Are health professionals getting caught in the crossfire? The personal implications of caring for trauma victims.

OBJECTIVES: To investigate the long term psychological sequelae of treating multiple victims of traumatic incidents, such as violent crime and motor vehicle accidents, and to assess staff exposure to violent patients in the emergency department. METHODS: A self administered questionnaire booklet was distributed to all full time and part time staff working within the Johannesburg Hospital Trauma Unit during September 2002. Participation was voluntary. The questionnaire was specifically designed for the study as no relevant, validated questionnaire was found to be suitable. Psychological assessment comprised two standardised measures, the impact of event scale-revised and the Maslach burnout inventory. RESULTS: Thirty eight staff members completed the questionnaire, a response rate of 90%. Over 40% of respondents had been physically assaulted while at work and over 90% had been verbally abused. Staff reported a significant level of post-traumatic symptoms, evaluated by the impact of event scale-revised (median = 17.5, range = 0-88), as a result of critical incidents they had been involved in during the previous six months. At least half of the respondents also reported a "high" degree of professional burnout in the three sub-scales of the Maslach burnout tnventory-that is emotional exhaustion, depersonalisation, and personal accomplishment. CONCLUSIONS: Preventative measures, such as increased availability of formal psychological support, should be considered by all trauma units to protect the long term emotional wellbeing of their staff.

A prospective study of 1000 hernias: results of the Plymouth Hernia Service.

BACKGROUND: A hernia service within a general hospital was prospectively evaluated to establish whether evidence-based protocols could deliver results comparable to those reported from specialist hernia clinics. METHODS: Protocols were devised according to established models. With the support of a nurse specialist, 1015 patients with inguinal hernia were treated. Quality-of-life analysis was undertaken using the Short Form 36. RESULTS: Patients ranged in age from 16-98 years (median, 56 years). Ambulatory day-case surgery was achieved in 820 patients (81%), with local anaesthesia in 891 (88%). Wound infection occurred in 10 patients (0.98%). Wound haematoma requiring surgical intervention occurred in three patients. Two patients formed wound seromas that settled spontaneously. One patient developed ischaemic orchitis resulting in testicular atrophy. At 5 days after operation, 91% of patients had returned to normal activity. At 1 year, 7 patients (0.7%) had pain sufficient to limit normal activity or employment. There were 8 recurrences (0.78%) at a median follow-up of 2.5 years. Quality-of-life was enhanced at 1 year postoperatively. CONCLUSION: A protocol-driven hernia service within a general hospital can provide patient outcomes comparable to specialist hernia clinics.

Bullet markers--a simple technique to assist in the evaluation of penetrating trauma.

Radio-opaque markers in penetrating trauma are useful in both the clinical evaluation of the injuries and in the permanent record of the location of the wounds. The use of an unfolded paperclip taped over the wound as a marker is recommended as a valuable adjunct in the radiological evaluation of penetrating trauma.