Chapters Transcript Injury Prevention and Why it Matters Lindsay Clukies, MD, discusses injury prevention from a public health perspective. Great. Thanks so much. Hi, everyone. Thanks for having me. Um, I'm Lindsay Luke. I'm a pediatric em physician at children's and the Associate trauma medical director. And my passion is injury prevention. So, something I can talk about for hours upon end, but I kind of chose a few slides that I thought were important to talk to you about here. Um, I have no disclosures and so I wanna start, just start by speaking about the basics of injury prevention, the scope of the problem, um, and discuss some alarming statistics, both locally and nationally. The statistics are pretty depressing, but I, I really hope they, wow, you, um, to emphasize really why prevention is so important. I'm going to spend some time specifically on firearm injuries because, um, that is a major mechanism of injury at our hospital. And we actually see more Children shot Children at ST Louis children's than any other, uh, pediatric hospital in the country which a lot of people don't realize. And then I'm going to talk about the what and the why. Um, what exactly is this field of medicine? Because I really believe that injury prevention is a field of medicine and how to approach it from a public health perspective. And then I'm going to talk about some of our initiatives we are doing at children's. And I understand that not all of the inpatient or the emergency setting um initiatives can be replicated in an outpatient setting, but I'm hoping that hearing about, about them can motivate us. Um and we can form some partnerships and even brainstorm how to, how to do uh outpatient prevention in the future. So this is a really important slide to me because I really believe that it rings true. So, Doctor C Everett Coop was a pediatric surgeon and the 13th surgeon general of the United States. And he had a dramatic impact on public health, especially related to advocating for Children. And he said this quote right here, if a disease were killing our Children and the proportion that injuries are people would be outraged and demand that this killer be stopped. And I really want everyone to think about this during my talk. So why does injury prevention matter? So pediatric trauma affects everyone. It is the leading cause of mortality and potential years. Life of life lost in Children and young adults. It's also the leading cause of medical costs in our country and in all of the developed world. And not only is it the number one cause of death for our Children, but it's also the number one cause of emergency visits. So over 6 million Children and young adults are seen in emergency departments every year after suffering an injury. And those of us in the outpatient setting or who are ED based are very well versed in how common injuries are. And with the frequency of Ed visits at the life lost from injuries, um there's obviously a huge financial burden and of course, in addition to the financial burden injuries lead to emotional trauma for Children, for their families and for the entire society. So this graph is from the CDC Whiskers database. Um and it shows that unintentional injury is the number one killer of Children and young adults and people's ages 1 to 44 years of age and over the past century, we've achieved great success with decreasing a lot of the major causes of death, including specific diseases and even the death rate from ischemic heart disease. Um We've dramatically reduced that but we haven't been quite as successful with injury prevention. And when you look at this chart, it hasn't budged since 1981 unintentional injuries continue to be at the top. And so injury kills more Children than anything else. And when you take things like sepsis and childhood cancer and congenital heart disease, and when you combine them all together, injuries still kill more Children than anything else combined. Yet, it is still one of the most unrecognized public health problems. And this is, this is true locally too. So this is from the Missouri Department of Health and Senior Services that it shows the top 10 leading causes of death for Missouri residents under the age of 18. So for Children and unintentional injuries are, are number one, I refer to them as unintentional injuries. I don't like to use the word accidents and I'll talk about that. Why in a few slides. So when we look at pediatric deaths, um, per state, we are not doing well. Basically, Missouri does not rank very highly. This is from the CDC Wonder Database which stands for wide ranging online data for epidemiologic research. Um and this is from 2019 to 2021. It's the most recent one that I have, but it looks at the number of deaths per 100,000 and it includes Children, ages 1 to 19 and unfortunately, Missouri is 40th. So we are near the bottom, which to me means that we have a lot of work to do and a lot of room for improvement. And I think it's important to note that injuries do not strike randomly. So they are a health disparity issue like everything else um both locally and nationally and and this holds true to us around, around our area as well. This is a heat map of what we call trauma stats, which are our highest level trauma activation at children's. So the more severely injured Children. Um and this