I’m not sure how we ever used to manage multi-traumas. We must have been frightfully underprepared. Back in the days before mandatory training we relied, rather guilelessly, on experience, a suite of knowledge from texts and journals and M & M meetings, the good-will of a team, and the wisdom of our trauma specialists. A precarious position, you’ll agree. And an area where you were never entirely clear whether you, and what you did, were good enough.
Now, thankfully, we, as employees, are standardised – acceptably and holistically checked off. Benchmarked and compliant and up to date with our mandatory on-line modules. This is good. Most aspects of emergency medicine are chaotic and messy enough as it is, seriously in need of a good digital check-list groom, let alone considering trauma, that most unpredictable of diseases. Trauma is another grade of disarray altogether. Anarchy held together by skin.
The beauty of on-line modules is the certainty. And the reproducibility. It is beyond edifying to know that the person working next to me is signed off as competent in accountable decision making, and I know they can safely handle a patient over a certain weight-grade. I can be confident the web spaces of their fingers are flawlessly washed and germ-free, and that they have practiced a variety of safety stances in the case of impending violence. They are, in the eyes of our executive, trained.
Although this does bring us back to the consummate violence – the type manifest by our major trauma patients. These patients are so damned disordered. Internally dishevelled. Disobedient. Take your eye off them for a second and they’re setting off fireworks somewhere in their innards, right where you didn’t expect. So we don’t. Take our eye off them.
Trauma is the ultimate team sport, best played with the slickest and most integrated, respectful team, peopled by the most experienced team members possible, running the shebang from the moment of the traumatic event somewhere in the giddy light-filled outdoors, sliding through the corridors of ED, then off to their various destinations; the end string of the maze chosen efficiently by leaders with a beady eye on the patient’s belligerent biology. But these people, these team members, seriously worry me. I have a growing suspicion that not all of them are up to date with their mandatory training. They seem to embrace uncertainty. Are comfortable with it. Are able to work within it and make quick, dancing decisions based on all sorts of unmeasurable factors. This simply will not do.
No. The tremendous sequel to the staggering increase in administrative staff over the past decade has been the glorification of the black and white. Nowhere is this demonstrated better than in the increasing production of mandatory on-line modules, and the reliance on these as a tool for signing off hospital staff as being compliant and competent. Time well spent, I can hear you all cry. What better way to prove that you are proficient in managing complex patients than by spending precious hours taking quizzes on terabytes of information about the muster points for a fire in the café? I know I’m not alone when my heart leaps a little with joy if I make a single error on the quiz, thus allowing me to return the start of the information package. Who wouldn’t rather read how to operate the hover mattress than a discussion of the nuances of trauma induced coagulopathy? Let us all learn to play chopsticks, not Chopin. No gaming or glazing while doing these tests, that’s for sure.
But, you say (rightly calling out my unseemly sarcasm), you have trauma meetings, missed injury reviews, audits and registries, discussions with colleagues and debriefs, to ensure you’re at your most capable. Yes we do (and thank the deities for these). Mostly, however, these are voluntary, certainly for the individuals within this vast swirling system. No. The only thing the institution expects of us is printed off, signed off, grinning compliance with the mandatory on-line education. And these are not the only digital incursions we must fill out, sitting lachrymose over our congealed coffee. The Working With Children Check (otherwise known as a ‘tax’) (a biennial, utterly baffling piece of bureaucracy that requires an ACTUAL visit to a post office), on-line credentialling at hospitals we have worked in for years if we want to even sneeze inside, and just when one’s hair is ready to be torn from its roots at the internal agony, an online mandatory training module for resilience and mindfulness (not yet at my institution – the irony bar has not yet swung so low).
It sometimes feels like a war. Us versus them. Complexity versus simplicity. Unmeasurable versus yardsticks. Commonsense versus the absurd. It shouldn’t be. Our goals should be aligned, we clinicians and non-clinicians – to provide the best patient and community care, approached sensibly, with respect enough that neither party should waste time on activities which do not contribute to either. We should not both be drowning in madness, in either the thick, or the administering of it. We await the return journey of the pendulum. In the meantime, it’s back to the mostly, unquantifiable mayhem.
This post originally appeared on Life in the Fast Lane.