Chapter 3 Public Health National EMS Education Standard

Chapter 3 Public Health

National EMS Education Standard Competencies Public Health Applies fundamental knowledge of principles of public health and epidemiology including public health emergencies, health promotion, and illness and injury prevention.

Introduction • EMS providers have an important role to play in injury and illness prevention. – Injury and illness prevention are an important part of public health.

Role of Public Health • Public health • Practice of preventing disease and promoting good health within groups of people • Health and wellness have become a focus of the US health care system.

Injuries as Public Health Threats • Intentional or unintentional damage to the person resulting from exposure to energy or absence of essentials • Injuries historically reported under distinct umbrellas © Ryan Mc. Vay/Photodisc/Getty Images © Carolyn Brule/Shutter. Stock, Inc. • Injuries

Injuries as Public Health Threats • May be intentional or unintentional – EMS usually has a greater impact on preventing unintentional injuries.

Injuries as Public Health Threats • Many health experts consider injury the largest problem facing the US today. • It is important to understand how injury affects different age groups.

Injuries as Public Health Threats • Years of potential life lost – Assume a productive work life until age 65. – Deduct the year of death from that age. • It is easier to measure death rates than morbidity rates.

Illness and Disease as Public Health Threats • Each year, 7 out of 10 Americans die from a chronic disease. • Causes include: – Poor nutrition – Excessive alcohol intake – Tobacco use – Sedentary lifestyle

Illness and Disease as Public Health Threats • Health threats include: – – Asthma Influenza Water supply or seafood contamination Lack of sanitary conditions following a natural disaster

Public Health Efforts • The APHA recommends three reforms: – Policies/funding – Strengthen public health system – All-access system © Capifrutta/Shutter. Stock, Inc. • Public health efforts can impact many levels of society.

Public Health Efforts • Preventing adverse outcomes is a major goal of public health programs. – Education campaigns have promoted: • Disease screening • Injury prevention • Prenatal care

Public Health Laws, Regulations, and Guidelines • Public health laws or regulations include: – HIPAA – State laws – WHO Framework Convention on Tobacco Control – FDA regulations

EMS Interface With Public Health • Joint agreement on medical and public health response to terrorism: – APHA – NAEMSP – National Association of State EMS Directors

EMS Interface With Public Health • September: National Preparedness Month – Get Ready Day • H 1 N 1 safety • Floods • Heat waves • Power outages • Winter storms • Earthquakes Courtesy of the American Public Heath Assocation. Photographed by David Fouse.

Injury and Illness Prevention and EMS • EMS providers can lead or support interventions. – EMS is an advocate and practitioner. © Dewitt/Shutter. Stock, Inc. • Illness and injury prevention have similar techniques.

Common Roots • “Accidental Death and Disability: The Neglected Disease in Modern Society” • There is a role for every provider. • Injury prevention always included EMS. – Primary – Secondary © Steven Townsend/Code 3 Images

Why EMS Should Be Involved • There a number of reasons EMS is especially suited to be involved. Providers: – – Reflect community composition Are medically sophisticated Are high-profile role models Have access to community

Principles of Injury and Illness Prevention • Risk – A potentially hazardous situation in which the well-being of people can be harmed © Vladimir Korostyshevskiy/Shutter. Sto ck, Inc Courtesy of Henry Pollak • Four E s of Prevention Courtesy of Captain David Jackson, Saginaw Township Fire Department

The 4 Es of Prevention • Education – Inform people about potential dangers, persuade them to change behaviors – Effective messages are: • Tailored to specific groups • Reinforced with meaningful rewards • Enforcement – Legislation and regulation • Formulates rules that require people, manufacturers, and governments to comply with safety practices – Litigation can also lead to enforcement.

The 4 Es of Prevention • Engineering/environment – Passive interventions – Can be social, legal, political, or cultural • Economic incentives – Economic self-interest provides monetary incentives to reinforce safe behavior.

The Value of Automatic Protections • Passive interventions are often the most successful. – Provide constant protection without conscious action from user • A combination of approaches is still the most effective strategy.

© Photos. com – Focuses on: host, agent, environment © Andreas Nilsson/Shutter Stock, Inc. • Visual models describe a health problem and how to approach it. © Cristina Fumi/Shutter. Stock, Inc. Models for Injury and Illness Prevention

The Haddon Matrix • Added factor of time to previous models to address causes of injury • The host, agent, and environment interact over time to cause injury and correspond to: – Pre-event – Event – Post-event

The Haddon Matrix • Matrix uses nine components to analyze the injury – Encourages creative thinking • Injury prevention requires broad and innovative thinking to be most successful.

Injury and Illness Surveillance • Data are collected, disseminated to people/ organizations that can effect change – Applied to interventions • Strong surveillance is fundamental to effective programs.

Getting Started in Your Community • To be effective, you need to understand: – Injury and illness patterns – Characteristics of the population, environment – The types of risks present • Your regional/state EMS department/public health office will have the most information.

