Honoring the Work of Pediatric Nurses

Children who are victims of trauma are some of my favorite and most memorable patients. I work as a Pediatric Nurse Practitioner at a children's hospital in Winston-Salem, N.C., as part of the team caring for pediatric trauma patients. I love taking care of kids because they do not complain, they are brave, and they do everything within their abilities to resume playing. Yes, kids with injuries can be whiny and irritable and scared, however they are easily distracted most of the time from their immediate circumstances. They have resilient spirits.

Imagine this: a 6-year-old boy with full thickness (third degree) leg burns singing silly songs during a painful dressing change, or a 10-year-old girl with a severe brain injury and multiple fractures, smiling like a sunbeam at a Border Collie therapy dog. Determination and perseverance are very evident in most of our patients. There are moments of joy and heartbreak every day.  I am blessed to be so rewarded by the small steps that the children take toward recovery from their injuries.

The role of a pediatric nurse practitioner is to view the whole child and his or her physical, psychological, and spiritual needs within the family and community. We try to anticipate the journey for an injured child and ensure that physical therapy, occupational therapy, counseling, play, family bonding and rehabilitation services are started in the hospital and continued after they leave us. We advocate for excellent pain control and superlative care. We teach patients and their families about their injuries and about the specific care they will need to learn, such as cast care, spine care, or wound care.

People often comment that it must be sad or difficult to be a nurse that works with children.  I like to reply that it is the best job in the world. When I am discouraged by the horrific injuries that some of our patients suffer, I pour my energy into promoting injury prevention for children. I wish more people in our society could see the importance of kids in car seats, wearing seat belts, and wearing helmets.  I would like to see the end of children riding on lawn mowers and ATVs. The public does not realize how life threatening, life-changing and devastating that the injuries caused by these large motorized vehicles can be. I am committed to any and all efforts to improve the care that we provide for pediatric trauma patients.

- Debbi Thomson, Co-Chair of the Trauma Special Interest Group of the American Pediatric Surgical Nurses Association

Sami's Story - an International Success

I am a surgeon in the Department of Paediatric Surgery at University Children‘s Hospital (UKBB) in Basel, Switzerland.  Only one week after the first Global Cast/Childress Institute for Pediatric Trauma international webinar on pediatric trauma management in 2012, we were able to save the life of a five-year-old boy, Sami, using techniques learned during the webinar. 

Sami was injured on a Swiss mountain farm - his abdomen was crushed between the tire of a tractor and a gate post. He immediately complained of severe abdominal pain and became very pale. At the regional trauma hospital, a CT scan revealed massive amounts of free fluid in his abdomen and thorax, which was due to bleeding of the liver, pancreas and spleen.

When he arrived by helicopter transport at our pediatric trauma center, his body was suffering from severe hemorrhagic shock. As recommended in the pediatric trauma webinar, my team utilized the new concept of damage control resuscitation and surgery to treat Sami's condition.

Sami underwent an emergency laparotomy to stop the ongoing abdominal hemorrhage.  The bleeding sites of the liver, spleen, and pancreas were controlled in the two-hour procedure and two parts of the spleen were preserved. Immediately after his surgery, Sami was transferred to the pediatric intensive care unit for further care.

Four weeks after his injury, Sami returned to his mountain farm home and has been well ever since. The pediatric-trauma-specific education provided by the webinar and the Childress Institute helped us to save the life of this five-year-old boy. The suggestions and opinions of the panelists that participated in the webinar were very helpful in the postoperative management of Sami.

Knowledge gained from these webinars is of considerable value, especially since it is not freely available elsewhere. It is even more valuable to the families that benefit directly. Everyone counts on the fact that a child’s doctor or surgeon knows the best procedure in an emergency, and these webinars connect us across the world in ways we usually cannot on our own. Having access to innovative techniques saves lives. Sami is one of them.

- Dr. Johannes Mayr

Meredith's Story - Brain Injury Awareness

March is Brain Injury Awareness Month and since brain injury is one of the most prevalent critical injuries children experience it seems appropriate to include the topic in our blog this month. Traumatic brain injury (TBI) is a form of acquired brain injury, occurring when a sudden trauma causes damage to the brain. Like other forms of pediatric trauma, brain injuries don’t discriminate, they can happen anywhere, at any time, to any child.  The timely access to expert trauma care makes all the difference for these patients and can dramatically affect survival rates and future quality of life. 

The Cross family learned how important it is to have appropriately trained first responders and a Level I Pediatric Trauma Center to provide emergency care. Their 15-year-old daughter Meredith was riding her horse without a helmet when she fell off, hitting the back of her head on a concrete pad. She sustained a life-threatening head injury that required emergency air transportation, CT scans and care from pediatric neurosurgeons. Meredith’s care included multiple procedures and surgeries by highly skilled pediatric specialists that were available at a Level I Pediatric Trauma Center.

