- Email: [email protected]
Injury prevention program for youthful traffic offenders
Injury prevention program for youthful traffic offenders Author: Christine B y r d , RN, MSN, C N R N , Cape Girardeau, M i s s o u r i
i s k - t a k i n g b e h a v i o r s p l a y a k e y role in t h e i n c r e a s e d i n c i d e n c e of d e a t h a n d injuries in a d o l e s c e n t s a n d y o u n g adults. Young drivers are signific a n t l y o v e r r e p r e s e n t e d in alcohol- a n d d r u g - r e l a t e d c r a s h e s , s p e e d m o r e often, a n d f r e q u e n t l y do n o t w e a r s e a t belts. ~,2 In 1990 w e b e g a n a n injury p r e v e n t i o n p r o g r a m at S a i n t F r a n c i s M e d i c a l C e n t e r in C a p e G i r a r d e a u , Missouri, to t a r g e t t h i s h i g h - r i s k p o p u l a t i o n . T h e p u r p o s e of t h e p r o g r a m w a s to e d u c a t e y o u n g drivers, a g e s 16 to 25 y e a r s old, a b o u t t h e p o s s i b l e c o n s e q u e n c e s of t h e i r d r i v i n g b e h a v i o r s . T h e s e y o u n g traffic offenders a r e " s e n t e n c e d " to s p e n d a d a y in t h e hospital. T h e p r o g r a m , called t h e Traffic Offender P r o g r a m (TOP), is a c o o p e r a t i v e effort of a c o m m u n i t y traffic s a f e t y o r g a n i z a t i o n , l a w e n f o r c e m e n t a g e n cies, a n d staff a t S a i n t F r a n c i s M e d i c a l Center.
R
Program design T h e p r o g r a m is s p e c i f i c a l l y d e s i g n e d for 16- to 25y e a r - o l d s w i t h traffic offenses, s u c h a s d r i v i n g w h i l e i n t o x i c a t e d , s p e e d i n g , or c a r e l e s s a n d i m p r u d e n t driving. Two a r e a j u d g e s enroll t h e offenders in t h e prog r a m a s p a r t of their s e n t e n c e . P r o g r a m e n r o l l m e n t is l i m i t e d to s e v e n p a r t i c i p a n t s at one t i m e b e c a u s e of t h e i n t e r a c t i v e n a t u r e of t h e p r o g r a m d e s i g n . T h e program, h e l d o n c e a m o n t h , is c o o r d i n a t e d b y t h e n e u r o s c i e n c e clinical n u r s e s p e c i a l i s t at S a i n t F r a n c i s M e d i c a l Center. A total of 141 p a r t i c i p a n t s h a v e b e e n enrolled in t h e p r o g r a m from S e p t e m b e r 1993 to J u l y 1996; t h e a v e r a g e a g e of p a r t i c i p a n t s is 19. Of t h e s e , 72% w e r e m a l e drivers a n d 28% w e r e female drivers; 52% of t h o s e s u r v e y e d s t a t e d t h e y h a d a t t e n d e d a driver e d u c a t i o n course, a n d 42% r e p o r t e d a pr~evious driv i n g offense (Figure 1). T h e h i g h e s t p e r c e n t a g e (28%) w e r e t i c k e t e d for d r i v i n g u n d e r t h e i n f l u e n c e of alcohol, w h e r e a s t h e s e c o n d h i g h e s t p e r c e n t a g e (21%) w e r e t i c k e t e d for s p e e d i n g . A v a r i e t y of o t h e r offense s a c c o u n t for t h e r e m a i n d e r of t h e g r o u p (Figure 2). During t h e d a y t h e p a r t i c i p a n t s visit v a r i o u s a r e a s of t h e h o s p i t a l t h a t c a r e for t r a u m a victims. T h e a g e n d a for t h e d a y is d e s c r i b e d in F i g u r e 3. In e a c h Christine Byrd is neuroscience clinical nurse specialist, Saint Francis Medical Center, Cape Girardeau, Missouri. J Emery Nurs 1997;23:326-9. Copyright © 1997 by the Emergency Nurses Association. 0099-1767/97 $5.00 + 0 18/1/83620
326 Volume 23, Number 4
area, p a r t i c i p a n t s talk to staff m e m b e r s i n v o l v e d in t r a u m a care, a n d w h e n e v e r p o s s i b l e , v i e w a c t u a l p a t i e n t s . In a r e a s s u c h as critical c a r e a n d t h e n e u r o s c i e n c e unit, p a r t i c i p a n t s go to t h e p a t i e n t ' s b e d s i d e and r e c e i v e a n e x p l a n a t i o n of t h e p a t i e n t ' s c o n d i t i o n and c a r e involved.
