Spotlight on Trauma Nursing: The Evolution of the Trauma System and the 25th Anniversary of the Crozer Regional Trauma Center
As mentioned above, Nurses Week ends on the birthday of Florence Nightingale, the founder of modern nursing. But what type of nurse was Nightingale? Because many of her nursing experiences included taking care of wounded soldiers (including the Crimean War in the 1850s), she can be considered the founder of modern trauma nursing as well.
Additionally, many of the early nursing leaders were trauma nurses. Stories of Clara Barton, Louisa May Alcott, Dorothea Dix and others leading the care of patients during the United States Civil War are legendary. According to a recent cover story in Nursing Spectrum, “The work of Civil War nurses proved that contrary to Victorian notions at the time, women could provide excellent care for men they weren’t related to without damaging delicate sensibilities or reputations.”
These early leaders in nursing provided trauma care in makeshift hospitals that ranged from tents to homes converted into hospitals. It was Dominique Jean Larrey in 1797 who, recognizing the need for in-field trauma care and faster transport to definitive care, developed the “ambulance volante,” the precursor to our prehospital care system. This system brought the wounded away from the battlefield to these makeshift field hospitals, where the early trauma nurses could provide assistance to the physicians treating the patient and the continued care of the injured.
“The beginnings of the first systematic approach to trauma care are difficult to pinpoint, but probably had their origins during wartime,” according to the American College of Surgeons manual for Trauma Systems Development. The first specialized trauma units began to appear in the United States between 1966 and 1972, according to the ACS manual.
“Trauma nursing became formalized as trauma systems began to develop in the United States,” says Debra Lillback, RN, director of Crozer-Chester Medical Center’s Trauma Program. “During this same period of time, physicians, nurses and medics were returning to the states from the military M.A.S.H. units of the Vietnam War and began to be employed in hospital emergency departments. This military approach to the care of the injured proved beneficial to the civilian community. Soon after, the need to formalize the discipline and provide additional education to nurses providing trauma care was recognized.”
This year is an especially good one to focus on trauma nursing because the Crozer Regional Trauma Center is celebrating its 25th year of providing the regional community with state-of-the-art trauma care.
Crozer’s Trauma Center has been a leader in trauma care since opening its doors in December of 1986 as one of the first to be accredited by the Pennsylvania Trauma Systems Foundation (PTSF). A quarter of a century later, our Trauma Center remains a regional and state leader in trauma care. It is one of 31 PTSF-accredited trauma centers statewide and remains the only trauma center in Delaware County.
Crozer’s trauma team is dedicated to helping patients and their families with the unique needs and challenges of the sudden and sometimes catastrophic effects of traumatic injuries, which include motor vehicle crashes, falls, gunshot wounds and stabbing wounds. Over the past 25 years, the professionals of the Trauma Center have cared for over 35,700 patients. During that time, patient volume has increased from about 600 annually to more than 2,500, including more than 450 burn patients treated annually in collaboration with the Nathan Speare Regional Burn Treatment Center.
Nursing plays a key role in the operation of the Trauma Center. Lillback says, “Trauma nursing is now inclusive of all nursing staff who care for trauma patients along the continuum of care, from prehospital RNs doing helicopter transports who initiate the hand off of the trauma patients’ care to the Emergency Department nursing staff, who may hand off care to the Radiology/Interventional Radiology nursing staff, who may hand off to the Operating Room and Post Anesthesia Care Unit nursing staff, who may hand off to the Shock Trauma Unit/Burn Unit nursing staff, who may hand off to the Step Down, who may ultimately hand off care to the 1 West/med.-surg. units, Physical Medicine and Rehabilitation and more. The patients are then prepared for discharge to their home or a rehabilitation center to continue their recovery from their traumatic injury. The outcome of trauma care is dependent on the timeliness and efficiency of these handoffs.”
These trauma nurses work as team members along with EMS professionals; Emergency Department physicians; neurosurgeons, orthopedic surgeons, anesthesiologists and other surgical specialists; and professionals in Crozer’s Physical Medicine and Rehabilitation, Radiology, Laboratory, Respiratory Therapy, Social Work and Patient Registration departments with the discharge of patients facilitated by the trauma case manager and social worker and supported by rehabilitation specialists. This multidisciplinary team approach to trauma care provides patients and their families with the needed care and support to recover from their injury. It is the mutual respect and support of each other which provides the strength for this multidisciplinary team to meet the emotional and physical challenges of providing trauma care “without damaging delicate sensibilities or reputations.”
Every morning, Crozer’s multidisciplinary team of surgeons, primary nurses, nurse practitioners, trauma case managers and trauma pharmacists visit every patient at the bedside. The team assesses the patient’s condition and progress, and updates his or her daily care plan. In addition, physicians and trauma nurse practitioners respond to the bedside immediately at the request of the nurse throughout the day. The multidisciplinary team meets once a week with an expanded team of healthcare professionals, including the trauma program manager, trauma unit nurse manager, physical and occupational therapists, nutritionist and dedicated social worker, to discuss each patient’s condition and progress, care plan and discharge plan.
Prevention of traumatic injuries by safety education in the community is a vital part of the Trauma Center’s mission. The Center also benefits from having the expertise of a nurse, Kathy Lehman, RN, director of ER3 Outreach, who leads community outreach efforts.
Lehman brings injury prevention programs and education about Crozer’s ER3 capabilities to the community in every imaginable setting, including schools, churches, health fairs and town meetings. She researches the latest data to ensure that her outreach efforts are in line with national goals while focusing where the greatest numbers of injuries occur in the local community, such as motor vehicle accidents, falls, and gunshot injuries. Prevention initiatives focus on child and bike safety, fall prevention, gun safety, and community violence. She has developed strong relationships with local law enforcement agents and state healthcare agencies, and partners with other members of the CKHS Community Health Education Network.
In addition, it’s worth noting that Crozer-Keystone’s vice president chief nursing officer, Nancy Bucher, RN, MSN, NEA-BC, has a master’s degree in burn, emergency and trauma nursing from Widener University.