The role of transport teams in pediatric injury prevention

Wagner, Christopher

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Volume 22, Issue 1 , Pages 8-9, January 2003

The role of transport teams in pediatric injury prevention☆

Christopher Wagner, RN, CFRN, EMT-P, is a flight nurse with Survival Flight at the University of Michigan Hospitals in Ann Arbor and section editor of the Pediatric Perspective column

School is the “primary workplace” of childhood, and school terms change the injury patterns and mechanisms seen and treated by transport teams. Injury remains the leading cause of death in pediatric patients older than 1.¹ Ideally, the role of emergency care providers in childhood injuries centers on both prevention and treatment. But while the treatment of pediatric injuries fills the pages of medical, paramedic, and nursing literature (not to mention the brochures of almost every trauma conference), very little discussion focuses on prevention.

Transport teams, by their very nature, often are the most visible and recognizable component of a community's emergency care/trauma system. This level of recognition offers them great opportunities to educate children, parents, and school systems on the prevention of these costly and frequent injuries. This article will discuss common injuries encountered in school-age children, along with gender and age implications. An understanding of these factors allows transport teams to tailor specific prevention programs that will be most beneficial to their individual communities.

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Types of injuries

Interestingly, in analysis of both American and European schoolchildren, the single most common injury suffered on both continents is extremity trauma related to falls.¹, ² Of these extremity injuries, fractures were the most serious complication.¹, ² Junkins et al¹ further divided these injuries into the school period, the activity, and the location of occurrence to better delineate prevention strategies. In their study, extremity injuries were most frequently caused by a fall or collision while engaged in sports or games on the playground during recess. So striking was the frequency of this combination that, had they been removed from analysis, the total number of extremity injuries would have decreased by almost half.¹ One can easily see where the use of this data focuses the educational component necessary for intervention.

After extremity trauma, head and mouth are the most common body parts injured.¹, ² Although the frequency of these injuries is lower, the potential for more serious complications (eg, concussions or closed head trauma) makes them more concerning to both school officials and health care providers. Several etiologies exist for head and facial injuries, and considering all of them, as well as age and gender differences, will aid in injury prevention. Some of the more common causes of head and facial injuries include sports (both direct injury and being struck by equipment), bicycle accidents, falls from play structures, assaults, falls on ice or snow, falls on loose gravel, motor vehicle crashes into school buses and private vehicles, and head strikes on stationary objects (eg, poles) in play areas.¹, ²

Although most discussions involving head and facial injuries from falls concentrate on falls from a considerable height, it is important not to discount falls from the same level when discussing pediatric patients. Many of these injuries occur when children are running, jumping, or simply walking. Avoiding concrete or asphalt play areas or areas with hazards, such as exposed tree roots, can be keys to controlling the frequency of these injuries.²

As with any discussion of head trauma, the appropriate use of a well-fitting helmet during activities that predispose children to head injuries cannot be overstated. Encouraging or providing helmets can be a very efficient and cost-effective measure.

Injuries to the extremities (including lacerations and contusions) and head/facial injuries, as discussed above, account for the vast majority of school-age injuries. Serious thoracic and abdominal injuries are uncommon but should be considered areas for education in school systems in which physical assault by students is an issue.

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Gender and age issues

Considering the gender and age of schoolchildren also aids in the effectiveness of prevention programs. Although injuries may occur at any age and to either gender, males of every age are injured more often, and the highest rate of injuries is incurred during grades 4-6.¹, ³ Intervention in the early elementary level that focuses on boys and the injuries discussed above can result in the most effective reduction of school-related injuries.

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School-related deaths

Fatal injuries at school are fortunately rare. In 1998 an estimated 40 students were fatally injured on school grounds.⁴ Of these fatalities, more than half were caused by firearms or intentional injury.⁴ The role of intervention for physical violence will be discussed in more detail in the next section of this article. Reducing fatalities from nonintentional injuries requires age-specific considerations. Older students will benefit from discussions of safety issues during off-site activities (eg, field trips) and transportation to and from school. Education on transportation issues should include safe operation of motor vehicles (cars/motorcycles) and bicycle safety.¹ In elementary school, the importance of vigilance and safe habits at crosswalks and while loading and unloading school buses is paramount in decreasing fatal injuries in this age group.

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Physical violence

Sadly, no injury prevention program is complete without considering the prevalence of physical violence in the lives of schoolchildren. Physical violence affects all age groups and genders, although older children and boys are more frequently injured.⁵ As discussed above, violence often is the leading cause of school-age fatalities, and the emotional impact of violence should not be overlooked.

Merely the threat of violence or the frequent witnessing of violent acts may lead to absenteeism or the persistent feeling of being unsafe.⁵ It is vital that school systems adopt a zero tolerance policy not only for assault, substance abuse, and weapon discovery but also for threats, bullying, and aggressive/violent behavior. This policy takes on great importance as prevention programs for school violence have not proven successful thus far.⁵ The multifactorial basis for violence is no less elusive on the school yard than in the general population.

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Conclusion

Transport teams have a unique opportunity to become involved in injury prevention programs for school aged children. An understanding of gender and age risk factors, as well as common injury patterns, allows for the development of specific programs best suited to individual school systems and communities.

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References

Junkins EP, Knight S, Olson LM, Lightfoot A, Keller P, Corneli HM. Analysis of school injuries resulting in emergency department or hospital admission. Acad Emerg Med. 2001;4:343–348
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Laflamme L, Ellert-Petersson E. School injury patterns: a tool for safety planning at the school and community levels. Accident Analysis Prevention. 1998;30:277–283
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Gratz RR. School injuries: what we know, what we need. J Pediatr Health Care. 1992;6:256–262

Miller TR, Spicer RS. How safe are our schools?. Am J Public Health. 1998;88:413–418

Orpinas P, Kelder S, Frankowski R, Murray N, Zhang Q, McAlister A. Outcome evaluation of a multi-component violence-prevention program for middle schools: the Students for Peace Project. Health Educ Res. 2000;15:45–58