NEEDS ASSESSMENT PREVENTION. December Central Mountains RETAC. Prepared by: Caring Anne Consulting, LLC. Anne Robinson-Montera, RN, BSN

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1 Central Mountains RETAC PO Box 555 Frisco, CO 8443 Web: Prepared by: Caring Anne Consulting, LLC Anne Robinson-Montera, RN, BSN PO Box 5973 Eagle, CO December 214 PREVENTION NEEDS ASSESSMENT

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3 Table of Contents I. Executive Summary... 1 II. About Central Mountains RETAC... 1 III. Participating Agencies... 2 IV. The Prevention Needs Assessment... 4 INTRODUCTION... 4 PRIMARY DATA COLLECTION... 4 SECONDARY DATA COLLECTION... 6 Background on Trauma Data... 6 Background on EMS Data... 6 Frequency of Injury... 6 V. The CMRETAC s Prevention Profile... 8 CAUSES OF INJURY... 8 DEMOGRAPHICS... 1 Total Injury by Gender... 1 Top 3 Causes of Injury by Age for Trauma... 1 Top 3 Causes of Injury by Age for EMS RESIDENTS VERSUS VISITORS Chaffee County Eagle County Lake County Park County Pitkin County Summit County Central Mountains RETAC... 2 PREVENTION RESOURCES CURRENT PREVENTION ACTIVITIES Teen Seat Belt Challenge PREVENTION NEEDS VI. Recommendations and Next Steps VII. End Notes... 26

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5 Page 1 I. Executive Summary The Central Mountains Regional Emergency Medical and Trauma Advisory Council (CMRETAC) has conducted a Injury Prevention Needs Assessment as directed by the Board Members. The CMRETAC completed the Systems Development Biennial Plan in early 213 as required by the Colorado Department of Public Health and Environment s Emergency Medical and Trauma Services Division. Aligning with priorities and goals from the Biennial Plan, the Board Members contracted with a Prevention Coordinator to coordinate, collaborate, and promote the prevention efforts throughout the region. One of the first goals of the position was to conduct a Prevention Needs Assessment. This report is the first of its kind conducted by the CMRETAC and represents the beginning of forming a Prevention Committee, aligning goals and efforts based on the needs identified. II. About Central Mountains RETAC The Central Mountains Regional Emergency Medical and Trauma Advisory Council (CMRETAC) region is primarily rural, stretching over 6,883 miles in the mountainous continental divide area of Colorado. The region is almost the size of the State of New Jersey and has unique passenger safety challenges that range from tens of thousands of travelers that do not reside in the region, to the risk taking teen population, and the non-english speaking service working population. Additional challenges include access to medical care due to the rural designation and weather constricting mountainous roads. Within the region, people travel up to 65 miles one way to be seen in a hospital. Image 1 is a map of Colorado outlining the 11 Regional Emergency Medical and Trauma Advisory Councils. Northwest RETAC Northeast Colorado RETAC Foothills RETAC Central Mountains RETAC Mile-High RETAC Plains to Peaks RETAC Western RETAC Southern Colorado RETAC Southeastern Colorado RETAC Southwest RETAC San Luis Valley RETAC Regional Emergency Medical and Trauma Advisory Councils Image 1 CMRETAC is made up of 6 counties: Chaffee, Eagle, Lake, Park, Pitkin, and Summit. All of which have unique characteristics and challenges. Table 1 outlines the demographics of each county according to the 214 Problem Identification Report published by the Colorado Department of Transportation (CDOT) i, with the demographic data based on 212 results.

