Pivoting injury prevention efforts during a pandemic.

Tanya Charyk Stewart, MSc
Purnima Unni, MPH
Holly R. Hanson, MD, MS
Jason Gilliland, PhD
Andrew Clark, PhD
Douglas D. Fraser, MD, PhD

Declaring COVID-19 a pandemic on March 11, 2021 changed the world. Public health directives to stay at home, socially distance, and lockdown by restricting access to businesses, schools, and recreation facilities, fundamentally changed our exposure to injury risk factors, resulting patterns of injury, and conducting injury prevention (IP). The objective of this study was to determine the impact the COVID-19 pandemic on injury and its prevention at trauma centers in Canada and the United States.

A survey was created and pre-tested on the REDCap platform. Survey domains were: 1) IP initiatives; 2) injury data; 3) staffing and funding; 5) IP pandemic pivots; 6) facilitators and barriers; 7) training; and 8) demographics. The online survey was distributed through trauma/IP associations: Pediatric Trauma Society, Trauma Association of Canada, and Injury Free Coalition for Kids. An initial survey invitation and two email reminders were distributed to members. Descriptive statistics were calculated on responses.

A total of 59 responses were received from pediatric (43%), adult (12%), and combined (34%) trauma centers, from 22 states and 4 provinces. Most respondents were female (71%), in an IP Specialist role (68%), averaging 10.5 years IP experience. The majority (89%) of programs targeted age groups from birth to 15 years old. Nearly one-third reported IP to be less of an institutional priority with 18% of centers having funding changes [median -17% (-41, 8.5)], resulting in staffing changes at 37% of centers (36% redeployments and 15% terminations). IP efforts decreased at 63% trauma centers during the pandemic, particularly with in-person programs, including community events (-87%) and school-based programs (-83%). Overall, 85% of respondents reviewed injury data to keep current with changing injury epidemiology. The top reported increased mechanisms were mainly intentional: GSW (78%), abuse (73%), assaults (70%), and self-inflicted (70%). Leading increased unintentional injuries were home (65%), ATV (64%), and cycling (56%) injuries. Leading pivots and innovations were presenting (75%) or participating (73%) in IP education virtually, posting on social media (61%), adding technology (31%), and combining COVID-IP messaging (17%). Virtual programming was the leading training requested (77%). Top barriers to pivoting were redeployment of partners (46%) and staff (31%), as well as lack of technology (39%) in the target population. Facilitators were technology at trauma center (76%), support of trauma program (66%), and having IP funding maintained (58%).

Nearly two-thirds of trauma centers decreased IP efforts during the pandemic due to staffing and funding reductions. The leading increased injury mechanisms were intentional, so further intentional and violence prevention is needed, along with support for mental health. While trauma centers successfully pivoted by using technology and going virtual, access issues in the target population were a barrier resulting in health inequities. This needs addressing to be able to prevent injuries for all subpopulations equally.

1. Describe the impact of the COVID-19 pandemic on injury prevention staffing, funding and programming at trauma centers in Canada and the United States.
2. Quantify changes in injury epidemiology and injury prevention efforts during the COVID-19 pandemic.
3. Identify facilitators and barriers to pivoting injury prevention efforts due to the pandemic, as well as training opportunities for injury prevention practitioners.