Chapter 3 Public health

Additional Advantages of EMS involvement in prevention education follow:

- EMS providers are widely distributed among the population -In a remote setting, EMS providers may be the most medically educated people available. May be only source of help, whether they are a 1 hour drive down the mountain to the nearest ED or 200 miles offshore on an oil platform -There are more than 826,111 credentialed EMS providers in the untied states at the EMT, advanced and paramedic levels. -EMS providers are considered advocates of the health care consumer. EMS providers work in concert with their patients and their patients families. - EMS providers are welcome in schools and other environments. -EMS providers are considered authorities on injury and prevention

Factors that constitute a teachable moment

- The injuries or illnesses are such that the parents, companions, or the patients themselves will be receptive to the message, you are aware of how ethnic and religious differences must temper the message. - The scene is conducive to delivering such a message in a nonthreatening, nonjudgmental way. you are not intruding inappropriately or causing embarrassment that could lead to the opposite reaction - There is a definitive prevention measure that could have helped. such as using a seat belt, getting a flu shot, installing a car seat correctly, stopping smoking, wearing a helmet, or keeping firearms locked and safe. Vague advice is less likely to have a lasting effect.

Chronic illnesses in the United States graph

-Diabetes is the leading cause of kidney failure, blindness, and amputations of the lower extremities in Americans 20 years of age or older. -Arthritis is the most common cause of disability, significantly impairing the lives of over 22 million americans. -1 in every 3 adults is obese - 1 in 5 children and young adults between the ages of 2 and 19 years is obese - one - third of people with chronic illness encounter basic or social problems that impair daily life.

Tips for promoting Safety and Health

-Teach children about safety measures, such as never inserting their fingers into a wall socket, avoiding the oven and stove and avoiding the pool when adults are not directly supervising. - Supervise children at all times -One they are old enough to understand, teachc children how to dial 911 , and teach them when it is appropriate to do so, -Program emergency phone numbers into your telephone, include numbers for the local police department, fire department, ems and poison control. If your phone is not programmable, post these phone numbers in a nearby visible location such as one on the refridgerator. - Ensure your home and its exterior are well lit and that surfaces are even. - Ensure all electrical cords are placed out of the flow of traffic. -avoid small rugs or runner that are not slip-resistant -install and maintain smoke alarms -if your home uses gas heat, install and maintain carbon monoxide detectors - use safety latches to prevent children opening drawers or cabinets that contain potentially dangerous substances, such as medicines or cleaning products -Install safety gates around stair and swimming pools -keep your hot water heater adjusted to less than 120 to prevent burns - teach hands-only CPR to your family and friends.

top 10 causes of death in 2014

1. Heart disease 2. cancer 3. chronic, lower respiratory disease 4. unitnetional injuries 5. stroke (cerbrovascular diseases) 6. Alzheimer disease 7. Diabetes 8. Influenza and pneuomonia 9. Kidney disease (nephritis, nephrotic syndrome, and neprhosis) 10. intentional self-harm (ex, suicide)

Top 5 causes of death by unintentional Injury, 2016

1. poisoning 2. motor vehicle collision 3. Falls 4. Choking and suffocation 5. Drowning

Public health Laws, Regulations, and Guidelines to improve safety and prevention State of New york and regarding AEDS

2002 Law passed that required at least one AED in each school and that at least one staff member be trained in its use. saved at least 95 lives as of february 2017

Public health Laws, Regulations, and Guidelines to improve safety and prevention State of Connecticut regarding AEDS

2009 Law that made AEDS available in public schools, ensured that at least two staff members are trained to use them, prompted by the death of a 15 year old student who died after collapsing during a run at school. companion bill reduced liability issues for AED users.

Public health Laws, Regulations, and Guidelines to improve safety and prevention Smoking and tobacco laws (federal)

2009 the 2009 Family smoking prevention and tobacco control act, food and drug administration of cigarettes and smokeless tobacco products to youth in the united states.

Nephritis

A condition in which the tissues in the kidney become inflamed and have problems filtering waste from the blood. Nephritis may be caused by infection, inflammatory conditions (such as lupus), certain genetic conditions, and other diseases or conditions.

