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Enfermería Global

versión On-line ISSN 1695-6141

Enferm. glob. vol.16 no.45 Murcia ene. 2017  Epub 01-Ene-2017

http://dx.doi.org/10.6018/eglobal.16.1.231801 

Originales

Epidemiological profile of the traumatic emergencies assisted by a mobile prehospital emergency service

Andréa Tayse de Lima Gomes*  , Micheline da Fonseca Silva**  , Bruno Araújo da Silva Dantas***  , Jéssica Maria Arouca de Miranda****  , Gabriela de Sousa Martins Melo*****  , Rodrigo Assis Neves Dantas***** 

*Nurse. MSc Student at the Postgraduate Program in Nursing of the Federal University of Rio Grande do Norte (UFRN). CAPES/DS Scholarship Student. Member of the research group Laboratory for Investigation of Care, Safety, Technologies in Health and Nursing (LABTEC)/UFRN. E-mail: andrea.tlgomes@gmail.com

**Nurse. Member of the research group Laboratory for Investigation of Care, Safety, Technologies in Health and Nursing (LABTEC) of the Federal University of Rio Grande do Norte.

***Nurse. MSc Student at the Postgraduate Program in Nursing of the Federal University of Rio Grande do Norte (UFRN). Member of the research group Incubator of Nursing Procedures/UFRN.

****Nurse. MSc Student at the Porstgraduate Program in Health Sciences of the Federal University of Rio Grande do Norte (UFRN). Member of the research group Incubator of Nursing Procedures /UFRN.

*****Nurse. Assistant Professor at the Graduation in Nursing of the Department of Nursing of the Federal University of Rio Grande do Norte (UFRN). Member of the research group Incubator of Nursing Procedures/UFRN. Brazil.

Abstract

Objective

To describe the epidemiological profile of the traumatic emergencies assisted by a mobile prehospital emergency service in Northeastern Brazil.

Methods

Documentary and quantitative study, performed from the patients' records of the emergencies between January and June 2014, consisting the sample of 1,960 records. A structured questionnaire to collect data was used, and the analysis was by descriptive statistics.

Results

There was predominance of Traffic Accidents (TA) - 67.7%; falls (17.1%); and perforation by firearms (6.8%). The most involved were men (76.2%), framed in the age group young adults (46.6%) and the largest number of occurrences was in the weekend (37.4%). Among them, 58.1% had mild trauma and 44.0% did not suffer polytrauma. There was neglect in relation to the annotation of the Glasgow coma scale in 39.0% of cases.

Conclusion

Among the traumatic emergencies, TA occurred mostly on Sunday, involving male young adults. One emphasizes that the negligence of professionals regarding basics notes in the patients' records are responsible for generating difficulties for the development of researches. Moreover, with regard to judicial proceedings, it is notorious that there is not documentary support concerning the provided assistance.

Keywords Prehospital assistance; Emergencies; Traumatology

Introduction

Deaths from accidents and violence, more commonly called "external causes" (EC), are the third cause of death in the general population and the first one in population aged from one to 39 years, behind cardiovascular disease and cancer, respectively1)(2.

Violence has assumed worrying role for the Brazilian society in recent decades and has become a serious public health problem because of its magnitude, severity, social impact and ability to make the individual and collective health vulnerable. External causes, which include violence and accidents, are the third cause of mortality in the general population and the sixth cause of hospital admissions in the country3)(4.

In relation to non-fatal events, there are a large number of hospitalizations, emergency services and permanent sequelae, resulting in high costs for society, since most victims are young and in socially productive situation. Absenteeism rates from sequelae resulting from trauma are responsible for the origin of potential pension expenses1)(5.

The scenarios of emergencies and urgencies care at public services in Brazil may not be prepared or adapted to the current epidemiological transition, to which EX contribute substantially, besides facing many difficulties regarding the structure and the material and human resources. There is a demand for greater State investment for the proper care of victims of trauma, effective public policies that can reduce the alarming rates and, consequently, the associated morbidity and mortality6.

Given this issue, the mobile prehospital emergency service plays an important role in the assistance provided to victims of trauma, since this service is characterized by quick response, rescue or transport of patients with declared urgency or emergency conditions7.

