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EMSC Webcast: On the Road to Injury Prevention

EMSC Webcast: On the Road to Injury Prevention. Mary Aitken, MD, MPH Brendan Campbell, MD, MPH May 24, 2012. Faculty Disclosure Statement.

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EMSC Webcast: On the Road to Injury Prevention

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  1. EMSC Webcast:On the Road to Injury Prevention Mary Aitken, MD, MPH Brendan Campbell, MD, MPH May 24, 2012

  2. Faculty Disclosure Statement As a provider accredited by ACCME, ANCC, and ACPE, the IHS Clinical Support Center must ensure balance, independence, objectivity, and scientific rigor in its educational activities. Course directors/coordinators, planning committee members, faculty, and all others who are in a position to control the content of this educational activity are required to disclose all relevant financial relationships with any commercial interest related to the subject matter of the educational activity. Safeguards against commercial bias have been put in place. Faculty will also disclose any off-label and/or investigational use of pharmaceuticals or instruments discussed in their presentation. Disclosure of this information will be included in course materials so those participating in the activity may formulate their own judgments regarding the presentations. The course directors/coordinators, planning committee members, and faculty for this activity have completed the disclosure process and have indicated that they do not have any significant financial relationships or affiliations with any manufacturers or commercial products to disclose.

  3. Accreditation The Indian Health Service (IHS) Clinical Support Center is accredited by the Accreditation Council for Continuing Medical Education to sponsor continuing medical education for physicians. The IHS Clinical Support Center designates this educational activity for a maximum of 1½ AMA PRA Category 1 Credit(s)™.  Physicians should claim only the credit commensurate with the extent of their participation in the activity. The Indian Health Service Clinical Support Center is accredited as a provider of continuing nursing education by the American Nurses Credentialing Center’s Commission on Accreditation. This activity is designated 1.50 contact hours for nurses.

  4. Accreditation applies solely to this educational activity and does not imply approval or endorsement of any commercial product, services or processes by the CSC, IHS, the federal government, or the accrediting bodies. Disclaimer

  5. CE Evaluation and Certificate Continuing Education guidelines require that the attendance of all who participate be properly documented.   Those who participate and wish to receive continuing education need to be registered for the course, attend the activity in it’s entirety and complete the online evaluation by (June 1st, 2012). The online evaluation link will be provided at end of the educational activity by the presentation moderator. The online link will be available for one week to complete your evaluation. If you need assistance accessing the online evaluation link , please contact the EMSC National Resource Center at 301-244-6300. Your CE certificate will be mailed to the address provided on the online evaluation form.

  6. Off-road and At Risk: Children and ATVs Mary Aitken, MD, MPH May 24, 2012

  7. Objectives Review the epidemiology of ATV-related injury in children Update on research on ATV injury prevention Outline available resources and programs on ATV safety

  8. 4-Wheeler / Quad Characteristics Gasoline powered Knobby, low pressure tires High center of gravity Engine displacement 50 to over 900 cc Speeds > 80 MPH on some models Made for a single rider only – the driver

  9. All-Terrain Vehicles ATVs are increasingly popular The number of ATVs in use in the U.S. has nearly tripled from about 3.6 million in 1999 to 10.2 million in 2008 1.1 million new ATVs were sold in the U.S. in 2007 ATVs are becoming larger, heavier, and faster US Government Accountability Office, 2010

  10. Estimated Number of Emergency-Room Treated Injuries for All-terrain Vehicles, 1985-2010

  11. Reported ATV-related Deaths, 1990-2010

  12. Deaths and ED Visits, Percentage of Children <16 Years

  13. ATV related Deaths Risk Factors: Child • CPSC 2008 Pilot In-depth investigation of Youth fatalities. N=85 incidents; 93 fatalities • 55% 12-15 years; 39% 6-11 years of age • 76% male • 75% ATV operators • 34% Helmeted • Training: Unknown Source: CPSC Pilot study on ATV Youth Deaths, 2008

