PUBLIC HEALTH/ CH.3

Role of Public Health

"The practice of preventing disease and promoting good health within groups of people" -Public health officials examine the overall needs of the population at large to see the best use of health resources to enhance the quality of life for the public. Example: -Immunization/ nutrition programs for kids -environmental heath monitoring/ regulation

Five steps to developing a prevention program

1. Conduct a community assessment. 2. What is already being accomplished 3. Bring people and groups together to assess: 4. Resources potentially available 5. Invite people who represent the community at large. 6. Include survivors and their families. 7. Potential partners include EMS groups, law enforcement, school groups, media, public health officials and health care providers, members of the business community, religious organizations, civic groups, service clubs, sports-related organizations, nonprofit groups, celebrities, community leaders, elected officials, and research groups.

Intentional injuries

Any injury or death that is self-inflicted or perpetrated by another person, usually in the context of violence • Assault, self-harm behavior, intentional overdose, and suicide

The value of passive interventions

Passive interventions are often the most successful aka automatic protection o Examples: Sprinkler systems in commercial buildings, airbags in cars • Provide constant protection without conscious action from user • A combination of approaches is still the most effective strategy. • Education is always an important component.

The American Public Health Association

(APHA) defines public health as "the practice of preventing disease and promoting good health within groups of people." • Public health professionals examine the overall needs of the population at large to determine the best use of health resources to enhance the quality of life for the public in general. o Examples: ▪ Efforts to prevent and control communicable disease ▪ Immunizations ▪ Nutrition programs ▪ Environmental health monitoring and regulation ▪ Community planning

To develop a successful prevention program, do the following as you build your team and create an implementation plan:

- Have a designated leader. • Build as broad a support base as possible. • Create a realistic timeline. • Choose SMART (simple, measurable, accurate, reportable, trackable) goals and objectives. • Build consensus in your community on the need for action. • Understand the religious, ethnic, cultural, and language challenges you may face. • Do not reinvent the wheel—seek others with experience. • Anticipate opposition and some losses. • When lobbying legislators, be brief. • Set up your program to measure results and make changes as needed. • Establish self-sustaining funding sources.

In EMS The Teachable Moment

Articulate and reinforce safety messages when opportunities arise. • Near misses cause people to realize how vulnerable they are; the lesson is more likely to stick. This is a teachable moment. • Use good judgment and be sensitive to the situation. • Factors of a teachable moment: • Injuries or illnesses are such that the patient or family will be receptive. • Ethnic and religious differences must temper the message. • The scene is conducive to delivering the messaging in a nonthreatening, nonjudgmental way. • You are not intruding inappropriately or causing embarrassment. • There is a definitive preventative measure that could have helped. • Vague advice will not be useful. • Sometimes a teachable moment can be preemptive. o Example: You are providing a wellness check in the home of an older patient when you notice a potential tripping hazard in the living room. Taking the time to inform the patient of the danger and then giving advice as to how this threat can be averted may very well save the patient from a fall and injury in the future.

Engineering/environment Passive interventions

Changing the design of products or spaces to offer automatic protection • Often without conscious behavior change o Example: Child-resistant medication bottles • Approaches can be social, legal, political, or cultural • Modifications usually happen once awareness is raised.

The 4 Es of prevention Education

Citizens do not always know that certain behaviors put them at risk. o Examples: Putting baby seat in front passenger seat • You can inform people about potential dangers and persuade them to change their behavior. • To be effective, messages should be: • Tailored to specific groups • Reinforced with meaningful rewards • Effective techniques include: o Contracts or participant commitment o Incentives o Behavioral feedback o Modeling

Funding a Prevention Program

Consider innovative ways to fund programs. • Partnering with the local media to create prevention messages • Seeking grants from regional, state, or national organizations • Seeking scholarships from local nonprofit service organizations or commercial firms • Networking with other organizations often provides greater leverage when seeking grants or sponsorships.

Matrix uses nine components to analyze the injury.

Encourages creative thinking in understanding causes of and potential interventions for injury Most EMS providers are trained to respond in the post-event phase, after an injury or illness has taken place. • This is reactive, not preventive. • May be the optimal time to reflect on the event and apply your firsthand knowledge • Why did this happen? • How might this be prevented in the future? Paramedics are uniquely qualified to speak to the problem and compel others to examine the problem more closely and ultimately to pursue and implement strategies solutions in the pre- event phase.

