Online Program

Using EMS data to identify persons at high risk for violent injury: Implications for surveillance and intervention

Wednesday, November 6, 2013

Amy Knowlton, MPH, ScD, Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
Brian W. Weir, MPH, PhD, Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
Gerald Cochran, MSW, PhD, Behavioral Pharmacology Research Unit, Johns Hopkins School of Medicine, Baltimore
Andrea C. Gielen, ScD, ScM, Center for Injury Research and Policy, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
Wade Gaasch, MD, Emergency Medicine, University of Maryland School of Medicine
Objectives: Concern about mass violence has led to calls for increased mental health support for violence prevention. Health information systems may help identify persons at risk of violence who may benefit from mental support services. Emergency medical services (EMS) serve an increasingly vulnerable population that, compared to other ED users, has high mental health problems. We explored the potential utility of EMS data in identifying at-risk persons. Methods: We reviewed Baltimore's 9-1-1 dispatch data and fire department EMS records over 23 months (2008-10). Health data was categorized and violent trauma related incident data was analyzed. We examined associations of subtypes of violent incidents to patient demographics, repeat EMS use, and evidence of behavioral (mental or substance use) problems. Results: We identified 7,190 violent trauma incidents linked to patient records, comprising 57.7% assaults; 13.3% shootings; 11.8% stabbings; 2.5% abuse/sexual assaults; and 14.7% attempted or threatened self-harm including suicide. Young Black males were over-represented for all incident types except abuse/sexual assault and self-harm, for which there was a wider age range, and whites, and only moderately males, were over-represented. There was evidence of repeat EMS use and behavioral health problems for one-fifth of all persons; of persons involved in self-harm, 35.2% were repeat users and 82.3% had behavioral health problems. Conclusions: Our findings suggest EMS data may aid in identifying persons at risk of violence to themselves or others. High levels of behavioral health problems and emergency care recidivism make them important targets for enhanced assessment and preventive intervention.

Learning Areas:

Other professions or practice related to public health
Provision of health care to the public

Learning Objectives:
Describe some strengths and limitations of using EMS data in identifying incidents and examining contextual factors associated with population violent injuries.

Keyword(s): Violence, EMS/Trauma

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I have been the PI or Co-I of numerous NIH and CDC sponsored research projects focused on engagement in medical services and medication adherence among substance abusing inner city persons with HIV/AIDS and/or other vulnerabilities.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.