Trauma-Informed Care for Violently Injured Patients in the Emergency Department.

Violent traumatic injury remains a common condition treated by emergency physicians. The medical management of these patients is well described and remains an area of focus for providers. However, violently injured patients disproportionately carry a history of physical and psychological trauma that frequently affects clinical care in the emergency department. The alteration of our clinical approach, taking into consideration how a patient's previous experiences influence how he or she may perceive and react to medical care, is a concept referred to as trauma-informed care. This approach is based on 4 pillars: knowledge of the effect of trauma, recognition of the signs and symptoms of trauma, avoidance of retraumatization, and the development of appropriate policies and procedures. Using this framework, we provide practical considerations for emergency physicians in the delivery of trauma-informed care for violently injured patients.

Pain sensitivity in sleepy pain-free normals.

STUDY OBJECTIVE: Past studies have shown that acute experimental reduction of time in bed in otherwise healthy, non-sleepy people leads to hyperalgesia. We hypothesized that otherwise healthy, sleepy people may also exhibit hyperalgesia relative to their non-sleepy counterparts. DESIGN: Between-groups sleep laboratory study. SETTING: Hospital-based sleep disorders center. PARTICIPANTS: Twenty-seven, healthy, normal participants (age 18-35 years) were recruited and categorized into sleepy and non-sleepy groups based on their average sleep latencies on a screening multiple sleep latency test (MSLT). INTERVENTIONS: Both groups were then allowed 8 hours time in bed, following which they underwent pain sensitivity testing (10:30 and 14:30) and sleepiness assessments by the MSLT (10:00, 12:00, 14:00, and 16:00). Pain sensitivity assessments were made by measuring finger withdrawal latencies to a radiant heat source delivering 5 different heat intensities. MEASUREMENTS AND RESULTS: This study showed that after only one night of 8 hours time in bed, the sleepy participants continued to be sleepy and exhibited a more rapid finger withdrawal response (i.e., increased pain sensitivity) to radiant heat than non-sleepy participants. CONCLUSION: This suggests that sleepy individuals experience hyperalgesia in response to a painful stimulus when compared with non-sleepy individuals.

Time Well Spent: Patient Industry and Occupation Data Collection in Emergency Departments.

OBJECTIVE: No comprehensive national system tracking work-related diseases and injuries exists in the United States. Industry and occupation (I/O) are the missing data elements that would make existing healthcare data useful for occupational health. The authors previously petitioned the National Uniform Billing Committee (NUBC) to adopt I/O standards for states to consider during their healthcare data rulemaking processes. METHODS: The NUBC asked for a pilot study to ascertain the potential burden. The time and cost to ask I/O questions in two hospital emergency departments was evaluated. RESULTS: Asking four I/O questions required 48 seconds on average and cost between $520 and $623 per Registrar per year. The annual cost for the two hospitals to gather I/O on every patient was $4160 and $15,000. CONCLUSIONS: We conclude no undue burden compared with the estimated $250 billion cost of occupational illnesses and injuries.

The Youth Nonfatal Violent Injury Review Panel: An Innovative Model to Inform Policy and Systems Change.

Among young people in the United States, nonfatal violent injuries outnumber fatal violent injuries by 171 to 1. The Child Fatality Review Team (CFRT) is a well-established model for informing injury prevention planning. The CFRT's restricted focus on fatal injuries, however, limits its ability to identify opportunities to prevent violent reinjury and address issues unique to nonfatal violent injuries. We adapted the CFRT model to develop and implement a Youth Nonfatal Violent Injury Review Panel. We convened representatives from 23 agencies (e.g., police, housing, and education) quarterly to share administrative information and confidentially discuss cases of nonfatal violent injury. In this article, we describe the panel model and present preliminary data on participants' perceptions of the process. Although outcomes research is needed to evaluate its impacts, the Youth Nonfatal Violent Injury Review Panel offers an innovative, promising, and replicable model for interagency collaboration to prevent youth violence and its effects.