Misplaced Pages

#336663

129-481: The methodologies of triage vary by institution, locality, and country but have the same universal underlying concepts. In most cases, the triage process places the most injured and most able to be helped as the first priority, with the most terminally injured the last priority (except in the case of reverse triage). Triage systems vary dramatically based on a variety of factors, and can follow specific, measurable metrics, like trauma scoring systems , or can be based on

258-437: A caesarean section in the event of cardiac arrest. Most research on trauma occurs during war and military conflicts as militaries will increase trauma research spending in order to prevent combat related deaths. Some research is being conducted on patients who were admitted into an intensive care unit or trauma center, and received a trauma diagnosis that caused a negative change in their health-related quality of life, with

387-623: A focused assessment with sonography for trauma (FAST) exam to check for internal bleeding. For those with relatively stable blood pressure, heart rate, and sufficient oxygenation , CT scans are useful. Full-body CT scans , known as pan-scans, improve the survival rate of those who have suffered major trauma. These scans use intravenous injections for the radiocontrast agent, but not oral administration. There are concerns that intravenous contrast administration in trauma situations without confirming adequate renal function may cause damage to kidneys, but this does not appear to be significant. In

516-430: A trauma center as well as provide primary stabilization by checking and treating airway, breathing, and circulation as well as assessing for disability and gaining exposure to check for other injuries. Spinal motion restriction by securing the neck with a cervical collar and placing the person on a long spine board was of high importance in the pre-hospital setting, but due to lack of evidence to support its use,

645-470: A baseline measurement of their current blood chemistry, such as an arterial blood gas or thromboelastography . In those with cardiac arrest due to trauma chest compressions are considered futile, but still recommended. Correcting the underlying cause such as a pneumothorax or pericardial tamponade , if present, may help. A FAST exam may help assess for internal bleeding. In certain traumas, such as maxillofacial trauma, it may be beneficial to have

774-452: A bed. They often delegate such care to nursing assistants . Medication management and administration are common hospital nursing roles, although prescribing authority varies across jurisdictions. In many areas, RNs administer and manage medications prescribed by others. Nurses are responsible for evaluating patients throughout their care – including before and after medication administration – adjustments to medications are often made through

903-713: A collaborative effort between the prescriber and the nurse. Regardless of the prescriber, nurses are legally responsible for the drugs they administer. Legal implications may accompany an error in a prescription, and the nurse may be expected to note and report the error. In the United States, nurses have the right to refuse to administer medication that they deem to be potentially harmful. Some nurses take additional training that allows them to prescribe medications within their scope of practice. Effective patient/family education leads to better outcomes. Nurses explain procedure, recovery, and ongoing care, while helping everyone cope with

1032-566: A community and creating solutions to decrease the incidence of injury, trauma referral systems may help to enhance the overall health of a population. Injury prevention strategies are commonly used to prevent injuries in children, who are a high risk population. Injury prevention strategies generally involve educating the general public about specific risk factors and developing strategies to avoid or reduce injuries. Legislation intended to prevent injury typically involves seatbelts, child car-seats, helmets, alcohol control, and increased enforcement of

1161-480: A disaster uses a multi-tier scale: This triage is performed by a physician called médecin trieur (sorting medic). The German triage system uses four color codes: In Hong Kong , triage in Accident & Emergency Departments is performed by experienced registered nurses , patients are divided into five triage categories: Critical , Emergency , Urgent , Semi-urgent and Non-urgent . In mass casualty incidents,

1290-633: A few hundred municipal hospices to remain in operation in northern Europe. Nuns who had been serving as nurses were given pensions or told to marry and stay home. Nursing care went to the inexperienced as traditional caretakers, rooted in the Roman Catholic Church , were removed from their positions. The nursing profession in Europe was extinguished for approximately 200 years. During the Crimean War , Grand Duchess Elena Pavlovna called for women to join

1419-570: A form of secondary triage, where the evaluation occurs at a secondary location like a hospital, or after the arrival of more qualified care providers. There are a three primary concepts referred to as Reverse Triage. The first is concerned with the discharge of patients from hospital often to prepare for an incoming mass casualty. The second concept of Reverse Triage is utilized for certain conditions such as lightning injuries, where those appearing to be dead may be treated ahead of other patients, as they can typically be resuscitated successfully. The third

SECTION 10

#1732852742337

1548-625: A half century, over 5,000 deaconesses had surfaced in Europe. Formal use of nurses in the military began in the latter half of the nineteenth century. Nurses saw active duty in the First Boer War , the Egyptian Campaign (1882), and the Sudan Campaign (1883). In the 19th and early 20th century, nursing was considered a woman's profession, just as doctoring was a profession for men. With increasing expectations of workplace equality during

1677-426: A highly trained health care provider available to maintain airway, breathing, and circulation. Traditionally, high-volume intravenous fluids were given to people who had poor perfusion due to trauma. This is still appropriate in cases with isolated extremity trauma, thermal trauma, or head injuries. In general, however, giving lots of fluids appears to increase the risk of death. Current evidence supports limiting

1806-567: A narrower scope of practice. Nursing is a female-dominated profession in many countries; according to the WHO's 2020 State of the World's Nursing, approximately 90% of the nursing workforce is female. For instance, the male-to-female ratio of nurses is approximately 1:19 in Canada and the United States. This ratio is matched in many other countries. Notable exceptions include Francophone Africa , which includes

1935-510: A neighborhood. Without proper personal protective equipment, more than 253 residents were evacuated and 50 were hospitalized. 20 vehicles were called to the scene, and a mobile operating center was setup nearby, likely within the zone of contamination. Unaware of the presence of Sarin, triage was performed following the standard system of the time, which ultimately resulted in eight care givers experiencing mild sarin poisoning, and an unknown amount of additional staff experiencing general malaise. At

2064-402: A person who has sustained a significant injury. While positive inotropic medications such as norepinephrine sometimes are used in hemorrhagic shock as a result of trauma, there is a lack of evidence for their use. Therefore, as of 2012 they have not been recommended. Allowing a low blood pressure may be preferred in some situations. The decision whether to perform surgery is determined by

