A DRUNK DRIVING TRAGEDY--WITH A SURPRISING TWIST. By: Dubin, Julie Weingarden, Cosmopolitan, 00109541, Dec2008, Vol. 245, Issue 6Database:MasterFILE Premier
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A DRUNK DRIVING TRAGEDY--WITH A SURPRISING TWIST
Contents Section:Real-Life Reads: THE COSMO POST
A car accident that momentarily claimed 27-year-old Sarah Panzau's life ended up forever changing the way she lives
After hanging out with friends at a bar past closing time, Sarah Panzau, then 21, called it a night a little after 4 a.m. She'd been drinking for eight hours.
She exited Highway 64 as she'd done many nights before, on an offramp whose posted speed limit was 25 mph. Only this time, she didn't slow down her '96 Saturn. Instead, Sarah began to take the sharp curve at 72 mph, then panicked and tried to swerve back onto the highway. Her car Hipped twice, slammed upside down onto a guardrail, and skidded 25 feet before flipping a third time. The hack windshield shattered, and Sarah was ejected from the car.
She hadn't been wearing a seat belt, and her blood alcohol content was 0.308 — which is almost four times the legal limit in Illinois.
By the time an ambulance arrived — one happened to be driving past the accident scene — Sarah was legally dead. Her heart had Stopped, and she had already lost so much blood that she was no longer even bleeding. Paramedics working to revive her looked at what they thought was a gruesome corpse and prepared to call the coroner when Sarah amazingly gasped for air.
At Saint Louis university Hospital, doctors had little hope she'd survive. She had massive bead injuries, lacerations all over her body, a severed left arm. a broken hip, a leg that had been completely twisted around, and crushed ribs. Sarah was put on a ventilator and into a drug-induced coma. "If she didn't die from all her injuries, doctors thought she'd very well die from infection," says Sarah's mother, Cindi, an army nurse who was forced to identify her mangled daughter in the hospital. "She was that bad. I didn't know if Sarah would be okay until she woke up from her coma two weeks later. One of the surgeons asked how she was doing, and she gave a thumbs-up."
Over the next 12 months, Sarah endured more than 30 surgeries. "I was stitched and Stapled and poked and prodded on every inch of my body," she says. "But I was determined to make it."
And she was determined to turn her life around. A year before the accident, the two-time All-American volleyball player had dropped out of college, giving up her full-ride Scholarship because she hadn't enjoyed her course work. She opted instead to tend bar and started abusing drugs and alcohol. "I didn't pay for medical or car insurance, but I paid for cocaine." Sarah recalls. "I didn't think I had to listen to any-body — I partied whenever I wanted and only cared about myself."
Now 27, Sarah says she suffers from chronic pain despite taking a massive dose of pain medication ever) day "I hurt so bad that some mornings, I don't want to get up," she says. "But I tell myself, Deal with it. because things could be worse — you could be dead."
After Sarah had recovered From her surgeries, a high school guidance counselor read about her in a local paper and asked her to speak to Students about her ordeal. "Of course I was nervous, but I knew it was something I wanted — and had — to do," she says. It eventually became a full-time job, as Sarah traveled all over the country, giving talks and using horrific photos of herself at the accident scene and in the hospital. Beermaker AnheuserBusch even signed her to its national speakers bureau.
"I give presentations dressed in a lank top and shorts, even though I'm self-conscious about the scars on my body," Sarah admits. "I do it because I know seeing them has a huge impact on people."
"I HURT SO BAD THAT SOME DAYS, I DON'T WANT TO GET UP. BUT THINGS COULD BE WORSE — I COULD BE DEAD."
PHOTO (COLOR): She turned her horrible accident into a teaching tool (inset).
PHOTO (COLOR): In the midst of a two-week coma - ec12mwitter Mar 5, 2009- ec12mwitter Mar 5, 2009
By Julie Weingarden Dubin
Motor vehicle accidents remain
the leading cause of death
for teenagers, accounting for
nearly 41% of fatalities in 2004 among
young people ages 13 to 19. Th is deadly
toll results, to a large extent, from lack
of driving experience, but it also refl
ects the fact that the teenage brain is
still a work in progress. Th e prefrontal
cortex, which contains the neural
mechanisms of self-control, is one of
the last parts of the brain to mature. As
a result, teenagers are prone to risk taking,
impulsive behavior, and sensation
seeking—all of which can cause trouble
behind the wheel of a two- or three-ton
vehicle hurtling down a highway.
One possible solution is to increase
the age requirement for driver’s licenses
to 17 or 18. But there is no consensus
that this will reduce crash rates.
Th e Institute of Medicine recently
convened a panel of experts to identify
behavioral and cognitive strategies
to prevent motor vehicle accidents involving
teenagers. Th eir fi ndings were
summarized in a special issue of the American Journal of Preventive Medicine
published in September 2008.
Some helpful tips for parents follow. Don’t count on driver’s ed
Although driver’s education courses
may be marketed for their safety, there
is no proof that they reduce the rate of
motor vehicle accidents involving teenagers.
In fact, specialized classes that
emphasize practice in skid control and
other emergency maneuvers may actually
increase risk of crashes, especially
for young men, possibly because of excess
confi dence or a desire to “show off ”
skills for friends.
Accumulating more hours of parentsupervised
driving may not help
either. Studies have found that teenagers
whose parents spend a lot of time
supervising their driving are no more
likely than teenagers with less supervised
driving to avoid motor vehicle
crashes once licensed. It’s not clear why,
but parents may be restricting practice
time to relatively safe conditions,
such as driving during the day on a
side road, rather than exposing novice
drivers to more complicated situations,
such as driving at night or in snow. Parents
may also inadvertently act as codrivers,
by helping to watch for other
cars and checking “blind spots”; as a
result, teenagers may not acquire the
skills they need to drive by themselves.
The research conclusively shows
that only by driving alone do teenagers
develop the complex skills they need to
be safe on the road. Monitor behavior, not the trip
Many parents set limits on car trips, by
asking where their teenagers are driving
and when they will return home.
But the research suggests that it may be
better for parents to impose strict limits
on particular risk conditions, even if it
means going beyond what state law requires,
because teenagers are then less
likely to become risky drivers or get involved
in a motor vehicle crash in the
fi rst year aft er earning a license. Stress dangers of drinking. This
may seem obvious, as the legal drinking
age is 21. Still, many teenagers fi nd
ways to obtain alcohol anyway. Teenagers
(like adults) may not realize they
don’t have to be legally drunk to become
risky drivers; at all blood alcohol
concentration levels, they are more
likely to crash a motor vehicle or die in
an accident. Restrict night driving. Many crashes
take place at night. Ask the teenager
to return the car home by 9 p.m. or
10 p.m., regardless of what state law
says, until age 18. Limit passengers. Even one teenage
passenger increases risk of a crash, but
the risk increases with each additional
passenger. (Teenage boys in particular
may want to show off for friends or egg
one another on.) Ask the teenager to
drive alone or with no more than one
other passenger at a time, until age 18. Encourage buckling up. Teenagers
are less likely than people of other age
groups to use seat belts while driving,
with disastrous results. In 2004, nearly
two-thirds of teenagers who died or
were injured in crashes were not wearing
a seat belt. Monitor sleep. A 2006 poll by the
National Sleep Foundation reported
that 45% of adolescents said they did
not get suffi cient sleep on school nights,
with 28% saying they felt irritable and
cranky as a result. Sleep deprivation
in teenage drivers contributes to lack
of attention, impaired judgment and
greater risk taking, more susceptibility
to alcohol intoxication, and increased
aggression and impulsivity. Th is may
explain why half of motor vehicle accidents
in teenagers occur at night. Write down “rules of the road.”
Surveys have found that parents and
teenagers may not agree about what
rules are in place or what the consequences
are for not following them.
Although electronic monitoring devices
are commercially available, they
undermine the development of independence
and trust—and few parents
use them anyway. It may help to
clarify rules, expectations, and conditions
for earning increased driving
privileges by writing them down.
This may not only help teenagers
abide by the established limits but also
encourage better driving practices.
Graham R, et al. “Preventing Teen Motor
Crashes,” American Journal of Preventive Medicine
(Sept. 2008): Vol. 35, No. 3S, pp. S253–57.
Shope JT, et al. “Teen Driving: Motor-Vehicle
Crashes and Factors that Contribute,” American Journal of Preventive Medicine (Sept. 2008):
Vol. 35, No. 3S, pp. S261–71.
For more references, please see
www.health.harvard.edu/mentalextra.
Section:THE FORUM: TWO TAKES Pro Since the mid-1980s, U.S. citizens have had to be at least 21 to purchase or consume alcohol. But a group of college presidents have reignited the 21drinkingage debate, arguing it has fostered a binge-drinkingculture. Advocates argue the law has saved lives. Should thedrinkingage stay at 21?
As the fall semester begins at colleges across the country, campuses once again face the challenge of combating underage and binge drinking. This is a serious and difficult issue for colleges, for communities, and for parents like me who are preparing to send a son or daughter to college.
Unfortunately, more than 100 college presidents have chosen to address the issue by signing on to a misguided initiative that ostensibly favors a debate but is supported by a group, Choose Responsibility, whose sole aim is lowering the drinking age from 21 to 18 years old. Mothers Against Drunk Drivingis open to a discussion about solving the problems of underage and binge drinking. But the discussion must be based on facts, and, in this case, the facts are clear: 21 saves lives.
Since states began setting the legal drinking age at 21, the law has been one of the most studied in our history. The evidence is overwhelming: More than 50 high-quality scientific studies all found the 21 law saves lives, both on and off the road. And the public agrees: 72 percent of adults think that lowering thedrinking age would make alcohol more accessible to kids, and nearly half think that it would increase binge drinking among teens, according to a new Nationwide Insurance poll.
This is why stakeholders from scientific, medical, and public health organizations have joined MADD to form the Support 21 Coalition: We believe in basing public health policy on sound medical research and are committed to highlighting the lifesaving impact of the 21 drinking age.
Twenty-one isn't just an arbitrary number set by Congress--more than 20 states already had laws setting the drinking age there in 1984. And since the 21 law was widely enacted, the number of young people killed annually in crashes involving drunk drivers under 21 has been cut in half, from more than 5,000 individuals in the early 1980s to around 2,000 in 2005. By the end of 2005, the 21 drinking age had saved nearly 25,000 American lives--approximately 1,000 lives a year.
The Support 21 Coalition stands behind the indisputable scientific research that demonstrates lowering the drinking age would make the difficult problems of underage and binge drinking far worse. Research indicates that when the minimum legal drinking age is 21, people under age 21 drink less overall and continue to do so through their early 20s. When the drinking age has been lowered, injury and death rates significantly increased.
Lowering the age of those who have easy access to alcohol would shift responsibility for underage drinking to high school parents and educators.
A neurotoxin. Research has shown that the harmful effects of alcohol abuse are magnified on a teenager's still-developing brain. The adolescent brain is a work in progress, marked by significant development in areas of the brain responsible for learning, memory, complex thinking, planning, inhibition, and emotional regulation. The neurotoxic effect of excessive alcohol use is a danger to these key regions of the maturing adolescent brain.
A person's brain does not stop developing until their early to mid-20s. During this period, alcohol negatively affects all parts of the brain, including cognitive and decision-making abilities as well as coordination and memory. Adolescent drinkers not only do worse academically but are also at greater risk for social problems like depression, violence, and suicidal thoughts.
Lowering the drinking age would have dangerous long-term consequences: Early teen drinkers are not only more susceptible to alcoholism but to developing the disease earlier and more quickly than others.
The problem of binge drinking on college campuses needs to be addressed, but lowering the drinking age would be not only short-sighted but deadly. The simple fact is that the 21 law saves lives and is, therefore, nonnegotiable. What do you think? Should the U.S. drinking age stay at 21? Or should it be changed? You can join the debate at www.usnews.com/drinkingage. Or send your thoughts to viewpoint@usnews.com or to Viewpoint, U.S. News & World Report, 1050 Thomas Jefferson Street NW, Washington DC 20007. Selected responses will appear in the next issue.
PHOTO (COLOR)
PHOTO (COLOR) - ec12mwitter Mar 5, 2009- ec12mwitter Mar 5, 2009
By Laura Dean-Mooney
Edited by Robert Schlesinger
Laura Dean-Mooney, the national president of Mothers Against Drunk Driving, has been involved with the organization for 15 years
BY AARON DEAN EVERY SPRING BEFORE PROMS AND GRADUATIONS,
high schools around the nation put on a drinking and
driving awareness program called "Every 15 Minutes."
The Every 15 Minutes (H15M) program is a two-day event
targeting high school juniors and seniors that illustrates the
lievastating effects of the poor choice to drink and drive. This
nationwide program takes eight to 10 months to plan and
incorporates many local agencies. The fire department plays
;i vital role in planning, coordinating, and implementing this
program.
The E15M program begins on Day 1
with students arriving to class as usual.
