arkansas trauma system injury prevention update mary aitken md

ARKANSAS TRAUMA SYSTEMARKANSAS TRAUMA SYSTEMINJURY PREVENTION INJURY PREVENTION UPDATEUPDATEMARY AITKEN MDMARY AITKEN MD

Statewide Injury Prevention ProgramStatewide Injury Prevention Program

MARY AITKEN, MDMARY AITKEN, MD

Arkansas Mortality RankingsArkansas Mortality RankingsIntent Ages Ranking

All intents All ages 10th

Unintentional All ages 11th

Unintentional Birth to 24 yrs. 3rd

Mechanism Ages Ranking

Motor vehicle All ages 5th

M t hi l Bi th t 24 3rdMotor vehicle Birth to 24 yrs. 3rd

Burns All ages 4th

Drowning All ages 6thDrowning All ages 6

Drowning 10 – 24 yrs. 3rd

Motorcycle All ages 2nd


Source: Centers for Disease Control and Prevention, WISQARS

Components of Trauma SystemsComponents of Trauma Systems

Emergency Medical Services (Pre‐hospital) g y ( p )Designated Trauma Centers

Trauma Registry Trained and Available Medical Professionals (Hospital)

Rehabilitation Facilities Injury Prevention and Control ProgramsInjury Prevention and Control Programs


Prevention Is a Good InvestmentPrevention Is a Good InvestmentPrevention Is a Good InvestmentPrevention Is a Good Investment

Intervention Cost per Unit Return on Investment*

Child Car Seat $52/seat $2,200

Booster Seat $35/seat $2,500

Child Bicycle Helmet $12/helmet $580

Voluntary ATV Helmet Use $150/helmet $570Voluntary ATV Helmet Use $150/helmet $570

*Return on investment is defined as the amount injury prevention interventions saved by preventingReturn on investment is defined as the amount injury prevention interventions saved by preventing injuries, including medical costs, work loss, and quality of life costs. Calculated at 2004 dollars

Source: Injury Prevention, What Works? 2010 Update. Children’s Safety Network, 2010. Available at: http://www.childrenssafetynetwork.org/publications_resources/PDF/data/InjuryPreventionWhatWorks.pdf


System Requirements for Injury Prevention

Section VII.G: “Injury prevention in the home and

y q j y

j y pindustry, on the highway and athletic fields; standardfirst aid; problems confronting public, medicalprofession, and hospitals regarding optimal care for thep , p g g pinjured. Could be a collaborative effort by severalhospitals or the region.”

Ref: Arkansas State Board of Health “Rules and Regulations for Trauma Systems” Rev. 2002

Injury Prevention is a requirement for all designated h l k (l l d )

e a sas State oa d o ea t u es a d egu at o s o au a Syste s e 00

trauma hospitals in Arkansas (levels 1, 2, 3, and 4)


Multiple Strategies:Multiple Strategies:Multiple Strategies: Multiple Strategies:

• EducationEducation

• Engineering/Environment

• Enactment/Enforcement

• Economics

• EvaluationEvaluation


Statewide Injury Prevention Program (SIPP)Statewide Injury Prevention Program (SIPP)

h f h d l d

j y g ( )j y g ( )

The mission of the SIPP is to reduce injury mortality andmorbidity within Arkansas across the age span.

The SIPP will serve as a resource and technical assistancecenter, collaborating with the Trauma Regional AdvisoryCommittees and assisting hospitals EMS services andCommittees and assisting hospitals, EMS services, andHometown Health Coalitions within each Trauma ServiceRegion with the identification, implementation, and

ill f id b d i j tisurveillance of evidence‐based injury preventionstrategies.


• Communities• Institutions• Capacity

• Communities• Institutions• Capacity

• Registry• Linked Data• State/Regional

• Registry• Linked Data• State/Regional STATEWIDE INJURY

PREVENTION PROGRAMp y

• Commitmentp y

• Commitmentg

analysisg

analysis PREVENTION PROGRAM

Surveillance NeedsAssessment

InterventionEvaluation

• Evidence-basedT il d

• Evidence-basedT il d

• ProcessO t

• ProcessO t • Tailored

• Sustainable• Technology

• Tailored• Sustainable• Technology

• Outcomes• Bidirectional• Outcomes• Bidirectional

Surveillance: Progress to DateSurveillance: Progress to Date

• Excellent working relationship andExcellent working relationship and communication with ADH established

