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Under the leadership of Richard Falcone, MD, director of trauma services at Cincinnati Children’s Hospital Medical Center, a variety of injury control and research studies are being conducted:
This multifaceted program is being conducted in partnership with Every Child Succeeds. The program focuses on increasing the use of effective injury prevention devices and behaviors among mothers of infants and toddlers, with the long-term goal of significantly reducing the number of injury-related hospitalizations and deaths among these children. The program comprises injury prevention education for home visitors, injury prevention education for mothers (conducted by home visitors) and child passenger safety.
The program focuses on those in our community who most need support. In particular, our efforts focus on reaching the African-American and Hispanic populations, which are disproportionately affected by such injuries.
This innovative and highly successful community-based injury-prevention initiative was developed as a partnership between trauma services and the African-American faith community. We have been able to educate families on fire and gun safety, home safety, drowning prevention, pedestrian safety and most important, motor vehicle safety and the proper use of child restraints. This program has been remarkably successful in increasing proper seating position and restraint use among African-American children and additionally has increased restraint use among adults. This program has been recognized by the National Highway Traffic Safety Administration and by the Ohio Department of Public Safety, which plans to use our YIP model for promoting car safety statewide.
We are currently working to expand our program and develop a packaged curriculum that can be distributed nationally.
Given the growing number of Hispanic children in our community and their disproportionate injury numbers, we have partnered with Toyota to develop a Youth Injury Prevention program that is culturally sensitive for the Hispanic community. Building upon the success of our African-American program, we have partnered with the Hispanic faith community to develop a safety curriculum and program implemented through the churches. In its early stages, this program has been well received, and we are collecting data to determine the success in improving safe behaviors.
This federally funded study is designed to reduce the risk of injury among preschool children. We are achieving this goal by (1) increasing awareness of the risks of pediatric injury among preschool children, parents and teachers participating in the Head Start program, (2) by identifying barriers to the use of injury prevention devices, and (3) by increasing the use of such devices.
This program addresses the special cognitive, physical and emotional needs of injured children returning to the classroom after hospitalization. Our goal is to facilitate smooth and successful re-entry into the school and to utilize the “teachable momentz” to promote injury prevention among classmates and friends. This education has been shown to improve knowledge in classmates that is retained on follow-up testing. Future studies will examine the ability to expand this program by training teachers and other injury-prevention specialists to facilitate school re-entry and educate children on injury prevention.
We have identified a significant impact on quality of life for both patients and their families following traumatic injury. Ongoing research will continue to expand upon our understanding of specific factors affecting quality of life and developing specific family and patient-centered approaches to minimize this effect.
Victor Garcia, MD, and Rebeccah Brown, MD
In collaboration with scientists from Qualia Computing Inc. and physicians in Cincinnati Children’s Division of Emergency Medicine and Cardiac Care Unit, we are developing a novel patient monitor that is based on the application of cognitive systems technologies. The monitor is capable of assessing the more meaningful and earlier non-linear responses of the body to major blood loss. The prototype of the Intelligent Patient Monitor detected the early phases of hemorrhage-related circulatory dysfunction prior to the onset of hypotension or changes in heart rate. The final product will change the paradigm for the treatment of shock and will have an immediate and direct impact on the care of the seriously injured patient.
Despite advances in injury prevention and care of the injured child, minority children continue to be disproportionately affected as the result of preventable injuries. The causes of such disparities are likely multifactorial but remain unclear. Using our comprehensive trauma database system, we are investigating these disparities to better understand the causes. As we better understand this complex problem, we will be able to develop specific interventions designed to reduce the inequities.
Victor F. Garcia, MD
We participate in this statewide study of the effectiveness of practice guidelines in managing children with hepatic and splenic injuries.
Pediatric head injury is a leading cause of death and long-term morbidity. In collaboration with pediatric neurosurgery as well as pediatric critical care and rehabilitation medicine we are working to develop guidelines and systems to maximize care of these injured children. In particular, we are interested in the management of elevated intracranial pressures in children with severe head injury. We are currently developing a prospective randomized study to evaluate the effectiveness and appropriate administration of hypertonic saline.
Management of pediatric trauma is complex and requires a multidisciplinary team including trauma surgeons, emergency medicine physicians, fellows and residents, nurses and respiratory therapists. To provide the highest level of care, this care group must work efficiently as a team and utilize a “shared mental model.” To maximize continued education in the care of the injured child we have begun utilizing a high-fidelity human patient simulator. Through this education we intend to be able to demonstrate improved teamwork and leadership among team members, more rapid recognition and management of injuries, and, ultimately, improved outcomes for severely injured children.
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