2193-625: A plan of care, working collaboratively with physicians , therapists , patients, patients' families, and other team members that focuses on treating illness to improve quality of life. In the United Kingdom and the United States, clinical nurse specialists and nurse practitioners diagnose health problems and prescribe medications and other therapies, depending on regulations that vary by state. Nurses may help coordinate care performed by other providers or act independently as nursing professionals. In addition to providing care and support, nurses educate

2322-409: A potential to create anxiety and symptoms of depression. New preserved blood products also are being researched for use in pre-hospital care; it is impractical to use the currently available blood products in a timely fashion in remote, rural settings or in theaters of war. Nurses Nursing is a health care profession that "integrates the art and science of caring and focuses on

2451-469: A quantifiable metric to measure the severity of injuries. The value may be used for triaging a patient or for statistical analysis. Injury scales measure damage to anatomical parts, physiological values (blood pressure etc.), comorbidities , or a combination of those. The Abbreviated Injury Scale and the Glasgow Coma Scale are used commonly to quantify injuries for the purpose of triaging and allow

2580-537: A ratio of 2:1. The world's five most common unintentional injuries in children as of 2008 are road crashes, drowning, burns, falls, and poisoning. Weight estimation is an important part of managing trauma in children because the accurate dosing of medicine may be critical for resuscitative efforts. A number of methods to estimate weight, including the Broselow tape , Leffler formula , and Theron formula exist. Trauma occurs in approximately 5% of all pregnancies, and

2709-612: A secondary or tertiary care facility to survive, those who require low-intensity care to survive, those who are uninjured, and those who are deceased or will be so imminently. In the United States, this most commonly takes the form of the START triage model, in Canada, the CTAS model, and in Australia the ATS model. Assessment often begins with asking anyone who can walk to walk to a designated area, labeling them

SECTION 20

#1732852742337

2838-758: A source of free/inexpensive labor. Exploitation of nurses was not uncommon by employers, physicians, and education providers. Many nurses saw active duty in the First World War , but the profession transformed again during the Second World War . British nurses of the Army Nursing Service were part of every overseas campaign. More nurses volunteered for service in the US Army and Navy than any other occupation. The Nazis had their own Brown Nurses, numbering 40,000. Two dozen German Red Cross nurses were awarded

2967-570: A system to monitor or "trend" a patient's condition in a clinical setting. The data also may be used in epidemiological investigations and for research purposes. Approximately 2% of those who have experienced significant trauma have a spinal cord injury. Injuries may be caused by any combination of external forces that act physically against the body. The leading causes of traumatic death are blunt trauma , motor vehicle collisions , and falls , followed by penetrating trauma such as stab wounds or impaled objects. Subsets of blunt trauma are both

3096-459: A trauma center. Improvements in pre-hospital care have led to "unexpected survivors", where patients survive trauma when they would have previously been expected to die. However these patients may struggle to rehabilitate. Management of those with trauma often requires the help of many healthcare specialists including physicians, nurses, respiratory therapists, and social workers. Cooperation allows many actions to be completed at once. Generally,

3225-482: A trauma system in place. In addition, most LMICs do not have a pre-hospital care system that treats injured persons initially and transports them to hospital quickly, resulting in most casualty patients being transported by private vehicles. Also, their hospitals lack the appropriate equipment, organizational resources, or trained staff. By 2020, the amount of trauma-related deaths is expected to decline in high-income countries , while in low- to middle-income countries it

3354-437: A tube or catheter to drain fluid from the peritoneum , chest , or the pericardium around the heart , often are used in cases of severe blunt trauma to the chest or abdomen, especially when a person is experiencing early signs of shock . In those with low blood-pressure , likely because of bleeding in the abdominal cavity, cutting through the abdominal wall surgically is indicated. By identifying risk factors present within

3483-412: A wide range of settings, including hospitals, private homes , schools , and pharmaceutical companies . Nurses work in occupational health settings (also called industrial health settings), free-standing clinics, physician offices, nurse-led clinics , long-term care facilities and camps. They work on cruise ships , military bases , and in combat settings. Nurses act as advisers and consultants to

3612-584: A wider applicability, as some conditions which may be survivable outside of extreme circumstances become unsurvivable due to the nature of a mass casualty incident. For these patients, as well as those who are deemed to be unsavable, palliative care can mean the difference of a painful death, and a relatively peaceful one. During the COVID-19 pandemic issues of palliative care in triage became more obvious as some countries were forced to deny care to large groups of individuals due to lack of supplies and ventilators . In

3741-440: Is a complex cause of trauma because it commonly includes both blunt and penetrating trauma, and also may be accompanied by a burn injury . Trauma also may be associated with a particular activity, such as an occupational or sports injury . The body responds to traumatic injury both systemically and at the injury site. This response attempts to protect vital organs such as the liver, to allow further cell duplication and to heal

3870-415: Is also an important component of community disaster preparedness, facilitating the care of people who have been involved in disasters that cause large numbers of casualties, such as earthquakes. The pre-hospital use of stabilization techniques improves the chances of a person surviving the journey to the nearest trauma-equipped hospital. Emergency medicine services determines which people need treatment at

3999-537: Is defined and governed by law, and entrance to the profession is regulated at the national or state level. The nursing community worldwide aims for professional nurses to ensure quality care, while maintaining their credentials, code of ethics , standards, and competencies, and continuing their education. Multiple educational paths lead to becoming a professional nurse; these vary by jurisdiction; all involve extensive study of nursing theory and practice as well as training in clinical skills. Nurses provide care based on

Triage - Misplaced Pages Continue

4128-520: Is described in many sources as "the first visiting nurse". These traditions were influential in the development of the ethos of modern nursing. Its religious roots remain in evidence in many countries. One example in the United Kingdom is the use of the historical title "sister" to refer to a senior nurse. During the Reformation , Protestant reformers shut down monasteries and convents, allowing

