International Emergency Nursing 23 (2015) 1–2
Contents lists available at ScienceDirect
International Emergency Nursing j o u r n a l h o m e p a g e : w w w. e l s e v i e r. c o m / l o c a t e / a a e n
EDITORIAL
Trauma care – A system fit for the 21st century?
Of the many public health challenges facing clinicians on a daily basis, trauma is one of the most significant. It is a major cause of death and disability and places huge requirements, both social and economic, on health system resources. Globally, in the past 20 years, the number of deaths from injury has risen by 24% (to 5.1 million deaths in 2010), and the rate of death by nearly 1% (Institute for Health Metrics and Evaluation, 2013). This increase is driven by a 46% rise in deaths worldwide due to road traffic injury and a rise in deaths from falls (Lozano et al., 2012). Road injuries now rank as the world’s eighth-leading cause of death and the number-one killer of young people ages 15–24 (Global Road Safety Facility, The World Bank, Institute for Health Metrics and Evaluation, 2014). For every death following injury, there are an estimated further 10 people that survive with major injuries requiring complex, multidisciplinary care, potentially with lifelong disability (Gosselin et al., 2009). In view of the magnitude of this problem, the role of nurses is pivotal. Nurses require not only an in-depth understanding of the mechanism of injury, physiological responses to trauma and structured approaches to injury management; they also need to understand the determinants of injury, trauma systems, their role within these systems and an understanding of how this role can optimise patient outcomes through the continuum of trauma care (Curtis et al., 2012). Holbery (2014) discusses the important aspect of nursing, the psychosocial care of the patient and family, in the initial resuscitation phase. Trauma care is generally delivered in the context of a trauma system, first introduced in the US in 1961 (Beachley et al., 1988), and now in varying stages of development around the globe. The aim of a trauma system is to facilitate treatment of the major trauma patient at a trauma centre where in hospital systems exist to provide specialised acute, diagnostic and/or definitive care, including postdischarge follow-up. Treatment of severe injuries at major trauma centres and trauma systems are associated with reduced morbidity and mortality around the world (Cameron et al., 2008; Celso et al., 2006; Twijnstra et al., 2010). In the UK a recent independent audit by the Trauma Audit and Research Network (TARN) demonstrated a 30% improvement in survival from major trauma since the introduction of regional trauma networks in 2012 (NHS England, 2014). As we develop trauma systems it is imperative that we learn from others. In this issue Gowing et al. (2014) outline the characteristics and outcomes of major trauma patients over the last years at the Royal Darwin Hospital. An innovative tool to facilitate pre hospital triage and improve the compliance of a trauma system in a region of England is outlined in Freshwater and Crouch (2014). Trauma patients are complex, they often have multiple injuries, co morbidities and as such, require specialist nursing care. The http://dx.doi.org/10.1016/j.ienj.2014.11.004 1755-599X/© 2014 Published by Elsevier Ltd.
