Chapter 3

Public Health
 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

© Carolyn Brule/ShutterStock, Inc.

person resulting
from exposure to
energy or absence © Ryan McVay/Photodisc/Getty Images

of essentials
• Injuries historically
reported under
distinct umbrellas
 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

• The APHA
recommends three
reforms:
– Policies/funding
– Strengthen public
health system
– All-access system
© Capifrutta/ShutterStock, Inc.
• 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 Courtesy of the American Public Heath Assocation.

• Earthquakes
Photographed by David Fouse.
Injury and Illness Prevention
and EMS
• EMS providers can
lead or support
interventions.
– EMS is an
advocate and
practitioner.

• Illness and injury

© Dewitt/ShutterStock, Inc.
prevention have
similar techniques.
 Common Roots

• “Accidental Death • There is a role for

and Disability: The every provider.
Neglected Disease
in Modern
Society”
• Injury prevention
always included
EMS.
– Primary © Steven Townsend/Code 3 Images

– Secondary
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 Henry Pollak

Korostyshevskiy/ShutterSto

Courtesy of Captain
David Jackson,
Saginaw Township
© Vladimir

Fire Department
ck, Inc
 The 4 Es of Prevention

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

© Cristina Fumi/ShutterStock, Inc.

• Visual models
describe a health
problem and how

© Photos.com
to approach it.
– Focuses on:
host, agent,
environment

Nilsson/Shutter
© Andreas

Stock, Inc.
 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: © Mikael Karlsson/On Scene Photography

• Reporting data
• Note risk factors
 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 • Priority prevention
children (cont’d) efforts are injuries
– Unintentional with highest:
injuries are greatest – Mortality rate
threat – Hospitalization rate
– School injuries are – Long-term disability
not uncommon. rate
– 45% of cases are – Effective
severe injuries.
countermeasures
 Getting Started in Your
Community
• Illness Prevention • Community
– Illness prevention is Organizing
gaining attention. – Implementation plan,
– Example: poor health should include:
in adolescents • Identify a leader.
• Tobacco/alcohol/oth • Build support base.
er drugs • Create a timeline.
• STDs/unplanned • Gather data, facts.
pregnancies
• Choose goals.
• Unhealthy diet
• Establish funding.
• Sedentary lifestyle
• Be positive, persist.
 Getting Started in Your
Community
• Five steps of a

© Steven Townsend/Code 3 Images

prevention program
– Conduct community
assessment.
• Bring people and
groups together.
• Represent the

© Mikael Karlsson/Alamy Images

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
• Education for EMS
providers
– Understand the
fundamentals of
prevention

• “Teachable moment”
– Articulate and reinforce
© Craig Jackson/IntheDarkPhotography.com 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.
•