Injury prevention is the most logical approach to reducing death and disability. Many public educational programs directed toward injury prevention are available locally and nationally. Death and disability rates have decreased when prevention efforts were accompanied by legislative activities—for example, in regard to drinking and driving, seat belt use, and bicycle and motorcycle helmet use. Youth programs have been successful in many areas and have focused on drug and alcohol abuse and the prevention of gun violence.
Despite decades of progress in the development of trauma centers and trauma systems, injury remains the leading cause of years of potential lives lost and leaves millions of Americans chronically disabled every year. The overall cost impact estimates for intentional and unintentional injuries now approach half a trillion dollars a year. Medical costs of injury account for 12 percent of national health care expenditures. The financial, physical, and emotional impacts touch every home, school, and workplace in all of our communities.
Perhaps the most challenging aspect of the burden of injury is that it is largely preventable. Almost all other major causes of death and disability have extensive detection, intervention, and prevention programs that are well funded by public and private sources. Injury prevention efforts receive far less attention and resources than do prevention efforts focused on cancer, cardiovascular disease, and a variety of other groups of diseases. In comparing preventability with resource commitment, injury prevention efforts are often neglected, receiving far less funding than other disease prevention programs. The need for effective action and advocacy could not be more compelling.
Trauma centers must have an organized and effective approach to injury prevention and must prioritize those efforts based on local trauma registry and epidemiologic data (CD 18–1). Physicians, nurses, and other trauma center personnel have unique perspectives and equally unique opportunities to focus community efforts on effective prevention programs and, perhaps most important, to partner with injury prevention experts and resources in the community. This collaboration leads to an exchange of data and ideas that allows better analysis of the problem and its solutions.
Injury prevention is the responsibility of all trauma team members working in collaboration with the community. The organization of these efforts begins with effective leadership. Each trauma center must have someone in a leadership position who has injury prevention as part of his or her job description (CD 18–2). In Level I centers, this individual must be a prevention coordinator (separate from the trauma program manager) with a job description and salary support (CD 18–2). In Level II, III, and IV centers, this position may be filled by a trauma program manager with a specific role in prevention efforts detailed in the job description, but only if this role does not negatively affect the work product of the trauma program manager. Trauma medical directors should have a demonstrable role in injury prevention. It is also highly desirable that other trauma physicians and nurses actively participate in injury prevention efforts at Level I, II, III, and IV centers.
Effective injury prevention begins with a focus on the most common causes of injury in the community. These causes include contributing factors such as drug and alcohol abuse and behavioral health problems. The same causes are often linked with the most common mechanisms of injury presenting to the trauma center. The trauma center injury prevention program should identify the three most common causes of injury or traumatic death at the trauma center or in the community using the trauma registry or other available epidemiologic data. Program and intervention strategies then should be selected based on these data.
Key Elements of an Effective Injury Prevention Program
- Target the community: Identify the primary causes of injury and death.
- Work upstream: Identify the root causes of injury and its contributing factors.
- Choose preexisting proved or promising programs: Understand that new program development, assessment, and implementation are complex and time-consuming.
- Always partner with other organizations: Make use of the fact that other trauma centers, prehospital providers, law enforcement agencies, schools, churches, and other organizations are interested and involved in community injury prevention efforts.
- Embrace the media: Learn to speak effectively, be prepared for the many opportunities that will arise, and allow trauma center leaders to become a reliable source of injury prevention information for local print and broadcast media.
- Be politically savvy: Realize that elected and appointed leaders can help if the trauma center understands their goals and the ways to work with them to create effective laws promoting prevention.
- Do not forget the data: Develop surveillance and monitoring tools to assess not only the available performance indicators of the trauma center’s prevention efforts but also the prevention effectiveness.