) • Water Safety Program • Fall Prevention Program • Helmet Safety Program • Many others

17. University Medical CenterCar Seat Inspection Programs • Classes provided (English & Spanish) culturally sensitive • Programs prioritized by families needs • Target programs based on zip codes • Target high risk populations • Target community areas lacking resources

18. Trauma Education & Injury Prevention Division Alamo Inspection Report 2008-2012 # of Parents/Caregivers: 702 By: Martha Montellano 10/29/2012

19. Trauma Education & Injury Prevention Division Community Safety Seat Inspection Report 2008-2012 # of Parents/Caregivers: 3,051 By: Martha Montellano 10/29/2012

20. Trauma Education & Injury Prevention Division Alamo-Community Safety Seat Inspection Report 2008-2012 # of Parents/Caregivers: 3,753 By: Martha Montellano 10/29/2012 Combined Inspection

21. Motor Vehicle Crashes (MVC) 2012 Safety Belt Use in Texas TXDOT, 2012

22. Fall Prevention Program 8 million: ED visits suffer falls 1 in 3 Americans fall annually 65 yrs Leading cause of deaths Every 15 seconds: treated Every 27 minutes: dies video

23. Tip Overs

24. Our Future Injury Prevention is one of seven priorities by National Prevention Strategy. America’s Plan for Better Health and Wellness, released in 2011. 17 federal agencies to move the nation from a focus on sickness and injury to Prevention and Wellness.

25. Trauma Level I Centers ATS, 2009 “Those Who Fail to Plan; Plan to Fail” “That When Prevention Succeeds, Trauma is Conquered”

26. References American Academy of Pediatrics (APA). 2011 State Legislation Report. Elk Grove, IL. American Academy of Pediatrics, 2011. American College of Surgeons Committee on Trauma. Advanced Trauma Life Support for Doctors (ATLS), Eight Edition, 2008. American College of Surgeons Committee On Trauma. Resources for Optimal Care of the Injured Patient 2006. American Trauma Society website. Injury Prevention Awareness Program: Facts and Figures, 2011. http://www.amtrauma.org/injuryprevention/injuryprev.html. Access November 1, 2012.

27. References Bone NN, Gilchrist J. Dellinger AM, et al. CDC childhood Injury Report: Patterns of Unintentional Injuries Among 0-19 Year Olds in the U.S., 2000-2006. Atlanta, GA: U.S. Centers for Disease Control and Prevention, National Center for Injury Prevention and Control, 2008. Centers for Disease Control and Prevention (CDC): Medical expenditures attributable to injuries in the U.S., 2000. MMWR Morb Mortal Weekly Rep 52:04, 2004. Criddle, L. M., PhD. Pediatric Care After Resuscitation, 2012. A Course for Nurses Across the Trauma System. The Laurelwood Group. Injury: Leading Cause of Death Among Persons 1-44. U.S. Centers for Disease Control and Prevention. http://www.cdc.gov/injury/overview/leadning_cod. Access November 1, 2012.

28. References McQuillan, K., Makic Flynn, M. B., & Whalen, E. Trauma Nursing from Resuscitation Through Rehabilitation, fourth edition, 2009. Resources for Optimal Care of the Injured Patient, 2006. Wood Robert Johnson Foundation. Trust for America’s Health. The Facts Hurt: A State-By-State Injury Prevention Policy Report.