is over the course of a couple of years and you can see on the left side of the screen, that's kind of the scope of the state of Missouri and then on the right um are more local areas around our hospital. The yellow star is ST Louis Children's Hospital and the red and the orange and the yellow. They indicate higher levels of trauma stats and you can see the neighborhoods listed there. They they have significantly higher levels of severe trauma and all of those areas have median incomes of less than $28,000 as of 2020. So this is from the Missouri Child Fatality Review program, um which is a wonderful program. It's a county based initiative that really focuses on improved community understanding and response to child deaths from, from any causes. And so county report to the state and every year, an annual report is compiled from the statistical data that is that is collected from the county panels. This is 2022 which is the most recent report that has been put out. Um They put out the reports every November and the data is broken down in an attempt to show you what types of child deaths occur across our state, ultimately, in an effort to increase our prevention strategies. And you can see here the top three for 2020 2021 and 2022 include motor vehicle accidents, infant, sleep related suffocation and firearm injuries. And this has been the case for many years. I do want to point out that um I just found it interesting because we really focus on the top three causes, but there's been some surges and drowning of submersion deaths as well as poisoning. And that really anecdotally fits in with what we're seeing at our pediatric emergency rooms. So there are three level one pediatric trauma centers in Missouri, um Children's Glennon and Children's Mercy. And we all work together because we really feel like prevention. Um We prevention needs a united front and this is the top three pediatric injury mechanisms that we see at our trauma on our pediatric trauma centers. Number one is falls. It's always been falls, falls are the number one cause of emergency department visits in general, um followed by motor vehicle accidents. And then you see number three at children's is non accidental trauma or child abuse, Glenn and it's firearm injuries and then children's mercy, it's animal bites. And when we talk about the top three injury fatality mechanisms, um Children's and Glennon are the same. Number one, firearm injuries followed by motor vehicle accidents. And then third, non accidental trauma or child abuse and children's mercy is a little bit different, but firearm injuries are still number two for them. And so I do want to spend some time just on the statistics about firearm injuries because I think that it's important to talk about, especially because of how many deaths we see nationally and locally. So this is children's this is the number of Children who present just the Saint Louis Children's hospital after being shot. Um And this is from 2005 through 2023. And you can see that our numbers are going up. Um And they're going up rather fast. 2020 2022 we had surges in Children being shot. In fact, in 2022 we finished the year with 100 and 63 Children. And again, it's just those coming to children's, that's not even including all the kids who, who are going to Glen. And um, this was a record year from us that we've never seen um such a high number of pediatric firearm injuries in our hospital history. And just for some uh for a rest, a reference that means we were seeing a child coming to our ed shot every 2.5 days, which is the same frequency in which in which we see a child with appendicitis appendicitis. So obviously horrible and staggering statistics. This was an informal poll we did a few years ago and when you look at, um, it, it's the top is from the best, the US news and world Report. Best Children's Hospital on a roll top 10. Um, and we, we just pulled the hospitals around the country who made the top 10 and asked them how many firearm injuries they see per year. Um And you can see this was a few years ago because we were only around 90 at the time. But we see way more than any of the other pediatric hospitals around the country. The only hospital that comes close is our neighbor down the street at Cardinal Glennon. So this is clearly an issue in our area and the age continues to trend down. So a lot of people think it's, it's mostly the older teenagers. Well, it's not, um, we see a lot of young adults, we see a lot of toddlers. We even see infants, unfortunately, and the average age is now in the 13 years range. And when we talk about severity, the severity is increasing as well. So is s stands for injury severity score. And it's a way that our trauma registers, look at the severity of the type of injury and you can see there that the injuries are becoming more severe. We're seeing larger caliber weapons being used, so they're causing more damage. And we're also seeing Children for the first time in my career, I'm seeing kids who have been shot then for a second time and unfortunately, even a third time and just as trauma is a racial disparity issue. Firearm injuries are as well. So black males are more are most likely to get shot at children's. Um, and nationally and you can see there the top graph, the blue line is males and the purple line or the pink