Pediatric Trauma

I recently returned from the 2017 Trauma Quality Improvement Process (TQIP) annual conference in Chicago, IL. If you did not attend, you missed an exciting event! From the keynote address by Lenworth M. Jacobs, MD, MPH, FACS on “Increasing Survival from Active Shooter and ALL Severe Hemorrhagic Events” to the trauma survivor talk by Noah Galloway, you could not have asked for a more engaging session. You may know Mr. Galloway as a contestant on Dancing with Stars season 20, but if you don’t, his story is truly inspirational as an Iraq War veteran who lost his left arm above the elbow and his left leg above the knee during his second deployment due to an IED (improvised explosive device). He has gone on to become an extreme sports enthusiast and motivational speaker as well as an author.

Now, turning to the topic of whether parents should be present during trauma care: recent literature suggests that there are benefits to pediatric patients when the parents are present through their child’s treatment in the trauma room. An early study done at Lehigh Valley Health Network in Allentown, PA (Wendling, 2010), noted that, “Trauma is an extremely unpredictable event and really heightens the stress response in families.” In their model, pastoral care providers use a script to screen families to determine if they can handle the situation or if they are intoxicated or impaired. Families are told that the patient is critically injured, given a brief description of what they may encounter in the trauma bay, and advised that they may have to step out if the situation warrants. The Trauma Team is then notified that the family wishes to be present, the family is escorted to the trauma bay and remains with the pastoral care provider.

There was the perception that parents get a better understanding of what the injuries are and what is being done when in contact with the trauma team providers. The concerns going into the study were twofold. The first involved legal liability to the hospital for having family in the trauma bay. After the study, the feeling was that family presence may actually deter litigation after parents observe the number of people involved in the care of their critically injured child and the team’s single-minded devotion to the child in their care.
The second concern had to do with distraction of the team treating the child in an already chaotic environment. However, in this study, the average times from trauma bay admission to CT were similar when families were and were not present, at 44 minutes and 45 minutes respectively.

In a second, more recent study, (Orlando Health Arnold Palmer Hospital for Children, 2017) it was found that parents actually help to guide the critical care decisions that need to be made by providing information on their child such as allergies, medical history and details on their injury or condition. Parents also help to keep their children calm, which oftentimes allows the trauma team to forgo sedation or administer less pain medication.

Traditionally, parents are asked to stay in a separate waiting area, which adds to their anxiety about their child’s status. In this study, parents were given the option to go into the trauma bay with their child and it was extremely rare for a parent to choose to wait outside. Approximately 95% of the parents in this study opted to go into the trauma bay, allowing them to receive real time information on the status of their child and the treatment options available to them.

This study found that parents have become an integral part of the trauma team and it is the researchers’ hope that more hospitals will adopt the practice of allowing parents to be in the trauma bay with their children.

Susan Schmunk, CAISS, CSTR

 

Orlando Health Arnold Palmer Hospital for Children. (2017, November 8). eurekalert.org. Retrieved from AAAS: https://www.eurekalert.org/pub_releases/2017-11/m-sps110117.php

Wendling, P. (2010, May). ACEP.org. Retrieved from Clinical&Practice Mangement: https://www.acep.org/Clinical—Practice-Management/Family-Presence-in-Trauma-May-Help/