Transcript Indian Health Service Aberdeen Area Division of Environmental Health Services

Indian Health Service
Aberdeen Area Division of
Environmental Health Services
Molly Patton, MPH REHS
Presentations from those of Myrna J. Buckles and John Weaver
Aberdeen Area IHS DEHS
Leadership Staff
• Director DEHS (vacant)
• Area Injury Prevention Specialist & Deputy
– John Weaver (Retired October 2008) & Kathey Wilson
• Institutional Environmental Health Officer
– Curt Smelley, MSEH, HEM, REHS,
• Three District Environmental Health Staff
– Chris Allen, MS, REHS, Sioux City
– Myrna Buckles, MSEH, REHS, Pierre
– Molly Patton, MPH, REHS, Minot
Field Staff
IHS
• Crow Creek
– Marcel Felicia, REHS
• Lake Traverse
– Vacant
• Lower Brule
– Terrold Menzie, REHS
• Pine Ridge
– Joe Amiotte, REHS
– Jennifer Franks
– Dawn Holguin
• Rosebud
– Charles Mack
• Turtle Mountain
– Jennifer Malaterre
• Yankton/Wagner
– Tim Balderrama
Field Staff
Tribal
• Cheyenne River
– Randolph Runs After,
REHS
• Omaha
– Carroll Webster, SR.
• Spirit Lake
– Chris Helgesen
• Standing Rock
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Bill Sherwood
Le Ray Skinner *
Jeannette Cluett
Mary Brunelle
• Three Affiliated
– Verlee White CalfeSayler
• Winnebago
– Mona Zuffante
Performance Improvement
Indicators – CY 2008
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Severe Injury Profile
High Priority Facility Surveys
Other Facility Surveys
Occupant Protection
Present Injury Data & Effective Strategies
Continuous Quality Improvement
Severe Injury Profile
• Three years of local data
• Provided to tribal & IHS leaders
• Develop an Area Severe Injury Profile
Priority Facility Surveys
• Custodial/Residential
Care
• Substance Abuse
Centers
• Jails
• Schools
• Head Starts
• Day Care Centers
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Senior Citizen Centers
Café/Restaurant
Gaming Facilities
Celebrations
Food Service
Operations
Facility Survey Data
IHS Direct Service Sites
1800
1600
1400
1200
1000
800
600
400
200
0
Surveys
Other
Jan 2003-Sept 2005
Oct 2005-June 2008
Facility Survey Data
Tribal Sites
500
450
400
350
300
250
200
150
100
50
0
Surveys
Other
Jan 1, 2003 Sept 30 2005
Oct 1, 2005 June 30, 2008
Occupant Protection
• Seat Belt Observation Surveys
• Plan to Implement a Proven Effective
Strategy – with community partners
• Implement Strategy
• Evaluate
Action Steps for Injury Intervention
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Presentation of data & interventions
Coalition formation
Selection of an effective strategy
Implementation of an effective strategy
Evaluation plan of implementation
Continuous Quality Improvement
• “Deep Look” type survey of a high-risk
facility
• Project to address critical items identified in
a high-risk facility
• Formalized technical assistance project
• Plan reviews and prevention activities
The Difference
Then & Now
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Focused DEHS Program
IHS & Tribal Staff Input
Improved EH Services to tribal members
Reduction to injury and/or illness exposure for
high risk individuals
• Increased local injury prevention activity
• Increased local injury data available
• Increased local injury knowledge & advocacy.
A Summary of Two Years of
Injury Data Gathered at Seven
Health Care Facilities
John Weaver
Aberdeen Area
Injury Prevention Specialist
Thoughts to Remember
• Trauma and death due to injuries are a major
health care problem in the Aberdeen Area
• There are evidence based interventions that can
reduce this problem
• Trauma has an impact on IHS direct care and
contract health care dollars
OEH&E has developed a Severe
Injury Surveillance System (SISS)
• It is a health care facility based data system
designed to collect and analyze injury data
• This active surveillance system is maintained
by the local service unit or tribal environmental
health staff
SISS Objectives
• Identify the leading causes of severe injury at the local
level
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Identify injury problem
Complete a Severe Injury Profile
Develop a special study
Involve tribal entities to choose interventions
• Generate awareness and provide information to
community, IHS, and Tribal Officials
• Combine data for an overview of Area injuries
Data Sources
• Emergency room logs
• Resource Patient management System (RPMS)
Visit General Query (VGEN)
• Patient charts
Data Sources
• Contract Health Service Records
– Minutes
– Logs
– Approvals
– Denials
• States vital records
• EMS reports
• Police reports
Severe Injury is Defined as an Injury
Resulting in
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Amputation
Loss of consciousness
Major fracture ( excludes fingers and toes)
Hospitalization for at least one day
Fatality
Severe Injuries are Separated into
Seven Main Categories by Cause
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Assaults
Drowning
Falls
Fire/Burns
Motor Vehicle Crashes
Other
Suicide/Self-inflicted
SISS Limitations
• Fatal cases
• Alcohol-related injuries
• Small number of cases
• Compare to national data
Injury Overview
Leading Causes of Injury Morbidity (N=3758) and Mortality (189) by
Disposition
Ambulatory Patients
2005-2006
Inpatients IHS/ Contract
2005-2006
Mortality
2005-2006
Cause
Number
Cause
Number
Cause
Number
Falls
1181
Falls
300
Motor
Vehicle
93
Assault
600
Motor Vehicle
295
Other
36
Other
386
Suicide
264
Suicide
29
Motor
Vehicle
254
Assault
256
Assault
15
Injury Overview
Number of severe injuries by gender, disposition of patient, intent, and alcohol use, 2005-2006 N = 3758
Gender
Frequency
Percentage
Male
2222
59.1
Female
1536
40.9
Outpatient
2449
65.2
Hospitalized
1273
33.9
36
.96
Unintentional
2598
69.1
Intentional
1160
30.9
Yes
1212
32.3
No
1312
34.9
Unknown
1234
32.8
Disposition of patient
Unknown
Intent
Alcohol related*1
*Alcohol-related
injuries were difficult to assess because data collectors reviewed a subjective assessment of
alcohol involvement by health personnel. In very few cases were BACs obtained. Also not all yes’s were
confirmed with BACs and not all no’s were tested in the patient population.