Several families, particularly of victims w i t h head injuries, have r e q u e s t e d to speak to the group personally to give the family's perspective. The participants sign a patient confidentiality s t a t e m e n t , a n d p e r m i s s i o n is a s k e d from t h e p a t i e n t s a n d / o r t h e i r families before e n t e r i n g p a t i e n t rooms. When the program was developed, we predicted that m a n y p a t i e n t s a n d families w o u l d r e f u s e p e r m i s s i o n . A l t h o u g h t h e o c c a s i o n a l refusal occurs, m o s t p a t i e n t s a n d families are v e r y s u p p o r t i v e . Several families, p a r t i c u l a r l y of v i c t i m s w i t h h e a d i n j u r i e s , h a v e r e q u e s t e d to s p e a k to t h e g r o u p p e r s o n a l l y to g i v e t h e family's p e r s p e c t i v e . T h e s e p e r s o n a l i n t e r a c t i o n s add a n effective d i m e n s i o n to t h e p r o g r a m . Role-playing and active participation are integral in t h e p r o g r a m d e s i g n . In t h e m o r n i n g t h e p a r t i c i p a n t s r a n d o m l y c h o o s e a d i s a b i l i t y card. A t y p i c a l d i s a b i l i t y c a r d m a y read: "You w e r e i n v o l v e d in a n a u t o m o b i l e crash, in w h i c h y o u w e r e n o t w e a r i n g your s e a t belt. You w e r e t h r o w n from t h e c a r a n d suffered a s p i n a l cord injury. You are n o w p e r m a n e n t l y p a r a l y z e d a n d m u s t u s e a w h e e l c h a i r to g e t around." P a r t i c i p a n t s m u s t role-play t h e i r d i s a b i l i t y for t h e m o r n i n g until after lunch. This i n c l u d e s v i s i t i n g t h e e m e r g e n c y d e p a r t m e n t a n d critical c a r e unit, a n d m o s t difficult of all, m a n e u v e r i n g t h r o u g h t h e h o s p i t a l c a f e t e r i a line. E x a m p l e s of o t h e r a s s i g n e d d i s a b i l i t i e s a r e a p h a s i a , limb paralysis, a n d m e m o r y loss. D u r i n g their v i s i t to t h e r e h a b i l i t a t i o n t h e r a p y area, t h e t h e r a p i s t s e n c o u r a g e a c t i v e p a r t i c i p a t i o n b y t h e group. T h e g r o u p m a y p a r t i c i p a t e in t h e r a p y routines, a t t e m p t to u s e a d a p t i v e d e v i c e s , or o b s e r v e a c t u a l p a t i e n t s in t h e r a p y . T h e p r o g r a m e n d s w i t h a f l a n k d i s c u s s i o n w i t h a traffic v i c t i m from t h e corn-
Byrd/JOURNAL OF EMERGENCY NURSING
Meet w i t h Program Coordinator
8:45-9i15AM
Traffic Offender Program
- O v e r v i e w of p r o g r a m - Preliminary questionnaire - Injury information
September '93 thru July '96 DEMOGRAPHICS (141 participants) Male 72%
__
Social Services
9:15-10:00 AM
- D i s c u s s i o n of family, social, and economic impact
AverageAge:19
Disability a s s i g n m e n t Emergency Department
10:00-10:15 AM 10:15-11:00 AM
MedianAge: 18 Female 28%
- Tour of h e l i c o p t e r / a m b u l a n c e - Tour of E m e r g e n c y Department & Trauma Room - D e s c r i p t i o n of e m e r g e n c y c a r e
Yes 52%
I n t e n s i v e Care Unit
11:00-11:30 AM
Hada Driver Education Course
- O b s e r v a t i o n of i n t e n s i v e c a r e patient care
Unknown 3% 45%
No
Lunch Rehabilitation Services
11:30-12:00 N o o n 12:00-1:00 PM
- Observe physical therapy, occupational therapy & speech therapy - D e s c r i p t i o n of l o n g - t e r m t h e r a p y n e e d s of p a t i e n t s w i t h h e a d & s p i n a l c o r d injury
Yes 42% HadPrevious Driving
Offense
Unknown 10%
Neurosurgical Unit and/or Rehabilitation Unit
1:00-1:30 PM
No 48%
- O b s e r v a t i o n of p a t i e n t s w i t h h e a d a n d / o r s p i n a l cord injury - D i s c u s s i o n w i t h p a t i e n t , if appropriate
Figure 1 D e m o g r a p h i c i n f o r m a t i o n of c o u r s e p a r t i c i p a n t s in traffic o f f e n d e r p r o g r a m .
