Injury Prevention

Injury Prevention

I have two beautiful children (yes, they look like their mother) and I will be the first to tell you that they are more apt to listen to anyone other then their parents.  I am not sure where this phenomena stems from, but it does seem to be universal.  My wife and I often coerce our children to behave by threatening to tell their teachers about their behavior.  I guess it is true that it really does take a village to raise a child.

Fortunately, while my kids might not listen to my advice, it seems that the words that I say to my pediatric patients often have profound impact (ok, at least in my mind).  Unquestionably, our ability to influence and educate our patients and their families should not be underestimated.  This is particularly true when it comes to Injury Prevention.

We have discussed previously the significant impact of Unintentional Injury.  Use your powers of suggestion, persuasion, and education to augment the community’s Injury Prevention efforts.

Unintentional Injuries

  • Without question, accidental injuries are the leading cause of morbidity and mortality for almost every age of life.
  • It is estimated that one child dies every hour from an injury.
  • It is estimated that EVERY 4 Seconds (in the USA), a child is treated in the Emergency Department for an injury!
  • While these numbers are startling, they also highlight an opportunity.  There are many children being seen in our Emergency Departments who can benefit from our perspective, wisdom, and education.

 

Injury Prevention in the ED

  • Yes, Injury Prevention topics are commonly discussed in the Primary Care Provider’s office, but that does not mean that we should overlook our opportunity to help in the ED or undervalue our impact.
  • A lesson is often not learned until hearing it multiple times.
    • Be a part of the chorus signing the songs of safety (close your eyes, you can almost hear it).
    • Your voice may be the one that is finally heard.
  • The lesson is often best appreciated when the true significance (or potential significance) is felt.
    • Fear is a powerful motivator.
    • If some one isn’t scared about what could have happened… paint a scary picture for them (you have seen enough to be able to do that vividly).
  • When you are evaluating a child with a minor injury, it is a perfect time to discuss ways to ensure that minor injuries do not become major injuries.
  • It is also useful to reinforce positive behaviors (ex, “I am so glad that you were wearing your seatbelt today.  This is why you don’t have any bad injuries.”)

 

But I don’t have time…

  • Yes, we are incredibly busy in the Emergency Department… but, many times we actually have MORE TIME than the kid’s Primary Care Provider has with them.
    • Most kids won’t spend multiple consecutive hours in their PCP’s office.
    • Even for kids with minor injuries, we still often have multiple encounters with them (ex, initial evaluation, discussion of x-ray results, wound irrigation, wound repair, discharge, etc.).
  • You don’t need to give the child a 20 min lecture (which they won’t listen to anyway).
    • Use short, pointed and memorable statements each time you interact with them. These can be very profound.
  • Don’t underestimate the significance of simple statements, like “Wear your helmet! I can fix your forearm. I cannot fix your brain.”

 

But I don’t want to offend the parent…

  • As I said in the beginning, it takes a village to raise a child… and ALL parents need help.
  • Many times the parents are on the same page, but the kid hasn’t been hearing them (like my kids are deaf to my instructions).
  • Occasionally, everyone in the room needs some education… and if that is what it takes to prevent this kid from getting another injury, then that is our job also.

 

Moral of the Morsel

  • We play a vital role in Injury Prevention, particularly with our Pediatric patients.
  • Your voice often is heard over others, so don’t muffle it.
  • Take EVERY opportunity to bring up Injury Prevention issues… to help prevent from seeing that child in your ED again.
  • Look at the Big 6 causes of injury in children and at least focus on those… but there are many others, like Firearm Safety, that are appropriate to bring up during ED visits also.

 

 

References

American College of Emergency Physicians. Role of the emergency physician in injury prevention and control for adult and pediatric patients. Ann Emerg Med. 2008 Nov;52(5):594-5. PMID: 18971004. [PubMed] [Read by QxMD]
Dowd MD, Sege RD; Council on Injury, Violence, and Poison Prevention Executive Committee; American Academy of Pediatrics. Firearm-related injuries affecting the pediatric population. Pediatrics. 2012 Nov;130(5):e1416-23. PMID: 23080412. [PubMed] [Read by QxMD]
American Academy of Pediatrics Section on Orthopaedics; American Academy of Pediatrics Committee on Pediatric Emergency Medicine; American Academy of Pediatrics Section on Critical Care; American Academy of Pediatrics Section on Surgery; American Academy of Pediatrics Section on Transport Medicine; American Academy of Pediatrics Committee on Pediatric Emergency Medicine; Pediatric Orthopaedic Society of North America, Krug SE, Tuggle DW. Management of pediatric trauma. Pediatrics. 2008 Apr;121(4):849-54. PMID: 18381551. [PubMed] [Read by QxMD]

Gielen AC, Wilson ME, McDonald EM, Serwint JR, Andrews JS, Hwang WT, Wang MC. Randomized trial of enhanced anticipatory guidance for injury prevention. Arch Pediatr Adolesc Med. 2001 Jan;155(1):42-9. PMID: 11177061. [PubMed] [Read by QxMD]

Sean Fox

I enjoy taking care of patients and I finding it endlessly rewarding to help train others to do the same. I trained at the Combined Emergency Medicine and Pediatrics residency program at University of Maryland, where I had the tremendous fortune of learning from world renown educators and clinicians. Now I have the unbelievable honor of working with an unbelievably gifted group of practitioners at Carolinas Medical Center. I strive every day to inspire my residents as much as they inspire me.

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