Risk factors for children

Injury patterns vary widely depending upon a child's age, gender, socioeconomic status, developmental stage, family environment, and a whole host of other factors. • Most injuries received at school occur during sports activities, industrial arts classes, and playground activities. • Each year, about 200,000 children 14 years of age and younger receive injuries • while playing on playgrounds. • More than 2.6 million children and teenagers are evaluated in the ED each year for sports-related injuries.

Plan and test interventions- community assessment

Interventions: Actions you take to accomplish your goals and objectives • Using the 4 Es of prevention and the Haddon matrix, brainstorm options. • Consider your available resources. • Review what others have already done. • Be aware of timing and cultural considerations. • Get a sample group together to test before rolling out the entire program

Unintentional injuries

Occur without intent to cause harm (accidents) • Account for the vast majority of all injuries • Risk: A potentially hazardous situation in which the well-being of people can be harmed • Risk factors: Characteristics that increase the likelihood that a person will suffer a particular disease or injury • Injury is the third leading cause of death for all age groups. • In the United States, injury is the leading cause of death in children ages 19 and younger. • Compared to adults, children have thinner skin, a smaller airway, a larger head in proportion to their bodies, and lesser ability to protect themselves from harm.

The Consensus Statement on the EMS Role in Primary Injury Prevention was published in 1996. Primary injury prevention should be an "essential" activity.

Primary prevention: Actions that stop injuries or illness before they begin Secondary prevention: Measures taken after a patient has an injury or illness to prevent the problem from becoming worse • Traditional focus of EMS • EMS culture has changed in recent years, and providers are now more involved in primary prevention efforts.

EMS providers have emerged as strong advocates—and practitioners—of injury and illness prevention .1

Strategies that promote interventions might include: • Fundraisers to purchase and distribute free bicycle helmets to children • Car seat checks and installations • Appearing at health fairs • Giving speeches to community groups and schoolchildren • Blood pressure checks • Fall prevention services for older adults • Swimming safety education

Why EMS Should Be Involved

The Consensus Statement on the EMS Role in Primary Injury Prevention was published in 1996. • Primary injury prevention should be an "essential" activity. • Primary prevention: Actions that stop injuries or illness before they begin • Secondary prevention: Measures taken after a patient has an injury or illness to prevent the problem from becoming worse • Traditional focus of EMS • EMS culture has changed in recent years, and providers are now more involved in primary prevention efforts.

Getting Started in Your Community

The most effective prevention programs focus on problems that impair the health and well-being of the greatest number of people. Recognizing injury and illness patterns in your community

Prevention programs for children

There are various government and private grants, commercial sponsors, and nonprofit groups that support: • Car seat inspections • Helmet donations • Fundraising events o Safe Kids Worldwide ▪ Nonprofit organization made up of more than 400 coalitions in the United States with partners in over 30 countries ▪ Goal is to reduce the prevalence of preventable childhood injuries. ▪ Website is filled with helpful information.

The Haddon matrix

William Haddon, Jr, MD, created a matrix that identified several principles of injury prevention. • Added factor of time to previous models to address causes of injury • Host, agent, and environment interact over time to cause injury and correspond to three phases of the event: o Pre-event o Event o Post-event

EMS must work closely with the local public health agency to develop a plan that:

• Addresses all logistical matters • Clearly defines each person's role and responsibilities • Identifies and resolves any issues pertaining to the need for additional training • Clearly explains the procedures for procuring the vaccine • Forestalls potential liability issues

Chronic illness

• Annually, 7 out of 10 Americans die from chronic diseases, with cancer, heart disease, and stroke causing more than 50% of the deaths. • In 2012 about half of all adults—117 million Americans—had at least one chronic illness. • In 2011 asthma was the primary diagnosis in 1,781,000 visits to the ED.

The Cost of Public Health Threats The costs of injury and illness are far-reaching. Years of potential life lost (YPLL)

• Assume a productive work life until age 65; deduct the year of death from that age. o Example: A 22-year-old who dies in bicycle crash loses 43 years of potential productive work life. Medical conditions such as heart disease and cancer typically result in a lower YPLL than trauma. • Even if the patient did not die but, remained in a comatose state for the rest of his life, he lost years in which he would be earning income, paying taxes, and making other contributions to society. • We all pay the price for this loss

The concept of community paramedicine gives providers many new and expanded avenues for preventing illnesses and injuries as part of their regular daily duties.