D i s c u s s i o n w i t h Victim of Head Injury Wrap-up
1:30-2:15 PM 2:15-2:45 PM
- R e v i e w of t h e d a y - Follow-up questionnaire
Traffic Offender Program S e p t e m b e r '93 thru July '96 Driving Offenses (141 participants)
Figure 3 T y p i c a l c o u r s e s c h e d u l e for traffic o f f e n d e r p r o g r a m .
Driving Intoxicated Speeding
~
Careless & Imprudent ~
13%
Failure to Yield ~ Hit
munity
who
cussion
has been highly rated in the program
has
sustained
a head
injury. This
dis-
evalua-
tions.
9%
a Parked Car ~
Participants must role-play their disability for the morning.
5%
Ran Traffic Signal ~ Other ~
21%
,
4% '
~
:
~
18%
Participants directly
Unknown ~ 2%
are required
to the
hospital,
expenses.
Staff time
cases,
addition
in
Figure 2
involved
T y p e of d r i v i n g o f f e n s e for c o u r s e p a r t i c i p a n t s .
from the emergency science
include unit,
to pay
which
is voluntary, to
their
and
regular
flight nurses, department,
rehabilitation
a program
covers
unit,
the
fee
program
is in most duties.
paramedics,
Staff nurses
critical care, neurophysical,
occupa-
A u g u s t 1997
327
JOURNAL OF EMERGENCYNURSING/Byrd
Traffic Offender Program
Traffic Offender Program
September '93 thru July '96 ParticipantResponses
September '93 thru July '96 Participant Responses
BEFORE PROGRAM: What % of the time do you wear your seatbelt?
BEFORE PROGRAM: Do you drink and drive?
AFTER PROGRAM: How often do you plan to wear your seatbelt? •
BEFORE
-
[]
AFTER PROGRAM: Will y o u d r i n k a n d d r i v e ?
AFTER []
/
100%
BEFORE
[]
AFTER
63% 3% !0~1
Often
75%- 100% 12%
N = 141
50%-75%
25%-50%
P
14%
Sometimes
b11%
1%
'/o 26%
3%
N = 141
31%
<25%
Rarely
Figure 4 Preprogram and postprogram survey of seat belt use among course participants.
52%
Never
tional, s p e e c h therapists, a n d social services. Staff i n p u t from all areas involved in the care of t r a u m a vict i m s h a s b e e n extremely valuable. A l t h o u g h there has n o t b e e n direct p h y s i c i a n i n v o l v e m e n t , the n e u r o s u r gical staff h a s b e e n very s u p p o r t i v e of t h e program.
Survey results P a r t i c i p a n t s c o m p l e t e a s u r v e y before the p r o g r a m a n d i m m e d i a t e l y after c o m p l e t i o n o~the p r g g r a m . No n a m e s are r e q u i r e d a n d p a r t i c i p a n t s a r ~ - e n c o u r a g e d to a n s w e r honestly. " *': S t u d i e s h a v e s h o w n t h a t y o u n g e r drivers are less likely to w e a r seat belts t h a n older drivers. 1, 2 In t h e presurvey, only 22% of our s a m p l e said t h e y wore a s e a t belt all of the time. A total of 54% wore a s e a t belt more t h a n half the time, a n d 46% wore it less t h a n half of the time. In t h e postsurvey, 63% s t a t e d t h e y p l a n n e d to w e a r a s e a t belt all of the time. Only 12% s t a t e d t h e y w o u l d w e a r a s e a t belt less t h a n half of the t i m e (Figure 4). There is a s t r o n g a s s o c i a t i o n b e t w e e n alcohol u s e a n d i n c i d e n c e of motor vehicle injury in y o u n g drivers. 3 In our s u r v e y 48% reported t h e y often, s o m e times, or rarely drink a n d drive, w h e r e a s only 52%
328
Volume 23, Number 4
Figure 5 Preprogram and postprogram survey of alcohol use among course participants.
