"A TIP From EMS" WISCONSIN PROBLEM IDENTIFICATION Youthful drivers, cyclists and pedestrians are disproportionately represented in roadway crashes, injuries and deaths. Studies show that drivers under the age of 30 account for more than one-half of all drinking drivers who are fatally injured in crashes. In Wisconsin in 1992, 115 drivers between ages 15 and 24 were killed in alcohol-related crashes, and such crashes caused serious injury to pedestrians, cyclists and others on the road. Young people are also observed to use safety belts less and to take significantly more risks when driving, cycling and walking on state roadways. Safety messages must be carefully targeted and delivered to reach this difficult audience. In response to this problem, Emergency Medical Services (EMS) personnel in Portage County, Wisconsin developed the "A TIP From EMS" Program. GOALS AND OBJECTIVES The "A TIP From EMS" (Trauma and Injury Prevention) Program was created to reduce injury and death among youth ages 16 to 24 by increasing their perception of the risks and of acceptable ways to reduce them. The "A TIP From EMS" Program consists of a videotape divided into short segments addressing motor vehicle trauma, alcohol, head injury and helmet use. It also includes a supporting brochure, poster and teacher guide. Emergency service providers present the program, that can be tailored to fit each audience. The presentation can convey the following messages to a young audience: þ Trauma is the leading cause of disability and death among young people, but traumatic injury is preventable þ The effects of alcohol and other drug use and the role of substance abuse in the prevalence of traumatic injury þ The role of seat belts and airbags prevents or minimizes injury þ The long-term effects of head injury and how the use of helmets when riding a motorcycle or bicycle can prevent or minimize these injuries þ The catastrophic emotional and economic costs of traumatic injuries STRATEGIES AND ACTIVITIES The "A TIP From EMS" program was developed by emergency care providers, law enforcement professionals, coroners, television news staff and injured crash survivors. These individuals formed the committee to oversee all phases of the program's development. The "TIP" Program has been presented to numerous audiences, including high school driver education classes, meetings of County Traffic Safety Commissions, the Wisconsin Emergency Nurses Association, the Coroners Association and the medical examiners. RESULTS Most of the students who have viewed the video rated the presentation as "good" or "excellent". Their comments indicate that the "A TIP From EMS" program positively influences students perceptions of the need to use safety belts and to prevent drinking and driving. A videotape in the same format is under development using Section 403 Bystander Care grant funds. Another one targeting a younger audience is also under development, using Section 402 funds. Community Occupant Protection Program INDIANA PROBLEM IDENTIFICATION In an effort to reduce the risk to teens of injury and death from traffic crashes in Elkhart County, Indiana, the Elkhart County Safe Kids Coalition determined that a safety education plan targeting high school youth was needed. A teen safety belt committee was formed, headed by a community volunteer for the American Red Cross. GOALS AND OBJECTIVES The primary goal of the Community Occupant Protection project was to implement an initiative that would result in a significant increase in safety belt usage rates by teens. This would reduce their risk of injury and death if they were involved in a traffic crash. The objectives were to: þ Raise the awareness level of seat belt safety þ Design and implement a student driven incentive program for five area high schools þ Form a committee of high school sponsors and students to develop the incentive program for their individual schools þ Provide leadership training for students/youth involved in the school-based programs þ Recruit and train volunteers to conduct safety belt usage surveys þ Achieve a minimum 70 percent safety belt usage rate by high school students STRATEGIES AND ACTIVITIES In the Spring of 1991, members of the Elkhart County Safe Kids Coalition formed the Teen Safety Belt Committee. The Committee developed the strategies and objectives, and solicited area high schools to participate in the program. Five high schools agreed to participate. Leadership conferences were conducted and school committees were established. Each school designed and implemented programs utilizing the "Buckle Your Bod" theme and logo. A dance was held to kick-off the program and 3,000 students attended. Other program activities included: þ The development and distribution of promotional items, such as lifesavers candy, t-shirts