Putting Together “Shattered Dreams”: A Program to Reduce Alcohol-Related and Distracted...

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PUTTING TOGETHER “SHATTERED DREAMS”: APROGRAM TO REDUCE ALCOHOL-RELATED AND

DISTRACTED DRIVING–RELATED CAR CRASHES

AMONG ADOLESCENTS

Author: Robin S. Powers-Jarvis, MS, RNC, CEN, CCRN, West Palm Beach, FL

Impaired and/or distracted driving is a significantproblem among teenagers in the United States. Despiteconcerted efforts to decrease the number of deaths and

injuries, the statistics continue to rise nationwide.1 In aneffort to address a rash of alcohol-related automotive crashesinvolving teenagers in their community, staff at a level 2trauma center in southeastern Florida created an injuryprevention program focused on high school–aged partici-pants. We gathered and analyzed data and found thatChristmas vacation, spring vacation, and prom nights/weekends were the periods during whichmost of the alcohol-related crashes occurred. The resulting program, ShatteredDreams, is presented to high school juniors and seniorsbefore prom, to educate them on the consequences of drivingunder the influence (DUI) and distracted driving—makingone “bad choice.” In the 20 years since its inception, it hasproven successful in eliminating DUI-related motor vehiclecrashes during prom weekend for all schools to which it hasbeen presented. The purpose of this article is to provide aguideline for others interested in presenting such a program.

Steps 1–4: Initial Preparation for “Shattered Dreams”

Creation of the concept is the initial step in any project. Toappeal to all types of learners, we use a combination of amultimedia presentation and demonstration. Our programstarts with a video and narrated slideshow presented in theschool’s auditorium that graphically depicts actual crashes andvictims (with identities obscured) andfictional stories designed

wers-Jarvis, Member, Palm Beach County Chapter, is Staff Nurse,edical Center, West Palm Beach, FL.

ndence, write: Robin S. Powers-Jarvis, MS, RNC, CEN, CCRN,, West Palm Beach, FL 33407; E-mail: rsp551@bellsouth.net

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$36.00

2014 Emergency Nurses Association. Published by Elsevier Inc.served.

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RNAL OF EMERGENCY NURSING

to enhance the impact of the photographs while complyingwith Health Insurance Portability and Accountability Actregulations. We intersperse slides describing anatomic andpathophysiologic information telling how the body respondschemically (related to alcohol/drug consumption) and phys-ically (related to the mechanical forces of traumatic injury)and the effects of multitasking on the ability to concentrate.

The students then move from the auditorium to thefootball field, where a crash scene has been created with 6 to8 crash victims. The victims include at least 1 “fatality” and1 drunk or distracted driver. The remaining victims are invarious states of injury and/or entrapment. We use students,enlisting the help of the student council, class officers, and/or drama club, as our victims. The narrated demonstrationgraphically and accurately depicts the response of local lawenforcement and fire rescue personnel (including extricationand our helicopter transport team), as occurs in actualmotor vehicle crash situations, excluding the time delay ofarrival. The concept of the “golden hour” in trauma care2 isstressed by the narrator. The narrator identifies the multiplesimultaneous activities of police, fire-rescue and extricationteam, victims, and so on, while placing emphasis on theimpact and results of the situation for those directlyinvolved and the effect on the parents and families of thevictims. The program concludes as the most criticallyinjured victim is transported by air rescue to the traumacenter and “fatalities” are removed by a funeral hearse, againstressing the ripple effect created by one bad choice. Itshould be noted that we chose a funeral hearse for bodyremoval in lieu of the medical examiner’s van because ahearse is a more readily recognized vehicle by the students.

The next step in program planning is the identification ofkey stakeholders. We identified the high school(s), the localschool board, the fire department(s), the police department(s),our air-rescue agency, and themedical examiner and/or a localfuneral home and sought their approval and cooperation.Cooperation of these agencies is imperative and can often beobtained by identifying the need for periodic training exercisesfor all police and fire-rescue personnel. Research related to the

VOLUME 40 • ISSUE 1 January 2014

Powers-Jarvis/INJURY PREVENTION

incidence of DUI-related and distracted driving–relatedcrashes involving teens in the local vicinity can be helpfulwhen approaching schools and/or school boards.