reported t h e y n e v e r drink a n d drive. In the postsurvey, 12% s t a t e d t h e y would drink a n d drive rarely, s o m e t i m e s , or often, a n d 88% s t a t e d t h e y would n e v e r drink a n d drive (Figure 5). A d o l e s c e n t s h a v e a n e e d to g a i n a n d m a i n t a i n control over their e n v i r o n m e n t a n d c a n often rebel a g a i n s t authority a n d control. Before a n d after the program, p a r t i c i p a n t s w e r e a s k e d to r e s p o n d to t h e statem e n t : "I feel s e a t belts are a p e r s o n a l choice a n d no o n e should b e forced to wear them." In this survey, t h o s e w h o strongly a g r e e d w i t h t h e s t a t e m e n t did n o t c h a n g e their o p i n i o n in t h e postsurvey. However, t h e n u m b e r of t h o s e who strongly d i s a g r e e d with t h e s t a t e m e n t almost d o u b l e d after t h e p r o g r a m (Figure 6). We r e c o g n i z e t h a t t h e s e results are reported i n t e n t i o n s of p a r t i c i p a n t s , a n d w e do n o t k n o w w h e t h e r a n y a c t u a l b e h a v i o r c h a n g e s took place. A l t h o u g h c h a n g e s in k n o w l e d g e a n d a t t i t u d e c a n b e
Byrd/JOURNAL OF EMERGENCYNURSING
Discussion
Traffic Offender Program September '93 thru July '96 Participant Responses I feel seatbelts are a personal choice and no one should be forced to wear them. •
BEFORE •
AFTER
12%
Strongly Agree
12% 31%
Agree
Not Sure
N = 141
17% Yo 23%
Disagree
Strongly Disagree
~/o
The National C e n t e r for E n v i r o n m e n t a l Health a n d Injury Control, a division of the C e n t e r s for Disease Control a n d Prevention, r e c o m m e n d s t h a t "Hospitals should actively work w i t h EMS p e r s o n n e l , state a n d local health d e p a r t m e n t s , h i g h w a y safety a g e n cies, a n d other g o v e r n m e n t a l a n d n o n - g o v e r n m e n t a l a g e n c i e s in d e v e l o p i n g a n d p r o m o t i n g injury prev e n t i o n programs. ''~ In this era of s c a r c e health care dollars, motor vehicle injury p r o g r a m s h a v e proved to b e more cost-effective t h a n almost a n y other k i n d of public health i n t e r v e n t i o n . Motor vehicle injuries a c c o u n t for 22% of all i n j u r y - a s s o c i a t e d hospitalizations a n d more t h a n 25% of all u n c o m p e n s a t e d h o s p i t a l i z a t i o n c h a r g e s . ~ Dollars alone, however, c a n n o t express t h e d e v a s t a t i n g costs to individuals, families, a n d society in t e r m s of pain, suffering, a n d loss of p r o d u c t i v i t y t h a t c a n occur with motor vehicle injury. More s t u d i e s n e e d to b e d o n e related to effectiveness of motor vehicle injury prev e n t i o n p r o g r a m s in c h a n g i n g h i g h - r i s k d r i v i n g behaviors.
33%
References Figure 6 Attitudes of course participants regarding seat belt use.
precursors to c h a n g e s in behavior, l o n g - t e r m followu p of t h e p a r t i c i p a n t s w o u l d b e n e e d e d to d e t e r m i n e w h e t h e r c h a n g e s in d r i v i n g behavior did occur.
1. Setting the national agenda for injury control in the 1990s (position papers from The Third National Injury Control Conference). Atlanta: US Department of Health and Human Services, Centers for Disease Control and Prevention; 1992. 2. Grossman DC, Rwara FR Injury control in childhood. Pediatr Clin North Am 1992;39:471-85. 3. Sommers MS. Alcohol and trauma: the critical link. Crit Care Nurse 1994;14:82-92.
