Leverage front-line expertise to maximize trauma prevention efforts
Focus outreach on vulnerable populations, referring facilities, and EMS providers
There is nothing like working on the front lines in a busy emergency department to learn about the impact of traumatic injuries. Consider, for example, the experiences of Brent Parry, NREMTP. Serving as a paramedic for LifeFlight, and as a tech for the ED at Geisinger Wyoming Valley (GWV) Medical Center in Wilkes-Barre, PA, Parry is often among the first to see patients who have been seriously injured. Connecting such individuals to care quickly is a critical part of Parry's job, but now he is also being given an opportunity to intervene at an earlier stage, perhaps preventing some traumatic injuries from occurring in the first place.
In December 2011, the trauma prevention program at GWV tapped Parry to take on the additional assignment as trauma injury prevention outreach coordinator. In this position, Parry regularly reviews data from Geisinger's trauma registry to see where there are opportunities for community intervention. "I will look at the information to determine what types of injuries we are seeing and what the volume is, and that tells me where I need to go in terms of prevention education," explains Parry. (See also "Management Tip: Access valuable resources through networking," below.)
For example, in the past few months, Parry has been speaking at senior centers, health fairs, and other community settings about fall prevention. This activity was triggered by a consistently high rate of fall-related injuries among seniors older than the age of 65 in Geisinger's trauma registry. In fact, the trauma prevention program at GWV has been targeting the community with education on this issue for more than a year, and there is evidence that these efforts are making a dent.
"We monitor [our success] through the data that is extracted to our registry," explains Terry Heller-Wescott, RN, the trauma program manager at GWV. "We have seen close to a 10% decrease in fall [related injuries] in the past year. That is a positive outcome and that is what we want to see."
In addition to fall prevention, Parry is also actively engaged in initiatives aimed at curbing motor vehicle crashes, which have been occurring at a higher rate at both ends of the age spectrum: among the very young and the very mature driver populations. The two age groups require different types of prevention outreach — so Parry is participating in a mature driver's task force while also visiting schools. (See also "Study: Preventive steps needed to curb stair-related injuries in young children," below.)
Reach out to referring facilities
The trauma prevention program has always been involved with community outreach, stresses Heller-Wescott, noting that as a trauma facility GWV is required to engage in prevention and outreach. However, she says that Parry is enabling the program to increase the magnitude of these efforts. "He also goes to other facilities that refer patients to GWV as a trauma center," she explains. "We are developing what we call the Rural Trauma Team Development Course for smaller, outlying facilities that are not able to care for injured patients."
The course, which covers the rapid assessment and transport of such patients, is primarily focused on making sure that ED personnel are equipped with the skills they need to connect these patients with appropriate care quickly. "Time is always of the essence in caring for all of these patients that get transferred to us," adds Heller-Wescott.
While Parry is new to the trauma prevention program, the idea of leveraging front-line expertise has long been a key preventive strategy. "We are involved on a daily and hourly basis sometimes," explains George Rittle, RN, CEN, the operations manager of the ED at GWV. And the ideas for improvement can flow in both directions. "Brent works in trauma as the outreach coordinator, but he also works in the ED as a tech, so he gets into the thick of things in the ED, and he is able to make recommendations and observations to us on how we can improve trauma care," adds Rittle.
For example, Rittle recalls that the trauma service was the first to notify him that there was a problem with the pediatric mobilization device that the ED was using. "Without someone informing me of that, the problem would not have been identified as something we needed to fix. And we fixed it immediately," he says.
Another issue that the trauma program identified was that the trauma flow sheets were not always being signed appropriately by the people responding, and sometimes there were delays in getting people to a resuscitation," says Rittle. "By just having anecdotes of these things, we were able to trouble-shoot and resolve these issues," he says.
Nurture relationship with EMS providers
Rittle emphasizes that the trauma program has been particularly successful at nurturing strong relationships with the EMS providers that serve the facility. "We have an EMS outreach coordinator whose job is primarily to communicate with EMS," he says. And one strategy that has strengthened these ties is the development of a monthly lecture series called "EMS Night Out," that focuses on education for the prehospital community and nursing staff.
"We have been having large turnouts at these lectures for the last six to eight months. We have anywhere between 50 to 75 attendees," says Heller-Wescott. The topics can vary, although the most popular sessions involve case reviews. "We will start with the prehospital phase and review the case from the time EMS had contact with the patient to time the patient is discharged."
The EMS providers are often eager to know what has happened with patients they have brought to the hospital for care, and they can also learn a lot by reviewing the cases, explains Rittle. "No department is a silo when it comes to a trauma patient," he says. "We could not have the success we have without our EMS partners.
Sources
- Terry Heller-Wescott, RN, Trauma Program Manager, Geisinger Wyoming Valley Medical Center, Wilkes-Barre, PA. Phone: 570-808-7300.
- Brent Parry, NREMTP, Trauma Injury Prevention Outreach Coordinator, Geisinger Wyoming Valley Medical Center, Wilkes-Barre, PA. Phone: 570-808-7300.
- George Rittle, RN, CEN, Operations Manager, Emergency Department, Geisinger Wyoming Valley Medical Center, Wilkes-Barre, PA. Phone: 570-808-7300.
Access valuable resources through networking Educational tools are available in abundance to trauma prevention programs that are willing to reach out and network with state and national organizations, explains Brent Parry, NREMTP, trauma injury prevention outreach coordinator, Geisinger Wyoming Valley Medical Center in Wilkes-Barre, PA. "There are a lot of good resources out there. It is just a matter of tapping into them," he says. Organizations that should be on your list of contacts include the American Trauma Society (www.amtrauma.org), Safe Kids (www.safekids.org), and your own state EMS authority, but there are many others, says Parry. |
Study: Preventive steps to curb stair-related injuries in young children Trauma prevention program administrators might want to brainstorm about how to best prevent stair-related injuries in young children in their communities. This is in light of new findings, suggesting that a young child is rushed to an emergency department in the United States as frequently as every six minutes with just this type of injury. In a study from the April 2012 issue of Pediatrics, investigators from the Center for Injury Research and Policy of the Research Institute at Nationwide Children's Hospital in Columbus, OH, report that from 1999 to 2008, more than 93,000 children younger than 5 years of age were treated in emergency departments in the United States.1 While the data show that the rate of stair-related injuries is trending downward, this type injury is still common among young children, according to the study's senior author, Gary Smith, MD, DrPH, director of the Center for Injury Research and Policy at Nationwide Children's Hospital, and a professor of pediatrics at Ohio State University College of Medicine in Columbus, OH. Smith advises that such injuries can be prevented through a combination of parent education, broader use of stair gates, and changes in building codes designed to make stairs safer. In the study, the researchers report that a majority of the injuries were the result of children falling down stairs without mention of another object or activity involved. However, one quarter of the injuries that occurred in children younger than the age of 1 year happened while the children were being carried down the stairs, and these children were three times more likely to be hospitalized than children with other types of stair-related injuries. Among all the stair-related injuries, soft-tissue injuries were the most common, followed by lacerations and puncture wounds. The injuries most commonly occurred in the head and neck regions, followed by injuries to the upper extremities. Reference
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There is nothing like working on the front lines in a busy emergency department to learn about the impact of traumatic injuries. Consider, for example, the experiences of Brent Parry, NREMTP. Serving as a paramedic for LifeFlight, and as a tech for the ED at Geisinger Wyoming Valley (GWV) Medical Center in Wilkes-Barre, PA, Parry is often among the first to see patients who have been seriously injured.
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