Iieginning in first period and continuing
throughout the school day, students are
randomly pulled from class by the "Grim
Keaper." dres.sed in a full black robe carrying
a scythe. The "random" students art-
.ictually preselected; they become part
of the "Living Dead" and are sequestered
from their peer group, friends, and
family until the next day. This requires
a parental consent form and the obtaining
of signed notification of event forms
beforehand.
A team that may include chaplains, law
enforcement personnel, and coroner representatives
then notifies the parents of
the "death" at their residence or place of
employment. The scene is very emotional.
Even though the parents' supervisors and coworkers have
received prior notice, the tension affects all present.
THE CRASH SCENE
During the morning, a scheduled mock crash scenario is
demonstrated in real time before the assembled students
(photo 1). Usually, the crash scene is staged on a football
field, which also allows for the safe preparation of a helicopter
landing zone (LZ). Before the students assemble, a
towing company delivers two damaged vehicles on the field.
If possible, the use of a helicopter is suggested; its presence
contributes greatly to the crash scene's realism (photo 2). This
venue allows excellent scene visibility and acoustics.
The scene is comprised of one or two vehicles strategically
located. Four students are preselected as crash scene participants.
Tlie injuries may vary, but one student must be the
driver driving under the influence (DL'l) and one must be the
dead-on-arrival (DOA) victim. The other two .students can be
considered critical trauma cases and treated and transported
appropriately. One of the two should be a paraplegic, and one
should require extrication at the crash scene (photo 3).
The four crash scene students are transported to appropriate
respective destinations: The police take the DUi driver to
jail for booking; the coroner takes the body of the DOA to
the morgue; and the two injured patients go to the trauma
center—one by ambulance and the other by helicopter. These
students will be "processed" through the normal routine of
events associated with each facility. 'Hie parents of the trauma
patients go to the emergency room, which is one element of
the program that really alTects the participants.
On completion ofthe demonstration, the assembled students
are released to continue with their normally scheduled
classes. Students continue to be removed every 15 minutes
by the Grim Reaper, accompanied by the sound of a
heartbeat that is broadcast over the school's public address
system. Tombstone.^ are erected on campus to symbolize the
losses. The school day ends with the remaining student body
being released in the normal manner. The Living Dead at this
point now number approximately 30. They will be shuttled www.FireEngineering.com FIRE ENGINEERING February 2008 85
• EVERY 15 MINUTES
to dii otl-L<iiupus loLdlioii, such a.-, an i:lks iodgc, where retreat
facilities have been arranged.
THE RETREAT
The retreat is led by law enforcement personnel, firefighters,
chaplains, counselors, teachers, or other designated persons.
The crash scene students are retrieved from each of their respective
locations (the morgue, the jail, and the hospital) and
reunited with the Living Dead, Tlie goal is that these students
reflect on the day's events and share those thoughts with their
peer group. The entire group remains out of contact with their
families. This a.spect of the program requires confidentiality
and understanding by all in attendance.
At the retreat, warm-up games and icebreakers are played.
In bigger schools, .students may not know every student in
the room. When the time is right, two activities are performed—
letter writing and the passing ofa candle. Although
others may be included, these two components are very
effective.
Each student writes a letter to his parents. The lener begins,
"Every 15 minutes in the United States, someone dies or is
seriously injured in an alcohol-related incident. Today, I died."
Thf student continues writing from the heart. The parents of
the Living Dead students in turn write letters to their children.
One or two letters will be read during the assembly the following
day.
1 he passing of the candle occurs when all persons are
seated in a circle in a darkened room. No one speaks unless
they have the candle. A quiet uneasiness settles on the room.
One can speak for as long or as short as he would like. The
candle is passed around the circle until all persons have had
the opportunity to speak. Some very troubling stories may be
shared during emotional times at the retreat. Not all .stories
will revolve around alcohol. Emotional issues such as drug
use, losing family members in a war, and abusive family situations
are examples of what has been shared. If a student
reveals that he or she is in danger or needs help, appropriate
measures must be started.
Having 30 teenagers sit quietly in a room is unner\'ing in
itself. When you can hear a pin drop in a room full of otherwise
active, high-spirited high school students, it is obvious
the message is being received. The evening concludes with the
students spending the night.
Day 2 begins back on campus with an assembly for the
seniors and juniors. The entire student body attends if .space
permits, A funeral-type procession commences with a focus
on yesterday's evenls. A casket is on stage. A video of the
previous day's events produced by the students is shown.
The student who was a paraplegic can finally get out of the
wheelchair he has l>een using since he was released from the
hospital. A guest speaker, such as a local TV news personality,
speaks. Counselors should be available. Closure begins.
In the Sacramento area, we like to close the assembly with
Roll Call. Roll Call illustrates the ripple effect. You or someone
you know will be affected by a drunk driver. The speaker
asks specific groups of people to stand, such as those who
responded to the crash scene or those who performed patient
care. The questions broaden in nature until ultimately every
person in the assembly is standing. Ihe point: Drunk driving
affects us all.
In California, the state Office of Traffic Safety (OTS) provides
minigrants of $10,000 to develop the program. The California
Highway Patrol (CHP) works closely with OTS, funding and
coordinating each program. Outside of California, minigrants
are available through the national E15M.' Local agencies assist
where needed. For instance, fire department jurisdictions may
differ from EMS response areas, local law enforcement boundaries
may vary as to location, or helicopter and hospital capabilities
may need to be addressed. Coordination is the key to a
successful program. Tlie CHP has a great procedures manual
available at www,chp.ca,gov/pdf/manLial.pdf.
HISTORY
Although there is some debate as to the origin of this program,
it is reported the E15M program originated in Spokane.
Washington,^ 1990, under the direction of then Sergeant Mark
Sterk of the Spokane (WA) Police Department (SPD). The traffic
unit of SPD assisted Gon/aga Prep High School in producing
a skit revolving around a traffic collision resulting from
drunk driving. This is believed to have been the .start of the
E15M program. The first high school program was pnxluced
in 1991, funded by a grant from Safeco Insurance for the pur-
86 February 2008 FIRE ENGINEERING www.FireEngineering.com
• EVERY 15 MINUTES
chase of a sound system. The program continued, and many
agencies came to see what was happening in Spokane.
Sterk was elected sheriff of Spokane County and continued
to build the program, He named it "Every 15 Minutes," which
represented the approximate frequency of drunk-driving
related deaths.^
It has been reported that Canada was performing a similar
program to the north around the same time. After attending
a Problem Oriented Police (POP) conference, the Chico (CA)
Department hosted a program in January 1996.'* Reportedly,
the Chico Police Department also played an integral role in
strengthening the program. Again, since very little documentation
of these events was formally recorded, the exact history
has been difficult to establish. One aspect is very clear—many
dedicated people have contributed and continue to contribute
to this powerful program.
In 1997, the national Every 15 Minutes organization was
formed. Dean Wilson of the Bethlehem Ibwnship (PA) Police
Department is the training coordinator and has spent countless
hours developing the program. "We want to further grow
this [program! ••• il has come so far already over the years." he
explains. Wilson says that an online format will be available at
www,everyl5minutes,com early this year to help coordinators
administer their local program.*
Every 15 Minutes Duties and Checklist
Preplanning
• Determine the number of students participating in crash
scene. Usually, there should be at least a DUI driver, a DOA,
a head injury/comatose patient, and a paraplegic patient.
• Establish the time of day at which the crash occurs and what
type of crash scenario it will be: head-on, rollover, T-bone, etc,
• Obtain tbe sciiedule of events from the planning committee.
• Make it clear to the planning committee that the fire
department has the final say on scene specifics regarding
safety. Do not compromise safety at any time!
Site Inspection
• Determine the most appropriate locations for the the crash
scene, the helicopter landing zone, and the audio setup, including
AC power and a good visual aspect of the crash scene.
• Ensure there is adequate entrance/egress to the crash scene
and for all apparatus.
" Ensure the safety of the entire scene, including the crash
scene, the students, spectators, and fire and police personnel.
Pay particular attention to the approach of apparatus, extrication,
the landing zone, and video crew locations at ai! times,
• Obtain towing company contact Information (contact person
and phone number) and discuss the vehicles involved (color,
make, model, year) and possible safety issues with vehicles:
air bags, "stuff" left in vehicle when towed to site, removal of
broken glass in seats prior to placing students in vehicles, etc.
Company Assignments
Contact/e-mail fire department superiors for assignment of
the following personnel and vehicles:
• a battalion chief on location for the event;
• a truck for extrication and two engines for patient care and
LZ support;
• an EMS unit for transport, possibly a second unit if weather
prevents helicopter participation;
• a medicai evacuation helicopter; and
• a dispatcher,
• Remain in touch with the police department contact for upto-
date information.
One Week Before the Event
E-mail all members of all companies assigned program information
specifics, including site-specific information, program
details, and any necessary miscellaneous information. Identify
the personnel projected to participate in the program.
The Day Before the Program
Follow up witii the towing company to confirm:
• the vehicles to be used,
• that a hoie has been cut in the passenger side of the vehicle's
windshield for the DOA patient and that the hole's
edges have been taped, and
• the arrival time ofthe vehicles.
Confirm each participating fire department company's attendance
and time of arrival.
The Morning of the Event
• Arrive at the site approximately three hours before the start
of the program.
• Position the vehicles on arrival of the towing company.
• In the morning, obtain a tactical channel to use from the
fire dispatch supervisor (usually D6), Cail and confirm the
helicopter's availability. If unavailable because of logistics or
weather, immed/ate/y request a second medic unit.
• Meet with crash scene students to explain Incident events/
procedures.
• Meet with audio/visua! crew—emphasize safety.
• Get mic'd up, if needed,
• Have a briefing with the fire companies and law enforcement
arresting officers (bring doughnuts/snacks from the
food committee to give to the companies during the briefing).
Hold the briefing approximately 40 minutes prior to
the time of the crash.
• Get two handheld radios from a company for your use onscene,
• Remind the police department arresting officer to leave the
audio microphone behind prior to departing for jail.
During the Event
If there is no dispatcher on-scene, you will become the dispatcher.
Dispatch the "incident" and fill the roie of fire dispatch
or command as needed, using only the one tactical channel.
After the Event
• Thank the participating companies.
• Determine if the companies want to continue to train on
extrication after the audience has cleared the bleachers.
• Return mics to the audio crew.
• Call Fire Dispatch and release the TAC channel,
• Call the tow company and request that the vehicles be
returned to the towing yard.
88 February 2008 FIRE ENGINEERING wvvvtf.FireEngineering.com
• EVERY 15 MINUTES
In the years since, this interactive, preventive program has
influenced numerous high school students, parents, and facult>-
In 200S. the 16,885 alcohol-related crashes in the United
States represent an average of one alcohol-related fatality
every 31 minutes.
DOES IT REALLY WORK?
Two studies are worth noting regarding the effectiveness of
the E15M program. The first, from Springfield, Missouri, was
published in the American fournal of Health Studies in 2000.''
Il was based on the Greene Count>' (MO) DWI Task Force,
which presented the E15M program in 2000 for the third time
to the 1,700-student Kickapoo High School. The Task Force
wanted to determine the effectiveness of the program. The
abstract reveals, through the use of a survey-ba.sed format,
"The intervention program had a favorable impact on attitudes
but not behavior. Survey and focus group data suggested there
would be no sustained behavioral change without combining
the intervention with stronger DWI law enforcement, communit>'
support, and educational programs,"
Another study, published in the California Journal of Health Promotion in 2003, had as its focus group 1,651 students
from 81 California high schools who participated in the
E15M program as the Living Dead. Data were collected in the
form of pre- and post-incident surveys. Results suggested lasting
program effects were congruent with other drinking- and
dri\ ing-prevention programs. The following was noted: "However,
one of the goals of the program is to prevent alcoholrelated
driving mishaps during prom and graduation months,
so short-term intervention may l>e successful,"
Also, an indirect aspect emerged, Barents whose children
participated as Living Dead ,.. were significantly different in
their attitudes and behaviors about alcohol ase among their
children. Following their participation in the program, parents
also reported being more likely to discuss drinking and driving,
more prepared to control or prevent alcohol problems, and
more confident that their teenager would not drink and drive.""
THE FIRE DEPARTMENT'S ROLE
The fire department can play an integral role in the E15M
program. As the fire department coordinator, your planning
is critical. Depending on your local geographical area of 911
response, various forms of service delivery may be performed.
If your fire department has ambulances and transports, continuity
of care and coordination may assist in the logistics of the
agencies involved.
As we in the fire service know, the plan is ever dynamic.
Therefore, it is imperative to give chief officers as much advance
notice as possible so that resources can be scheduled.
Send, as needed, follow-up e-mails to ensure everyone is
informed. Since different personnel or actors may fill certain
positions because of promotion or vacation, multiple notifications
ensure companies wilt be where they need to be at
the proper time. The worst scenario is telling a firefighter on
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90 February 2008 FIRE ENGINEERING www.FtreEngineering.com
• EVERY 15 MINUTES
arrival at the firehouse to get ready to go do a "dog and pony"
show in 10 minutes.