6 Page 2 Table 1: CMRETAC 212 Demographics County Square Miles Population Traffic Fatalities Serious Injuries in Traffic Crashes Chaffee 1,15 18, Eagle 1,692 51, Lake 384 7, Park 2,211 16, Pitkin , Summit 68 28, CMRETAC Totals 6, , With a population of 51,944, Eagle County covers over one-third of the region s total population of 138,745. The smaller rural counties of Chaffee, Lake, Park and Pitkin s population are less than 2,, where Summit is more densely populated than any other county. The region had 18 traffic fatalities and 416 serious injuries in traffic crashes during 212, making this a priority for the future. III. Participating Agencies The CMRETAC s mission statement is OPTIMIZING THE CARE OF SICK AND INJURED PATIENTS, AND PREVENT INJURY THROUGH THE INTEGRATION OF HEALTH CARE FACILITIES AND EMERGENCY MEDICAL RESOURCES; UTILIZING COMMUNICATIONS, DATA, PROTOCOLS, CQI AND SYSTEMS DEVELOPMENT. This mission could not be possible without the contribution from the Board Members and participating agencies in each county. There are also agencies that are not currently participating in the RETAC Board meetings, but through this assessment process were identified. A recommendation is to start expanding participation in the regional Prevention Coalition in order to ensure all stakeholders are involved so all of the needs of the communities will be met. Below is a list of agencies by county, separating out current and future members. Chaffee: Buena Vista Fire Department, Buena Vista, CO Chaffee County EMS, Salida and Buena Vista, CO Chaffee County Emergency Manager, Salida, CO Chaffee County Fire Protection District, Buena Visita, CO Chaffee County Public Health, Salida, CO Heart of the Rockies Regional Medical Center, Salida, CO Salida Fire Department, Salida, CO Eagle: Bond/McCoy Fire, Bond, CO Colorado Mountain College, Edwards, CO (Regional Educational Institution) Eagle County Airport Fire Department, Eagle, CO Eagle County Emergency Manager, Eagle, CO Eagle County Paramedic Service, Edwards, CO

7 Page 3 Eagle County Public Health, Eagle, CO Eagle River Fire Protection District, Edwards, CO Greater Eagle Fire Protection District, Eagle, CO Gypsum Fire Protection District, Gypsum, CO Vail Fire, Vail, CO Vail Valley Medical Center, Vail, CO Lake: Lake County Emergency Manager, Leadville, CO Lake County Fire Department, Leadville, CO Lake County Public Health, Leadville, CO St. Vincent Hospital and Ambulance Service, Leadville, CO Park: North-West Fire Protection District, Fairplay, CO Park County Emergency Manager, Fairplay, CO Park County Public Health, Fairplay, CO Platte Canyon Fire Department, Bailey, CO South Park Ambulance District, Fairplay, CO Southern Park County Fire Protection District, Guffey, CO Ute Pass Ambulance District, Woodland Park, CO Pitkin: Aspen Fire Protection District, Aspen, CO Aspen Valley Hospital, Aspen, CO Aspen Ambulance District, Aspen, CO Basalt Fire, Basalt, CO Pitkin County Public Health, Aspen, CO Pitkin County Emergency Manager, Aspen, CO Snowmass Fire Department, Snowmass, CO Summit: Breckenridge Medical Center, Breckenridge, CO Copper Mountain Fire Department, Copper Mountain, CO Copper Mountain Medical Clinic, Copper Mountain, CO Keystone Medical Clinic, Keystone, CO Lake Dillon Fire Department, Silverthorne, CO Red, White, and Blue Fire Protection District, Breckenridge, CO St. Anthony / Summit Medical Center, Frisco, CO Summit County Ambulance Service, Silverthorne, CO Summit County Emergency Manager, Frisco, CO Summit County Public Health, Frisco, CO

8 Page 4 IV. The Prevention Needs Assessment INTRODUCTION: The Prevention Needs Assessment provides an analysis of the current prevention programs, services, and injuries treated for in the CMRETAC. This information compares survey findings regarding perceived prevention efforts among CMRETAC Board members and analyzed results from county level EMS and Trauma data collected over a specific time range. The methodology of collecting primary and secondary data identified prevention priorities in the CMRETAC to help further the work and build on best practices in the future. Methodology Primary Secondary Survey of Board Members County Level EMS Data County Level Trauma Data PRIMARY DATA COLLECTION: In conducting the Prevention Needs Assessment for the CMRETAC, information was gathered from the primary data collection source in the form of a Prevention Survey using SurveyMonkey. All CMRETAC Board Members were asked to fill out the survey and specify what type of agency they represented: EMS, Hospital, Police/Fire, or Public Health. The Board Members were also asked to pass on the survey link to anyone in their community that wasn t included in the initial contact list. In total, the survey was ed to 42 respondents, with a response rate of 48 percent. Individuals surveyed included local EMS administrators, Trauma nurse coordinators, prevention and outreach coordinators, fire department administrators, public health officials, sheriff deputies and administrators, police administrators, and emergency managers. Actual respondents to the survey included representation from the following agencies or organizations by county as seen in Table 2: Table 2: Responses by Agency Type County EMS Hospital Police/Fire Public Health Chaffee Eagle 1 1 Lake Park 3 1 Pitkin 1 Summit 4 2

