Two years ago this October, a mass murderer firing
military-grade weapons showered a crowd of concertgoers in Las Vegas with
bullets, striking hundreds of victims from 32 floors above. His act of terror
created scenes of mayhem few people in this country have ever seen.
And that includes the health care workers tasked with
responding to the massacre.
A book co-edited by University
of Colorado College of Nursing’s trauma expert Mary Beth Flynn Makic
tackles the issues those emergency and hospital workers faced, among many other
challenges these caregivers confront every day.
“Mass casualty, sadly, is an evolving dynamic in our
society,” said Flynn Makic, a clinical professor on the CU Anschutz Medical Campus who responded
as a trauma nurse during the nearby Columbine massacre in 1999 and the Aurora
theater shooting in 2012.
Book revisions reflect changing times
As the title suggests, “Trauma Nursing: From Resuscitation
Through Rehabilitation” covers all of the trauma care basics for nurses in
critical care. In its fifth edition, many of its revisions mirror the times,
especially an entire chapter on mass casualty incidents.
Slated for a mid-September release and endorsed by the Society
of Trauma Nurses and the American Association of Critical Care Nurses,
the book’s foreword notes that accidental injury became the No. 3 cause of
death for the first time ever in the United States in 2016.
That 21st century reality stands true even with significant
advancements in trauma care over the years, Flynn Makic said. Many of those
improvements stem from advances in trauma care learned from the military, she
Warzone lessons influence civilian care
Flynn Makic has teamed up with lead editor Karen McQuillan
since the third edition of the book, when the two worked together at the R
Adams Cowley Shock Trauma Center, University of Maryland Medical Center, in
Baltimore, Maryland. The first book emerged from that center, staffed by many
ex-military nurses who served in Vietnam.
“The whole trauma profession really did evolve out of wars,”
she said. “And we’ve learned a lot from our current conflicts, such as in
Afghanistan, in terms of how to mitigate the consequences of trauma, how to
help improve the survival of our soldiers,” she said.
Now those skills transfer too-often to the civilian world, Flynn
Makic said. Bomb blasts and high-speed, semi-automatic weapons create wounds
and situations non-military providers seldom faced.
Evolving threats require different protocol
For example, in 2013, a planted pipe bomb sent shrapnel into
runners during the Boston Marathon, presenting first-responders with impalement
injuries they rarely see and in numbers that change the game.
“Applying tourniquets saved a lot of lives,” Flynn Makic
said. “They lost limbs, but saved lives.”
Trauma surgeons and nurses running the ERs in Las Vegas the night
of the shooting not only faced high-powered-weapon injuries in patients’ heads,
chests and abdomens. They faced massive numbers of them at once.
“How do you mobilize EMS?” Flynn Makic asked. “Who is going
to assess? Where do you set up triage? How do you triage for optimal success?”
Those are all questions the book addresses.
Need for taking care of the caregivers intensifies
Another section with new content in the book focuses on
moral distress caregivers experience and the need for self-care.
“It’s really hard when you are taking care of people in these
situations,” Flynn Makic said. “After Las Vegas, there was a lot of chatter by
doctors and nurses about how hard it was to process the tragedy later.” Some
left their jobs. “You kind of go into care mode and then afterward, you have to
True for all trauma workers, whether they ever face a mass
casualty situation or not, the book discusses ways providers can maintain
compassion and passion for their critical jobs.
Other updated highlights include:
Current evidence-based practice considerations for care of special trauma
populations, including pregnant women, children, the elderly, bariatric and
burn patients, organ donors, and those with a history of substance use
Trauma concepts that affect all patients regardless of injury, including
mechanism of injury, traumatic shock, patient/family psychosocial responses to
trauma, pain, anxiety, delirium, sleep management, infection, wound healing and
New certification review questions.
Evidence-based information on pathophysiology, care across all phases of trauma
care, and diverse patient populations.
Team-centered and interdisciplinary approaches to trauma care
Responding to pandemics, unprecedented natural disasters, and chemical and
Trauma center funding challenges.
Cultural sensitivity for diverse populations.
Updates on opioid use, sedation and alternative means of pain management.
Published by Elsevier (www.elsevier.com),
the book will be available through amazon.com