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Trauma care—a team sport in the 21st century
Injury, Int. J. Care Injured (2007) 38, 5—6
www.elsevier.com/locate/injury
EDITORIAL
Trauma care–—a team sport in the 21st century The phrase ‘‘trauma is a surgical disease’’ was once held as an indisputable truth which allowed surgeons the right to declare that trauma was their province. Any process which affected the delivery of trauma care needed, by definition, to have surgical input and surgical sanction. This has evolved over recent decades,3 and while trauma care benefits from surgical input in general, many injuries can now be adequately treated by medical practitioners from other disciplines, predominantly emergency medicine and intensive care. In order to cope with the non-specific nature of trauma there is a requirement for ‘Generalism’ which has been discussed in a previous issue of Injury,6 and it is clear that trauma care benefits from integrated trauma systems.2,13 Although technical surgical intervention is essential for treatment of a wide range of injuries, the increasing sub-specialisation of surgery, has meant that it is virtually impossible for the surgeon to be a ‘‘one stop shop’’ for the management of trauma patients. That the trauma patient needs to be cared for by a team of specialists from a range of disciplines has become accepted in the 21st century. Some patients clearly require multidisciplinary teams, such as the pregnant,16 very young,14 or patients with single injuries affecting regions with multiple systems such as head and neck injuries.10 What is still apparent however is that the true multidisciplinary nature of trauma care has yet to be fully embraced. Growing specialisation and traditional role delineation has resulted in the development of a range of nursing, paramedical and allied health professionals who are essential to the delivery of quality trauma care. This may seem obvious in patients with complex, multiple trauma,5 but even ‘simple’ injuries such as a femoral neck fracture occur in patients with multiple problems, medical and social. Early discharge of patients with proximal femoral fractures, with the appropriate social services in place, could reduce morbidity rates.17
Segregation between professions, not just between medical specialties, can be counterproductive. In the medical arena, it is still common for journals, conferences and societies to consist largely of medical professionals from the same group and within surgery for example, very small subsections of expertise have their own societies, meetings and journals. Trauma as an area of practice has gone some way down the track of identifying educational methods11 and recognising that effective education requires appropriate cross fertilisation of ideas. Many trauma societies have conferences and journals comprising specialists from more than one surgical discipline with general surgeons, orthopaedic surgeons and neurosurgeons commonly meeting and publishing together. Communication is suboptimal in real life in a trauma room4 and in an effort to improve interdisciplinary communication, some trauma societies have gone further with multiple medical disciplines meeting and publishing conjointly. Injury has long recognised this perspective and its aim, as described on its cover page is ‘‘to facilitate the exchange of ideas, techniques and information between all members of the trauma team’’. In the 21st century there is a vital role for paramedics,15 nurses, physiotherapists, occupational therapists and dieticians. In recent years Injury has published a number of papers with primary authorship from nursing,7,8 paramedical9 or dietitian12 led teams and this edition also includes a paper with primary research nursing authorship.1 Injury’s commitment to the wider concept of trauma care is also evident in its new affiliation with the Australasian Trauma Society. This society, established in 1997, allows unrestricted full membership to medical, nursing and allied health professionals and its current president is a nurse. That trauma care is a team sport in incontestable and while individual areas of expertise need to be pursued, the collective knowledge base and
0020–1383/$ — see front matter # 2006 Elsevier Ltd. All rights reserved. doi:10.1016/j.injury.2006.11.013
6 the ability to work constructively together needs to be preserved. Valid contributions to the literature can be made from both the highly focused and the broadly general perspective, and both are essential. With increasing specialisation comes an increasing importance of recognising the general perspective; in its current form Injury embraces both.
References 1. Aitken LM, Davey TM, Ambrose J, et al. Health outcomes of adults 3 months after injury. Injury 2007;38. 2. Atkin C, Freedman I, Rosenfeld JV, et al. The evolution of an integrated State Trauma System in Victoria, Australia. Injury 2005;36:1277—87. 3. Bose D, Tejwani NC. Evolving trends in the care of polytrauma patients. Injury 2006;37:20—8. 4. Bergs EAG, Rutten FLPA, Tadros T, et al. Communication during trauma resuscitation: do we know what is happening? Injury 2005;36:905—11. 5. Brooks AJ, Sperry D, Riley B, et al. Improving performance in the management of severely injured patients in critical care. Injury 2005;36:310—6. 6. Civil IDS. What is the place of ‘‘GENERALISM’’ in trauma care? Injury 2006;37:581—2. 7. Curtis K, Zou Y, Morris R, Black D. Trauma case management: improving patient outcomes. Injury 2006;37:626—32. 8. Lloyd JM, Elsayed S, Majeed A, et al. The practice of outlying patients is dangerous: a multicentre comparison study of nursing care provided to trauma patients. Injury 2005; 36:710—3.
