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Injury prevention and community education evaluating success

Robert Smith rfsmithmd at comcast.net
Thu May 28 17:26:22 BST 2015


Vicky,

Tim’s answer would certainly represent a Gold Standard of evaluation. While being ultimately persuasive, difficulties may arise in terms of access to data, and data collection. Even if those large issues are addressed, the population you are targeting may not be large enough to observe significant but real changes.

Prevention initiatives like bike helmets are attractive because you’re dealing with a nice(r) group of people, they seem simple and doable and you avoid the “land war in Asia” morass of violence prevention. Evaluation of even the most benign and simple appearing intervention is crucial because, though it’s hard to imagine with bike helmets, you can end up doing harm, or you can end up spending resources on something that doesn’t work. On the other hand maybe some or all of your program is working and you want to be able to prove it and replicate it.

Basically there are two types of outcomes or goals. These used to be called Process and Outcome but now may be Throughput and Output or something. The former type have to do with setting up and executing the nuts and bolts of your program. You will have much more control over these and they are actually quite valuable to learn from in and of themselves. If you fail here, you cannot expect the Gold Standard type goals to succeed.

So. Your program will cost money. You need to secure funding. You need to design and plan the program. You need to hire or designate staff for implementation and oversight, helmet acquisition, storage and maintenance, training and distribution and replacement for post fall or growth, evaluation, marketing and communication. All of these parts will have details and steps within themselves that will represent measurable outcomes too. You probably have already done these things. Evaluate them too! Before measuring the ultimate outcome of injury reduction, you need to show that you were successful at fitting, training, usage and follow up of the kids and families. These are really important goals for your program that you want to be abel to show that you were successful at. Maybe you want to reward the kids for each time they wear their helmet. Maybe have the parents validate this. Maybe organize the kids into teams that compete for most compliant usage. Ultimately you’d like to build a culture of hemet usage.

For the injury reduction part, you need access to a data  base that tracks this, from something small like your trauma registry to possibly a state registry or city wide or state wide discharge data. The smaller the data set the more accessible and reliable the data but the less impactful.

Hopefully the ACS or AAST has a data base of prevention initiatives and could give you people to contact. I believe Ron Maier in Seattle used to do work in this area and his folks could probably help you as he is extremely well known in Trauma and Injury Prevention. http://www.ncbi.nlm.nih.gov/pubmed/7636907 <http://www.ncbi.nlm.nih.gov/pubmed/7636907> Possibly Dr. Schwab at U Penn and the Pennsylvania Trauma Registry people could help too. Or Ellen Mackenzie’s group at Johns Hopkins. http://www.jhsph.edu/faculty/directory/profile/1521/MacKenzie/Ellen <http://www.jhsph.edu/faculty/directory/profile/1521/MacKenzie/Ellen>. There should be a lot of people who are engaged in this type of prevention and willing to help you.

Good luck,

Rob

Robert F. Smith MD, MPH
Cook County Trauma (ret)




