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Sun Oct 15 18:26:54 BST 2006

The issue of family presence during critical care and critical procedures deserves the same evidence based approach that this care and those procedures should be based upon. Obviously family grief and coping is a major issue to be dealt with. Effective communication is an extremely important goal. The efficacy of the care provided, however, would seem to take priority. If we are to learn anything from aviation, it would be that crew coordination, communication, and focus have been more important than even the hottest new technology they use to fly aircraft. Unless family presence improves "crew coordination, etc." among trauma team members, it would be hard to make a case for this. However, effective and prompt communication followed by reuniting family with their injured loved one ASAP should be the next priority after effective resuscitation. We all know how to do that and how moving it is to bring a family manner to the side of the trauma room gurney to hold a loved one's hand, or
give them a kiss on their way into the OR. Let's put some thought and study into this whole process. 

Mike Sise

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From: KMATTOX at aol.com [mailto:KMATTOX at aol.com]
Sent: Sat 10/14/2006 5:17 PM
To: gabiford at hotmail.com; ccm-l at ccm-l.org
Cc: trauma-list at trauma.org
Subject: Re: ccml IO again

In a message dated 10/14/2006 7:00:29 P.M. Central Standard Time, 
gabiford at hotmail.com writes:

Take a  chill pill, K.  ;)

Not required.

1.    The predominant discussion at the AAST and the  ACS was that
prehospital  and emergency room post traumatic hypotension  care was to allow permissive
resuscitation and RESTRICT  fluids.     Aggressive fluids resulted in
repeated  documentation of unacceptable complications.    Should this be  true and
the predominance of evidence is that it is, then the need for IO and  other
large bore venous access for large volumes of fluid becomes a mute  point.  

2.    The last I checked, the predominant nursing  organization interacting
with trauma systems, trauma surgeons, and hospital  policy was the SOCIETY OF
TRAUMA NURSES, not the ENA.   AND the policy  regarding who is in the OR (or an
OR surrogate location such as the trauma  resuscitation area of the emergency
center), is the surgeon, not a national  nursing organization.  The trauma
surgeons have repeatedly stipulated that  the policy of having family members
present during surgery is NOT A GOOD  IDEA.   After the surgery is over (either
in the holding area of the  EC or the PACU) surgeons have no problem with the
family visiting the patient in  keeping with hospital policy.    

I would recommend that chill out pills are not needed by the surgeons, but 
common sense pills are needed by other clip board carrying policy making do 
gooders who have lost contact with reality. 

k

I just returned from a local trauma course.  One of the topics was, of 
course, intra osseous needles.
The general opinion was that they were  being used more than in the past.
With the newish screw tips, people claimed  they were easy enough to insert.

Two ER nurses in attendance stated they  had IOs placed and found the pain
related to the insertion to be minimal --  comparable to having an IV cath
placed.

Also, was told that the  official position of the ENA (Emergency Nurses
Association) is in favor of  family's presence during codes.

Take a chill pill, K.   ;)

Gabi, RN

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