line I should say are females and then below, you can see that the red line is Black or African American patients. So racism alive and present when it comes to firearm injuries as with um everything else in the United States. And when you look at black youth, they are four times more likely to have a fatal firearm injury and almost 20 times more likely to have a non fatal firearm injury. Um And in the in the country in the United States, they make up over half of all the homicide victims despite making up 7% of the population. So this is a study done by Doctor Sai Abe, who's one of our surgery, our pediatric sur sorry, our general surgery residents who's interested in pediatric surgery. Um, she presented it at the Pediatric Trauma Society. She did a retrospective review of all patients less than 15 years who presented to one of the eight level one trauma centers in our entire state. And she looked at various demographics, age, sex, race injury, severity score, et cetera. But what I want to focus on with this slide is the intent. So there's a misconception that firearm injuries are all violent or they're, you know, teenagers, 17 year olds outside shooting at each other. But, but it's really not when she looked at intent in our state, at least in Missouri, almost 50% of them were unintentional or what we call accidental. And this is significantly higher than we expected and significantly higher than most other estimates around the country. And she, she took, um, trends over a 10 year period from 2010 to 2019. And she grouped them into two groups. The first half of the study period is the green column there from 2010 to 2014. And then the second half or the most recent time period was 2015 to 2019 and kind of the salmon color there. And she looked at um the, the number of injuries every year and she found a huge increase in the mean annual numbers across all age groups. But the highest increase were those in the age 5 to 9 group, they increased over 100 and 50%. Um in, in the second five years compared to the first. So clearly, these injuries are increasing at an alarming rate. And so when we look at um specifically firearm injuries again, um there's AAA social disparity issue. So when we, when we distinguished between unintentional or accidental injuries and intentional injuries, there was a big difference. So the unintentional injuries were spread out. And when I think of an unintentional firearm injury, I think of, you know, a younger child or a toddler finding an unsecured firearm and quote unquote, accidentally firing it. They, we saw patients from 94 different zip codes. It didn't matter where you lived, your socio-economic status, no community is immune. And when we looked at the intentional injuries, they were really clustered around seven zip codes similar to the, the trauma sta heat map from before. Um really around our hospital noted there by the yellow star again, and they all have median income of less than $30,000 per year. And I think this kind of information is really important to have when it comes to injury prevention because geo targeting our, our education is really, really important. So again, firearm injuries like all trauma is really a health disparity issue. So those were really depressing statistics. And I, I hope I didn't bore you. I hope I didn't make you sad, but they're just, they're so staggering to me, especially the ones in our area. And I really think it's important for us to, to be aware that while this is a national issue, it really is a, a really significant issue in our area. So I wanna talk a little bit just about injury prevention as a whole from a public health perspective. And this slide right here is the central theme of injury epidemiology. So injuries are not accidents. I I know I use that, that word in my talk, but I really don't like to use that word because they're not a result of a child being accident prone, accidents are defined as random, uncontrolled acts of fate. And that's not what injuries are. We know that child injury is understandable, it's predictable and it's preventable. And most importantly, it's cured by prevention. And so when we talk about injury deaths, historically, they follow a Trimodal distribution. So about 50% of people suffer immediate deaths and those are within minutes. Those are the patients who die at the scene. They have non survivable injuries. They don't make it to our hospital right there. That's about 50%. And then another 30% this the second peak there um suffer early deaths. So u usually within minutes to hours, those are the patients that we see in the emergency department. They most commonly die from hemorrhage or traumatic brain injury. And then 20% of our patients die from uh suffer from late deaths. And those are days to weeks later, those are the patients that typically pass away in our pediatric IC US, um usually from multisystem organ failure. And I'd argue that we're really good with our, our rehabilitation and our IC U care and our inpatient care. And over the last few decades, we've really improved our, our access to trauma care and our leveling of trauma systems and things like time critical diagnoses in Missouri. But we haven't focused on primary prevention and that's the key to preventing half of these deaths. And so how do we address injury prevention and what