• Review of mortality and hospitalization data at• Review of mortality and hospitalization data at the state, regional, and county level

M h i f i d• Mechanisms for ongoing data requests developed

Unintentional Injury Related Deaths in Arkansas by Injury Mechanism, 2007-2009, All Ages

Source: CDC WISQARS 11

Hospitalizations from Motor Vehicle CrashesAmong Arkansans By Trauma System Region, 2007-2009

Source: Arkansas Hospital Discharge Data System, Health Statistics Branch

Needs AssessmentNeeds AssessmentNeeds AssessmentNeeds Assessment

• Lead agency: Injury Prevention CenterLead agency: Injury Prevention Center

• Assess existing activitiesAssess existing activities– Community level: HHI, Civic and Service Groups– Institution level: Trauma Hospitals, EMSp ,

• Measure capacity and investment– BaselineBaseline – Training

• Strategic planning


Strategic planning

Needs Assessment: ProgressNeeds Assessment: ProgressNeeds Assessment: ProgressNeeds Assessment: Progress

• Electronic survey conducted by students from theElectronic survey conducted by students from the Clinton School for Public Services during 2010‐2011 academic year

• Final report demonstrates: – Strong support for injury prevention initiatives

– Limited capacity in staffing and funding

d f– Need for training

– Need for technical assistance for evidence based program identification and implementation


identification and implementation

SIPP ImplementationSIPP Implementation

• Located at Arkansas Children’s Hospital Injury• Located at Arkansas Children s Hospital Injury Prevention Center

Lif h t ti• Lifespan approach to prevention

• Staffing– SIPP Program Manager

– Professional education coordinator

– Content‐area coordinators (motor vehicle, recreational, intentional, and home safety)

– Administrative assistant

CommunicationCommunication

• TRAC Injury Prevention subcommittees formed• TRAC Injury Prevention subcommittees formed to identify priorities for interventions

Data reviewed with TRAC IP subcommittees– Data reviewed with TRAC IP subcommittees

– TRACs setting up plans and activities

N k• Networks– SIPP web presence and listserv development

– http://www.healthy.arkansas.gov/programsServices/injuryPreventionControl/Pages/default.aspx

Resource Development and Resource Development and DisseminationDisseminationDisseminationDissemination

• Analysts have identified• Analysts have identified broad range of resources

• Resource binder providedResource binder provided to trauma affiliates– Print ready fact sheets, y ,presentations, and contacts

– Order forms for full toolkits

• In progress:– Toolkits on specific topics

f


– Training of trainers

Professional EducationProfessional Education

• Injury Prevention 101• Injury Prevention 101– Basic overview of injury prevention approach

Off d l l t t– Offered regularly across state

• Injury prevention education integrated into i i hexisting outreach programs

– PedsPLACE, EdsPLACE telemedicine programs

• Next steps:– Training of trainers on specific prevention strategies

– On‐line training

Injury Prevention 101Injury Prevention 101Injury Prevention 101Injury Prevention 101

• Injury Prevention (IP) 101 is a one day 8 hour class

Injury Prevention 101Injury Prevention 101• Injury Prevention (IP) 101 is a one day, 8-hour class

which provides an overview of the basics of the field ofinjury prevention and how to implement an injuryprevention program

• This class discusses where and how to access data,partnering with community groups and how to planpartnering with community groups, and how to plan,implement and evaluate evidence-based injuryprevention programs

• Classes are offered monthly across the state• CEUs are offered for ARNA, CHES, APCB, ADE and

EMS

archildrens.org uams.eduarpediatrics.org

EMS

COUNTIES HOSTING INJURY PREVENTION 101 COURSES

Carroll

Izard Sharp

Baxter

Stone

Lawrence

RandolphBenton

Mississippi

Marion

Fulton ClayBoone

Madison

Greene

Washington Newton SearcyC i h d

White

Stone

ConwayCrittenden

Independence

Jackson

FranklinCrawford Van BurenJohnson

PopeCleburne

Poinsett

S b tiCross

Logan

Craighead

Garland

Prairie

Monroe

Faulkner

Yell

WoodruffCrittendenSebastian Logan

St. FrancisPerry

Scott

Lee

Saline

PulaskiLonoke

Polk

SevierHoward

LincolnCl l d

Hot Spring Jefferson Arkansas

PhillipsMontgomery

Grant

PikeClark

Dallas

NORTH CENTRAL

NORTHEAST

SOUTHEAST

IP 101 CLASS COMPLETED

Calhoun

Bradley

Ouachita

LincolnClevelandDesha

Miller

Little River Hempstead NevadaDrew

SOUTHEAST

SOUTHWEST

ARKANSAS VALLEY

IP 101 CLASS SCHEDULED UnionColumbia

MillerChicotLafayette

Ashley NORTHWEST

CENTRAL

Capacity BuildingCapacity Building

• Core Injury and Violence Prevention GrantCore Injury and Violence Prevention Grant– CDC funded grant