and water bottles þ Dissemination of educational materials þ Announcements through the school public address system þ Contest drawings Four students and an adult volunteer attended the National Student Safety Program (NSSP) Conference in Texas. This resulted in the establishment of the first NSSP chapter in the State of Indiana. RESULTS Evaluation methods consisted of observational surveys as well as feedback and follow-up sessions with participants. Four out of five schools demonstrated increased safety belt use rates. Two of the schools achieved a 69 percent usage rate, while overall increases ranged from 4 to 51 percent. Students continue to develop leadership and communication skills through networking with other students and organizations. One additional high school has submitted a request to participate in the program. Elementary Education Initiative MAINE PROBLEM IDENTIFICATION Comprehensive primary prevention programming in elementary schools is important because national surveys indicate that children are now beginning to use alcohol and other drugs at much younger ages than in the past. Developing and fostering positive "no-use" attitudes at an early age can help to prevent people from eventually choosing to drive when under the influence of alcohol or other drugs. The Elementary Education Initiative educates school children about the risks of impaired driving, and it enhances awareness of these issues for school personnel and treatment providers in the community. GOALS AND OBJECTIVES As part of a comprehensive prevention effort at each site, the program sought to: þ Increase awareness on the part of school staff of the issue of driving under the influence of alcohol or other drugs (DUI) þ Establish chemical health policy and procedures for employees and students þ Set up support groups for students and staff þ Plan and execute a student awareness plan þ Implement a curriculum model þ Provide alternative activities that are alcohol and other drug free þ Complete staff development activities STRATEGIES AND ACTIVITIES In educating elementary school children about the risks of DUI, the Division of Alcohol and Drug Education Services provides leadership in the following areas: þ Assisting school administrators and treatment providers in the development and implementation of chemical dependency services for elementary school children, including support groups þ Designing and implementing substance abuse prevention programs and activities þ Providing consultation to school administrators and school boards in revising and adopting policy and procedures þ Providing instruction for elementary school personnel in primary prevention curricula þ Offering consultation on the design, implementation and evaluation of elementary school student awareness programs þ Facilitating inclusion of parents in comprehensive prevention programs þ Establishing the implementation of the DARE America program in schools statewide RESULTS More than 30 school systems have been trained to implement the primary alcohol and other drug use prevention curriculum in elementary schools. Schools adopting these curricula within a comprehensive program have reported a more positive climate in classrooms, greater student awareness of DUI risks, and enhanced abilities for teachers to intervene with children who are most at risk for early onset of chemical use. After the Elementary Education Initiative had received 3 years of Section 402 grant funding from the National Highway Traffic Safety Administration (NHTSA), Maine lawmakers initiated a 5 cent tax on all bottle liquor sales for use in financing the program's continuation. Missouri HEADS UP MISSOURI PROBLEM IDENTIFICATION The University of Missouri-Columbia School of Medicine conducted an incident study on traumatic spinal cord injury in central Missouri and found that young people between the ages of 15 and 25 years were consistently over-represented. Traumatic head and spinal cord injuries result in permanent, life-altering disabilities which have no known cure. Given the nature of these injuries and the baseline data, it became very clear that an intervention targeting adolescents and young adults was desperately needed. GOALS AND OBJECTIVES The primary goal of the Missouri HEADS UP program is to increase young peoples' knowledge and understanding of the causes and consequences of injuries to the head and spinal cord, and of measures to prevent these injuries. Motor vehicle crashes are the leading cause of head and spinal cord injury, contributing to about half of all new cases each year. This program emphasizes safety belt use, safe driving behavior, motorcycle and bicylce helmet use, proper bystander behavior and safety with all-terrain vehicles. It also emphatically discourages drinking and driving. STRATEGIES AND