Also, consider alternative plans. For instance, the initial
helicopter may not be able to attend because of a mission in
progress. If a secondary' agency has not filed a flight safety
plan of the high school prior to the event, a "no go" will
result. Weather may also disrupt flights, requiring additional
ground ambulances. Programs usually continue as planned
regardless of the weather.
The exact number of companies needed depends on your
level of staffing and standard operating procedures. If particifor
them to get tunnel vision when behind a camera; they
must be accounted for at all times. Often, they will accompany
the first-arriving company and the transporting medic to the
hospital. However, the helicopter does not generally take the
videographer because of weight restrictions. The fire department
coordinator is responsible for the vicjeographers' safety.
A safety briefing for all crash scene participants is imperative.
High school students want the pn)gram to Ix" successful and will
typically listen to your directions. Administrators and principals
may be a problem; they must know that your word is final on all
safety matters, including where they stand at the crash scene.
From student participants to firefighters,
everyone siiouid be safe and injury-free
at tiie end of tiie demonstration.
pation will require overtime, chief officers may be less likely
to permit full involvement. Generally, this program will need
one engine company for patient care, one truck company for
extrication, one engine company for LZ support, and one medic
company for ground transport. A second medic unit may be
needed if weather prevents the use of a helicopter. Although
a battalion chief and a dispatcher add to the realism of the
event, they are not necessary. The fire department coordinator
can assume those roles if necessary.
The keys to the crash scene are choreography and safety.
As the fire department coordinator, you are responsible for
the trash .scene, ensuring all students can see al! action and
that all action is timed appropriately. Remember, whatever
happens was exactly what was supposed to happen. The
;iiidience will not know if you depart from the script slightly
because of game-time difficulties, such as a delayed helicopter
arrival.
In addition to extrication and transport, law enforcement
wilt perform field .sobriety tests on the DUI driver when
planned. The officer, the DLII driver, and generally one
firefighter are wired for microphones. Radio traffic can be
transmitted over the public address system for the audience to
hear. Occasionally, the paramedic radio report to the trauma
center will be broadcast to the audience. It provides a chilling
effect. Sajety is paramount/ As fire department coordinator, you
also assume the role of safety officer on-scene. From student
participants to firefighters, everyone should be safe and injurefree
at the end ofthe demonstration.
Don't overlook basic principles such as using all appropriate
personal protective equipment, including eye protection
and full turnouts with gloves during extrication; appropriate
crash scene and LZ isolation; and entrance/egress of apparatus,
for which a traffic plan is highly desirable. Typically,
"patient" extrication goes well if normal safety precautions are
taken, such as covering the patient with a salvage cover and
keeping a firefighter with the patient during cutting operations.
Videographers, usually students, will be present. It is easy
Your fire department's involvement in this community event
can be very rewarding and also serve as a training evolution for
the incident command system (ICS), multiple casualty incident
(MCI) protocols, EMS, and extrication tactics. Probationary firefighters
can leam much from a simulated incident such as this
one. Often, after the student body has exited the bleachers, fire
companies can finish cutting up the vehicles l>efore the towing
companies arrive.
EVALUATION OF AN UNDERAGEDRINKINGANDDRIVINGPREVENTION PROGRAM
Underage drinkingandits associated consequences, includingdrivingafterdrinkingandriding with adrinkingdriver, remain a major public health concern to this nation. Underagedrinkingis also a major contributor to motor-vehicle injuriesandfatalities among persons age 15 to 20. School-based alcohol prevention programs are essential in helping to preventdrinkinganddrivingamong adolescents. This paper will present methodsandresults of a preliminary evaluation conducted on a school-baseddrinkinganddrivingprevention program for high school students that simulates alcohol-related consequencesandinvolves various community elements.
Recent epidemiological studies suggest that alcohol remains the primary drug of choice among adolescents, with the average age of first use being 13.2 years (Arata, Stafford, & Tims, 2003; Harris, Jolly, Runge, & Knox, 2000; Maney, Higham-Gardill & Mahoney, 2002; Stewart, 1999). The National Center on AddictionandSubstance Abuse (CASA) at Columbia University estimates that 20% of alcohol consumption occurs among persons less than 21 years of age (2003). According to the Centers for Disease ControlandPrevention (CDC) (2004), approximately 75% of high school students nationwide reported using alcohol at least once during their lifetime (i.e. one more drinks on one or more occasions) while 45% reported being current alcohol users (one or more drinks on one or more occasions within the last 30 days). In regards to heavy alcohol use, 28% of high school students reported bingedrinking(five or more drinks in a row on one or more occasions)andbetween 18%and31 % reported being drunk within the last 30 days (CDC, 2004; Johnston, O'Malley, Bachman, & Schulenberg, 2003).
Alcohol also significantly contributes to motor vehicle crashes, which remain the leading cause of death for persons 15-20 years of age (CDC, 2004, Lazy, Wiliszowski, & Jones, 2004). According to the Office of Applied Studies at the Substance AbuseandMental Health Services Administration (2004), in 2003, 21 % of persons aged 16 to 20 reported that they had driven within the past year while under the influence of alcohol or illicit drugs. The National Highway Traffic Safety Administration (NHTSA) reports that in 2003, a quarter of young drivers ages 15 to 20 years killed in motor vehicle crashes were intoxicated (NHTSA, 2004). Young male drivers are also at higher risk for being killed in an alcohol-related motor-vehicle crash. In 2003, 28% of the young male drivers involved in fatal crashes had beendrinkingat the time of the crash, compared with 13% of the young female drivers involved in fatal crashes (NHTSA). Exposure to alcohol-related injuriesandfatalities among adolescents are also enhanced by a series of otherdrivingrisks which include limiteddrivingandroad experience, nighttimedriving, speeding,andfailure to use proper safety restraints.
The objectives of this study are to (a) describe the process of an evaluation conducted on an underagedrinkinganddrivingprevention program for high school students, (b) report whether participants expressed changes in expectancy scores regarding underage alcohol use,and(c) develop programmatic recommendations that will strengthen the future design, implementation,andevaluation of this experiential underagedrinkinganddriving prevention program.
Elemental to effective school-based alcohol prevention programs are integrated community wide initiatives to raise awareness of the consequences of underage alcohol useandto deter access through a combination of countermeasures including legal, enforcement, medical, media,andpolitical entities. Shattered Dreams is a model of both schoolandcommunity-based alcohol prevention that incorporates simulated alcohol-related consequences with 14 community elements that include students, parents, educators, school administrators, health systems,andlaw enforcement personnel (Burandt, Guerra, Villarreal, Ramirez, & Harding, 1998)
In 1998, the Bexar County DWI Task Force Advisory Board on UnderageDrinking, in response to an increase in alcohol-related motor vehicle fatalities, established a program that would enhance awarenessandunderstanding of the relationship between alcohol useandthe occurrence of motor vehicle-related injuriesandfatalities among adolescents. Shattered Dreams was modeled after Every 15 Minutes, a similar program developedandimplemented in 1996 by the Chico, California Police Department (Burandt et al., 1998). This programs tide symbolized the death of a person every 15 minutes as a result of an alcohol-related traffic crash (Burandt et al., 1998).
The comprehensive nature of Shattered Dreams requires substantial community effort from the volunteersandplanning committees involved in sponsorship. School personnel, parents,andcommunity volunteers plan the event at least six months in advanceandmust organizeanddevelop specific program teams to solicit participationandsupport from various local public safetyandhealth care professionals (Beer, Price, Villarreal, & Salazar, 2002). Program teams include assembly, counseling, death notification, debriefing, historian, living dead, mock crash, retreat, scholarship, video production,andpublic information.
This intensive two-day experiential program visually demonstrates the social, physicalandemotional consequences that underagedrinkinganddrivingcan have both on a schoolanda community. The programs target audience includes high school juniorsandseniors (a segment of the adolescent population in which a majority have fulfilled the legal requirements to operate a vehicleanda group that is at a higher risk to engage in alcohol-related risk behavior). This program requires participation from the various elements located withinandoutside the high school setting including students, educators,andcounselors, as well as medical, law,andvarious other emergency service entities (Burandt et al., 1998). A significant portion of this simulation occurs on the campus of the participating high school to dramatizeandreinforce among me student body the significance of an alcohol-related fatality.
The first day begins with an enactment of an alcohol-related motor-vehicle crash involving direct participants (student volunteers) in various stages of trauma including deceased passengersandthe injured drunk driver. Law enforcementandemergency response follows (i.e., paramedics, stateandlocal law enforcement officers, airandfire rescue)andincludes the transporting of surviving passengers via groundandair to a local medical facility for emergency treatment while the deceased are taken to a local funeral home. The intoxicated driver is given a field sobriety test, arrested,andmen delivered to the local juvenile detention center to await arraignment. During this rime, localandstate enforcement agents are dispatched to the participating students' homes to notify parents that their son or daughter has been killed in an alcohol-related crash. The loss of life as a result of underagedrinkinganddrivingis dramatized throughout the day as a student or adult volunteer dressed as a Grim Reaper enters selected classroomsandremoves a student volunteer to symbolize the number of persons killed by alcohol within a designated time interval. The reading of a obituary to the entire class immediately follows the student's departure. The student volunteers return to their individual classroomsandare identified as, "Living Dead." Their faces are covered in white makeup to reinforce the notion of deathandfinality of a life cut short as a result of alcohol. The Living Dead do not speak nor make eye contact with fellow students for the remainder of the day.
Direct student participants (usually numbering around twenty-five) attend an overnight retreat where the central focus is skill-building activities that promoteandreinforce healthy behaviorsandchoices that reduce the likelihood of alcohol use. Other activities focus on team-building, taskandgoal completion, promoting alternative patterns of communication that include redirection, reinforcement of positive peer influence, leadership developmentandreflection,andreinforcementandstrengthening of familial relationships. Retreat activities use a mixed-method approach of interactive, videoandpersonal presentations by a series of community, medical,andlaw enforcement personnel. These presentations include personal experience or knowledge-based topics regarding underagedrinkinganddriving. Additional retreat activities stimulate youth leadership development that incorporates group discussions regarding personal power, identity,andthe impact ofdrinkinganddrivingon both friendsandfamily (Beer et al., 2002; Burandt et al., 1998).
On the second day, both direct participantsandobservers (students exposed to the living deadandmock crash) attend a school-wide assembly with a mock funeralanda series of presentations by various medical,andlaw enforcement personnel, students, parents,andeducators. Supportive debriefing sessions are held afterwards for students, parents,andvolunteers who are interested in talking about issues or topics that might have been raised as a result of their involvement in the program. An optional follow-up activity enacts a mock trial of the drunk driver involved in the simulated alcohol-related motor-vehicle crash (Burandt et al., 1998).
The current evaluation utilized a single-group pretest-posttest (Reflexive Control) design (Cook & Campbell, 1979; Rog, 1994). Within this specific design, information on individuals is collectedandmeasured prior toandafter participating in an intervention. The information collected at these two different time points then serves as a point of comparison (i.e., whether individuals exhibited change after participating in the intervention). Despite previously cited design limitations, this type of design was adoptedandidentified as a logistically efficientandcost-effective approach to evaluate this program.
INSTRUMENT
Pre- andpost-program questionnaires were standardized, closed-ended,andcomposed of 24-matched items. Sixteen items measured perceptions, attitudes,andlevel of awareness of underage alcohol use (a) in social activities, (b) on behaviorandrelationships, (c) in the ability to communicate the consequences associated withdrinkinganddrivingto peers,and(d) the likelihood of negative consequences occurring as a result ofdrinkinganddrivingincluding injuryanddeath. Responses were based on a 4-point Likert-type scaleandranged from strongly agree to strongly disagree. Four Texas zero tolerance items were included in order measure student knowledge about the legal consequences associated with alcohol use for individuals less than 21 years of age including fines, suspension of license,andimprisonment.
The final component of the pre-andpost-program questionnaire incorporated four demographic (pre-program)andthree items that asked participants about the perceived impact of Shattered Dreams (post-program). A unique identifier was created to ensure that responses at both time points corresponded to individuals who were exposed to Shattered Dreamsandthat respondents at both preandpost were similar with respect to characteristics that may otherwise cloud or confound conclusions.
ADMINISTRATION
Permission was granted to administer student questionnaires upon review andapproval by the University of Texas Health Science Center's Institutional Review Boardandschool district administration. Pre-andpost-program questionnaires were administered approximately four weeks beforeandfour weeks after the Shattered Dreams program to seniors enrolled at a high school in northeast San Antonio. This high school volunteered to conduct the Shattered Dreams program in the fall of 2002. According to the Texas Education Agency (2003), approximately 75% of the senior class were white non-Hispanic, 17% Hispanic, 3% blackand5% Asian/Pacific Islander/Native-American. In terms of campus characteristics, 4% of the student body was identified as economically disadvantagedand0.7% as having limited English proficiency with a student to teacher ratio of 16:1.