Most trauma deaths occur in the scene or in the first hour of trauma; however, 76% could be avoided. Agile and quality prehospital care becomes, then, a very important part to ensure the survival of trauma patients. Therefore, the first hour of the initial care to patients in the prehospital phase is referred to as "golden hour"8.

Thus, knowing the characteristics that involve trauma is a major factor in the development of operational strategies of multidisciplinary teams in the directed care, the educational and preventive measures to minimize the damage to human life and society.

For this, the following research question arose: How are characterized the traumatic emergencies treated by prehospital emergency service? Thus, this study aimed to describe the epidemiological profile of traumatic emergencies assisted by a mobile prehospital emergency service in Northeastern Brazil.

Material and Method

This is a documentary and descriptive study, with cross-sectional design and quantitative approaches, performed from the records of occurrences assisted between January and June 2014 by the Mobile Emergency Service of Rio Grande do Norte (SAMU 192 RN). The researchers collected the data during the morning and afternoon shifts at the filing sector of SAMU 192 RN, located in the municipality of Macaíba/RN, in the period from May to July 2014.

The study population consisted of the nursing care records of 2,952 occurrences assisted by SAMU 192 RN. The inclusion criteria were records of nursing notes of cases of traumatic emergencies, involving traffic accidents (TA), perforation by firearms (PF), perforation by white weapon (PWW), falls and physical assault by physical force. Exclusion criteria consisted of records of people with medical conditions and records with illegible notes. According to the selection criteria, 992 records were excluded, totaling a sample of 1,960.

Data were collected through a structured questionnaire, which was prepared based on the record of nursing notes of SAMU 192 RN, consisting of the following variables: service data (date, day of week, time, city and type of service), victim information (gender and age) and the gravity of the accident (vital signs, level of consciousness, Glasgow coma scale, types of injuries caused by the accident and injured anatomical segment). For the characterization of the victims, the age was classified in age groups, namely: zero to 24 years = youngster; 25 to 44 years = young adult; 45 to 59 years = adult; 60 years or more = elderly.

Data were analyzed by descriptive statistics, organized in a spreadsheet in Microsoft Excel 2010 software, and then exported to SPSS version 20.0. The results were presented using absolute and relative frequencies in tables.

The research followed the ethical and legal aspects as Resolution No. 196/96 of the National Health Council, supplemented and updated by resolution. 466/12. The study obtained a favorable opinion by the Research Ethics Committee of the University Hospital Onofre Lopes (CEP/HUOL), with protocol number 437/10 and Presentation Certificate to Ethics Assessment (CAAE): 0025.0.294.051-10.

Results

The sample consisted of 1,960 records of services to victims of traumatic emergencies, being 1,327 (67.7%) by TA, 335 (17.1%) from falls, 134 (6.8%) by PF, 93 (4.7%) physical aggression by physical force and 71 (3.6%) by PWW, assisted by SAMU 192 RN between January and June 2014.

Table I shows the characterization of the victims of traumatic emergencies treated by the SAMU 192 RN, according to gender, age and day of the week when the trauma occurred.

Table I Characterization of victims of traumatic emergencies treated SAMU 192 RN nd of the day of the week when the trauma occurred, 2015. 

CHARACTERIZATON OF THE VICTIMS AND THE DAY OF THE OCCURRENCE
Gender n %
Male 1494 76.2
Female 466 23.8
Age group
Youngster 600 30.6
Young adult 913 46.6
Adult 269 13.7
Elderly 178 9.1
Day of the week
Sunday 385 19.6
Monday 254 13.0
Tuesday 235 12.0
Wednesday 221 11.3
Thursday 225 11.5
Friday 291 14.8
Saturday 349 17.8
TOTAL 1960 100.0

Source: research itself.

According to Table I, most individuals were men (76.2%), classified in the age group of young adults (46.6%) with a mean of 33.9 years (± 19.0), and the largest number of calls for traumatic emergencies was during the weekend, including Saturday and Sunday (37.4%).

