All posts by TheTraumaPro

The Patient Care Totem Pole

This piece applies to all trauma professionals. Actually, it applies to anyone who has the privilege of providing patient care. It has to do with this:

A totem pole is a sculpture that usually depicts a hierarchy of people or concepts. In patient care of any type, there are individuals who are closely involved in patient care (first responders, first year residents/registrars, nurses) and there are those who are a bit further removed (supervisors, nurse managers, attending physicians/consultants). The first group are those usually thought to be nearer the bottom of the totem pole, the latter closer to the top.

But the thing is, those nearer the bottom have valuable experience and insight into what is happening to their patient clinically. And they usually know what needs to be done if the patient is in trouble. Unfortunately, they may have to get authorization (orders) from others higher on the totem pole, or have those individuals actually see the patient, to deal with a problem.

Too often, I hear that a patient problem has developed and, as expected, their nurse calls the next level up the totem pole for instructions (intern/first year registrar). That person doesn’t give them the desired response, or refuses to come see the patient. The nurse frets and tries to do the best he or she can given the circumstances. They wait a bit. They call again. Still no joy. 

Many times, there is an undesirable patient outcome when this happens. There’s a lot of pressure to avoid calling the chief resident or attending physician. But this reluctance cannot be allowed to happen! Remember, the whole reason we are here is to make sure our patients have the best outcomes possible! This is far more important than not ruffling the feathers of the higher-ups.

Bottom line: If you have a patient who has a problem, you probably know what needs to be done to fix it. If you have to call someone to get orders to do it, they should either issue the order or provide a good explanation as to why they want to do something else. If they don’t, go up the next level of the totem pole immediately to get it. Don’t be shy about going quickly to the top. Remember, your patient and their well-being are counting on you! And by the way, the image at the bottom of a totem pole is thought to be the most important. It’s the largest (because the base of a tree is bigger) and it’s at eye level where everyone can see it.

FebruaryTraumaMedEd Newsletter

The February newsletter is here! Click the image below or the link at the bottom to download. This month’s topic is Prevention, providing information on:

  • EAST evidence-based review on distracted driving
  • New developments on distracted driving
  • Can texting bans be bad?
  • Distracted driving and police officers
  • Reporting unsafe drivers
  • Seat best use in trauma professionals

Subscribers had the newsletter emailed to them over the weekend. If you want to subscribe (and download back issues), click here.

Download the newsletter

A Million Ways To Die?

Some interesting facts on how likely you or your patients are to die from a given cause this year:

  • choking on a non-food object – 1 in 96,300
  • drowning in a bathtub – 1 in 724,900
  • firearm discharge – 1 in 4,101,000
  • contact with a powered lawnmower – 1 in 4,606,000
  • strenuous movement – 1 in 23,030,000
  • handheld power tool accident – 1 in 24,950,000
  • contact with hot food (?) – 1 in 74,850,000
  • escalator accident – 1 in 90,470,000
  • vending machine accident – 1 in 112,000,000
  • win the Powerball (sorry, this won’t kill you) – 1 in 175,223,510
  • shark attack – 1 in 251,800,000
  • noise exposure (?) – 1 in 281,400,000
  • fall from playground equipment – 1 in 299,400,000
  • scorpion sting – 1 in 299,400,000

Motorcyclists Just Aren’t What They Used To Be

Used to be, motorcyclists were young men riding modest machines. But I’m sure all of you have noticed the changing demographic. Nowadays, they tend to be middle aged (or older!) men, who are losing their hair, growing their waistline, and taking warfarin.

At the same time, I’ve noted more significant injuries from motorcycles, and deadlier outcomes. A recent study has now quantified this and confirmed my impression. Brown University researchers analyzed data in the National Electronic Injury Surveillance System, focusing on the injuries and outcomes of motorcycle crashes over an 8 year period.

Some of the more interesting tidbits:

  • Of course, most injured riders were male (86%)
  • Injuries occurred most frequently in younger age groups, and least frequently in older age groups
  • Odds of having injuries requiring hospitalization doubled in the middle age group (40-59), and tripled in the older age group (60+)
  • Similar trends were seen in injury severity as age increased
  • The number of injuries in middle aged riders increased 62% from year 1 to year 8
  • The number of injuries in older riders increased 247% during the study!
  • Injuries in the middle aged and older groups tended to be upper torso and head/neck

Bottom line: Subjective impressions of injury trends in older motorcycle riders are borne out by this study. Why? As we age, we have less reserve, more comorbidities, loss of elasticity and bone density, and a host of other lesser factors. Additionally, older riders can often afford more expensive (“better”?) bikes that may tax their ability to ride safely in unexpected conditions. Trauma professionals need to be aware of these trends and always treat these patients as if they have life-threatening injuries until you can prove otherwise.

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Reference: Injury patterns and severity among motorcyclists treated in US emergency departments, 2001–2008: a comparison of younger and older riders. Injury Prevention, ePub Feb 6, 2013.