August 1997 329
i s k - t a k i n g b e h a v i o r s p l a y a k e y role in t h e i n c r e a s e d i n c i d e n c e of d e a t h a n d injuries in a d o l e s c e n t s a n d y o u n g adults. Young drivers are signific a n t l y o v e r r e p r e s e n t e d in alcohol- a n d d r u g - r e l a t e d c r a s h e s , s p e e d m o r e often, a n d f r e q u e n t l y do n o t w e a r s e a t belts. ~,2 In 1990 w e b e g a n a n injury p r e v e n t i o n p r o g r a m at S a i n t F r a n c i s M e d i c a l C e n t e r in C a p e G i r a r d e a u , Missouri, to t a r g e t t h i s h i g h - r i s k p o p u l a t i o n . T h e p u r p o s e of t h e p r o g r a m w a s to e d u c a t e y o u n g drivers, a g e s 16 to 25 y e a r s old, a b o u t t h e p o s s i b l e c o n s e q u e n c e s of t h e i r d r i v i n g b e h a v i o r s . T h e s e y o u n g traffic offenders a r e " s e n t e n c e d " to s p e n d a d a y in t h e hospital. T h e p r o g r a m , called t h e Traffic Offender P r o g r a m (TOP), is a c o o p e r a t i v e effort of a c o m m u n i t y traffic s a f e t y o r g a n i z a t i o n , l a w e n f o r c e m e n t a g e n cies, a n d staff a t S a i n t F r a n c i s M e d i c a l Center.
R
Program design T h e p r o g r a m is s p e c i f i c a l l y d e s i g n e d for 16- to 25y e a r - o l d s w i t h traffic offenses, s u c h a s d r i v i n g w h i l e i n t o x i c a t e d , s p e e d i n g , or c a r e l e s s a n d i m p r u d e n t driving. Two a r e a j u d g e s enroll t h e offenders in t h e prog r a m a s p a r t of their s e n t e n c e . P r o g r a m e n r o l l m e n t is l i m i t e d to s e v e n p a r t i c i p a n t s at one t i m e b e c a u s e of t h e i n t e r a c t i v e n a t u r e of t h e p r o g r a m d e s i g n . T h e program, h e l d o n c e a m o n t h , is c o o r d i n a t e d b y t h e n e u r o s c i e n c e clinical n u r s e s p e c i a l i s t at S a i n t F r a n c i s M e d i c a l Center. A total of 141 p a r t i c i p a n t s h a v e b e e n enrolled in t h e p r o g r a m from S e p t e m b e r 1993 to J u l y 1996; t h e a v e r a g e a g e of p a r t i c i p a n t s is 19. Of t h e s e , 72% w e r e m a l e drivers a n d 28% w e r e female drivers; 52% of t h o s e s u r v e y e d s t a t e d t h e y h a d a t t e n d e d a driver e d u c a t i o n course, a n d 42% r e p o r t e d a pr~evious driv i n g offense (Figure 1). T h e h i g h e s t p e r c e n t a g e (28%) w e r e t i c k e t e d for d r i v i n g u n d e r t h e i n f l u e n c e of alcohol, w h e r e a s t h e s e c o n d h i g h e s t p e r c e n t a g e (21%) w e r e t i c k e t e d for s p e e d i n g . A v a r i e t y of o t h e r offense s a c c o u n t for t h e r e m a i n d e r of t h e g r o u p (Figure 2). During t h e d a y t h e p a r t i c i p a n t s visit v a r i o u s a r e a s of t h e h o s p i t a l t h a t c a r e for t r a u m a victims. T h e a g e n d a for t h e d a y is d e s c r i b e d in F i g u r e 3. In e a c h Christine Byrd is neuroscience clinical nurse specialist, Saint Francis Medical Center, Cape Girardeau, Missouri. J Emery Nurs 1997;23:326-9. Copyright © 1997 by the Emergency Nurses Association. 0099-1767/97 $5.00 + 0 18/1/83620
326 Volume 23, Number 4
area, p a r t i c i p a n t s talk to staff m e m b e r s i n v o l v e d in t r a u m a care, a n d w h e n e v e r p o s s i b l e , v i e w a c t u a l p a t i e n t s . In a r e a s s u c h as critical c a r e a n d t h e n e u r o s c i e n c e unit, p a r t i c i p a n t s go to t h e p a t i e n t ' s b e d s i d e and r e c e i v e a n e x p l a n a t i o n of t h e p a t i e n t ' s c o n d i t i o n and c a r e involved.