We also identified a source for wrecked cars, the promattire, and makeup necessary for moulage of the “victims.”We enlisted the assistance of a local towing company for thecars (cars “abandoned” by owners/insurance companies),and staff from our hospital donated the formal wear andmakeup for moulage of the victims.

Step 5: Implementing the Program

Creation of the lecture portion is laborious and time-consuming, but once completed, the presentation can beused many times over. Stories enhance the photographs of theinjuries and describe the injuries and sequelae that the victimsexperience. Videotaping emergency/trauma nurses and sur-geons relating stories of horrific injuries that they have seen anddealt with in the emergency department is especially impactful.

Meeting with the professional personnel who willactually be involved in the demonstration and the student“victims” 3 to 4 weeks before the presentation is imperativeto ensure that everyone understands the intent of thepresentation and their roles in the production. At this time,the physical layout of the football field is reviewed with theathletic director and the professional personnel, along withthe location of the “crash scene,” the staging area for therescue vehicles, and the area that will be designated for thelanding zone (if air rescue/transport is to be used). It is alsohelpful to enlist the assistance of the media coordinator forthe school to review the necessary audio/visual equipmentavailabilities both for the auditorium and on the field.

The entire program is designed to last approximately 2hours: about 50 minutes for the lecture, 10 minutes formovement from the auditorium to the field, and aboutanother 50 minutes for the outside demonstration. The“victims” will be out of their classes for additional timebefore the program for preparation (dressing and moulage)and for cleanup after the presentation concludes. Reportsfrom high school principals and students alike have indicatedthat the time spent on this program is well worth it, and theimpact of this presentation has been profound. One studentsaid the following in an anonymous letter of thanks:

You will never know how much of an effectShattered Dreams had on me and many of my fellowstudents. My friends and I had planned on getting verydrunk after prom to celebrate our upcoming gradua-tion. After listening to you and seeing your presenta-tion, we changed our minds. We went to four after

January 2014 VOLUME 40 • ISSUE 1

prom parties at different peoples’ houses and althoughthere was alcohol available at all of them, no one wasdrinking. And, as you had promised, it was wonderfulto return to school on Monday and be able to recountall that had happened during prom—I actuallyremember every detail, which I probably would not havebeen able to do had I gotten drunk. It was awesome!Thank you again for the time you spent creatingShattered Dreams and teaching us about the dangers ofdrinking and driving. I believe you changed lives.Sincerely,Someone Whose Dreams Could Have Been Shattered,but Weren’t

Implications for Emergency Nurses

Emergency nurses have the opportunity to reduce the risk ofinjury in their communities. Sommers and Ribak3 discussfindings related to teenage behaviors, their contribution torisky driving by teenagers, and some suggestions related tomodifying these behaviors. One of their recommendedstrategies is the application of health teaching by traumanurses, which Shattered Dreams incorporates. Emergencynurses can use this information, including the tableoutlining a suggested timetable for developing and present-ing a program such as Shattered Dreams, as an example forcommunity-based injury prevention. Best of luck, and mayall your prom weekends be crash-free!

Emergency nurses can use this information, includinga table outlining a suggested timetable for developing andpresenting a program such as Shattered Dreams (availableon request from the author), as an example forcommunity-based injury prevention.

REFERENCES1. National Highway Traffic Safety Administration. 2013 Fatality Analysis

Reporting System. http://www-fars.nhtsa.dot.gov/QueryTool/QuerySection/Report.aspx. Accessed March 14, 2013.

2. Lopez-Viego MA. The Parkland Trauma Handbook. St Louis, MO:Mosby; 1994.

3. Sommers MS, Ribak J. A model for preventing serious traffic injury inteens or “Keep those teenagers out of our ICU!”. Dimens Crit Care Nurs.2008;27(4):143-51.

Submissions to this column are encouraged and may be sent toTomi St. Mars, RN, MSN, CEN, FAENtst33@aol.comorAnna Maria Valdez, RN, PhD, CEN, CFRNannav409@gmail.com

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