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Mass casualties to substance abuse: Trauma nursing book tackles new-world issues

By Debra Melani


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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 said.

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.

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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 decompress.”

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 disorders.

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 nutrition.

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 biological situations.

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

and www.aacn.org.