8 lessons trauma centers can learn from the Toward Zero Deaths injury prevention partnership

In 2003, Minnesota traffic deaths rose, totaling 655, along with the number of serious injuries. Researchers in the Minnesota departments of Public Safety, Transportation and Health predicted numbers would go higher. Thus, departmental leadership determined this trend was unacceptable and a strategy was urgently needed to counter it.

The departments decided to bring all interested parties together to address the traffic death rate and make reversal plans. The groups that gathered encompassed representatives from trauma centers, emergency medical services, public health, fire and police departments, traffic engineering and other organizations. The Toward Zero Deaths (TZD) program was born.

The TZD program focused on four areas to reduce traffic fatalities, called the 4 E's:

  • Education
  • Emergency medical and trauma services
  • Enforcement
  • Engineering

"Bringing people representing the four E's to the table was an 'aha moment,'" says Kristine Hernandez, statewide TZD program coordinator. "Everybody was working in their silos and didn't understand what others were doing. Getting people to start talking to each other was half the battle."

Coalescing as a partnership to form the TZD program has been highly successful: By 2017, preliminary data showed there were 358 Minnesota traffic-related fatalities, a 45 percent reduction, which Hernandez says benefits everyone statewide.

"For us at Mayo Clinic Trauma Center, it's been a great partnership," says Kimberly (Kim) J. Lombard, Mayo Clinic Trauma Center injury prevention coordinator, explaining as a result of the effort "the numbers speak for themselves."

Though the TZD program is more expansive than one community, its journey and successful results provide lessons that are helpful for trauma centers looking to begin or improve injury prevention community partnerships:

1. Modeling your community partnership on an existing one is not only okay, but encouraged.

When the three Minnesota departments started organizing TZD, they patterned it after Vision Zero, a Swedish program, which provided a launching pad, including data, and helped them formulate the program more quickly. They changed the name and tweaked the objectives to fit Minnesota's needs.

"It's not necessary to reinvent the wheel," says Terri A. Elsbernd, R.N., pediatric trauma coordinator at Mayo Clinic Hospital, Saint Marys Campus. "It makes more sense to build on what someone else has already created."

2. Gathering people from different organizations to work together is key.

For TZD, statewide meetings include representatives from the Federal Highway Administration, the University of Minnesota Center for Transportation Studies, trauma centers and state patrol, along with the county engineer safety committee chairs and others interested in traffic safety.

Such diverse personnel coalescing with unique perspectives helped TZD make crucial realizations about traffic safety. For example, discussions between engineers, law enforcement, emergency medical services and others prompted the conclusion that Minnesota needed to address a certain radius of curves that were causing numerous crashes on its roads. The group decided to highlight the curvatures with chevron signs to indicate marked direction change.

3. Launching a smaller pilot before a major program is helpful.

Before the statewide TZD program was established, the group conducted a pilot program, representing the four E's, by forming the Southeast Minnesota Toward Zero Deaths regional program and a regional steering committee to target traffic fatalities. Starting on a smaller scale and evaluating during the pilot allowed lesson learning before establishing more TZD regions statewide.

4. Human resources depth can be useful.

Hernandez explains the TZD program has traffic safety partners statewide. It intentionally includes multiple personnel layers, so if people move positions or locations, efforts don't fall apart.

5. Get in front of community leadership with your injury prevention plans.

Presenting to community leaders played a major role in promoting TZD, providing state traffic fatality education and strategies to counteract the trend and bringing stakeholders onboard. In Southeast Minnesota's pilot, for example, Hernandez indicates that she and the local partners representing the four E's made presentations to multiple county boards to explain objectives and garner support.

6. Focus on effective countermeasures, starting with "low-hanging fruit."

The TZD program identified specific countermeasures to combat traffic fatalities, including combining education and enforcement. Hernandez indicates that a focus on strategies to implement quickly and easily first helped gain momentum.

For example, during a TZD regional steering committee meeting, challenges in identifying distracted drivers emerged, as law enforcement didn't have vehicles high enough to view driver behavior. Minnesota Department of Transportation leaders who were present volunteered the department's trucks, starting further collaboration with county public works also partnering with sheriffs' offices to help identify unfocused drivers, rapidly solving the initial problem.

7. Go with practicality, not just protocol.

Following a serious crash in a rural Minnesota town, emergency personnel waited an unusually long time for hydraulic rescue tools to extricate victims. The delay turned out to be territorial. Though hydraulic rescue equipment was available closer than the equipment that eventually arrived on the scene, it was not dispatched because it was not in the right territory.

Recognizing the primary value for crashes was removing victims from vehicles to reach medical care as quickly as possible, this scenario led TZD to a protocol change, empowering dispatchers to call for hydraulic rescue equipment located closest to a crash versus going solely by map territory.

"This was an 'aha moment,'" says Hernandez. "We realized we wanted the best service. We didn't care about territory."

8. Target culture change and influence risk takers.

To see long-term results, Hernandez says, it's important to take a page out of public health's playbook and focus on culture change. In public health models, says Hernandez, true culture change typically takes seven to 10 years, citing the long-term campaign to ban Minnesota bar and restaurant smoking.

In TZD, collaborators determined to target young men under age 25, a high-risk group for traffic-related deaths. To reach them, TZD launched campaigns designed to influence their influencers: parents, peers and co-workers.

Hernandez is definite about the power of community-level injury prevention partnerships. TZD has witnessed grassroots measures have been critical to lifesaving, such as collaborating with local driver education organizations to teach about distracted driving and passing a state primary seat belt law.

"Half of all people who die on the road are still unbuckled," says Hernandez. "Without the grassroots people who sent emails and made phone calls, we couldn't have gotten the seat belt law passed."

For more information

Minnesota Toward Zero Deaths.