When The Unthinkable Happens

When trauma nurses Rhett Whitlow, BSN, CPEN, and Terrika Johnson, BSN, CPEN, clock in for a shift in the Le Bonheur Children’s Hospital Emergency Department (ED), they know they must be prepared for anything. Between them, the nurses have 23 years experience caring for critically ill and injured children at Le Bonheur. But both agree that every day working in emergency medicine is different.

In an average 24-hour period, Le Bonheur’s ED staff treats more than 200 patients with a wide range of injuries and acute medical concerns, and trauma nurses may see anywhere from one to five trauma patients in a single shift. During peak seasons vehicle accidents, concussions and potential spinal injuries as training begins for football season.

Traumas typically arrive at a moment’s notice, and the ED must often organize an entire trauma response team within 15 minutes time. Thankfully, Le Bonheur’s Level 1 Pediatric Trauma Center designation means children throughout the region have access to the highest-quality trauma care at the most critical times.

Le Bonheur trauma nurses are certified in advanced pediatric lifesaving skills and must successfully complete the Trauma Nurse Core Course (TNCC), as well as eight hours of annual continuing trauma education. Whitlow, who serves as one of Le Bonheur’s TNCC instructors, invests in any trauma learning experiences he can find, from advanced life-support courses to rural trauma team development.

“Children need someone who knows how to take care of them, who’s compassionate, who wants to be there and can be their voice, because sometimes we may be a child’s only advocate in the room,” said Whitlow. “Becoming as trained and knowledgeable as I can to give them the best outcome possible truly feels like a calling.”

Children need someone who knows how to take care of them, who’s compassionate, who wants to be there and can be their voice, because sometimes we may be a child’s only advocate in the room. Becoming as trained and knowledgeable as I can to give them the best outcome possible truly feels like a calling.

While Whitlow has always worked nights in his nine years at Le Bonheur, Johnson spent one year working days and another year as a nurse for Pedi-Flite, Le Bonheur’s medical transport team. But ultimately, nights in Le Bonheur’s ED have her heart. Besides preferring the after-hours rhythms, Johnson has a two-hour commute to the hospital from her Jackson, Tenn., home, and working nights allows her to pick her 6-year old twin boys up from school, even on the days she works.

Johnson admits the job can be nerve-wracking, even for a seasoned nurse, and reflects that some patient stories are hard to move past, particularly as a mother to young children. But, she also asserts that roles like hers are where loving what you do and making a difference come into play.

“When I am at work and the radio goes off, I have to be calm. I cannot get overly worked up. I cannot raise my voice,” said Johnson. “Families do not wake up thinking this is going to happen today, and taking the time to talk to them, to calmly explain what’s going on and to just hold their hand — it means a world of difference. It’s our job to take care of the family as well as the child.”

And when staff need help coping after a difficult case, debriefing sessions are held so team members can process their experience together. Debriefings are typically chaplain-led, and while any team member may request one, sessions are automatic following larger-scale traumas.

Team members also benefit from opportunities to see and hear from children who suffered severe traumas and had good long-term outcomes. Trauma Program Director Anissa Revels, MSN, RN, recalls the case of a young patient who survived multiple gunshot wounds and shared her story to spotlight the daily challenges some community members face.

“She spoke with so much determination to move on with her life, and she shared deep appreciation for our team for helping her overcome her mental wounds as well as the physical ones,” said Revels.

Beyond the frontline ED staff, Le Bonheur’s trauma program is comprised of five nurses devoted to quality improvement and community outreach, a dedicated trauma social worker, three registrars who connect Le Bonheur’s trauma data with national registries and a clinical analyst to identify research opportunities and up-todate information in the trauma field.

Put simply, caring for trauma patients takes a village, and part of Le Bonheur’s community-based mission includes offering education for schools and families on injury prevention and safety, as well as training Mid South health care workers on pediatric trauma care. Nurses from institutions citywide seek out TNCC education taught by Le Bonheur experts, whose courses are routinely at capacity.

“Pediatric trauma happens more often than we’d like to think,” said Revels, “but Le Bonheur is the place to handle it when it does.”