4257-468: Is expected to increase. 260,000 175,000 96,000 47,000 45,000 Due to anatomical and physiological differences, injuries in children need to be approached differently from those in adults. Accidents are the leading cause of death in children between 1 and 14 years old. In the United States, approximately sixteen million children go to an emergency department due to some form of injury every year, with boys being more frequently injured than girls by

4386-406: Is further complicated by the numerous interpretations of nursing's defining essence. During the 1980s there was an increased focus on research utilization (RU). Nursing research took an interest in clinical issues and US nursing schools began teaching research methods to facilitate interpretation and integration of scientific findings in routine practice. Several RU initiatives were active during

4515-407: Is less likely to occur when triaging is performed by hospital medical teams, rather than paramedics or EMTs. In telephone triage, care providers like nurses assess symptoms and medical history, and make a care recommendation over the phone . A review of available literature found that these services provide accurate and safe information about 90% of the time. In triage, palliative care takes on

4644-566: Is not immediately obvious, it is used in any patient who appears to be a child (patients who appear to be young adults are triaged using START). In hospital settings, Australia and New Zealand rely on the Australasian Triage Scale (abbreviated ATS and formally known as the National Triage Scale ). The scale has been in use since 1994. The scale consists of 5 levels, with 1 being the most critical (resuscitation), and 5 being

4773-469: Is rapid patient assessment designed to check bodily function in order of importance. A triage tag is a premade label placed on each patient that serves to accomplish several objectives: Triage tags take a variety of forms. Some countries use a nationally standardized triage tag, while in other countries commercially available triage tags are used, which vary by jurisdictional choice. In some cases, international organizations also have standardized tags, as

4902-406: Is selected based on the care setting and the population served. In providing nursing care, the nurse uses both nursing theory and best practice derived from nursing research . Many nursing theories are in use. Like other disciplines, the profession has developed multiple theories derived reflecting varying philosophical beliefs and paradigms or worldviews . In general terms, the nursing process

5031-750: Is the case with NATO . The most commonly used commercial systems include the METTAG, the SMARTTAG, E/T LIGHT and the CRUCIFORM systems. More advanced tagging systems incorporate special markers to indicate whether or not patients have been contaminated by hazardous materials, and also tear off strips for tracking the movement of patients through the process. In advanced triage, those with advanced training, such as doctors, nurses and paramedics make further care determinations based on more in-depth assessments, and may make use of advanced diagnostics like CT scans . This can also be

5160-475: Is the concept of treating the least injured, often to return them to functional capability. This approach originated in the military, where returning combatants to the theatre of war may lead to overall victory (and survivability). Undertriage is underestimating the severity of an illness or injury. An example of this would be categorizing a Priority 1 (Immediate) patient as a Priority 2 (Delayed) or Priority 3 (Minimal). The rate of undertriage generally varies by

5289-445: Is the leading cause of maternal death. Additionally, pregnant women may experience placental abruption , pre-term labor , and uterine rupture . There are diagnostic issues during pregnancy; ionizing radiation has been shown to cause birth defects, although the doses used for typical exams generally are considered safe. Due to normal physiological changes that occur during pregnancy , shock may be more difficult to diagnose. Where

Triage - Misplaced Pages Continue

5418-742: Is the method used to assess and diagnose needs, plan outcomes and interventions, implement interventions, and evaluate outcomes. The nursing process as defined by the American Nurses Association comprises five steps: 1) evaluate, 2) implement, 3) plan, 4) diagnose, and 5) assess. Digital health platforms connect nurses and nurse assistants with job openings in healthcare facilities such as skilled nursing homes, home health agencies, and hospitals. Platforms offer an app to facilitate communication and allow nurses to find work opportunities based on their preferences. Healthcare partners and facilities benefit from access to qualified nurses. In 2017,

5547-408: Is the most diverse of all health care professions . Nurses practice in a wide range of settings, but generally follows the needs of their patients. The major specialties are: Nurses with additional degrees allow for specialization. Nursing professions can be separated into categories by care type, age, gender, certain age group, practice setting, individually or in combination. Nurses practice in

5676-428: Is twice as common in males as it is in females, this is believed to be because males are much more willing to engage in risk-taking activities. Teenagers and young adults are more likely to need hospitalization from injuries than other age groups. While elderly persons are less likely to be injured, they are more likely to die from injuries sustained due to various physiological differences that make it more difficult for

5805-457: Is undertaken to identify any life-threatening problems, after which the secondary examination is carried out. This may occur during transportation or upon arrival at the hospital. The secondary examination consists of a systematic assessment of the abdominal , pelvic , and thoracic areas, a complete inspection of the body surface to find all injuries, and a neurological examination . Injuries that may manifest themselves later may be missed during

5934-529: The German forces . Once at a casualty clearing station, wounds were dressed, and anyone requiring immediate surgical intervention was placed in a cart and brought immediately to an ambulance pickup area. If the wounded could wait, they would be evacuated by ambulance during the night. Ambulances, driven by YMCA and American Red Cross trained drivers then removed the casualties to mobile surgical centers , called postes avances des hospitaux du front or outposts of

6063-504: The Iron Cross for heroism under fire. The development of undergraduate and post-graduate nursing degrees came after the war. Nursing research and a desire for association and organization led to the formation of professional organizations and academic journals . Nursing became recognized as a distinct academic discipline, initially tasked to define the theoretical basis for practice. Nurses are perceived to be in short supply around

6192-835: The START triage system is used. In Japan , the triage system is mainly used by health professionals. The categories of triage, in corresponding color codes, are: All public hospitals in Singapore use the Patient Acuity Category Scale (PACS) to triage patient in Emergency Departement. PACS is a symptom-based differential diagnosis approach that triages patients according to their presenting complaints and objective assessments such as vital signs and Glasgow Coma Scale, allowing acute patients to be identified quickly for treatment. PACS classifies patients into four main categories: P1, P2, P3, and P4. In mass casualty incidents,