roots of trauma nursing developed in wartime experiences, including those of Florence Nightingale in the Crimean War in 1854, military nurses in the Spanish–American War of 1898, in World Wars I and II and then in the Korean and Vietnam Wars (Beachley et al., 1988). These nurses established the first principles for nursing management of devastating traumatic injuries: triage, rapid evacuation, surgical intervention, stabilisation and early rehabilitation (Beachley et al., 1988). The importance of nursing leadership in trauma resuscitation is evidenced by Clements et al. (2014); demonstrating improved communication and importantly decreasing negative aspects of communication. The field of trauma encompasses a large variety of nursing specialties, such as injury prevention, emergency, perioperative, intensive care, high-dependency and ward surgical roles to rehabilitation. There are also roles such as the trauma nurse specialist or coordinator who manages the complex care required in the major trauma patient through the entire span of their care (Curtis et al., 2012). The trauma nurse specialist role was pioneered in the United States in 1961 (Beachley et al., 1988) and now encompasses many titles such as the trauma program manager, trauma nurse coordinator, trauma nurse practitioner and trauma case manager. Trauma nurse specialist roles span a varied scope of practice including data collection, treatment facilitation, coordination of trauma care, education, and patient assessment (Curtis et al., 2008; Gillard et al., 2011 Morris et al., 2012;). There is also evidence that trauma nurse specialists reduce complication rates and hospital length of stay (Curtis et al., 2002; Gillard et al., 2011). Their role in the UK context is discussed for the first time in the paper by Crouch et al. (2014). The development in major trauma management has been driven by new knowledge gained through research and importantly the adoption of that evidence in practice. Cole and Davenport (2014) outline the evidence behind the use of Tranexamic Acid in trauma haemorrhage and its beneficial effects. The management of different types of injuries has also been influenced by research; Singh and Hardcastle (2014) outline the current evidence to support selective non-operative management of gunshot wounds to the abdomen. The evidence developed over the last three decades has been derived from international multicentre trials. Bryceland et al. (2014) , outline the challenges with good clinical practice and research when patients who are recruited to trials move between centres. The significant advances in major trauma management are increasing chances of survival; however we should not rest in our pursuit to curb this modern epidemic. Whilst continuing the focus on management we must pursue, with equal tenacity, strategies to enhance injury prevention, as this is where the ultimate gain will be.
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Editorial/International Emergency Nursing 23 (2015) 1–2
References Beachley, M., Snow, S., Trimble, P., 1988. Developing trauma care systems: the trauma nurse coordinator. Journal of Nursing Administration. 18, 34–42. Bryceland, C., Ellis, S., Beaumont, D., Shakur, H., Coats, T.J., 2014. Inter-hospital transfer and good clinical practice in trauma care research: a contemporary issue. International Emergency Nursing. Cameron, P.A., Gabbe, B.J., Cooper, D.J., Walker, T., Judson, R., McNeil, J., 2008. A statewide system of trauma care in Victoria: effect on patient survival. The Medical Journal of Australia. 189, 546–550. Celso, B., Tepas, J., Langland-Orban, B., et al., 2006. A systematic review and meta-analysis comparing outcome of severely injured patients treated in trauma centers following the establishment of trauma systems. Journal of Trauma – Injury, Infection and Critical Care. 60, 371–378. Clements, A., Curtis, C., Horvat, L., Shaban, R., 2014. The effect of a nurse team leader on communication and leadership in major trauma resuscitations. International Emergency Nursing. Cole, E., Davenport, R., 2014. Early tranexamic acid use in trauma haemorrhage: why do we give it and which patients benefit most? International Emergency Nursing. Crouch, R., McHale, H., Palfrey, R., Curtis, K., 2014. The trauma nurse coordinator in England: a survey of demographics, roles and resources. International Emergency Nursing. Curtis, K., Donoghue, J., 2008. The trauma nurse coordinator in Australia and New Zealand: a progress survey of demographics, role function, and resources. Journal of trauma nursing: the official journal of the Society of Trauma Nurses. 15, 34– 42. Curtis, K., Lien, D., Chan, A., Grove, P., Morris, R., 2002. The impact of trauma case management on patient outcomes. Journal of Trauma. 53, 477–482. Curtis, K., Caldwell, E., Delprado, A., Munroe, B., 2012. Traumatic injury in Australia and New Zealand. Australasian Journal of Emergency Nursing. 15, 45–54. Freshwater, E., Crouch, R., 2014. Technology for trauma: testing the validity of a smartphone app for pre-hospital clinicians. International Emergency Nursing. Gillard, J.N., Szoke, A., Hoff, W.S., Wainwright, G.A., Stehly, C.D., Toedter, L.J., 2011. Utilization of PAs and NPs at a level I trauma center: effects on outcomes. JAAPA: Journal of the American Academy of Physician Assistants (Haymarket Media, Inc.). 24, 34–43.