Editorial 9. Mulholland SA, Gabbe BJ, Cameron P. Is paramedic judgement useful in prehospital trauma triage? Injury 2005; 36:1293—7. 10. Perry M, Dancey A, Mireskandari K, et al. Emergency care in facial trauma–—a maxillofacial and ophthalmic perspective. Injury 2005;36:875—96. 11. Petrisor BA, Bhandari M. Principles of teaching evidencebased medicine. Injury 2006;37:335—9. 12. Rowan CJ, Gillanders LK, Paice RL, Judson JA. Is early enteral feeding safe in patients who have suffered a spinal cord injury? Injury 2004;35:238—42. 13. Sharma BR. Development of pre-hospital trauma-care system–—an overview. Injury 2005;36:579—87. 14. Smith R, Davis N, Bouamra O, Lecky F. The utilisation of intraosseous infusion in the resuscitation of paediatric major trauma patients. Injury 2005;36:1034—8. 15. Soriede E, Deakin CD. Pre-hospital fluid therapy in the critically injured patient–—a clinical update. Injury 2005;36:1001—10. 16. Tsuei BJ. Assessment of the pregnant trauma patient. Injury 2006;37:367—73. 17. Umarji SIM, Lankester BJA, Prothero D, Bannister GC. Recovery after hip fracture. Injury 2006;37:712—7.
I.D.S. Civil* Trauma Services, Auckland City Hospital, 7th Floor, Support Building, Private Bag 92024, Auckland, New Zealand *Tel.: +64 9 379 7440x22796; fax: +64 9 307 8931 E-mail address: [email protected]
www.elsevier.com/locate/injury
EDITORIAL
Trauma care–—a team sport in the 21st century The phrase ‘‘trauma is a surgical disease’’ was once held as an indisputable truth which allowed surgeons the right to declare that trauma was their province. Any process which affected the delivery of trauma care needed, by definition, to have surgical input and surgical sanction. This has evolved over recent decades,3 and while trauma care benefits from surgical input in general, many injuries can now be adequately treated by medical practitioners from other disciplines, predominantly emergency medicine and intensive care. In order to cope with the non-specific nature of trauma there is a requirement for ‘Generalism’ which has been discussed in a previous issue of Injury,6 and it is clear that trauma care benefits from integrated trauma systems.2,13 Although technical surgical intervention is essential for treatment of a wide range of injuries, the increasing sub-specialisation of surgery, has meant that it is virtually impossible for the surgeon to be a ‘‘one stop shop’’ for the management of trauma patients. That the trauma patient needs to be cared for by a team of specialists from a range of disciplines has become accepted in the 21st century. Some patients clearly require multidisciplinary teams, such as the pregnant,16 very young,14 or patients with single injuries affecting regions with multiple systems such as head and neck injuries.10 What is still apparent however is that the true multidisciplinary nature of trauma care has yet to be fully embraced. Growing specialisation and traditional role delineation has resulted in the development of a range of nursing, paramedical and allied health professionals who are essential to the delivery of quality trauma care. This may seem obvious in patients with complex, multiple trauma,5 but even ‘simple’ injuries such as a femoral neck fracture occur in patients with multiple problems, medical and social. Early discharge of patients with proximal femoral fractures, with the appropriate social services in place, could reduce morbidity rates.17
Segregation between professions, not just between medical specialties, can be counterproductive. In the medical arena, it is still common for journals, conferences and societies to consist largely of medical professionals from the same group and within surgery for example, very small subsections of expertise have their own societies, meetings and journals. Trauma as an area of practice has gone some way down the track of identifying educational methods11 and recognising that effective education requires appropriate cross fertilisation of ideas. Many trauma societies have conferences and journals comprising specialists from more than one surgical discipline with general