  14. ATV Related Youth DeathsRisk Factors: Equipment Source: CPSC Pilot study on ATV Youth Deaths, 2008 • 98% full size, adult models (>90cc ) • 90% >200cc engine displacement • 70% Utility models • 69% owned by family, friends (0 rented)

  15. ATV Youth DeathsRisk Factors: Event Source: CPSC Pilot study on ATV Youth Deaths, 2008 • 39% Multiple passengers; 85% < 16 years • 40% Collisions • 32% Overturning/Ejection on uneven grade • 13% Overturning/Ejection on level grade • 11% Failure to turn with subsequent collision or ejection

  16. What are “child-sized” ATVs? www.atv4kids.com

  17. A changing paradigm Under current CPSC plans, shift from ATV size recommendations for children based on engine size to those based on speed

  18. American Academy of PediatricsPolicy Statement, 2001 Pediatrics 2000;105;1352 • Children under 16 should not operate ATVs. • A drivers license should be required. • ATVs should be banned on paved roads. • A helmet should be required. • Passengers should be prohibited.

  19. Key Messages, Skimpy Evidence Base Use an age- appropriate ATV Wear a helmet Get training No passengers

  20. Human Vehicle Physical Environment Socio-economic Environment Pre-event Driver experience, size, maturity Vehicle size, HP, safety features, stability Weather, Site of use, obstacles Training, Legislation (helmets, etc) Event Helmet use, other protective gear Trauma systems Post-event Healthcare/EMS training Road/trail accessibility Trauma systems, Insurance, Health Care, Rehabilitation Haddon Matrix for ATV Injury Vehicle size, speed Trail design GPS or other signaling devices

  21. Major Areas of Research Activity • Policy • Policy effectiveness • Engineering • ATV size and stability • Helmet design • Epidemiology • Large database analyses • Coding and data quality • Trends for risk groups • Education • Community projects • Targeted interventions • Qualitative research • Media studies

  22. Multi-disciplinary Work Group Health: Physicians, Nurses, Community Outreach, Public Relations, Government Relations, Researchers, Public Health Community: Insurance Industry, CPSC, Game and Fish Commission, ATV Industry, Cooperative Extension/4H Activities: Planning, research, education, and advocacy Practical and evidence-based solutions sought

  23. What in ATV education works? 4H program developed in the 1980’s had promising evaluation—knowledge gains No known evaluation of consent-decree mandated training by SVIA to demonstrate its utility Doing education at all is controversial

  24. Awareness Building First step: Develop educational materials Focus group responses to story boards PSAs and print materials TRIPPS acronym Outreach to physicians

  25. Community Education Campaign Dean’s CUMG Fund, Graham, PI Non-randomized, controlled design Dissemination of materials in a rural setting County-level health coalition Surveys in secondary schools First draft of an implementation guide

  26. Challenges in Measurement:Observational Surveys West Virginia University Injury Control Research Center, Aitken PI Attempt at measuring safety behaviors Multiple mechanisms of observation tested Trained local observers w/ stipends Subject to observer bias - no interview - observation from a distance

  27. Targeted ATV Education Program EMSC Targeted Issues Grant # H34MC08514-01-00: Development and Evaluation of Targeted ATV Education Strategies for Rural Children, 9/1/07-8/31/11) • Aims: • To develop and evaluate educational materials for use in general community based ATV injury prevention • To develop and evaluate more targeted educational strategies for use in populations at high risk for ATV injury • To explore innovative message delivery strategies for ATV injury prevention for children and adolescents

  28. Targeting High Risk Groups Education targeting youth and adults taking hunter safety class in Arkansas Partnership with AR Game and Fish Commission Pre and post season surveys with video intervention Instructor satisfaction

  29. Hunter Safety Education Project

  30. Hunter Safety Education Project

  31. Primary Activities • Education tailored for specific target groups • Use of expanded technologies for education delivery including video/DVD, movie theatre trailers • Serial qualitative and quantitative evaluation of materials

