Physiotherapy Trauma Talks
In Physiotherapy Trauma Talks we discuss the key roles that physiotherapists and other healthcare practitioners play in the management and rehabilitation of patients with traumatic injury. Experts in trauma care offer their insights about in-hospital patient care and post-discharge follow up service delivery. New research in the field of trauma care and rehabilitation is shared to provide answers to your questions.
Physiotherapy Trauma Talks
Unlocking the Secrets of Trauma Nursing with Dr. Santel de Lange
What if the journey to becoming a trauma nurse could lead you to unexpected adventures in aviation medicine? Join me as I welcome Dr. Santel de Lange, an expert in trauma and emergency care nursing from Stellenbosch University, to Physiotherapy Trauma Talks. Dr. de Lange shares her inspiring path from emergency units to the skies, providing critical care on air ambulance flights. She illuminates the indispensable role of trauma emergency care nurses in the fast-paced environment of emergency departments. With insights into the use of Advanced Trauma Life Support (ATLS) principles, she explains how nurses are crucial in triaging and managing patients with multiple injuries. Through a combination of expert assessments and critical interventions, Dr. de Lange highlights the teamwork that defines successful trauma care.
Podcast website: https://physiotherapytraumatalks.buzzsprout.com
‘Cardiopulmonary Physiotherapy in Trauma: An Evidence-based Approach’ published by World Scientific: https://doi.org/10.1142/13509
Hi there, fellow physiotherapists. I am Helene van Aswegen, your host for Physiotherapy Trauma Talks, where we discuss everything related to trauma care. So if you are passionate to learn more about physiotherapy in the field of trauma to ensure that you provide the best possible care for your patients, then this is the right podcast series for you. So today I am joined by Dr Santel De Lange, who is a lecturer in the Department of Nursing and Midwifery in the Faculty of Medicine and Health Sciences at Stellenbosch University of Medicine and Health Sciences at Stellenbosch University, and together we are going to talk about the role of the trauma emergency care nurse in the management of patients with multiple injuries. Santel, thank you so much for joining me today.
Speaker 2:Thank you very much, Helene, for inviting me to this interview today.
Speaker 1:It's my pleasure, santel, as we start, would you mind just introducing yourself to our listeners and telling them what made you interested in working in the field of trauma and emergency care nursing?
Speaker 2:Thank you very much, eliane, as I said, for the invitation to talk to you today. So I am an emergency nurse. I did my training and completed my postgraduate training in trauma and emergency nursing in 2011 and have worked in trauma and emergency units basically ever since I completed my basic nursing training. So it has been a great passion of mine since I completed my basic emergency nursing training to start into my emergency nursing, and it's actually a bit of a strange story how I got into this, as I met my now husband during my emergency basic training of nursing training and we there I obviously got exposed. He was a paramedic and I got exposed to the pre-hospital environment and emergencies, together with the emergency training that we received during our basic training, and so when I completed my nursing, I decided at the spur of the moment that, yes, trauma and emergency nursing is what I want to go and do further. So I then enrolled at the very last minute, I did application and registration at the university and started with my postgraduate diploma in trauma and emergency nursing.
Speaker 2:And ever since then I have been involved in it. I've worked for quite a few years post my training in clinical, the clinical environment. I only came into academics four years ago, so I have spent quite a majority of my career in clinical practice and my love since I started with it has just grown. Even the pre-hospital environment has also been a great interest of mine, and then I also even did a little bit of aviation medicine and also did that for about three, four years, where we would fly patients from different countries back to South Africa, which also involves quite a lot of trauma and emergency care of these patients when we pick them up. So yeah, and that is how I got into trauma and emergency nursing and now I'm lecturing in trauma and emergency nursing. So still involved in it.
Speaker 1:Yeah, that's fantastic and it really sounds like such an exciting field to work in, especially with the air ambulance service bringing patients to the trauma centers. That really sounds quite fascinating. I spoke in a previous episode with Professor Timothy Hartcastle, a trauma surgeon from Durban, and he mentioned that when patients with multiple injuries arrive at the emergency department, they are managed according to the principles of ATLS. I was wondering whether you can maybe tell us a little bit about the role of the trauma emergency care nurse in that setup in the emergency department.
