Injury Prevention should or should not be the role of the Trauma Service
Colin Graham
Outline Injury prevention should or should not be the role of the trauma service
Colin A Graham
Professor, Emergency Medicine
Chinese University of Hong Kong
August 2010
Scotland
Scotland
Scotland
Hong Kong
Hong Kong
Hong Kong Island
Typical Hong Kong trauma
Falls
Objectives
* What is trauma prevention?
* Why is it important?
* Why should the trauma service do it?
* Why should the trauma service not do it?
* What should we do then?
What is trauma prevention?
* "efforts to forestall or prevent events that might result in injuries"
- National Highway Traffic Safety Administration
* "the interventions that eliminate or reduce the likelihood of injury"
- Monterey County Health Department
Different types of prevention
* Primary prevention - prevention of a disease before it occurs
* Secondary prevention - prevention of recurrences or exacerbations of a disease
that already has been diagnosed
* Tertiary prevention - reduction in the amount of disability caused by a
disease to achieve the highest level of function
Why is trauma
prevention important?
Prevention saves lives
Why should the trauma
service do trauma prevention?
* We are able to speak about trauma with authority as we deal with its
consequences
* We know the catastrophic effects of trauma on patients, their families and
their world
* We have a captive audience in the ED, ICU and trauma wards in hospital
Example: talking to parents
* Usually appreciated after childhood injury
* Often a 'teachable moment'
* Sometimes negative responses due to guilt
* Be careful not to blame
Why should the trauma
service do trauma prevention?
* We see patients with risky conditions before significant trauma occurs
- Excessive alcohol intake
- Illicit drug users
- Minor injuries from dangerous mechanisms
- We know the epidemiology of trauma
* We are required to do it for trauma centre accreditation (United States)
Why should the trauma
service not do trauma prevention?
* We don't have the time
- In US level 1 trauma centres, 14% of the time of the trauma coordinator is
spent on prevention
* We don't have expertise with the media
* We are not good at targeting the right people in our communities
Why should the trauma
service not do trauma prevention?
* Patients and their families don't listen to us
- Not true: good evidence supporting brief alcohol interventions in the ED and
admission wards
* Trauma centre prevention is not cost effective
- Very little evidence 'for' or 'against'
* Trauma centres in the US have no financial incentive to reduce the trauma
burden
- Trauma centres are partially paid for by trauma patients
What is the answer?
* Trauma prevention needs dedicated staff
- Doesn't matter whether they are from ED, ICU, wards, or trauma coordinator
- They need 'ring fenced' time and support
* Trauma prevention needs an integrated and truly multidisciplinary approach
- Police, rescue, fire, ambulance, hospital, families
What is the answer?
* Trauma prevention methods need to be rigorously researched
- Not just effectiveness, but cost-effectiveness
- May be easier to do in the developing world
* Trauma prevention strategies need to be compared for effectiveness and costs
- Hospital based v public health based
- General prevention v targeted approaches
Violence Reduction Unit
Aim: to reduce violent crime and behaviour by working with partner agencies to
achieve long-term societal and attitudinal change, and, by focusing on
enforcement, to contain and manage individuals who carry weapons or who are
involved in violent behaviour
Summary
* Prevention is important
* Prevention is best done by people who
- Understand the problem
- Have the skills to intervene at the source
- Have the time and expertise to do it properly
* Multidisciplinary approaches are the key
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Ministry of Health
