The role of the trauma nurse in injury prevention

Return to Nursing Progress contents list
Back to Issue 15 contents list

Many areas of Barts and The London NHS Trust are involved in the care and treatment of trauma patients; A&E, theatres and anaesthetics, ITU, pathologies, trauma and orthopaedic wards, neurosurgery, HDU, paediatrics, and general surgery, to name but a few. There is an understandable focus on the physical and psychological care of the patient once they have arrived in the Trust.

Back to Top

Injury is the leading cause of death under the age of 44. (1) Indeed it is suggested that after cardio-vascular system disease and cancer, traumatic injury is the largest cause of death across all ages. (2) In addition, many people are left permanently disabled following injury, requiring extensive treatment and rehabilitation. At Barts and The London NHS Trust, approximately 1,000 trauma patients are admitted through A&F each year. Whilst the costs of the devastating effects of trauma on society are incalculable, 7% of the National Health Service funding is consumed by injury alone. (3)

Yet despite these figures, there is often a fatalistic attitude towards the causes of injuries accidents just happen. However, they don't. Moreover, the word 'accident' is a misnomer, traditionally being used to imply that it is something beyond the control of the victim. (4) Nevertheless, a common perception prevails that accidents are random, unpredictable events with very little that can be done to prevent them.

"Accidents are not totally random events striking innocent victims like bolts out of the blue... Accidents have a natural history in which predisposing factors converge to produce an accidental event." (5)

We know from experience that injuries occur in specific predictable, often preventable patterns. A person's environment or behaviour can put him at risk, so, if unsafe behaviours are modified and precautions taken, injury can then be avoided. (6)

Considering that a large number of trauma deaths and disability are preventable, it is interesting to note that within the field of trauma care, a much lower significance is placed on prevention in comparison to resuscitation. Nevertheless, some authors have acknowledged that the best treatment for a large percentage of trauma-related deaths and injuries is to prevent them happening in the first place. (7, 8, 9, 10)

A study undertaken in Scotland compared the trimodal death distribution of British trauma (9) with the widely acknowledged American statistics. (11) Interestingly, results demonstrated that three quarters of British trauma deaths occur at the time of the injury or shortly afterwards (first peak of death), (11) whilst only half of the American trauma deaths occurred in this period. This may be attributable to a number of factors, for example, the mechanism of injury (blunt vs penetrating) and pre-hospital care provision can differ greatly between the two countries. Nevertheless, a conclusion might be drawn to suggest that, if the large number of people dying at the time of the injury was representative throughout Britain, then injury prevention offers the most effective approach for these patients.

In addition to health professionals recognising the need for injury prevention there is a political agenda to be considered The Government has set targets to reduce injury-related death and disability by 20% in all age groups by 20l0. (12) Less emphasis is placed on sole individual behaviour change and more on central and local initiatives.

It is accepted that successful injury prevention needs a three-pronged approach focusing on education, legislation and engineering^. (13, 14, 15, 16) While most trauma nurses would regard themselves as experts in care and treatment rather than prevention, there is a potential to influence all three areas.

Back to Top

There are many examples of successful American initiatives. (14, 15, 17, 18)  One such programme entitled, 'Trauma Nurses Talk Tough about Saving your Life'  was conceived by a group of nurses from Seattle. (17)  Using their specialist trauma knowledge and experience, they are allocated time and financial support to go to community groups, teaching about injury prevention, which relates to that particular group. Graphic visual images are used to illustrate the consequences of risk and the need for behaviour change. Interestingly, this programme has been positively received, and the nurses are seen as credible specialists in their field, who are knowledgeable by virtue of their working experiences in the trauma environment.

Furthermore, whilst limited in number, there are a number of injury prevention programmes that have been introduced by trauma nurses in Britain and which are said to have had an impact on altering perception and behaviour. Two of the programmes targeted school children in the pre-adolescent age group, prior to the teenage years, when risk taking behaviour dramatically increases. (19, 20) The programmes included causal factors, mechanism of injury, effects of injury and preventative strategies taught by health care personnel in collaboration with schoolteachers.

Back to Top

This aspect involves introducing legal sanctions against behaviour likely to cause injury or increase the risk of damage from an injury. This may be said to have the greatest compliance of all injury prevention strategies; for example, compulsory seat belt wearing. (21)  However, many trauma nurses and physicians would not consider themselves to be public health experts nor social activists. Nevertheless, there are examples (including the aforementioned seatbelt legislation) where physicians have used their knowledge of injury deaths and disability to inform campaigns.

An example of legislation where medical staff collaborated with legal personnel and pressure groups is the making of cycle helmet wearing compulsory in Australia. (22) In addition, recommendations by professional nursing organisations have had an impact on many areas of injury prevention legislation. (23)  Furthermore, there are examples of nurses working in collaboration with the Government to raise the profile of injury prevention techniques, such as cycle helmet wearing for children, (24) which may help to support future legislation.

This involves changing the environment to reduce the risk of the injury occurring. Unfortunately, it is often all too easy to adopt a fatalistic approach to such strategies, asking, for example, 'What can I do to make the roads safer?' However, it is suggested that trauma personnel who are naturally orientated to the front end of care should be looking even further forward. (21)

Obvious barriers preventing environmental improvement might exist; for example, the cost involved and the inability of an individual to act on his or her own. And it is recognised that it might be easier for an organisation to exact change rather than an individual. (25) Considering this, trauma nurses could interface with campaigning organisations, developing new relationships outside of the hospital environment to minimise the risk of injury occurring and affect positive environmental change for their patients.

One example of where environmental strategies would have massive benefits is road modification and speed restriction. Having witnessed the devastating effects of road traffic accidents, trauma personnel could help identify this problem further' to support speed restriction campaigns. As was wryly observed by one child health expert, "Transport is the single biggest issue in preventative child health, but most politicians don't realise that and neither do enough medical professionals:' (26)

Trauma nurses must use their knowledge and expertise to have an impact on all aspects of injury prevention. Locally, nurses can target patients and families, using health promotion strategies to introduce the need for injury prevention. Information on national injury prevention strategies can be gained through organizations such as the Royal Society for the Prevention of Accidents (RoSPA website). Finally, City University has started to include the need for injury prevention in pre- and post-registration modules, with the aim of increasing the awareness of this subject among current and future nurses.

Back to Top

1. Stewart RM, Harlan DR. The problem. http://rmstewart.uthscsa.edu/Theproblem.html

3. McGinley A. Accident prevention - Does it prevent traumatic injury? http://www.trauma.org/nurse/accidentprevention.html

4. Hansen KA. Its no accident… it's preventable. Journal of Emergency Nursing. 1998:24; 101-3.

23. Emergency Nurses Association. Position Statement. Injury Prevention. http://www.ena.org/servics/posistate/data/injprev.htm

Progress in Practice: June 2004.

Back to Top

Back to index for Progress in Practice (issue 15)

Back to Progress in Practice series contents

Page last update by D E Barnett 3/12/2005

[RLH League]

[League Notices]

[Membership]

[League history]

[Education]

[Hospital History]