Speaker 2:Yes, sure. So we use those ATLS principles. When a patient arrives at our emergency centers, they will be triaged, so we'll get a quick initial history from them, we will do some vital signs and, based on the information that we receive, we will then allocate a specific triage color to them to assign a specific priority. So obviously, the more severely injured a person is, the highest priority they will get, and we will start with their initial treatment, where we will then follow the ATLS principles and start with our assessment. So part of the ATLS principles is to start off with what they call a primary survey. So that's just basically doing a quick assessment on the patient and try and identify whether or not there are any life-threatening injuries that needs immediate management, and then we can go over to do a more focused assessment after that.
Speaker 2:So our role as the emergency nurse is that, together with the doctors that we are working with, we will conduct the assessment. If we identify any priorities that needs interventions, we will assist to get all of the equipment and everything ready to perform the intervention. In our scope of practice as an emergency nurse, we can perform some of the interventions on our own. Others can only be performed by the medical doctor. So we will then just assist in conducting those procedures and assisting the doctor with the implementation, in conducting those procedures and assisting the doctor with the implementation, and then we have the big role after that to then monitor and evaluate the patient's response and to do a continuous assessment to make sure that there's improvement and that the patient is not deteriorating, and if there's any change in condition, that we then alert the doctor and then perform any other further assessments or interventions.
Speaker 1:Okay, yeah, so a very fast paced and, I would think, a high stress environment.
Speaker 2:The emergency care department yeah, no, very high paced.
Speaker 1:You mentioned that there are some procedures that the emergency care nurse can do during the primary and secondary surveys. Would you mind expanding on that a little bit? Yes, certainly.
Speaker 2:So some of the interventions that we can do, for example, if we look at the airway, which is our first thing, so we follow the A, b, c, d, e approach. So when we look at the A for airway we can do the full-on assessment. For all of these A to E approach, we will assess the airway, see if the person can talk. If they can't talk we would say it's open. If they are not able to, then we will need to intervene.
Speaker 2:And some of the interventions can then be like, for example, to do what we call a head tilt, chin lift, so where we just tilt the head back so that we can open up the airway. If that is sufficient to open the airway, then we can also go and add some of the basic airway adjuncts, for example like inserting a oropharyngeal tube, so it's a little tube that we just then place into the mouth to just keep the tongue away and to keep the airway open. And then, if we go over to breathing, to assist with that intervention that we just did, we can then use what the back valve mask to just deliver breaths for a patient if they are, for example, not breathing. So that's just some of the interventions.
Speaker 1:Yeah, that sounds really interesting. Did you ever encounter physiotherapists that work in an emergency department with trauma patients the less severe trauma patients, I would think? To give them walking aids and teach them how to use those before they're discharged.
Speaker 2:Yes, I have. As you mentioned, usually when they are more stable, less severely injured, then we are ready to discharge them home. We also have to provide them with certain aids, like maybe crutches after we've applied a plaster of Paris or a back slap for a fracture, and then we have had the assistance of physiotherapists that would come and give some advice and some to the patients and then also a referral for patients to follow up with physiotherapy once they are discharged from our department, so that can help with their further healing and also obviously prevent further complications.
Speaker 1:Okay. So coming back to the more severely injured patients, when they go out of the emergency department to theatre and then to the ICU setting, is the role of the trauma nurse any different from what it is in the emergency department?
Speaker 2:What we will do usually as the emergency nurse is that we will prepare them to go for the procedure to the theatre, or we will prepare them, we will stabilise them, treat all of the severe injuries, do all of the necessary investigations in order to the ICU or the theatre.
Speaker 2:And that is almost where our role will then stop when we hand over that patient to the next healthcare professional. That is then where they will take over the responsibility to for the care of that of that patient. So then our role, our role in the patient management, actually then stops in a way, if you can call it like that, and then it's given over to the next person. So our role of the emergency nurse there would basically just be to observe the patient while we take them to the next ward, and then just a hand over and making sure that we transfer all of the information that we have about the patient what was done, etc. Their condition to the next person in order for them to now continue with care and that there's no break in the continuity of patient care.