Several families, particularly of victims w i t h head injuries, have r e q u e s t e d to speak to the group personally to give the family's perspective. The participants sign a patient confidentiality s t a t e m e n t , a n d p e r m i s s i o n is a s k e d from t h e p a t i e n t s a n d / o r t h e i r families before e n t e r i n g p a t i e n t rooms. When the program was developed, we predicted that m a n y p a t i e n t s a n d families w o u l d r e f u s e p e r m i s s i o n . A l t h o u g h t h e o c c a s i o n a l refusal occurs, m o s t p a t i e n t s a n d families are v e r y s u p p o r t i v e . Several families, p a r t i c u l a r l y of v i c t i m s w i t h h e a d i n j u r i e s , h a v e r e q u e s t e d to s p e a k to t h e g r o u p p e r s o n a l l y to g i v e t h e family's p e r s p e c t i v e . T h e s e p e r s o n a l i n t e r a c t i o n s add a n effective d i m e n s i o n to t h e p r o g r a m . Role-playing and active participation are integral in t h e p r o g r a m d e s i g n . In t h e m o r n i n g t h e p a r t i c i p a n t s r a n d o m l y c h o o s e a d i s a b i l i t y card. A t y p i c a l d i s a b i l i t y c a r d m a y read: "You w e r e i n v o l v e d in a n a u t o m o b i l e crash, in w h i c h y o u w e r e n o t w e a r i n g your s e a t belt. You w e r e t h r o w n from t h e c a r a n d suffered a s p i n a l cord injury. You are n o w p e r m a n e n t l y p a r a l y z e d a n d m u s t u s e a w h e e l c h a i r to g e t around." P a r t i c i p a n t s m u s t role-play t h e i r d i s a b i l i t y for t h e m o r n i n g until after lunch. This i n c l u d e s v i s i t i n g t h e e m e r g e n c y d e p a r t m e n t a n d critical c a r e unit, a n d m o s t difficult of all, m a n e u v e r i n g t h r o u g h t h e h o s p i t a l c a f e t e r i a line. E x a m p l e s of o t h e r a s s i g n e d d i s a b i l i t i e s a r e a p h a s i a , limb paralysis, a n d m e m o r y loss. D u r i n g their v i s i t to t h e r e h a b i l i t a t i o n t h e r a p y area, t h e t h e r a p i s t s e n c o u r a g e a c t i v e p a r t i c i p a t i o n b y t h e group. T h e g r o u p m a y p a r t i c i p a t e in t h e r a p y routines, a t t e m p t to u s e a d a p t i v e d e v i c e s , or o b s e r v e a c t u a l p a t i e n t s in t h e r a p y . T h e p r o g r a m e n d s w i t h a f l a n k d i s c u s s i o n w i t h a traffic v i c t i m from t h e corn-
Byrd/JOURNAL OF EMERGENCY NURSING
Meet w i t h Program Coordinator
8:45-9i15AM
Traffic Offender Program
- O v e r v i e w of p r o g r a m - Preliminary questionnaire - Injury information
September '93 thru July '96 DEMOGRAPHICS (141 participants) Male 72%
__
Social Services
9:15-10:00 AM
- D i s c u s s i o n of family, social, and economic impact
AverageAge:19
Disability a s s i g n m e n t Emergency Department
10:00-10:15 AM 10:15-11:00 AM
MedianAge: 18 Female 28%
- Tour of h e l i c o p t e r / a m b u l a n c e - Tour of E m e r g e n c y Department & Trauma Room - D e s c r i p t i o n of e m e r g e n c y c a r e
Yes 52%
I n t e n s i v e Care Unit
11:00-11:30 AM
Hada Driver Education Course
- O b s e r v a t i o n of i n t e n s i v e c a r e patient care
Unknown 3% 45%
No
Lunch Rehabilitation Services
11:30-12:00 N o o n 12:00-1:00 PM
- Observe physical therapy, occupational therapy & speech therapy - D e s c r i p t i o n of l o n g - t e r m t h e r a p y n e e d s of p a t i e n t s w i t h h e a d & s p i n a l c o r d injury
Yes 42% HadPrevious Driving
Offense
Unknown 10%
Neurosurgical Unit and/or Rehabilitation Unit
1:00-1:30 PM
No 48%
- O b s e r v a t i o n of p a t i e n t s w i t h h e a d a n d / o r s p i n a l cord injury - D i s c u s s i o n w i t h p a t i e n t , if appropriate
Figure 1 D e m o g r a p h i c i n f o r m a t i o n of c o u r s e p a r t i c i p a n t s in traffic o f f e n d e r p r o g r a m .