9 Page 5 Chart 1 shows the break down by type of agencies that responded to the survey. Hospital and Fire/Police accounted for 65 percent of all responses. Public Health 1% Chart 1: Agency Type Response EMS 25% Hospital 35% Fire/Police 3% Chart 2 shows the responses by County, with Summit and Park accounting for 5% of responses. Note that some counties had multiple responses from the same type of agencies. Chart 2: Responses by County Summit 3% Chaffee 2% Eagle 1% Pitkin 5% Park 2% Lake 15%

10 Page 6 SECONDARY DATA COLLECTION: The CMRETAC conducted secondary data collection by asking The Colorado Department of Public Health and Environment (CDPHE) s Trauma and EMS division to run specific statistical reports for The reports were run in the Trauma and EMS reporting systems, inquiring about the top 5 causes for injuries at the county and regional level. Additional demographic data was collected including age, sex and home residence for each of the patients. Since not every county within the CMRETAC has a hospital and injury types vary by county, it was important to run the reports from both of these databases. Background on Trauma Data: Trauma data is collected at designated Trauma facilities throughout the state. Only Level I, II, and III facilities are required to report Trauma data and Level IV and V facilities have the option to contribute. The data is collected on patients that meet the Inclusion Criteria as defined by the State of Colorado Department of Public Health and Environment Health Facilities and Emergency Medical Services Division ii and are listed in Table 3. Table 3: INCLUSION CRITERIA: ALL Trauma patients who: 1. Die anywhere in the hospital (deaths in the emergency department, DOA deaths, deaths in the OR, deaths as an inpatient). OR 2. Are transferred into or out of an acute care facility, regardless of injury severity, length of stay at the transferring facility, or mode of transfer (by EMS or by private vehicle). Information should be downloaded to the state registry from both the transferring facility and the receiving facility for any patient transferred (even if the patient is discharged from the ED of the receiving facility). OR 3. Have an ED disposition = OBS and either (a) and Injury Severity Score (ISS) 9 or (b) a hospital stay of 12 hours from the time of arrival at the emergency department. OR 4. Have an ED disposition = FLOOR, ICU, TELE, ADMIT, OR, or DIRECT. OR 5. Are admitted for missed diagnoses, complications, failed conservative management or iatrogenic injuries identified after a previous hospital encounter. For these unplanned returns, the original ED visit or admission could have been at your facility or at another facility. Patients who are readmitted as part of standard or planned care for a given injury (e.g., removal of hardware after an orthopedic procedure) should NOT be included as a readmission. The readmission should occur within 3 days of when the patient was last discharged. Background on EMS Data: EMS data is collected by air and ground ambulance transport agencies that are licensed by CDPHE. As stated in Chapter 3 Rules iii, All agencies licensed in Colorado shall report the required data elements on all responses that resulted in patient contact. Although not required, agencies may also report the required data elements on responses that did not result in patient contact or transport (all calls). The required data and information on patient care is based on the National Emergency Medical Services Information System (NEMSIS) released and recommended by the National Highway Traffic Safety Administration (NHTSA) in 28. Background on Frequency of Injury: All of the data received from the state s EMS and Trauma departments has been evaluated and prioritized for this publication by state and regional data experts and regional Trauma nurse coordinators. It was concluded that the data will be presented separately as EMS and Trauma, but then evaluated together as

11 Page 7 recommendations have been made for future regional prevention efforts. With the Trauma data, the results are based on the location where the injury occurred versus the location where the patients were treated. Where with the EMS data, the results are based on where the call for care originated. In addition, Trauma data is based on one patient s medical record where EMS data is based on each incident or call. For example, a patient can be transported by EMS to a hospital, treated, and transported again to another facility. This would account for two transports and one patient visit to the hospital. At first glance, the Chart 3 below shows the frequency of Injury by county for the 213 Trauma data set. Summit and Eagle Counties account for almost 7% of the regional s 264 recorded Trauma injuries. Where the four other counties, Chaffee, Lake, Park and Pitkin make up the remaining 3% of total injuries in 213. Chart 3: 213 Trauma Frequency of Injury by County CHAFFEE EAGLE LAKE PARK PITKIN SUMMIT Looking at Chart 4 below, the 213 EMS Frequency of Injury by County, Eagle County accounts for 48% of the total 2213 EMS regional calls, where the other five counties together make up the remaining 52%. Chart 4: 213 EMS Frequency of Injury by County Chaffee Eagle Lake Park Pitkin Summit Comparing both charts shows that both Pitkin and Summit Counties see more patients in their Level III and IV Trauma Centers, but more than 5% of their patients are transported to their facility by non-licensed transport agencies. Where in Chaffee, Lake, and Park Counties, EMS transports more non-trauma patients then higherlevel Trauma patients.