6321-423: The START triage system is used. In Spain , there are 2 models which are the most common found in hospitals around the country: Major trauma Major trauma is any injury that has the potential to cause prolonged disability or death . There are many causes of major trauma, blunt and penetrating , including falls , motor vehicle collisions , stabbing wounds , and gunshot wounds . Depending on

6450-585: The Surgeon in Chief of Napoleon's Imperial Guard laid the groundwork for what would eventually become modern triage introducing the concept of "treat[ing] the wounded according to the observed gravity of their injuries and the urgency for medical care, regardless of their rank or nationality". Simple triage is usually used in a scene of an accident or " mass-casualty incident " (MCI), in order to sort patients into those who need critical attention and immediate transport to

6579-418: The first schools of nursing to be connected to a hospital and medical school. It spread widely in Europe and North America after 1870. Nightingale included five factors that helped nurses in her time who worked amidst poor sanitation and little education. These factors included fresh air, clean water, a working drainage system, cleanliness, and good light. Nightingale believed that a clean working environment

SECTION 50

#1732852742337

6708-550: The 19th century in the Crimea, Central America, and Jamaica. Her predecessors had great success as healers in the Colony of Jamaica in the 18th century, and they included Seacole's mother (Mrs. Grant), Sarah Adams, Cubah Cornwallis , and Grace Donne, the mistress and doctress to Jamaica's wealthiest planter, Simon Taylor . Other important nurses in the development of the profession include: Red Cross chapters, which began appearing after

6837-566: The Canadian Triage and Acuity Scale (CTAS), which is used across the country to sort incoming patients. The system categorizes patients by both injury and physiological findings, and ranks them by severity from 1–5 (1 being highest). The model is not currently used for mass casualty triage, and instead the START protocol and METTAG triage tags is used. In France , the Prehospital triage in case of

6966-526: The Edwin Smith Papyrus contains descriptions of the assessment and treatment of a multitude of medical conditions, and divides injuries into three categories: During the reign of Emperor Maximilian I , during wartime, a policy was implemented where soldiers were prioritized over all others in hospitals, and the sickest soldiers received treatment first. Modern triage grew out of the work of Baron Dominique-Jean Larrey and Barron Francois Percy during

7095-505: The Nursing and Midwifery Council (NMC) are male. The number of male nurses in the United States doubled between 1980 and 2000. On average, male nurses in the US receive more pay than female nurses. Nursing practice is the actual provision of nursing care. In providing care, nurses implement a nursing care plan defined using the nursing process . This is based around a specific nursing theory that

7224-720: The Order of Exaltation of the Cross ( Krestodvizhenskaya Obshchina ) for a year of service in military hospitals. The first section of twenty-eight "sisters", headed by Aleksandra Petrovna Stakhovich, the Directress of the Order, reached Crimea early in November 1854. Florence Nightingale laid the foundations of professional nursing after the Crimean War , in light of a comprehensive statistical study she made of sanitation in India, leading her to emphasize

7353-504: The Trauma and Injury Severity Score, the latter of which has been shown to be most effective at determining outcome. S.T.A.R.T. (Simple Triage and Rapid Treatment) is a simple triage system that can be performed by lightly trained lay and emergency personnel in emergencies. It was developed at Hoag Hospital in Newport Beach, California for use by emergency services in 1983. Triage separates

7482-414: The U.S., CT or MRI scans are performed on 15% of those with trauma in emergency departments . Where blood pressure is low or the heart rate is increased—likely from bleeding in the abdomen—immediate surgery bypassing a CT scan is recommended. Modern 64-slice CT scans are able to rule out, with a high degree of accuracy, significant injuries to the neck following blunt trauma. Surgical techniques, using

7611-517: The UK's National Health Service began trialing such a platform. Platforms such as United States –based ConnectRN, Nomad Health, Gale Healthcare solutions or Lantum add resources, career development tools, and networking opportunities. Florence Nightingale's seminal epidemiological study examining mortality among British soldiers during the Crimean War was published in 1858. With the exception of her works, nursing practice remained an oral tradition until

7740-478: The United States directly. The fact that the U.S. was no longer seen as untouchable, along with the later Oklahoma City bombing in 1995, and the September 11th attack lead to long term changes in triage practices to be more focused on operational safety and the risk of secondary attacks designed to kill care providers. In June 1994, emergency crews began responding to calls related to symptoms of toxic gas exposure in

7869-497: The advent of the tiered triage, wherein care providers sorted people into categories defined ahead of time. These categories, immediate, delayed, minimal and expectant are still the basis for most triage systems today. The time period was also marked by improvements in medical understanding, including shock, which allowed effective interventions to be administered earlier in the Triage process, which in turn significantly improved outcomes. At

SECTION 60

#1732852742337

7998-432: The amount of money spent on treatment and the loss of potential economic gain through absence from work. The average financial cost for the treatment of traumatic injury in the United States is approximately US$ 334,000 per person, making it costlier than the treatment of cancer and cardiovascular diseases . One reason for the high cost of the treatment for trauma is the increased possibility of complications, which leads to

8127-623: The body as mentioned before including the skin, cannot be correctly described by one who is not well versed in anatomy. Hence, anyone desirous of acquiring a thorough knowledge of anatomy should prepare a dead body and carefully, observe, by dissecting it, and examining its different parts." In the Middle Ages , members of religious orders such as nuns and monks often provided nursing-like care. Examples exist in Christian , Islamic , Buddhist , and other traditions. The biblical figure of Phoebe

8256-512: The body increases production of glucose through gluconeogenesis and its consumption of fat via lipolysis . Next, the body tries to replenish its energy stores of glucose and protein via anabolism . In this state the body will temporarily increase its maximum expenditure for the purpose of healing injured cells. The initial assessment is critical in determining the extent of injuries and what will be needed to manage an injury, and for treating immediate life threats. Primary physical examination

8385-535: The body to compensate for the injuries. The primary causes of traumatic death are central nervous system injuries and substantial blood loss . Various classification scales exist for use with trauma to determine the severity of injuries, which are used to determine the resources used and, for statistical collection. The human remains discovered at the site of Nataruk in Turkana , Kenya, are claimed to show major trauma—both blunt and penetrating—caused by violent trauma to

