Small World nursing survey

SURVEY:
April 1999, over the Internet ER-ICU-Nursing Medical list servers
Respondents: 78% Nurses, 19% MDs (mostly Europeans) & 3% EMTs (working in ER)
Wards: 82% worked in ERs, 14% in ICUs, 3% Clinical RNs & 1% on Medevac
Country: 57 USA, 14 Australia, 12 France, 8 Canada, 3UK, 1 each from
New-Zealand, South Africa, Austria, Germany & Spain for a total of 99 entries.


FEMUR fractures


This line of questioning was inspired & brought on in the wake of a
decision by
the Montreal EMS to withdraw the use of pre-hospital traction splints. 
Probable reasons being that… 
-) Ambulance transport times were short
-) They were hardly ever used 
-) & They wanted to reduce costs in equipment.
So the dependence by ERs on pre-hospital application of said devices needed to
be documented.
To bring on further light to the subject, the time delays of in-hospital
application of traction devices needed to be evaluated. The answers pretty
much
confirmed my expectations in the time to application delays. But also brought
out a suspicion that their may not be a priority in the speed of
application of
traction. The question brought out even more the regional differences in
medical treatments & just made it harder to evaluate the reasons justifying
the
spread in practices.


To the question:
What is the estimated time between the arrival of an obviously displaced Femur
fracture in your Emergency Room and the time of applying a traction device ?

AVERAGE ESTIMATED TIME TO FEMUR TREATMENT (TRACTION or surgical reduction)
1.15 HOURS
Pretty much the same average times between large & small hospital (1 to 1.2
hrs)
42 min Australia
54 min hrs USA
2,1 hrs France 
2,2 hrs Canada

In France Pt is more likely to go directly to OR. 
Although I can not very well imagine all hospitals to offer this service in a
consistent manner… 
Related to this, some respondents did mention either prior triage by EMS to
trauma facilities, lack of which brought on ulterior transfers out to tertiary
care centers(nothing to improve the time to reduction of Femur fracture). 
0 hrs to reduction are due to pre-hosp use of traction splint
If traction splint is not applied Pre-hosp. This translates into big delays in
in-hospital application
… Ambulances sometime are still called in to smaller hospitals to install
traction splints in the ER

I can not imagine how a Femur fracture that is in muscular spasm, clearly
resulting in additional injury in theory & excruciating pain in reality… would
end up being treated in anywhere but the ER or pre-hospital ! ? 


To the question:
Do you use a portable traction device _____% ?


USE OF PORTABLE TRACTION SPLINT in ER
46,4% of ERs use portable tractions
63,6% Australia
51,7% USA
47,1% Canada
12,5% France 

The  Snazzy portable tractions are American devices (Hare, Sager etc)(the
Australian also have a nifty device(Donway ?). It would’nt be the first time
that national origin of a medication/procedure/devices prove to be an
hindrance
to it’s wide distribution. Is it the case here ?


To the question:
Do you use contra balancing weights in the ER ______% ?
FEMUR Fx REDUCTION WITH COUNTER BALANCING WEIGHT in ER
23,6% of ERs will use counterbalancing weight in ER to reduce Femur Fx. 
30,7% Canada
17,9% USA
13,5% Australia
12,5% France


To the question:
Contra balancing weights are done up on the floors ______% ?

FEMUR Fx REDUCTION WITH COUNTER BALANCING WEIGHT on FLOORS
62,5% will use counterbalancing weight on orthopedic or ICU department to
reduce Femur Fx.
74,1% USA
59,2% Canada
40,0% Australia
39,9% France

Most answers where YES-NO type to each questions (100%-0%)
Some answers where in the wished upon format of Traction ER,  Weights ER, 
Weights Floor = 100%
The conclusions are hard to draw other than showing a good example how not to
formulate a survey question and/or instructions.

Note that ICU people wisely avoided answering when they were not sure or felt
it inappropriate to judge a mostly ER intervention.
This was  the least successful question of the survey.
Both in the comprehension & in its formulation
… mostly in the clarity of the initial question
This is to be blamed on the fact that the format was deliberately intended to
be kept simple(KISS) & the question was based solely on the North American
context. 


Charles Brault EMT-P,





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