Dispatcher CPR Instructions Across the Age Continuum.

Background: Survival rates following out-of-hospital cardiac arrest (OHCA) increase two to three times when cardiopulmonary resuscitation (CPR) is started by bystanders, as compared to starting CPR when Emergency Medical Services (EMS) arrives. Municipalities that have implemented dispatcher-assisted bystander CPR programs have seen increased rates of bystander CPR. Cardiopulmonary resuscitation instructions are given for victims of all ages, but it is unknown if offering instructions results in similar rates of EMS-documented bystander CPR across the age continuum in these municipalities.

Accrued Cost Savings of a Free Clinic Using Quality-Adjusted Life Years Saved and Return on Investment.

Introduction: Savings garnered through the provision of preventive services is a form of profit for health systems. Free clinics have been using this logic to demonstrate their cost-savings. The Community-Based Chronic Disease Management (CCDM) clinic treats hypertension using nurse-led teams, clinical protocols, and community-based settings.

Effect of the 2011 Revisions to the Field Triage Guidelines on Under- and Over-Triage Rates for Pediatric Trauma Patients.

Background: In 2011, revised Field Triage Guidelines were released jointly by the Centers for Disease Control and Prevention (CDC) and the American College of Surgeons - Committee on Trauma (ACS-COT). It is unknown how the modifications will affect the number of injured children identified by EMS providers as needing transport to a trauma center.

Objective: To determine the change in under- and over-triage rates when the 2011 Field Triage Guidelines are compared to the 2006 and 1999 versions.

Are rural places less safe for motorists? Definitions of urban and rural to understand road safety disparities.

The objectives of the study are to understand road safety within the context of regional development processes and to assess how urban-rural categories represent differences in motor vehicle occupant fatality risk. We analysed 2015 motor vehicle occupant deaths in Wisconsin from 2010 to 2014, using three definitions of urban-rural continua and negative binomial regression to adjust for population density, travel exposure and the proportion of teen residents. Rural-Urban Commuting Area codes, Beale codes and the Census definition of urban and rural places do not explain differences in urban and rural transportation fatality rates when controlling for population density.

Multicenter Evaluation of Prehospital Opioid Pain Management in Injured Children.

Background: The National Association of Emergency Medical Services Physicians' (NAEMSP) Position Statement on Prehospital Pain Management and the joint National Highway Traffic Safety Administration (NHTSA) and Emergency Medical Services for Children (EMSC) Evidence-based Guideline for Prehospital Analgesia in Trauma aim to improve the recognition, assessment, and treatment of prehospital pain. The impact of implementation of these guidelines on pain management in children by emergency medical services (EMS) agencies has not been assessed.

Objective: Determine the change in frequency of documented pain severity assessment and opiate administration among injured pediatric patients in three EMS agencies after adoption of best practice recommendations.

Effect of System-Wide Interventions on the Assessment and Treatment of Pain by Emergency Medical Services Providers.

Background: An estimated 20% of patients arriving by ambulance to the emergency department are in moderate to severe pain. However, the management of pain in the prehospital setting has been shown to be inadequate. Untreated pain may have negative physiologic and psychological consequences.

Ability of the Physiologic Criteria of the Field Triage Guidelines to Identify Children Who Need the Resources of a Trauma Center.

Background: There is limited research on how well the American College of Surgeons/Center for Disease Control and Prevention Guidelines for Field Triage of Injured Patients assist EMS providers in identifying children who need the resources of a trauma center.

Objective: To determine the accuracy of the Physiologic Criteria (Step 1) of the Field Triage Guidelines in identifying injured children who need the resources of a trauma center.

Methods: EMS providers who transported injured children 15 years and younger to pediatric trauma centers in 3 mid-sized cities were interviewed regarding patient demographics and the presence or absence of each of the Field Triage Guidelines criteria.

How do the definitions of urban and rural matter for transportation safety? Re-interpreting transportation fatalities as an outcome of regional development processes.