Global Road Safety Facility, The World Bank, Institute for Health Metrics and Evaluation, 2014. Transport for Health: The Global Burden of Disease from Motorized Road Transport. University of Washington, Seattle, WA. Gosselin, R.A., Spiegel, D.A., Coughlin, R., Zirkle, L.G., 2009. Injuries: the neglected burden in developing countries. Bulletin of the World Health Organization. 87 (4), 246. Gowing, C.J., McDermott, K.M., Ward, L.M., Martin, B.L., 2014. Ten years of trauma in the ‘Top End’ of the Northern Territory, Australia: a retrospective analysis. International Emergency Nursing. Holbery, N., 2014. Emotional intelligence – essential for trauma nursing. International Emergency Nursing. Institute for Health Metrics and Evaluation, 2013. The Global Burden of Disease: Generating Evidence, Guiding Policy. Seattle, WA. Lozano, R., Naghavi, M., Foreman, K., et al., 2012. Global and regional mortality from 235 causes of death for 20 age groups in 1990 and 2010: a systematic analysis for the Global Burden of Disease Study 2010. The Lancet. 380, 2095–2128. Morris, D.S., Reilly, P., Rohrbach, J., Telford, G., Kim, P., Sims, C.A., 2012. The influence of unit-based nurse practitioners on hospital outcomes and readmission rates for patients with trauma. Journal of Trauma & Acute Care Surgery. 73, 474–478. NHS England, 2014. Press release 1st July. acccessed 08/11/2014. Singh, N., Hardcastle, T.C., 2014. Selective non operative management of gunshot wounds to the abdomen: a collective review. International Emergency Nursing. Twijnstra, M.J., Moons, K.G.M., Simmermacher, R.K.J., Leenen, L.P.H., 2010. Regional trauma system reduces mortality and changes admission rates: a before and after study. Annals of Surgery. 251, 339–343.
Kate Curtis, Robert Crouch * Guest Editors Major Trauma Special Issue, International Emergency Nursing * Robert Crouch, Emergency Department. University Hospital Southampton. Tremona Road, Southampton. SO16 6YD. E-mail addresses: [email protected] (R. Crouch); [email protected] (K. Curtis)
Contents lists available at ScienceDirect
International Emergency Nursing j o u r n a l h o m e p a g e : w w w. e l s e v i e r. c o m / l o c a t e / a a e n
EDITORIAL
Trauma care – A system fit for the 21st century?
Of the many public health challenges facing clinicians on a daily basis, trauma is one of the most significant. It is a major cause of death and disability and places huge requirements, both social and economic, on health system resources. Globally, in the past 20 years, the number of deaths from injury has risen by 24% (to 5.1 million deaths in 2010), and the rate of death by nearly 1% (Institute for Health Metrics and Evaluation, 2013). This increase is driven by a 46% rise in deaths worldwide due to road traffic injury and a rise in deaths from falls (Lozano et al., 2012). Road injuries now rank as the world’s eighth-leading cause of death and the number-one killer of young people ages 15–24 (Global Road Safety Facility, The World Bank, Institute for Health Metrics and Evaluation, 2014). For every death following injury, there are an estimated further 10 people that survive with major injuries requiring complex, multidisciplinary care, potentially with lifelong disability (Gosselin et al., 2009). In view of the magnitude of this problem, the role of nurses is pivotal. Nurses require not only an in-depth understanding of the mechanism of injury, physiological responses to trauma and structured approaches to injury management; they also need to understand the determinants of injury, trauma systems, their role within these systems and an understanding of how this role can optimise patient outcomes through the continuum of trauma care (Curtis et al., 2012). Holbery (2014) discusses the important aspect of nursing, the psychosocial care of the patient and family, in the initial resuscitation phase. Trauma care is generally delivered in the context of a trauma system, first introduced in the US in 1961 (Beachley et al., 1988), and now in varying stages of development around the globe. The aim of a trauma system is to facilitate treatment of the major trauma patient at a trauma centre where in hospital systems exist to provide specialised acute, diagnostic and/or definitive care, including postdischarge follow-up. Treatment of severe injuries at major trauma centres and trauma systems are associated with reduced morbidity and mortality around the world (Cameron et al., 2008; Celso et al., 2006; Twijnstra et al., 2010). In the UK a recent independent audit by the Trauma Audit and Research Network (TARN) demonstrated a 30% improvement in survival from major trauma since the introduction of regional trauma networks in 2012 (NHS England, 2014). As we develop trauma systems it is imperative that we learn from others. In this issue Gowing et al. (2014) outline the characteristics and outcomes of major trauma patients over the last years at the Royal Darwin Hospital. An innovative tool to facilitate pre hospital triage and improve the compliance of a trauma system in a region of England is outlined in Freshwater and Crouch (2014). Trauma patients are complex, they often have multiple injuries, co morbidities and as such, require specialist nursing care. The http://dx.doi.org/10.1016/j.ienj.2014.11.004 1755-599X/© 2014 Published by Elsevier Ltd.
