SCENARIO
Jose and Gwen are putting their rig back in service after a car crash that ended with three fatalities, including an infant and a child. “Jose, I just can’t stop thinking about how this would have had a very different ending if this woman had put her babies in infant and child seats. She might have survived herself if she had used her seat belt and shoulder harness.” “I’m with you, Gwen. Someone needs to do something about compliance with seat belt and child seat laws around here.” “Do you think it’s just ignorance of the dangers, or is it an economic issue, Jose?” “Well, I suppose buying the seats might be an economic issue, but the unrestrained driver made a conscious decision not to use seat belts. There must be a way to get the message out.” Is prevention a realistic approach in preventing injury and death in car crashes and other causes of traumatic injury? Is there evidence that compliance with seat belt and safety seats has an impact in preventing injury and death? What can we as providers do to prevent these types of deaths and injuries?
A major impetus in the development of modern emergency medical services (EMS) systems was the publication of the 1966 white paper by the National Academy of Sciences/ National Research Council (NAS/ NRC), Accidental Death and Disability: the Neglected Disease of Modern Society . The paper spotlighted shortcomings in injury management in the United States and helped launch a formal system of on-scene care and rapid transport for patients injured as a result of “accidents.” This educational initiative was instrumental in the creation of a more efficient system to deliver prehospital care to sick and injured patients. 1 Death and disability from injury in the United States have fallen since the publication of the white paper. 2 Despite this progress, however, injury remains a major public health problem. More than 179,000 Americans die from injuries annually, and millions more are adversely affected to some degree. 3 However, injury is a global problem as well. Over 5 million people worldwide died from injuries in 2002, accounting for 9% of deaths worldwide. Injuries remain a leading cause of death for all age groups. 4 For some age groups, particularly children, teenagers, and young adults, injury is the leading cause of death. The desire to care for patients stricken by injury draws many into the field of EMS. The Prehospital Trauma Life Support (PHTLS) course teaches prehospital providers to be efficient and effective in injury management. The need for well-trained prehospital providers to care for injured patients will always exist. However, the most efficient and effective method to combat injury is to prevent it from happening in the first place. Health care providers at all levels play an active role in injury prevention to achieve the best results for not only the community at large but for themselves as well. Even in 1966, the authors of the NAS /NRC white paper recognized the importance of injury prevention when they wrote: The long-term solution to the injury problem is prevention … Prevention of accidents involves training in the home, in the school, and at work, augmented by frequent pleas for safety in the news media; first aid courses and public meetings; and inspection and surveillance by regulatory agencies. 1 Prehospital personnel can easily play an active role in most, if not all, of the current recommendations for injury prevention. Prevention of some diseases, such as rabies, has been so effective that the occurrence of a single case makes front-page news. Public health officials recognize that prevention results in the greatest reward toward the amelioration of disease. Emergency medical technician (EMT ) curricula have long included formal instruction in scene safety and personal protective equipment as a means of self-injury prevention for the EMT. To spur EMS systems to take a more active role in community prevention strategies, the EMS Agenda for the Future, developed by and for the EMS community, lists prevention as one of 14 attributes to develop further in order to “improve community health and result in more appropriate use of acute health resources .” 5 To this end, the US Department of Transportation (DOT) paramedic curriculum and now the National EMS Core Content include community injury-prevention training. EMS systems are transforming themselves from a solely reactionary discipline to a broader, more effective discipline that includes more emphasis on prevention. This chapter introduces key concepts of injury prevention to the prehospital care provider.
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