D i s c u s s i o n w i t h Victim of Head Injury Wrap-up
1:30-2:15 PM 2:15-2:45 PM
- R e v i e w of t h e d a y - Follow-up questionnaire
Traffic Offender Program S e p t e m b e r '93 thru July '96 Driving Offenses (141 participants)
Figure 3 T y p i c a l c o u r s e s c h e d u l e for traffic o f f e n d e r p r o g r a m .
Driving Intoxicated Speeding
~
Careless & Imprudent ~
13%
Failure to Yield ~ Hit
munity
who
cussion
has been highly rated in the program
has
sustained
a head
injury. This
dis-
evalua-
tions.
9%
a Parked Car ~
Participants must role-play their disability for the morning.
5%
Ran Traffic Signal ~ Other ~
21%
,
4% '
~
:
~
18%
Participants directly
Unknown ~ 2%
are required
to the
hospital,
expenses.
Staff time
cases,
addition
in
Figure 2
involved
T y p e of d r i v i n g o f f e n s e for c o u r s e p a r t i c i p a n t s .
from the emergency science
include unit,
to pay
which
is voluntary, to
their
and
regular
flight nurses, department,
rehabilitation
a program
covers
unit,
the
fee
program
is in most duties.
paramedics,
Staff nurses
critical care, neurophysical,
occupa-
A u g u s t 1997
327
JOURNAL OF EMERGENCYNURSING/Byrd
Traffic Offender Program
Traffic Offender Program
September '93 thru July '96 ParticipantResponses
September '93 thru July '96 Participant Responses
BEFORE PROGRAM: What % of the time do you wear your seatbelt?
BEFORE PROGRAM: Do you drink and drive?
AFTER PROGRAM: How often do you plan to wear your seatbelt? •
BEFORE
-
[]
AFTER PROGRAM: Will y o u d r i n k a n d d r i v e ?
AFTER []
/
100%
BEFORE
[]
AFTER
63% 3% !0~1
Often
75%- 100% 12%
N = 141
50%-75%
25%-50%
P
14%
Sometimes
b11%
1%
'/o 26%
3%
N = 141
31%
<25%
Rarely
Figure 4 Preprogram and postprogram survey of seat belt use among course participants.
52%
Never
tional, s p e e c h therapists, a n d social services. Staff i n p u t from all areas involved in the care of t r a u m a vict i m s h a s b e e n extremely valuable. A l t h o u g h there has n o t b e e n direct p h y s i c i a n i n v o l v e m e n t , the n e u r o s u r gical staff h a s b e e n very s u p p o r t i v e of t h e program.
Survey results P a r t i c i p a n t s c o m p l e t e a s u r v e y before the p r o g r a m a n d i m m e d i a t e l y after c o m p l e t i o n o~the p r g g r a m . No n a m e s are r e q u i r e d a n d p a r t i c i p a n t s a r ~ - e n c o u r a g e d to a n s w e r honestly. " *': S t u d i e s h a v e s h o w n t h a t y o u n g e r drivers are less likely to w e a r seat belts t h a n older drivers. 1, 2 In t h e presurvey, only 22% of our s a m p l e said t h e y wore a s e a t belt all of the time. A total of 54% wore a s e a t belt more t h a n half the time, a n d 46% wore it less t h a n half of the time. In t h e postsurvey, 63% s t a t e d t h e y p l a n n e d to w e a r a s e a t belt all of the time. Only 12% s t a t e d t h e y w o u l d w e a r a s e a t belt less t h a n half of the t i m e (Figure 4). There is a s t r o n g a s s o c i a t i o n b e t w e e n alcohol u s e a n d i n c i d e n c e of motor vehicle injury in y o u n g drivers. 3 In our s u r v e y 48% reported t h e y often, s o m e times, or rarely drink a n d drive, w h e r e a s only 52%
328
Volume 23, Number 4
Figure 5 Preprogram and postprogram survey of alcohol use among course participants.