Long term capacity building at ADH– Long term capacity building at ADH

– Four focus areas: • Motor Vehicle Safety• Motor Vehicle Safety

• Unintentional Poisoning

• SuicideSuicide

• Concussion

– Other key areas: Falls, Violence, othersy , ,

– Injury Community Planning Group formed

Capacity BuildingCapacity Building

• Ongoing assessment of capacityOngoing assessment of capacity– Safe States STAT visit August 2011

Participation in TRAC meetings and IP– Participation in TRAC meetings and IP Subcommittees

• Resources for ADH staff statewide to engage in• Resources for ADH staff statewide to engage in injury prevention activities

T i i f HHI t ff– Training for HHI staff

– Integration of HHI and TRACs

Technical AssistanceTechnical Assistance

• SIPP will assists partners withSIPP will assists partners with– Data review and analysis

Identification of community partners– Identification of community partners

– Identification of evidence‐based interventions

P i l t ti d t i bilit– Program implementation and sustainability

• Next steps:– Pilot funding mechanisms

– Statewide motor vehicle intervention

– Pilot local and regional interventions

HHI

Trauma Hospital/EMS

Agency

Funding from multiple sourcesAgency sources

PreventionInitiative

Engagementngagement

• Universal– Use of standardized materials in clinical and community settings: Resource binder, toolkits

C i i i i i li b i– Communication: participate in listserv, website

• Statewide initiativesChild P S f t– Child Passenger Safety

– Training

• Regional and local initiatives• Regional and local initiatives– TRAC‐ and institution‐led based on local data

– Current activities: teen driving, ATV safety, child passengerCurrent activities: teen driving, ATV safety, child passenger safety, falls

SIPP TECHNICAL ASSISTANCE REQUESTS, b C t t A J l 1 2011 M h 31 2012by Content Area, July 1, 2011-March 31, 2012


SIPP STAFF TECHNICAL ASSISTANCE CONTACTS BY TRAC REGIONCONTACTS, BY TRAC REGION


SIPP CONTACTS BY COUNTYJuly 1, 2011 – March 31, 2012

Carroll

Izard Sharp

Baxter

Stone

Lawrence

RandolphBenton

Mississippi

Marion

Fulton ClayBoone

Madison

Greene


White

Stone

ConwayCrittenden

Independence

Jackson


PopeCleburne

Poinsett

S b tiCross

Logan

Craighead

Garland

Prairie

Monroe

Faulkner

Yell


St. FrancisPerry

Scott

Lee

Saline

PulaskiLonoke

ShelbyTN

Polk

SevierHoward

LincolnCl l d


PhillipsMontgomery

Grant

PikeClark

Dallas

Calhoun

Bradley

Ouachita


Miller


Counties assisted by the Statewide Injury Prevention Bowie

TX

UnionColumbia


Ashley

j yProgram during the reporting cycle.

TX

ADH/Trauma System Statewide InitiativesADH/Trauma System Statewide Initiatives

In February 2012, the Arkansas Department of Health, Injury Prevention andIn February 2012, the Arkansas Department of Health, Injury Prevention and Control Branch issued a project application request to injury prevention partners within the Trauma Service Regions to submit proposals in two targeted areas:

1. Conduct Child Passenger Safety check-up events and distribute car seats to the community participants as needed.

2 E h T R i l Ad i l f f d t2. Each Trauma Regional Advisory may apply for funds to sponsor one individual to attend the 2012 Joint Annual meeting of the Safe States Alliance and the CDC Core Violence and Injury Prevention Program set for May 1-4, 2012 in Atlanta, Georgia.g y , , g

There were 29 requests for car seats for distribution and 3 requests forsponsorship to the Safe States/CDC Conference.


