Young Crew and Severe Injury

I have spent some time working with young people on a program attempting to engage them on the concept of choices and consequences, particularly around partying and road safety. It was hard work. It was enjoyable work. Most importantly, it was work that allowed me to hang out with young people and hope that they cared about what I had to say. It sometimes felt a lot like high school.

When you’re in high school you are desperate for people to like you. To talk to you. To think that you are worthy of their attention and they you have something interesting and useful to say. There is so much at stake. What if they hate me? What if what I say sucks? My work allowed me to return to those anxieties, but at seemingly much higher stakes. I wasn’t just hanging out at lunchtime with young crew, I was trying to convince them that keeping their limbs on was worth their attention.

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Until recently I worked on a project that involved coordinating and delivering a program that focused on reducing youth trauma – particularly trauma resulting from drinking or high risk behaviour. I was basically trying to teach teenagers how to not be stupid. And really, the focus is predominately on young men not being stupid. In 2016, a staggering 71% of trauma patients through the major trauma centre in WA (15-24 year old age bracket) were young men. And primarily young men that had taken stupid, high risk choices. From my home region – young people accounted for 25% of people killed or seriously injured on our local roads between 2004 and 2013. The excuses of the excesses of youth, the difficulties in delivering programmes or vagrancies of funding can’t be excuses for not trying to educate this group.

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I was involved in a really fun program to deliver. I am also the first person to admit it wasn’t always perfect. It could always have been improved, expanded, built upon. Health promotion is most effective when delivered as part of a structured program that is embedded in to multiple areas; rather than one-off field trips – but when you only have the capacity to deliver the one-offs, you have to decide whether one-off interventions are better than no interventions. We endeavoured to ensure the program was delivered in conjunction with other projects and programs, but occasionally it was purely stand-alone. I know what the research says, but sometimes you can only do what you can do.

A major challenge involved in running a project like this, was stakeholder management. So many stakeholders, all very important to the project, all with different needs, goals and motivations for their involvement. There were tense moments during development and delivery that would have been easier to manage with less people to worry about, but that may have reduced the efficacy of the program or the internal and external support. It was a delicate balancing game.

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After navigating the stress of just getting the project up and running – my main joy was delivering the actual program days. Delivering programs to young people takes a significant amount of energy. You have to just go for it and second best will not do. Program days would first involve juggling presenters and pretending on top of everything; then once that was under control the real fun would begin. It would be my turn to hurtle head first in to an awaiting pack of rabid youths, desperate to make my mark, or at the very least, a smeary smudge against the windshield of their youthful egos.

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That is where when head back to high school. Now, this was not peer-education. I’m old. Like grey hair, married with children old. I am so not lit. Sure, I’ve met young people and some of them have even spoken to me in a consensual two way conversation – but I am O. L. D. The young crew I was speaking to were generally in the sticky, messy part of the teenage dream, where parties, booze, sex and risk taking come crashing together with awkwardness, naivety and acne. I’m old enough (if I’d made some dramatic life choices) to be their dad. Or at least their uncle. In fact, for one of the kids – I was their uncle. Now, that was a tough day of trying to balance role duality. The challenges of working in regional areas.

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So, how do you make yourself relevant when speaking to young people without making yourself a grade-A example of an epic toolie? The first step is to sincerely acknowledge that you are not their peer, you are old and you do not know what they are going through. Aside from the fact that this is 90% the truth, it helps establish that you aren’t trying to be cool – you’re trying to be useful.

One thing that was VERY successful for me and a I recommend to anyone working with young people: don’t be afraid to ridicule yourself. It helps reduce the feeling that you are holier than thou and preaching to the group. I never felt that I lost standing mixing strong messages with some self targeted ribbing. One of the most talked about slides from my presentations has been my then and now picture. I use it to introduce the concept of choices and consequences to the program – mainly my poor choices in hair style and fashion.

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Another tip: find a concept and deliver it well. We worked hard on the choices and consequences concept – reduce your risks, help your mates, beware the ripple effect. Trying to convince a group of young people that a potentially silly error could lead to ongoing and possibly lifelong effects is a tough sell – one that can be achieved through making what you are talking about real, relatable and raw. A participant has to be able to put themselves or someone they know in the picture.

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The ripple effect was one of the key tenements of the program. It sprung in to existence from almost nowhere one day and became a core principle of explaining the concept of road trauma to young people. We don’t give young people much credit – they can be portrayed as lazy and self-absorbed. An unfair generalisation that doesn’t allow for the fact that there is great compassion and empathy in amongst our young crew. I would often explain the concept that health workers – the paramedics, doctors and nurses that dealt with front-line trauma are not robots. They are people, with families, and friends and lives that went on beyond delivering emergency health care. The concept that their decisions may actually impact on me and my children’s lives proved to be surprisingly effective in gaining their attention.

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Another pointer: tell real stories. Scenarios are great. Real life is even better. I have, unfortunately, lost far too many friends and peers through road accidents. Some were drinking driving. Some were speeding. Some remain unexplained, many, many years later. All were young men. All were tragedies. All ripped the heart and soul out of families, communities, sporting groups. There is nothing like the jarring finality of the loss of a young life through road trauma. There is a jarring reality when you stand in front of a group of young people and speak candidly about how hard it can be to see the mother of a dead friend, even years later. Explain the times you catch yourself day dreaming about the possible children a mate could have had, what type of dad he may have been, what type of partner. Retelling the reality of a life lost aids with cut-through.