8514-447: The care of large numbers of patients, or are places that could be so set up. Examples include schools, sports stadiums, and large camps that can be prepared and used for the care, feeding, and holding of large numbers of victims of a mass casualty or other type of event. Such improvised facilities are generally developed in cooperation with the local hospital, which sees them as a strategy for creating surge capacity. While hospitals remain

8643-460: The concepts created during the Korean War. Advances in helicopters allowed the introduction of the first helicopter medics, who were able to provide fluid resuscitation , and other interventions mid-flight. This made it so that the average time from injury to definitive care was less than two hours. This evolution also flowed into the everyday life, with air ambulances emerging in the civilian world by

8772-494: The countries of Benin, Burkina Faso, Cameroon, Chad, Congo, Côte d'Ivoire , the Democratic Republic of Congo , Djibouti , Guinea , Gabon , Mali , Mauritania , Niger , Rwanda , Senegal , and Togo , which all have more male than female nurses. In Europe, in countries such as Spain , Portugal , Czech Republic and Italy , over 20% of nurses are male. In the United Kingdom, 11% of nurses and midwives registered with

8901-554: The damage. The healing time of an injury depends on various factors including sex, age, and the severity of injury. The symptoms of injury may manifest in many different ways, including: Various organ systems respond to injury to restore homeostasis by maintaining perfusion to the heart and brain. Inflammation after injury occurs to protect against further damage and starts the healing process. Prolonged inflammation may cause multiple organ dysfunction syndrome or systemic inflammatory response syndrome . Immediately after injury,

9030-695: The establishment of the International Committee of the Red Cross in 1863, offered employment and professionalization opportunities for nurses (despite Nightingale's initial objections). Catholic orders such as Little Sisters of the Poor , Sisters of Mercy , Sisters of St. Mary , St. Francis Health Services, Inc. and Sisters of Charity built hospitals and provided nursing services during this period. The modern deaconess movement began in Germany in 1836. Within

9159-459: The extent of the damage and the anatomical location of the injury. Bleeding must be controlled before definitive repair may occur. Damage control surgery is used to manage severe trauma in which there is a cycle of metabolic acidosis , hypothermia , and hypotension that may lead to death, if not corrected. The main principle of the procedure involves performing the fewest procedures to save life and limb; less critical procedures are left until

9288-405: The field, evacuation of all casualties is the ultimate goal, so that the site of the incident can ultimately be cleared, if necessary investigated, and eventually rendered safe. Additional considerations must be made to avoid overwhelming local resources, and in some extreme cases, this can mean evacuating some patients to other countries. Alternative care facilities are places that are set up for

9417-493: The field. Moreover, the recent development of new machine learning methods offers the possibility to learn optimal triage policies from data and in time could replace or improve upon expert-crafted models. Most simply, the general purpose of triage is to sort patients by level of acuity to inform care decisions; so that the most people possible can be saved. Although a multitude of systems, color codes, codewords, and categories exist to help direct it, in all cases, triage follows

9546-426: The fifth and seventh leading causes of deaths worldwide, accounting for 6.23% and 2.84% of all deaths. For research purposes the definition often is based on an Injury Severity Score (ISS) of greater than 15. Injuries generally are classified by either severity, the location of damage, or a combination of both. Trauma also may be classified by demographic group , such as age or gender. It also may be classified by

9675-420: The first step of managing trauma is to perform a primary survey that evaluates a person's airway, breathing, circulation, and neurologic status. These steps may happen simultaneously or depend on the most pressing concern such as a tension pneumothorax or major arterial bleed. The primary survey generally includes assessment of the cervical spine, though clearing it is often not possible until after imaging, or

9804-452: The first three hours after trauma. For severe bleeding, for example from bleeding disorders , recombinant factor VIIa —a protein that assists blood clotting—may be appropriate. While it decreases blood use, it does not appear to decrease the mortality rate. In those without previous factor VII deficiency, its use is not recommended outside of trial situations. Other medications may be used in conjunction with other procedures to stabilize

9933-507: The following definitions: Nursing encompasses autonomous and collaborative care of individuals of all ages, families, groups and communities, sick or well, and in all settings. Nursing includes the promotion of health, prevention of illness, and the care of ill, disabled and dying people. Advocacy, promotion of a safe environment, research, participation in shaping health policy and in patient and health systems management, and education are also key nursing roles. The use of clinical judgment in

10062-557: The founding of the Cochrane Collaboration in 1993. The emerging area of evidence-based medicine also applies to nursing. Common barriers to the study and integration of research findings into clinical decision making include: a lack of opportunity, inexperience, and the rapid pace of evidence accumulation. Nurses manage and coordinate care to support activities of daily living (ADL). This includes assisting in patient mobility, such as moving an activity intolerant patient within

10191-514: The frontline hospitals. At the mobile surgical hospitals, the most severe cases were treated, specifically those who were likely to die before reaching a permanent, more equipped hospital. Anyone who could survive the trip was transported to a farther away, often costal, hospital. Upon reaching a permanent hospital, casualties received appropriate care to treat all of their injuries. By the onset of World War II, American and British forces had adopted and adapted triage, with other global powers doing

10320-405: The head, neck, ribs, knees, and hands, which has been interpreted by some researchers as establishing the existence of warfare between two groups of hunter-gatherers 10,000 years ago. The evidence for blunt-force trauma at Nataruk has been challenged, however, and the interpretation that the site represents an early example of warfare has been questioned. The financial cost of trauma includes both

10449-418: The heart or of large blood vessels. Early deaths occur within minutes to hours and often are due to hemorrhages in the outer meningeal layer of the brain , torn arteries , blood around the lungs , air around the lungs , ruptured spleen , liver laceration , or pelvic fracture . Immediate access to care may be crucial to prevent death in persons experiencing major trauma. Late deaths occur days or weeks after

