Tis the season... for ATV crashes

I see it has turned into ATV season again. We are seeing more ATV crash injuries coming into the hospital now that the weather has cooled off in the desert. Half of the trauma service is now ATV crashes. And as if riding an ATV weren't dangerous enough, people seem to invariably come in with an alcohol level and/or positive toxicology.

I suppose I can understand 20 or 30-somethings riding ATVs (sober, of course), but 80 year olds? Really? What's with the elderly riding ATVs? We even had a 92 year old. They seem to say, "Well, I've been riding ATVs for years. This has never happened." I'm all for being active in your old age, but I at some point you might need to re-evaluate your "activities."

I see ATV crashes commonly result in spine fractures. Head injuries are seen as well. And that is in younger folks. All of elderly that have come in lately did have spine fractures and and one with significant pelvic fractures also.

The hard part about elderly being injured with pelvic or back fractures is the toll immobility takes. When younger people are laying flat in bed for days waiting for a back brace and/or surgery, they can recover physical strength faster. Elderly lose their strength quickly and get it back slowly. This often results in a discharge to a skilled nursing facility, which doesn't always have the best rehab outcomes.

Personally, I've seen far too many devastating injuries from ATVs and would recommend just staying away from them. Since I know not everyone will, I then recommend being smart about it:

1. Don't drink or do drugs (ever, really, but in this case when planning on riding an ATV)
2. If you are over 55 years of age really consider it a sport not for you anymore (or maybe over 60 if you are really fit and super cautious)
3. Wear a helmet
4. Don't ride around like a maniac- use common sense.

I suppose if you stick to those recommendations you should fair much better than the people I see in the hospital.

NPs in ED

I just read a journal article that came out recently on patients' thoughts about being treated by an NP in the ED. They surveyed 190 patients being seen in the fast track area of the ED asking about 8 questions, with the crux of the questionnaire essentially being "Would you be willing to be treated by a nurse practitioner today?" I found the results interesting. Albeit the majority, 65% said yes (17% were unsure and 17% said no). To me, this is lower than I would like to see it and I think it stresses the fact that people need further education on the NP role.

Also, 56% stated they had previously been treated by an NP (with 22% saying no and 21% unsure). I would venture to say some of the patients that fell into the "no" or "unsure" category have actually been seen by an NP before. Quite often I am referred to as "doctor" even after I've introduced myself as a nurse practitioner. I can continue to repeat myself, and some folks will still stick with "doctor." Eventually I give up because ultimately it doesn't really matter; care and treatment will proceed the same regardless.

Perhaps I used to also be guilty of no delineation. Back when I worked in the ER as an RN I used to say, "...blah, blah, blah...the doctor will be in to see you." We had physicians, PAs, and NPs working in that ED so it really could be any one of them, but I generally didn't know which one would get that patient. So unless stated by the provider, it is largely assumed to be a physician.

I think this study really pointed out some things most of us already notice in practice. Since I noticed this knowledge gap, I have made great efforts in educating my patients, and others in general, about NPs and the role. Hence, the development of the www.worldofnursepractitioners.com website. The observation was actually the impetus behind that website, but of course it still takes many, many more health care workers educating patients/public.

By the way, the article is "A Patient Survey on Emergency Department Use of Nurse Practitioners" in Advanced Emergency Nursing Journal.

PhD

Oh dear, I've let time pass again. My apologies. I had been consumed by yet another standardized test in my life. But it is now behind me and I can move forward again.

As you might remember, I mentioned my debate about returning to school for a PhD. Well, the process is in full swing now. And through the process I have decided to open the application process to several schools, not just my alma mater. I think this is a wise decision. But, of course, for every school added, I see the amount of work to do multiply exponentially. I still think it's smart to cast a broader net, at least for comparison.

Part of the process is deciding what I really want to study for the next 4+ years. Trauma, of course, no doubt about that part. But I love so many things about trauma it's about committing to one aspect of trauma that I will want to research until I'm blue in the face. It appears things are settling down to two main camps: trauma in the elderly vs. violence (esp. intimate partner). My particular interest is in prevention and I am on the hunt for the right faculty to work with.

Right now each school is on it's own pace. While I am just starting to communicate with some schools, others are approaching their deadline as I type. The first application is due at the end of this month. I actually find this an exciting time. I will be sure to add updates about my progress intermingled in my blogs.