As for the association between the gender of victims of traumatic emergencies, and the type of trauma (Table II), men were the most involved in the five types of studied traumatic emergencies. composing 76.2% of the sample, especially by TA (52.7%). TA was the most evident traumatic emergency, followed by falls.

Table II Association between the type of trauma and the gender of victims treated by SAMU 192 RN, 2015. 

TYPE OF TRAUMA Gender TOTAL
Male Female
n % N % n %
Traffic accident 1033 52.7 294 15.0 1327 67.7
Perforation by firearm 114 5.8 20 1.0 134 6.8
Perforation by white weapon 53 2.7 18 0.9 71 3.6
Falls 220 11.2 115 5.9 335 17.1
Physical assault by physical force 74 3.8 19 1.0 93 4.8
TOTAL 1494 76.2 466 23.8 1960 100.0

Source: research itself.

Regarding the association between the type of injury and age group, there was a predominance of young adults (46.6%) individuals between 25 and 44 years, in all types of traumatic emergencies, as shown in Table III.

Table III Association between the type of trauma and age group of victims of traumatic emergencies treated by SAMU 192 RN, 2015. 

TYPE OF TRAUMA Age group TOTAL
Youngster Young adult Adult Elderly
n % n % n % n % n %
TA 429 21.9 656 33.5 173 8.8 65 3.3 1323 67.5
PF 60 3.1 64 3.3 10 0.5 1 0.1 135 6.9
PWW 21 1.1 41 2.1 9 0.5 0 0.0 71 3.6
Falls 65 3.3 102 5.2 61 3.1 109 5.6 337 17.2
Physical assault 25 1.3 50 2.6 16 0.8 3 0.2 94 4.8
TOTAL 600 30.6 913 46.6 269 13.7 178 9.1 1960 100.0

Source: research itself.

Table IV explains the association between the Glasgow coma scale and finding polytrauma, or not, in individuals who have suffered some kind of traumatic emergency, during the studied period.

Table IV Association of the Glasgow Coma Scale with the occurrence of polytrauma in victims treated by SAMU 192 RN, 2015. 

GLASGOW COMA SCALE Polytrauma TOTAL
Yes No
Classification n % n % N %
3-8 Severe traumas 10 0.5 23 1.2 33 1.7
9-12 Moderate traumas 3 0.2 21 1.1 24 1.2
13-15 Mild trauma 277 14.1 862 44.0 1139 58.1
Ignored 157 8.0 607 31.0 764 39.0
TOTAL 447 22.8 1513 77.2 1960 100.0

Source: research itself.

One verified that 58.1% of subjects had a Glasgow Coma Scale between 13 and 15 points, being classified as mild trauma. However, among them, 14.1% suffered polytraumas and 44.0% did not suffer polytraumas. Moreover, there was negligence on the annotation of the Glasgow coma scale in 39.0% of the nursing care records.

Discussion

The trauma can cause temporary and permanent damage, such as death, disability, prolonged and high-cost treatment, causing socioeconomic damage to patients and their families9.

A study conducted in 24 Brazilian states and another, in Cuiabá/Mato Grosso/Brazil, found that the most frequent traumatic emergencies were TA, followed by falls, PF, physical assaults by physical force and PWW, which corroborates this study10)(11.

TA are considered complex episodes, for they may relate to human error, the vehicle itself and even environmental errors. Some of those factors result from the driver's recklessness, such as risky maneuvers, alcoholism and drugs, excessive speed and fatigue, and may also associate with climatic factors, pathways and inadequate signage and lack of maintenance of vehicles12.

The Brazilian traffic is considered one of the most dangerous in the world and sets up a public health problem, being subject of serious proportions for modern society, for it is responsible for high rates of morbidity, mortality and disability with physical and/or cognitive permanent sequelae. In Brazil, alcohol consumption associated with driving is identified as one of the main factors responsible for accidents5)(13.

Men are most involved in traumatic events. This prevalence may be due to cultural, biological and social factors that promote violent behavior, making them more vulnerable to external causes9)(14. Research shows that the treatment of women occurred mainly for clinical causes11. Moreover, those events occurred, in greater extent, during the weekend, because of the relationship with festive events, alcohol consumption and decreased supervision15.