p p

Statewide Initiative:Child P S fChild Passenger Safety

• Goal: Improved child passenger safety

• Capacity: Child Passenger Safety Technician p y g ytraining targeting trauma affiliates

• Training infrastructure: Training sites in allTraining infrastructure: Training sites in all trauma regions (7 new sites)

• Access to equipment: Car seat distribution• Access to equipment: Car seat distribution throughout state to qualified sites


Current Statewide Injury Prevention Initiatives

Carroll

Izard Sharp

Baxter

Stone

Lawrence

RandolphBenton

Mississippi

Marion

Fulton ClayBoone

Madison

Greene


White

Stone

ConwayCrittenden

Independence

Jackson


PopeCleburne

Poinsett

S b tiCross

Logan

Craighead

Garland

Prairie

Monroe

Faulkner

Yell


St. FrancisPerry

Scott

LeeSaline

PulaskiLonoke

ShelbyTN

Polk

SevierHoward

LincolnCl l d


PhillipsMontgomery

Grant

PikeClark

Dallas Counties receiving car seats

Calhoun

Bradley

Ouachita


Miller


Counties receiving car seatsfor Child Passenger Safetyevents.

Counties receiving fundingfor the Safe States/CDC

UnionColumbia


Ashleytraining visit

Counties with facilitiesreceiving training equipment

Unintentional Injury Deaths, All Ages, 2000‐2009

50

60

40

per 1

00,000

20

30

Age

adjusted rate

United States

Arkansas

10

0

2000 2001 2002 2003 2004 2005 2006 2007 2008 2009

Over last 10 years an average of 1300 Arkansans have died from unintentional

Source: WISQARS, Centers for Disease Control and Prevention

Over last 10 years an average of 1300 Arkansans have died from unintentionalinjury each year. This is 28% higher than the national average.

30

Motor Vehicle Related Deaths, All Ages, 2000‐2009

25

30

20

per 100,000

United States

Arkansas

10

15

Age

adjusted rate

5

0

2000 2001 2002 2003 2004 2005 2006 2007 2008 2009


Over the last 10 years an average of 600 Arkansans have died from Motor Vehicle Related crashes. Although our death rate has dropped by 15% in the last ten years our death rate is still 40% higher than the US.

Motor Vehicle Related Deaths, Ages 0‐13, 2000 2009

8

9

2000‐2009

6

7

0 United States

4

5

e Ra

te per 100,00 United States

Arkansas

2

3

Crud

e

0

1

2000 2001 2002 2003 2004 2005 2006 2007 2008 2009


45

50

Motor Vehicle Related Death, Ages 14‐19, 2000‐2009

35

40

45

United States

25

30

e Ra

te per 100,000

United States

Arkansas

10

15

20

Crud

e

0

5

2000 2001 2002 2003 2004 2005 2006 2007 2008 2009


Seat Belt Use Arkansas and US: 2002 ‐ 2010

85%90%

78%

85%84%83%

82%81%82%80%79%80%

85%

se

70%70%69%68%

74%75%

70%

75%ARUSSe

at B

elt U

s

64%63% 62%

60%

65%

US

Perc

ent

S

AR Primary StopSeat Belt Law

55%

60%

2002 2003 2004 2005 2006 2007 2008 2009 2010

0%

2002 2003 2004 2005 2006 2007 2008 2009 2010Note: Seat Belt Law effective July 2009. NHTSA 2009 Seat Belt Survey done in AR July – Sept 2009Source: National Highway Traffic Safety Administration (NHTSA)

Slide courtesy of Gordon Reeve, ADH Epidemiology

Center for Applied Research and Evaluation1 Children’s Way, Slot 512-26Little Rock, Arkansas 72202-3591 Phone: 501-364-3400

SIPP Program CoordinatorGary Ragen, BSE, MEP, EMT-APhone: 501-364-3434Email: [email protected]

Home Safety Project AnalystReid Parnell, BAPhone: 501-364-3442Email: [email protected]

Professional Education CoordinatorRavina Daphtary, MAPhone: 501-364-3431Email: [email protected]

Recreational Safety Project AnalystLacye Vance, BS, ATCPhone: 501-364-3395Email: [email protected] I

Motor Vehicle Safety Project AnalystAmy Witherow, MPH, CHESPhone: 501-364-3443Email: [email protected]

Intentional Injury Project AnalystNichetra Magee, BAPhone: 501-364-3436Email: [email protected]

arkansas trauma system injury prevention update mary aitken md

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