> On May 28, 2015, at 8:54 AM, Timothy Hardcastle <Hardcastle at ukzn.ac.za> wrote:
> 
> Vicky
> 
> That is the challenge of prevention – I think the only way to see if the prevention process is working is with a before/after study looking at the injury type under review: e.g. you do a prevention education project on cycle helmets – what happened to the incidence of TBI in the next 3-6 months after cycling incidents.
> 
> Regards,
> Tim
> Dr Timothy Hardcastle
> MB,ChB(Stell); M.Med(Chir)(Stell); PhD, FCS(SA), Trauma Surgery(HPCSA)
> Head: UKZN Trauma Surgery Training Unit
> Deputy Director: IALCH Trauma Service and Trauma ICU
> Hardcastle at ukzn.ac.za<mailto:Hardcastle at ukzn.ac.za> / timothyhar at ialch.co.za<mailto:timothyhar at ialch.co.za>
> Mobile +27824681615
> Postal: PostNet 27, Private Bag X05, MALVERN, 4055
> Durban, South Africa
> 
> From: trauma-list-bounces at trauma.org [mailto:trauma-list-bounces at trauma.org] On Behalf Of Vicki Tarnow
> Sent: 28 May 2015 14:36
> To: Trauma-List [TRAUMA.ORG]
> Subject: Re: Injury prevention and community education evaluating success
> Importance: High
> 
> 
> Hey does anyone help a person out. Needing some assistance. Any help would be appreciated. How does anyone evaluate their injury prevention and community education its success or failure.
> 
> 
> Thanks
> 
> 
> 
> V.Tarnow,RN
> Trauma Program Coordinator
> The Medical Center of Southeast Texas
> 2555 Jimmy Johnson Blvd.
> Port Arthur,Texas 77640
> Phone: (409) 853-5669
> Cell Phone: (409) 719-3157
> Pager # : (409) 726-3978
> Fax: (409) 853-5399
> VTarnow at iasishealthcare.com<mailto:VTarnow at iasishealthcare.com>
> 
> NOTICE: This e-mail may contain PRIVILEGED and CONFIDENTIAL information and is intended only for the use of the specific individual(s) to which it is addressed. It may contain Protected Health Information that is privileged and confidential. Protected Health Information may be used or disclosed in accordance with law and you may be subject to penalties under law for improper use or further disclosure of the Protected Health Information in this email. If you are not an intended recipient of this email, you are hereby notified that any unauthorized use, dissemination or copying of this email or the information contained in it or attached to it is strictly prohibited. If you have received this e-mail in error, please delete it and immediately notify the person named above by reply email. Thank you.
> 
> 
> -----trauma-list-bounces at trauma.org<mailto:-----trauma-list-bounces at trauma.org> wrote: -----
> To: "Trauma-List [TRAUMA.ORG]" <trauma-list at trauma.org<mailto:trauma-list at trauma.org>>
> From: Mary Langcake
> Sent by: trauma-list-bounces at trauma.org<mailto:trauma-list-bounces at trauma.org>
> Date: 05/28/2015 06:59AM
> Subject: Re: Traumatic cardiac arrest
> He'd be a bit of a schlemiel if he spelt it wrong :-)
> 
> Sent from my iPad
> 
>> On 28 May 2015, at 01:21, Gross, Ronald <Ronald.Gross at baystatehealth.org<mailto:Ronald.Gross at baystatehealth.org>> wrote:
>> 
>> Hehehe!  And you even spelled schmuck correctly!!!
>> 
>> Ronald I. Gross, MD, FACS
>> Chief, Division of Trauma, Acute Care Surgery & Surgical Critical Care
>> Baystate Medical Center
>> Associate Professor of Surgery
>> Tufts School of Medicine
>> 759 Chestnut Street<x-apple-data-http://www.trauma.org/index.php/community/list/url/http:list.ftech.net/pipermail/trauma-list/2015-May/detectors://0/0>
>> Springfield, MA 01199<x-apple-data-http://www.trauma.org/index.php/community/list/url/http:list.ftech.net/pipermail/trauma-list/2015-May/detectors://0/0>
>> 413-794-4022<tel:413-794-4022>
>> ronald.gross at baystatehealth.org<mailto:ronald.gross at baystatehealth.org>
>> 
>> On May 27, 2015, at 8:59 AM, Bjorn, Pret <pbjorn at emhs.org<mailto:pbjorn at emhs.org>> wrote:
>> 
>> There are certain advantages to being a schmuck.  I have carefully cultivated my specious credibility and irreverent approach.  Makes the List safer for me than for esteemed doctors and other leaders such as yourselves.  Plus it's kind of more fun.
>> 
>> You're welcome.
>> 
>> Pret
>> 
>> -----Original Message-----
>> From: trauma-list-bounces at trauma.org<mailto:trauma-list-bounces at trauma.org> [mailto:trauma-list-bounces at trauma.org] On Behalf Of Gross, Ronald
