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Enhanced EMS for Injury Prevention: Responding Before the Emergency

What if you could respond to an emergency before it happened and actually prevent it? Far from being a time-traveling fantasy, the idea of preventing injury is one EMS providers talk about a lot. In the November 2004 issue of EMS Magazine, Thom Dick and Chris Hendricks each presented practice protocols to assist readers in developing the skill of seeing where injury could occur and ways to intervene. National studies and roundtable discussions on the issue have been sponsored by the National Highway Traffic Safety Administration (NHTSA), the Centers for Disease Control and Prevention (CDC) and the Institute of Medicine (IOM), among others. In fact, according to Joseph Sabato, Jr., MD, medical director of the Nashua (NH) Division of Public Health, "Back in 1988, the IOM said there was a need for a well-trained injury prevention work force at the community level. And in 1998, they said the same thing." In 2000 - 2001, NHTSA, the CDC and the National Association of EMS Physicians (NAEMSP) got into the act with a roundtable about bringing emergency response and public health together to reduce injuries. They saw how the fire service had created one of the most successful public health efforts in history, cutting fire deaths in half over the last 20 years.

"It's not a big jump from investigating fires and understanding causes and prevention to doing the same thing with traffic crashes and other risks in the community," says Sabato. When he read an article by Rick Smith of the Indian Health Service, who said there had been effective injury prevention utilizing EMS in that system, Sabato thought, "Why not everywhere?" Indeed, why not create a program for injury prevention and certify paramedics in the skill set?

Now the medical director is project coordinator of the very thing. Under the umbrella of the New Hampshire Intersections Project, a joint effort of Keane State College, the Safety and Health Council of New Hampshire and local Nashua Highway Safety, which brings public health, public safety and emergency response together for education around injury prevention, the certification of Enhanced EMS for Injury Prevention is one aspect of an even broader vision called Emergency Public Health.

Enhanced EMS for Injury Prevention is only a first step, Sabato says, toward an advanced EMS degree at the bachelor's or master's level in Emergency Public Health. "Emergency Public Health is a concept recognizing emergencies as opportunities for prevention, intervention and preparation," says the concept's official website. This certification program for paramedics, then, is a strong start.

Underwritten by NHTSA and presented at Keane State College and the Richard M. Flynn Fire Academy, in Keane and Concord, NH, respectively, the 48-hour course combines coursework with independent community projects over a three-and-ahalf month period. Students learn about the causes and frequency of crashes, falls and other risks, as well as the efficacy of different prevention techniques and practices (such as the impact seat belt and helmet laws have had on traffic fatalities). Participants must gather information to identify risks in their own communities and develop intervention techniques that might reduce them. Each medic then proposes and initiates a community project to help prevent injuries in their area of service. Projects included an educational program geared to teenagers about seat belt use and safe driving; a community contest that involved kids in the identification of dangerous intersections, as well as redesigning and reconstructing them more safely; free child safety seat inspections and more. The initial class enrolled and graduated 11 participants from eight different agencies in Massachusetts and New Hampshire. The NHTSA involvement required all projects to be traffic related, though Sabato says many graduates went back to their communities and developed new initiatives to prevent injury from falls and other risks. (See Making a Baby’s Safe Haven Safer).

"EMS folks are problem-solvers," says Sabato. "They bring public health and public safety together, so this is right for EMS. A fire chief who had some of his paramedics in the project said, 'I want the folks who go to town meetings to begin to associate us with the flu clinic, with safety in their homes for things like fall prevention. I want people to think about us beyond the guy who put them in the back of an ambulance. If they see us as more than that one bad day, it makes marketing our value that much easier.'"

The next training is scheduled for January 2006. A train-the-trainer program is in development for emergency physicians to implement these programs in their areas. For more information, visit www.emergency, or contact the project coordinator at 603/537-1903 or e-mail at

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