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ED shares lessons learned for multiple trauma cases
Tracking patients was 'extremely difficult'
Every ED nurse at Montgomery Regional Hospital in Blacksburg, VA, recently attended the Trauma Nursing Core Course (TNCC) offered by the Emergency Nurses Association. The nurses never dreamed they soon would be relying on this training to care for 14 gunshot wound victims in a single day.
"Through repetition, TNCC teaches trauma assessment and treatment through utilization of the ABCs [airway, breathing, circulation]," says H. David Linkous, RN, BSN, disaster preparedness coordinator. "So, the class was very valuable in being able to rapidly assess the patients as they arrived."
The TNCC course was made mandatory for ED nurses after the hospital was designated as a Level 3 trauma center, says Linkous. "Every time multiple victims come in from a motor vehicle accident, the staff must triage and assess to determine the type and severity of injuries and then prioritize the patients," he says. "We see a good deal of trauma here, but the difference on that day was the number of trauma patients that we saw all at once."
Tracking patients was difficult at times, because they were coming in so rapidly, says Linkous. "They moved to different locations as they were assessed and triaged to the appropriate areas, and then sent for diagnostic testing or surgery," he says.
As each patient arrived at the ambulance doors, a quick triage was done. The patient then was moved to a trauma or orthopedics bay where a team of nurses and doctors did a head-to-toe assessment, ordered all the proper laboratory tests and X-rays, determined if the patient was stable or critical, and decided where the patient would go from there, he explains.
"The system we used worked, in that there were no mix-ups and everyone received the appropriate treatment. But at times, one had to stop and think where a particular patient was at that particular moment," says Linkous. "You should always learn and improve from a situation or incident, and we feel that we can improve on our tracking method. We have set a meeting of key individuals to work on this."
As patients were brought in, each was assigned a number to bypass the usual registration process. To learn the full extent of each patient's injury, immediate laboratory and X-ray results were needed, says Loressa Cole, RN, the hospital's chief nursing officer. "With a gunshot wound, you have a penetrating hole, but you don't really know what is going on inside the body," she says. Since the results were tracked by number, nurses had to be extremely careful to match the data to the correct patient, she says.
"We didn't get it wrong, but it was extremely difficult and perhaps there is an easier way to manage that," she says. "That was particularly challenging, and I think that will be something we will be working on in the future. We will be revising our trauma registration process as a result of this event."
ED nurses may practice labeling patients as they arrive during disaster drills, but often don't realize how difficult it will be to keep up with multiple victims when using a numbered system, Cole explains. Stable patients who didn't require immediate surgery were brought into an outpatient area, which made things even more difficult, she adds. "We wanted to clear the rooms as quickly as possible. But as we moved them from one area to another, it became even more difficult to track where they were," Cole says.
Currently, the ED's numbering system is done by medical record, but an easier method is needed with numbers that are not consecutive so they won't be so similar, says Cole. "We were successful using our current system, but have concluded that a simplified system will save valuable time, especially in receiving multiple victims simultaneously," she says.
For more information about tracking patients during disasters, contact:
For more information about the Trauma Nursing Core Course (TNCC), contact the Course Operations Department at the Emergency Nurses Association's (ENA's) National Office at (800) 900-9659, then press 2. For course schedules in your state, go to the ENA's web site (www.ena.org). Under "CATN II/ENPC/TNCC," click on "TNCC" and "U.S. courses." The cost of the course varies depending on location.