Advanced Trauma Life Support ATLS Student Course Manual 2018

397
INJURY PREVENTION
to be studied to determine what kinds of injuries are
involved and where, when, and why they occur. Injuryprevention
strategies may begin to emerge with this
additional information. Some trauma problems vary
from community to community; however, certain risk
factors are likely to remain constant across situations
and socioeconomic boundaries. Abuse of alcohol and
other drugs is an example of a contributing factor
that is likely to be pervasive regardless of whether the
trauma is blunt or penetrating, whether the location is
the inner city or the suburbs, and whether fatality or
disability occurs. Data are most meaningful when the
injury problem is compared between populations with
and without defined risk factors. In many instances,
the injured people may have multiple risk factors, and
clearly defined populations may be difficult to sort
out. In such cases, it is necessary to control for the
confounding variables.
Build Local Coalitions
Strong community coalitions are required to change the
perception of a problem and to design strategies that
are likely to succeed in an individual community. What
works in one community may not work in another, and
the most effective strategy will fail if the community
targeted for intervention does not perceive the problem
as important.
Communicate the Problem
Although sentinel events in a community may
identify an individual trauma problem and raise
public concern, high-profile problems do not lend
themselves to effective injury prevention unless they
are part of a larger documented injury-control issue/
injury-prevention strategy. Local coalitions are an
essential part of any communication strategy—not only
in getting the word out, but in designing the message
that is most likely to be effective. Members of the media
are also key partners in any communication plan.
Develop and Implement Prevention
Activities
The next step is to develop and test interventions. This is
the time to review best practices, and if there are none,
it may be appropriate to develop pilot programs to test
intervention effectiveness. Rarely is an intervention
tested without some indication that it will work. It
is important to consider the views and values of the
community if an injury prevention program is to be
accepted. End points must be defined up front, and
outcomes reviewed without bias. Sometimes it is not
possible to determine the effectiveness of a test program,
especially if it is a small-scale trial intervention. For
example, a public information program on safety-belt
use conducted at a school can be assessed by monitoring
the incoming and outgoing school traffic and showing
a difference, even when safety-belt usage rates in the
community as a whole may not change. Nonetheless,
the implication is clear—broad implementation of
public education regarding safety-belt use can have a
beneficial effect in a controlled community population.
Telephone surveys are not reliable measures to confirm
behavioral change, but they can confirm that the
intervention reached the target group.
With confirmation that a given intervention can effect
favorable change, the next step is to implement injuryprevention
strategies. From this point, the possibilities
are vast.
Evaluate the Impact of an
Intervention
With implementation comes the need to monitor the
impact of the program or evaluation. An effective
injury-prevention program linked with an objective
means to define its effectiveness can be a powerful
message to the public, the press, and legislators. It
ultimately may bring about a change in injury rates
or a permanent change in behavior.
Injury prevention seems like an immense task, and
in many ways it is. Yet, it is important to remember
that a pediatrician in Tennessee was able to validate
the need for infant safety seats, and that work led to
the first law requiring use of infant safety seats. A New
York orthopedic surgeon gave testimony that played
an important role in achieving the first safety-belt
law in the United States. Although not all healthcare
providers are destined to make as significant an impact,
they can influence their patients’ behaviors. Injuryprevention
measures do not have to be implemented
on a grand scale to make a difference. Individual
healthcare providers may not be able to statistically
prove a difference in their own patient population, but if
all doctors and other healthcare providers make injury
prevention a part of their practice, the results will be
significant. As preparations for hospital or emergency
department discharge are being made, consideration
should be given to patient education and community
partner referral to prevent injury recurrence. Whether
it is alcohol abuse, returning to an unchanged hostile
home environment, riding a motorcycle without
wearing head protection, or smoking while refueling
the car, there are many opportunities for healthcare
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