Because of the expert care she received, Meredith is back at school, playing in the marching band and almost fully recovered.

Not everyone is lucky enough to have the access to expert care that Meredith did, but they should.  Where you're injured does make a difference.  There is little time to travel long distances to the "best" place for care.

We should push for access to high-quality, expert pediatric trauma care for all children in the U.S. – no matter when or where they get hurt - and encourage everyone we know to do the same. 

There are also things you should know that are proven to improve your child’s outcome if they are injured:

• Call 911 for all serious injuries - it's a proven fact that chances of survival are greatest if care is received within a short period of time after a severe injury
• Know the location of your nearest trauma center - the risk of death for injured children is significantly lower when care is provided in a trauma center
• Ask your emergency responder to take your child to a trauma center if at all possible, and more specifically, a pediatric trauma center if one is close enough
• Advocate for increased medical education in your community - emergency medical technicians and other emergency care givers need specialized pediatric medical education to increase effectiveness for treating seriously-injured children 

If your child suffers a TBI or any other type of life-threatening injury and doesn't receive highly-trained care immediately, then your family's life could change forever. Children need you to be their advocates. Be informed about your options and how we can all improve care for our children when they are injured. With your help we can change the outcome from devastation to hope for many children and their families, and help ensure a happy ending to their story – just like Meredith’s. 

To hear Meredith and her family tell their story, visit http://bit.ly/1qvWH0N. For more information about brain injuries you can visit the CDC’s Injury Center at http://www.cdc.gov/traumaticbraininjury/ or the Brain Injury Association of America at http://www.biausa.org/.

International Perspective from Dr. Meredith

In the United States, trauma is the number one killer of kids. In the world, especially the third world, but depending on the country, it is second or third to infectious diseases and birth-related problems.

As those issues improve and sanitation improves and vaccinations improve, trauma is rapidly becoming a greater percentage of the deaths of children than ever before. Fortunately it's because the other diseases are becoming less frequent and less fatal. It's good that they're becoming less frequent and less fatal, but it's bad that trauma is not becoming less frequent and less fatal. Trauma is, in fact, globally becoming more frequent. It is more fatal in many parts of the world, injury per injury, than it is here.

There are several reasons for that. The first reason that it’s globally becoming more common is as you industrialize countries and the economies of countries improve, there's a lot more traffic. There's a lot more development needed in the supporting infrastructure: in the safety, in the emergency response, the treatment knowledge, and all the pieces that we've taken for granted in this country for years. The infrastructure is not there in a lot of countries, especially third world countries.

There are a lot of transportation injuries that are fatal to children. There are a lot more fires that are fatal to children, and sadly, war. There's a lot of war. I participated in a global web symposium last week that connected surgeons, emergency physicians and nurses to share knowledge about techniques and experiences that can help everyone. In these webinars, we have talked a lot about blast injury effects, and some other things that you would not otherwise know about. Part of the reason is that citizens and physicians of this country need to be made aware of it.

It's rare here, but we have our Boston Marathon bombings, and when these catastrophes occur, people need to be able to step up and know. You need to train and drill on things that are not common. Also, you need to learn from the experiences of people in our military and other places, experts that can inform the physicians in the world where these injuries are not uncommon. Without the international and convenient capability of the webinar medium, we wouldn’t be able to gather this knowledge or connect with such a broad audience.

Reducing the number of children dying from critical injuries is easier to attempt with the current technology for these webinars that can transmit knowledge worldwide. There is a huge appetite for this kind of knowledge, especially because it’s available and of interest to our colleagues around the world. These medical professionals need educational opportunities about pediatric trauma.

Additionally, there are some types of injuries that are relatively rare for us that other people around the world see that we need to know about. There are brilliant, creative people who are treating and taking care of patients in very austere conditions with very few resources who have come up with ideas that will be helpful to the other members of the world community. They will be helpful to us even though we have more resources in the highly-industrialized world.

The pediatric trauma web seminar I participated in is the busiest one that the provider, GlobalCast MD, hosts. We had approximately 1,400 attendees from 26 countries around the world. Of all the pediatric health seminars that they host, this is the most well-attended, most highly subscribed, by quite a margin. It just goes to show how ubiquitous the problem is and how thirsty people are in the world for these solutions.

Good smart ideas are still good smart ideas. Creating this network, this community of individuals committed to improving the fate of injured children is in-and-of-itself a good thing. It is a good thing at an intellectual level. It's a good thing at a humanitarian level. It's just the right thing to do.