Urban and rural places are integrated through economic ties and population flows. Despite their integration, most studies of road safety dichotomize urban and rural places, and studies have consistently demonstrated that rural places are more dangerous for motorists than urban places. Our study investigates whether these findings are sensitive to the definition of urban and rural.

Reaching Urban Poor Hypertensive Patients: A Novel Model of Chronic Disease Care Versus a Traditional Fee-for-Service Approach.

Background: There is a significant disparity in hypertensive treatment rates between those with and without health insurance. If left untreated, hypertension leads to significant morbidity and mortality. The uninsured face numerous barriers to access chronic disease care.

Prehospital Opioid Administration in the Emergency Care of Injured Children.

Objective: Prior studies have identified provider and system characteristics that impede pain management in children, but no studies have investigated the effect of changing these characteristics on prehospital opioid analgesia. Our objectives were to determine: 1) the frequency of opioid analgesia and pain score documentation among prehospital pediatric patients after system wide changes to improve pain treatment, and 2) if older age, longer transport times, the presence of vascular access and pain score documentation were associated with increased prehospital administration of opioid analgesia in children.

Methods: This was a retrospective cross-sectional study of pediatric patients aged 3-18 years assessed by a single EMS system between October 1, 2011 and September 30, 2013.

Evaluation of a Consensus-Based Criterion Standard Definition of Trauma Center Need for Use in Field Triage Research.

Research on field triage of injured patients is limited by the lack of a widely used criterion standard for defining trauma center need. Injury Severity Score (ISS) >15 has been a commonly used outcome measure in research for determining trauma center need that has never been validated. A multidisciplinary team recently published a consensus-based criterion standard definition of trauma center need, but this measure has not yet been validated.

Prehospital Pediatric Care: Opportunities for Training, Treatment, and Research.

Objective: Pediatric transports comprise approximately 10% of emergency medical services (EMS) requests for aid, but little is known about the clinical characteristics of pediatric EMS patients and the interventions they receive. Our objective was to describe the pediatric prehospital patient cohort in a large metropolitan EMS system.

Methods: This retrospective analysis of all pediatric (age <19 years) EMS patients transported from October 2011 to September 2013 was conducted by reviewing a system-wide National EMS Information System (NEMSIS)-compliant database of all EMS patient encounters.

Translating a Fall Prevention Intervention Into Practice: A Randomized Community Trial.

Objectives: We examined whether community translation of an effective evidence-based fall prevention program via standard monetary support can produce a community-wide reduction in fall injuries in older adults and evaluated whether an enhanced version with added technical support and capacity building amplified the fall reduction effect.

Methods: We completed a randomized controlled community trial among adults aged 65 and older in (1) 10 control communities receiving no special resources or guidance on fall prevention, (2) 5 standard support communities receiving modest funding to implement Stepping On, and (3) 5 enhanced support communities receiving funding and technical support. The primary outcome was hospital inpatient and emergency department discharges for falls, examined with Poisson regression.

The impact of behavioral risk assessments and tailored health information on pediatric injury.

Background: Integrating age appropriate injury prevention messages during a well-child visit is challenging in the face of competing demands.

Purpose: To describe a 7-month pilot using technology to facilitate injury prevention risk assessment and education integration.

Methods: We prospectively tracked responses to the computer-based injury prevention self-assessment tool, safety product distribution, and any subsequent contact with the local hospital system for related unintentional injuries.

Revisiting exposure: fatal and non-fatal traffic injury risk across different populations of travelers in Wisconsin, 2001-2009.

Comparing the injury risk of different travel modes requires using a travel-based measure of exposure. In this study we quantify injury risk by travel mode, age, race/ethnicity, sex, and injury severity using three different travel-based exposure measures (person-trips, person-minutes of travel, and person-miles of travel) to learn how these metrics affect the characterization of risk across populations. We used a linked database of hospital and police records to identify non-fatal injuries (2001-2009), the Fatality Analysis Reporting System for fatalities (2001-2009), and the 2001 Wisconsin Add-On to the National Household Travel Survey for exposure measures.