roots of trauma nursing developed in wartime experiences, including those of Florence Nightingale in the Crimean War in 1854, military nurses in the Spanish–American War of 1898, in World Wars I and II and then in the Korean and Vietnam Wars (Beachley et al., 1988). These nurses established the first principles for nursing management of devastating traumatic injuries: triage, rapid evacuation, surgical intervention, stabilisation and early rehabilitation (Beachley et al., 1988). The importance of nursing leadership in trauma resuscitation is evidenced by Clements et al. (2014); demonstrating improved communication and importantly decreasing negative aspects of communication. The field of trauma encompasses a large variety of nursing specialties, such as injury prevention, emergency, perioperative, intensive care, high-dependency and ward surgical roles to rehabilitation. There are also roles such as the trauma nurse specialist or coordinator who manages the complex care required in the major trauma patient through the entire span of their care (Curtis et al., 2012). The trauma nurse specialist role was pioneered in the United States in 1961 (Beachley et al., 1988) and now encompasses many titles such as the trauma program manager, trauma nurse coordinator, trauma nurse practitioner and trauma case manager. Trauma nurse specialist roles span a varied scope of practice including data collection, treatment facilitation, coordination of trauma care, education, and patient assessment (Curtis et al., 2008; Gillard et al., 2011 Morris et al., 2012;). There is also evidence that trauma nurse specialists reduce complication rates and hospital length of stay (Curtis et al., 2002; Gillard et al., 2011). Their role in the UK context is discussed for the first time in the paper by Crouch et al. (2014). The development in major trauma management has been driven by new knowledge gained through research and importantly the adoption of that evidence in practice. Cole and Davenport (2014) outline the evidence behind the use of Tranexamic Acid in trauma haemorrhage and its beneficial effects. The management of different types of injuries has also been influenced by research; Singh and Hardcastle (2014) outline the current evidence to support selective non-operative management of gunshot wounds to the abdomen. The evidence developed over the last three decades has been derived from international multicentre trials. Bryceland et al. (2014) , outline the challenges with good clinical practice and research when patients who are recruited to trials move between centres. The significant advances in major trauma management are increasing chances of survival; however we should not rest in our pursuit to curb this modern epidemic. Whilst continuing the focus on management we must pursue, with equal tenacity, strategies to enhance injury prevention, as this is where the ultimate gain will be.
