Brought to you by Saint Alphonsus Trauma & Emergency Care, expert(s) at Trauma Medicine.

Trauma medicine, from battlefields to neighborhoods

Emergency medicine has come a long way in a short time, transforming from a battlefield practice used on the troops into a routine presence in American society.
The practice got its start in the late 1950s, when doctors returning from the war realized the techniques they utilized on the troops could save lives on the home front.
While things were pretty rudimentary at first, with interns forced into emergency room duty and hearses used as ambulances, emergency medicine has become an important part of daily life for thousands, as well as a board-certified specialty.
But compared to other medical specialties, emergency medicine is relatively new. The American Medical Association and the American Board of Medical Specialties officially recognized it as a medical specialty in 1979.
Emergency physicians are highly educated and have training that crosses different medical specialties to meet demanding and ever-changing challenges. They work with state-of-the-art diagnostic equipment and are assisted by well-trained staff of assistants and nurses.
They also are governed by a code of ethics and a federal law that requires hospital emergency departments to offer care to all patients, regardless of their ability to pay, making emergency physicians a key part of the country's health safety net.
The majority of emergency physicians practice in hospitals, but others work in settings as diverse as cruise ships, military bases or for federal agencies like the Federal Emergency Management Agency, to help communities respond when disasters strike.

Education

Like all doctors, emergency physicians go through four years of college and four years of medical school. After that, they train for three to four more years in a residency program at an accredited teaching hospital.
During an emergency medicine residency program, residents care for patients while supervised by physician faculty. They also participate in educational and research activities. They are trained to treat both adults and children in a host of emergencies, such as medical, surgical, trauma, cardiac, orthopedic and obstetric.
They also learn skills for dealing with social problems, such as family violence and substance abuse.
Emergency physicians also earn continuing medical education credits - typically 50 hours a year - to keep their medical licenses.

Emergency Room Visits

No one plans to end up needing emergency medical services, but in the event you find yourself in the emergency room, there are certain procedures you can expect.
If you arrive by ambulance or are unconscious, you will be assigned to a patient bed and treated immediately.
If someone else drives you to the emergency department, you will enter the waiting room, where your medical condition will be assessed. No one will be turned away from an emergency department, even if they can't pay.
When you first arrive, a triage nurse will determine how serious your condition is based on your symptoms. The nurse may check your vital signs, including temperature, heart rate and blood pressure. Someone will collect your name, address and medical history.
After the initial assessment, you will be placed in an examination area, where an emergency physician will examine you and possibly order tests, such as X-rays, blood and electrocardiogram. Your vital signs will be monitored throughout, and nurses and other medical staff will assist you.
If you are critically ill or require intravenous medications or fluids, you may be admitted to the hospital.
If you are not seriously ill, an emergency physician will discuss your diagnosis and treatment plan with you before you are discharged. You may receive written instructions regarding medications, restrictions or symptoms that may require a follow-up visit.

Dealing With Emotional Effects

Those who experience an emergency medical situation often must deal with more than just physical symptoms. Following traumatic events, people often feel overwhelmed by feelings of fear, helplessness or horror and experience problems they didn't have prior to the event.
Without some form of help, those who suffer from traumatic experiences face a loss in the quality of his or her life.
How serious the symptoms and problems are depends on many things including a patient's life before the trauma, his or her own ability to cope with stress, how serious the trauma was, and what kind of help and support comes from family, friends, and professionals immediately following the trauma.
Because most trauma survivors are not familiar with the effects of trauma, they often have trouble understanding what is happening to them.

What Trauma Survivors Need to Know

- Traumas happen to many competent, healthy, strong, good people. No one can completely protect him or herself from traumatic experiences.
- Many people have long-lasting problems following exposure to trauma.
- People who react to traumas are not going crazy. They are experiencing symptoms and problems that are connected with having been in a traumatic situation.
- Having symptoms after a traumatic event is not a sign of personal weakness.
- When a person understands trauma symptoms better, he or she can become less fearful of them and better able to manage them.
- By recognizing the effects of trauma and knowing more about symptoms, a person is better able to decide about getting treatment.

Common Symptoms

During a trauma, survivors often become overwhelmed with fear and may even re-experience the trauma mentally and physically. Because this can be uncomfortable and sometimes painful, survivors tend to avoid reminders of the trauma. These symptoms create a problem called posttraumatic stress disorder (PTSD). PTSD is a specific set of problems resulting from a traumatic experience.

Because those suffering PTSD are anxious and physically agitated, they may have trouble sleeping and concentrating. The survivor usually can't control these symptoms or stop them from happening. Mentally re-experiencing the trauma can include:
- Upsetting memories such as images or thoughts about the trauma.
- Experiencing flashbacks.
- Bad dreams and nightmares.
- Getting upset when reminded about the trauma.
- Anger or aggressive feelings and feeling the need to defend oneself.
- Trouble concentrating or thinking clearly.

People also can have physical reactions to trauma reminders such as:
- Trouble falling or staying asleep.
- Feeling agitated and constantly on the lookout for danger.
- Getting very startled by loud noises or something or someone coming up on you from behind when you don't expect it.
- Feeling shaky and sweaty.
- Having your heart pound or having trouble breathing.

Re-experiencing symptoms are a sign that the body and mind are actively struggling to cope with the traumatic experience.

Avoidance

Because thinking about the trauma and feeling as if you are in danger is upsetting, people who have been through traumas often try to avoid reminders of the trauma.

Ways of avoiding thoughts, feelings and sensations associated with the trauma can include:
- Avoiding conversations and staying away from places, activities or people that might remind you of the trauma.
- Trouble remembering important parts of what happened during the trauma.
- Shutting down emotionally or feeling emotionally numb.
- Finding that things around you seem strange or unreal.
- Feeling disconnected from the world.
- Losing interest in things you used to enjoy doing.

Trying to avoid thinking about the trauma and avoiding treatment for trauma-related problems may keep a person from feeling upset in the short term, but avoiding treatment means that in the long term, trauma symptoms will persist.
Understanding the effects of trauma on relationships can also be an important step for family members or friends.

Information provided by the American College of Emergency Physicians and the National Trauma Data Bank