Only students who participated in the Shattered Dreams program (directandobservers) were administered program questionnaires via their student advisory period. At both time points, questionnaires were collected by school faculty, placed in their assigned envelopeandsubmitted to the evaluation team.
SAMPLE CHARACTERISTICS
A total of 349 seniors completed the pre-program questionnaire, prior to Shattered Dreams, for an overall response rate of 60%. Table 1 indicates that slightly more than half of respondents were female (53%) andwhite non-Hispanic (66%) with a mean age of 17.2 years (SD = .46).
Chi-square tests (c²) of statistical significance were calculated to assess whether differences existed between sex of respondent andpositiveandnegative alcohol expectancy items. An alpha level of .05 was used for all statistical tests. Table 2 shows statistically significant differences between attitudes expressed towards underagedrinkinganddrivingunder the influenceandrespondent's sex in this sample. For example, when respondents were asked to state whether they agreed or disagreed that "having two to three drinks is a good way to relax," 79% of females disagreed with the statement compared to 57% percent of males c² (1,N = 349) = 19.99, p = .01, 1 =. 47. Similarly males were more likely to agree that "a parry was more fun when alcohol was being served"andthat it was "okay to drive if you have only had two to three drinks," 48%and27% respectively compared to females; 27%and10% respectively. On "taking the issue ofdrinkinganddrivingseriously," 81% of females agreed with this statement compared to 67% of males c² (1,N = 349) = 8.73, p = .01, 1 =.35. Females were also more likely to agree "that they could talk to their friends aboutdrinkinganddriving" compared to males (87%and74% respectively; c² (1,N = 349) = 9.411, p = .01, 1 =.39. On whether it is "rare for people who drinkanddrive to cause injury or death to others," 18% of males agreed with the statement compared to 6% of females c² (1,N = 349) = 11.36, p = .01, 1 =.52. No significant differences in intensity of response by sex of respondent was identified for the statement regarding whether it was okay to "drink if you are underage, as long as you do not drive" with 55% of females reporting disagreement compared to 52% of males.
Cramer's Contingency Coefficient (V) was utilized to assess strength of association between variables. Strength of association on these seven items ranged from low to moderate (Cramer's V = 0.14 to 0.23). Tests of significance were similarly utilized to assess if there were differences between attitudes towards underagedrinkinganddrivingunder the influenceandthe race or ethnicity of respondent. Race was recoded into three categories (white non-Hispanic, Hispanic,andother). Only one item was identified as statistically significant. White non-Hispanics (36%) were more likely to agree with the statement, "having two to three drinks is a good way to relax," compared to Hispanics (24%)andother (17%) c² (1,N= 349) = 10.662, p = .01, n =.17.
POST-PROGRAM QUESTIONNAIRE RESULTS
From the original sample of 349 seniors who participated in the pre-program questionnaire, a total of 191 or 33% completed the post-program questionnaire. Respondents were mostly female (63%), white non-Hispanic (63%) with a mean age of 17 years (SD = .458). To assess global change from pre- to post- in alcohol expectancy scores among respondents, a scale was created through principal component analysis, based on the 16 original items.
Four internal consistency estimates of reliability were computed for both the pre- andpost- Positive Alcohol Expectancy Scale (PAES) (The coefficient alphaanda split-half coefficient expressed as a Spearman-Brown corrected correlation). Due to the odd number of items the unequal-length split-half coefficient is reported. In splitting the items, sequencingandwhether the item indicated or measured alcohol as a relaxant or as a socially acceptable behavior were taken into account. Values for the alphaandthe Spearman Brown coefficient for each of the respective pre-andpost-program sub-scales measured .88and.84 respectively. The three items combined to form a scale of positive alcohol expectancy. Each item was coded 0 to 3 or (values ranged from 0 = Strongly Agree, 1 = Agree, 2 = Disagree, 3 = Strongly Disagree). These items combined to form an overall scale that ranged from 0 to 9. An individual who expressed an overall score of 0 would be more inclined to initiate alcohol use compared to an individual who scored a 9 (indicating less of an inclination to initiate alcohol use).
REPEATED MEASURES ANOVA
To assess whether mean scores differ on the Positive Alcohol Expectancy Scale across two assessments, a repeated measures (One-Way Within-Subjects) ANOVA was conducted with the within-subjects factor being Time 1 mean score on the PAES andTime 2 mean score on the PAES. Meansandstandard deviations are presented in Table 3. The results of the ANOVA indicate a significant time effect, Wilks' L = .70 (1,190) = 80.198, p = .000, multivariate n² = .30.
A follow-up paired-samples t test indicated a significant linear effect. For example, the post-score on the PAES (M = 5.98, SD = 2.19) was significantly greater than the baseline score (M = 3.18, SD = 2.37), t (191) = 8.955, p = .000. The standardized effect six index, d, was .64, a moderate value. The mean difference was 2.8 points between the 9-point Likert preandpost rating scales. Results suggest that across two assessments individuals who participated in Shattered Dreams were less inclined to express agreement with positive expectations regarding alcohol use (specifically its utility as a relaxantandas socially acceptable behavior).
DIFFERENCES BY SEX
Repeated measures (One-Way Within-Subjects) ANOVA were also conducted separately for both males andfemales to assess whether scores differed across two assessments of the PAES. Results of the ANOVA demonstrated significant time effects for both males (Wilks' L = .76 (1,70) = 21.905, p = .001, multivariate n² = .24)andfemales (Wilks' L = .67 (1,118) = 60.607, p = .001, multivariate n² = .30).
In addition, paired-samples t tests were also conducted to evaluate differences in scores between malesandfemales prior toandafter exposure to the intervention. Results also reported in table 3 demonstrate that the post-program mean for the PAES was significantly greater than the pre-program mean. For example, males expressed a post-program mean of 5.94 (SD = 2.32)andwas significantly greater than the pre-program mean for the PAES (M = 3.37, SD = 2.62), t (70) = 4.680, p = 0.000. The standardized effect size index, d, was .55, a moderate value. The mean difference was 2.57 points between the 9-point Likert pre-andpost-rating scales.
Paired-samples t test results similarly suggested a significant change for females. The post-program mean the PAES of 6.01 (SD = 2.13) was greater than the pretest mean (M = 3.06, SD = 2.22), t (118) = 7.785, p = 0.000. The standardized effect size index, d, was .71, a substantial value. The mean difference was 3.20 points between the 9-point Likert pre-andpost- rating scales. Sub-group results similarly suggest that across two assessments, both malesandfemales exposed to Shattered Dreams were less likely express agreement with positive expectancies regarding alcohol useandwere just as likely to report that as result of the program the would be more likely to speak to their friends about underagedrinking,drinkinganddriving, the risks associated withdrinkinganddriving,andthat their friends as a result of participating in the program would be less likely to drinkanddrive. There are however notable differences. For example males not only reported slightly higher baseline expectancy scores compared to females (3.37and3.06, respectively) but males also were less likely to show a decrease in intentions to use alcohol compared to females (2.57and3.20, respectively). DISCUSSION Preliminary evaluation demonstrates that this program reduced positive expectations towardsdrinkinganddrivingamong participants. Results also demonstrate a measurable difference in alcohol expectancy scores from pre-program to post-program assessment between malesandfemales. This compliments other investigations into dissimilarities indrinkingmotivationsandoutcomes between adolescent malesandfemalesandthe various socialandenvironmental factors that promote these differences, which include social or cultural expectations, differential pathways of coping as well as familialandpeer affiliation (Copeland & Shope, 1996; Piko, 2001, Metrik, Frissell, McCarthy, D'Amico, & Brown, 2003).
For example, pre-program scores reported that females were more likely to demonstrate disagreement towards alcohol as a relaxantandas an element of planned social activities. Females were also more likely to express an awareness of the relational effect of alcohol related to both peer relationshipsandin causing injury or death to othersandto acknowledge that they could speak with their friends about the effects of underagedrinkinganddriving. Males on the other hand, were more likely to endorse alcohol as a relaxant (42%); as acceptable to drive drunk (26%),andto be in disagreement regarding the seriousness of underagedrinkinganddriving(32%).
Although promising, these results are far from conclusiveandare subject to careful interpretation due to limitations including (a) the absence of a comparison group to more accurately assess whether changes in student responses were a result of being exposed to Shattered Dreams, (b) the absence of items to measure the prevalence of underagedrinkinganddrivingamong participants prior toandafter the program,and(c) the need to develop outcome measures based on precise programmatic assumptions of Shattered Dreams.
First, the absence of a comparison group similar in characteristic to the group exposed to Shattered Dreams significantly limits conclusive statements regarding effectiveness or impact of this program. Therefore, to assess whether changes in participant responses are a direct result of being exposed to a program or treatment, a comparison group should be incorporated in the research design. Specifically, Weiss (1998)andRog (1994) observe that such a design is strengthened by the inclusion of periodic measurements, which can be helpful in assessing programmatic change over time.
Second, measures were not included to assess change in self-reportdrinkinganddrivingamong students prior toandafter the program. A series of self-report items were initially included as part of the program questionnaires submitted for review to the participating school district. Amid the clarification that was made regarding data collections procedures, the specific purpose of the study, relevance of measures to evaluation outcomes,andthe confidentiality of participant's school district; officials still requested that self-report measures be removed. Grube, Keefe,andStewart (2002) observe that in studies involving schools, investigators must often make strenuous efforts to convince school authorities on the importance of participation. Such negotiations occur within the context of other school-related activities that can significantly diminish the participation of both administratorsandeducators. In addition, school administrationanddistrict officials may be concernedandor uneasy about dealing with study results affecting their students. It is important, therefore, to convey to school authorities the important programmatic assumptions that a study is attempting to identifyandmeasure.
Third, is the development of a limited number of outcome measures reflective of the programmatic assumptions of Shattered Dreams. For example, participants were measured on legal knowledge regarding specific situations involving underagedrinkinganddriving. Results however demonstrated that student knowledge did not increase from pre-to post. One programmatic assumption of Shattered Dreams was that the students would increase their knowledge of Texas underagedrinkinglaws otherwise known as zero-tolerance. While specific zero-tolerance information was provided to only a small number of students (direct participants who attended the overnight retreat), less intensive efforts were made to provide observers (students not directly involved in the program but who observed the mock crashandassembly) with information regarding zero-tolerance. Therefore, the unequal dissemination of zero-tolerance information perhaps limited most students from fully learningandcomprehending state underagedrinkinganddrivinglaws.
Although results will serve to informandguide the development of a zero-tolerance component in Shattered Dreams, future recommendations include clearly statinganddefining the programmatic assumptions to be measured. For example in regards to zero-tolerance laws, it should clearly state the type of information that will be provided, the specific target audienceandhow it will be used. Clearandspecific use of information should lead to the development of items that effectively measure zero-tolerance knowledge among participants.
Amid the limitations involved in the current design, results also demonstrate the need to utilize background measures that report on pathways of risk or protection towards alcohol use by adolescents. Additionally, both programmaticandevaluative activities should not only address comprehensive alcohol prevention strategies to address the social intricacies that increase or decrease adolescent's awareness regarding underagedrinkinganddrivingbut developandutilize the disparities in sex regarding alcohol useandexperimentation. Further, information gleaned from this study augments a previous evaluation conducted by Hover, HoverandYoung (2000) on a similar school-based underagedrinkinganddrivingprevention program involving the community. In addition to recommendations offered in this previous study, we advise adoption of a more rigorous evaluation design, incorporation of standardized behavioral measures related todrinkinganddriving,anda more thorough understanding of the relationship between theoretical assumptions, programmatic objectivesandoutcome measures.
Future efforts will also focus on strengthening the developmentandevaluation of this program. This will include the adoption and application of behavioral theory in order to enhance our understanding of the processes that foster behavioral change as a result of students participating in this program. A concerted effort will also be made to include more schoolsandcommunities diverse in regards to both socialandcommunity characteristics (i.e., urban, rural, economically underserved) as well as obtain a more representative sample of students to more thoroughly examine the multiple risks associated with underageanddrinking. Qualitative examinations with both studentsandkey stakeholders on norms regarding underagedrinkinganddrivingwill be essential to measuring the overall impact of Shattered Dreams on both a schoolandcommunity. These approaches should also be complimented by repeated measuresandextended follow-up of program participants. These activities will help to strengthen the validityandreliability of resultsandhelp determine both the short-and** long-term effects of this program.
This study was supported by a grant from University Health System, Bexar County, Texas under contract 2201063-LS. This paper is based on the first author's thesis which was presented at the 99th annual meeting of the American Sociological Association in San Francisco, California, August 2004.
A DRUNK DRIVING TRAGEDY--WITH A SURPRISING TWIST. By: Dubin, Julie Weingarden, Cosmopolitan, 00109541, Dec2008, Vol. 245, Issue 6Database:MasterFILE Premier
HTML Full Text
A DRUNK DRIVING TRAGEDY--WITH A SURPRISING TWIST
Contents Section: Real-Life Reads: THE COSMO POST
A car accident that momentarily claimed 27-year-old Sarah Panzau's life ended up forever changing the way she livesAfter hanging out with friends at a bar past closing time, Sarah Panzau, then 21, called it a night a little after 4 a.m. She'd been drinking for eight hours.
