trauma 1cd hhbn class 2016
TRANSCRIPT
https://www.youtube.com/watch?v=sOeVRLtpvrU
Trauma Defined
a: an injury (as a wound) to living tissue caused by an extrinsic agent
b: a disordered psychic or behavioral state resulting from severe mental or emotional stress of physical injury
From: http://www.merriam-webster.com/dictionary
Trauma is:
• Sudden
• Severe
• Shocking
• We don’t see it coming, and we
can’t plan for it
Trauma:• Effects our ability to function
normally• Can shake our belief system• Can change our worldview
“Trauma is a thief. It steals from people. It takes away their sense of well-being, security, predictability, and safety.” – Dr. H. Norman Wright
Trauma Affects the Whole Person
Physical
• Disfigurement
• Internal
injuries
• Disabilities
Cognitive
• Memory loss
• Confusion
• Inability to
make
decisions
• Permanent
brain damage
Emotional
• Fear
• Depression
• Anxiety
• Anger
Spiritual
• Doubting
• Anger
• Withdrawal
• Increased
spirituality
What is Trauma
• A serious injury or shock to the body, as from violence or an accident.
• An emotional wound or shock that creates substantial, lasting damage to the psychological development of a person, often leading to neurosis.
• An event or situation that causes great distress and disruption
What does a Trauma Chaplain do?
The Trauma Chaplain does not try to convert, but rather observes needs; listens to the anger, hurt, frustration,
and pain!
Ministry of Presence Roles
1. Symbolic Representation
2. Tangible Evidence
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Symbolic Representation
a. Professional Spiritual Healer
b. Caring Presence
c. Calming Presence
d. Pastor to Staff
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SACRED STORY
1.What is the role of the Chaplain with the patients
2.What is the role of the Chaplain with the unit family, ?(Squad, Team, Company, BC/CSM)
3.What is the role of the Chaplain with the BN Aid Station Staff? (Doctor, Nurses, Medics)
4.What information would be helpful prior to meeting with the family?
Anesthesia
Medic Medic
Nurse Nurse
Trauma MD
Medication
Nurse
X-Ray
Chaplain
Recorder
Nurse
Head
R L
TRAUMA TEAM MEMBERS
•G-Get the Information•R-Relationships•A-Awareness of Surroundings•C-Community•E-Extended Ministry
GRACE in the ED
• Get the patient's name from the EMTs Medics, ID Tags.
• Know the injury or illness of the patient.• Find out from Medics who if anyone has
followed the patient to the Emergency Department.
• Move to the patient's head on the side of the patient where there is room. This is generally on the left. However, if the medical team is working on the left side move to the right. (DO NOT GET IN THE WAY OF THE MEDICAL STAFF!)
G – Get the Information
• Introduce yourself. (Hello I am Chaplain ______ I come down for every emergency! Let the patient know that they are being taken care of by the best trained staff.
• Helping them to relax by using rhythmic breathing as a source to calm them and helping the staff to focus on the injury can be very helpful.
• Touching the patient is encouraged. However do not cause more pain or get in the way of the medical treatment being given.
• A short prayer or a Scripture Verse can be useful. (Caution: some patients see a Chaplain as a DEATH deliverer. Choose Scripture with care.)
• If possible, find out the names of the patient’s Commander, family, significant relationship or care giver. This will help later in the waiting area meeting with family.
• Establishing a relationship with the Command team/family with an introduction. (“Hello, I’m Chaplain Russell, one of the ED staff. Do you mind if we talk?")
• Minister to them and allow them to accept or reject the offer.
R- Relationships
• Grieving a loss or having anxiety over the trauma is to be expected with the family. Privacy for those in the family can be facilitated with the two quiet rooms located within the waiting areas outside the ED. If a death occurs, your ministry is critical to the family/command as well as the staff.
• Give the family time to grieve. They will usually give verbal or non-verbal cues when they are ready to move.
A- Awareness of Surroundings
Some family members may want to view their loved one’s body. Others may not. Either way let them make the choice and do not ask if they want to view. This may place them into an awkward emotional state. Allow the family to ask if they can see their loved one.
Inform the staff that the family would like some time to see the body. Let the staff have some time to clean and prepare the body. (Many times the staff will move the body out of the trauma room to a secondary room.)
• Always view the body prior to escorting the family. Describe to the family what they will see.
• Escort the family to the viewing and position yourself close to the next of kin.– If it is a legal case, the family may not be able
to touch the body. Have this information before you escort the family to see the body.
