The IHS Trauma and Preventive Services supports a coordinated effort in the defined American Indian/Alaskan Native geographic area that delivers the full range of care to all injured patients and is integrated with the local public health system. The Trauma system should provide transition between each phase of care, integrating existing resources to achieve improved patient outcomes.

Program Objectives

• Develop an awareness supported by an operational concept of the IHS trauma system that has a central focus on the prevention of injury and addresses the financial burden as well as those of morbidity and mortality.
• Provide technical assistance and support to facilities that deliver acute care to the American Indian/Alaskan Native community.
• Maintain and monitor trauma registry data to ensure that unmeasured needs are met.
• Coordinate with public health aspects of the healthcare delivery system to increase positive patient outcomes and faster return to productivity.

Current Projects

Alcohol Screening and Brief Intervention

Injuries and poisonings are the number two reason that young Native Americans and Alaskan Natives are admitted to the hospital. Many of these injuries are due to motor vehicle crashes, often alcohol related. Death related to alcohol consumption occurs seven times more often in American Indians and Alaskan Natives than in the general U. S. population. The Alcohol Screening and Brief Intervention (ASBI) Initiative aims to address these problems by mobilizing multiple healthcare providers to implement the technique by screening and conducting brief motivational interviews. When employed, this method has been shown to dramatically decrease the number of repetitive injuries and the amount of alcohol consumed. Implementation of the ASBI program will be the largest targeted alcohol-related injury prevention program to date.

The ASBI Initiative capitalizes a wealth of studies from across the globe demonstrating that with training and just a few extra minutes, health care providers in acute settings can reduce the rate of repeat injuries up to 27-65%. The benefits accrue for at least one year after the initial intervention, potentially longer. The critical steps to the program involve targeted screening of patients for non-dependent, hazardous or harmful alcohol use. In a compassionate manner, providers guide the patient to the connection between the current consequences (i.e. injury, arrest) and his/her d rinking and then negotiate a plan for change. Booster sessions to provide reinforcement are useful and can be supplied by any provider at the patient's follow-up visit, at primary care visits, or ideally at all visits to a healthcare professional. The Society for Academic Emergency Medicine Public Health Task Force has given the technique to be used an "alpha" rating, fully supporting its use. This Indian Health System is being implemented in all hospitals and will be expanded to primary care and behavioral health clinics within the next year. It is expected to have significant impact on morbidity and mortality in preventing alcohol-related injuries.

Objectives:

• Decrease the number of alcohol-related injuries and deaths. Decrease hazardous and harmful alcohol use.
• Monitoring the breadth of implementation as well as the results of the initiative to evaluate success and potential to utilize technique for other causes of morbidity and mortality.

Boyd, D.R. (1980). Trauma - A Controllable Disease in the 1980’s [Electronic Version]. The Journal of Trauma. Vol. 20, No.1, 14-24. (PDF - 2.1MB)

Boyd, David R. and Cowley, R. Adams. (1983). Comprehensive Regional Trauma/Emergency Medical Service (EMS) Delivery Systems: The United States Experience. World Journal of Surgery, 7, 149-157. (PDF - 571KB)