2
Editorial/International Emergency Nursing 23 (2015) 1–2
References Beachley, M., Snow, S., Trimble, P., 1988. Developing trauma care systems: the trauma nurse coordinator. Journal of Nursing Administration. 18, 34–42. Bryceland, C., Ellis, S., Beaumont, D., Shakur, H., Coats, T.J., 2014. Inter-hospital transfer and good clinical practice in trauma care research: a contemporary issue. International Emergency Nursing. Cameron, P.A., Gabbe, B.J., Cooper, D.J., Walker, T., Judson, R., McNeil, J., 2008. A statewide system of trauma care in Victoria: effect on patient survival. The Medical Journal of Australia. 189, 546–550. Celso, B., Tepas, J., Langland-Orban, B., et al., 2006. A systematic review and meta-analysis comparing outcome of severely injured patients treated in trauma centers following the establishment of trauma systems. Journal of Trauma – Injury, Infection and Critical Care. 60, 371–378. Clements, A., Curtis, C., Horvat, L., Shaban, R., 2014. The effect of a nurse team leader on communication and leadership in major trauma resuscitations. International Emergency Nursing. Cole, E., Davenport, R., 2014. Early tranexamic acid use in trauma haemorrhage: why do we give it and which patients benefit most? International Emergency Nursing. Crouch, R., McHale, H., Palfrey, R., Curtis, K., 2014. The trauma nurse coordinator in England: a survey of demographics, roles and resources. International Emergency Nursing. Curtis, K., Donoghue, J., 2008. The trauma nurse coordinator in Australia and New Zealand: a progress survey of demographics, role function, and resources. Journal of trauma nursing: the official journal of the Society of Trauma Nurses. 15, 34– 42. Curtis, K., Lien, D., Chan, A., Grove, P., Morris, R., 2002. The impact of trauma case management on patient outcomes. Journal of Trauma. 53, 477–482. Curtis, K., Caldwell, E., Delprado, A., Munroe, B., 2012. Traumatic injury in Australia and New Zealand. Australasian Journal of Emergency Nursing. 15, 45–54. Freshwater, E., Crouch, R., 2014. Technology for trauma: testing the validity of a smartphone app for pre-hospital clinicians. International Emergency Nursing. Gillard, J.N., Szoke, A., Hoff, W.S., Wainwright, G.A., Stehly, C.D., Toedter, L.J., 2011. Utilization of PAs and NPs at a level I trauma center: effects on outcomes. JAAPA: Journal of the American Academy of Physician Assistants (Haymarket Media, Inc.). 24, 34–43.
Global Road Safety Facility, The World Bank, Institute for Health Metrics and Evaluation, 2014. Transport for Health: The Global Burden of Disease from Motorized Road Transport. University of Washington, Seattle, WA. Gosselin, R.A., Spiegel, D.A., Coughlin, R., Zirkle, L.G., 2009. Injuries: the neglected burden in developing countries. Bulletin of the World Health Organization. 87 (4), 246. Gowing, C.J., McDermott, K.M., Ward, L.M., Martin, B.L., 2014. Ten years of trauma in the ‘Top End’ of the Northern Territory, Australia: a retrospective analysis. International Emergency Nursing. Holbery, N., 2014. Emotional intelligence – essential for trauma nursing. International Emergency Nursing. Institute for Health Metrics and Evaluation, 2013. The Global Burden of Disease: Generating Evidence, Guiding Policy. Seattle, WA. Lozano, R., Naghavi, M., Foreman, K., et al., 2012. Global and regional mortality from 235 causes of death for 20 age groups in 1990 and 2010: a systematic analysis for the Global Burden of Disease Study 2010. The Lancet. 380, 2095–2128. Morris, D.S., Reilly, P., Rohrbach, J., Telford, G., Kim, P., Sims, C.A., 2012. The influence of unit-based nurse practitioners on hospital outcomes and readmission rates for patients with trauma. Journal of Trauma & Acute Care Surgery. 73, 474–478. NHS England, 2014. Press release 1st July. acccessed 08/11/2014. Singh, N., Hardcastle, T.C., 2014. Selective non operative management of gunshot wounds to the abdomen: a collective review. International Emergency Nursing. Twijnstra, M.J., Moons, K.G.M., Simmermacher, R.K.J., Leenen, L.P.H., 2010. Regional trauma system reduces mortality and changes admission rates: a before and after study. Annals of Surgery. 251, 339–343.
Kate Curtis, Robert Crouch * Guest Editors Major Trauma Special Issue, International Emergency Nursing * Robert Crouch, Emergency Department. University Hospital Southampton. Tremona Road, Southampton. SO16 6YD. E-mail addresses: [email protected] (R. Crouch); [email protected] (K. Curtis)
