Evidence-Based Practice Guidelines for Trauma Care

Anumber of proven evidence-based guidelines are in place for accident and injury prevention. A couple of well-known examples are seat belts and child safety seats. Although the number of lives saved with these policies continues to increase, until our society lives injury free, we will continue to need to provide trauma care. Evidence-based guidelines for trauma care encompass 3 distinct venues of care: prehospital care, ED care, and ICU care. In the ICU, protocols exist regarding the prevention and management of ventilator-associated pneumonia, central line–associated bloodstream infections, and many other patient-related issues. The American Association of Critical Care Nurses has a library of practice alerts that address nursing and multidisciplinary activities important to critical care practice. These alerts are an effort to provide guidance and standardize critical care practice and are reviewed and updated regularly to reflect current literature. ENA supports evidence-based practice through the Institute for Quality, Safety and Injury Prevention (IQSIP). IQSIP provides subject matter expertise on issues related to practice, quality, safety, injury prevention, and wellness. A great deal of information is included in the IQSIP repository, but very little of it deals specifically with the care of trauma patients in the emergency department. ENA does offer both the Trauma Nurse Core Course and the Course in Advanced Trauma Nursing. Both of these courses provide didactic and skills components for the nursing management of trauma patients in the emergency department and are based on the most recent literature. Guidelines published by the American College of Surgeons (ACS) address both the ICU and ED management of trauma patients. The ACS is the agency that verifies and credentials trauma centers in the United States and sponsors the Advanced Trauma Life Support Course. The programs sponsored by the ACS include education, professional development, standards of care, and assessment of outcomes. The ACS manages the repository for the National Trauma Data Bank and the Trauma Quality Improvement Program. With the data collected, research has been conducted to assist in creating evidence-based protocols for care in both the ICU and the emergency department. Another agency involved in the development of trauma care protocols and guidelines is the Eastern Association for the Surgery of Trauma (EAST). EAST publishes practice management guidelines for trauma care that are systematically developed statements to help practitioners and patients make decisions about appropriate health care for specific clinical circumstances in accordance with the Institute of Medicine Report on Clinical Practice Guidelines. EAST published guidelines in 2010 on the triage of trauma patients that are related to the specific management of the trauma patient in the prehospital and ED settings. These guidelines include triage in both the prehospital and ED setting and present the conclusion that a more comprehensive definition of the trauma patient requiring trauma center care needs to be developed. EAST has convened a subcommittee to work toward developing a more comprehensive definition that will also consider major trauma, complex care, resource availability, and regionalization of care. Another guideline published by EAST related to trauma care is the 2008 prehospital fluid resuscitation guideline. This guideline states that few data support the practice of prehospital venous access placement and fluid resuscitation. The practice recommendation from this guideline is that if venous access is obtained, it should be obtained en route to the trauma center and that fluid resuscitation should be withheld in patients who are alert or have a palpable radial pulse. A third guideline published in 2010 outlines the recommended procedure for blood transfusion in trauma patients. This work is guiding the development of evidence-based massive transfusion protocols in use in trauma centers. Kathryn Moore, Member, Bluegrass Chapter, is Assistant Professor, University of Kentucky College of Nursing, Lexington, KY.