She exited Highway 64 as she'd done many nights before, on an offramp whose posted speed limit was 25 mph. Only this time, she didn't slow down her '96 Saturn. Instead, Sarah began to take the sharp curve at 72 mph, then panicked and tried to swerve back onto the highway. Her car Hipped twice, slammed upside down onto a guardrail, and skidded 25 feet before flipping a third time. The hack windshield shattered, and Sarah was ejected from the car.
She hadn't been wearing a seat belt, and her blood alcohol content was 0.308 — which is almost four times the legal limit in Illinois.
By the time an ambulance arrived — one happened to be driving past the accident scene — Sarah was legally dead. Her heart had Stopped, and she had already lost so much blood that she was no longer even bleeding. Paramedics working to revive her looked at what they thought was a gruesome corpse and prepared to call the coroner when Sarah amazingly gasped for air.
At Saint Louis university Hospital, doctors had little hope she'd survive. She had massive bead injuries, lacerations all over her body, a severed left arm. a broken hip, a leg that had been completely twisted around, and crushed ribs. Sarah was put on a ventilator and into a drug-induced coma. "If she didn't die from all her injuries, doctors thought she'd very well die from infection," says Sarah's mother, Cindi, an army nurse who was forced to identify her mangled daughter in the hospital. "She was that bad. I didn't know if Sarah would be okay until she woke up from her coma two weeks later. One of the surgeons asked how she was doing, and she gave a thumbs-up."
Over the next 12 months, Sarah endured more than 30 surgeries. "I was stitched and Stapled and poked and prodded on every inch of my body," she says. "But I was determined to make it."
And she was determined to turn her life around. A year before the accident, the two-time All-American volleyball player had dropped out of college, giving up her full-ride Scholarship because she hadn't enjoyed her course work. She opted instead to tend bar and started abusing drugs and alcohol. "I didn't pay for medical or car insurance, but I paid for cocaine." Sarah recalls. "I didn't think I had to listen to any-body — I partied whenever I wanted and only cared about myself."
Now 27, Sarah says she suffers from chronic pain despite taking a massive dose of pain medication ever) day "I hurt so bad that some mornings, I don't want to get up," she says. "But I tell myself, Deal with it. because things could be worse — you could be dead."
After Sarah had recovered From her surgeries, a high school guidance counselor read about her in a local paper and asked her to speak to Students about her ordeal. "Of course I was nervous, but I knew it was something I wanted — and had — to do," she says. It eventually became a full-time job, as Sarah traveled all over the country, giving talks and using horrific photos of herself at the accident scene and in the hospital. Beermaker AnheuserBusch even signed her to its national speakers bureau.
"I give presentations dressed in a lank top and shorts, even though I'm self-conscious about the scars on my body," Sarah admits. "I do it because I know seeing them has a huge impact on people."
"I HURT SO BAD THAT SOME DAYS, I DON'T WANT TO GET UP. BUT THINGS COULD BE WORSE — I COULD BE DEAD."
PHOTO (COLOR): She turned her horrible accident into a teaching tool (inset).
PHOTO (COLOR): In the midst of a two-week coma
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By Julie Weingarden Dubin
"Preventing driving accidents involving teenagers." Harvard Mental Health Letter 25.6 (Dec. 2008): 6-6. MasterFILE Premier. EBSCO. [Library name], [City], [State abbreviation]. 5 Mar. 2009 <http://search.ebscohost.com/login.aspx?direct=true&db=f5h&AN=35606896&site=ehost-live>.
Motor vehicle accidents remain
the leading cause of death
for teenagers, accounting for
nearly 41% of fatalities in 2004 among
young people ages 13 to 19. Th is deadly
toll results, to a large extent, from lack
of driving experience, but it also refl
ects the fact that the teenage brain is
still a work in progress. Th e prefrontal
cortex, which contains the neural
mechanisms of self-control, is one of
the last parts of the brain to mature. As
a result, teenagers are prone to risk taking,
impulsive behavior, and sensation
seeking—all of which can cause trouble
behind the wheel of a two- or three-ton
vehicle hurtling down a highway.
One possible solution is to increase
the age requirement for driver’s licenses
to 17 or 18. But there is no consensus
that this will reduce crash rates.
Th e Institute of Medicine recently
convened a panel of experts to identify
behavioral and cognitive strategies
to prevent motor vehicle accidents involving
teenagers. Th eir fi ndings were
summarized in a special issue of the
American Journal of Preventive Medicine
published in September 2008.
Some helpful tips for parents follow.
Don’t count on driver’s ed
Although driver’s education courses
may be marketed for their safety, there
is no proof that they reduce the rate of
motor vehicle accidents involving teenagers.
In fact, specialized classes that
emphasize practice in skid control and
other emergency maneuvers may actually
increase risk of crashes, especially
for young men, possibly because of excess
confi dence or a desire to “show off ”
skills for friends.
Accumulating more hours of parentsupervised
driving may not help
either. Studies have found that teenagers
whose parents spend a lot of time
supervising their driving are no more
likely than teenagers with less supervised
driving to avoid motor vehicle
crashes once licensed. It’s not clear why,
but parents may be restricting practice
time to relatively safe conditions,
such as driving during the day on a
side road, rather than exposing novice
drivers to more complicated situations,
such as driving at night or in snow. Parents
may also inadvertently act as codrivers,
by helping to watch for other
cars and checking “blind spots”; as a
result, teenagers may not acquire the
skills they need to drive by themselves.
The research conclusively shows
that only by driving alone do teenagers
develop the complex skills they need to
be safe on the road.
Monitor behavior, not the trip
Many parents set limits on car trips, by
asking where their teenagers are driving
and when they will return home.
But the research suggests that it may be
better for parents to impose strict limits
on particular risk conditions, even if it
means going beyond what state law requires,
because teenagers are then less
likely to become risky drivers or get involved
in a motor vehicle crash in the
fi rst year aft er earning a license.
Stress dangers of drinking. This
may seem obvious, as the legal drinking
age is 21. Still, many teenagers fi nd
ways to obtain alcohol anyway. Teenagers
(like adults) may not realize they
don’t have to be legally drunk to become
risky drivers; at all blood alcohol
concentration levels, they are more
likely to crash a motor vehicle or die in
an accident.
Restrict night driving. Many crashes
take place at night. Ask the teenager
to return the car home by 9 p.m. or
10 p.m., regardless of what state law
says, until age 18.
Limit passengers. Even one teenage
passenger increases risk of a crash, but
the risk increases with each additional
passenger. (Teenage boys in particular
may want to show off for friends or egg
one another on.) Ask the teenager to
drive alone or with no more than one
other passenger at a time, until age 18.
Encourage buckling up. Teenagers
are less likely than people of other age
groups to use seat belts while driving,
with disastrous results. In 2004, nearly
two-thirds of teenagers who died or
were injured in crashes were not wearing
a seat belt.
Monitor sleep. A 2006 poll by the
National Sleep Foundation reported
that 45% of adolescents said they did
not get suffi cient sleep on school nights,
with 28% saying they felt irritable and
cranky as a result. Sleep deprivation
in teenage drivers contributes to lack
of attention, impaired judgment and
greater risk taking, more susceptibility
to alcohol intoxication, and increased
aggression and impulsivity. Th is may
explain why half of motor vehicle accidents
in teenagers occur at night.
Write down “rules of the road.”
Surveys have found that parents and
teenagers may not agree about what
rules are in place or what the consequences
are for not following them.
Although electronic monitoring devices
are commercially available, they
undermine the development of independence
and trust—and few parents
use them anyway. It may help to
clarify rules, expectations, and conditions
for earning increased driving
privileges by writing them down.
This may not only help teenagers
abide by the established limits but also
encourage better driving practices.
Graham R, et al. “Preventing Teen Motor
Crashes,” American Journal of Preventive Medicine
(Sept. 2008): Vol. 35, No. 3S, pp. S253–57.
Shope JT, et al. “Teen Driving: Motor-Vehicle
Crashes and Factors that Contribute,” American
Journal of Preventive Medicine (Sept. 2008):
Vol. 35, No. 3S, pp. S261–71.
For more references, please see
www.health.harvard.edu/mentalextra.
Dean-Mooney, Laura. "A Lower Age Would Be Unsafe." U.S. News & World Report 15 Sep. 2008: 10+. MasterFILE Premier. EBSCO. [Library name], [City], [State abbreviation]. 5 Mar. 2009 <http://search.ebscohost.com/login.aspx?direct=true&db=f5h&AN=34274767&site=ehost-live>.
A Lower Age Would Be Unsafe
Section: THE FORUM: TWO TAKESPro
Since the mid-1980s, U.S. citizens have had to be at least 21 to purchase or consume alcohol. But a group of college presidents have reignited the 21 drinking age debate, arguing it has fostered a binge-drinking culture. Advocates argue the law has saved lives. Should the drinking age stay at 21?
As the fall semester begins at colleges across the country, campuses once again face the challenge of combating underage and binge drinking. This is a serious and difficult issue for colleges, for communities, and for parents like me who are preparing to send a son or daughter to college.
Unfortunately, more than 100 college presidents have chosen to address the issue by signing on to a misguided initiative that ostensibly favors a debate but is supported by a group, Choose Responsibility, whose sole aim is lowering the drinking age from 21 to 18 years old. Mothers Against Drunk Drivingis open to a discussion about solving the problems of underage and binge drinking. But the discussion must be based on facts, and, in this case, the facts are clear: 21 saves lives.
Since states began setting the legal drinking age at 21, the law has been one of the most studied in our history. The evidence is overwhelming: More than 50 high-quality scientific studies all found the 21 law saves lives, both on and off the road. And the public agrees: 72 percent of adults think that lowering thedrinking age would make alcohol more accessible to kids, and nearly half think that it would increase binge drinking among teens, according to a new Nationwide Insurance poll.
This is why stakeholders from scientific, medical, and public health organizations have joined MADD to form the Support 21 Coalition: We believe in basing public health policy on sound medical research and are committed to highlighting the lifesaving impact of the 21 drinking age.
Twenty-one isn't just an arbitrary number set by Congress--more than 20 states already had laws setting the drinking age there in 1984. And since the 21 law was widely enacted, the number of young people killed annually in crashes involving drunk drivers under 21 has been cut in half, from more than 5,000 individuals in the early 1980s to around 2,000 in 2005. By the end of 2005, the 21 drinking age had saved nearly 25,000 American lives--approximately 1,000 lives a year.
The Support 21 Coalition stands behind the indisputable scientific research that demonstrates lowering the drinking age would make the difficult problems of underage and binge drinking far worse. Research indicates that when the minimum legal drinking age is 21, people under age 21 drink less overall and continue to do so through their early 20s. When the drinking age has been lowered, injury and death rates significantly increased.
Lowering the age of those who have easy access to alcohol would shift responsibility for underage drinking to high school parents and educators.
A neurotoxin. Research has shown that the harmful effects of alcohol abuse are magnified on a teenager's still-developing brain. The adolescent brain is a work in progress, marked by significant development in areas of the brain responsible for learning, memory, complex thinking, planning, inhibition, and emotional regulation. The neurotoxic effect of excessive alcohol use is a danger to these key regions of the maturing adolescent brain.
A person's brain does not stop developing until their early to mid-20s. During this period, alcohol negatively affects all parts of the brain, including cognitive and decision-making abilities as well as coordination and memory. Adolescent drinkers not only do worse academically but are also at greater risk for social problems like depression, violence, and suicidal thoughts.
Lowering the drinking age would have dangerous long-term consequences: Early teen drinkers are not only more susceptible to alcoholism but to developing the disease earlier and more quickly than others.
The problem of binge drinking on college campuses needs to be addressed, but lowering the drinking age would be not only short-sighted but deadly. The simple fact is that the 21 law saves lives and is, therefore, nonnegotiable.
What do you think? Should the U.S. drinking age stay at 21? Or should it be changed? You can join the debate at www.usnews.com/drinkingage. Or send your thoughts to viewpoint@usnews.com or to Viewpoint, U.S. News & World Report, 1050 Thomas Jefferson Street NW, Washington DC 20007. Selected responses will appear in the next issue.
PHOTO (COLOR)
PHOTO (COLOR)
-
By Laura Dean-Mooney
Edited by Robert Schlesinger
Laura Dean-Mooney, the national president of Mothers Against Drunk Driving, has been involved with the organization for 15 years
_
Dean, Aaron. "Every 15 Minutes. (cover story)." Fire Engineering 161.2 (Feb. 2008): 85-94. MasterFILE Premier. EBSCO. [Library name], [City], [State abbreviation]. 5 Mar. 2009 <http://search.ebscohost.com/login.aspx?direct=true&db=f5h&AN=30104090&site=ehost-live>.