exactly is it? So, Doctor William Haddon Junior, he was really the father of modern injury epidemiology. Um He was the first director of the National Highway Safety Bureau in the sixties and he looked at injury from a multidisciplinary approach. He believed that the understanding and prevention of disease and injury should be the first strategy of medicine. And that treatment no matter how necessary is not the logical first line of attack. And he developed this conceptual tool that we call Hadden's matrix. It's been used for decades in injury prevention and different response strategies. And he applied the basic principles of public health to the problem of traffic safety when he worked for the Highway Safety Bureau. So he included things like pre injury, injury and post injury phases and then the different influencing factors including the host, the agent, which in his case was it was a car. Um and then the physical and socio-economic environment and what he he conceptualized was that the host, the environment and the agent are all intertwined. And he applied this matrix to traffic safety. And he did things like advocate for airbags and seatbelt use and better um road safety laws and he truly had an impact on traffic safety and deaths over the years. And so these 10 items are often called hadden strategies. They are possible ways of presenting injury during the various phases such as preventing the injury from happening in the first place by doing things like avoiding drinking and driving or removing access to firearms and then preventing or minimizing injury during or after the event has occurred. And that's things like like child passenger safety seats, car seats, smoke alarms and a fire, things like that and then lastly reducing the long term consequences and that's by rehabilitation and trauma care. And again, we're really good at the post event care with our continued improvements in trauma care and our, you know, our updates with evidence based medicine, but we're not as successful with the pre event strategies. So to solve public health problems, we use a systemic approach called the public health approach. Um and I really, I think it's really important to apply this to injury prevention in order to improve our pre event strategies and to target injury prevention as a whole, we need to treat injuries as a public health problem. And that this approach really has four steps. The first thing is to define the problem. Second is to identify risk and protective factors. Third is to develop and test prevention strategies and then lastly to assure widespread adoption of effective injury prevention principles and strategies. And this is how we'll decrease injuries overall. And so public health is often confused with health care. When we talk about a health system, the primary focus is on an individual and there's an emphasis on diagnosis and treatment. But with public health, public health professionals diagnose whole communities and they really develop a plan of action to improve the health status of the entire population. And I think, you know, it's important to note that the primary focus with public health is on the population. There's an emphasis on disease prevention and health promotion that really shape a community's overall health profile. And this is a perfect example of why that's important. So again, when treated as diseases, both intentional and unintentional injuries are cured by prevention. And you can see here, this was published in the New England Journal of Medicine. A few years ago, the orange line there is the beautiful decreasing in motor vehicle accidents, deaths that we see in Children ages 1 to 24. And for more than 60 years, motor vehicle crashes were the leading cause of injury related death among young people. And you can see there they've had that continuous decline. And that's really thanks to public health interventions and things like Hadden's matrix. And actually the CDC proclaimed this reduction in deaths for motor vehicle accidents to be one of the most substantial public health achievements of the 20th century. And again, this was because of things like increase in seatbelt use reduction in drunk driving, better safety awareness, airbags, et cetera. And all of this is despite having more cars on the road and cars traveling so many more miles. And you can see there that yellow arrow in 2017, all of this changed and firearm related injuries became number one. they took the place of motor vehicle crashes to become the most common cause of death for Children and young adults. And we call this the crossing of the lines. Um and it really shows it demonstrates how a concerted approach to injury prevention can reduce injuries and deaths like with motor vehicle crashes. And then conversely, unfortunately, how a public health problem can be exacerbated in the absence of, of such attention like with firearm injuries. So what are we doing at children's? Um, so we are focusing on a few different initiatives that I'd love to share with you guys. Um The first thing we, we really started to do was to normalize the conversation. We wanted to standardize our anticipatory guidance. And I want to start by saying there are no physician, there's no current legislation to prevent physicians about asking about firearms. There are no physician gag