Don't believe these myths about pediatric traumas

You might see only a handful of pediatric trauma cases every year, but chances are you will see at least one. This is a dangerous "low-volume, but high-risk" patient for most emergency nurses. Here are some common misconceptions about these patients:

  • Traumas only come by ambulance.

"A trauma patient can walk through the front door," says Carrie L. Baumann, RN, BSN, patient care supervisor in the Emergency Department Trauma Center (EDTC) at Children's Hospital of Wisconsin in Milwaukee. "Whether a child is carried in by mom, or a teenager walks in after a motor vehicle crash, we activate the trauma team if it meets the criteria." [The ED's criteria for the trauma team response is included.]

  • There is only one type of trauma. Most trauma patients are awake and talking or crying, as opposed to "blood-and-guts" cases, says Baumann.
  • New nurses will get "thrown into" a trauma situation.

At Children's, each ED nurse gets extensive training to be a trauma competent nurse. "We also have them shadow in each role the EDTC nurse performs," says Baumann.

  • Trauma cases are out of control.

"They can be scary for the first couple of times because the fear of making a mistake is increased," says Baumann. "But in fact, traumas are one of the most controlled environments in the ED."

She notes that if the trauma team is activated, a minimum of 12 people are involved: three physicians, five nurses, pharmacy, lab, social worker, security, and radiology. "It is controlled chaos, with a systematic assessment with monitors for vital signs," Baumann says. "One person gives orders and is in control of the team."

It is a little different if the patient walks through the door or an ambulance is upgraded upon arrival, because the team has not been activated yet. "But it quickly becomes more controlled as the team comes together," says Baumann.

  • Trauma patents are always in the hospital for extended periods of time.

"Some traumas are discharged the same day," says Baumann. "This is where outpatient follow-up and social services come into play. They follow the child well after they have been discharged."

  • Children don't require blankets on them because they aren't modest about having their clothing removed.

It's incorrect that children do not require blankets to cover them after completion of the initial clinical exam. "Removal of clothing is a standard for trauma care in both children and adults," says Gordon Lee Gillespie, RN, an ED nurse at Cincinnati Children's Hospital Medical Center. "Children just as adults are at risk for hypothermia due to a traumatic injury and trauma care. Blankets should be applied as soon as soon as clothing is cut off or removed."

Sources

For more information on pediatric trauma care in the ED, contact:

  • Carrie L. Baumann, RN, BSN, Patient Care Supervisor, Emergency Department Trauma Center, Children's Hospital of Wisconsin. Phone: (414) 266-4768. E-mail: CBaumann@chw.org.
  • Gordon Lee Gillespie, RN, PhD, Clinical Nurse, Emergency Department, Cincinnati Children's Hospital Medical Center. E-mail: Gordon.Gillespie@cchmc.org.