Trauma, the unintentional or intentional wound or injury inflicted on the body from a mechanism against which the body cannot protect itself, is the fourth leading cause of death in the United States. Trauma is the leading cause of death in children and in adults younger than 44 years of age (McQuillan, VonReuden, Hartsock, Flynn, & Whalen, 2002). The incidence is increasing in adults older than 44 years of age. Alcohol and drug abuse are often implicated as factors in both blunt and penetrating trauma.
In assessing and managing any patient with an emergency condi-tion, but especially the patient experiencing trauma, documenta-tion of all that occurs is essential. Included in documentation are descriptions of all wounds, mechanism of injury, time of events, and collection of evidence. In trauma care, the nurse must be ex-ceedingly careful with all potential evidence, handling and docu-menting it properly.
The basics of care management for patients with traumatic injury include an understanding that trauma in any patient (living or dead) has potential legal, or forensic, implications. Hence, proper management from both a medical and forensic perspective is essential.
When clothing is removed from the patient who has experi-enced trauma, the nurse must be careful not to cut through or dis-rupt any tears, holes, blood stains, or dirt present on the clothing. Each piece of clothing should be placed in an individual paper bag. If the clothing is wet, it should be hung to dry. Clothing should not be given to families. Valuables should be placed in the hospital safe or clearly documented as to which family member they were given. If a police officer is present to collect clothing or any other items from the patient, each item is labeled. The trans-fer of custody to the officer, the officer’s name, the date, and the time are documented.
If suicide or homicide is suspected in a deceased trauma patient, the medical examiner will examine the body on site or have the body moved to the coroner’s office for autopsy. All tubes and lines must remain in place. The patient’s hands must be covered with paper bags to protect evidence on the hands or under the finger-nails. In the surviving patient, tissue specimens may be swabbed from the hands and nails as potential evidence. Photographs of wounds or clothing are essential and should include a reference ruler in one photo and one without the ruler.
Documentation should also include any statements made by the patient in the patient’s own words and surrounded by quota-tion marks. A chain of evidence is essential. If the patient’s case is adjudicated in the future, clear documentation will assist the ju-dicial process and help to identify the activities that occurred in the ED.
Any discussion of trauma management must include a discussion of injury prevention. A component of the emergency nurse’s daily role is to provide injury prevention information to every patient with whom there is contact, including patients admitted for rea-sons other than injury. The only way to reduce the incidence of trauma is to prevent the injuries in the first place. Everyone can benefit from injury prevention information. Using the informa-tion after leaving the ED or other health care site is the patient’s responsibility. However, the information must be provided.
The key to decreasing the incidence of trauma and saving the lives of productive members of society and children is injury pre-vention. The emergency nurse should make injury prevention part of daily nursing practice.
There are three components of injury prevention. The first is education. Providing information and materials to help prevent violence and to maintain safety at home and in vehicles is im-portant. Involvement in local injury prevention organizations, nursing organizations, and health fairs promotes wellness and safety. In practice, nursing and other health care professionals should avoid using the word “accident,” because trauma events are preventable and should be viewed as such rather than as “fate” or “happenstance.” Responsibility and accountability must be as-signed to traumatic incidents, particularly because of the high rate of trauma recidivism. Those who are at risk for trauma and re-peated trauma should be identified and provided with education and counseling directed toward altering risky behaviors and pre-venting further trauma.
The second component of injury prevention is legislation. Nurses should be actively involved in safety legislation at the local, state, and federal levels. Such legislation is meant to provide universal safety measures, not to infringe on rights.
The third component is automatic protection. Airbags and automatic safety belts are in this category. These mechanisms provide for safety without requiring personal intervention.