10578-523: The hospital, the availability of advanced life support does not greatly improve the outcome for major trauma when compared to the administration of basic life support . Evidence is inconclusive in determining support for pre-hospital intravenous fluid resuscitation while some evidence has found it may be harmful. Hospitals with designated trauma centers have improved outcomes when compared to hospitals without them, and outcomes may improve when persons who have experienced trauma are transferred directly to

10707-466: The importance of sanitation. "After 10 years of sanitary reform, in 1873, Nightingale reported that mortality among the soldiers in India had declined from 69 to 18 per 1,000". Nightingale believed that nursing was a social freedom and mission for women. She believed that any educated woman could help improve the care of the ill. Her Notes on Nursing (1859) was a popular call to action. The Nightingale model of nursing education led to one of

10836-435: The individual's physical, emotional, psychological, intellectual, social, and spiritual needs. The profession combines physical science, social science, nursing theory, and technology. Nurses typically hold one or more formal credentials. Roles and responsibilities follow the level of education. For example, in the United States, Licensed Practical Nurses (LPN) have less education than Registered Nurses (RN) and accordingly,

10965-435: The initial assessment, such as when a patient is brought into a hospital's emergency department. Generally, the physical examination is performed in a systematic way that first checks for any immediate life threats (primary survey), and then taking a more in-depth examination (secondary survey). Persons with major trauma commonly have chest and pelvic x-rays taken, and, depending on the mechanism of injury and presentation,

11094-454: The injured into four groups: Triage also sets priorities for evacuation and transport as follows: The JumpSTART pediatric triage MCI triage tool is a variation of the S.T.A.R.T. model. Both systems are used to sort patients into categories at mass casualty incidents (MCIs). However, JumpSTART was designed specifically for triaging children in disaster settings. Though JumpSTART was developed for use in children from infancy to age 8, where age

11223-609: The injury and often are related to infection. Prognosis is better in countries with a dedicated trauma system where injured persons are provided quick and effective access to proper treatment facilities. Long-term prognosis frequently is complicated by pain; more than half of trauma patients have moderate to severe pain one year after injury. Many also experience a reduced quality of life years after an injury, with 20% of victims sustaining some form of disability. Physical trauma may lead to development of post-traumatic stress disorder (PTSD). One study has found no correlation between

11352-461: The late 20th century, but the RU movement was superseded by evidence-based practice in the 1990s. Evidence-based practice (EBP) is about using research, but unlike RU it allows for the integration of research findings with clinical expertise and patient preferences. The EBP movement had originated in the field of medicine with Archie Cochrane publishing Effectiveness and Efficiency in 1972, leading up to

11481-412: The late 20th century, nursing became an officially gender-neutral profession, though in practice the percentage of male nurses remained well below that of female physicians in the 21st century. Hospital-based training became standard in the US in the early 1900s, with an emphasis on practical experience. The Nightingale-style school began to disappear. Hospitals and physicians saw women in nursing as

11610-530: The least critical (nonurgent). In field settings, various standardized triage systems are used, and there is no area wide standard. In 1995, the CAEP Triage and Acuity scale was launched in Canada relying on a simplified version of the Australian National Triage Scale. This scale used three categories, emergent, urgent, and non-urgent. This scale was deprecated in 1999 with the introduction of

11739-730: The legislation. Other controllable factors, such as the use of drugs including alcohol or cocaine , increases the risk of trauma by increasing the likelihood of traffic collisions, violence, and abuse occurring. Prescription drugs such as benzodiazepines may increase the risk of trauma in elderly people. The care of acutely injured people in a public health system requires the involvement of bystanders, community members, health care professionals, and health care systems. It encompasses pre-hospital trauma assessment and care by emergency medical services personnel, emergency department assessment, treatment, stabilization, and in-hospital care among all age groups. An established trauma system network

11868-461: The list. A 2023 American survey found that around 30% were considering leaving patient care. According to the traditional interpretation physicians are concerned with curing or treating medical conditions, while nurses focus on care. In healthcare settings this line is often blurred, complicating the task of distinguishing the professions. Although nursing practice varies both through its various specialties and countries, nursing organizations offer

11997-577: The location of the triage, with a 2014 review of triage practices in emergency rooms finding that in-hospital undertriaging occurred 34% of the time in the United States, while reviews of pre-hospital triage finding undertriage rates of 14%. Overtriage is the overestimating of the severity of an illness or injury. An example of this would be categorizing a Priority 3 (Minimal) patient as a Priority 2 (Delayed) or Priority 1 (Immediate). Acceptable overtriage rates have been typically up to 50% in an effort to avoid undertriage. Some studies suggest that overtriage

12126-517: The lowest priority, and assessing other patients from there. Upon completion of the initial assessment by the care provider, which is based on the so-called ABCDE approach , patients are generally labelled with their available information, including "patient’s name, gender, injuries, interventions, care-provider IDs, casualty triage score, and an easily visible overall triage category". An ABCDE assessment (other variations include ABC, ABCD, ABCDEF, and many others, including those localized to non-English)

12255-464: The medical opinion of the provider. Triage is an imperfect practice, and can be largely subjective, especially when based on general opinion rather than a score. This is because triage needs to balance multiple and sometimes contradictory objectives simultaneously, most of them being fundamental to personhood: likelihood of death, efficacy of treatment, patients' remaining lifespan, ethics, and religion. The term triage comes directly from French , where

12384-409: The medical situation. Many times, nurses are busy, leaving little time to educate patients. Patients' families needs similar education. Educating both patient and their families increases the chance for a better outcome. Nurses have to communicate in a way that can be understood by patients. Education techniques encompass conversations, visuals, reading materials, and demonstrations. Nursing

12513-436: The method of intubation used is rapid sequence intubation followed by ventilation, though intubating in shock due to bleeding can lead to arrest, and should be done after some resuscitation whenever possible. Trauma resuscitation includes control of active bleeding. When a person is first brought in, vital signs are checked, an ECG is performed, and, if needed, vascular access is obtained. Other tests should be performed to get