ACTIVITIES Staff members developed an educational assembly for junior and senior high school audiences across the state. The program is presented in a manner that is suitable to adolescent audiences, and is designed to provide information in a non- threatening, non-authoritative manner. Audiences are exposed to the following information through videos and a brief lecture: þ Their vulnerability to serious injury þ Specifics about the mechanisms of injury, especially as they pertain to motor vehicle injury þ Facts about the permanence of injury þ Details about the anatomy of the brain and spinal cord Additionally, a young person who has had a head or spinal cord injury then speaks to the audience about his or her personal experience with injury and all aspects of living with a disability. This includes changes in urinary and bowel functions, sexual options and other elements that may not be readily apparent to those who have never had a spinal cord injury. After the speaker's presentation, the floor is open to questions from the students. RESULTS Over the past 13 years, assemblies have been conducted in over 500 schools, reaching nearly 182,000 students. Similar HEADS UP programs have been established in St. Louis, Kansas City, Cape Girardeau, Springfield and Joplin. These partner HEADS UP programs are supported and operated by hospitals and trauma centers. The American Association of Neurological Surgeons (AANS) and Congress of Neurological Surgeons (CNS) provided a national budget which was used to found the National Head and Spinal Cord Injury Prevention Program office in Park Ridge, Illinois. This allowed for the replication of Missouri HEADS UP in other states. There are now approximately 100 programs in 49 states using the Missouri assembly model or a similar model from Pensacola, Florida. Most of the programs are referred to as THINK FIRST, the name of the recently established national office. Former President Ronald Reagan and former US Surgeon General C. Everett Koop have both publicly endorsed this injury prevention model initiated by the University of Missouri School of Medicine. Northern Kentucky Rural Office of Traffic Safety KENTUCKY PROBLEM IDENTIFICATION According to the "Analysis of Traffic Data in Kentucky (1987- 1991)," the rate of fatal crashes on the state's urban highways was less than one-half the fatal crash rate on its rural highways. To address this major traffic safety concern in rural areas, the Northern Kentucky Rural Office of Traffic Safety (Northern KY ROOTS) developed a program targeting seven rural counties of Northern Kentucky whose populations ranged from 5,393 to 15,737. GOALS AND OBJECTIVES One of the main objectives of this project was to establish safety committees in Gallatin, Grant, Owen, Carroll, Henry, Trimble and Pendleton counties. Each committee was given a Traffic Crash Data Sheet to identify their county's main highway safety concerns. The following areas were then targeted for the project: þ Safety belt and safety seat usage among youth þ Underage drinking and driving STRATEGIES AND ACTIVITIES Northern KY ROOTS works with many organizations on this project, including the Department of Education, the Extension Service, the Farm Bureau, Students Against Driving Drunk (SADD), Future Homemakers of America (FHA), American Association of Retired Persons (AARP), and various religious, law enforcement and education committees in the communities. Each county committee planned and executed activities for special emphasis events such as Child Passenger Safety Awareness Week and Buckle Up America! Week. The project provided materials and technical assistance for the activities. The committees worked hand-in-hand with local school systems, health departments, law enforcement agencies, ambulance services and administrative offices of the courts. Most activities were conducted in high schools and included birthday parties for students turning 16, education on the dangers of drinking and driving, an annual seat belt use competition titled "Battle of the Belts", and distribution of new driver packets. Other activities included media spots, church bulletin inserts and informational brochures included with paychecks. Northern KY ROOTS also works with the Kentucky Early Childhood Association Conference by providing a highway safety exhibit and related materials for teachers of young children. RESULTS According to surveys, four counties have shown increases in their safety belt usage rates since 1993. They include Gallatin County with an increase of 7 percent, Grant County with an increase of 16 percent, Owen County with an increase of 14.9 percent, and Pendleton County with an increase of 7 percent. Additionally, no youth alcohol-related fatalities or injuries were reported in any of these four counties in 1993, compared to