The only effective vaccine against the disease of injury is prevention.
How well does this vaccine work?
What can be done to make it better?
How can it be refined so that the incidence of injury and its severity pose less threat to a child’s life and more likelihood for a more complete recovery?
The Jacksonville project of The Robert Wood Johnson Injury Free Coalition for Children continues to seek answers to these questions.
· The project began because regional trauma system data identified the children of Jacksonville’s urban core as having the highest risk for premature traumatic death among all the children of the 24 adjacent counties in Northeast Florida and Southeast Georgia.
· It continues because the tools developed by the project continue to measure the effect of injury and guide more effective prevention.
What is ShandsJacksonville?
For the past 20 years, Shands Jacksonville has provided a state-designated Level I trauma service, including a pediatric trauma referral center, for a 24 county geographic region. In additional to providing definitive trauma care, Shands Jacksonville has also developed a comprehensive dataset defining the physiologic presentation and outcome of acute care of severe pediatric injury.
What is the Jacksonville Project?
The Jacksonville project combines the efforts of a community coalition led by Shands Jacksonville, a state designated Level I trauma center and pediatric trauma referral center serving this 24 county region. The community coalition included representatives from city government, emergency medical services agencies, health department, rehabilitation, brain and spinal cord injury surveillance program, and the full spectrum of medical disciplines routinely involved in the care of injured children. The core of this group, the Jacksonville Pediatric Injury Control System (JPICS), was established in 1991 as a bi-monthly forum for the evaluation of the disease of injury in the children of Northeast Florida.
Project Team Strategy
The Jacksonville project was designed to attack the disease of injury from two fronts.
Prevention: The population with the highest severity and incidence of injury would be analyzed to define more effective prevention strategies.
Effect of the disease. The effect of disease of childhood injury would be redefined beyond simple metrics of survival to a more comprehensive and objective description of functional recovery, societal re-integration, and need for long term social service support.
Effective management of a problem requires valid measurement and accurate monitoring.
Emergency department electronic surveillance system Status: fully functional
Quarterly reports of volume and type of injury encountered in the pediatric emergency department. Analysis of epidemiology of adolescent pedestrian injury in Jacksonville compared to National Pediatric Trauma Registry data. Integration with GIS mapping to track incidence of pedestrian injuries and effect of prevention initiatives. Surveillance of incidence and epidemiology of traumatic brain injury resulting from toddler falls. Longitudinally linked EMS, Trauma , Rehabilitation, and Brain Injury Surveillance system. Status: Components built, linkages being established as statewide initiative.
1. Full integration with Kiwanis International Pediatric Trauma Registry and Knowledge Portal
2. Fully functional web based pediatric trauma registry
Prevention Education Tools
"Mothers Against Brain Injury" (M.A.B.I.) was founded help provide simple creature comforts intended to make the long hours in cold hospital waiting rooms a little more tolerable. Its founders all experienced the pain of caring for a child with an acute traumatic brain injury, and confronted firsthand the anxiety and confusion that such catastrophe engenders. To date this organization has established programs in every Florida Trauma Center, and has expanded to centers in eight other states. Over 3,000 totes of hope have been distributed throughout the country.
Besides raising TBI awareness, this program continues to engender the sincere gratitude of many mothers as evidenced by notes of thanks to the organizers of M.A.B.I. The organization’s unique mission focused on what has traditionally been an under served aspect of the disease of injury has earned it recognition as an important component in both the acute care of brain injury and in helping families prepare for the arduous road to recovery.
Turning Point: Preventing Violence
This project offers teens convicted of a first violent crime a family based mandatory 14 hour educational program. It was begun in 1999, and its effect in preventing recidivism published in 2002 (Scott KK, Tepas JJ, Frykberg E: Turning Point: Rethinking Violence--Evaluation of Program Efficacy in Reducing Adolescent Violent Crime Recidivism. J Trauma 53:21-27, 2002.). A follow- up analysis of five years’ experience and continued low recidivism was presented at the annual meeting of the Eastern Association for the Surgery of Trauma in 2007 and won the Templeton Award for Injury Prevention
Teens Telling Teens
Plan: Safe Driving / Seat Belt Safety Initiate and implement education and community involvement with law enforcement efforts to surround zone 1 residents with safe driving and riding practices addressing seat belt usage, appropriate child restraint use, and driving under the influence (DUI) of drug and / or alcohol. The education and awareness programs will be implemented through local businesses, the religious community, and neighborhood organizations.
Result: This project was coordinated by MABI and funded by a grant from Allstate Insurance Company. Each Jacksonville high school was challenged to produce a 30-60 second video regarding teen driving safety. Winning three presentations were selected by a group of judges and televised by a local station. For 2009, teens will actually judge the winners and all finalists will be televised to enable viewers to determine the winner.
Plan: Bicycle Safety Program A comprehensive Bicycle Safety Educational Program stresses the importance of helmet use and other bicycle safety measures with one fundamental objective: prevention. This will be accomplished through addressing the issue of helmet acceptance by children, ensuring the availability of low-cost or no-cost helmets, and Police enforcement of the Florida Bicycle Helmet Law. Concentrated efforts to raise community awareness regarding bicycle safety will include community workshops utilizing developed bicycle curricula for all age groups and the establishment of a network of trained professionals to provide safety instruction. Educational materials coupled with intensive hands on practice via "bicycle rodeos" will be inserted as a mandatory component within the school curriculum thus providing all children attending school in Zone 1 the opportunity to practice their skills in a controlled environment.
Walk Safety / Safe Ways to School Conduct a school site design analysis and a neighborhood site assessment to determine the conditions of street traffic, parent and bus drop-off locations, sidewalks, crossings, and the overall safety of existing routes to school. Results of the analysis and assessment will direct a list of planned improvements to enhance the potential for safe walking or riding to and from school.
Results: The long established prevention programs promulgated by Shands TraumaOne continue to focus special emphasis on areas that remain major contributors to preventable childhood injury. These include Safe Walk and Bicycle Safety. A major component of this has been the purchase and implementation of two trailers designed to provide a complete course in bicycle safety and to serve as a model home in which to demonstrate critical aspects of home safety.