Transcript Document

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 McVay/Photodisc/Getty Images
© Carolyn Brule/ShutterStock, 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/ShutterStock, 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
• H1N1 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/ShutterStock, 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 are 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/ShutterSto
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/ShutterStock, 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”
© SuperStock/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
• Community
Organizing
– Implementation plan,
should include:
• Identify a leader.
• Tobacco/alcohol/oth
er drugs
• Build support base.
• STDs/unplanned
pregnancies
• Gather data, facts.
• Unhealthy diet
• Sedentary lifestyle
• Create a timeline.
• 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/IntheDarkPhotography.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,
(NCP1603)
• 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.
•