Haider, A., Saleem, T., Bilaniuk J., & Barraco, R. (2011). Efficacy of safety helmets in reduction of head injuries in recreational skiers and snowboarders. Chicago (IL): Eastern Association for the Surgery of Trauma (EAST). National Guideline Clearinghouse. Web.
Scope and Purpose of the Clinical Practice Guideline
The scope of the document under consideration covers the safety issues occurring in different sports and the efficacy of protective gear such as helmets in reducing the health risks of injuries. The significance of these issues is proved by the high rate of mortality among individuals failing to use protective gear. The relevance of the research problem is supported by the need to obtain specific information concerning the interconnection between the probability of traumas and accidents in hazardous sports. According to a row of researchers working in the area of safety standards development, substantial data is to be provided on the basis of current scholarly information from reliable recourses to establish the statutory safety standards for the participants of risky sports often exposed to possible traumas and injuries (Cusimano et al., 2013; Jones & Shults, 2009; Hooshmand, Hotz, Neilson & Chandler, 2014: Kiss, Polo, Pinter & Sarkozy, 2010). With an objective to find information on the above-mentioned, the researchers evaluate current medical studies observing the outcomes of the head injuries and their severity for an individual engaging in sports activities. The questions the Clinical Practice Guideline (CPG) raises are as follows from:
Does helmet use increase or decrease the rate of fatal and non-fatal head injury among skiers and snowboarders? (2) Does helmet use increase or decrease the rates of neck or cervical spine injury in skiers and snowboarders? (3) Is helmet use associated with higher or lower risk compensation behavior among skiers and snowboarders? (Haider, Saleem, Bilaniuk & Barraco, 2011).
Speaking about the target population, the patients are recreational skiers and snowboarders; and the consumers are advanced practice nurses, physician assistants, physicians, public health departments, parents, and family members (Haider et al., 2011).
Stakeholder Involvement
The committee that has produced the given CGP is Eastern Association for the Surgery of Trauma (EAST) Injury Control and Violence Prevention Committee (Haider et al., 2011). This committee is a multi-disciplinary professional society working in the area of care improvement for patients with injuries (Haider et al., 2011). Within the frames of its activity, the committee develops and publishes evidence-based knowledge with an objective to facilitate clinical decision-making, enhance organizational practices in the healthcare institutions, and promote healthcare quality. In the committee that developed the guideline, the following highly qualified professionals are present:
- Adil Haider (MD, MPH) from the Center for Surgery Trials and Outcomes Research and Johns Hopkins School of Medicine, Baltimore
- Taimur Saleem (MD) from the Center for Surgery Trials and Outcomes Research (CSTOR) and Johns Hopkins School of Medicine, Baltimore
- Jaroslaw Bilaniuk (MD) from Morristown Memorial Hospital, Morristown NJ
- Robert Barraco (MD, MPH) from Department of Surgery, Lehigh Valley Health Network, Allentown PA (Haider et al., 2011).
In the development of the document, the members of the target population have not been consulted. Despite the fact that the target population did not have an opportunity to participate in the document development, it is hardly possible that conflicts of interest may occur. However, with respect to the CPG recommendations concerning the risk-compensation behavior, the conflict is probable due to the different vision of the issue demonstrated by the scholars and the targeted population who insist on the freedom of choice. In addition, sportsmen may feel that the interdependence between the helmet use and the lower or higher risk-compensation behavior is not properly identified by researchers since they do not have the full understanding of the matter because of the absence of experience in the risky sports.
Rigor of Development
The credibility of the articles represented in the CPG is high. Such conclusion can be justified by the fact that researchers have developed effective selection criteria, which enabled them to identify 16 studies that create the basis for providing a reliable answer to the research questions. The levels of evidence of the studies used in the CPG have been measured according to the epidemiologic norms assessing external and internal validity. As the research committee has substantially implemented considerable efforts to evaluate the strengths of study design, power calculation, selection bias, and eliminated the search criteria with too broad connotations such as the search word “equipment”, the chosen studies can be qualified as relevant and trustworthy. Besides, the scholars excluded the results that appeared to be in a different languages, study duplications, and research results that did not fall into the category of scientific study including letters to editor, reviews, reports of a different kind, etc.
