In 2015, 25.5% of Kentuckians reported using the Emergency Department in the past year (State Health Access Data Assistance, 2017.)   In 2018 there were 2.1 million Emergency Department Encounters in Kentucky. (Source: Kentucky Emergency Department Encounter Claims) https://chfs.ky.gov/agencies/ohda/Documents/2018Emergency.pdf. Nearly half of all US medical care is delivered by emergency departments, according to a new study by researchers at the University of Maryland School of Medicine (UMSOM). When does an incident or health condition constitute a visit to the emergency room? When should you call 911? Good questions posed by the committee planning the First Aid Seminar for spring 2019.

House fires are extremely common and preventable with fully functioning smoke detectors. Almost three of every five home fire deaths resulted from fires in homes with no smoke alarms (40%) or no smoke alarms that were working (17%). The death rate per 1,000 reported home fires was more than twice as high in homes that did not have any working smoke alarms (12.3 deaths per 1,000 fires), either because no smoke alarm was present or an alarm was present but did not operate), as it was in homes with working smoke alarms (5.7 per 1,000 fires).  https://www.nfpa.org/-/media/Files/News-and-Research/Fire-statistics-and-reports/Detection-and-signaling/ossmokealarms.pdf. 

After a discussion of emergencies, the conversation naturally diverted to the number of opioid overdose-related needs in emergency situations. Drug overdoses continue to climb at an alarming rate and remain a major cause of preventable deaths. Calling 911 during an overdose can mean the difference between life and death, but some witnesses avoid calling due of fear of arrest. In response, Kentucky has enacted KRS 218A.133, which protects people from prosecution when they report a drug overdose. This is commonly known as a “Good Samaritan Law,” and it provides an important tool to save lives. There is no longer any need to watch a friend or family member die due to a fear of criminal prosecution. 

In 2017 there were 1,500 opioid-related drug overdose deaths in Kentucky—the highest number of deaths to date as related to opioid use. The timely delivery of Naloxone (Narcan) to an overdose victim can be lifesaving.  The Center for Disease Control (CDC), in their plan to address the opioid crisis in this country, recommends a coordinated, informed effort to better prevent opioid overdoses and deaths. This plan suggests increased Naloxone distribution to first responders, family members, friends and other community members and includes a need for adequate training for administration of Naloxone.  

Ft. Harrod area consists of eight rural counties in central Kentucky. The largest city within the area, Frankfort, has a population of 27,500.  The Extension Homemaker members in the Ft. Harrod area each year submit ideas for monthly lessons that will be taught over eight months during the upcoming program year.   The approximately 700 members always have a variety of suggestions that lead the Family & Consumer Science Agents to combine and filter the ideas into an area ballot which then filters into the monthly lessons and possible area-wide seminar topics. In the 2018-19 planning year, it was evident from lesson suggestions and emerging issues within our respective counties, a seminar focusing on First Aid and emergencies would be relevant. 

The opioid crisis has also affected our rural area. Of the 1500 overdose deaths in Kentucky in 2017, 95 deaths were in our eight county area. Kentucky is among the top 10 states with the highest prescribing rates. In 2017, Kentucky providers wrote 86.8 opioid prescriptions for every 100 persons compared to the average U.S. rate of 58.7 prescriptions (CDC).   The 2017 prescribing rate, however, represents a more than 36 percent decrease from a peak of 137.0 opioid prescriptions per 100 persons in 2011.  As part of an overabundance of availability of opioid prescriptions, the rate of overdose deaths involving opioid prescriptions rose steadily from 1.0 deaths per 100,000 persons in 1999 to 10.2 deaths per 100,000 persons in 2017. Any lesson about first aid clearly needed to address emergencies involving overdoses or possible criminal actions surrounding an overdose.  

Program Description:

Approximately every 40 seconds an American will have a heart attack and of those heart attacks, 69.5% will occur in the home (American Heart Association, 2019). The objectives of the ‘Be Safe Be Well’ seminar included efforts to identify and recognize emergencies, make appropriate first aid care decisions, learn skills needed to provide immediate care for the ill/injured and understand the basics of a first aid kit. A later planned ‘Overdose First Response Training’ was held on the same day in the same location.

Participants in the first part of the day received information they would carry back to Extension Homemaker Club members in the Ft. Harrod area at their monthly club meetings. A copy of KRS 218A.133 was distributed to participants and explained as part of the First Aid lesson. The content was delivered in a variety of ways to create this innovative and engaging program. First, the agents performed a live dramatic skit to demonstrate a variety of reactions to an emergency situation. After the skit, the agents discussed each role in the skit and how the characters could have handled the situation differently. There were a host of speakers sharing tips on different topics. The firemen presented on fire prevention and how to properly use and store fire extinguishers. This was a huge impact on our group. Many participants were unaware of the safety concerns the firemen discussed. Other topics included items commonly found in first aid kits, the Good Samaritan Law, Medical Reserve Corps, and more.

The ‘Overdose First Response Training’ was an optional opportunity for Extension Homemakers but was promoted to law enforcement officials, first responders, college students, local human services staff, Extension Service volunteers, and family members of folks with opioid addictions. Participants of the Overdose Response Training received a free dose of Narcan at no charge thanks to the sponsorship of the Boyle County Agency for Substance Abuse and Policy (ASAP).   

This program was innovative for several reasons. From the way the information was presented to the scope of information given, this program was extremely beneficial for any and all participants. The skit was written by and performed by the agents. It was entertaining while still delivering an important message. Many forms of media were used to present including PowerPoint, video clips, demonstrations, and performance art. 

First aid is and will always be a worthwhile topic to educate the public. In recent years, the opioid epidemic has moved first aid to a new level. Counties in the Fort Harrod area have been hit hard by this emerging issue. Being able to respond quickly to someone suffering an overdose can truly be the difference between life and death. Partnering with Boyle County ASAP created a new way to offer free programming to new audiences in our communities. The majority of people who attended the Overdose Response Training had never been to the Extension Office. 

Impact:

On a written evaluation immediately following the seminar the following results were reported: 

76% reported an increase in knowledge of being able to identify and recognize an emergency. 

70% reported an increase in knowledge in being able to make appropriate first aid care decisions. 

69% reported an increase in knowledge about skills needed to provide immediate care. 

46% reported an increase in knowledge of what is needed in a basic first aid kit. 

95% of attendees planned to update and/or create a first aid kit. 

A follow- up survey 9 months after the seminar reported:

• 55% of respondents reported having purchased or plan to purchase a fire extinguisher since the seminar. 
• 67% of respondents reported having purchased or updated their current first aid kits.
• 89% of respondents have shared the information they learned at the seminar with others. 
• 100% of respondents reported feeling more confident in making decisions in emergency situations because of having attended the seminar.
• 56% of respondents reported having had the opportunity to utilize information learned at the seminar. 

Quotes:

“You guys did a great job as did the EMS people who came in to talk. The carbon monoxide information was also appreciated.”

“Great seminar-information, contacts, materials.”

“When I came in, I didn’t have a good understanding of an emergency, now I do.” This was reported by one participant after the multi-county event. 

Plans for Expansion:

Follow-up programs in several counties including Franklin Co. were implemented, e.g, Narcan training.  held a Narcan training as a follow-up. Those programs were on a smaller scale than our multi-county seminar but were well attended. Boyle County ASAP has already been in communication about scheduling another training at the Extension Office as well as other locations in the area. The Fort Harrod FCS Agents plan to do a follow-up seminar similar to Be Safe, Be Well once the Boyle County Extension Office building renovation is complete.