laws or anything like that. And in fact, the A AP says that as pediatricians, we are all responsible for talking to our patients about firearm safety. So this is the policy statement from the A AP from 10 years ago when things weren't even as bad as they are now. Um And they said that pediatricians should advocate for improved legislation and regulation of firearms and for consumer product regulation regarding child access to firearms. We should provide health information to parents. We should educate the next generation of pediatricians on fire, the firearm epidemic. And then we should research really uh research prevention of firearm injuries. And a couple of years ago, um Dr Lois Lee, who's one of my mentors actually came up with up updated recommendations during the A AP conference in 2022 about what we should be doing as pediatricians. And that includes to provide anticipatory guidance to families about the importance and effectiveness of barriers to prevent access to firearms in the home. Um to encourage parents and caregivers to ask about firearms and, and their storage where anywhere where their child may spend time to discuss the risk and removal of firearm access for those at risk for suicide and homicide, To know your local laws and then to learn about community and hospital uh based violence intervention programs and how are we doing? And, and the short answer is not very well. Um Despite this being a recommendation for the A ap for over 10 years, studies show that as medical professionals, we're just not doing a great job at firearm injury prevention with our patients and their families. And there are tons of studies that show this. Um there are studies that so that even with some prompts in the in the uh electronic medical record, um we're not doing a good enough job, but even for patients who are at higher risk, like those who are suffering mental health crises, we're not doing a good enough jobs. There are are also studies showing that a large percentage of us never counsel on firearms. But there are surveys that show that most physicians believe we should be counseling. We just never rarely or we never rarely do it. And that's for a variety of reasons. Number one being time, uh most people cite time as a as a big barrier. And then they also cite lack of training, lack of familiarity with prevention programs, lack of knowledge and, and lack of just comfort. And I wanted to share this study because it was um it was done in our area and it shows that a large portion of parents are willing to discuss this. So Dr Jane Garbett completed this study in collaboration with a lot of our outpatient pediatrician offices. So she put a survey in the waiting room that asked questions about two parents to ask if they were receptive to discussing firearm safety with their pediatricians. The results, it was over 1000 surveys. So a really large study and the results showed that half indicated that their child had access to firearms and many were not stored safely. And only 13% reported that their pediatrician had asked about firearms. 65% agreed that pediatricians should be asking. And almost and about three quarters agreed that pediatricians should be advising parents on the safest way to store firearms. And I I mean, I was shocked with the fact that 50% of the of the patients reported that their Children had access. But this is true nationally as well. This is from a population based survey of us adults um that was used to assess self reported firearms storage practices among gun owners, gun owners, excuse me. And this was from 2018. But we, from this study, we know that over 4.5 million Children live in a home where there's at least one firearm that is present and stored either loaded or unlocked. Um, so not stored properly. That's 4.5 million Children, at least right now, who potentially have access to a firearm. And there's also good data to show that there's quite a disconnect between what parents believe their Children have access to. Um and and have access to and, and knowledge really about when it, when it comes to firearms. So we often hear from, from families or from parents that I I do have a firearm but my child doesn't know where it is. I I hide it in this, you know, in my drawer under my mattress or wherever. But studies show that three quarters of Children know where a firearm is stored in their house despite what parents think and almost half of teenagers report having easy access to firearms. And I have to include one slide about the mental health crisis because access matters and means matters be we know that people who attempt suicide more often than not do it impulsively. And I know you guys know more than anyone that we are in a, in a mental health crisis right now. And there are more teenagers citing um depression and anxiety and and suicidal ideation and things like that. But many suicide attempts are impulsive and that's particularly true for adolescents who are just developmentally impulsive. Most patients do not think about it for months at a time. They don't plan it out. This one study cited that um almost 33 quarters of suicide survivors and this was both Children and adults reported attempting within an hour of deciding and almost half within 10 minutes of deciding. And so I wanna mention this because it's extremely important to