The CPG rely mostly on the randomized controlled trials: eight of the chosen studies fall into this category. Besides, to ensure a multidimensional approach to the studied problem, the scholars have included qualitative studies among all. Specifically, three of the chosen studies are qualitative. Overall, the methods, criteria, and selection of articles for these documents are clear and justified. Thus, implementing the recommendation provided in the CPG is connected with low level of risks since the studies chosen for the document are characterized by the high external validity. The benefits and risks for the target population have been fully considered. The benefits are the reduction of possibility of being injured. The risks are injuries of varied complexity with possible lethal outcomes. The researchers have considered the risks associated with all types of injuries resulting from sportsmen’s rejection of a helmet as a means of protection. The unintended risks and the risks related to the risk of compensation behavior have been addressed.
Recommendations
Based on the given CPG, I would recommend the development and implementation of a new safety culture among people in the community that I serve. Generally, my objective it to work on solving the issues related to safety in hazardous sports. The problem concerns children going in for extreme sports without proper supervision from parents and having no safety equipment. Introducing the CPG under consideration into practice in the community, I would advise and support the local authorities to implement the CPG with parents and children as its core. The program should inform people about the benefits of helmet use and positive outcomes of helmet use in case of an accident. In addition, the program is to include the helpful tips on choosing the quality helmets that guarantee the high level of protection. The next step of the CPG implementation into practice is launching the school program promoting the use of helmets while engage in extreme sports. Schoolchildren are to participate in the series of three lessons teaching them about the basic rules of safety in extreme sports. I see this series as one theoretical lesson, one practical session, and one assessment session that would help students actualize their knowledge on protective measures. In the offered program, my role as a nurse practitioner is informative and educative. Emphasizing the major points of the offered implementation strategy, the role of a nurse is collaboration with the local leaders and facilitation of the school-based course. Most importantly, my role as the nurse practitioner will be in communicating with my patients and their family members to educate them about preventive practices.
Implementation
The potential barriers to implementing the recommendations in this CPG are (1) overreliance on the risk compensation behavior frequently demonstrated by the affected population; (2) specific hardships connected with the work with such a complicated category as children who fail to wear helmets due to a variety of reasons ranging from a mere unwillingness to forgetfulness and stargazing; and (3) financial aspect of the problem since not all families are able to afford buying quality helmets that correspond the state safety standards.
Potential costs of following the recommendations can be subdivided into the two categories: the costs for the city and the costs for the affected families. To help the families with low income, I plan to apply for grant to offer free helmets.
Estimating the outcomes of carrying out the recommendations, I would note that the issue of safety in extreme sports in the city will be removed from the category of burning issues. The affected population and children will benefit from the significant decrease of injury risk in extreme sports. Moreover, the rates of mortality due to fatal traumatism in extreme sports will decrease. The state budget, local healthcare system resources/budgets, as well people’s own budgets, will experience the decrease of expenditures on injuries treatment on average based on the reduction of injuries.
References
Cusimano, M., Faress, A., Luong, W., Lockhart, S., Amin, K., Garland, R., & Russell, K. (2013). Evaluation of a bicycle helmet safety program for children. The Canadian Journal Of Neurological Sciences, 40(5), 710-716.
Haider, A., Saleem, T., Bilaniuk J., & Barraco, R. (2011). Efficacy of safety helmets in reduction of head injuries in recreational skiers and snowboarders. Chicago (IL): Eastern Association for the Surgery of Trauma (EAST). National Guideline Clearinghouse. Web.
Jones, S., & Shults, R. (2009). Trends and subgroup differences in transportation-related injury risk and safety behaviors among US high school students, 1991-2007. The Journal Of School Health, 79(4), 169-176.
Hooshmand, J., Hotz, G., Neilson, V., & Chandler, L. (2014). BikeSafe: Evaluating a bicycle safety program for middle school aged children. Accident Analysis & Prevention, 66, 182-186.
Kiss, K., Polo, A, Pinter, S., & Sarkozy, S. (2010). Bicycle injuries in children: An analysis based on demographic density. Accident Analysis and Prevention, 42(6), 1566-9.