Haddon Matrix

A framework developed by William Haddon Jr MD, as a method to generate ideas about injury prevention that address the host, agent, and environment and their impact in the pre - event, event, and post-event phases of the injury process.

years of potential life lost

A way of measuring and comparing the overall impact of deaths resulting from different causes; calculated based on a fixed age minus the age at death.

The Haddon Matrix

William Haddon, Jr, MD, the Nationa Highway Traffic Safety Administrations first director, was given a mandate: To find ways to prevent people from being killed and injured on the nations highways. Created a matric that identified several principles of injury prevention. The Matrix proved so successful in helping researchers think about injuries, that it was named after him. Haddon added the factor of time to the previous models used to address the causes of injury. The Host, agent , and environment are seen as factors that interact over time to cause injury. These factors correspond to three phases of the event: pre-event, event, and post event. Uses nine separate components to analyze the injury. Encourages creative thinking in understanding the causes of and potential interventions for injury. The post event phase is considered reactive not preventive. Prevention is always better than crisis management

Contraceptives

a device or drug serving to prevent pregnancy

risk

a potentially hazardous situation that puts people in a position in which they could be harmed.

Malignant neoplasms

are cancerous tumors. They develop when cells grow and divide more than they should. Malignant neoplasms can spread to nearby tissues and to distant parts of your body. Treatment options may include surgery, chemotherapy or radiation therapy. Early detection is key, so be sure to attend all recommended cancer screenings.

Public health Laws, Regulations, and Guidelines to improve safety and prevention Bicycle Helmets

as of July 2012 No federal law 22 states, the district of columbia, and over 200 municipalities and counties had child helemt laws. Most of these laws only cover bicyclists less than 18 years of age. 13 states had no state or local bicycle helmet laws.

evaluation

collection of the methods, skills, and activities necessary to determine whether a service or program is needed, likely to be said, conducted as planned, and actually helps people

H1N1 flu

commonly known as swine flu, is primarily caused by the H1N1 strain of the flu (influenza) virus. H1N1 is a type of influenza A virus, and H1N1 is one of several flu virus strains that can cause the seasonal flu. Symptoms of the H1N1 flu are the same as those of the seasonal flu.

mortality

deaths caused by the injury and disease, usually expressed at a rate, meaning the number of deaths in a certain population in a given time period divided by the size of the population

The leading cause of kidney failure in americans 20 years of age and older is

diabetes. drug abuse. hypertension. heart disease.

When organizing community illness or injury program, you should first

gather data regarding the most prevalent injuries. build as broad a base of support as possible. Correct Answer identify a lead person to coordinate the effort. choose a goal that is broad and in depth.

Community paramedic and mobile integrated health care

gives privders many new and expanded avenues for preventing illnesses and injuries as part of their regular daily duties. Conducting home health visits and well-being checks, providing wound care and other in-home therapies, ensuring medication complience. May eventually be recognized as a cost effective supplement or alternative to ED visits and hospital admissions. Providers could also play a significant role in reducing unneccessary hospital readmission, wherein patients who were recently discharged from the hospital return only days later for conditions that could have been managed or prevented at home.

Funding a prevention program

highly motivated people have found a number of innovative ways to secure the resources they need, following -Partnering with the local media to create prevention messages, especially related to seasonal injuries or hazards -Seeking grants from regional, state or national resources such as the EMSC program (contacting your state EMS office about grant programs is a good place to start -Seeking a sponsorship from local nonprofit service organizations or commercial firms.

One of the MOST visible ways in which EMS professionals have interacted with public health agencies is through:

home and workplace safety inspections. You Answered community-wide CPR training. coordinating Stop the Bleed campaigns. Correct Answer the provision of immunizations.

In the next 18 months, 500 older adult community members will be offered the flu vaccine. This is an example of a/an

impact objective. You Answered outcome objective. passive intervention. Correct Answer process objective.

With regard to injury prevention, effective educational techniques include all of the following, EXCEPT:

incentives. Correct Answer penalties. modeling. behavioral feedback. Educational techniques that seem to be particularly promising include the use of contracts or participant commitment, incentives, behavioral feedback, and modeling.

nephrotic syndrome

is a kidney disorder that causes your body to pass too much protein in your urine. Nephrotic syndrome is usually caused by damage to the clusters of small blood vessels in your kidneys that filter waste and excess water from your blood.

nephrosis

kidney disease, especially when characterized by edema and the loss of protein from the plasma into the urine due to increased glomerular permeability. Also called nephrotic syndrome.

sydrnomic surveillance

monitoring and comparing the current number and nature of medical cases against the expected volume of these cases at a given time and place in the community

morbidity

number of nonfatally injured or disabled people, usually expressed as a rate, meaning the number of nonfatal injuries in a certain population in a given time period divided by the size of the population

surveillance

ongoing and systematic collection, analysis and interpretation of injury data essential to the planning, implementation, and evaluation of public health practice.

