1. Indian Health Service Aberdeen Area Division of Environmental Health Services Molly Patton, MPH REHS Presentations from those of Myrna J. Buckles and John Weaver Aberdeen Area IHS DEHS

2. Leadership Staff Director DEHS (vacant) Area Injury Prevention Specialist & Deputy –John Weaver (Retired October 2008) & Kathey Wilson Institutional Environmental Health Officer –Curt Smelley, MSEH, HEM, REHS, Three District Environmental Health Staff –Chris Allen, MS, REHS, Sioux City –Myrna Buckles, MSEH, REHS, Pierre –Molly Patton, MPH, REHS, Minot

3. Field Staff IHS Crow Creek –Marcel Felicia, REHS Lake Traverse –Vacant Lower Brule –Terrold Menzie, REHS Pine Ridge –Joe Amiotte, REHS –Jennifer Franks –Dawn Holguin Rosebud –Charles Mack Turtle Mountain –Jennifer Malaterre Yankton/Wagner –Tim Balderrama

4. Field Staff Tribal Cheyenne River –Randolph Runs After, REHS Omaha –Carroll Webster, SR. Spirit Lake –Chris Helgesen Standing Rock –Bill Sherwood –Le Ray Skinner * –Jeannette Cluett –Mary Brunelle Three Affiliated –Verlee White Calfe- Sayler Winnebago –Mona Zuffante

5. Performance Improvement Indicators – CY 2008 Severe Injury Profile High Priority Facility Surveys Other Facility Surveys Occupant Protection Present Injury Data & Effective Strategies Continuous Quality Improvement

6. Severe Injury Profile Three years of local data Provided to tribal & IHS leaders Develop an Area Severe Injury Profile

7. Priority Facility Surveys Custodial/Residential Care Substance Abuse Centers Jails Schools Head Starts Day Care Centers Senior Citizen Centers Café/Restaurant Gaming Facilities Celebrations Food Service Operations

8. Facility Survey Data IHS Direct Service Sites

9. Facility Survey Data Tribal Sites

10. Occupant Protection Seat Belt Observation Surveys Plan to Implement a Proven Effective Strategy – with community partners Implement Strategy Evaluate

11. Action Steps for Injury Intervention Presentation of data & interventions Coalition formation Selection of an effective strategy Implementation of an effective strategy Evaluation plan of implementation

12. Continuous Quality Improvement “Deep Look” type survey of a high-risk facility Project to address critical items identified in a high-risk facility Formalized technical assistance project Plan reviews and prevention activities

13. The Difference Then & Now Focused DEHS Program IHS & Tribal Staff Input Improved EH Services to tribal members Reduction to injury and/or illness exposure for high risk individuals Increased local injury prevention activity Increased local injury data available Increased local injury knowledge & advocacy.

14. A Summary of Two Years of Injury Data Gathered at Seven Health Care Facilities John Weaver Aberdeen Area Injury Prevention Specialist

15. Thoughts to Remember Trauma and death due to injuries are a major health care problem in the Aberdeen Area There are evidence based interventions that can reduce this problem Trauma has an impact on IHS direct care and contract health care dollars

16. OEH&E has developed a Severe Injury Surveillance System (SISS) It is a health care facility based data system designed to collect and analyze injury data This active surveillance system is maintained by the local service unit or tribal environmental health staff

17. SISS Objectives Identify the leading causes of severe injury at the local level –Identify injury problem –Complete a Severe Injury Profile –Develop a special study –Involve tribal entities to choose interventions Generate awareness and provide information to community, IHS, and Tribal Officials Combine data for an overview of Area injuries

18. Data Sources Emergency room logs Resource Patient management System (RPMS) Visit General Query (VGEN) Patient charts

19. Data Sources Contract Health Service Records –Minutes –Logs –Approvals –Denials States vital records EMS reports Police reports