Speaker 1:And I suppose communication is really important in that aspect. Written communication and also verbal communication? I would think yes, definitely. So. I know that we talked about physiotherapy working within the emergency care department, helping patients with their discharge and then following them up as outpatients within the physiotherapy practices. Is there any instance where, as an emergency care nurse, you would expect a patient that came to your department with a traumatic injury and they've been discharged home to come back and to see you again for follow-up?
Speaker 2:We don't usually see them in the emergency departments for follow-up. In some hospitals they do have follow-up systems in the emergency department, especially for those patients that has work injuries as part of workman's compensation. So they will go back. They will go for their follow ups at the emergency department, but you do not. That's more in some of the private hospital institutions In government, depending also on the type of hospital, whether or not they will receive referrals.
Speaker 2:So our big tertiary hospitals, the emergency departments, usually do not get the follow ups back to them. We will refer them to go back to either the district level hospital or their primary health care clinic, their primary healthcare clinic. So that is actually where we rely quite a lot on the primary healthcare clinics for the follow-ups of these patients. So they will get their referral letter and they will then go back there for do all of the initial follow-ups with, whatever the type of service that they need to receive, and should there then be complications again that require more advanced interventions that can't be done on that level, then they will refer them back to us.
Speaker 1:Okay, yeah, no, that sounds very appropriate. I wondered based on your experience as a pre-hospital nurse and also as a nurse within the emergency department. You see many cases of trauma and I was just wondering if you have any thoughts to share with our audience regarding what can be done towards trauma prevention or injury prevention, specifically in South Africa, where we know that the incidence of trauma is so high.
Speaker 2:Yes, Now our incidences are very, very high. I was telling someone this morning, actually, about just how sad it is actually to see the amount of violence that we have in our province alone, and that was very evident with us working very closely in the hospital for this week, and it's really something that there has been a lot of effort that has been put into injury prevention and in education of the community. But I do think that these we might have campaigns where there is injury prevention programs done and there's some education giving to communities, but then everything is quiet again. So it's almost as if there's these bursts of prevention programs and then we keep quiet and then we see, oh, it's a problem, and we do it again. So I think it is really something that we would need to do more consistently and more prominently and really to identify those communities where those injuries are most or more prevalent maybe than other communities and to concentrate efforts towards that.
Speaker 2:I also do think that it is a collaborative approach that needs to be followed, so we do need to get all the different stakeholders and role players to help with this and it shouldn't be just something that comes from healthcare professionals and we tell them about, not how to store safely their poisons, for example, and how to stay, but it should be something that comes from safety and security and all of those different stakeholders also should be involved for combined primary and injury or injury prevention programs. And then it should be something that should be done continuous, because, yeah, we are one of the countries, as we all know, with the highest burden of trauma injuries and, yes, yeah, it's definitely, if we can get this right at primary level, then our prevention level, then already it should reduce our injuries that we see in hospital quite significantly.
Speaker 1:Yes, I agree, and I feel that it's also the responsibility of all the health care workers that work in trauma care to be more vocal about injury prevention and also using platforms like social media to promote injury prevention. Yeah, so it's a huge job, but I think, you know, if we do a little bit more frequently, then hopefully at some stage we'll see a change.
Speaker 2:Yes, definitely, definitely. All the small little bits gets a lot at the end. And yeah, if you want to just do their little part, and not just on big days where we need to create awareness. But it should be a continuous yeah, it should actually be part of our daily conversations.
Speaker 1:Yes, for sure, Santel. As we finish off our discussions, are there any last words or thoughts from your side that you would like to share with our physiotherapy listeners?
Speaker 2:Yes, I can say that for us in emergency nursing and in emergency care, the physiotherapist really does play quite a big role. We can do all the initial emergency management and we can put that fracture or that injury in a sling or in a cast, but it is actually the rehabilitation afterwards that that needs. That plays a huge role on how what the outcome would be for that patient at the end. So I do think that you're working very closely together between the two disciplines is something that's also really important and that we can't go without one another actually.
Speaker 1:Yes, yeah, no, I totally agree, Santel. Thank you so much for your time. It's been lovely to have you on the show and hopefully we'll have opportunities in the future to invite you back again.
Speaker 2:Thank you very much for the invitation, eliane, and yes, hopefully I'll speak to you soon again.