12642-467: The mid-1960's. The use of triage in emergency departments and ambulance services also quickly followed. In 1993, the north tower of the World Trade Center was bombed , in a plot with a similar intended outcome as the later September 11th attacks . While search, rescue and triage operations immediately following were ordinary, the attack itself represented one of the first terrorist attacks affecting

12771-424: The mid-20th century. The inaugural issue of Nursing Research , the first scientific journal specialized in nursing, came in in 1952. During the 1960s, interest in attaining PhDs increased among nurses in the US, but nursing remained a fledgling area of research, with few journals until the 1970s. Nursing research is increasingly presented as a valid discipline, although lacking a prevailing definition. The question

12900-684: The mindset of treating only what was absolutely necessary fell away. Although triage almost certainly occurred in the days after the atomic bombings of Hiroshima and Nagasaki , the pandemonium caused by the attack left records of such action non-existent until after the fifth day, at which point they are largely without historical use. In 1947, the Texas City Disaster occurred when the SS Grandcamp exploded in Texas City, Texas , killing 600 people and injuring thousands more. The entire fire department

13029-665: The need for more interventions. Maintaining a trauma center is costly because they are open continuously and maintain a state of readiness to receive patients, even if there are none. In addition to the direct costs of the treatment, there also is a burden on the economy due to lost wages and productivity, which in 2009, accounted for approximately US$ 693.5 billion in the United States. Citizens of low- and middle-income countries (LMICs) often have higher mortality rates from injury. These countries accounted for 89% of all deaths from injury worldwide. Many of these countries do not have access to sufficient surgical care and many do not have

13158-520: The number one and two causes of traumatic death. For statistical purposes, injuries are classified as either intentional such as suicide, or unintentional, such as a motor vehicle collision. Intentional injury is a common cause of traumas. Penetrating trauma is caused when a foreign body such as a bullet or a knife enters the body tissue , creating an open wound. In the United States, most deaths caused by penetrating trauma occur in urban areas and 80% of these deaths are caused by firearms. Blast injury

13287-432: The nurse is to assist the individual, sick or well, in the performance of those activities contributing to health or its recovery (or to peaceful death) that he would perform unaided if he had the necessary strength, will or knowledge. The practice of nursing is based upon a social contract that delineates professional rights and responsibilities as well as accountability mechanisms. In almost all countries, nursing practice

13416-505: The person has improved. After immediate life threats are controlled, a person is either moved into an operating room for immediate surgical correction of the injuries, or a secondary survey is performed that is a more detailed head-to-toe assessment of the person. Indications for intubation include airway obstruction, inability to protect the airway, and respiratory failure. Examples of these indications include penetrating neck trauma, expanding neck hematoma, and being unconscious. In general,

13545-402: The practice is losing favor. Instead, it is recommended that more exclusive criteria be met such as age and neurological deficits to indicate the need of these adjuncts. This may be accomplished with other medical transport devices, such as a Kendrick extrication device , before moving the person. It is important to quickly control severe bleeding with direct pressure to the wound and consider

13674-461: The preferred destination for all patients, during a mass casualty event such improvised facilities may be required in order to divert low-acuity patients away from hospitals in order to prevent the hospitals becoming overwhelmed. The general concept was first described in a 17th-century BCE Egyptian document, the Edwin Smith Papyrus . Discovered in 1862, outside of modern-day Luxor, Egypt ,

13803-443: The protection, promotion, and optimization of health and human functioning; prevention of illness and injury; facilitation of healing; and alleviation of suffering through compassionate presence". Nurses practice in many specialties with varying levels of certification and responsibility. Nurses comprise the largest component of most healthcare environments. There are shortages of qualified nurses in many countries. Nurses develop

13932-515: The provision of care to enable people to improve, maintain, or recover health, to cope with health problems, and to achieve the best possible quality of life, whatever their disease or disability, until death. Nursing is the protection, promotion, and optimization of health and abilities; prevention of illness and injury; alleviation of suffering through the diagnosis and treatment of human responses; and advocacy in health care for individuals, families, communities, and populations. The unique function of

14061-524: The public and promote health and wellness. In the U.S., nurse practitioners are nurses with a graduate degree in advanced practice nursing, and are permitted to prescribe medications. They practice independently in a variety of settings in more than half of the United States. In the postwar period, nurse education has diversified, awarding advanced and specialized credentials , and many traditional regulations and roles are changing. Nursing historians face challenges of determining whether care provided to

14190-418: The reign of Napoleon . Larrey in particular introduced the concept of a "flying ambulance " (flying in this case meaning rapidly moving) or in its native French, Ambulance Volante . In 1914, Antoine Depage developed the five-tiered Ordre de Triage , a triage system which set specific benchmarks on evacuation, described staged evacuation. French and Belgian doctors began using these concepts to inform

14319-538: The same basic process. In all systems, patients are first assessed for injuries, then, they are categorized based on the severity of those injuries. Although the number of categories differs from system to system, all have at least three in common; high severity, low severity, and deceased. Some systems involve features like scoring systems, such as the Revised Trauma Score , the Injury Severity Score , and

14448-478: The same time, Mobile Army Surgical Hospitals (MASH) were introduced along with helicopters for evacuation. These helicopters, however were used for evacuation only, and care was not provided in the air during the evacuation. These advances reduced fatalities for injured soldiers by up to 30%, and changed the nature of battlefield medicine significantly. The conditions of the Vietnam War drove further development on

14577-461: The same. The increased availability of airplanes allowed rapid evacuation to a hospital outside of the warzone to become a part of the triage process. Although the basic practices remained the same as in World War I, with initial evacuation to an aid station, followed by transitions to higher levels of care, and eventual admission to a permanent hospital, more advanced care was provided at each stage, and

14706-438: The severity of injury, quickness of management, and transportation to an appropriate medical facility (called a trauma center ) may be necessary to prevent loss of life or limb. The initial assessment is critical, and involves a physical evaluation and also may include the use of imaging tools to determine the types of injuries accurately and to formulate a course of treatment. In 2002, unintentional and intentional injuries were