The statement, "The bicycle safety program will increase the rate of helmet use by children younger than 18 years of age from 30% to 50% within the next 18 months," is an example of a(n):

proactive intervention. short-term objective. Correct! outcome objective. process objective.

Nova scotia paramedic care

providing non transport preventive and primary care services as part of a paramedic-based integrated care model on two remote islands in the province, hospitalizations of residents of the islands were reduced 23% over a 3 year study period.

epidemiologist

public health professional who investigates patterns and causes of disease and injury in a given population, and seeks to reduce the risk, occurence, and negative impacts or these threats through research, public education, and legislative change.

epidemiology

the study of the causes, patterns, prevalence, and control of disease in groups of people.

The pennsylvania MEDICVAX project

EMS must work closely with a local public health agency to develop a plan that addresses all logistical matters, clearly defines each persons role and responsibilities, identifies and resolves any issues pertaining to the need for additional training, clearly explains the procedures for procuring the vaccines, and forestalls potential liability issues. Most of the time, these challenges are nowhere near as complicated as they may sound. demonstrated the efficacy of EMS agencies in providing more than 2,000 adult influenza vaccinations. Most likely, nearly one-third of the clients would not have received vaccinations otherwise.

Which of the following is NOT a reason why EMS providers are in the ideal position to serve as advocates for injury prevention?

EMS providers are high-profile role models and are perceived as champions of their patients. In many remote communities, the EMT might be the most medically educated person. Correct Answer Most EMS systems require their personnel to participate actively in injury prevention programs. EMS providers are distributed widely in the population and are welcome in environments conducive to delivering prevention messages.

CHildhood Motor vehicle occupant injuries Using the Haddon matrix Host human

Pre event : -Wear seat belts and use care seats at all times -ensure the babysitter, day care, and extended family members use car seat. -drive defensively -reduce driving during high-risk times, such as rush hour, holiday weekends, or high-speed long-distance travel. Event: -Driver maintains control of vehicle -driver is belted. -child is restrained post-event : -Bystanders are trained in first repsonse -EMS personnel are expertly trained in treating pediatric injuries as well as car seat and seat belt extrications.

CHildhood Motor vehicle occupant injuries Using the Haddon matrix environment

Pre- event: -Enforce seat belt and car seat laws -Encourage safer roads with lower speeds, breakaway poles, and medians. -encourage low-cost care seat programs -Conduct media and education campaigns about seat belts, car sears, drunk driving, and enforcement. Event: -Breakaway signs and light poles are in place. -Guardrails and medians are in place. Post-event: -Roadside call boxes are in place -911 emergency medical dispatch systems are in place -adequate road shoulder for emergency use are in place -There is quality EMS response and transport -The patient is transported to a trauma center per protocol.

CHildhood Motor vehicle occupant injuries Using the Haddon matrix Agent (car seat/vehicle)

Pre-event -Maintain up-to-date recall information on car seats. -Manufacture easy to use car seats -provide 3-point seat belts in rear seating positions. -regulate good maintenance and safety features of vehicle. Event: -Seat belts and correctly used car seats restrain and protect -vehicle design provides crash protection Post-event : -Ambulances are outfitted with up-to-date supplies and equipment designed for children.

The cost of public health threats

Societal costs of injuries can be measured using the concept of years of potential life lost (YPLL) - This method assumes that, on average, most people live a productive life until the age of 65 years. formula (YPLL = 65 - age at death) The YPLL associated with injuries is far greater than the YPLL linked with cancer or heart disease. -Younger people typically participate in more risk-taking activites than do older generations and as a result are more susceptible to fatal injuries.

passive interventions

Something that offers automatic protection from injury or illness, often without requiring any conscious change of behavior by the person; child-resistant bottles and air bags are some examples.

process objectives

State how a program will be implemented, describing the service to be provided, the nature of the service, and to whom it will be directed. Examples: 1,000 child safety seats will be distributed to low-income families within the next 18 months, or 500 older adult community members will receive the flu vaccine.

outcome (impact) objectives

State the intended effect of the program on participants or on the community in such terms as the participants' increased knowledge, changed behaviors or attitudes, or decreased injury rates. Examples: The bicycle safety program will increase the rate of helmet use by children younger than 18 years from 30% to 50% within the next 18 months, or the flu vaccinations by 25% during the next year.

