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The More Things Change, the More They Remain the Same

Macauley, Karen DHA, RN, MEd

doi: 10.1097/JTN.0000000000000027
News and Notes

All Children's Hospital, St Petersburg, Florida.

Correspondence: Karen Macauley, DHA, RN, MEd, All Children's Hospital, 501 Sixth Street South, St Petersburg, FL 33701 (

The author declares no conflicts of interest.

The more things change, the more they stay the same—have you heard that before? Maybe you have thought it or even said it yourself—I think this very thing when I think about trauma care over the years. Wow! Things have changed, right? We are smarter, we are better at what we do, and yet some things are still the same.

Some of us remember when trauma systems did not exist. It was a time of medical chaos—we saw everyday things happening to young and old and knew there had to be a better way. These pioneers of trauma care and trauma systems made a tremendous difference in the lives of countless people through the years by deciding that the way it is is not the way it should be and making a change. Today, we are a pretty sophisticated system across a good part of our country.

Oh, we are not perfect. There are still parts of the country that do not have what they need. There are still human errors that occur that change the lives of those entrusted to us to make it better, but we have come a long way, right?

One thing that strikes me as stay the same is injury. Kids today get into much the same trouble as kids a century ago. Oh, it looks different, but is not it the same? Toddlers and school-age kids still fall and get injured. Their development has not changed, and they still get hit by cars and crash their bikes. Teenagers and young adults still push their limits and think they are invincible—they experiment with drugs and alcohol and they drive their cars too fast. They leap off tall buildings without a thought to the landing because that is what teenagers and young adults have done since the start of time.

As we get a little older and settle down some, we see what life is really all about we slow down—we have kids of our own and we age at an incredible rate as we see all the dangers around us. Who knows this better than trauma professionals? We see it every day and I am confident each of us goes home and tells our own kids—do not do this and do not do that—you can get hurt and you matter to me. We do not take as many risks as we did when we were younger because now we know what can happen.

Here is where things get a little different—they are not just the same anymore. It used to be that older people died of medical stuff—oh, we would see a trauma injury here and there but trauma was so not the leading cause of death after the age of 44 years. Now, I keep waiting for the statistics to catch up and tell us what we already know—traumatic injury has a huge impact on our older population. They are healthier and more active—no longer are we even surprised that a 95-year-old has been involved in a motor vehicle crash while driving. This change in demographics of trauma care has required us to think differently—to readjust our care from triage through reintegration to home because this population needs something different from us. In many ways, they are teenagers again—they are invincible and love life too much to understand what might happen and how that might impact their lives and the lives of those around them.

Geriatric trauma care is a specialty—it has become the same as pediatrics, spinal cord injury, and burns. There is no room for error and indecision. These patients are sick with little reserve. A missed injury might mean the difference between life and death for them. We have to think differently and we have to resuscitate differently. We have to think about the impact of medications and manage their underlying medical issues while trying to patch up and repair traumatic injuries. We need to add different professionals to our team because these patients have different needs and their care is going to be complex, complicated, and life altering for many.

Find out more about cutting-edge trauma care at the STN Web site Collaborate with your colleagues and ask them questions on the listserve. Attend the annual conference in New Orleans in April 2014 to find out what is new in trauma care. Join a special interest group or even apply for a board position within the organization to make a difference in the lives of each other and our patients and families. The Society of Trauma Nurses is another example of the more things change—the more they remain the same. For many years, the Society of Trauma Nurses has been an advocate, has been an educational resource, and has bonded trauma professionals. The mission and vision have not changed, but the organization is continually growing and changing to meet your needs.

What I respect most about trauma professionals is your ability to see a need and to make an adjustment. You see it and you adjust and change to provide the best care. Status quo is not good enough and that is what makes you a trauma professional. You change the lives of those you see every day, but what you really do is change the world and make it a better place for everyone. You think outside the box, you question, you learn, you share your triumphs and your heartaches so that others may learn and become better trauma professionals, you search, and you care. That impact is priceless.

Copyright © 2014 by the Society of Trauma Nurses.