have a barrier between a firearm preventing these impulsive decisions. Um Su suicide by firearm has an extremely high case fatality rate. Um It's almost 90% which is much higher than other mechanisms. And so those who use a firearm to attempt suicide are more likely to complete it. And so I, I just, I had to mention this, I feel like we can do a whole additional talk obviously on the mental health crisis. But if people nearing suicide are kept away from a means of killing themselves, even for a short period of time, then their risk of dying can drop dramatically. And we know that safe storage work, there's plenty of data that safe storage works. And that includes the four components of storing firearms, locked, storing firearms, unloaded, storing ammunition, locked and stored separately. And so taking all of this information, we decided to make it mandatory to ask and counsel on safe storage in our emergency room at children's. And so we see about 50,000 patients a year, um We call this the, the Slch firearm triage project and it was led by one of our fellows, Doctor Teresa Tim. And she created an epic prompt for our triage nurses to ask families about access to firearms. Um And if so, how were they stored? And then most importantly, if they wanted to receive a gun lock free of charge. Um And so, despite what family said, even if they said no, there are no guns present in my household, we still offered them a free gun lock and a lot of them took it. Um Basically, if they wanted the free gunlock, our social workers then went and just did some safe storage counseling and provided them one or five or 10 gun locks. However many that they wanted, she then took a small sub subset of these families who, who received the gun locks in the emergency department and called them and followed up with them. Uh 1 to 2 months later to see if they were using the gun locks. Overall, about 18% of our our population said they had access to firearms and on the follow up call, almost uh about two thirds um stated that they were using the gun lock that we provided to them. And then there was a statistically significant improvement in storage practices. So more families reported storing their firearms safely than when we initially saw them in the emergency departments. This was started a few years ago, it is still happening every day in our emergency department. And at the same time, we started what we call the no questions asked basket, basket. So super simple concept, we put a clear basket of free gun locks entry and you can see there it's in a, in a visible location but not a super visible location where everyone has their eyes on you. It's a little bit conspicuous, but there's a sign right there that just says free God locks. Um Please take however many you want and then an educational handout and it is against such a simple concept, but it has been so incredibly successful that BJC as a hospital system decided to expand the no questions asked basket, they funded it all. They, they pledged to initiate access to free gunlock system wide. And so the no questions asked basket is currently present in all of the BJC emergency departments in Missouri and Illinois. Um They're present in our CS CCS at safety stop in a few other outpatient offices. And it's just, it's been a tremendous success. I think we've given out over 15,000 gun locks to date. Um And again, it's, it's, well, it's a simple concept. It's something that we're really proud of and we've had tons of great feedback from families. So we were a little nervous starting the triage questioning because firearms can be a hot topic for people. Um And we didn't want to alienate anyone we really wanted to meet families where they were. And so we met with a multidisciplinary team of nurses and physicians and family partners and social workers to come up with a script. And I can say that 99% of the time the conversation is really, really positive. And in fact, our social workers tell us that they've never had such positive feedback from any conversations they've ever had with families. And last year, they actually featured our, our um our initiatives on CNN when they talked about the firearm epidemic. The other thing we're doing is through the um the Loeb teaching fellowship at Wash U. And this is a fellowship sponsored by the Lobe, the wonderful Loeb Family that provides fellows the opportunity to implement um ideas that impact medical education. And so this is a fellowship that I received for this year and next year. And I'm developing in the process of developing what I'm calling the firearm curriculum. Um We have completed surveys about 1000 surveys with uh from families in our emergency department and then from all of our pediatric trainees just asking about the barriers to firearm education, who is the best person to, to give you that education just um really a needs assessment survey. And this has helped us design a curriculum that will take place um as a workshop in the fall and the spring. And eventually all pediatric trainees will become um educated on the local and the national firearm laws, um how to talk to families in a neutral and non judgmental way, how to have these difficult conversations, all of the, the resources that we have available to families and the best practices for safety storage. Um The goal is then when