Factors that can influence injury patterns in a child include all of the following except

The gender of the child the childs age Correct: number of relatives Developmental stage

Teachable moment

The time immediately following an event, when the sense of distress and danger is still very real and everyone concerned is perhaps more receptive to instruction on how the event or illness could have been prevented.

Which of the following statements regarding unintentional injuries and death is correct?

Their incidence cannot be reduced. Unintentional falls are the leading cause of death. Few motor vehicle deaths are unintentional. Correct! They occur without the intent to cause harm.

public health

An industry whose mission is to prevent disease and promote good health within groups of people

risk factors

Characteristics of people, behaviors, or environments that increase the chances of disease or injury; some examples are alcohol use, poverty, smoking, or gender.

The five steps to developing a prevention program 3,4,5

3. Set goals and objectives -Goals : make this a broad, general statement about the long term changes the prevention initiatives are designed to make (for example, a goal can be to decrease preventable, injuries to children on the communitys roadways) Objectives: Make these specific, time-limited, and quantifiable. There are two types: process objectives (ex 1,000 child safety seats will be distributed to low-income families within the next 18 months, or 500 older adult community members will receive the flue vaccine) and outcome (impact) objectives (ex, the bicycle safety program will increase the rate of helmet use by children younger than 28 months, or the flu clinic will increase the number of flu vaccinations by 25% during the next year) 4. Plan and test interventions : Interventions are the actions you take to accomplish your goals and objectives. Using the 4 Es of prevention, brainstorm about options. Consider the resources you have available, and consider what other communities have done in similar situations. you may discover an intervention that proved successful for them, in which case you might be able to duplicate their actions. Experienced prevention specialists also suggest that you consider timing and cultural elements as you plan your intervention. Finally, getting a sample group together and testing the intervention before actually initiating the full program often helps to improve your chances of success. 5. Implement and evaluate interventions: To be credible, the results of your intervention must be measureable. A formal evaluation will definitively tell you whether you have met your goals and objectives. You want to spend your time and resources on efforts that you can show make a difference. For example, if your goal is to increase the usage of seat belts, you could establish a measurable objective such as "seat belt usage in the community will increase by 50%. Be aware that many, if not most, interventions demand ongoing attention to remain effective. ' Build up a long term maintenance plan into any intervention program, if you wish to see it keep its momentum

The five steps to developing a prevention program. 1 and 2

Advocated by the Emergency Medical Services for Children (EMSC) program emphasizes the need to carefully establish goals and objectives with measurable outcomes. 1. Conduct a community assessment: Establish what resources (expertise, time, money) are potentially available. family members who have had a loved one die from a disease can be powerful advocates. Potential partners include: -EMS groups -Law enforcement -School groups -The media (management, editorial board members, staff reporters) -Public health officials and health care providers (groups representing emergency physicians and nurses, pediatricians, managed care organizations, hospitals, clinics) -members of the business community -Religous organizations, civic groups, and service clubs (such as the kiwanis and the boy scouts and girl scouts) -Local chapter of nonprofit groups -local and national celebrities -research groups 2. Define the problems: On the basis of the community assessment and the data you have been able to gather, define the problem in specific, quantifiable terms. For example you should be able to answer the following questions for your community. - What are the most frequent causes of fatal and nonfatal childhood injuries. -what are the most frequent diseases and chronic illnesses in the community. -what population (by age,location, and other characterisitics) are at the highest risk of these injuries or illneses? when and where are they occurring. -What, if anything, is already being done to prevent these injuries or illnesses. is an effective intervention available? what resources do you have to develop, implement, and evaluate different interventions.

