Illinois Emergency Medical Services for Children (EMSC)

Illinois Emergency Medical Services for Children (EMSC)

Authors Ruth Kafensztok, DrPH, IL EMSC Program, Loyola University Medical Center, Maywood, IL Daniel Leonard, MS, IL EMSC Program, Loyola University Medical Center, Maywood, IL Evelyn Lyons, RN, MPH, IL EMS for Children (EMSC) Program, Illinois Department of Public Health, Chicago/Springfield, Maywood, IL

Acknowledgements The project presented in this session is supported in part by funding from the Illinois Department of Transportation and the Maternal & Child Health Bureau, Department of Health and Human Services.

This Presentation How medical and public health related data systems can be used to understand the population burden of motor vehicle traffic (MVT) injuries. From the epidemiologist perspective we will examine: The evolution of the concept of injury in epidemiology A framework to study MVT injury epidemiology How we capture MVT injuries in statewide populationbased data sources Limitations and opportunities of current data systems

BURDEN OF INJURIES IN THE US, 2006 MV traffic (24.4%) 179,065 Deaths 3,000,000 Hospital admissions 3 th major cause of all hospitalization 42,400,000 ED visits MV traffic (9.5%) 81,400,000 Outpatient visits Source: National Center for Health Statistics data sources and surveys

10 Leading Causes of Death, United States 2006, All Races, Both Sexes Age Groups Rank <1 1-4 5-9 10-14 15-24 25-34 35-44 45-54 55-64 65+ All Ages 1 5,819 1,610 1,044 1,214 16,229 14,954 17,534 50,334 101,454 510,542 631,636 2 Short Gestation 4,841 515 459 448 Homicide 5,717 Suicide 4,985 13,917 38,095 65,477 387,515 559,888 3 SIDS 2,323 377 182 Homicide 241 Suicide 4,189 Homicide 4,725 12,339 19,675 12,375 117,010 137,119 4 Maternal Pregnancy Comp. 1,683 Homicide 366 Homicide 149 Suicide 216 1,644 3,656 Suicide 6,591 Liver 7,712 11,446 106,845 124,583 5 1,147 161 90 163 1,076 3,307 HIV 4,010 Suicide 7,426 11,432 Alzheimer's 71,660 121,599 6 Placenta Cord Membranes 1,140 125 52 162 460 HIV 1,182 Homicide 3,020 6,341 10,518 52,351 72,449 7 Distress 825 88 45 63 210 673 Liver 2,551 5,692 Liver 7,217 49,346 Alzheimer's 72,432 8 Bacterial Sepsis 807 Perinatal Period 65 40 50 HIV 206 527 2,221 HIV 4,377 Suicide 4,583 Nephritis 37,377 56,326 9 Neonatal Hemorrhage 618 Benign 60 40 44 184 437 2,094 3,924 Nephritis 4,368 36,689 Nephritis 45,344 10 Circulatory System 543 54 Benign 38 Benign 38 Complicated Pregnancy 179 335 870 Viral Hepatitis 2,911 4,032 26,201 Produced By: Office of Statistics and Programming, National Center for Prevention and Control, Centers for Control and Prevention Data Source: National Center for Health Statistics (NCHS), National Vital Statistics System 34,234

What is? Historically referred as accidents singular, individualized and unrelated event Industrialization (19 th century) injury becomes more apparent and clustered along the new environmental risks posed by industrialization. 1942 Dugh De Haven Studied the structural conditions in which injuries occurred Mid 20 th century and later Development of injury epidemiology and prevention

1950 s John Gordon Applied the classic framework of Epidemiology to the study of Host Agent (e.g., MV, Guns) Environment 1961 James Gibson Defined the agent of occurrence as abnormal/excessive energy interchange Host Agent as energy interchange Environment 1968 William Haddon Incorporated the absence of energy elements, such as oxygen and heat, to the definition of agent Host Agent as energy interchange or absence of necessary energy elements Environment

Historical Highlights Policy Development: 1965 Unsafe at Any Speed (Ralph Nader) 1966 US Highway Safety Act 1966 NAS/NRC: Accidental Death and Disability: The Neglected of Modern Society 1970 Occupational Safety and Health Act 1972 Consumer Product Safety Act 1973 EMS System Act 1985 in America: A Continuing Public Health Problem 1992 National Center for Prevention and Control, CDC

What is injury? Current definition: any unintentional or intentional damage to the body resulting from acute exposure to thermal, mechanical, electrical, or chemical energy or from the absence of such essentials as heat or oxygen. (National Committee for Prevention and Control, 1989)

Types of Harmful Energy Transfer Energy Type Mechanical (Kinetic) Thermal Chemical Electrical Radiation Absence of Energy Elements Oxygen Heat Example Unrestrained MV occupant ejection Heat and flames of a fire Ingestion of cleaning fluid Contact with exposed high-voltage wire Severe sunburn Example Drowning Hypothermia

Types of Harmful Energy Transfer Energy Type Mechanical (Kinetic) Thermal Chemical Electrical Radiation Absence of Energy Elements Oxygen Heat Example Unrestrained MV occupant ejection Heat and flames of a fire Ingestion of cleaning fluid Contact with exposed high-voltage wire Severe sunburn Example Drowning Hypothermia

Natural History of MVT Injuries Pre-Crash Crash Post-Crash Crash Information System Other traffic records data sources Prehospital Care Report Outpatient ED visit data Trauma Registry Hospital Inpatient admission data Death Certificate data system Fatality Analysis Reporting System