reported t h e y n e v e r drink a n d drive. In the postsurvey, 12% s t a t e d t h e y would drink a n d drive rarely, s o m e t i m e s , or often, a n d 88% s t a t e d t h e y would n e v e r drink a n d drive (Figure 5). A d o l e s c e n t s h a v e a n e e d to g a i n a n d m a i n t a i n control over their e n v i r o n m e n t a n d c a n often rebel a g a i n s t authority a n d control. Before a n d after the program, p a r t i c i p a n t s w e r e a s k e d to r e s p o n d to t h e statem e n t : "I feel s e a t belts are a p e r s o n a l choice a n d no o n e should b e forced to wear them." In this survey, t h o s e w h o strongly a g r e e d w i t h t h e s t a t e m e n t did n o t c h a n g e their o p i n i o n in t h e postsurvey. However, t h e n u m b e r of t h o s e who strongly d i s a g r e e d with t h e s t a t e m e n t almost d o u b l e d after t h e p r o g r a m (Figure 6). We r e c o g n i z e t h a t t h e s e results are reported i n t e n t i o n s of p a r t i c i p a n t s , a n d w e do n o t k n o w w h e t h e r a n y a c t u a l b e h a v i o r c h a n g e s took place. A l t h o u g h c h a n g e s in k n o w l e d g e a n d a t t i t u d e c a n b e
Byrd/JOURNAL OF EMERGENCYNURSING
Discussion
Traffic Offender Program September '93 thru July '96 Participant Responses I feel seatbelts are a personal choice and no one should be forced to wear them. •
BEFORE •
AFTER
12%
Strongly Agree
12% 31%
Agree
Not Sure
N = 141
17% Yo 23%
Disagree
Strongly Disagree
~/o
The National C e n t e r for E n v i r o n m e n t a l Health a n d Injury Control, a division of the C e n t e r s for Disease Control a n d Prevention, r e c o m m e n d s t h a t "Hospitals should actively work w i t h EMS p e r s o n n e l , state a n d local health d e p a r t m e n t s , h i g h w a y safety a g e n cies, a n d other g o v e r n m e n t a l a n d n o n - g o v e r n m e n t a l a g e n c i e s in d e v e l o p i n g a n d p r o m o t i n g injury prev e n t i o n programs. ''~ In this era of s c a r c e health care dollars, motor vehicle injury p r o g r a m s h a v e proved to b e more cost-effective t h a n almost a n y other k i n d of public health i n t e r v e n t i o n . Motor vehicle injuries a c c o u n t for 22% of all i n j u r y - a s s o c i a t e d hospitalizations a n d more t h a n 25% of all u n c o m p e n s a t e d h o s p i t a l i z a t i o n c h a r g e s . ~ Dollars alone, however, c a n n o t express t h e d e v a s t a t i n g costs to individuals, families, a n d society in t e r m s of pain, suffering, a n d loss of p r o d u c t i v i t y t h a t c a n occur with motor vehicle injury. More s t u d i e s n e e d to b e d o n e related to effectiveness of motor vehicle injury prev e n t i o n p r o g r a m s in c h a n g i n g h i g h - r i s k d r i v i n g behaviors.
33%
References Figure 6 Attitudes of course participants regarding seat belt use.
precursors to c h a n g e s in behavior, l o n g - t e r m followu p of t h e p a r t i c i p a n t s w o u l d b e n e e d e d to d e t e r m i n e w h e t h e r c h a n g e s in d r i v i n g behavior did occur.
1. Setting the national agenda for injury control in the 1990s (position papers from The Third National Injury Control Conference). Atlanta: US Department of Health and Human Services, Centers for Disease Control and Prevention; 1992. 2. Grossman DC, Rwara FR Injury control in childhood. Pediatr Clin North Am 1992;39:471-85. 3. Sommers MS. Alcohol and trauma: the critical link. Crit Care Nurse 1994;14:82-92.
August 1997 329