our trainees then go on to their, their respective careers and, and you know, spread out through, through the country that they will continue to ask about firearms and continue to educate. And then I do have to mention our victims of violence program. So this is the, we call it the VOV program. Um It's part of our region wide hospital Violence Inter intervention program called Life Outside of Violence with Cardinal Glennon Slew Hospital and BJH. And it's something that we have um through our emergency department for Children who are the victims of violence. Um And that includes things like stabbings, assaults, et cetera. And really the goal is to curb the recurrence of interpersonal violence with our patients because we know that patients who are affected by some type of violent um violent injury are then more likely to go on and perpetrate violence to others. So the contact is made with our emergency in our emergency department. And then those who agree to participate are paired with a culturally competent mentor for at least six sessions. It is a phenomenal program. Um There is data that shows that those who are enrolled in the program are then less likely to go on and suffer um, re injuries. Um And so it's just, it's a really, really incredible program that we're really proud of at our hospital. And we celebrate, we celebrate things at children's and we'd love to get um people in the outpatient setting to celebrate with us. So we celebrate Ask Day, which stands for asking saves kids. This is a day um, backed by the A AP, it's June 21st, the first day of summer every year. And it just encourages families to ask about firearms and to add firearms to the play date checklist, just like they would ask about car seats and pools at home and who's, you know, who's supervising our play dates? And do you have animals at home, et cetera? We want firearms to be part of that conversation. And so we celebrate that day and if anyone wants to celebrate with us, please let me know. We also celebrate where Orange Day, um, this is in June as well, the, the first weekend in June and it's really National and Gun Violence Day and it's something that we celebrate throughout our hospital. And of course, now on social media because that's how everything goes. And then we're part of the Injury Free Coalition For Kids. Um And the, the Ifck is one of the country's most effective injury prevention programs. This is a national program that children's is part of and it's a hospital based based community oriented programs whose efforts are anchored in research and education and, and advocacy. There's I think 45 hospitals um around the country. But one of the big things we do is celebrate National Injury Prevention Day. And again, this is something that I want you guys to be aware of because um what we, what we like to do is what we call shine a shine, a green light on injury prevention. There is a Twitter chat that, um that, that talks about injury prevention tips and it's usually well regarded. The A ap always joins and then we light up our city green and you can see here some beautiful pictures we've had um, the Enterprise Center, the Blues, the Magic House, tons of places around the city, um lighting up green and even our local firehouse and our EMS stations and the rigs and, and tons of places around the area. Light up green and I'd really love to, for some of you guys to participate with us. Um This is in November. We also teach Stop the Bleed, which is a national campaign um to inform and empower the general public to become trained on basic trauma care in order to stop or to slow bleeding during emergencies. Um And the goal is to increase bystander access to bleeding control kits and to really just educate people on how to stop the bleed. We do this everywhere. Now we train our ancillary staff, we go to schools we trained medical students, we trained undergrad students. We are happy to train anyone um that you feel like, you know, should be trained. Once you're trained, if you're a physician, then you're able to teach, stop the bleed. And so it's something that we're really spreading around the country. Um And please reach out to me if anyone knows a group that may be interested in hearing it. So those are mostly firearm, um, firearm outreach activities. I should say we are doing subs similar uh safe sleep related initiatives and for the sake of time, I'm gonna go through this a little fast. So um we obviously see uh have been seeing a continuous high rate of safe unsafe sleep related deaths. Um This is from, again, the Missouri Child Fatality Review program and when we looked at those Children who died from unsafe sleep, the majority of them were found in an adult bed. And so in the emergency department setting, we wanted to again normalize our an anticipatory guidance and most importantly, improve access to, to the to safe sleep best practices for our families. And so we started a new screening process where anyone less than 12 months of age presenting to our emergency department, um obviously not those who are, you know, undergoing life, life sustaining interventions, but any other patient, less than 12 months are screened for um safe sleep practices. So we have a BP A that comes up that just reminds the residents that they have to screen. And then we document in our epic note