BY AARON DEAN
EVERY SPRING BEFORE PROMS AND GRADUATIONS,
high schools around the nation put on a drinking and
driving awareness program called "Every 15 Minutes."
The Every 15 Minutes (H15M) program is a two-day event
targeting high school juniors and seniors that illustrates the
lievastating effects of the poor choice to drink and drive. This
nationwide program takes eight to 10 months to plan and
incorporates many local agencies. The fire department plays
;i vital role in planning, coordinating, and implementing this
program.
The E15M program begins on Day 1
with students arriving to class as usual.
Iieginning in first period and continuing
throughout the school day, students are
randomly pulled from class by the "Grim
Keaper." dres.sed in a full black robe carrying
a scythe. The "random" students art-
.ictually preselected; they become part
of the "Living Dead" and are sequestered
from their peer group, friends, and
family until the next day. This requires
a parental consent form and the obtaining
of signed notification of event forms
beforehand.
A team that may include chaplains, law
enforcement personnel, and coroner representatives
then notifies the parents of
the "death" at their residence or place of
employment. The scene is very emotional.
Even though the parents' supervisors and coworkers have
received prior notice, the tension affects all present.
THE CRASH SCENE
During the morning, a scheduled mock crash scenario is
demonstrated in real time before the assembled students
(photo 1). Usually, the crash scene is staged on a football
field, which also allows for the safe preparation of a helicopter
landing zone (LZ). Before the students assemble, a
towing company delivers two damaged vehicles on the field.
If possible, the use of a helicopter is suggested; its presence
contributes greatly to the crash scene's realism (photo 2). This
venue allows excellent scene visibility and acoustics.
The scene is comprised of one or two vehicles strategically
located. Four students are preselected as crash scene participants.
Tlie injuries may vary, but one student must be the
driver driving under the influence (DL'l) and one must be the
dead-on-arrival (DOA) victim. The other two .students can be
considered critical trauma cases and treated and transported
appropriately. One of the two should be a paraplegic, and one
should require extrication at the crash scene (photo 3).
The four crash scene students are transported to appropriate
respective destinations: The police take the DUi driver to
jail for booking; the coroner takes the body of the DOA to
the morgue; and the two injured patients go to the trauma
center—one by ambulance and the other by helicopter. These
students will be "processed" through the normal routine of
events associated with each facility. 'Hie parents of the trauma
patients go to the emergency room, which is one element of
the program that really alTects the participants.
On completion ofthe demonstration, the assembled students
are released to continue with their normally scheduled
classes. Students continue to be removed every 15 minutes
by the Grim Reaper, accompanied by the sound of a
heartbeat that is broadcast over the school's public address
system. Tombstone.^ are erected on campus to symbolize the
losses. The school day ends with the remaining student body
being released in the normal manner. The Living Dead at this
point now number approximately 30. They will be shuttled
www.FireEngineering.com FIRE ENGINEERING February 2008 85
• EVERY 15 MINUTES
to dii otl-L<iiupus loLdlioii, such a.-, an i:lks iodgc, where retreat
facilities have been arranged.
THE RETREAT
The retreat is led by law enforcement personnel, firefighters,
chaplains, counselors, teachers, or other designated persons.
The crash scene students are retrieved from each of their respective
locations (the morgue, the jail, and the hospital) and
reunited with the Living Dead, Tlie goal is that these students
reflect on the day's events and share those thoughts with their
peer group. The entire group remains out of contact with their
families. This a.spect of the program requires confidentiality
and understanding by all in attendance.
At the retreat, warm-up games and icebreakers are played.
In bigger schools, .students may not know every student in
the room. When the time is right, two activities are performed—
letter writing and the passing ofa candle. Although
others may be included, these two components are very
effective.
Each student writes a letter to his parents. The lener begins,
"Every 15 minutes in the United States, someone dies or is
seriously injured in an alcohol-related incident. Today, I died."
Thf student continues writing from the heart. The parents of
the Living Dead students in turn write letters to their children.
One or two letters will be read during the assembly the following
day.
1 he passing of the candle occurs when all persons are
seated in a circle in a darkened room. No one speaks unless
they have the candle. A quiet uneasiness settles on the room.
One can speak for as long or as short as he would like. The
candle is passed around the circle until all persons have had
the opportunity to speak. Some very troubling stories may be
shared during emotional times at the retreat. Not all .stories
will revolve around alcohol. Emotional issues such as drug
use, losing family members in a war, and abusive family situations
are examples of what has been shared. If a student
reveals that he or she is in danger or needs help, appropriate
measures must be started.
Having 30 teenagers sit quietly in a room is unner\'ing in
itself. When you can hear a pin drop in a room full of otherwise
active, high-spirited high school students, it is obvious
the message is being received. The evening concludes with the
students spending the night.
Day 2 begins back on campus with an assembly for the
seniors and juniors. The entire student body attends if .space
permits, A funeral-type procession commences with a focus
on yesterday's evenls. A casket is on stage. A video of the
previous day's events produced by the students is shown.
The student who was a paraplegic can finally get out of the
wheelchair he has l>een using since he was released from the
hospital. A guest speaker, such as a local TV news personality,
speaks. Counselors should be available. Closure begins.
In the Sacramento area, we like to close the assembly with
Roll Call. Roll Call illustrates the ripple effect. You or someone
you know will be affected by a drunk driver. The speaker
asks specific groups of people to stand, such as those who
responded to the crash scene or those who performed patient
care. The questions broaden in nature until ultimately every
person in the assembly is standing. Ihe point: Drunk driving
affects us all.
In California, the state Office of Traffic Safety (OTS) provides
minigrants of $10,000 to develop the program. The California
Highway Patrol (CHP) works closely with OTS, funding and
coordinating each program. Outside of California, minigrants
are available through the national E15M.' Local agencies assist
where needed. For instance, fire department jurisdictions may
differ from EMS response areas, local law enforcement boundaries
may vary as to location, or helicopter and hospital capabilities
may need to be addressed. Coordination is the key to a
successful program. Tlie CHP has a great procedures manual
available at www,chp.ca,gov/pdf/manLial.pdf.
HISTORY
Although there is some debate as to the origin of this program,
it is reported the E15M program originated in Spokane.
Washington,^ 1990, under the direction of then Sergeant Mark
Sterk of the Spokane (WA) Police Department (SPD). The traffic
unit of SPD assisted Gon/aga Prep High School in producing
a skit revolving around a traffic collision resulting from
drunk driving. This is believed to have been the .start of the
E15M program. The first high school program was pnxluced
in 1991, funded by a grant from Safeco Insurance for the pur-
86 February 2008 FIRE ENGINEERING www.FireEngineering.com
• EVERY 15 MINUTES
chase of a sound system. The program continued, and many
agencies came to see what was happening in Spokane.
Sterk was elected sheriff of Spokane County and continued
to build the program, He named it "Every 15 Minutes," which
represented the approximate frequency of drunk-driving
related deaths.^
It has been reported that Canada was performing a similar
program to the north around the same time. After attending
a Problem Oriented Police (POP) conference, the Chico (CA)
Department hosted a program in January 1996.'* Reportedly,
the Chico Police Department also played an integral role in
strengthening the program. Again, since very little documentation
of these events was formally recorded, the exact history
has been difficult to establish. One aspect is very clear—many
dedicated people have contributed and continue to contribute
to this powerful program.
In 1997, the national Every 15 Minutes organization was
formed. Dean Wilson of the Bethlehem Ibwnship (PA) Police
Department is the training coordinator and has spent countless
hours developing the program. "We want to further grow
this [program! ••• il has come so far already over the years." he
explains. Wilson says that an online format will be available at
www,everyl5minutes,com early this year to help coordinators
administer their local program.*
Every 15 Minutes Duties and Checklist
Preplanning
• Determine the number of students participating in crash
scene. Usually, there should be at least a DUI driver, a DOA,
a head injury/comatose patient, and a paraplegic patient.
• Establish the time of day at which the crash occurs and what
type of crash scenario it will be: head-on, rollover, T-bone, etc,
• Obtain tbe sciiedule of events from the planning committee.
• Make it clear to the planning committee that the fire
department has the final say on scene specifics regarding
safety. Do not compromise safety at any time!
Site Inspection
• Determine the most appropriate locations for the the crash
scene, the helicopter landing zone, and the audio setup, including
AC power and a good visual aspect of the crash scene.
• Ensure there is adequate entrance/egress to the crash scene
and for all apparatus.
" Ensure the safety of the entire scene, including the crash
scene, the students, spectators, and fire and police personnel.
Pay particular attention to the approach of apparatus, extrication,
the landing zone, and video crew locations at ai! times,
• Obtain towing company contact Information (contact person
and phone number) and discuss the vehicles involved (color,
make, model, year) and possible safety issues with vehicles:
air bags, "stuff" left in vehicle when towed to site, removal of
broken glass in seats prior to placing students in vehicles, etc.
Company Assignments
Contact/e-mail fire department superiors for assignment of
the following personnel and vehicles:
• a battalion chief on location for the event;
• a truck for extrication and two engines for patient care and
LZ support;
• an EMS unit for transport, possibly a second unit if weather
prevents helicopter participation;
• a medicai evacuation helicopter; and
• a dispatcher,
• Remain in touch with the police department contact for upto-
date information.
One Week Before the Event
E-mail all members of all companies assigned program information
specifics, including site-specific information, program
details, and any necessary miscellaneous information. Identify
the personnel projected to participate in the program.
The Day Before the Program
Follow up witii the towing company to confirm:
• the vehicles to be used,
• that a hoie has been cut in the passenger side of the vehicle's
windshield for the DOA patient and that the hole's
edges have been taped, and
• the arrival time ofthe vehicles.
Confirm each participating fire department company's attendance
and time of arrival.
The Morning of the Event
• Arrive at the site approximately three hours before the start
of the program.
• Position the vehicles on arrival of the towing company.
• In the morning, obtain a tactical channel to use from the
fire dispatch supervisor (usually D6), Cail and confirm the
helicopter's availability. If unavailable because of logistics or
weather, immed/ate/y request a second medic unit.
• Meet with crash scene students to explain Incident events/
procedures.
• Meet with audio/visua! crew—emphasize safety.
• Get mic'd up, if needed,
• Have a briefing with the fire companies and law enforcement
arresting officers (bring doughnuts/snacks from the
food committee to give to the companies during the briefing).
Hold the briefing approximately 40 minutes prior to
the time of the crash.
• Get two handheld radios from a company for your use onscene,
• Remind the police department arresting officer to leave the
audio microphone behind prior to departing for jail.
During the Event
If there is no dispatcher on-scene, you will become the dispatcher.
Dispatch the "incident" and fill the roie of fire dispatch
or command as needed, using only the one tactical channel.
After the Event
• Thank the participating companies.
• Determine if the companies want to continue to train on
extrication after the audience has cleared the bleachers.
• Return mics to the audio crew.
• Call Fire Dispatch and release the TAC channel,
• Call the tow company and request that the vehicles be
returned to the towing yard.
88 February 2008 FIRE ENGINEERING wvvvtf.FireEngineering.com
• EVERY 15 MINUTES
In the years since, this interactive, preventive program has
influenced numerous high school students, parents, and facult>-
In 200S. the 16,885 alcohol-related crashes in the United
States represent an average of one alcohol-related fatality
every 31 minutes.
DOES IT REALLY WORK?
Two studies are worth noting regarding the effectiveness of
the E15M program. The first, from Springfield, Missouri, was
published in the American fournal of Health Studies in 2000.''
Il was based on the Greene Count>' (MO) DWI Task Force,
which presented the E15M program in 2000 for the third time
to the 1,700-student Kickapoo High School. The Task Force
wanted to determine the effectiveness of the program. The
abstract reveals, through the use of a survey-ba.sed format,
"The intervention program had a favorable impact on attitudes
but not behavior. Survey and focus group data suggested there
would be no sustained behavioral change without combining
the intervention with stronger DWI law enforcement, communit>'
support, and educational programs,"
Another study, published in the California Journal of
Health Promotion in 2003, had as its focus group 1,651 students
from 81 California high schools who participated in the
E15M program as the Living Dead. Data were collected in the
form of pre- and post-incident surveys. Results suggested lasting
program effects were congruent with other drinking- and
dri\ ing-prevention programs. The following was noted: "However,
one of the goals of the program is to prevent alcoholrelated
driving mishaps during prom and graduation months,
so short-term intervention may l>e successful,"
Also, an indirect aspect emerged, Barents whose children
participated as Living Dead ,.. were significantly different in
their attitudes and behaviors about alcohol ase among their
children. Following their participation in the program, parents
also reported being more likely to discuss drinking and driving,
more prepared to control or prevent alcohol problems, and
more confident that their teenager would not drink and drive.""
THE FIRE DEPARTMENT'S ROLE
The fire department can play an integral role in the E15M
program. As the fire department coordinator, your planning
is critical. Depending on your local geographical area of 911
response, various forms of service delivery may be performed.