one fatality in Owen County in 1992. Young Driver Deterrence Project HAWAII PROBLEM IDENTIFICATION Across the nation, studies have concluded that alcohol-related traffic fatalities are still the number one killer of young people between the ages of 16 and 24. In Hawaii, a December 1989 report on drunk driving by the State Attorney General's Office found that Hawaii's alcohol-related teenage traffic fatalities were at a rate 38 percent above the national average. Based on data from the 1991 Fatal Accident Reporting System, the Motor Vehicle Safety Office of the Hawaii Department of Transportation reported that 76 percent of traffic fatalities involving youth between the ages of 16 and 24 were alcohol-related. GOALS AND OBJECTIVES In an effort to deter young people from drinking and driving, the Young Drivers DUI Deterrence Project was established within the Maui Police Department. The project initiated a Juvenile Alcohol Contact program designed to advise parents of situations involving the use of alcohol that may place their children in jeopardy. The project objectives are to: þ Increase the DUI arrest rate of 16 to 21 year old drivers þ Eliminate illegal liquor sales to minors þ Reduce alcohol-related violations, incidents and citizen complaints involving 16 to 21 years olds in Maui County STRATEGIES AND ACTIVITIES The Maui Police Department established sobriety checkpoints in areas and at times where frequent rates of youth driving under the influence had been previously detected. Roving patrol teams were also established in public areas where teenagers are known to congregate and consume alcohol. On an overtime basis, police officers monitored alcohol establishments suspected of selling liquor to minors. Appropriate enforcement action was taken in instances where warranted. The Juvenile Alcohol Contact Program sought to increase parental awareness. When a youth was found in a situation involving the use of alcohol, but was not in violation of the law, the officer sent the parents a letter advising them of the situation and the potential jeopardy for the child involved. RESULTS The program has achieved positive results and has been received favorably. A total of 382 labor-hours have been expended using teams of 2 to 3 officers on roving patrols. As a result, they have made 39 arrests for alcohol or drug violations, of which 32 involved minors. As a result of the deterrence projects high visibility in Maui County, particularly during the holiday season, patrol officers observed a substantial reduction in both public consumption of alcohol by juveniles, and illegal attempts to purchase alcohol. Youthful DUI Offender MISSOURI PROBLEM IDENTIFICATION National traffic safety data for 1992 showed that drinking contributed to 38.3 percent of the fatal crashes involving drivers under the age of 21. Drinking and driving crashes constitute 60.6 percent of single vehicle crashes during weekend and evening hours. DUI enforcement is a critical component of every impaired driver control system. GOALS AND OBJECTIVES The primary goal of the Youthful DUI Offender project is to detect and deter impaired driving, especially as it occurs among underage drinkers. The objectives of the program are to: þ Use sobriety checkpoints to decrease by 20 percent the serious traffic crashes involving underage drinkers þ Reduce the number of safety belt violations þ Increase media coverage of underage drinking risks by inviting local media and school newspapers to each checkpoint STRATEGIES AND ACTIVITIES The Missouri Division of Highway Safety (MDHS) utilized officers on an overtime basis to conduct sobriety checkpoints. These checkpoints targeting underage drinking drivers were conducted in areas where minors were known to congregate and consume alcoholic beverages. The department also responded to complaints from citizens concerning establishments that sold alcohol to minors. When such a call was received, police officials deployed one of their civilian employees who was a minor to attempt to purchase alcohol at the establishment in question. If the individual was successful, appropriate apprehensions and arrests would be conducted. The department's Vice Unit participated in this effort by also obtaining intelligence information, and by effecting the appropriate arrest of those employees of businesses found to sell alcoholic beverages to minors. Enforcement efforts were coupled with appropriate public information releases aimed at escalating the perceived risk of arrest. RESULTS The department was able to purchase an undercover vehicle for use in surveillance activities. Four sting operations and 11 saturation patrols have been conducted between March and October of 1994 resulting in 17 minor and 96 adult arrests. Funding to continue efforts through 1995 has been requested.