>> Sent: Wednesday, May 27, 2015 8:52 AM
>> To: Trauma-List [TRAUMA.ORG<http://TRAUMA.ORG<http://trauma.org/>>]
>> Subject: Re: Traumatic cardiac arrest
>> 
>> As I have chosen to be at present!  :-)
>> 
>> Ronald I. Gross, MD, FACS
>> Chief, Division of Trauma, Acute Care Surgery & Surgical Critical Care Baystate Medical Center Associate Professor of Surgery Tufts School of Medicine
>> 759 Chestnut Street<x-apple-data-http://www.trauma.org/index.php/community/list/url/http:list.ftech.net/pipermail/trauma-list/2015-May/detectors://0/0>
>> Springfield, MA 01199<x-apple-data-http://www.trauma.org/index.php/community/list/url/http:list.ftech.net/pipermail/trauma-list/2015-May/detectors://0/0>
>> 413-794-4022<tel:413-794-4022>
>> ronald.gross at baystatehealth.org<mailto:ronald.gross at baystatehealth.org><mailto:ronald.gross at baystatehealth.org>
>> 
>> On May 27, 2015, at 8:35 AM, Timothy Hardcastle <Hardcastle at ukzn.ac.za<mailto:Hardcastle at ukzn.ac.za><mailto:Hardcastle at ukzn.ac.za>> wrote:
>> 
>> And then you wonder why I am generally silent on this topic..... :)
>> 
>> Regards,
>> Tim
>> Dr Timothy Hardcastle
>> MB,ChB(Stell); M.Med(Chir)(Stell); PhD, FCS(SA), Trauma Surgery(HPCSA)
>> Head: UKZN Trauma Surgery Training Unit
>> Deputy Director: IALCH Trauma Service and Trauma ICU Hardcastle at ukzn.ac.za<mailto:Hardcastle at ukzn.ac.za><mailto:Hardcastle at ukzn.ac.za> / timothyhar at ialch.co.za<mailto:timothyhar at ialch.co.za><mailto:timothyhar at ialch.co.za>
>> Mobile +27824681615
>> Postal: PostNet 27, Private Bag X05, MALVERN, 4055 Durban, South Africa
>> 
>> 
>> -----Original Message-----
>> From: trauma-list-bounces at trauma.org<mailto:trauma-list-bounces at trauma.org><mailto:trauma-list-bounces at trauma.org> [mailto:trauma-list-bounces at trauma.org] On Behalf Of Bjorn, Pret
>> Sent: 27 May 2015 14:31
>> To: Trauma-List [TRAUMA.ORG<http://TRAUMA.ORG<http://trauma.org/>><http://TRAUMA.ORG<http://trauma.org/>>]
>> Subject: RE: Traumatic cardiac arrest
>> 
>> Let me just wonder aloud whether REBOA isn't just 21st-Century PASG's with an immensely higher degree of difficulty and a variety of additional risks?
>> 
>> I'll eagerly await data from folks bolder than we are; but let's note that this is the same Trauma-List that regularly argues over a gram or two of Tranexamic Acid...
>> 
>> Pret Bjorn, RN
>> Bangor, ME USA
>> 
>> 
>> 
>> -----Original Message-----
>> From: trauma-list-bounces at trauma.org<mailto:trauma-list-bounces at trauma.org><mailto:trauma-list-bounces at trauma.org> [mailto:trauma-list-bounces at trauma.org] On Behalf Of Paul Bailey
>> Sent: Tuesday, May 26, 2015 8:45 PM
>> To: Trauma-List [TRAUMA.ORG<http://TRAUMA.ORG<http://trauma.org/>><http://TRAUMA.ORG<http://trauma.org/>>]
>> Subject: Re: Traumatic cardiac arrest
>> 
>> Excuse the question - how many out there are performing REBOA prehospital / how many in their trauma centre / ED?
>> 
>> Cheers
>> 
>> PB
>> 
>> On Wed, May 27, 2015 at 2:32 AM, Blueflightmedic <trauma at emergencyunit.com<mailto:trauma at emergencyunit.com><mailto:trauma at emergencyunit.com>>
>> wrote:
>> 
>> All together now - REBOA.
>> 
>> -----Original Message-----
>> From: trauma-list-bounces at trauma.org<mailto:trauma-list-bounces at trauma.org><mailto:trauma-list-bounces at trauma.org> [mailto:
>> trauma-list-bounces at trauma.org<mailto:trauma-list-bounces at trauma.org><mailto:trauma-list-bounces at trauma.org>]
>> On Behalf Of Paul Bailey
>> Sent: 26 May 2015 14:07
>> To: Trauma-List [TRAUMA.ORG<http://TRAUMA.ORG<http://trauma.org/>><http://TRAUMA.ORG<http://trauma.org/>>]
>> Subject: Traumatic cardiac arrest
>> 
>> Greetings to the list - long time lurker, rare contributor.
>> 
>> I have a question for those of you involved in the pre-hospital / EMS sphere - with regards to cardiac arrest.
>> 
>> Does your system treat traumatic cardiac arrest differently to "medical"
>> cardiac arrest, and if so are you willing to share your thoughts.
>> 
>> Particularly interested in evidence base, if any.
>> 
>> Also interested to see if anyone is working in a system that administers blood pre-hospital and what logistics problems that might throw up.
>> 
>> Cheers
>> 
>> Paul
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