• Conducing home health visits and well-being checks • Providing wound care and other in-home therapies • Ensuring medication compliance • By offering these expanded services, EMS agencies could take a more proactive approach in decreasing the morbidity and subsequent mortality of their patients. • They can also play a significant role in unnecessary hospital readmission. • Opportunities for reimbursement could exist through creative contracting with hospitals, managed care agencies, or other third-party payers.

One of the most visible ways EMS professionals interact with public health agencies is through the provision of immunizations.

• EMS professionals are ideally suited to reach at-risk populations because: • Their inherent mobility allows them to reach widely dispersed populations. • There is a typically positive perception of EMS in small communities. • Many EMS providers have the requisite clinical training in: o Medication security o Aseptic technique o Medication administration • Post-injection care • Documentation of informed consent for treatment • How to discuss risks, benefits, and possible side effects with the patient

Economic incentives

• Economic self-interest provides monetary incentives to reinforce safe behavior. o Example: Insurance rate reduction for careful drivers • Organizations may also offer free or subsidized safety products to encourage use

Enforcement

• Even if some members of the community do not change their behavior, your educational effort may lead to legislative or environmental/technological changes. • Sometimes behavior change can be facilitated by changes in the law. • Legislation/regulation formulates rules that require people, manufacturers, and governments to comply with safety practices

Set goals and objectives- community assessment

• Goals: Make this a broad, general statement about the long-term changes. • Objectives: Make these specific, time-limited, and quantifiable. Two types: • Process objectives • Outcome (impact) objectives

EMS providers have emerged as strong advocates—and practitioners—of injury and illness prevention

• Have more opportunities for prevention education than other health care professionals • Are widely distributed in the population • May be the most medically sophisticated person in a rural community • Are considered advocates of the health care consumer, and work in concert with their patients and their patients' families • Are welcome in schools and other environments • Considered authorities on injury and prevention

Injury and illness surveillance

• In prevention, surveillance refers to ongoing, systematic collection, analysis, and interpretation of data for planning, implementation, and evaluation of public health practice. o Data are analyzed and interpreted by epidemiologists. o Information can be used to develop interventions intended to prevent further injury or illness. • Strong surveillance systems are fundamental to effective prevention programs. • Who is being injured, where, by what mechanism, and why?

Getting started in your community, To be effective, you need to understand

• Injury and illness patterns • Characteristics of the population and environment • The types of risks present Your regional or state EMS department or public health office would be an excellent place to start. • They will likely have the most data, statistics, and other resources with relevant information. • Many state organizations even make this information available on the Internet. EMS providers play important roles in prevention by carefully reporting data and noting risk factors while on scene. • Paramedic training prepares you to recognize and report the signs and risk factors associated with intentional violence. • Empowers you to be proactive in the fight against suicide, domestic violence, and child abuse

Define the problem- community assessment

• On the basis of community assessment and data you collected, define the problem in specific, quantifiable terms. o Examples: What are the most frequent causes of fatal and nonfatal childhood injuries? What are the most frequent diseases and chronic illnesses in the community?

Focus on children's issues can have other unintended benefits The "pass-along effect"

• Other members of a child's family benefit from the message originally intended solely for the welfare of the child. o Example: A third grader is educated on the importance of wearing a seat belt and later insists that Daddy buckle up too. • Experts in public health suggest focusing prevention efforts on injuries associated with a high rate of mortality, hospitalizations frequently accompanied by long-term disability, or those known to have highly effective countermeasures.

Implement and evaluate interventions- community assessment

• Results must be measurable. • A formal evaluation will tell you whether or not you met your goals and objectives. • You want to spend your time and resources on efforts that you can show make a difference. • Be aware that many interventions demand ongoing attention to remain effective.

Acute illness

• The United States declared a public health emergency in April 2009, when the H1N1 influenza was first detected. • The World Health Organization (WHO) declared a global pandemic in June 2009. • In September 2009, the Food and Drug Administration (FDA) approved four vaccines to prevent the disease. • The WHO declared an end to the emergency in August 2010.

Other public health threats

• Water supply or seafood contamination • Radiation leaks • Lack of sanitary conditions following a natural disaster • Increased incidence of cancer after major inciden