12 Page 8 V. The CMRETAC s Prevention Profile CAUSES OF INJURY: To help identify and prioritize regional prevention efforts, the top causes of injury needs to be identified based on Trauma and EMS data. In Chart 5, the top 5 Trauma causes of injury throughout the region over the past 5 years shows Falls as the number one and primary injury accounting for 8% of all injuries. The other 2% of injuries comes from motor vehicle traffic occupants, pedal cyclists, other transports, and struck by/against. Chart 5: CMRETAC Trauma's Top Causes of Injury FALL MVT OCCUPANT PEDAL CYCLIST, OTHER TRANSPORT, OTHER STRUCK BY, AGAINST In order to understand the causes of injury, the Trauma definitions are cited below from the Center for Medicare and Medicaid Services ICD-9 codes iv Fall accounts for over 1 ICD-9 codes including a wide range of activities as well as skiing, snowboarding, falls from a standing height, and falls from trains, ladders, rafts, stairs, scaffolding, wheelchair, skateboard, etc.* Fall Injuries relating to how a patient falls. Accounts for over 1 ICD-9 codes* Motor Vehicle Traffic Occupant Pedal Cyclist, Other Injuries that Involve both motor vehicle collisons and single car accidents (rollovers) and accounts for 2 ICD-9 codes Injury involving a pedal cyclist Transport, Other Injury caused by transport device other than a motor vehicle including snowmobiles, ATV, etc Struck by, Against Refers to several different mechanisms like striking a tree while skiing, colliding with another person while skiing, a tackle in football or hit by a puck in hockey

13 Page 9 In Chart 6, the top 5 EMS causes of injury throughout the region from the past 5 years, also shows falls as the number one injury accounting for 58% of all injuries. Motor vehicle traffic accident is second at 29% followed by bicycle accident, motor vehicle non-traffic accident, and motorcycle accident Falls Chart 6: CMRETAC EMS's Top 5 Causes of Injury Motor Vehicle Traffic Accident Bicycle Accident Motor Vehicle Non- Traffic Accident Motorcycle Accident All of the EMS definitions for cause of injury below were cited from The National Association of State EMS Officials Extended Definition Document NEMSIS/NHTSA Data Dictionary v except for Motorcycle Accident* which was not included in the document. Falls Motor Vehicle Traffic Accident Excludes falls which occur in the context of other external causes of injury such as fire, or falling in incidents involving machinery Includes any motor vehicle incident occurring on a public road or highway Bicycle Accident Includes bicycle-related incidents not involving a motorized vehicle Motor Vehicle Non- Traffic Accident Motorcycle Accident* Includes any motor vehicle incident occurring entirely off public roadways or highways. (ATV, snowmobile) Includes any motorcycle accident occurring on a public road or highway

14 Page 1 DEMOGRAPHICS: Total Injury by Gender: When combining all injuries throughout the region from the past 5 years, males have a higher prevalence of injuries, both in the Trauma and EMS cases. Chart 7: CMRETAC Trauma's Total Injuries by Gender Chart 8: CMRETAC EMS's Total Injuries by Gender Female Male Female Male Total Total Top 3 causes of injury by age for Trauma: When prioritizing prevention activities, it is important to target the population with the most risk and occurrence of injury. The definition of fall can result while skiing or just being in one s own home. The break down of age can help evaluate what types of falls are occurring in the region. In Chart 9 injuries occur primarily with persons ages but followed closely behind are persons ages Age 75+ Years Age Years Age Years Age Years Age Years Age Years Age Years Age Years Age 5-12 Years Age -4 Years Chart 9: #1 Trauma FALL

15 Page 11 In Chart 1, patients years old are involved in more motor vehicle accidents than anyone else. Age 75+ Years Age Years Age Years Age Years Age Years Age Years Age Years Age Years Age 5-12 Years Age -4 Years Chart 1: #2 Trauma MVT OCCUPANT In Chart 11, year old patients are involved in more bicycle accidents than any other population. Age 75+ Years Age Years Age Years Age Years Age Years Age Years Age Years Age Years Age 5-12 Years Age -4 Years Chart 11: #3 Trauma PEDAL CYCLIST