surgeons, orthopaedic surgeons and neurosurgeons commonly meeting and publishing together. Communication is suboptimal in real life in a trauma room4 and in an effort to improve interdisciplinary communication, some trauma societies have gone further with multiple medical disciplines meeting and publishing conjointly. Injury has long recognised this perspective and its aim, as described on its cover page is ‘‘to facilitate the exchange of ideas, techniques and information between all members of the trauma team’’. In the 21st century there is a vital role for paramedics,15 nurses, physiotherapists, occupational therapists and dieticians. In recent years Injury has published a number of papers with primary authorship from nursing,7,8 paramedical9 or dietitian12 led teams and this edition also includes a paper with primary research nursing authorship.1 Injury’s commitment to the wider concept of trauma care is also evident in its new affiliation with the Australasian Trauma Society. This society, established in 1997, allows unrestricted full membership to medical, nursing and allied health professionals and its current president is a nurse. That trauma care is a team sport in incontestable and while individual areas of expertise need to be pursued, the collective knowledge base and
0020–1383/$ — see front matter # 2006 Elsevier Ltd. All rights reserved. doi:10.1016/j.injury.2006.11.013
6 the ability to work constructively together needs to be preserved. Valid contributions to the literature can be made from both the highly focused and the broadly general perspective, and both are essential. With increasing specialisation comes an increasing importance of recognising the general perspective; in its current form Injury embraces both.
References 1. Aitken LM, Davey TM, Ambrose J, et al. Health outcomes of adults 3 months after injury. Injury 2007;38. 2. Atkin C, Freedman I, Rosenfeld JV, et al. The evolution of an integrated State Trauma System in Victoria, Australia. Injury 2005;36:1277—87. 3. Bose D, Tejwani NC. Evolving trends in the care of polytrauma patients. Injury 2006;37:20—8. 4. Bergs EAG, Rutten FLPA, Tadros T, et al. Communication during trauma resuscitation: do we know what is happening? Injury 2005;36:905—11. 5. Brooks AJ, Sperry D, Riley B, et al. Improving performance in the management of severely injured patients in critical care. Injury 2005;36:310—6. 6. Civil IDS. What is the place of ‘‘GENERALISM’’ in trauma care? Injury 2006;37:581—2. 7. Curtis K, Zou Y, Morris R, Black D. Trauma case management: improving patient outcomes. Injury 2006;37:626—32. 8. Lloyd JM, Elsayed S, Majeed A, et al. The practice of outlying patients is dangerous: a multicentre comparison study of nursing care provided to trauma patients. Injury 2005; 36:710—3.
Editorial 9. Mulholland SA, Gabbe BJ, Cameron P. Is paramedic judgement useful in prehospital trauma triage? Injury 2005; 36:1293—7. 10. Perry M, Dancey A, Mireskandari K, et al. Emergency care in facial trauma–—a maxillofacial and ophthalmic perspective. Injury 2005;36:875—96. 11. Petrisor BA, Bhandari M. Principles of teaching evidencebased medicine. Injury 2006;37:335—9. 12. Rowan CJ, Gillanders LK, Paice RL, Judson JA. Is early enteral feeding safe in patients who have suffered a spinal cord injury? Injury 2004;35:238—42. 13. Sharma BR. Development of pre-hospital trauma-care system–—an overview. Injury 2005;36:579—87. 14. Smith R, Davis N, Bouamra O, Lecky F. The utilisation of intraosseous infusion in the resuscitation of paediatric major trauma patients. Injury 2005;36:1034—8. 15. Soriede E, Deakin CD. Pre-hospital fluid therapy in the critically injured patient–—a clinical update. Injury 2005;36:1001—10. 16. Tsuei BJ. Assessment of the pregnant trauma patient. Injury 2006;37:367—73. 17. Umarji SIM, Lankester BJA, Prothero D, Bannister GC. Recovery after hip fracture. Injury 2006;37:712—7.
I.D.S. Civil* Trauma Services, Auckland City Hospital, 7th Floor, Support Building, Private Bag 92024, Auckland, New Zealand *Tel.: +64 9 379 7440x22796; fax: +64 9 307 8931 E-mail address: [email protected]