Getting Started in Your Community • Intentional injuries – Assaults are more likely to be fatal in the US. – There are risk factors connected with intentional violence. – EMS providers: • Reporting data • Note risk factors © Mikael Karlsson/On Scene Photography

Getting Started in Your Community • Unintentional Injuries – “Accidents” • In Children: – 20 million annually – Children are: • At higher risk • More likely to be seriously affected – “Pass-along effect” © Super. Stock/age fotostock

Getting Started in Your Community • Risk factors for children – Lower socioeconomic status – Injuries are more likely to occur where there is: • • Water Heat Toxic agents High potential “energy”

Getting Started in Your Community • Risk factors for children (cont’d) – Unintentional injuries are greatest threat – School injuries are not uncommon. – 45% of cases are severe injuries. • Priority prevention efforts are injuries with highest: – Mortality rate – Hospitalization rate – Long-term disability rate – Effective countermeasures

Getting Started in Your Community • Illness Prevention – Illness prevention is gaining attention. – Example: poor health in adolescents • Tobacco/alcohol/oth er drugs • STDs/unplanned pregnancies • Unhealthy diet • Sedentary lifestyle • Community Organizing – Implementation plan, should include: • • Identify a leader. Build support base. Create a timeline. Gather data, facts. Choose goals. Establish funding. Be positive, persist.

– Conduct community assessment. • Bring people and groups together. • Represent the community at large. • Include survivors, their families. • Identify partners. © Mikael Karlsson/Alamy Images • Five steps of a prevention program © Steven Townsend/Code 3 Images Getting Started in Your Community

Getting Started in Your Community • Five steps of a prevention program (cont’d) – Define problem. • In specific, quantifiable terms – Set goals and objectives. • Goals: broad, general, long-term • Objectives: specific, time-limited, quantifiable – Process or outcome

Getting Started in Your Community • Five steps of a prevention program (cont’d) – Plan and test interventions. • Actions to accomplish your goals, objectives – Implement and evaluate interventions. • Must be able to measure results quantitatively

Getting Started in Your Community • Funding a prevention program – – Consider innovative ways to fund programs. Partner with the media. Look for grants and sponsorships. Network with other prevention programs.

How Every Provider Can Be Involved • Paramedics can, and should, be involved in prevention to some extent. – Be a role model. • Responding to the call – Very few calls require the use of lights and sirens. – Dispatchers can be a resource.

How Every Provider Can Be Involved • Education for EMS providers – Understand the fundamentals of prevention • “Teachable moment” © Craig Jackson/Inthe. Dark. Photography. com – Articulate and reinforce safety messages. – Use good judgment. – Be sensitive.

How Every Provider Can Be Involved • Collection/analysis of data and research – Vital for: • • Measuring trends Validating interventions Assessing resources Persuading others to act

How Every Provider Can Be Involved • Collection/analysis of data and research (cont’d) – Starts with prehospital care reports – Be a leader by: • Being a role model • Reaching out in your community

Summary • Public health encompasses health promotion and disease prevention for groups of people. • Federal, state, and international rules, regulations, guidelines, and laws govern public health. • Every September is National Preparedness Month.

Summary • Many paramedics have been motivated by their field experience to work actively on prevention. • The 1966 National Academy of Sciences/National Research Council study, “Accidental Death and Disability: The Neglected Disease of Modern Society, ” noted that EMS could help with trauma after an event, and injury prevention could help prevent an accident before it happens.

Summary • The 1996 Consensus Statement on the EMS Role in Primary Injury Prevention emphasized that primary injury prevention is an essential activity of EMS. • EMS can play a supporting role in preventing intentional injuries and can have an even larger impact in preventing unintentional injuries.

Summary • The years of potential life lost concept is another way to measure the cost of unintentional injury to society. • The 4 Es of prevention are education, enforcement, engineering/environment, and economic incentives. • Automatic protections do not require a conscious decision to act; an example is including air bags in automobiles

Summary • The Haddon matrix uses nine separate components to analyze injury. • Surveillance is the ongoing systematic collection, analysis, and interpretation of data essential to the planning, implementation, and evaluation of public health practice. • Paramedics need to triage their focus on prevention—do not let the headlines be your guide.

Summary • The five steps to developing a prevention program are: conduct a community assessment, define the problem, set goals and objectives, plan and test interventions, and implement and evaluate interventions. • Primary prevention begins at home by taking care of yourself and presenting a role model for others in your service and in the community.

Summary • The best teachable moments are those that convey positive reinforcement. • The importance of collecting data in measuring trends, validating interventions, assessing resources, and ultimately persuading others to act cannot be overestimated.

Credits • Chapter opener: © National Museum of Health and Medicine, Armed Forces Institute of Pathology, (NCP 1603) • Backgrounds: Green – Courtesy of Rhonda Beck; Blue – Courtesy of Rhonda Beck; Orange – © Keith Brofsky/Photodisc/Getty Images; Purple – Courtesy of Rhonda Beck. • Unless otherwise indicated, all photographs and illustrations are under copyright of Jones & Bartlett Learning, courtesy of Maryland Institute for Emergency Medical Services Systems, or have been provided by the American Academy of Orthopaedic Surgeons. •