Host: Drivers

Agent: Alcohol

Environment:

Mecosta County

Alcohol Well known is the fact that the consumption of alcohol can cause

impairment. Perhaps less recognized is that fact that impairment rises gradually

at lower levels but dramatically at higher levels of blood alcohol concentration (BAC).

About half of auto fatalities involve drivers with BACs of .16 or

higher.

(Hanson, 2009)

Statistics Michigan Statistics 2008 National Statistics 2008

262 fatal accidents in Michigan where at least one driver had a BAC of 0.8% or above

282 people were killed in Michigan in accidents where at least one driver had a BAC of 0.8% or above

49 people were killed in Michigan in accidents where at least one driver had a BAC between 0.01% and 0.07%

331 total deaths caused in Michigan where at least one driver had a BAC of 0.01% or above

10,684 fatal accidents nationally where at least one driver had a BAC of 0.8% or above

11,773 people were killed nationally in accidents where at least one driver had a BAC of 0.8% or above

2,072 people were killed nationally in accidents where at least one driver had a BAC between 0.01% and 0.07%

13,846 total deaths were caused nationally where at least one driver had a BAC of 0.01% or above

(DUI-USA.Drunk Driving.org. 2008)

Utilizing resources can reduce the number of drunk drivers even eliminate them if people use them.

Taxi Dial a Ride Designated Driver Public Buses

These are a few resources that can be utilized. A known problem is

Mecosta county has a lot of small towns, in small towns buses, taxi’s, and dial a ride might not be a realistic option. That leaves a designated driver, for people in smaller towns. There are services, but they are not adequate.

Analysis

“Alcoholism is the most common chronic disease in trauma patients, affecting 25% to 40% of those treated in major trauma centers. Trauma patients with alcohol problems are more than twice as likely to be readmitted with injuries during the next two years than patients without a problem drinking. Alcoholism results in repeated episodes of trauma, drunk driving and alcohol related crashes”.

(Mecosta County General Hospital, 2009)

FACTS: Medical and health care

professionals are among the first to see the consequences of an impaired driving crash.

During 2002, 17,419 people in the

U.S. died in alcohol-related motor vehicle crashes. This represents 41% of all traffic-related deaths.

Drugs other than alcohol (e.g. marijuana and cocaine) have been identified as factors in 18% of motor vehicle driver deaths.

Other drugs are generally used in combination with alcohol

(Mecosta County General Hospital, 2009)

Epidemiology

“Drinking and driving remains a significant public health threat in the United States. Approximately 40% of traffic deaths in the United States are alcohol related, and crashes involving alcohol are more likely to result in injuries and deaths than non-alcohol related crashes.”

(NIAAA,2007)

Nursing Problem:

Drinking and driving can lead to major traffic accidents. That’s where it becomes a nursing problem. People injured from these accidents come in to the Emergency Department for those injuries. Then depending on what type of injury and the length of stay, this can lead to many different nursing diagnosis.

Funding and Policy Implications:

There are many policies implemented to deter people from driving drunk. In Michigan you are considered to be drunk driving when you are driving with a blood alcohol level of .08 of higher. Police officer can arrest you if you are over the limit. This can lead to jail time, fines, court costs, lawyer costs, and can even cost you your license. These policies are in place for the safety of everyone on the road. States have to add law enforcement for certain “drinking occasions” such as holidays, and some other well known drinking days. This lead to extra funding needing to be supplied by the state. Not to mention the extra funding for emergency responding individuals, and certain people with governmental health insurance if they are hurt.

BAC

• 0.02-0.05

Effects on Driving

• ability to see or locate moving lights correctly: diminished

• ability to judge distances: diminished

• tendency to take risks: increased

• ability to respond to more than one thing happening at once: diminished.

Crash Risk

• Double

• (Road Safety Task

Force,2009)

BAC

• 0.05-0.08

Effects on Driving

• ability to judge distances: reduced further

• sensitivity to red lights: impaired

• reactions: slower • concentration

span: much shorter.

Crash Risk

• Five Times Greater

• (Road Safety Task Force,2009)

BAC

• 0.08-.012

Effects on Driving

• euphoria sets in • overestimation of

ability leads to reckless and unsafe driving

• peripheral vision: impaired (often results in crashes due to hitting passing vehicles and obstacles).

Crash Risk

• Ten Times Greater

• (Road Safety Task Force,2009)

Mecosta county and all other counties have a vested interest in drunk driving.

Everyone wants to feel safe on the road to be driving to the best of the their ability.

Risk for injury related to drunk driving as evidenced by higher than state average accidental injury, death and drunk driving rates.

“Health planning is a continuous social process by which data about clients are collected and analyzed for the purpose of developing of developing a plan to generate new ideas, meet identified client needs, solve health problems, and guide changes in health care delivery” (Maurer and Smith, 2009, pg 432).

The target population we are looking to address is the teens and young adults involved with drinking and driving. The target population is the persons you desire change to occur (Maurer & Smith, 2009).

The program is at the primary level of prevention involving education about drinking and drunk driving, including distracted driving that causes accidents and bodily harm. “Population-focused health planning can range from planning health care for a small group of people to planning care for a large aggregate or an entire city, state or nation” (Maurer & Smith, pg 432).

We proposed an “Alcohol Awareness Forum” using the community empowerment model. This is “an approach to create conditions of economic and social progress for the whole community and involves the community in active participation” (Maurer & Smith, pg 434). The proposed Forum would not only benefit the individual but the community as well by decreasing property loss and loss of lives. This would be a self-help program for community members that would involve a broad group of people trying to solve their own problem or situation.

Participation in the Forum Community, church and business leaders would be involved

School Community Center

Church Public Building

A prominent location would be needed

Presenters

Local, City, and State law enforcement

Their presence of authority and community members would be of value.

Most departments have educational teams and information available.

There also may be the availability of viewing autos involved in accidents to strengthen the message of drinking and driving.

National Organizations

MAAD

SADD

MCRUD

• Mothers against Drunk Driving

• Students against Drunk Driving

• Michigan Coalition to Reduce Underage Drinking

MAAD

• was founded by a mother who lost her daughter in a crash. It is the nation’s largest non-profit organization working to protect families against drunk driving and under-age drinking. It also supports drunken driving victims and survivors. It is one of the largest service organizations in the United States.

• (MAAD Website)

SADD

• was founded in 1981 in Wayland Massachusetts. It is the nation’s dominant peer-to-peer youth education and prevention organization with thousands of chapters in middle schools, high schools and colleges. It expanded its name in 1991 and now sponsors chapters called Students Against Destructive Decisions. It endorses a firm “no use” message to destructive behaviors and attitudes to young people including under-age drinking, substance abuse, impaired diving, violence and suicide. SADD’s unique approach delivers education and prevention messages to their peers through community and school activities and campaigns.

• (SAAD Website)

MCRUD

• provides leadership to grassroot groups and organizations to reduce under aged drinking. It emphasizes community level approaches and works with teen leaders and local youth groups in projects and peer education.

How much is too much?

One Drink is Considered

1 Beer

1 Three Ounce Glass of Wine

1 Shot or 1 Ounce of Hard Liquor

Are you legally drunk?

A chart listing body weights and the number of drinks with corresponding BAL’s (blood alcohol levels)

(Hanson, 2009)

Blood alcohol corresponds to what response? A list of blood alcohol levels and the corresponding

symptoms

Remember this table is only a reference, there are a number of variables that determine if a person is legally drunk that are not addressed in this table.

A 0.080 percent Blood Alcohol Concentration is considered legally drunk in all states. One question we have heard over and over is "How many drinks does it take to become legally drunk?" The question is often asked because people want to know how many drinks they can have before they drive

without risking a DUI conviction. Our suggestion is to have zero drinks before you drive, but if you want to calculate how many drinks you

can have before you could be arrested for drunk driving, you can use our drink calculator or, use the table below to see a listing based on body weight and number of drinks.

If you are taking medication, one drink could put you into the "drunk driver" category. It often takes very little alcohol to become legally drunk and your physical characteristics such as weight,

gender and body fat percentage can all be factors in the equation. Eating is another variable, if you are going to drink and drive you are more likely to fail a Blood Alcohol

Test if you do not eat. The best answer is to the question of drinking and driving is to have zero drinks before you drive.

Mobilize the community Encourage responsible beverage service Monitor access to alcohol Increase local enforcement of drinking and driving laws

Rationale: “A coordinated, comprehensive, community-based intervention can

reduce high-risk alcohol consumption and alcohol-related injuries resulting from motor vehicle crashes and assaults” (Holder, p.2).

Develop a community coalition and media advocacy. Begin a monthly meeting of an advisory committee consisting of local law enforcement officers, medical service providers, and alcohol-beverage control agents as well as community activists, youth, and parents. Rationale: Treno’s study concluded that, “the committees provided valuable guidance into appropriate means to conduct intervention and data collection activities, which shaped the actual implementation” (Treno, p.6).

“We believe the key is to use several mutually reinforcing strategies: media attention to alcohol problems, changes in alcohol serving practices in local bars and restaurants, reductions in retail sale of alcohol to young people, increased enforcement of drinking and driving laws, and reductions in the concentration of alcohol retail outlets.” (Holder, p.10)

Create brochures and training sessions for alcohol outlets that: (1) raising awareness of the problems of youthful drinking and the sale of

alcohol to minors and intoxicated persons (2) raising awareness of community norms against the sale of alcohol to minors

and intoxicated persons (3) training in methods of age identification, estimating intoxication levels, and

techniques for interacting with customers (4) providing information about laws and associated penalties for sales to minors

and intoxicated persons (5) reviewing with owners and managers existing policies and providing new

policy options to reduce sales to minors and intoxicated persons. (Treno, p. 7).

Rationale: A. “Beer has been shown to be the

beverage of choice for individuals convicted of driving while intoxicated (DWI)” (voas, p.5), B. “beer consumption is associated with higher rates of drinking drivers involved in fatal crashes” (Voas, p.11), and C. “Environmental prevention efforts may fail by focusing exclusively on underage sales and ignoring social or informal access to alcohol, which have been identified as critical sources for underage youth (Harrison et al., 2000). (Treno, p.4).

Maintain minimum alcohol access points per capita and increase alcohol monitoring units around access points.

Rationale:

“neighborhoods with high levels of formal access (i.e., high densities of alcohol outlets) are often characterized by alcohol-related problems such as violence and driving after drinking (Treno, p.4).

Monitor quantities of beer sales at access points. Make this information available to committee for focused outlet education.

Rationale:

“adjusted beer consumption measure was, as expected, positively correlated with the impaired driver odds ratio indicating that states with higher consumption levels had more impaired underage drivers.. . . beer consumption is associated with higher rates of drinking drivers involved in fatal crashes,” (Voas, pp. 10 and 11).

Enforce seat belt laws, particularly around access points. Rationale: drunk drivers are less apt to wear seat belts (Voas, p.7).

Maintain and publicize zero tolerance for underage 21 blood alcohol level at any level. Rationale: “lower drinking ages were associated

with increased alcohol-related fatalities among youth. Zero tolerance laws provide that the Blood Alcohol limit for drivers younger than age 21 years is 0.02%, or essentially zero. . . the first 12 states that adopted these laws found a 20% decline in nighttime fatal crashes (a surrogate for alcohol-related crashes) as compared to similar states without such laws.” (Voas, p.3) “limiting youth access to alcohol through MLDA laws and reinforcing this action by making it illegal for underage drivers to have any alcohol in their system when driving is reducing the proportion of fatal crashes involving drinking drivers.” (Voas, p.12).

Monitor local and state legislation regarding drinking, driving, and alcohol access points. Rationale: “It has generally been found that media campaigns in the absence of newly institutionalized actions (such as legislation) do not produce measurable reductions in crash frequencies (Voas, p.12).

“Formative evaluation is evaluation that occurs throughout the nursing process but before evaluation of the outcomes of care (Maurer and Smith, 2009, p. 455)”. Formative evaluation occurs during the formation on nursing care and during process of delivery of care. “The steps of evaluation are:

Process (Millstein, 1999) Applies to the next three slides

1. Engage the Stakeholders

2. Describe the Program

3. Focus the evaluation design

4. Gather credible evidence

5. Justify conclusions

6. Ensure use and share lessons learned

Step 3 will determine the focus of the evaluation

This focus is to bring awareness to, and to decrease drinking and driving among adolescents.

Pre and post questionnaires will be delivered to area high to determine exposure to interventions and attitudes towards information obtained. Numerous studies have shown that successful campaigns

against drunk driving have been due to attitude changes.

Step 2 would be a description of the program

A consensus on what program is meant to accomplish should be determined; also determination of a budget and a time line for

evaluation of progress.

Processes will be developed for collection of data through observations and interviews. Determination of who will collect the

data will also be determined.

Step 1 Meeting with the stakeholders

This could include enforcement officers, school administrators, school principals, MAAD (Mothers against Drunk Driving) members, SADD

members, bar owners, liquid store owners, and members of the community who are willing to donate their services or monies.

These members will be our community coalition.

Finally, Step 6 will reevaluate.

Share successes and failures with others for lessons learned.

Make improvements and readjustments.

Step 5 is to justify conclusions

Reach well substantiated conclusions based on sound evidence.

Be prepared to explain how and why conclusion was reach.

Step 4 is the collection of credible evidence

Use multiple procedures for collecting, analyzing and interpreting evidence.

Use credible sources and double check all facts

References Ackley, B.J., & Ladwig, G.B. (2006). Nursing diagnosis handbook. A guide to planning care (7th Ed.). St. Louis, MO: Mosby Elsevier DUI-USA.Drunk Driving.org. (2008). In National DUI Statistics. Retrieved November 15, 2010, from http://www.dui-

usa.drinkdriving.org/dui_drunkdriving_statistics.php DUI-USA.Drunk Driving.org. (2008). In Michigan DUI Statistics. Retrieved November 15, 2010, from http://www.dui-

usa.drinkdriving.org/Michigan_dui_drunkdriving_statistics.php Hanson, D. J. (2009). What is Impairment. In Alcohol Problems and Solutions. Retrieved November 15, 2010, from

http://www2.potsdam.edu/hansondj/DrivingIssues/1043412430.html Holder, Harold D., Gruenewald, Paul J., Ponicki, William R., Treno, Andrew J., Grube, Joel W., Saltz, Robert F., Voas, Robert B., Reynolds, Robert,

Davis, Johnetta, Sanchez, Linda, Gaumont, George, & Roeper, Peter. (2000). Effect of Community-Based Interventions on High-Risk Drinking and Alcohol-Related Injuries. JAMA. 284(18):2341-2347.

Mecosta County General Hospital. (2004, December). In Mecosta Health Services and MCGH Community News. Retrieved November 21, 2010, from http://www.mcmcbr.com/newsletter/dec_04/dec04.html

Milstein, B., Wetterhall, S., & CDC (Centers for Disease Control and Prevention) Evaluation Working Group. (1999). Community Toolbox: A framework for program evaluation: A gateway to tools, University of Kansas. Retrieved from http://ctb.ku.edu

NIAAA. (2007, December 23). Epidemiology in Alcohol Research. Retrieved November 21, 2010, from http://alcoholism.about.com/od/homework/a/blniaa040606.htm

Road Safety Task Force. (2009). Drinking and Drug Driving. In Alcohol and Drugs. Retrieved November 21, 2010, from http://www.rstf.tas.gov.au/campaigns/alcohol_and_drugs

Treno, A J, Gruenewald, P J, Lee, J P, & Remer, L G (March 2007). The Sacramento neighborhood alcohol prevention project: outcomes from a community prevention trial *. Journal of Studies on Alcohol and Drugs, 68, 2. p.197(11). Retrieved November 04, 2010, from Expanded Academic ASAP via Gale:http://0find.galegroup.com.libcat. ferris.edu/gtx/start.do?prodId=EAIM&userGroupName=lom_ferrissu

Voas, Robert B., Tippetts, Scott A., & Fell, James C. (July 2003). Assessing the effectiveness of minimum legal drinking age and zero tolerance laws in the United States, Accident Analysis & Prevention, Volume 35, Issue 4, July 2003, Pages 579-587, ISSN 0001-4575, DOI: 10.1016/S0001-4575(02)00038-6. (http://www.sciencedirect.com/science/article /B6V5S-4603N30-1/2/bbf641efc5cb81cf8ed4fcf0aa92a11f)