Does EMS perceived anatomic injury predict trauma center need?

Objective: Our objective was to determine the predictive value of the anatomic step of the 2011 Field Triage Decision Scheme for identifying trauma center need.

Methods: Emergency medical services (EMS) providers caring for injured adults transported to regional trauma centers in three midsized communities were interviewed over two years. Patients were included, regardless of injury severity, if they were at least 18 years old and were transported by EMS with a mechanism of injury that was an assault, motor vehicle or motorcycle crash, fall, or pedestrian or bicyclist struck.

Are we underestimating the burden of traumatic brain injury? Surveillance of severe traumatic brain injury using centers for disease control International classification of disease, ninth revision, clinical modification, traumatic brain injury codes.

Background: The epidemiology of traumatic brain injury (TBI) is often studied through the use of International classification of disease, ninth revision, clinical modification (ICD-9-CM), diagnosis codes from the Centers for Disease Control and Prevention TBI Surveillance System. Recent studies suggest that these codes may underestimate the burden of TBI because of inaccuracies and low sensitivity.

Objective: To determine the sensitivity and specificity of ICD-9-CM codes in a severe TBI population.

A model to translate evidence-based interventions into community practice.

There is a tension between 2 alternative approaches to implementing community-based interventions. The evidence-based public health movement emphasizes the scientific basis of prevention by disseminating rigorously evaluated interventions from academic and governmental agencies to local communities. Models used by local health departments to incorporate community input into their planning, such as the community health improvement process (CHIP), emphasize community leadership in identifying health problems and developing and implementing health improvement strategies.

Does mechanism of injury predict trauma center need?

Objective: To determine the predictive value of the mechanism-of-injury step of the American College of Surgeons Field Triage Decision Scheme for determining trauma center need.

Methods: Emergency medical services (EMS) providers caring for injured adult patients transported to the regional trauma center in three midsized communities over two years were interviewed upon emergency department (ED) arrival. Included was any injured patient, regardless of injury severity.

Risk factors for falls and fall-related injuries in adults 85 years of age and older.

Falls are a leading cause of morbidity and mortality in older adults. No previous studies on risk factors for falls have focused on adults 85 years and older, the most rapidly growing segment of adults. We examined demographic, health, and behavioral risk factors for falls and fall-related injuries in adults 65 years and older, with a particular focus on adults 85 years and older.

Motor vehicle crashes associated with alcohol: child passenger injury and restraint use.

Background: The role of alcohol in fatal motor vehicle crashes involving children has been well established. However, the nonfatal injury burden of alcohol on child passengers has not been comprehensively assessed.

Purpose: This study sought to determine injury burden and restraint use in child passengers aged 1-15 years in alcohol-related motor vehicle crashes.

Booster seat legislation: does it work for all children?

Objective: To assess the impact of a booster seat law in Wisconsin on booster seat use in relation to race, ethnicity and socioeconomic status.

Methods: A longitudinal study in Milwaukee County, Wisconsin, involving repeated direct observational assessments of booster seat use rates by child passengers aged 4-7 years over five time periods, before and after legislation mandating booster seat use.

Results: Overall, booster seat use increased from 24% to 43%, whereas proper restraint use increased pre to post-legislation from 21% to 28%.

Reliability and validity of child passenger safety restraint observations by community observers.

Objective: To compare the accuracy of trained community observers for direct observation of child passenger restraint use to certified child passenger safety technicians who are either professional observers or community-based technicians, and to compare these three groups with a gold standard.

Methods: This is a cross-sectional study of interobserver agreement and accuracy in which 75 photos of children depicted in different child passenger restraint systems were rated by 9 observers total, with 3 representing professional observers, 3 representing certified child passenger safety technicians, and 3 representing trained community observers. For each photo, observers indicated type of restraint; the appropriateness of the harness, if applicable; and overall appropriateness of the restraint.