um how the baby sleeps where the baby sleeps and if they sleep with anything around them, and if any of this is all done by providers, they, they're in charge of doing the screening. And if there's any concerning answers, then we have a consult process where we consult either our social workers or safety stop who completes safe sleep education. Um And then most importantly, ensures the family has a safe sleep environment and provides a crit, which is a pack and play. I I don't know why we call them ribes. It's, it's a pack and play. Um If they don't have access to a safe sleep environment and then we automatically discharge any patient less than 1212 months with a safe sleep education, regardless of how they answered. And I do want to mention safety stop because it's a really, really great resource. Um They're amazing. Um And I think, you know, I think we should be referring more patients than we do, especially in, in the emergency department. I'm guilty of it as well, but they offer free educational service for anyone and they cover car seat safety. I just noticed a typo on my slide, it's not care seat, it's car seat safety, home safety, helmet safety and sleep safety. And they do consults on those topics and we've recently expanded home safety to include more education on drowning injuries or subversion injuries, safe storage of firearms, and then especially poisonings because we've seen a big increase in that. And so there's five locations. I hope to expand the locations in the future to even um more areas. But they are, it's a tremendous resource. And those of you who are was U affiliated, you can refer an epic um If you type in safety stop, an ambulatory referral will show up. The other thing I want to mention about safety stop is that if you go to the website Saint Louis, children's dot.org backs backslash, excuse me, safety stop. You can access, you can type in an address and, and a name and you will be mailed a free gun lock and we've actually mailed to almost 40 states around the country. So this is a great resource to, to provide to families because no one has to ask them any questions. They just have a, a free gunlock show up at their house. So what else can we do? Um You know, I, I hope I didn't depress you guys too much, but I think it's really important for us to make a commitment to do the work to make a public commitment to asking not only about firearm injuries but all injury prevention because like the A AP says on, on National Ask Day asking saves kids and, and one question really does have the potential to save a child's life. Um And I, I just think it's really important knowing the statistics, knowing that firearm injuries are the number one cause of death for Children that, that we have to make a commitment to asking. And there's lots of ways that, that we can learn about, um, about this. I, I am the first to admit, um I, and from Canada, we didn't have a lot of firearm injuries. I didn't know a lot about firearms but I learned about them. Um, because, you know, it's similar to when I don't know, an, an, an antibiotic dose, I looked it up and I, I learned about firearms and safe storage and these horrible statistics and I think we should be doing the same with injury prevention as a whole. I think this matters enough that it's important for us to, to look into it. And so there's a lot of great resource. This is the bullet points project. This is um this is resources for clinicians to learn about firearm injury prevention. So it's, it's for medical providers. And the A AP also has great um resources. They have the safer storing firearms prevents harm course. And the, and the counseling on access to lethal means and you don't have to be an A AP member to take these, they're free and you get MOC credit for completing them. The A EP also offers gun violence prevention advocacy, toolkit and a gun safety campaign tool kit. Um Both of them, I, I've looked at them. They're amazing. They're again, great resources, they're posters and then um and printed uh visuals that you can print out both in English and Spanish to provide to families or to put out um in, in your offices. And I do want to mention this if anyone has a trainee that works with them. Um trainees for child injury prevention or T four C IP is an amazing, amazing program through nationwide. They target medical students, residents and fellows, but it's a year long outreach and advocacy training program. Um And really the the trainees learn how to lead a national advocacy campaign. So if you have any trainees that rotate with you or to work uh or who work with you who are interested in injury prevention, um Please share this with them or have them reach out to me because it's a really great program. So I, again, I hope I didn't depress you all too much. Um I, I hope that this kind of stressed the importance of injury prevention and that injury really affects everyone. And that really the public health approach to injury prevention is how we save lives. That is all I have right now. I could have spent another hour talking about poisonings, um especially with edibles and our fentaNYL epidemic. But I I decided to focus on a couple other things and I'm happy to take any questions that you guys have Created by Presenters Lindsay Clukies, MD Pediatric Emergency Medicine View full profile
