Public Health

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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. National EMS Education Standard Competencies

Introduction:

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:

Role of Public Health Public health Practice of preventing disease and promoting good health within groups of people Public health professionals examine the overall needs of the population to determine the best use of health resources.

Public Health Threats:

Public Health Threats Injuries Intentional: Inflected by self or another person Unintentional: Accident Risk factors Increase the likelihood of disease or injury Data from: NEISS All Injury Program operated by the Consumer Product Safety Commission for numbers of injuries. Bureau of Census for population estimates. National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, 2014. http://webappa.cdc.gov/cgi-bin/broker.exe. Accessed August 30, 2016.

Public Health Threats:

Public Health Threats Unintentional injuries in children Leading cause of death in children ages 19 and younger Children have lesser ability to protect themselves from harm.

Public Health Threats:

Public Health Threats Risk factors for children: Age Gender Socioeconomic status Developmental stage Family environment © SuperStock /age fotostock .

Public Health Threats:

Public Health Threats Each year, 7 out of 10 Americans die from a chronic disease. In 2012, about half of all adults had at least one chronic illness.

Public Health Threats:

Public Health Threats Acute illness H1N1 influenza Other public health threats Water or seafood contamination Radiation leaks Lack of sanitary conditions following a natural disaster Increased incidence of cancer after major incidents

Injuries as Public Health Threats:

Injuries as Public Health Threats Years of potential life lost (YPLL) Assume a productive work life until age 65. Deduct the year of death from that age. Lost years of earning income, paying taxes, and making other contributions to society Medical conditions result in lower YPLL than trauma.

Injuries as Public Health Threats:

Injuries as Public Health Threats Data from: National Center for Injury Prevention and Control, 2014, United States.

The Teachable Moment:

The Teachable Moment Articulate and reinforce safety messages when opportunities arise. Use good judgment, and be sensitive to the situation. Can be preemptive © Craig Jackson/IntheDarkPhotography.com.

Prevention:

Prevention Interventions Specific actions intended to improve health and safety outcomes Courtesy of Henry Pollak. © Vladimir Korostyshevskiy / Shutterstock , Inc. Courtesy of Captain David Jackson, Saginaw Township Fire Department. © Jones & Bartlett Learning. Photographed by Kimberly Potvin .

The 4 Es of Prevention:

The 4 Es of Prevention Education Inform people about potential dangers, persuade them to change behaviors. Effective messages: 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

The 4 Es of Prevention:

The 4 Es of Prevention Economic incentives Economic self-interest provides monetary incentives to reinforce safe behavior. Free or subsidized safety products Engineering/environment Passive interventions Changing design of products or spaces to offer automatic protection Social, legal, political, or cultural

The Value of Automatic Protections:

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.

Why EMS Should Be Involved:

Why EMS Should Be Involved Primary injury prevention should be an essential activity. Primary prevention Before injury occurs Now involves EMS Secondary prevention After injury occurs Prevents problem from getting worse

Why EMS Should Be Involved:

Why EMS Should Be Involved EMS providers: Are widely distributed in the population May be the most medical sophisticated person in a rural community Are considered advocates of the health care consumer Are welcome in schools and other environments Are considered authorities on injury and prevention

How EMS Can Get Involved:

How EMS Can Get Involved Strategies that promote interventions: Fundraisers Car seat checks Health fairs Speeches BP checks Fall prevention Swimming safety Courtesy of St. Charles County Ambulance District.

How EMS Can Get Involved:

How EMS Can Get Involved Provision of immunizations Ideally suited to reach at-risk populations Inherent mobility Positive perception of EMS in small communities EMS providers are trained in: Medication security Medication administration Post-injection care Discussion of risks, benefits, side effects

How EMS Can Get Involved:

How EMS Can Get Involved Develop a plan that: Addresses all logistical matters Clearly defines each person’s role and responsibilities Identifies and resolves any issues pertaining to the need for additional training Clearly explains the procedures for procuring the vaccine Forestalls potential liability issues

How EMS Can Get Involved:

How EMS Can Get Involved The concept of community paramedicine gives providers new and expanded avenues for preventing illnesses and injuries. Conducting home health visits Providing wound care and other therapies Ensuring medication compliance More proactive approach in decreasing morbidity, mortality, and unnecessary hospital readmission Opportunities for reimbursement

Injury and Illness Surveillance :

Injury and Illness Surveillance Ongoing, systematic collection, analysis, and interpretation of data Planning, implementation, and evaluation of public health practice Information can be used to develop interventions intended to prevent further injury or illness. Strong surveillance is fundamental to effective programs.

The Haddon Matrix:

The Haddon Matrix Added factor of time to previous models to address causes of injury Host, agent, and environment interact over time to cause injury and correspond to: Pre-event Event Post-event

The Haddon Matrix:

The Haddon Matrix Matrix uses nine components to analyze the injury. Encourages creative thinking Most EMS providers are trained to respond in the post-event phase. Paramedics can compel others to examine the problem more closely and pursue and implement solutions in the pre-event phase.

The Haddon Matrix:

The Haddon Matrix

Getting Started in Your Community:

Getting Started in Your Community To be effective, you need to understand: Injury and illness patterns Characteristics of the population and environment Types of risks present Your regional/state EMS department/public health office will have the most information.

Getting Started in Your Community:

Getting Started in Your Community EMS providers play important roles in: Reporting data Noting risk factors Trained to recognize and report signs and risk factors of intentional violence. © Mikael Karlsson /On Scene Photography.

Prevention Programs for Children:

Prevention Programs for Children Grants, commercial sponsors, and nonprofit groups will sponsor: Car seat inspections Helmet donations Fundraising events Safe Kids Worldwide Nonprofit organization of more than 400 coalitions to reduce the prevalence of preventable childhood injuries

Prevention Programs for Children:

Prevention Programs for Children “Pass-along” effect Other members of a child’s family benefit from the message originally intended for the child Priority prevention efforts are injuries with highest: Mortality rate Hospitalization rate Long-term disability rate Effective countermeasures

Five Steps of a Prevention Program:

Five Steps of a Prevention Program Conduct community assessment. Bring people and groups together who represent the community at large. Identify partners. © Steven Townsend/Code 3 Images. © Mikael Karlsson/Alamy Images.

Five Steps of a Prevention Program:

Five Steps of a Prevention Program Define the problem. Use specific, quantifiable terms. Set goals and objectives. Goals: Broad, general, long term Objectives: Specific, time limited, quantifiable Process or outcome

Five Steps of a Prevention Program:

Five Steps of a Prevention Program Plan and test interventions. Actions to accomplish your goals, objectives Consider your available resources. Implement and evaluate interventions. Must be able to measure results quantitatively

Community Organizing:

Community Organizing Designate a leader. Build a broad support base. Create a realistic timeline. Choose SMART objectives. Understand the religious, ethnic, cultural, and language challenges you may face.

Community Organizing:

Community Organizing Do not reinvent the wheel. Anticipate opposition. Be brief when lobbying legislators. Set up your program to measure results. Establish self-sustaining funding sources. Keep a sense of humor and persist.

Funding a Prevention Program:

Funding a Prevention Program Consider innovative ways to fund programs. Partnering with local media to create prevention messages Seeking grants Seeking scholarships from local nonprofit service organizations or commercial firms Networking with other organizations often provides greater leverage when seeking grants or sponsorships.

Summary:

Summary The field of medicine continues to dedicate more and more attention and resources to the mission of: Public health Promoting health and wellness Preventing injury and illness How can you make a difference in your community?

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