YPLL graph

All causes 11,468,507 100% unintentional injury 2,401,254 : 20.9 % Malignant neoplasms 1,737,694 15.2 % Heart disease 1,347,979 11.8 % Suicide : 869,164 7.6 % Perinatal period 759,988 6.6% Homicide 557,474 4.9% congenital abnormalities 423,092 3.7% Liver disease : 304,113 2.7 % Diabetes mellitus 248,247 2.2 % cerebrovascular 222,025 1.9% All others 2,597,477 22.6 %

chronic illness

Annually 7 out of 10 americans die from chronic diseases with cancer, heart disease, and stroke causing more than 50% of death. In 2012 one half of all adults 117 million americans had at least one chronic illness. One in 4 had two or more chronic diseases. In 2011 asthma a common chronic illness, was the primary diagnosis in 1,781,000 visits to the ED. Among these, 611,000 occurred in patients less than 15 years of age. another 772,000 cases occurred in patients between 15 and 64 years of age.

Public health Laws, Regulations, and Guidelines to improve safety and prevention Seat belts

As of november 2016 34 states and the District of columbia had laws allowing law enforcment to stop and cite violators independent of any other traffic violations. 15 states had laws that only permitted law enforcement to give citations to violators who had initially been stopped for some other violation New Hampshire had no seat belt law for adults.

Public health Laws, Regulations, and Guidelines to improve safety and prevention Smoking and tobacco laws (state and local)

As of october 2016 Highly variable from one state or municipality to another. Of all the states, along with the District of Columbia, Puerto rico and the Us virgin islands, 25 had comprehensive laws that require non-hospitality workplaces, bars, and restaurants to be 100% smoke -free. In 30 others, similar laws apply only to resturants and bars, but not workplaces. And 21 have laws that only regulate smoking in gambling establishments

Role of Public health

For decades, the health care are system in the united states concentrated on treating illnesses and injuries as apposed to preventing them. Due to skyrocketing health care costs, the incidence of chronic disease, and health care reform, there has been a shift in focus toward greater emphasis on prevention. 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. Examples include immunization and nutrition programs for children, environmental health monitoring, regulation, and remediation, community planning, and exploration of the social determinants of health.

intentional injuries

Injuries that are purposefully inflicted by a person on himself or herself or on another person; examples include suicide or attempted suicide, homicide, rape, assault, domestic abuse, elder abuse, and child abuse.

unintentional injuries

Injuries that occur without intent to harm (commonly called accidents); some examples are motor vehicle crashes, poisonings, drownings, falls, and most burns.

Acute illness

In april of 2009, the H1N1 influenza virus was first detected in a 10-year patient in caliornia. As an outbreak unfolded, the CDC declared a US public health emergency. Which eventually became a global pandemic as defined by the world health organization (WHO) in june of 2009. In september the food and drug administration approved four vaccines for children and adults to prevent the disease. The WHO declared an end to the emergency in august 2010

injury and illness surveillance

In prevention surveillance involves watching over society, and collecting and analyzing data. It is the ongoing, systematic collection, analysis, and interpretation of data essential to the planning, implementation, and evaluation of public health practice. Once the data have been carefully analyzed and interpreted by epidemiologists, scientists who study the causes, patterns, prevalence, and control of disease in groups of people - a field of study referred to as epidemiology - the information can be employed in the development of interventions intended to prevent further injury and illness. A strong surveillance system is fundamental to creating an effective prevention program. In the case of injury surveillance, you need to know who is being injured, where, by what mechanism - and if readily discernable - why.

interventions

In the context of prevention, specific measures or activities designed to meet a program objective; categories include education/behavior change, enforcement/legislation, engineering/technology, and economic incentives.

Why EMS should be Involved

In the historic National Academy of Sciences/ National Research Councils 1966 study, accidental Death and Disability: The neglected Disease of Modern Society : The commision noted that just as EMS could help with trauma after an event, injury prevention initiatives could help before an accident happened. 1996: Consensus statement on the EMS role i primary injury prevention Contended that working toward this level of prevention should be seen as an essential activity that must be undertaken by the leaders, decision-makers, and providers of every EMS system. EMS providers have more oppurtunities for prevention education than do other health care professionals.

Unintentional injuries in children

In the united states, injury is the leading cause of death in children ages 19. In 2009 children and teens accounted for an estimated 33.7 million annual average emergency Department visits, with almost 12 million of these involving injuries. 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. Most frequently 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 sustain injuries while playing on playgrounds, with more than 20,000 of these children suffering traumatic brain injuries. The CDC also reports that more than 2.6 million children and teenagers are evaluated in the ED each year for sports related injuries.