If your fire department has ambulances and transports, continuity
of care and coordination may assist in the logistics of the
agencies involved.
As we in the fire service know, the plan is ever dynamic.
Therefore, it is imperative to give chief officers as much advance
notice as possible so that resources can be scheduled.
Send, as needed, follow-up e-mails to ensure everyone is
informed. Since different personnel or actors may fill certain
positions because of promotion or vacation, multiple notifications
ensure companies wilt be where they need to be at
the proper time. The worst scenario is telling a firefighter on
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90 February 2008 FIRE ENGINEERING www.FtreEngineering.com
• EVERY 15 MINUTES
arrival at the firehouse to get ready to go do a "dog and pony"
show in 10 minutes.
Also, consider alternative plans. For instance, the initial
helicopter may not be able to attend because of a mission in
progress. If a secondary' agency has not filed a flight safety
plan of the high school prior to the event, a "no go" will
result. Weather may also disrupt flights, requiring additional
ground ambulances. Programs usually continue as planned
regardless of the weather.
The exact number of companies needed depends on your
level of staffing and standard operating procedures. If particifor
them to get tunnel vision when behind a camera; they
must be accounted for at all times. Often, they will accompany
the first-arriving company and the transporting medic to the
hospital. However, the helicopter does not generally take the
videographer because of weight restrictions. The fire department
coordinator is responsible for the vicjeographers' safety.
A safety briefing for all crash scene participants is imperative.
High school students want the pn)gram to Ix" successful and will
typically listen to your directions. Administrators and principals
may be a problem; they must know that your word is final on all
safety matters, including where they stand at the crash scene.
From student participants to firefighters,
everyone siiouid be safe and injury-free
at tiie end of tiie demonstration.
pation will require overtime, chief officers may be less likely
to permit full involvement. Generally, this program will need
one engine company for patient care, one truck company for
extrication, one engine company for LZ support, and one medic
company for ground transport. A second medic unit may be
needed if weather prevents the use of a helicopter. Although
a battalion chief and a dispatcher add to the realism of the
event, they are not necessary. The fire department coordinator
can assume those roles if necessary.
The keys to the crash scene are choreography and safety.
As the fire department coordinator, you are responsible for
the trash .scene, ensuring all students can see al! action and
that all action is timed appropriately. Remember, whatever
happens was exactly what was supposed to happen. The
;iiidience will not know if you depart from the script slightly
because of game-time difficulties, such as a delayed helicopter
arrival.
In addition to extrication and transport, law enforcement
wilt perform field .sobriety tests on the DUI driver when
planned. The officer, the DLII driver, and generally one
firefighter are wired for microphones. Radio traffic can be
transmitted over the public address system for the audience to
hear. Occasionally, the paramedic radio report to the trauma
center will be broadcast to the audience. It provides a chilling
effect.
Sajety is paramount/ As fire department coordinator, you
also assume the role of safety officer on-scene. From student
participants to firefighters, everyone should be safe and injurefree
at the end ofthe demonstration.
Don't overlook basic principles such as using all appropriate
personal protective equipment, including eye protection
and full turnouts with gloves during extrication; appropriate
crash scene and LZ isolation; and entrance/egress of apparatus,
for which a traffic plan is highly desirable. Typically,
"patient" extrication goes well if normal safety precautions are
taken, such as covering the patient with a salvage cover and
keeping a firefighter with the patient during cutting operations.
Videographers, usually students, will be present. It is easy
Your fire department's involvement in this community event
can be very rewarding and also serve as a training evolution for
the incident command system (ICS), multiple casualty incident
(MCI) protocols, EMS, and extrication tactics. Probationary firefighters
can leam much from a simulated incident such as this
one. Often, after the student body has exited the bleachers, fire
companies can finish cutting up the vehicles l>efore the towing
companies arrive.
_
Salazar, Camerino I., et al. "EVALUATION OF AN UNDERAGE DRINKING AND DRIVING PREVENTION PROGRAM." American Journal of Health Studies 21.1/2 (Mar. 2006): 49-56. MasterFILE Premier. EBSCO. [Library name], [City], [State abbreviation]. 5 Mar. 2009 <http://search.ebscohost.com/login.aspx?direct=true&db=f5h&AN=25219314&site=ehost-live>.
EVALUATION OF AN UNDERAGE DRINKING AND DRIVING PREVENTION PROGRAM
Underage drinking and its associated consequences, including driving after drinking and riding with a drinkingdriver, remain a major public health concern to this nation. Underage drinking is also a major contributor to motor-vehicle injuries and fatalities among persons age 15 to 20. School-based alcohol prevention programs are essential in helping to prevent drinking and driving among adolescents. This paper will present methodsand results of a preliminary evaluation conducted on a school-based drinking and driving prevention program for high school students that simulates alcohol-related consequences and involves various community elements.Recent epidemiological studies suggest that alcohol remains the primary drug of choice among adolescents, with the average age of first use being 13.2 years (Arata, Stafford, & Tims, 2003; Harris, Jolly, Runge, & Knox, 2000; Maney, Higham-Gardill & Mahoney, 2002; Stewart, 1999). The National Center on Addiction and Substance Abuse (CASA) at Columbia University estimates that 20% of alcohol consumption occurs among persons less than 21 years of age (2003). According to the Centers for Disease Control and Prevention (CDC) (2004), approximately 75% of high school students nationwide reported using alcohol at least once during their lifetime (i.e. one more drinks on one or more occasions) while 45% reported being current alcohol users (one or more drinks on one or more occasions within the last 30 days). In regards to heavy alcohol use, 28% of high school students reported binge drinking (five or more drinks in a row on one or more occasions) and between 18% and 31 % reported being drunk within the last 30 days (CDC, 2004; Johnston, O'Malley, Bachman, & Schulenberg, 2003).
Alcohol also significantly contributes to motor vehicle crashes, which remain the leading cause of death for persons 15-20 years of age (CDC, 2004, Lazy, Wiliszowski, & Jones, 2004). According to the Office of Applied Studies at the Substance Abuse and Mental Health Services Administration (2004), in 2003, 21 % of persons aged 16 to 20 reported that they had driven within the past year while under the influence of alcohol or illicit drugs. The National Highway Traffic Safety Administration (NHTSA) reports that in 2003, a quarter of young drivers ages 15 to 20 years killed in motor vehicle crashes were intoxicated (NHTSA, 2004). Young male drivers are also at higher risk for being killed in an alcohol-related motor-vehicle crash. In 2003, 28% of the young male drivers involved in fatal crashes had been drinking at the time of the crash, compared with 13% of the young female drivers involved in fatal crashes (NHTSA). Exposure to alcohol-related injuries and fatalities among adolescents are also enhanced by a series of other driving risks which include limited driving and road experience, nighttime driving, speeding, and failure to use proper safety restraints.
The objectives of this study are to (a) describe the process of an evaluation conducted on an underage drinking anddriving prevention program for high school students, (b) report whether participants expressed changes in expectancy scores regarding underage alcohol use, and (c) develop programmatic recommendations that will strengthen the future design, implementation, and evaluation of this experiential underage drinking anddriving prevention program.
Elemental to effective school-based alcohol prevention programs are integrated community wide initiatives to raise awareness of the consequences of underage alcohol use and to deter access through a combination of countermeasures including legal, enforcement, medical, media, and political entities. Shattered Dreams is a model of both school andcommunity-based alcohol prevention that incorporates simulated alcohol-related consequences with 14 community elements that include students, parents, educators, school administrators, health systems, andlaw enforcement personnel (Burandt, Guerra, Villarreal, Ramirez, & Harding, 1998)
In 1998, the Bexar County DWI Task Force Advisory Board on Underage Drinking, in response to an increase in alcohol-related motor vehicle fatalities, established a program that would enhance awareness and understanding of the relationship between alcohol use and the occurrence of motor vehicle-related injuries and fatalities among adolescents. Shattered Dreams was modeled after Every 15 Minutes, a similar program developed and implemented in 1996 by the Chico, California Police Department (Burandt et al., 1998). This programs tide symbolized the death of a person every 15 minutes as a result of an alcohol-related traffic crash (Burandt et al., 1998).
The comprehensive nature of Shattered Dreams requires substantial community effort from the volunteers and planning committees involved in sponsorship. School personnel, parents, and community volunteers plan the event at least six months in advance and must organize anddevelop specific program teams to solicit participation and support from various local public safety and health care professionals (Beer, Price, Villarreal, & Salazar, 2002). Program teams include assembly, counseling, death notification, debriefing, historian, living dead, mock crash, retreat, scholarship, video production, and public information.
This intensive two-day experiential program visually demonstrates the social, physical and emotional consequences that underage drinking anddriving can have both on a school and a community. The programs target audience includes high school juniors and seniors (a segment of the adolescent population in which a majority have fulfilled the legal requirements to operate a vehicle and a group that is at a higher risk to engage in alcohol-related risk behavior). This program requires participation from the various elements located within and outside the high school setting including students, educators, and counselors, as well as medical, law, and various other emergency service entities (Burandt et al., 1998). A significant portion of this simulation occurs on the campus of the participating high school to dramatize and reinforce among me student body the significance of an alcohol-related fatality.
The first day begins with an enactment of an alcohol-related motor-vehicle crash involving direct participants (student volunteers) in various stages of trauma including deceased passengers and the injured drunk driver. Law enforcement and emergency response follows (i.e., paramedics, state and local law enforcement officers, air and fire rescue) and includes the transporting of surviving passengers via ground and air to a local medical facility for emergency treatment while the deceased are taken to a local funeral home. The intoxicated driver is given a field sobriety test, arrested, and men delivered to the local juvenile detention center to await arraignment. During this rime, local and state enforcement agents are dispatched to the participating students' homes to notify parents that their son or daughter has been killed in an alcohol-related crash. The loss of life as a result of underage drinking and driving is dramatized throughout the day as a student or adult volunteer dressed as a Grim Reaper enters selected classrooms and removes a student volunteer to symbolize the number of persons killed by alcohol within a designated time interval. The reading of a obituary to the entire class immediately follows the student's departure. The student volunteers return to their individual classrooms and are identified as, "Living Dead." Their faces are covered in white makeup to reinforce the notion of death andfinality of a life cut short as a result of alcohol. The Living Dead do not speak nor make eye contact with fellow students for the remainder of the day.
Direct student participants (usually numbering around twenty-five) attend an overnight retreat where the central focus is skill-building activities that promoteand reinforce healthy behaviors and choices that reduce the likelihood of alcohol use. Other activities focus on team-building, taskand goal completion, promoting alternative patterns of communication that include redirection, reinforcement of positive peer influence, leadership development and reflection,and reinforcement and strengthening of familial relationships. Retreat activities use a mixed-method approach of interactive, video and personal presentations by a series of community, medical, and law enforcement personnel. These presentations include personal experience or knowledge-based topics regarding underage drinking and driving. Additional retreat activities stimulate youth leadership development that incorporates group discussions regarding personal power, identity, and the impact of drinking anddriving on both friends and family (Beer et al., 2002; Burandt et al., 1998).
On the second day, both direct participants and observers (students exposed to the living dead and mock crash) attend a school-wide assembly with a mock funeral and a series of presentations by various medical, and law enforcement personnel, students, parents, and educators. Supportive debriefing sessions are held afterwards for students, parents, and volunteers who are interested in talking about issues or topics that might have been raised as a result of their involvement in the program. An optional follow-up activity enacts a mock trial of the drunk driver involved in the simulated alcohol-related motor-vehicle crash (Burandt et al., 1998).
The current evaluation utilized a single-group pretest-posttest (Reflexive Control) design (Cook & Campbell, 1979; Rog, 1994). Within this specific design, information on individuals is collected and measured prior to and after participating in an intervention. The information collected at these two different time points then serves as a point of comparison (i.e., whether individuals exhibited change after participating in the intervention). Despite previously cited design limitations, this type of design was adopted and identified as a logistically efficient and cost-effective approach to evaluate this program.
INSTRUMENT
Pre- and post-program questionnaires were standardized, closed-ended, and composed of 24-matched items. Sixteen items measured perceptions, attitudes,and level of awareness of underage alcohol use (a) in social activities, (b) on behavior and relationships, (c) in the ability to communicate the consequences associated with drinking and driving to peers, and (d) the likelihood of negative consequences occurring as a result of drinking and driving including injury and death. Responses were based on a 4-point Likert-type scale and ranged from strongly agree to strongly disagree. Four Texas zero tolerance items were included in order measure student knowledge about the legal consequences associated with alcohol use for individuals less than 21 years of age including fines, suspension of license, and imprisonment.The final component of the pre- and post-program questionnaire incorporated four demographic (pre-program) and three items that asked participants about the perceived impact of Shattered Dreams (post-program). A unique identifier was created to ensure that responses at both time points corresponded to individuals who were exposed to Shattered Dreams and that respondents at both pre and post were similar with respect to characteristics that may otherwise cloud or confound conclusions.