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There was great opportunities to learn from the groups. Not just from what they were saying, but their actions, their responses, their feedback. There is something really exposing about presenting to young people (if you care). You are putting yourself out there – and they will provide direct and cutting feedback if what you are serving up isn’t to standard. The groups I spoke to had no qualms in questioning what was presented, how it was presented. They were fair but harsh critics – and they demand the best of you as a presenter.

The content we delivered was hard going and the manner it was interactive, challenging and occasionally fun. There can be a misconception that if you are learning about a serious topic you can’t enjoy yourself. It is widely accepted that children learn best through play. Surely adults and young adults are the same. This week I was reading an article by Dorothy Lucardie, who highlights that having fun and experiencing enjoyment were recognised by adult learners and teachers as a significant motivators to attendance and learning the knowledge and skills; while fun and enjoyment were considered a mechanism that encouraged concentration by learners and helped in the absorption of learning. We shouldn’t be afraid of making learning about serious topics fun. Why not engage a group, have them invested and involved when talking about the challenges of managing a trauma patient?

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The element of fun, some self-depreciation and relatability and acknowledging that while I definitely wasn’t a peer, I was at least worth listening to – meant that I had a lot of fun delivering this program and excellent feedback from my harsh, teen critics. Delivering alongside some exceptional presenters made my job that little bit easier, and definitely ensured that we had maximum impact on participants. This project was heavily evaluated, and the feedback forms were always glowing – but the biggest things that I would take from delivering the program were the unexpected outcomes, the remembrances, and the relationships with my fellow presenters.

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The value in presenting that program was always the things on top of the content. The outcomes no-one knew would exist. Two male students chose to study nursing after attending the project, changing their study preferences in perhaps the biggest professional compliment I have ever received. One student spent the day seemingly ignoring the key points of the program, before everything clicked in the final 15 minutes of the day. He solemnly shook my hand at the end of the day, staying back explicitly to do so – and still welcomes me in the street 2 years after he attended the program. The young people who remind me they were participants as they serve me coffee in local cafes, thanking me for the program. The parents who approach me and tell me their child raved about the program at home and that they hope it continues. Those were the things that made it really worthwhile, and are the things that cannot be captured on an evaluation or wider expansion of a program. The intangibles, the connections you make, the moments of realisation in a participant’s eyes. You can’t capture that – but it makes it worth throwing so much of yourself in to it.

How can you ride a motorbike?

“You’re a nurse – how can you ride a motorbike?”

I’ve been asked this question hundreds of times by incredulous family, co-workers and strangers. The risks, the amputations, the deaths – they’re horrific! How could I take such a risk? Well, avoiding the clichés of life is full of risks and I definitely am not one trying to live fast and die young – I’m just not that worried about motorcycle related trauma.

Through circumstance, timing and career, I’ve not seen that much motorcycle related trauma to scare me away. Sugar on the other hand – sugar is a nightmare!

Working as a nurse, especially in the Northern Territory, exposed me to the dangers of sugar. It’s terrible. It puts motorcycles to shame. I’ve seen horrific lower leg amputations carried out on the lower limbs of diabetics with a poorly controlled condition. Many more amputations than what I have seen relating to road-trauma.

I’ve seen toe amputations progress to forefoot to foot to lower leg to above knee – almost in the blink of an eye.

The amputations, mixed in with cases of peripheral vascular disease and diabetic neuropathy that have had led to patients having small, somewhat insignificant foot ulcers infiltrated and colonised by maggots have turned my stomach and made me think long and hard about the sugar intake in my life. Much harder than whether to take my motorbike to work or not. There’s nothing like picking maggots one-by-one out of a wound to make you start soul-searching about what went wrong here.

Don’t get me wrong – road-trauma, especially motorcycle related trauma is incredibly confronting, destructive and depressing.

Amputations, decapitations, burns and fractures. Terrible, but not that common. A 2012 paper from the Journal of Foot and Ankle research found that between 2006 and 2007 53% of Lower extremity amputation cases performed at the Princess Alexandra Hospital (Brisbane, Australia) were related to type 2 diabetes (8% to trauma, 18% to peripheral arterial disease) (Lazzarini, O’Rourke, Russell, Clark, & Kuys, 2012) and that 65 diabetics were having amputations every day in Australia in 2005 (Australian Diabetes Council, 2013).

So – how can I ride a motorbike with what I’ve seen as a nurse? Easily – how do you eat that biscuit?

 

Australian Diabetes Council. (2013). Diabetes Facts from http://www.australiandiabetescouncil.com/diabetes-education/diabetes-facts

Lazzarini, P. A., O’Rourke, S. R., Russell, A. W., Clark, D., & Kuys, S. S. (2012). What are the key conditions associated with lower limb amputations in a major Australian teaching hospital? Journal of Foot and Ankle Research, 5(1), 12. doi: 10.1186/1757-1146-5-12