Epidemiology and Prevention Framework: Haddon Matrix (1970) Phases Factors Human Agent/Vehicle Environment Pre-event Event Post-event

Haddon Matrix (Applied to MVT) Human Vehicle Environment Pre- Phase Motor Vehicle in Transit Phase Traffic Crash Transfer of energy at rates and in amounts above or below the tolerance of human tissue No Post- Phase Fatality Non-Fatality Host: MV occup/non-occupant Agent: Mechanical energy Vehicle: Motor Vehicle Environment: Road, Weather, Light Return to preinjury state Disability state

Epidemiology and Prevention Framework: Haddon Matrix (1970) Phases Pre-event Event Post-event Factors Human Agent/Vehicle Environment Primary Prevention Human: driver education Secondary Agent/Vehicle: Prevention Vehicle maintenance Human: Environment Seat belt (Physical): modifications Agent/Vehicle: Tertiary to roadways, Prevention Crashworthiness speed limits (crush space, forgiving windshield, no dashboard protrusions) Environment (Sociocultural): Public Human: Crash victim underlying health status attitudes/awareness Environment (Physical): Motorway safety barriers (side rails) Environment Agent/Vehicle: (Sociocultural): Gas tanks designed Enforcement to minimize of seatbelt chance use of laws post-crash fire Environment (Physical): Effective EMS/Trauma system Environment (Sociocultural): Public support for EMS

How do we capture MVT injury data? (1) Multidimensional Concept of : Intentionality Intentional Undetermined Intent External Cause Place of Occurrence ICD-9 E-Code E-Code 849x 810.x-819.x 849.5 Clinical Manifestation ICD-9 Code 800-959 Severity Severity Scales

How do we capture MVT injury data? (2) Statewide health/medical data sources Can MVT injury be captured by Prehospital Care Report Emergency Department visits and Hospital admissions Trauma Registry Death Certificate Traffic Crash Report External Cause? Complaint Reported By Dispatch E-code fields (3 fields) E-code (3 fields) Underlying MVT exclusively Cause of Cause of Death Clinical Manifestation? Possible Principal Diagnosis Nature of (20 fields) Other causes of death No Provider's Impression Other Diagnoses (24 fields) (4 fields) (Primary and Secondary) Severity? Glascow Coma Scale (ISS can be calculated) Glascow Coma Scale KABCO scale Pediatric Trauma Score Abbreviated Scale (AIS) Severity Score (ISS) Place of Occurrence? Incident Location Type Recorded mostly in 2nd or Place of injury Place of Code Public roadway 3rd E-code field Intentionality? No Yes Yes Yes No Other? Use of Occupant Safety Equipment Safety Equipment County of Airbag Deployment Vehicle Seat Position City of Vehicular Indicators Ejection from Vehicle Community Area of Law Enforcement/Crash Number Crash Record Number Month of

BURDEN OF MVT INJURIES Illinois, 2009 911 MVT Deaths 108 thousand injury/poisoning hospitalizations Approx. 1 million injury/poisoning related ED visits Approx 90,000 Crash Report Fatal and Non- Fatal Injuries + Unknown number of private roadways injuries + Other unreported injuries Sources: 2009 Illinois Crash Facts and Statistics, IDOT; and 2009 Inpatient & Outpatient data, IHA.

10 Leading Causes of Death, Illinois 2007, All Races, Both Sexes Age Groups Rank <1 1-4 5-9 10-14 15-24 25-34 35-44 45-54 55-64 65+ All Ages 1 2 3 4 5 6 7 8 9 10 Short Gestation 295 216 Maternal Pregnancy Comp. 79 SIDS 54 50 Placenta Cord Membranes 43 Distress 31 Neonatal Hemorrhage 30 Bacterial Sepsis 27 Circulatory System 27 55 26 Homicide 17 14 9 4 Benign 3 3 42 14 9 Homicide 8 5 3 1 Perinatal Period 1 Pneumonitis 1 3 Three Tied 2 54 Homicide 21 18 9 Suicide 9 4 4 Benign 3 Aortic Aneurysm 2 2 554 Homicide 309 Suicide 164 57 43 12 11 11 9 8 504 Homicide 237 166 Suicide 163 135 HIV 31 23 23 22 22 606 559 525 Suicide 222 Homicide 108 Liver 108 HIV 90 75 70 55 2,137 1,690 696 Liver 289 264 Suicide 235 209 150 Nephritis 134 130 4,336 2,770 443 436 412 396 272 Liver 243 Nephritis 217 158 20,578 16,840 5,076 4,092 Alzheimer's 2,692 2,207 Nephritis 2,127 2,097 1,595 1,407 WISQARS TM Produced By: Office of Statistics and Programming, National Center for Prevention and Control, Centers for Control and Prevention Data Source: National Center for Health Statistics (NCHS), National Vital Statistics System 25,813 24,115 5,864 4,742 4,367 2,851 Alzheimer's 2,734 2,550 Nephritis 2,536 2,099

Limitations: Within data systems: Practice of e-coding injury data Granularity of MVT injury data Missing information Across data systems: Data fragmentation Need for better partnerships among agencies

Opportunities: Data integration efforts (CODES) Mandatory E-coding in inpatient data (as of 2008) Mandatory reporting of Emergency Department visits (as of 2009) Other data collection efforts

Questions?