Kevin Henshall

Trauma Nurse Specialist, General Surgery, Counties Manukau DHB, Auckland, NZ

Kevin Henshall is currently working at the Counties Manukau Health as the Nurse Specialist for the Trauma Service, and is a member of the Northern Regional Major Trauma Clinical Governance Committee. A graduate of The University of Manchester his clinical background is critical care and has extensive pre-hospital nursing & paramedicine experience both here in New Zealand and United Kingdom.

He has been fortunate enough to mix his keen interest in motorsport & pre-hospital medicine, working as part of the motorsport medical teams, both here in New Zealand and in the UK, ranging from local club events through to the British Formula 1 Grand Prix & World Rally Championship events.

Kevin is a member of the New Zealand Medical Assistance Team (NZMAT), who was deployed in 2014 to the Solomon Islands following a communicable disease outbreak as a result of flooding from the evolving Tropical Cyclone Ita. In 2015 deploying to Shefa Province, Vanuatu post the infrastructural devastation of Cyclone Pam.

Real World Emergency Nursing and Pain Management

Resource constrained nations predominately have limited healthcare strategies which are often compounded by their hardware and consumables diversit, not being expansive.  In the aftermath of a natural disaster those resources are limited further, by a combination of overwhelming use; and limited availability due to the fragility of their supply chain.

Over the past few years I have deployed with the New Zealand national medical response, to Solomon Islands & Vanuatu following natural disasters.  I wish to share these experiences of real world emergency medicine and pain management with you.

Turning Chest Trauma Patients Analgesia Strategies on its Head

Blunt chest wall trauma is estimated to account for more than 15% of all emergency room presentations1. It is well documented that length of stay and  complications associated with rib fractures as a result of blunt chest wall trauma doubles in the elderly and the co-morbid population when compared to the under 55 year olds2.

Whilst the mortality rates reported varies significantly from 4% to 60%, Australasian and UK studies are consistently reporting  mortality in the elderly at <10% for multiple rib fractures3,4,5.

These statistics aren't a new finding nor are they surprising, yet we don't seem to be abetting this. Given the platinum tsunami is gaining momentum maybe we need to be more proactive than reactive?

Analgesia has been seen as a cornerstone intervention within patient care with rib fractures. I now want you to think about your current patient management and introduce the concept that the analgesia ladder can be fraught with large gaps - and if those gaps are big enough, complications evolve very quickly.

I would like to take you on the Counties Manukau Health journey, looking at our process and our (perceived or not) barriers and our new strategy.

References

1.      Demirhan, R. Onan, B. Oz, K. Halezeroglu, S. (2009) Comprehensive analysis of 4205 patients with chest trauma: a 10-year experience. Interactive Cardiovascular and Thoracic Surgery 9(3): 450–453.

2.      Bulger, EM. Arneson, MA. Mick, CN & Jurkovich GJ. (2000) Rib fractures in the elderly. Journal of Trauma. 48(6) : 1040-6

3.      Söderlund, T. Ikonen, A. Pyhältö, T. Handolin, L (2014) Factors Associated With in-Hospital Outcomes in 594 Consecutive Patients Suffering From Severe Blunt Chest Trauma Scandinavian Journal of Surgery 104: 115–120.

4.      Battle, CE. Hutchings, H. Evans P A (2013) Expert opinion of the risk factors for morbidity and mortality in blunt chest wall trauma: Results of a national postal questionnaire survey of Emergency Departments in the United Kingdom International Journal of the Care of the Injured 44 (1) 56–59.

5.      Counties Manukau Health (2017) CMH Rib Fracture Presentations 2014-2016 via Collector Trauma Registry.