II. ENVIRONMENTAL INTERVENTIONS:
WHY THEY OFTEN WORK BEST
The most important point to be made about interventions is that whenever possible the intervention that you plan to use should be environmentally based. An environmental intervention is based on identifying and modifying or removing a specific hazard so that no further injury event will occur, or the event that does occur will not release enough damaging energy into the patient to cause a fatal injury. Environmental interventions are highly effective for specific hazards, they cost comparatively little and they require no action on the part of the person to be protected. Childproof packaging of medication is one example of an environmental intervention.
Crushable containers filled with water or sand around fixed objects on freeways is another.
Research has shown that the people who are most at-risk of fatal trauma are often the very people who are least likely to change their behavior, even when they understand the risks. Therefore, educational strategies, which require behavioral change, decision-making and frequent effort, are the least likely to result in protective changes among the highest-risk groups.
"Failure to use automobile seat belts, for example, has been shown to be especially common among those at greatest risk of being involved in crashes, such as teenagers, alcohol-impaired drivers, people traveling at night, drivers who follow other cars too closely or ignore red traffic lights, and people in low income areas. Thus the groups at risk are often those whose behavior is the most difficult to change. If injuries among the people at greatest risk are to be reduced, the difficulty of changing their behavior must be taken into account in planning effective approaches. Virtually all available evidence indicates that, for injuries as for diseases, the most effective way to protect high-risk groups as well as the rest of the population is with measures – such as pasteurizations and household fuses – that do not require individual motivation and frequent effort." (Baker, 1992).
EMS AND EDUCATIONAL INJURY PREVENTION EFFORTS:
EMT’s have spent many years voluntarily providing educational injury prevention and this is to be commended, but education in itself is not always the most effective approach. By adding a proactive EMS component, three different strategies become one... education/behavioral for young children who will hopefully influence their parents, environmental strategies for the high-risk group who does not always respond to education, and EMS for the injured.
Since EMS is in the business of caring for injured people, teaching the public how to avoid injury is a natural and useful thing for us to do. It reaches out into the community and encourages interaction between the local population and their emergency services. Child safety-seat programs, 911 awareness, public service announcements, CPR classes, Sober-Grad, Stop-Drop-and-Roll, and safety belt programs all have contributed to reduced rates of trauma deaths throughout the United States. I encourage you to continue performing this valuable service to your community. All public safety agencies that have voluntarily responded in support of these and other educational projects deserve commendation for them.
Occasionally we will be contacted by a mother who saved her child with the Heimlich maneuver, or we will hear of a child who dialed 911 and saved his unconscious mother. This is direct evidence that what we do with education saves people. But these events are rare and we don’t get that kind of positive feedback very often. Education targets a large audience in hopes that the message will result in protective behavior that may save a few.
Beyond educational injury prevention:
Many EMT’s I’ve spoken to over the years have said, "We do injury prevention already". This is true, but not the whole picture. Linda Ford, former director of Cherokee Nation EMS, and former president of the National Native American EMS Association probably said it more accurately when she said, to Rick Smith, (see acknowledgements) "We do injury prevention, but we don’t do what you do."
By expanding your current injury prevention efforts to include targeting specific hazards, you not only know you are helping, you can see the results in reduced deaths year after year. You will see a complete cessation of fatal events where they once were common. With proactive EMS we target the few hazards we know to exist in order to protect everyone.