Injury Morbidity by Cause
Percent of Injuries by Cause 2005-2006
Other
14%
Fire/Burn
1%
Drowning
.03%
Motor Vehicle
15%
Assault
23%
Falls
40%
Suicide
8%
Motor Vehicle Crash Trauma
What Can Be Done ?
• Tribal policy and procedures can have a direct impact
on levels of safety belt use
• Tribal efforts can be most effective in establishing and
improving safety belt usage levels (NHTSA DOT HS809
921 Oct. 2005)
• Evidence-based research shows that passage of seatbelt use laws, coupled with education and enforcement
efforts, are effective tools to increase seat belt use
• Use of seatbelts can reduce the risk of death in a motor
vehicle crash by 45% to 60%, and can reduce moderate
to critical injury 50% to 65%
Motor Vehicle Crash Trauma
What Can Be Done?
• National Highway Traffic Safety Administration
(NHTSA) Survey of Native American Tribal
Reservations found
– Reservations with primary safety belt laws have
85% of the vehicle occupants belted
– Reservations with secondary safety belt laws
averaged 53% seat belt use
– Reservations with no safety belt laws of any kind
have a usage rate of 26%.
Aberdeen Area Seat Belt Survey
• A total of 20,927 seatbelt use observations were
conducted (n=15,196 drivers and n=5,731 passengers)
• The overall all passengers seatbelt use rate for
individual tribes ranged from 8% to 42%.
• Combining seat belt use data for the 10 reservations,
the overall seatbelt use rate was 21% for drivers, 16%
for passengers, and 20% for all vehicle occupants
Aberdeen Area Seat Belt Survey
• The seatbelt use rate for Americans Indians in the
Northern Plains is low
• 2007 observed seatbelt use rate in Aberdeen Area is
20%
• 2007 National use rate was 82%
• 2007 North Dakota use rate was 82%
• 2007 South Dakota use rate was 73%
Injury Mortality by Cause
Leading Cause of Injury Mortality by Cause 2005-2006
(Percent of Mortality)
Other
19
Assault
7.9
Suicide
15.3
Drowning
0.5
Fire/Burn
2.6
Motor Vehicle
49.2
Falls
5.3
Years of Potential Life Loss
YPLL Before Age 65, All Deaths, AI/AN, 2005 North Dakota
All Others 20.7%
All Injuries 46.5%
Diabetes 4%
CongAnom 4.5%
Cancer 5.1%
Perinatal 5.9%
Heart Disease 6.7%
Liver Disease 6.7%
Leading Cause of Death
Leading Causes of Death,
2005 North Dakota Native Americans,
Age 1-44 Years
All Other 13.8%
HIV 1.7%
Heart Disease 3.4%
Diabetes 5.2%
Liver Disease
10.3%
Injuries 65.5%
Conclusion
• Intentional & unintentional injury morbidity & mortality
are a major public health problem
• Injuries cause more that 46 % of the YPLL
• In the age group 1 to 44 injuries cause more then 46% of
the deaths
• 49% of all injury deaths are cause by motor vehicle
crashes
• Seat belt usage rate in our population is 20%
Conclusion
• Alcohol involvement is difficult to assess
because limited data
• We have the same injury causes as that of
the United States & there are evidence –
based interventions that we can use
• IHS has a network of injury prevention
specialist, evidence-based interventions,
support from our agency – we should act
now
*Questions*
Molly Patton
Minot District office
100 1st Street Fed Bldg 302
Minot ND 57803
(701) 852-0250
[email protected]