Family Presence, IO, and Exaggeration

[Bjorn, Pret]

As an emergency nurse with no shortage of constructive criticism for the
ENA, I must nonetheless defend objective reality.  

The history of both Family Presence and IO access threads on the
Trauma-List feature a tiresome tendency toward hyperbole, bordering on
outright fiction.  Ken, you sound like Dick Cheney telling a fundraiser
audience that DEMOCRATS WANT THE TERRORISTS TO WIN.

Although it shares much of the blame for ignoring this sort of false and
inflammatory interpretation, I am all but certain that the ENA has not
included laparotomy or thoracotomy or craniotomy among its list of
invasive procedures (IP's).  As far as I am aware, IP is meant mostly to
describe activities like IV starts, wound repair, tube & catheter
insertions and the like.  There is emerging experience at a variety of
fine hospitals (including Parkland and Harborview) that carefully
implemented and protocol-driven family presence is a proper and
typically positive experience for patients, families, and -- perhaps
surprisingly -- even healthcare providers.  And I defy anyone to find
evidence that force or coercion have anything to do with it, for anyone
involved.

Further, it is unfair to presume that trauma is not the world's only
disease, nor is the OR the planet's only healthcare setting.  Both
Family Presence and Intraosseous Access have indications and variously
established benefits outside the experience of the finest trauma
surgeons.

Times are tough enough without us inventing things to be angry or afraid
of.

Leaders of the Trauma-List should strive for more civil and constructive
debate.

As if I can talk.

Pret Bjorn, RN
Bangor, ME USA


-----Original Message-----
From: trauma-list-bounces at trauma.org
[mailto:trauma-list-bounces at trauma.org] On Behalf Of kmattox at aol.com
Sent: Saturday, October 14, 2006 9:39 PM
To: revegg at att.net
Cc: gabiford at hotmail.com; trauma-list at trauma.org; Ccml
Subject: Re: ccml IO again

The ENA has been trying to FORCE surgeons to allow family members in the
OR site for major surgery in the EC for almost a decade.   This is yet
another attempt to do something far beyond their understanding.    

K


Sent via BlackBerry, return via KMattox at aol.com
  

-----Original Message-----
From: revegg at att.net
Date: Sun, 15 Oct 2006 01:19:50 
To:KMATTOX at aol.com
Cc:gabiford at hotmail.com, ccm-l at ccm-l.org, trauma-list at trauma.org
Subject: Re: ccml IO again

Ken,
I believe the statement was "Family Presence during a CODE" and yes,
this is common practice and one that is favorably acceted by family
members who WISH to be present, not forced. 
I do accept your statement that family members should not be in the OR,
there are too many issues regarding that openness. 
Contamination is a big one. Not really understanding the process and
procedure, limited anatomic, scientific knowledge are among the other
big ones. Unfortunately, the misunderstanding is understandable.

 -------------- Original message ----------------------
From: KMATTOX at aol.com
>  
> In a message dated 10/14/2006 7:00:29 P.M. Central Standard Time,  
> gabiford at hotmail.com writes:
> 
> Take a  chill pill, K.  ;)
> 
> 
> Not required. 
>  
> 1.    The predominant discussion at the AAST and the  ACS was that 
> prehospital  and emergency room post traumatic hypotension  care was
to allow 
> permissive 
> resuscitation and RESTRICT  fluids.     Aggressive fluids resulted in 
> repeated  documentation of unacceptable complications.    Should this
be  true 
> and 
> the predominance of evidence is that it is, then the need for IO and
other 
> large bore venous access for large volumes of fluid becomes a mute
point.   
>  
> 2.    The last I checked, the predominant nursing  organization
interacting 
> with trauma systems, trauma surgeons, and hospital  policy was the
SOCIETY OF 
> TRAUMA NURSES, not the ENA.   AND the policy  regarding who is in the
OR (or an 
> OR surrogate location such as the trauma  resuscitation area of the
emergency 
> center), is the surgeon, not a national  nursing organization.  The
trauma 
> surgeons have repeatedly stipulated that  the policy of having family
members 
> present during surgery is NOT A GOOD  IDEA.   After the surgery is
over (either 
> in the holding area of the  EC or the PACU) surgeons have no problem
with the 
> family visiting the patient in  keeping with hospital policy.     
>  


> I would recommend that chill out pills are not needed by the surgeons,
but  
> common sense pills are needed by other clip board carrying policy
making do  
> gooders who have lost contact with reality.  
>  
> k
>  
>  
> I just returned from a local trauma course.  One of the topics was, of

> course, intra osseous needles.
> The general opinion was that they were  being used more than in the
past. 
> With the newish screw tips, people claimed  they were easy enough to
insert.
> 
> Two ER nurses in attendance stated they  had IOs placed and found the
pain 
> related to the insertion to be minimal --  comparable to having an IV
cath 
> placed.
> 
> Also, was told that the  official position of the ENA (Emergency
Nurses 
> Association) is in favor of  family's presence during codes.
> 
> Take a chill pill, K.   ;)
> 
> Gabi, RN
> 
>