16 Page 12 Top 3 causes of injury by age for EMS: EMS data reflects the Trauma data with the top 3 causes of injuries that are fall, motor vehicle accidents, and bicycle accidents. EMS systems are responding to more falls in the older population, of over the age of 75 as seen in Chart 12. This number will continue to increase as the population ages. Age 75+ Years Age Years Age Years Age Years Age Years Age Years Age Years Age Years Age 5-12 Years Age - 4 Years Chart 12: #1 EMS FALLS In Chart 13, patients years old are involved in more motor vehicle traffic accidents any other population. Age 75+ Years Age Years Age Years Age Years Age Years Age Years Age Years Age Years Age 5-12 Years Age - 4 Years Chart 13: #2 EMS Motor Vehicle Traffic Accident

17 Page 13 As with the Trauma data, patients years old are the population that is involved in more bicycle accidents as seen in Chart 14. Age 75+ Years Age Years Age Years Age Years Age Years Age Years Age Years Age Years Age 5-12 Years Age - 4 Years Chart 14: #3 EMS Bicycle Accident RESIDENTS VERSUS VISITORS: The CMRETAC has a unique opportunity to provide various health care services to local, state, and out of state residents. The influx of visitors challenges the regional system throughout the year. Each county within the region serves a population with many similarities and differences. Below is a break down by county and region for Trauma and EMS causes of injury based on the patient s home residence. CHARTS TO FOLLOW

18 Page 14 Chaffee County: The Trauma program treats 49% of patients that live within the county as seen in Chart 15. The other 51% are visitors, primarily during the warmer months of the year, with 33% live in Colorado, and almost 18% live out of state. Chart 15: Trauma: Chaffee County Cause of Injury Patient Home Residence Lives in County Colorado Resides Out of State 45 As seen in Chart 16, the EMS agency also provides services to the patients living within the county, accounting for 56%. Almost 1% of patients have an unknown place of residence, 27% live in Colorado, and almost 8% live out of state. Chart 16: EMS: Chaffee County Cause of Injury Patient Home Residence Unknown Residence Lives In County Colorado Non-Colorado

19 Page 15 Eagle County: Chart 17 outlines the patients seen by the Trauma program in Eagle County. Of the 5 year total 3366, 54% of patients are from out of state, 29% live within the county, and almost 17% live within the state Chart 17: Trauma: Eagle County Cause of Injury Patient Home Residence Unknown Lives in County Colorado 183 Resides Out of State EMS in Eagle County is more difficult to evaluate due to the 28% of patients have an unknown place of residence. Excluding unknown residence it shows that the services treats 3% of local residents, 24% of Colorado residents, and 17% of non-colorado residents. In addition, non-transport agencies do bring Trauma patients to the hospital and are not accounted into these results Chart 18: EMS: Eagle County Cause of Injury Patient Home Residence Unknown Residence Lives In County 554 Colorado 45 Non-Colorado

20 Page 16 Lake County: In Lake County, the Trauma program treats 7% of local residents that live within the county, where 6% are Colorado residents, and 24% live out of state as shown in Chart 19. Chart 19: Trauma: Lake County Cause of Injury Patient Home Residence Unknown Lives in County Colorado 4 Resides Out of State Aligning with the county s Trauma program, Chart 2 shows that greatest amount of patients treated, 44%, live within the county. In addition, 13% live in Colorado, 2% live out of state, and 22% have an unknown residence Chart 2: EMS: Lake County Cause of Injury Patient Home Residence Unknown Residence 176 Lives In County 52 Colorado 81 Non-Colorado

21 Page 17 Park County: Park County doesn t have a hospital that treats local patients; so all Park County residents and visitors are treated at other facilities. Of the 365 patients treated over the 5 years, 47% live in the county, 44% are Colorado residents, and 9% live out of state based on the information in Chart 21. Chart 21: Trauma: Park County Cause of Injury Patient Home Residence Unknown Lives in County Colorado 32 Resides Out of State EMS patients treated in Park County as shown in Chart 22 the majority of patients are Colorado residents is 47%, with 25% living within the county, 16% are from out of state, and 12% have an unknown place of residence. Chart 22: EMS: Park County Cause of Injury Patient Home Residence Unknown Residence Lives In County Colorado Non-Colorado