20. Severe Injury is Defined as an Injury Resulting in –Amputation –Loss of consciousness –Major fracture ( excludes fingers and toes) –Hospitalization for at least one day –Fatality

21. Severe Injuries are Separated into Seven Main Categories by Cause Assaults Drowning Falls Fire/Burns Motor Vehicle Crashes Other Suicide/Self-inflicted

22. SISS Limitations Fatal cases Alcohol-related injuries Small number of cases Compare to national data

23. Injury Overview Leading Causes of Injury Morbidity (N=3758) and Mortality (189) by Disposition Ambulatory Patients 2005-2006 Inpatients IHS/ Contract 2005-2006 Mortality 2005-2006 CauseNumberCauseNumberCauseNumber Falls1181Falls300Motor Vehicle 93 Assault600Motor Vehicle295Other36 Other386Suicide264Suicide29 Motor Vehicle 254Assault256Assault15

24. Injury Overview Number of severe injuries by gender, disposition of patient, intent, and alcohol use, 2005-2006 N = 3758 GenderFrequencyPercentage Male222259.1 Female153640.9 Disposition of patient Outpatient244965.2 Hospitalized127333.9 Unknown36.96 Intent Unintentional259869.1 Intentional116030.9 Alcohol related* 1 Yes121232.3 No131234.9 Unknown123432.8 * Alcohol-related injuries were difficult to assess because data collectors reviewed a subjective assessment of alcohol involvement by health personnel. In very few cases were BACs obtained. Also not all yes’s were confirmed with BACs and not all no’s were tested in the patient population.

25. Injury Morbidity by Cause

26. Motor Vehicle Crash Trauma What Can Be Done ? Tribal policy and procedures can have a direct impact on levels of safety belt use Tribal efforts can be most effective in establishing and improving safety belt usage levels (NHTSA DOT HS809 921 Oct. 2005) Evidence-based research shows that passage of seat- belt use laws, coupled with education and enforcement efforts, are effective tools to increase seat belt use Use of seatbelts can reduce the risk of death in a motor vehicle crash by 45% to 60%, and can reduce moderate to critical injury 50% to 65%

27. Motor Vehicle Crash Trauma What Can Be Done? National Highway Traffic Safety Administration (NHTSA) Survey of Native American Tribal Reservations found –Reservations with primary safety belt laws have 85% of the vehicle occupants belted –Reservations with secondary safety belt laws averaged 53% seat belt use –Reservations with no safety belt laws of any kind have a usage rate of 26%.

28. Aberdeen Area Seat Belt Survey A total of 20,927 seatbelt use observations were conducted (n=15,196 drivers and n=5,731 passengers) The overall all passengers seatbelt use rate for individual tribes ranged from 8% to 42%. Combining seat belt use data for the 10 reservations, the overall seatbelt use rate was 21% for drivers, 16% for passengers, and 20% for all vehicle occupants

29. Aberdeen Area Seat Belt Survey The seatbelt use rate for Americans Indians in the Northern Plains is low 2007 observed seatbelt use rate in Aberdeen Area is 20% 2007 National use rate was 82% 2007 North Dakota use rate was 82% 2007 South Dakota use rate was 73%

30. Injury Mortality by Cause

31. Years of Potential Life Loss

32. Leading Cause of Death

33. Conclusion Intentional & unintentional injury morbidity & mortality are a major public health problem Injuries cause more that 46 % of the YPLL In the age group 1 to 44 injuries cause more then 46% of the deaths 49% of all injury deaths are cause by motor vehicle crashes Seat belt usage rate in our population is 20%

34. Conclusion Alcohol involvement is difficult to assess because limited data We have the same injury causes as that of the United States & there are evidence – based interventions that we can use IHS has a network of injury prevention specialist, evidence-based interventions, support from our agency – we should act now

35. *Questions* Molly Patton Minot District office 100 1 st Street Fed Bldg 302 Minot ND 57803 (701) 852-0250 molly.patton@ihs.gov