We have all had cases. A 19-year-old alcoholic man presents with a severe laceration to his face and scalp following an assault involving broken glass. The triage nurse asks the usual questions: When did this happen? What was the weapon used? How old are you? Tetanic status? Etc.
Triage completed, information transmitted electronically, the patient is placed in an examination room for evaluation and treatment. Then we send the patient back to the community. But isn’t there more to the story? Isn’t there another question we can ask, that we should ask?
Where did the assault take place? In a tavern? Address of the tavern? That’s what Jonathan Shephard asked for. Dr Shephard is an oral, maxillofacial surgeon who was constantly responding to emergency calls in Cardiff, Wales to provide specialist care for severe lacerations.
He began to ask a key question for prevention: where did the assault take place? Thanks to his leadership and the increased interest of emergency personnel, Cardiff emergencies have started asking this question on a regular basis. The anonymized information about the case – gender, age, time and day of the injury, weapon used (fist, knife, weapon, etc.) and location of the assault (nearest address, name of bar, park, etc. .) – were downloaded and sent to an “honest broker” (public health agency, university center).
Emergency assault cases were then geocoded for location, time and police information. This more complete picture of assaults and their patterns of place and time (studies suggest police do not know about 20-50% of assaults in their jurisdiction) was presented to community leaders, including police for discussion. led by the community (these discussions are not to judge the crime), to develop strategies and interventions adapted to the place.
The Cardiff model was initiated in the 1990s. Significant gaps in information on police assault were consistently found, and information on emergency services filled this gap. Place-based interventions could then be discussed with the more comprehensive near real-time information presented to community leaders.
And it works! The model has been tested in several cities besides Cardiff, and emergency room assault injuries have fallen by 30-40%. (Surgeon. 2007; 5: 114; J Trauma nurses. 2018; 25: 149.)
Replication of the Cardiff model is occurring in countries other than Great Britain, including Australia, Jamaica, and the United States. Several US cities have started to translate the model (Atlanta, GA; Milwaukee, WI; and West Allis, WI). And more and more cities are considering it.
Social emergency care is transforming the specialty of emergency medicine and expanding treatment for patients whose needs go beyond laceration repair or management of abdominal pain. Emergency medicine is also increasingly recognized as a room with a view of the community and its preventable illnesses and injuries.
The adoption of the Cardiff model into the routine of the triage nurse’s admission of an assaulted patient is in line with the growing community engagement that began with the Affordable Care Act. Adopting the Cardiff model does not affect the direct care of the assaulted patient, but anonymized and geocoded information can inform the community of patterns of abuse unknown to law enforcement and community organizations and leaders.
Emergency physicians, nurses and other members of the ER team are making a difference at the bedside 24/7/365. By working with the community and advancing and supporting the translation of the Cardiff model into our emergency services, we can collectively make a bigger difference and help make our communities healthier and safer places for everyone. world.
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Dr Hargartenis professor of emergency medicine at the Medical College of Wisconsin.