22 Page 18 Pitkin County: Very similar to Eagle County, the majority of patients treated in Pitkin County are non-colorado residents (53%). In addition, 29% of patients live in the county, and 19% live within the state as shown in Chart 23. Chart 23: Trauma: Pitkin County Cause of Injury Patient Home Residence Unknown Lives in County Colorado 795 Resides Out of State Again, similar to Eagle County, the EMS data in Pitkin County shows in Chart 24 that a large percent of patients have an unknown place of residence (47%). Apart of that, 26% of patients live in the county, 18% in state, and only 9% out of state. Chart 24: EMS: Pitkin County Cause of Injury Patient Home Residence Unknown Residence Lives In County Colorado Non-Colorado

23 Page 19 Summit County: The Summit County Trauma program treats 5% of patients that live out of state as seen in Chart 25. In addition, only 16% of Trauma patients live in the county and 34% are Colorado residents. Chart 25: Trauma: Summit County Cause of Injury Patient Home Residence Unknown Lives in County Colorado 2661 Resides Out of State The EMS patient s place of residence is not very accurate as seen in Chart 26, with 21% unknown. 3% of patients live within the county, 37% within the state, and only 11% reside out of state. As in Eagle County, nontransport agencies do bring Trauma patients to the hospital and are not accounted into these results. Chart 26: EMS: Summit County Cause of Injury Patient Home Residence Unknown Residence Lives In County Colorado Non-Colorado

24 Page 2 Central Mountains RETAC: The CMRETAC s regional Trauma programs together treat 4% of patients that live out of state as seen in Chart 27. In addition, only 25% of patients live in Colorado and 29% live within the region. Chart 27: Trauma: CMRETAC Cause of Injury Patient Home Residence Unknown Lives in RETAC Colorado Resides Out of State The regional EMS patient s place of residence is not very accurate as seen in Chart 28, with 26% unknown. 32% of patients live within the region, 28% within the state, and only 13% reside out of state. In both Summit and Eagle Counties, non-transport agencies do bring Trauma patients to the hospital and are not accounted into these results. Chart 28: EMS: CMRETAC Cause of Injury Patient Home Residence Unknown Residence Lives In Region Colorado Non-Colorado

25 Page 21 PREVENTION RESOURCES: It is important not only to identify the causes of injury and demographic data of the regional population, but also what resources are currently available to take care of the population. In the Prevention Survey, the participants were asked, Do you have a community outreach / injury prevention position in your organization? Of the 18 respondents, 8 responded with a Yes. Chart 29 shows the break down. Chart 29: "Do you have a Community Outreach/Injury Prevention position?" No 56% Yes 44% Of the 44% that responded Yes, the next questions was asked about the total number of hours each individual spent on prevention activities each month. 34% spent -5 hours, where the remaining were spread out equally among almost all of the rest of the choices given. Chart 3 outlines the distribution of hours. Chart 3: Number of Hours per Month 41+ hours 11% 36 4 hours 11% hours % 5 hours 34% 26 3 hours 11% hours 11% 16 2 hours 11% 6-1 hours % hours 11%

26 Page 22 With further evaluation, calculations were made to show the total hours dedicated to prevention activities per month but by agency type. The results show that the majority of time spent on prevention activities comes from resources in the hospitals throughout the region, where only ONE EMS agency in the region dedicates on average 1 hours per month. Chart 31 shows the breakdown. Chart 31: Hours Per Month Injury Prevention by Agency Type EMS Hospital Fire/Police Total Prevention Hours Per Month RETAC CURRENT PREVENTION ACTIVITIES: The CMRETAC is well known around the State of Colorado for the prevention efforts and activities conducted in the region. The Prevention Survey asked each respondent to list all of the prevention activities that their agency is currently involved with in the county. This gave participants the opportunity to free text their responses and further provide current and up to date information. After extensive evaluation of the answers, the top five activities were identified in random order. Ski and Bike Helmets Seat Belts Car Seats Fall Prevention Health Promotion

