Advanced Trauma Life Support ATLS Student Course Manual 2018

396
INJURY PREVENTION
Safety Administration adopted this design, which
resulted in a sustained reduction in the fatality rate
per vehicle mile driven over the past several decades.
The Four Es of
iNjury Prevention
Injury prevention can be directed at human factors
(behavioral issues), vectors of injury, and/or
environmental factors and implemented according
to the four Es of injury prevention
••
Education
••
Enforcement
••
Engineering
••
Economics (incentives)
Education is the cornerstone of injury prevention.
Educational efforts are relatively simple to implement;
they promote the development of constituencies
and help bring issues before the public. Without an
informed and activist public, subsequent legislative
efforts (enforcement) are likely to fail. Education
is based on the premise that knowledge supports a
change in behavior. Although attractive in theory,
education in injury prevention has been disappointing
in practice. Yet it provides the underpinning for
implementation of subsequent strategies, such
as that to reduce alcohol-related crash deaths.
Mothers Against Drunk Driving is an organization
that effectively uses a primary education strategy to
reduce alcohol-related crash deaths. Through their
efforts, an informed and aroused public facilitated the
enactment of stricter drunk-driving laws, resulting in
a decade of reduced alcohol-related vehicle fatalities.
For education to work, it must be directed at the
appropriate target group, it must be persistent, and
it must be linked to other approaches. More recent
examples are campaigns to prevent distracted driving
through legislation outlawing the use of smartphones
while driving.
Enforcement is a useful part of any effective injuryprevention
strategy because, regardless of the type of
trauma, some individuals always resist the changes
needed to improve outcome—even if the improved
outcome is their own. Where compliance with injury
prevention efforts is lacking, legislation that mandates
certain behavior or declares certain behaviors illegal
often results in marked differences. For example,
safety-belt and helmet laws resulted in measurable
increases in usage when educational programs alone
had minimal effect.
Engineering, often more expensive at first, clearly
has the greatest long-term benefits. Despite proven
effectiveness, engineering advances may require
concomitant legislative and enforcement initiatives,
enabling implementation on a larger scale. Adoption
of air bags is a recent example of using advances in
technology and combining them with features of
enforcement. Other advances in highway design and
safety have added tremendously to the margin of safety
while driving.
Economic incentives, when used for the correct
purposes, are quite effective. For example, the linking
of federal highway funds to the passage of motorcycle
helmet laws motivated the states to pass such laws
and enforce the wearing of helmets. This resulted
in a 30% reduction in fatalities from head injuries.
Although this economic incentive is no longer in effect,
and rates of deaths from head injuries have returned
to their previous levels in states that have reversed
their helmet statutes, the association between helmet
laws and reduced fatalities confirmed the utility of
economic incentives in injury prevention. Insurance
companies have clear data on risk-taking behavior
patterns, and the payments from insurance trusts;
discount premiums are available to those who avoid
risk-taking behavior.
Developing an Injury
pRevention ProgRAm—The
Public Health Approach
Developing an injury prevention program involves
five basic steps: Analyze the data, Build local coalitions,
Communicate the problem, Develop and
implement injury prevention activities, and Evaluate
the intervention.
Analyze the Data
The first step is a basic one: define the problem. This
may appear self-evident, but both the magnitude and
community impact of trauma can be elusive unless
reliable data are available. Population-based data on
injury incidence are essential to identify the problem
and form a baseline for determining the impact of
subsequent efforts at injury prevention. Information
from death certificates, hospital and/or emergency
department discharge statistics, and trauma registry
data and dashboards are, collectively, good places
to start.
After identifying a trauma problem, researchers must
define its causes and risk factors. The problem may need
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