The 4 Es of prevention

Interventions- specific actions intended to improve health and safety outcomes - need to combine education with three other types of interventions: enforcement, engineering/environment, and economic incentives. These are commonly referred to as the 4 es of prevention. The most effective prevention efforts reflect a combination of these interventions. Education: through education you can often inform people about potential dangers and then act to persuade them to change risky behavior. To be effective, messages need to be tailored to very specific groups and reinforced with meaningful rewards. Enforcement: Sometimes behavior change can be facilitated by chnages in the law. Legislation/regulation formulates rules that require people, manufacturers, and governments to comply with certain safety practices. Elected government bodies legislate, or enact laws, that require safe practices. Bureaucracies or agencies that set policies and establish procedures create regulations that control the manufacture, sale, and/or use of products. Economic incentives: Organizations often recognize the value of offering free or subsized safety products (bike helmets, fire extinguishers, safety locks, smoking cessation kits, contraceptives) which may lead to a reduction in certain threats to public health. Engineering/Environment: Making environmental chnages or changing the way certain products are designed (ex adding a new safety feature to vehicles) can offer automatic protection from

primary prevention

Keeping an injury or illness from occurring

How EMS can get involved

Motivate by their field experiences. ems providers have emerged as strong advocates and practioners of injury and illness prevention. EXAMPLE: in 2016 paramedic Lisa cassidy of the st charles county ambulance district in missouri lead the charge in an awarness campaign called stop heroin. Cassidy and over 200 of her colleagues began every shift by donning "stop Heroin" uniforms. 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, or swimming safety education. one of the most visible ways in which EMS professionals have interacted with public health agencies is through the provision of immunizations.

Public health Laws, Regulations, and Guidelines to improve safety and prevention Motorcycle helmets As of june 2015

Motorcycle helmets As of june 2015 -No federal law -state laws vary widely 19 states, the district of columbia, puerto rico, and the US virgin and Northern Mariana islands had laws requiring all riders to wear a helmet Most other states and territories required some riders to wear a helmet 3 states (illinois, Iowa, and Newhampshire) did not have a motorcycle helmet law.

secondary prevention

Reducing the effects of an injury or illness that has already happened.

Prevention programs for children

Safe Kids worldwide: a nonprofit organization made up of more than 400 coalitions in the united states and partners in over 30 countries. There goal is to reduce the prevalence of preventable childhood injuries . SOmetimes our focus on childrens issues can have other unintended benefits, The pass-along effect: wherein other members of a childs family benefit from the message originally intended solely for the welfare of the child. EXAMPLE: a third grader is educated on the importance of whereing a seatbelt and later insists daddy buckle up. Give priority to injuries that are common, severe, and readily preventable.

Getting started in your community

The most effective prevention programs elect to focus on problems that impair the health and well-being of the greatest number of people, thereby potentially helping the greatest number of people.

community organizing

Those in EMS who have created successful prevention programs give the following advice as you build your team and create an implementation plan - Identify a lead person to coordinate the effort, -build as broad a base of support as possible - create a realistic time line for nay project keeping mind that most must be ongoing to be effective - Gather data and facts that pinpoint who is being injured where, with what, and how frequently, or data on what types of diseases are most common in your community - CHose goals and objectives that are SMART - Simple, Measurable, Accurate, reportable, and Trackable, build consensus in the community on the need for action -Ensure you understand the religious, ethnic, cultural, and laguage challanges that you may face in implementing an intervention -Do not reinvent the wheel - seek out others who have had success with similar interventions or who have expertise in public health - Anticipate opposition and expect some losses, turf battles are common but not inevitable - as you lobby to legislators, be brief in phone calls, visits, and testimony - set up your program so that you can measure results and make changes as needed. -Establish self-sustaining funding sources -Keep a sense of humor and persist- change does not happen overnight

Passive interventions

Those preventive measures that do not require conscious effort on the part of a potential victim - are often the most successful. Referred to as automatic protection. Include: sprinkler systems, airbags, softer, yielding surfaces on playgrounds. Can provide 24 hour protection without doing anything The most effective strategies include a combination of education, enforcement, engineering/environmental modifications, and /or economic incentive programs