National EMS Education
Standard Competencies
Public Health
Applies fundamental knowledge of principles of public health and epidemiology including public health emergencies, health promotion, and illness and injury prevention.

Introduction
• EMS providers have an important role to play in injury and illness prevention.
– Injury and illness prevention are an important part of public health.

Role of Public Health
• Public health
• Practice of preventing disease and promoting good health within groups of people
• Health and wellness have become a focus of the US health care system.

Injuries as Public Health
Threats
• Injuries
• Intentional or unintentional damage to the person resulting from exposure to energy or absence of essentials
• Injuries historically reported under distinct umbrellas
© Ryan McVay/Photodisc/Getty Images

Injuries as Public Health
Threats
• May be intentional or unintentional
– EMS usually has a greater impact on preventing unintentional injuries.

Injuries as Public Health
Threats
• Many health experts consider injury the largest problem facing the
US today.
• It is important to understand how injury affects different age groups.

Injuries as Public Health
Threats
• Years of potential life lost
– Assume a productive work life until age 65.
– Deduct the year of death from that age.
• It is easier to measure death rates than morbidity rates.

Illness and Disease as Public
Health Threats
• Each year, 7 out of
10 Americans die from a chronic disease.
• Causes include:
– Poor nutrition
– Excessive alcohol intake
– Tobacco use
– Sedentary lifestyle

Illness and Disease as Public
Health Threats
• Health threats include:
– Asthma
– Influenza
– Water supply or seafood contamination
– Lack of sanitary conditions following a natural disaster

Public Health Efforts
© Capifrutta/ShutterStock, Inc.
• The APHA recommends three reforms:
– Policies/funding
– Strengthen public health system
– All-access system
• Public health efforts can impact many levels of society.

Public Health Efforts
• Preventing adverse outcomes is a major goal of public health programs.
– Education campaigns have promoted:
• Disease screening
• Injury prevention
• Prenatal care

Public Health Laws,
Regulations, and Guidelines
• Public health laws or regulations include:
– HIPAA
– State laws
– WHO Framework Convention on Tobacco
Control
– FDA regulations

EMS Interface With Public
Health
• Joint agreement on medical and public health response to terrorism:
– APHA
– NAEMSP
– National Association of State EMS Directors

EMS Interface With Public
Health
• September: National
Preparedness Month
– Get Ready Day
• H1N1 safety
• Floods
• Heat waves
• Power outages
• Winter storms
• Earthquakes
Courtesy of the American Public Heath Assocation.
Photographed by David Fouse .

Injury and Illness Prevention and EMS
© Dewitt/ShutterStock, Inc.
• EMS providers can lead or support interventions.
– EMS is an advocate and practitioner.
• Illness and injury prevention have similar techniques.

Common Roots
• “ Accidental Death and Disability: The
Neglected Disease in Modern
Society ”
• Injury prevention always included
EMS.
– Primary
– Secondary
• There is a role for every provider.
© Steven Townsend/Code 3 Images

Why EMS Should Be Involved
• There are a number of reasons EMS is especially suited to be involved. Providers:
– Reflect community composition
– Are medically sophisticated
– Are high-profile role models
– Have access to community

Principles of Injury and Illness
Prevention
• Risk
– A potentially hazardous situation in which the well-being of people can be harmed
• Four E s of Prevention
Courtesy of Captain
David Jackson,
Saginaw Township
Fire Department

The 4 Es of Prevention
• Education
– Inform people about potential dangers, persuade them to change behaviors
– Effective messages are:
• Tailored to specific groups
• Reinforced with meaningful rewards
• Enforcement
– Legislation and regulation
•
Formulates rules that require people, manufacturers, and governments to comply with safety practices
– Litigation can also lead to enforcement.

The 4 Es of Prevention
• Engineering/environment
– Passive interventions
– Can be social, legal, political, or cultural
• Economic incentives
– Economic self-interest provides monetary incentives to reinforce safe behavior.

The Value of Automatic
Protections
• Passive interventions are often the most successful.
– Provide constant protection without conscious action from user
• A combination of approaches is still the most effective strategy.

Models for Injury and Illness
Prevention
• Visual models describe a health problem and how to approach it.
– Focuses on: host, agent, environment

The Haddon Matrix
• Added factor of time to previous models to address causes of injury
• The host, agent, and environment interact over time to cause injury and correspond to:
– Pre-event
– Event
– Post-event

The Haddon Matrix
• Matrix uses nine components to analyze the injury
– Encourages creative thinking
• Injury prevention requires broad and innovative thinking to be most successful.

Injury and Illness Surveillance
• Data are collected, disseminated to people/ organizations that can effect change
– Applied to interventions
• Strong surveillance is fundamental to effective programs.

Getting Started in Your
Community
• To be effective, you need to understand:
– Injury and illness patterns
– Characteristics of the population, environment
– The types of risks present
• Your regional/state EMS department/public health office will have the most information.

