Adapting to Trauma

[medicalmallady]

For all of the EM MDs, PAs, NPs, EMTs, and Paramedics, how do you get used to seeing trauma? I am currently in an EMT-B course and plan on becoming an Acute Care NP. However, I have yet to encounter trauma. I can look at pictures and videos of trauma and don't feel the least bit squeamish. I also realize there is a significant difference between seeing a picture or video, and being in the presence of trauma. Also, how are cases determined whether they visit an ER or Trauma center? I was always under the impression that patients are taken to an ER for non-severe trauma. While people with greater trauma (i.e. gsw, stabbings, auto accidents, missing body parts) are taken to a trauma center.

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[Rendar5]

For all of the EM MDs, PAs, NPs, EMTs, and Paramedics, how do you get used to seeing trauma? I am currently in an EMT-B course and plan on becoming an Acute Care NP. However, I have yet to encounter trauma. I can look at pictures and videos of trauma and don't feel the least bit squeamish. I also realize there is a significant difference between seeing a picture or video, and being in the presence of trauma. Also, how are cases determined whether they visit an ER or Trauma center? I was always under the impression that patients are taken to an ER for non-severe trauma. While people with greater trauma (i.e. gsw, stabbings, auto accidents, missing body parts) are taken to a trauma center.

Trauma centers are Emergency Departments. I think you're trying to think of primary, secondary, and tertiary trauma centers, in which case the severity of the injury dictates where they go. The super severe injuries go to the nearest emergency department regardless of their trauma center status if immediate stabilization is needed. But those are more rare. In general, your local EMS has protocols established under the department of health that dictate where patients go based on mechanism and severity of injury.

As for your first question, you get used to seeing trauma by being exposed to it. Pure and simple.

 

[deleted92121]

Trauma you see in movies, books, etc is usually well-defined and cleaned up nicely so you can identify numerous parts, intact or not. The trauma you see that you run into in the field or in the ED is not nearly as polished so to speak. It is messy and mangled, sometimes difficult to identify a lot of anything. It all depends on what kind of trauma it is. And contrary to popular belief, GSW are not normally that gruesome.

And for getting used to, it's called desensitization. Enough exposure and it becomes second nature.

Just some thoughts from your local medic.

 

[Arcan57]

As mentioned above, you get used to trauma by seeing trauma personally. It helps to have something to do. It's emotionally to just stand around and see someone screaming hysterically while they bleed all over the place. Addressing the ABCs while thinking about what you need to do to stabilizie the patient helps maintain some emotional distance which will expand as time goes on. You still will feel some of the effects after it's over, but it gets easier with time.

 

[medicalmallady]

I understand what you all are saying. I have done as much, "research" as I can to become desensitized to trauma. Seeing pictures medics may have taken in the field or videos pedestrians captured of a scene in the ER or accident site, don't disturb me. I think it's the fact I have yet to encounter it firsthand and don't want to freeze up and let the patient down when I see it for the first time. DXU, you were right. I always thought gsws would look far worse. Is that true for all manner of caliber, or the smaller handgun rounds?

 

[Rendar5]

I understand what you all are saying. I have done as much, "research" as I can to become desensitized to trauma. Seeing pictures medics may have taken in the field or videos pedestrians captured of a scene in the ER or accident site, don't disturb me. I think it's the fact I have yet to encounter it firsthand and don't want to freeze up and let the patient down when I see it for the first time. DXU, you were right. I always thought gsws would look far worse. Is that true for all manner of caliber, or the smaller handgun rounds?

if you forget what to do, just hit the gas and don't spend 25 minutes in the field trying to get the tube in. =p

 

[EctopicFetus]

As mentioned the blunt traumas are the messiest. the GSWs even through the face, through the brain etc just arent that horrid. The mangled extremities from industrial accidents and Peds Vs Auto are the gruesome ones. Over time its like a video game, you dont internalize it and fix what you can, stabilize what you can.

 

[pseudoknot]

I think it's the fact I have yet to encounter it firsthand and don't want to freeze up and let the patient down when I see it for the first time.

You won't be seeing it for the first time or even the tenth by the time you have any real responsibility for patients. It'll be fine.

 

[EMS5]

Ditto on pseudoknot...the more experienced providers are aware of who the new guys are, and they won't throw you in as lead provider on a trauma...your first couple months expect to be doing the "subject fallen" calls...find out who the best teaching providers are and ride with them, they will slowly get you in a comfort zone...

I did a bunch of traumas as an EMT where at a minimum I had another EMT with me (very rural, no ALS some nights)...fights, minor accidents, falls, the such...

I didn't actually come across my first nasty severe trauma until I was out of EMT-I school... 18 wheeler vs parked motorcycle...nasty...but by then I had seen enough that it was more of a go-with-the-flow than stop and stare at the breaks and gashes...I did my assessment, stuffed the bleeding holes, had another emt hold cspine and we were gone in 6 minutes...moving on to trauma centers...

This guy went to the closest hospital, which happened to be a very well equipped level 3 trauma center...emergency departments come in 5-6 types depending on the state

Level 1 trauma center...comes with all the bells and whistles, residents, full range of specialties...equipped to take whatever you bring to them, from trauma room to discharge

level 2 trauma center... a step down, isn't required to have residents but still has a pretty good range of medical and surgical specialties to handle the patient

level 3...a regional trauma center...equipped to handle most traumas, stabilize and transport, surgery on call, and fly-out if the pt is stable enough

level 4 in some places in a local package and transport type trauma center

Regular ED's - not trauma centers, but they can still take trauma pt's for stabilization and treatment if they are minor

There are also others...peds, burn, cardiac centers, stroke centers, etc

In the field, your state will typically have a protocol to help you evaluate when a pt needs to go to a trauma center or not...

If a trauma center is not your closest facility, then you will typically be doing a flyout, where (once you are approved for the helo) the flight physician/nurse/medic will determine the exact hospital to go to

Hope this helps out a little bit, it's a very generalized statement but some variation of it is present across the country