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Trauma Nurses Talk Tough to Save Young Lives


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By Glenna Murdock, RN, contributor

As an emergency department nurse, Joanne Fairchild, RN, AA, had seen more than her share of teenagers with catastrophic injuries—some with fatal outcomes and almost all occurring as a result of risky behavior coupled with a vehicle of some sort.

Trauma Nurses Talk Tough
Dropping a melon in a helmet, such as the one held here by Joanne Fairchild, RN, dramatically demonstrates the degree of protection a helmet provides.

As much as these cases affected her, however, it wasn’t until Fairchild began working as a flight nurse and saw the carnage at the accident scenes first-hand that she became a crusader in a battle to end this senseless waste of young lives.

The seminal event was a particularly tragic car crash near a high school. The young driver, estimated to be traveling at 90 miles per hour, lost control and hit a telephone pole. The driver and his two front seat passengers died and two others in the car suffered head injuries. Enough was enough.

“Even with immediate transfer to a hospital and no matter how skilled the trauma team, accident victims still die,” Fairchild said. “The best way to decrease unnecessary deaths caused by risky behavior is to prevent them.”

Thus was born Trauma Nurses Talk Tough (TNTT), an education program that promotes the use of seatbelts, the wearing of helmets for cyclists and boarders, and safe, responsible behavior. The program was established in Portland, Oregon, in 1986 with the support of Fairchild’s employer, Legacy Health System, beginning with a single in-service class for school nurses. The program has grown steadily in the ensuing 22 years and now reaches an estimated 56,000 participants annually through safety fairs, community clinics, court ordered classes and school-related presentations.

“Hollywood treats risks as just one more toy in the toy box,” Fairchild said. “Kids get the message that breaking traffic laws results only in a traffic ticket and a fine and everyone walks away from a crash.”

The TNTT classes tell the participants a different story—the accurate one. The story is also geared to make an impact on audiences in different age groups.

Age appropriate information begins in a presentation called Safety Town for four to six year olds that takes place over a two week period. As part of the class, Fairchild and her crew of leaders conduct a melon drop demonstration that never fails to make an impression on the youngsters.

A honeydew melon is placed in a skateboard helmet and dropped with some force. After the damage is inspected, the melon is then dropped without the protection of the helmet, with dramatic results. Teenagers who now assist with these classes often tell Fairchild that the thing they remember most from their own Safety Town experience is the melon drop.

The TNTT program is designed so that, from that class onward, the older the participants, the tougher the talk. Media presentations of actual accidents and their aftermath are shown. Young people living with injuries as a result of a preventable accident speak to the classes, as do parents who describe the anguish of losing a child needlessly.

“Teenagers aren’t worried about their own deaths,” Fairchild explained, “until they are made aware and begin to imagine the emotional devastation their death would cause their family.”

Most class participants are receptive but some are resistant, at least initially, to the message that TNTT presents.

“Teenagers don’t like being told what to do and want to know what’s in it for them,” said Fairchild. “What’s in it for them is their life. We want them to know that the results of taking risks are real. We show them why they shouldn’t take risks and what can happen when they do. They learn what brain injuries are and what they can do to prevent them.”

“They don’t understand the physics of a car crash,” Fairchild continued, “so we show them the damage to a vehicle and its passengers that can occur in a low-speed, 20-miles-per-hour crash. We want them to ‘get it’ that the faster they go, the harder they hit.”

TNTT leads a class called Bike Wheels to Steering Wheels for teenagers who are approaching driving age. Knowing that changing the attitudes of teenagers is made more successful by parent participation, TNTT offers parent-teen classes, as well as stand-alone classes for parents only.

Teens, it turns out, aren’t the only ones who come away from the classes with safer habits.

“We tell parents that they don’t start teaching their children to drive when they’re 16—they’ve been teaching them all their lives, and adults often haven’t been modeling the safest behavior,” Fairchild emphasized.

Surveys of participants taken before and after completing a TNTT class show that the program works. More than half report that their risky behaviors have been replaced by safe and responsible actions, which undoubtedly contributes to the fact that teen drivers in Oregon rank among the safest in the nation.

In addition to establishing educational outreach programs, TNTT has influenced public policy in Oregon, including the passage of a mandatory helmet law for those up to age 16. TNTT distributes 9,000 bike helmets annually, selling them below cost or providing them at no charge to youngsters whose families cannot afford to pay. The organization also cooperates with the court system. Young traffic and alcohol offenders in the Portland area are required to attend TNTT classes, for which they pay a fee instead of a fine, which in turn helps support the helmet program.

Nurses are known for saving lives, but in the past two decades Joanne Fairchild and her TNTT team have undoubtedly saved far more than most—with the numbers likely in the thousands—and, they’ve done it on the front end by promoting prevention before a cure is needed.

Other states now want to implement Fairchild’s program, which received the American Hospital Association’s 2007 NOVA Award for transformational change in the community. Individual organizations can already make use of a number of training tools on TNTT’s web site.

As TNTT’s message reaches more young people across the country, Fairchild hopes that it can continue to make an impact on even the most stubborn of teenagers.

“Some who come to class don’t want to be there and are there only because the court ordered them to be there. They sit with arms crossed, staring at the floor,” Fairchild said. “To see them transform into interested participants—looking up, attentive and wiping away tears—is enormously rewarding.”

For more information about the TNTT program, go to the Trauma Nurses Talk Tough page.

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