Getting Started in Your
Community
• Intentional injuries
– Assaults are more likely to be fatal in the US.
– There are risk factors connected with intentional violence.
– EMS providers:
• Reporting data
• Note risk factors
© Mikael Karlsson/On Scene Photography

Getting Started in Your
Community
• Unintentional
Injuries
– “ Accidents ”
• In Children:
– 20 million annually
– Children are:
• At higher risk
• More likely to be seriously affected
– “ Pass-along effect ”
© SuperStock/age fotostock

Getting Started in Your
Community
• Risk factors for children
– Lower socioeconomic status
– Injuries are more likely to occur where there is:
• Water
• Heat
• Toxic agents
• High potential “ energy ”

Getting Started in Your
Community
• Risk factors for children (cont ’ d)
– Unintentional injuries are greatest threat
– School injuries are not uncommon.
– 45% of cases are severe injuries.
• Priority prevention efforts are injuries with highest:
– Mortality rate
– Hospitalization rate
– Long-term disability rate
– Effective countermeasures

Getting Started in Your
Community
• Illness Prevention
– Illness prevention is gaining attention.
– Example: poor health in adolescents
• Tobacco/alcohol/oth er drugs
• STDs/unplanned pregnancies
• Unhealthy diet
•
Sedentary lifestyle
• Community
Organizing
– Implementation plan, should include:
• Identify a leader.
• Build support base.
• Create a timeline.
•
Gather data, facts.
• Choose goals.
•
Establish funding.
• Be positive, persist.

Getting Started in Your
Community
• Five steps of a prevention program
– Conduct community assessment.
• Bring people and groups together.
• Represent the community at large.
• Include survivors, their families.
• Identify partners.

Getting Started in Your
Community
• Five steps of a prevention program (cont ’ d)
– Define problem.
• In specific, quantifiable terms
– Set goals and objectives.
• Goals: broad, general, long-term
• Objectives: specific, time-limited, quantifiable
– Process or outcome

Getting Started in Your
Community
• Five steps of a prevention program (cont ’ d)
– Plan and test interventions.
• Actions to accomplish your goals, objectives
– Implement and evaluate interventions.
• Must be able to measure results quantitatively

Getting Started in Your
Community
• Funding a prevention program
– Consider innovative ways to fund programs.
– Partner with the media.
– Look for grants and sponsorships.
– Network with other prevention programs.

How Every Provider Can Be
Involved
• Paramedics can, and should, be involved in prevention to some extent.
– Be a role model.
• Responding to the call
– Very few calls require the use of lights and sirens.
– Dispatchers can be a resource.

How Every Provider Can Be
Involved
© Craig Jackson/IntheDarkPhotography.com
• Education for EMS providers
– Understand the fundamentals of prevention
• “ Teachable moment ”
– Articulate and reinforce safety messages.
– Use good judgment.
– Be sensitive.

How Every Provider Can Be
Involved
• Collection/analysis of data and research
– Vital for:
• Measuring trends
• Validating interventions
• Assessing resources
• Persuading others to act

How Every Provider Can Be
Involved
• Collection/analysis of data and research
(cont ’ d)
– Starts with prehospital care reports
– Be a leader by:
• Being a role model
• Reaching out in your community

Summary
• Public health encompasses health promotion and disease prevention for groups of people.
• Federal, state, and international rules, regulations, guidelines, and laws govern public health.
• Every September is National Preparedness
Month.

Summary
• Many paramedics have been motivated by their field experience to work actively on prevention.
• The 1966 National Academy of
Sciences/National Research Council study,
“ Accidental Death and Disability: The
Neglected Disease of Modern Society, ” noted that EMS could help with trauma after an event, and injury prevention could help prevent an accident before it happens.

Summary
• The 1996 Consensus Statement on the
EMS Role in Primary Injury Prevention emphasized that primary injury prevention is an essential activity of EMS.
• EMS can play a supporting role in preventing intentional injuries and can have an even larger impact in preventing unintentional injuries.

Summary
• The years of potential life lost concept is another way to measure the cost of unintentional injury to society.
• The 4 Es of prevention are education, enforcement, engineering/environment, and economic incentives.
• Automatic protections do not require a conscious decision to act; an example is including air bags in automobiles

Summary
• The Haddon matrix uses nine separate components to analyze injury.
• Surveillance is the ongoing systematic collection, analysis, and interpretation of data essential to the planning, implementation, and evaluation of public health practice.
• Paramedics need to triage their focus on prevention —do not let the headlines be your guide.

Summary
• The five steps to developing a prevention program are: conduct a community assessment, define the problem, set goals and objectives, plan and test interventions, and implement and evaluate interventions.
• Primary prevention begins at home by taking care of yourself and presenting a role model for others in your service and in the community.

Summary
• The best teachable moments are those that convey positive reinforcement.
• The importance of collecting data in measuring trends, validating interventions, assessing resources, and ultimately persuading others to act cannot be overestimated.

Credits
• Chapter opener: © National Museum of Health and
Medicine, Armed Forces Institute of Pathology,
(NCP1603)
• Backgrounds: Green – Courtesy of Rhonda Beck;
Blue – Courtesy of Rhonda Beck; Orange – © Keith
Brofsky/Photodisc/Getty Images; Purple – Courtesy of Rhonda Beck.
•
• Unless otherwise indicated, all photographs and illustrations are under copyright of Jones & Bartlett
Learning, courtesy of Maryland Institute for
Emergency Medical Services Systems, or have been provided by the American Academy of
Orthopaedic Surgeons.