14835-438: The severity of trauma and the development of PTSD. Trauma is the sixth leading cause of death worldwide, resulting in five million or 10% of all deaths annually. It is the fifth leading cause of significant disability. About half of trauma deaths are in people aged between 15 and 45 years and trauma is the leading cause of death in this age group. Injury affects more males; 68% of injuries occur in males and death from trauma

14964-534: The sick or injured in antiquity is called nursing care. In the fifth century BC, for example, the Hippocratic Collection in places described skilled care and observation of patients by male "attendants," who may have provided care now provided by nurses. Around 600 BC in India, it is recorded in Sushruta Samhita , Book 3, Chapter V about the role of the nurse as "the different parts or members of

15093-1068: The solution of choice. If blood products are needed, a greater use of fresh frozen plasma and platelets instead of only packed red blood cells has been found to improve survival and lower overall blood product use; a ratio of 1:1:1 is recommended. The success of platelets has been attributed to the fact that they may prevent coagulopathy from developing. Cell salvage and autotransfusion also may be used. Blood substitutes such as hemoglobin-based oxygen carriers are in development; however, as of 2013 there are none available for commercial use in North America or Europe. These products are only available for general use in South Africa and Russia. Tranexamic acid decreases death in people who are having ongoing bleeding due to trauma, as well as those with mild to moderate traumatic brain injury and evidence of intracranial bleeding on CT scan. It only appears to be beneficial, however, if administered within

15222-545: The term means to pick or to sort, it itself coming from the Old French verb trier , meaning to separate, sort, shift, or select; with trier in turn came from late Latin tritare, to grind. Although the concept existed much earlier, at least as far back as the reign of Maximillian I , it was not until the 1800s that the Old French trier was used to describe the practice of triage. That year, Baron Dominique-Jean Larrey ,

15351-564: The time, no decontamination procedures or gas masks were available for incidents involving contaminants. In response, the Japan Self-Defense Forces created a decontamination team, which was then instrumental to the response of the Tokyo subway sarin attack which occurred only seven months later. As medical technology has advanced, so have modern approaches to triage, which are increasingly based on scientific models. The categorizations of

15480-468: The treatment of casualties at aid stations behind the front. Those responsible for the removal of the wounded from a battlefield or their care afterwards would divide the victims into three categories: From that delineation, aid workers would follow the Ordre de Triage : In the first order of triage, the injured would be evacuated to clearing stations in the night, when darkness offered maximum protection from

15609-557: The type of force applied to the body, such as blunt trauma or penetrating trauma . For research purposes injury may be classified using the Barell matrix , which is based on ICD-9-CM . The purpose of the matrix is for international standardization of the classification of trauma. Major trauma sometimes is classified by body area; injuries affecting 40% are polytrauma , 30% head injuries , 20% chest trauma , 10%, abdominal trauma , and 2%, extremity trauma. Various scales exist to provide

15738-495: The use of hemostatic agents or tourniquets if the bleeding continues. Conditions such as impending airway obstruction, enlargening neck hematoma, or unconsciousness require intubation. It is unclear, however, if this is best performed before reaching hospital or in the hospital. Rapid transportation of severely injured patients improves the outcome in trauma. Helicopter EMS transport reduces mortality compared to ground-based transport in adult trauma patients. Before arrival at

15867-528: The use of fluids for penetrating thorax and abdominal injuries, allowing mild hypotension to persist. Targets include a mean arterial pressure of 60 mmHg, a systolic blood pressure of 70–90 mmHg, or the re-establishment of peripheral pulses and adequate ability to think. Hypertonic saline has been studied and found to be of little difference from normal saline. As no intravenous fluids used for initial resuscitation have been shown to be superior, warmed Lactated Ringer's solution continues to be

15996-414: The victim is more stable. Approximately 15% of all people with trauma have abdominal injuries, and approximately 25% of these require exploratory surgery. The majority of preventable deaths from trauma result from unrecognised intra-abdominal bleeding. Trauma deaths occur in immediate, early, or late stages. Immediate deaths usually are due to apnea , severe brain or high spinal cord injury, or rupture of

16125-460: The victims are frequently the result of triage scores based on specific physiological assessment findings. Some models, such as the START model may be algorithm -based. As triage concepts become more sophisticated, and to improve patient safety and quality of care, several human-in-the-loop decision-support tools have been designed on top of triage systems to standardize and automate the triage process (e.g., eCTAS, NHS 111 ) in both hospitals and

16254-561: The woman is more than 23 weeks pregnant, it is recommended that the fetus be monitored for at least four hours by cardiotocography . A number of treatments beyond typical trauma care may be needed when the patient is pregnant. Because the weight of the uterus on the inferior vena cava may decrease blood return to the heart, it may be very beneficial to lay a woman in late pregnancy on her left side. also recommended are Rho(D) immune globulin in those who are rh negative, corticosteroids in those who are 24 to 34 weeks and may need delivery or

16383-459: The world, particularly in South East Asia and Africa. A global survey by McKinsey & Company in 2022 found that between 28% and 38% of nurse respondents in the United States, the United Kingdom, Singapore, Japan, and France said they were likely to leave their role in direct patient care in the next year. The top five factors which they said would make them stay were: Pay ranked eighth on

16512-530: Was important in caring for patients. In the 19th century, this theory was ideal for helping patients, providing a guide for nurses to alter the environment around patients for the betterment of their health. Nightingale's recommendations built upon the successes of Jamaican "doctresses" such as Mary Seacole , who like Nightingale, served in the Crimean War. Seacole practised hygiene and the use of herbs in healing wounded soldiers and those suffering from diseases in

16641-518: Was killed in the blast, and what followed was a massive informal triage of the victims. Drug stores, clinics, and homes were opened as makeshift triage stations. As the city has no hospital, they had to evacuate casualties to area facilities, including those in Galveston and Houston , with at least one doctor relying on skills he had learned in World War II to inform care decisions. The Korean War saw

#336663