27 Page 23 Teen Seat Belt Challenge: Every year, The Colorado Department of Transportation (CDOT) conducts multiple seat belt use surveys throughout the State of Colorado. Only 3 of the CMRETAC s 6 counties have been observed in the studies over the past 5 years showing a seat belt use rate lower than the state average of 8.7% vi. To respond to lack of data and results, the CMRETAC Prevention Coalition was created in 211 to address the seat belt usage problems in all 6 counties of the region. These efforts resulted in a grant partnership with CDOT over the past 5 years. There is at least one high school in each county, which became the only consistent target for the CMRETAC to capture data and create an opportunity for improvement within the region. Also, according to NHTSA, belt use rates for occupants 16 to 24 years old tends to be lower than the use rates of all other age groups vii. So during the first grant cycle in 211 it was identified that the CMRETAC would need to start collecting seat belt use data due to the limited resources in the mountainous rural setting. Since that time, four seat belt use surveys have been consistently and accurately conducted each year at the local high schools throughout the region. The data collected has been used to justify the need for continued grant support in the past and is the only consistent source of data available to show what is truly going on in the rural mountain communities in Colorado. Built on the best practices established during the first 3 Teen Seat Belt Challenges, the CMRETAC Prevention Coalition will continue to engage partners and grow the stakeholder groups throughout all of the 6 counties in order to ensure the most effective strategies for behavior change. The communication and outreach strategies are the core activities during the CMRETAC s Teen Seat Belt Challenge. This student lead project has demonstrated amazing results with a variety of activities. From school and community wide signage, to kick-off events including community stakeholders and great educational opportunities, to t-shirt design contests that push the safety message, to pledge banners, this six week long event is focused on influencing and changing life long behaviors. This program sets up young drivers with the skill and expertise to make educated decisions about wearing their seat belts for the rest of their lives. During the spring of 214, the third annual CMRETAC Teen Seat Belt Challenge was held. Over 5, students participated from six high schools from around the region with the goal to increase seat belt usage. The six high schools were as follows: Aspen HS in Aspen, CO; Buena Vista HS in Buena Visita, CO; Eagle Valley HS in Gypsum, CO; Salida HS in Salida, CO; South Park HS in Fairplay, CO, and Summit HS in Frisco, CO. The data collected in the fall of 213 was used at the starting point of the Challenge. The studies not only observed students, but parents and school staff as well. The activities of the Teen Seat Belt Challenge proved to be successful. Summit HS held the highest ending buckle up rate at 98.5% and tied for first place. The most improved and also tied for first place was Salida HS with a rate increase of 38.1%. They went from 55.5% to 93.6% in seat belt use compliance. There was improvement in all six schools and the CMRETAC as a region increased seat belt usage to 86.3%. The state average is 8%. CDOT has awarded the CMRETAC a fifth grant to host the fourth annual Teen Seat Belt Challenge in the spring of 215.

28 Page 24 PREVENTION NEEDS: The assessment of current prevention activities is one thing, but identifying the needs in the community and region is another. Each participant of the Prevention Survey was asked to list out what prevention needs have been identified in his or her county. This gave each respondent the opportunity to list where the prevention activities should be focused in the future. The following needs were identified and made as recommendations for the focus of activities in the future. #1 Fall Prevention #2 Older Adult Injury Prevention #3 Ski Injuries #4 Seat Belt Use #5 Motor Vehicle Safety

29 Page 25 VI. Recommendations and Next Steps TO BE DEVELOPED BY THE CENTRAL MOUNTAINS RETAC s PREVENTION COALITION

30 Page 26 VII. End Notes i FY 214 Problem Identification Report, March 214, Colorado Department of Transportation. ii Level III Trauma Center Designation Application, State of Colorado Department of Public Health and Environment Health Facilities and Emergency Medical Services Division, Revised 212. iii Chapter Three Rules Pertaining to Emergency Medical Services Data and Information Collection and Record Keeping, Section 3 Reporting Requirements, Department of Public Health and Environment, Health Facilities and Emergency Medical Services Division 6 CCR iv ICD-9 Code Lookup, Centers for Medicare and Medicaid Services website, v Extended Definition Document NEMSIS/NHTSA Data Dictionary, The National Association of State EMS Officials and EMS Data Managers Council, Version vi 212 State of Colorado STATEWIDE Seat Belt Survey, Colorado Department of Transportation, Seat Belt Study conducted by the Colorado State University, Institute of Transportation Management. vii Countermeasures That Work: A Highway Safety Countermeasure Guide For State Highway Safety Offices, Seventh Edition, 213, section 2-24.

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32 Acknowledgments: