- Pain, broken bones and bloody wounds are only some of the outcomes of physical injury inflicted on the body as a result of either blunt force trauma or penetrating trauma.

These types of traumas are usually caused by one of two major categories, vehicle crashes and falls by the elderly.

According to the CDC, at least one out of four older adults in the United States falls each year, while traffic crashes are among the leading causes of death in the United States and 50 million injuries worldwide.

On this episode, we will introduce you to some community programs, touch on some important laws, and take a closer look at some safety devices that will hopefully lower some of these statistics.

Welcome to a A Su Salud - cheers to good health.

I'm your host, Genesis Ortega.

We're broadcasting from inside the PPL Public Media Center in Bethlehem, Pennsylvania.

My first guest is Andrea Nesfeder from St. Luke's University Health Network.

Thanks for joining us today, Andrea.

- Thank you for having me.

- Let's dive right in with our first question.

Can you describe the main types of physical trauma?

What are some of the causes for this?

- Sure.

We see a lot of motor vehicle crashes, but our number one mechanism of injury is falls in the older adult population.

So, we have injury-prevention programs that focus on both of those target populations.

We're trying to prevent these people coming in with motor vehicle crashes and trying to prevent older adults from falling.

- Now, St. Luke's has a number of trauma-prevention programs.

Can you tell us a little bit more?

Let's start with this.

The Car Seat and Booster program.

- Yes, the Car Seat program.

We work through care management at St. Luke's, and we provide car seats to those in need.

And so, patients come in for a motor vehicle crash, and the car seat gets broken or something.

We can provide them with a car seat, or if there is a parent in need who comes in giving birth, and they don't have the money to get a car seat or a booster seat.

We can provide that for them, as well.

Care management will give them a voucher to Babies...

Excuse me, Buy Buy Baby.

And then, the patient can go redeem the car seat at the store.

- Now, you have a similar program with bicycle helmets.

What's that about?

- Yes, the bicycle helmet's a similar kind of situation.

If a person comes in and they've broken their helmet or they can't afford to get a helmet, we can provide them, as well.

- Now, here's something.

Injuries due to fall, especially among the elderly community, is always a fear.

I'm sure you've heard about it.

I've heard about it, as well.

We've see tons of commercials, you know, with Lifeline.

You know, what about this program that you offer for older individuals and family members?

- So, the program is called A Matter of Balance, and we have been offering A Matter of Balance since 2012.

So, it's been quite a while that we've been offering it to the community.

And we reached about 2,000 people so far.

It is a course that's eight sessions in length.

Each session is two hours long.

So, it is kind of a commitment.

But we do talk about reducing the fear of falling and, ultimately, getting people to exercise.

There is also an exercise component to it.

So, again, it's just kind of getting people out and moving.

- That's great.

This is something that I found interesting, because I didn't know this, uncontrolled bleeding is the number one cause of preventable death from trauma.

And so, as such, St. Luke's has a program called Stop the Bleed program.

How did that come about?

- So, Stop the Bleed is a national program, and it really came out of the Sandy Hook incident, as well as the Boston Marathon bombing, and they were saying that, you know, potentially a lot of those children and a lot of people at the Boston Marathon bombing could have been saved if people knew how to use a tourniquet and how to pack a wound.

We can do a lot of bleeding control on the limbs.

And there were a lot of people and children who were hurt on their limbs.

And that potentially could have been controlled, that we could've saved their life.

So, yes, it's paramount to learn these skills.

And so, we have been doing Stop the Bleed since 2018.

And so, in almost about two years, a little over two years, we have trained about 35 school districts, and we've trained about, in total, almost 4,500 community members on how to use a tourniquet and how to pack a wound.

- Now that's incredible.

I mean, two-and-a-half years in, what type of feedback are you hearing from people who've gone through the program?

- They think it's a very valuable training, and that, you know, we always tell them hopefully they will never have to use the skill.

But, like anything, it's great to be prepared.

And so, they're just happy to learn that.

We have gotten so many calls, we offer monthly trainings here at the hospital.

You know, things are a little different because of Covid, but our trainings are always full.

There are people who come from the tristate area to get Stop the Bleed training.

So, it really has been an excellent program for the community.

- Now that you mention it, how has Covid impacted some of these trainings?

What are you guys doing now?

- Yeah, so it definitely has impacted injury prevention.

I feel like we're kind of getting back on track.

We have done certain things virtually.

So, we just did a Stop the Bleed training where myself and another Stop the Bleed trainer trained virtually the presentation, and then, the nurses who have been trained in Stop the Bleed were performing with the staff on site.

So, that's been a different kind of thing.

And then, for our Matter of Balance program, we are also...

I will be getting trained virtually in order to present that virtually to our older adults.

So, I don't, you know, I haven't been trained yet.

I'll be doing that in February, but I'm excited to see how that program can be kind of presented virtually, because I think it's such an important program for our older adults.

- So, how does one get more information?

How do you sign up for something like that?

- So, A matter of Balance, you can either go on to the St. Luke's website, and my name and number is on there, as well as a trauma IP address and email address.

So, just go on the website, where you can call the trauma department, look up trauma, injury prevention and all of our programs are listed there.

If you have any more information, you can certainly contact us.

- Now, here's something I'm excited for.

You have a bleed control kit.

Why don't you show us that?

What's inside?

How do you use it?

- Sure.

Sure.

- So, this is the Stop the Bleed kit that we offer to the school districts and police.

And quickly, what is in it...

This is an individual kit.

So, there is one tourniquet, a compression bandage, and then, there's a booklet and QuikClot, all the things that you would need to control bleeding.

So, this is an individual kit.

And then, quickly, we have a large Stop the Bleed kit, which has eight of those individual kits in it.

And these we provide to the school districts, potentially one bag per school.

That's kind of, we do have an algorithm to donate these out.

And lastly, we provide tourniquets and belt-holder clips to the police officers when we go train the police officer, we provide each officer with a tourniquet and a belt holder.

And then, we also provide them a kit for their patrol car.

- All wonderful resources, Andrea.

Are there any other trauma injury prevention materials or resources that are available to people in the community?

- Yes.

Again, if they would like some pamphlets or brochures, or any kind of injury-prevention materials, they can certainly contact the trauma department and look up injury prevention, contact me.

Because I have access to a lot of injury-prevention materials through the American Trauma Society, because we are a member hospital with that organization, they provide us with a lot of injury-prevention materials such as bullying, on dating violence, on, you know, all kinds of things, winter sport safety, concussion management, all kinds of different injury-prevention materials.

So, we can definitely... We also have them in the waiting rooms and in the emergency department.

So, they're out there if you do come to the hospital.

But if you want more information, it's best to look on the website or contact trauma or contact me directly.

- Well, thanks again for the work that you're doing, Andrea, it's really life-changing.

I can see that.

So, I appreciate your time and being with us today.

- Thank you.

Thank you so much.

I love what I do.

And so, this is so great that you can get out there into the community about injury prevention.

- My next guest is Mildred Ozawa, a certified child passenger safety technician.

Thanks for joining us today, Mildred.

- Thank you.

Thank you for having me.

- Let's begin with this question.

Why are car seats important?

- One of the main things is keeping our children safe in the vehicles.

- So, definitely using the proper child passenger safety seat is definitely important.

- I recently became a new mom in the past year.

And I'll tell you, one of the things for me that was very overwhelming was shopping for a car seat.

So, you know, for parents that are shopping for a car seat, how do you find out what the best one is on the market?

- OK, well, definitely doing your research, but I think a lot of parents believe that buying the most expensive car seat is buying the best car seat.

And reality is that's not the case.

So, every car seat has to pass certain standards.

So, whether you buy, let's say, a $50-100 car seat, or a $2-400 car seat, the safety is pretty much the same.

So reality is they all passed the same standards.

- So, aside from doing your research, is there any independent agency that makes recommendations for car seats that parents can go to?

- So, we really can't make recommendations.

So, all the manufacturers, like I said, they have to meet those standards.

All the different car seats, they pretty much have their different, I want to say bells and whistles.

So, some have, like, let's say cup holders.

Other parents choose them for the different fabrics.

Some have different...

I want to say different things to make it easier for parents to use them, to make it easier for them to use.

But like I said, they all meet the same standards.

So, it's pretty much the one the parent chooses to use.

But I always recommend that you pick the car seat that fits your vehicle the best.

But when you're choosing the right car seat, you have to choose it based on the child.

So, you're basing it off of the child's age, their weight limit and their height.

- When all is said and done, once a parent chooses a car seat, the next big step is installation, which is equally as important.

Where can you learn about proper car installation?

- You can learn about...

I mean, I'm a certified safety technician, so you could contact your local health bureaus, the hospitals, they do safety checks, the police departments.

A lot of police departments have certified technicians on hand.

I always just recommend calling ahead, setting up appointments, but definitely your local hospitals, health bureaus and police stations.

- Is there anything that you need to keep in mind when using a secondhand car seat?

I'm a part of a lot of moms groups on Facebook, and a lot of people resell their car seats.

So, are there any dangers in that?

- There is.

So, with secondhand car seats, we normally don't recommend them unless you know the history behind the car seat.

So, if you're buying a car seat, let's say, from a yard sale, we probably wouldn't recommend that.

But let's say you have a car seat handed down from a family member who knows that that car seat has not been involved in a crash.

So, who knows the history behind the car seat.

Then that is OK.

But every car seat has an expiration date on it.

So, you want to make sure that the car seat isn't expired.

- Where do you find that expiration date?

- So normally it's on the shell of the car seat.

So, you can look on the shell of the car seat.

Most car seats, they have to come... Well, all car seats have to come with the registration card.

So, it would be on that registration card, as well.

But if you are getting a hand-me-down or you are getting a car seat from a family member, you probably won't have that registration card.

So, you will look on the shell of the car seat.

- What would you say is the best or safest location for a car seat in the vehicle?

- So, best location, we always tell everyone wherever the car seat fits the best.

So, a lot of people choose the middle seating position, because it's the furthest from impact.

But pretty much, sometimes it's not always the best fit for the car seat.

So, it's pretty much wherever the car seat fits the best.

So, it could be one of the side positions.

A lot of parents choose, I want to say, the seating position, the passenger seating position, because they like to take the baby out on the side of the sidewalk versus on the side of traffic.

So, they'll choose the passenger side...

The car seat, so the front seats can't really touch the car seat.

So, if we have a rear-facing car seat, that front seat can't really touch it.

So, if you have a tall parent or car giver - or caregiver - you don't want to have that seat touch the car seat.

So, they'll choose also the passenger side.

- Now, do you have to keep those same precautions in mind when it comes to talking about booster seats?

- So, with booster seats, so that's one of the, I want to say, kind of like the final step before the child goes into the seatbelt system.

So, with the booster seat, we do get a lot of parents who come in to have the booster seat installed.

Most definitely, the booster seat is very, very important.

We do a lot of education with the booster seat.

It's definitely that final step right before they go into the seatbelt system.

But, yeah, we do a lot with booster seats.

- When would you say is the best time to put the child in a seatbelt system, as you say, rather than keeping them in the booster seat?

- OK, so for the booster seat, when they outgrow the booster seat, every seat has a weight and a height limit.

So, you definitely always want to read the instructions for the car seat.

So, once the child outgrows that booster seat.

But you also want to make sure the child fits the seat belt system properly, so they should fit the seat belt system like we would.

So, you don't want that seat belt system riding across their face.

You don't want the lap belt riding across their belly.

You want it more across their hip bones.

And you also want the child to fit, I want to say, the seat of the vehicle like we would, so their feet to touch the ground, so their backs should be flat up against the back of the seat.

So, most times that happens when the child is between the ages of eight and 12.

So, that's when they're usually ready.

- Now, how dangerous is it to graduate a child from a booster seat to the seatbelt system too quickly?

- Definitely could be dangerous, I think, with the law, so the law in Pennsylvania is a child has to be in an approved safety seat up until their eighth birthday.

But we normally tell everyone, keep them in that booster seat as long as you can.

So, as long as they're in the weight requirement and the height requirement to stay in that booster seat, definitely keep them in the booster seat.

There's no rush in putting them in the seat belt system.

It definitely can be dangerous if you take them out too early, if they're not ready to be in that seat belt system, it could cause more harm.

- Now, let me ask you this, I mean, you're an expert in your field, so what have you seen across the years, you know, either questions that parents have, or just no-nos that you try to steer people away from?

- So, a lot of questions...

I think a lot of parents before when a child would turn one and they would have that first birthday, they were very quick to want to turn them around and have them forward-facing.

And now, the law in Pennsylvania is you have to keep them rear-facing up until they're two.

But our recommendation, we do best practice.

So, we tell them to keep them rear-facing as long as you can.

So, keep them rear-facing up until that seat tells you you can't have them rear-facing.

So, as long as they're within the weight and the height requirement to stay rear-facing, keep them rear-facing as long as you can.

So, that might be one of them.

A lot of parents believe that their legs are too crunched up in the back seat, when they're rear-facing.

But children are flexible.

They bend their legs, they chew on their toes.

So, they might look uncomfortable, but they're really not.

They're just a lot safer rear-facing.

- Wonderful.

Well, I appreciate your time today with us, Mildred.

Thank you so much for your insight.

- Thank you.

Thank you for having me.

- My next guest is from the Pennsylvania Department of Transportation, Mr. Sean Brown.

Thanks for joining us today, Sean.

- Thank you for having me.

- Our focus today is trauma and injury prevention.

So, let's start here.

Why are seatbelts important?

- Well, as statistics have shown, you are much more likely to be injured in a crash if you're not wearing a seatbelt.

Chances of being ejected from the vehicle, if you're not wearing a seatbelt greatly increases, serious injury or fatality in a crash if you're just not wearing seat belts, it's really important to another extent of having your child, you know, in an appropriate child passenger safety device.

It's also very important, they can be really injured.

We see a lot of fatalities and major injuries if people are not being buckled-up properly.

- Now, in the course of your work, I'm sure you've heard many excuses as to why people don't wear seatbelts.

So, enlighten us.

What have you heard?

What have people said?

- Oh, I've heard from the general public, friends and family of mine... Any excuse in the book.

The seatbelt's uncomfortable, really the seatbelt, "you could be more likely to be injured if you're wearing "a seatbelt," really just anything they can come up with.

They're not going very far.

They don't need it when they're just riding five minutes down the road, they don't need a seatbelt.

But we see that most crashes and fatalities out there happen within really a radius of your house, 20-25 miles, most fatal injury crashes happen.

So, really want people to know that a crash can happen anywhere at any time.

And really, you need to buckle up every ride, every time.

- Now, my brothers went through a phase where they would wear their seat belt behind their back.

So, is there any danger in that?

You know what are proper seatbelt guidelines, and how important is it to adhere to them?

- Well, seatbelts are made to be used a certain way.

They're made to go across your lap and across your chest, and the webbing goes across your, sort of, bony structures, goes across your sternum and your chest, and then your hips.

And it's made and designed that way to keep you in the seatbelt, if you crash, the seatbelt will lock and hold you in place.

It's designed that way.

Engineers spend a lot of time and probably spend a lot of money to design these to be as safe as possible.

So, when you put it behind your back, you're really getting rid of some of the safety features.

Now, a lot of your older viewers might remember just the lap belt they had years ago, especially in the back seat.

Well, they found that those really aren't very safe, it doesn't keep a driver or passenger in there very well.

You need to have that over your shoulder to really keep you safe and in the seat properly.

- Let's move on to driving in severe and bad weather conditions.

I mean, we've had an unbelievable amount of snow here in Pennsylvania in recent weeks.

So, let's start there.

I mean, what tips can you offer to drivers in driving in hazardous snow conditions?

- Well, this time of year, it's especially important.

I do a lot of interviews, I talk to a lot of people about this.

So, it is really important when you get out there, one, when you're first getting ready before this winter even starts, you really want to make sure that your vehicle is properly prepared.

Check your tires, tires are so important that they have enough tread that can handle the snow.

Your brakes, so very important.

You want to have an emergency kit in your car, keep your car properly gassed, have a cell phone, food, water in case you're stuck.

A lot of your viewers are living in rural areas that might not get as much piling done as regularly.

So, you want to have it in case you get stuck out there, be able to get the stuff out, shovel, things like that.

Those are important well before the storm.

But really, when the storm happens, the most important advice is to avoid travel, if at all possible.

But if you do need to go out, the key to it is really to slow down.

Driving too quickly for conditions is ripe for disaster.

You go out there and you're driving your normal speeds.

Maybe you don't even think the road's that bad.

Maybe it's just, you see it's wet.

Well, maybe it's icy, and you could get into really serious, bad crashes.

And they happen all the time when you're driving too fast.

- I want to go back to talk about something that you mentioned, which are emergency winter travel kits.

What should be in that?

- Your travel kit, you want to make sure they're prepared.

You want to have food, water, recharge, cell phone, anything like a shovel or some sort of sand, or maybe kitty litter to help in case your car gets stuck, a blanket, warm coat, something to be able to, in case your car gets stuck in an area where they can't get to you, you can't get out and emergency folks, you want to be able to have something so that you're not going to be injured.

You want to keep warm and just get ready for any emergency folks that might be able to come rescue you.

- Let's move on for a second about winter weather conditions.

And I want to talk about aggressive driving.

So, aggressive driving behaviors are one of the leading causes of highway crashes in Pennsylvania, which I found was interesting.

So I wonder, you know, what are some examples of aggressive driving?

What would you consider that to be?

- Aggressive driving can take a lot of forms, there's a lot of different driving behaviors that contribute to it.

The most notable being speeding, which is the leading factor.

But we also look at things like tailgating, failure to obey traffic signs or signals, merging improperly, and other behaviors that really take this form.

And what we look at for aggressive driving is aggressive driving, you have two or more behaviors that you exhibit, and then, we'll consider it a crash, or being an aggressive driving incident.

- Now, for those people that drive a lot and drive at night, it's possible that you can fall asleep while you're driving.

So, what advice can you offer to people in that situation where they're feeling groggy, a little sleepy?

What can you do?

- Drowsy driving is a major problem.

We see it when people are driving long distances and truck drivers.

So, really, your best bet is to pull over.

If you're feeling drowsy, don't risk it.

Don't think that you can be able to overcome it, because when you're driving, you can get warm in there, cozy, and you can really nod off quickly without realizing.

So, you need to pull over wherever you can to just be able to take a quick catnap or a rest for a while until you're feeling better to be on the road.

- Going back to weather here, what are some best practices when it comes to snow and cleaning your vehicle?

I mean, I recently was in a situation where I was on the highway and you could see snow falling off of the roof of cars.

So, you know, again, what are the best practices when it comes to cleaning your car in the winter?

- You have to clean your car when there's snow and ice on there, they become snow missiles on the highway.

You can get a situation where they become hard with ice, and they can literally fall off and crack people's windshields.

It happens almost every storm where you hear an incident of a driver that has their vehicle damaged, and maybe there's a crash related to these things.

And even tractor trailers, busses, they need to be aware, too.

I know they do have issues on top of that, that they need to be done.

People are injured and there's crashes all the time due to these snow missiles on top of the vehicle.

- Now, when it comes to vehicle safety and trauma prevention, Sean, what is your top advice for drivers and remaining safe while they're driving?

- There's just a lot of different things.

When we look at behaviors on the roadway, we actually fund several different sort of enforcement education programs.

We look at aggressive driving that we've talked about, we look at seatbelts, and we look at driving under the influence.

And these are three major things that we've put a lot of money into both educating the public, and also enforcing, giving money to police officers to enforce the law out there.

Because we see, these are some of...

They're some of the biggest causal factors for crashes on the roadway.

And they're just such a concern because many of these are all preventable.

And we really need motorists to be our partner-in-safety out there.

Another aspect that has been gaining in fears is distracted driving, driving while distracted, not just by a cell phone, but by a radio or eating, or different things.

And we notice that there are a lot of factors and crashes due to distracted driving.

So, really just ask motorists when you're looking at these things and these behaviors, to really just get out there and drive, put the cell phone down, food down, wear your seatbelt, drive non-aggressively, follow the speed limit, follow the signs, and really just take your own safety and the safety of others at heart.

And just, when you're out there, think about that when you're driving.

- Well, I appreciate your time today, Sean.

Thanks again for joining us.

- Thank you for having me.

- I want to thank our St. Luke's University Health Network expert, Andrea Nesfeder, and our other guests, Mildred Osawa and Sean Brown, for being with us today.

And thank you for tuning in.

We look forward to seeing you again soon.

If there's a medical subject you'd like for us to cover, send me a message on social media.

You can find me on Facebook and Instagram.

Plus, you can tune in to hear more of my reporting on 91.3 FM, WLVR News, your local NPR news source all day, every day.

I'm Genesis Ortega and, from all of us here at Lehigh Valley Public Media, stay safe, be healthy, and cheers to your health.