– If someone faints, try to lower them to the floor and call for the Medical Staff to assist in their care.
• When the family is ready, escort them back to the quiet room and ask them if they have any questions for the doctor. After that arrange for the AOD or the social worker to come in and attend to any paperwork that needs to be completed.
• Debriefing the staff can be achieved in two ways. (Personal and Informal)Personal debriefings: give yourself a few moments to decompress before going to another call or to a patient on the wards. Drink some water and catch your breath. Informally debrief the staff by letting them know you are there for them. It may be helpful to pull the staff off to the side and allow them to take a knee. Do not force yourself on them!
C-Community
– Pediatric cases can be more traumatizing to the staff and to the Chaplain.
– Follow up with the staff later as well. Some people need time to process the event internally before they will open up to the Chaplain, so make rounds when time permits.
• Enter the event into the Duty log!! Remember to give the Trauma #, the patient’s name, the type of injury, the patient’s religious preference, the time event started and finished, where the patient ended up (CT/ OR/ Ward-Room #) and if you spoke to the family members. Inform the Senior Clinical Chaplain and report all the information at the morning/shift report.
E- Extended Ministry
Summary Review of Main Points
1. Identified the two ministry of presence roles the Chaplain performs on the Trauma Team
2. Stated the four responsibilities of the Chaplain on the Trauma Team
3. Listed the functions of the Chaplain as Priest and Pastor on the Trauma Team
4. Identify the GRACE concept in Trauma Ministry
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QUESTIONS
Your Reactions to Trauma
Expect:• Strong emotions like anger, sadness, and nausea
• Challenges to your beliefs, habits, behaviors
• Are you ready to step out of your comfort zone?
Vignette
Dec 2015
Casualty type Army Navy Marine Air Force TotalHostile 2536 64 852 29 3481
Non Hostile 697 39 171 23 930
Total 3233 103 1023 52 4411
Casualty type
Army Navy Marine Air Force Total
HostileTotal
22,229 646 8626 450 31951
Total Wounded
Total Deaths
What Might you sense?
See: Blood, Broken Bones, Burns, Controlled chaos Hear: Yelling, Sounds of Combat, Nothing at all!Smell: Burt flesh, Garlic smell, Pine, Taste: Salty sweat, dirt.Feel: Anger, Fear, Sadness, and Nausea, High adrenalin Rush.
Dec 2015
Combat TraumaGreen Phase
Red Phase
Black Phase
Gun Shot Wound Avulsion
Open tib-fib fraction
Vignette
Chaplain Vignette
• You are the Chaplain of the 2/7 Cavalry 1CD. On your first day of deployment one of your fire teams is attacked by a sniper with one casualty. SPC Waterson has a head wound and is evacuated to the BAS. When you arrive with the command team you encounter the Doctor, Nurse Anesthetist, PA and the Medics arguing over to continue care on SPC Waterson or to terminate care.
Chaplain Vignette
1. SPC Waterson is still conscious, however, the head wound is expected to end in his death.
2. Who is/are the identified patient/s?3. What is your role in the situation to
continue care?4. How do you perform you 3 major
chaplain competencies?
HIPPA • Everyone who will be on-call at
CRDAMC must be HIPPA Certified.• Take a copy of your Certificate to the
DMPC with your SSN on it. This is to be placed in your file for security reasons.
• https://medchart.ngb.army.mil/lod/Public/HIPPA.aspx
Resources• Gateway To PTSD Information
GriefNetInternational Society for Traumatic Stress StudiesNational Center for PTSD
• Books:• "Compassion Fatigue: Coping with Secondary Traumatic Stress." Charles Figley,
PhD."CopShock, Surviving Posttraumatic Stress Disorder." Allen R. Kates."Covering Violence: A Guide To Ethical Reporting About Victims and Trauma." . William Cote and Roger Simpson, Columbia University Press."Disasters: Mental Health Interventions (Crisis Management Series).". John D. Weaver, PhD.The International Handbook of Traumatic Stress Syndromes Dr. John P. Wilson & Dr. Beverly Raphael, Editors, Plenum 1993."Post-Traumatic Stress Disorder-A complete guide to PTSD." Aphrodite Matsakis, Ph.D. Author, New Harbinger Publications, Inc., 1994."Post Traumatic Therapy and Victims of Violence." Brunner Mazel Publishers Frank M. Ochberg, M. D. (1988).
• https://www.dmdc.osd.mil/dcas/pages/report_oif_woundall.xhtml