  32. Movie Theatre Project Graham et al, MS in progress Conducted during summer 2009 in a single rural community Phased use of brochures, lobby art, preview PSAs Surveys by trained student volunteers More patrons recalled ATV PSA (75%) than soda ad (75% vs. 58%, p<0.001) Patrons who saw PSA more likely to endorse ATV safety message (90% vs. 75%, p<0.001)

  33. Lessons Learned: Education Pragmatic approach of risk reduction Credible spokespersons Non-traditional venues Tailored messaging

  34. Process Evaluation • Coalitions • Partnerships • Cooperative Extension/4-H • Game and Fish Commission • Children’s Safety Network • Unplanned opportunities • Unanticipated challenges

  35. Do laws work for ATV safety? • Early study compared states with • No laws, laws governing equipment only, laws governing driver behavior • States with no laws had injury rates twice as high as those with lawsHelmkamp, AJPH 2001 • Several studies of single states indicate a trend toward increased helmet use in jurisdictions with helmet laws

  36. ATV Laws 2011 Minimum Age for ATV Use Helmet Use Laws While Riding ATV

  37. ATV law effectiveness, 2012 Helmkamp, Aitken, et al, Public Health Reports, in press • Review of new wave of laws requiring helmets and training are effective • In states with helmet laws: • Death rates consistently lower except among the elderly • Death rates 23% lower overall • Training regulations had no clear relationship to death rates

  38. Engineering: How well do ATVs really work? • Limited research on real-world performance of ATVs with adult or child riders • One study measured rider-ATV fit for children ages 6-11 (N=8) and those 12-15 (N=11) on youth and adult ATVs using SVIA standards • Older youth fit better on adult ATVs than youth models • Younger children did not fit either youth or adult models • Overall conclusion is that aged based guidelines are not enough and size metrics should be considered Bernard et al, Accident Analysis and Prevention, 2010

  39. Engineering: do helmets work? • Little study of protective gear or helmet effectiveness • reduction of 42% for mortality; 62% reduction in any head injury reported in a single study in 1990 (Rodgers, Accident Anal Prev) • Follow up study conducted of ATV riders of all ages admitted to trauma centers • Unhelmeted riders: • 62% increased risk for any TBI • 3 times more likely to sustain severe TBI • more than twice as likely to die in hospital Bowman et al, Injury Prevention, January 2009

  40. Helmet use? • Studies show variable but low helmet use—10-50% overall • Qualitative study of • Focus groups of ATV riders, both helmet wearers and non wearers • Presumed barriers and facilitators explored • Cost, comfort, and style less importantfactors than lack of perceived risk of injury on ATV

  41. Engineering projects • Co-investigators at UAMS, ACH, University of AR, UA Cooperative Extension, private engineering firm • Use advanced computer simulation technology to simulate performance of ATVs under differing conditions • Potential applications • Education (short term) • Improved ATV and helmet design

  42. Engineering Simulation ATV Speed 10mph Slope 30 degrees Slope length 2m

  43. Building an ATV research program • Ongoing epidemiologic studies • Actively monitor available data and trends • Push field toward intervention rather than just descriptive studies • Policy • Innovative educational tools (video, simulations) • Explore engineering approaches • Continue current studies • Collaboration

  44. Arkansas ATV Research Group • West Virginia • Maria Brann, Mass Communications • Denver • Jim Helmkamp, Epidemiology • Baltimore • Steve Bowman, HSR • Arkansas • Mary Aitken, Pediatrics • James Graham, PEM • Beverly Miller, Education • Hope Mullins, Public Health • Chandra Thorbole, Engineering • Mechelle Winslow, Health Education

  45. Efficacy of Driving Simulator Training for Novice Teen Drivers Brendan Campbell, MD, MPH May 24, 2012

  46. Project Collaborators Brendan Campbell, Kevin Borrup, Hassan Saleheen, Garry Lapidus Connecticut Children’s Medical Center, Hartford, CT

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