Although men have been the most affected in all categories of traumatic emergencies, one cannot disregard the female victims, for it is a factor that influences health and the social context9. In this study, the highest incidence of events among women was the TA. According to the literature, in most TA cases involving women, they were in the passenger seat14.

Young adults, aged between 34 and 37.6 years, are the main victims of trauma10)(11)(14. All age groups, except the elderly, suffered mainly TA. It is noteworthy the number of episodes with PF and PWW among youngsters and young adults. Perhaps, violence in this group happens by social inequality and the difficult integration of the youngster in the labor market16.

Social and cultural determinants related to gender expose men to greater risk for trauma, such as excessive speed, risky maneuvers, violence and alcohol consumption. Nevertheless, this study found that women may be exposed to traumatic situations, although not drinking; they are accompanied by young men who use alcohol, and put their own safety and of those with them at risk17.

The early age of regular alcohol consumption can leave them more exposed because they are undergoing profound physical and psychological changes, and lead to socially undesirable behavior17.

Among the elderly, the main cause of injury was falls. People in this age group require great care due to the high mortality rate due to the type of trauma previously mentioned. A research with elderly people living in São Paulo showed that falls from their own height tend to increase the severity according to the increase in age18.

The Glasgow coma scale assesses the level of awareness and the severity of the injury; therefore, it is of great value in trauma care to estimate the prognosis of the victim14)(19. This scale is also used to evaluate the response-time relationship in the service according to the patient's needs14.

After a thorough evaluation of the protocol steps for care to the patient with polytrauma and the proper correction of the found lesions, the professional of the emergency service should identify the neurological pattern in which the victim is, and one indicates the use of the Glasgow Coma Scale for this purpose20.

There was negligence of this data in most of the nursing care records, demonstrating the vulnerability of the team to record information, which may indicate possible lack of theoretical knowledge about the proper use of this scale. In turn, professionals associate the decreased level of consciousness with the decrease in the breathing pattern, which, they say, requires the application of the Guedel's cannula21.

The participants of the study, as well as in this research, did not properly describe the use of the Glasgow Coma Scale as a neurological assessment tool for the polytraumatized victim. Although some information may be ignored, because of the need for speed and flexibility of services, which should prioritize the stabilization of the victim and not the filling of information, those failures make the record incomplete and with no support for situations involving the justice11,21.

In order to prevent the occurrence of traumatic events, reduce the severity of injuries, the occupation of hospital beds and rates of lost years and disabled, especially among young people, there should be investments in hazard and risk control strategies, using systematic measures for health promotion and disease prevention so that they can live their youth safely and without injury to health17.

Since the nurse is a professional focused on the implementation of health care in all life cycles, aiming at comprehensive care, he/she must be able to implement health education programs for the youngster and his/her family, planning strategies and targets to encourage harm reduction and safe behavior, in order to reduce the traumatic episodes17)(22.

Conclusions

One observed that, among the traumatic emergencies treated by the SAMU 192 RN from January to June 2014, there was a greater quantity of TA, followed by falls. Most involved were men, aged between 25 and 44 years (young adult). Most calls occurred during the weekend, with the highest number on Sunday. As for the relationship between the type of trauma and gender, both male as female young adults experienced a higher proportion of TA. As for the elderly, they were most affected by falls.

Regarding the severity of the trauma, most victims of traumatic emergencies were classified between 13 and 15 points (mild trauma) on the Glasgow coma scale and the individual, in most cases, did not suffer polytrauma. However, it is noteworthy the neglect of professionals regarding the annotation of the classification of the Glasgow coma scale, for it is an essential data for the assessment of the severity of the trauma. In addition, the data deficiency in service records hinders the development of researches, as well as in court proceedings, since there is no evidential document support.

One knows that deaths from external causes are considered a public health problem with high rates of deaths and high absenteeism numbers by irreversible sequelae involving young people. The rapid and qualified service to this type of occurrence is directly proportional to the prognosis of the victim. It is noteworthy the importance of continuing education for health professionals working in the prehospital setting, since the first hour, called golden hour, is considered crucial to the survival of people in emergency situations.

Referencias

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Received: July 06, 2015; Accepted: September 07, 2015

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