Rural Trauma Team Development Course Instills Confidence in Critical Access Hospitals.

PURPOSE: The American College of Surgeons' Rural Trauma Team Development Course (RTTDC) was designed to help rural hospitals optimize a team approach to trauma management recognizing the need for early transfer. Little literature exists on the success of RTTDC achieving its objectives. The purpose of this study was to determine the impact of RTTDC on rural trauma team members. METHODS: RTTDC was hosted at seven rural hospitals. A pre-course 30-question Likert survey gauging confidence managing trauma patients was administered to participants. Four weeks following, participants received a post-course survey with corresponding Likert questions and 11 trauma knowledge-based questions. Chi-square, Fisher's exact tests and general linear models were utilized. Statistical significance is set as p < 0.05. RESULTS: 111 participants completed the pre-course survey; 53 (48%) completed the post-course survey. Results presented on a 5-point Likert scale with 1 = "not at all comfortable" to 5 = "extremely comfortable." Participants knowing their role in the trauma team improved by 16% (p = 0.02). Familiarity with the roles of other trauma team members was significantly improved (3.4 vs. 4.15; p < 0.01). Participants comfort with resuscitating trauma patients and managing traumatic brain injury significantly improved (3.29 vs. 3.69; p = 0.01 and 2.62 vs. 3.14; p = 0.004, respectively). Comfortability communicating with the regional trauma center improved significantly (3.64 vs. 4.19; p = 0.004). Participant decision to transfer trauma patients within 15 min of arrival improved by 3.2%. Participants answered 82% of the knowledge-based questions correctly. CONCLUSION: RTTDC instills confidence in providers at rural hospitals. The information taught is well retained, allowing for quality care and timely patient transfer to the nearest trauma center.

Perceptions of violence in justice-involved youth.

BACKGROUND: Youth are tragically affected by violence. Justice-involved youth are at elevated risk for the effects of violence, as incarceration serves as a risk factor. The objective of this study is to explore the risks and needs of justice-involved youth and identify channels for future hospital-based programming. METHODS: Four weekly focus groups were conducted by a credible messenger at the Douglas County Youth Center with former participants of Dusk 2 Dawn, a youth violence prevention program delivered at the Douglas County Youth Center. Eight participants were prompted with preset interview questions. All focus groups were recorded and transcribed by a professional transcription service. A thematic analysis was performed by 2 independent coders to identify themes using Dedoose software. RESULTS: The 3 most frequently occurring themes involved topics on protection, identified 40 times; family, identified 36 times; and the challenge of overcoming violence, identified 31 times. These themes often overlapped with one another, demonstrating the complexity of youth violence. CONCLUSION: Providing a safe and judgement-free space for the youth to discuss issues of violence was beneficial for 3 reasons: (1) inclusion of youth perspectives allows violence prevention programs to be tailored to specific needs, (2) participants were able to deeply reflect on violence in their own lives and consider steps toward positive change, and (3) open communication encourages trust building and collaborative prevention efforts between the hospital and community.

Dusk to Dawn: Evaluating the effect of a hospital-based youth violence prevention program on youths' perception of risk.

BACKGROUND: Historically, youth violence prevention strategies used deterrence-based programming with limited success. We developed a youth violence prevention program, Dusk to Dawn (D2D), intended to improve youths' recognition of high-risk situations and teach new skills in conflict resolution. The aim of this study was to evaluate the effect of D2D on youths' perceptions of personal risk factors and high-risk situations. METHODS: Youth ages 12 years to 18 years were referred to D2D by community-based organizations, probation, or youth detention center. The youth completed a self-report survey before and after participating in D2D. RESULTS: One hundred eight youth participated in D2D. Pretest and posttest results for self-reported personal risk factors and high-risk situations for violence are presented. For personal risk factors, a statistically significant increase in the perception that family (p < 0.01) and other issues (p < 0.05), and a decrease in the perception that school problems (<0.05) were seen as important personal risk factors. For high-risk situations, increases in the perception that peer violence and substance use as high-risk situations were seen as significant at the trend level (p < 0.10). Of the 60% of participants who answered questions regarding satisfaction with D2D, 83.3% agreed or strongly agreed that D2D helped them to better understand violence and 83.3% would recommend D2D to others. CONCLUSION: Youth violence prevention programming including an explicit discussion of how violence is learned and the role of family, friends, school, and a community in shaping youths' attitudes toward violence can effectively raise awareness of one's own risk factors. Risk factors for youth violence are often preventable or modifiable, making awareness of one's own risk factors a realistic target for youth violence prevention programs. LEVEL OF EVIDENCE: Therapeutic/Care Management, Level III.