ADMINISTRATION
Permission was granted to administer student questionnaires upon review and approval by the University of Texas Health Science Center's Institutional Review Board and school district administration. Pre-and post-program questionnaires were administered approximately four weeks before and four weeks after the Shattered Dreams program to seniors enrolled at a high school in northeast San Antonio. This high school volunteered to conduct the Shattered Dreams program in the fall of 2002. According to the Texas Education Agency (2003), approximately 75% of the senior class were white non-Hispanic, 17% Hispanic, 3% black and 5% Asian/Pacific Islander/Native-American. In terms of campus characteristics, 4% of the student body was identified as economically disadvantaged and 0.7% as having limited English proficiency with a student to teacher ratio of 16:1.Only students who participated in the Shattered Dreams program (direct and observers) were administered program questionnaires via their student advisory period. At both time points, questionnaires were collected by school faculty, placed in their assigned envelope and submitted to the evaluation team.
SAMPLE CHARACTERISTICS
A total of 349 seniors completed the pre-program questionnaire, prior to Shattered Dreams, for an overall response rate of 60%. Table 1 indicates that slightly more than half of respondents were female (53%) and white non-Hispanic (66%) with a mean age of 17.2 years (SD = .46).MALE/FEMALE DIFFERENCES REGARDING ALCOHOL EXPECTANCIES
Chi-square tests (c²) of statistical significance were calculated to assess whether differences existed between sex of respondent and positive andnegative alcohol expectancy items. An alpha level of .05 was used for all statistical tests. Table 2 shows statistically significant differences between attitudes expressed towards underage drinking and driving under the influence and respondent's sex in this sample. For example, when respondents were asked to state whether they agreed or disagreed that "having two to three drinks is a good way to relax," 79% of females disagreed with the statement compared to 57% percent of males c² (1,N = 349) = 19.99, p = .01, 1 =. 47. Similarly males were more likely to agree that "a parry was more fun when alcohol was being served" and that it was "okay to drive if you have only had two to three drinks," 48%and 27% respectively compared to females; 27% and 10% respectively. On "taking the issue of drinking and driving seriously," 81% of females agreed with this statement compared to 67% of males c² (1,N = 349) = 8.73, p = .01, 1 =.35. Females were also more likely to agree "that they could talk to their friends about drinking and driving" compared to males (87%and 74% respectively; c² (1,N = 349) = 9.411, p = .01, 1 =.39. On whether it is "rare for people who drink and drive to cause injury or death to others," 18% of males agreed with the statement compared to 6% of females c² (1,N = 349) = 11.36, p = .01, 1 =.52. No significant differences in intensity of response by sex of respondent was identified for the statement regarding whether it was okay to "drink if you are underage, as long as you do not drive" with 55% of females reporting disagreement compared to 52% of males.Cramer's Contingency Coefficient (V) was utilized to assess strength of association between variables. Strength of association on these seven items ranged from low to moderate (Cramer's V = 0.14 to 0.23). Tests of significance were similarly utilized to assess if there were differences between attitudes towards underage drinking and driving under the influence and the race or ethnicity of respondent. Race was recoded into three categories (white non-Hispanic, Hispanic, and other). Only one item was identified as statistically significant. White non-Hispanics (36%) were more likely to agree with the statement, "having two to three drinks is a good way to relax," compared to Hispanics (24%) and other (17%) c² (1,N= 349) = 10.662, p = .01, n =.17.
POST-PROGRAM QUESTIONNAIRE RESULTS
From the original sample of 349 seniors who participated in the pre-program questionnaire, a total of 191 or 33% completed the post-program questionnaire. Respondents were mostly female (63%), white non-Hispanic (63%) with a mean age of 17 years (SD = .458). To assess global change from pre- to post- in alcohol expectancy scores among respondents, a scale was created through principal component analysis, based on the 16 original items.Four internal consistency estimates of reliability were computed for both the pre- and post- Positive Alcohol Expectancy Scale (PAES) (The coefficient alphaand a split-half coefficient expressed as a Spearman-Brown corrected correlation). Due to the odd number of items the unequal-length split-half coefficient is reported. In splitting the items, sequencing and whether the item indicated or measured alcohol as a relaxant or as a socially acceptable behavior were taken into account. Values for the alpha and the Spearman Brown coefficient for each of the respective pre- and post-program sub-scales measured .88 and .84 respectively. The three items combined to form a scale of positive alcohol expectancy. Each item was coded 0 to 3 or (values ranged from 0 = Strongly Agree, 1 = Agree, 2 = Disagree, 3 = Strongly Disagree). These items combined to form an overall scale that ranged from 0 to 9. An individual who expressed an overall score of 0 would be more inclined to initiate alcohol use compared to an individual who scored a 9 (indicating less of an inclination to initiate alcohol use).
REPEATED MEASURES ANOVA
To assess whether mean scores differ on the Positive Alcohol Expectancy Scale across two assessments, a repeated measures (One-Way Within-Subjects) ANOVA was conducted with the within-subjects factor being Time 1 mean score on the PAES and Time 2 mean score on the PAES. Meansand standard deviations are presented in Table 3. The results of the ANOVA indicate a significant time effect, Wilks' L = .70 (1,190) = 80.198, p = .000, multivariate n² = .30.A follow-up paired-samples t test indicated a significant linear effect. For example, the post-score on the PAES (M = 5.98, SD = 2.19) was significantly greater than the baseline score (M = 3.18, SD = 2.37), t (191) = 8.955, p = .000. The standardized effect six index, d, was .64, a moderate value. The mean difference was 2.8 points between the 9-point Likert pre and post rating scales. Results suggest that across two assessments individuals who participated in Shattered Dreams were less inclined to express agreement with positive expectations regarding alcohol use (specifically its utility as a relaxant and as socially acceptable behavior).
DIFFERENCES BY SEX
Repeated measures (One-Way Within-Subjects) ANOVA were also conducted separately for both males and females to assess whether scores differed across two assessments of the PAES. Results of the ANOVA demonstrated significant time effects for both males (Wilks' L = .76 (1,70) = 21.905, p = .001, multivariate n² = .24) and females (Wilks' L = .67 (1,118) = 60.607, p = .001, multivariate n² = .30).In addition, paired-samples t tests were also conducted to evaluate differences in scores between males and females prior to and after exposure to the intervention. Results also reported in table 3 demonstrate that the post-program mean for the PAES was significantly greater than the pre-program mean. For example, males expressed a post-program mean of 5.94 (SD = 2.32) and was significantly greater than the pre-program mean for the PAES (M = 3.37, SD = 2.62), t (70) = 4.680, p = 0.000. The standardized effect size index, d, was .55, a moderate value. The mean difference was 2.57 points between the 9-point Likert pre- and post-rating scales.
Paired-samples t test results similarly suggested a significant change for females. The post-program mean the PAES of 6.01 (SD = 2.13) was greater than the pretest mean (M = 3.06, SD = 2.22), t (118) = 7.785, p = 0.000. The standardized effect size index, d, was .71, a substantial value. The mean difference was 3.20 points between the 9-point Likert pre- and post- rating scales. Sub-group results similarly suggest that across two assessments, both males and females exposed to Shattered Dreams were less likely express agreement with positive expectancies regarding alcohol use and were just as likely to report that as result of the program the would be more likely to speak to their friends about underagedrinking, drinking and driving, the risks associated with drinkingand driving, and that their friends as a result of participating in the program would be less likely to drink and drive. There are however notable differences. For example males not only reported slightly higher baseline expectancy scores compared to females (3.37 and 3.06, respectively) but males also were less likely to show a decrease in intentions to use alcohol compared to females (2.57 and 3.20, respectively).
DISCUSSION
Preliminary evaluation demonstrates that this program reduced positive expectations towards drinking and driving among participants. Results also demonstrate a measurable difference in alcohol expectancy scores from pre-program to post-program assessment between males andfemales. This compliments other investigations into dissimilarities in drinking motivations and outcomes between adolescent males and femalesand the various socialand environmental factors that promote these differences, which include social or cultural expectations, differential pathways of coping as well as familial andpeer affiliation (Copeland & Shope, 1996; Piko, 2001, Metrik, Frissell, McCarthy, D'Amico, & Brown, 2003).
For example, pre-program scores reported that females were more likely to demonstrate disagreement towards alcohol as a relaxant and as an element of planned social activities. Females were also more likely to express an awareness of the relational effect of alcohol related to both peer relationships and in causing injury or death to others and to acknowledge that they could speak with their friends about the effects of underagedrinking and driving. Males on the other hand, were more likely to endorse alcohol as a relaxant (42%); as acceptable to drive drunk (26%), and to be in disagreement regarding the seriousness of underage drinking and driving (32%).
Although promising, these results are far from conclusive and are subject to careful interpretation due to limitations including (a) the absence of a comparison group to more accurately assess whether changes in student responses were a result of being exposed to Shattered Dreams, (b) the absence of items to measure the prevalence of underage drinking and driving among participants prior to and after the program, and (c) the need to develop outcome measures based on precise programmatic assumptions of Shattered Dreams.
First, the absence of a comparison group similar in characteristic to the group exposed to Shattered Dreams significantly limits conclusive statements regarding effectiveness or impact of this program. Therefore, to assess whether changes in participant responses are a direct result of being exposed to a program or treatment, a comparison group should be incorporated in the research design. Specifically, Weiss (1998) andRog (1994) observe that such a design is strengthened by the inclusion of periodic measurements, which can be helpful in assessing programmatic change over time.
Second, measures were not included to assess change in self-report drinking and driving among students prior to and after the program. A series of self-report items were initially included as part of the program questionnaires submitted for review to the participating school district. Amid the clarification that was made regarding data collections procedures, the specific purpose of the study, relevance of measures to evaluation outcomes, and the confidentiality of participant's school district; officials still requested that self-report measures be removed. Grube, Keefe, andStewart (2002) observe that in studies involving schools, investigators must often make strenuous efforts to convince school authorities on the importance of participation. Such negotiations occur within the context of other school-related activities that can significantly diminish the participation of both administrators and educators. In addition, school administration and district officials may be concerned and or uneasy about dealing with study results affecting their students. It is important, therefore, to convey to school authorities the important programmatic assumptions that a study is attempting to identify and measure.
Third, is the development of a limited number of outcome measures reflective of the programmatic assumptions of Shattered Dreams. For example, participants were measured on legal knowledge regarding specific situations involving underage drinking and driving. Results however demonstrated that student knowledge did not increase from pre-to post. One programmatic assumption of Shattered Dreams was that the students would increase their knowledge of Texas underage drinking laws otherwise known as zero-tolerance. While specific zero-tolerance information was provided to only a small number of students (direct participants who attended the overnight retreat), less intensive efforts were made to provide observers (students not directly involved in the program but who observed the mock crash and assembly) with information regarding zero-tolerance. Therefore, the unequal dissemination of zero-tolerance information perhaps limited most students from fully learningand comprehending state underage drinking and driving laws.
Although results will serve to inform and guide the development of a zero-tolerance component in Shattered Dreams, future recommendations include clearly stating and defining the programmatic assumptions to be measured. For example in regards to zero-tolerance laws, it should clearly state the type of information that will be provided, the specific target audience and how it will be used. Clear and specific use of information should lead to the development of items that effectively measure zero-tolerance knowledge among participants.
Amid the limitations involved in the current design, results also demonstrate the need to utilize background measures that report on pathways of risk or protection towards alcohol use by adolescents. Additionally, both programmatic and evaluative activities should not only address comprehensive alcohol prevention strategies to address the social intricacies that increase or decrease adolescent's awareness regarding underage drinking and driving but develop and utilize the disparities in sex regarding alcohol use and experimentation. Further, information gleaned from this study augments a previous evaluation conducted by Hover, Hover and Young (2000) on a similar school-based underagedrinking and driving prevention program involving the community. In addition to recommendations offered in this previous study, we advise adoption of a more rigorous evaluation design, incorporation of standardized behavioral measures related to drinking and driving, and a more thorough understanding of the relationship between theoretical assumptions, programmatic objectives and outcome measures.
Future efforts will also focus on strengthening the development and evaluation of this program. This will include the adoption and application of behavioral theory in order to enhance our understanding of the processes that foster behavioral change as a result of students participating in this program. A concerted effort will also be made to include more schools and communities diverse in regards to both social and community characteristics (i.e., urban, rural, economically underserved) as well as obtain a more representative sample of students to more thoroughly examine the multiple risks associated with underage and drinking. Qualitative examinations with both students and key stakeholders on norms regarding underage drinking and driving will be essential to measuring the overall impact of Shattered Dreams on both a school and community. These approaches should also be complimented by repeated measures and extended follow-up of program participants. These activities will help to strengthen the validity and reliability of results and help determine both the short-and** long-term effects of this program.
This study was supported by a grant from University Health System, Bexar County, Texas under contract 2201063-LS. This paper is based on the first author's thesis which was presented at the 99th annual meeting of the American Sociological Association in San Francisco, California, August 2004.