Last week I successfully completed the TNCC course which I first took in 2001 or 2002. TNCC is Trauma Nursing Core Course and it is sponsored by the Emergency Nurses Association. It is a national certification valid for 4 years. Whether or not we work in a trauma center, every emergency room has the potential to receive a trauma patient, sometimes because of inclement weather and the inability to get a helicopter in the air, sometimes because it happens in such close proximity that they are rolled in your door. The principle behind TNCC is to give the nurse a systematic approach to each patient, whether it is a victim of a car crash, an electrocution, drowning, or violent crime. Each patient should be approached in exactly the same manner and if all steps are followed, a positive outcome should ensue.
In a perfect world. It is not that difficult to memorize the steps and listen to a lecture with gruesome slides in a quiet, private classroom. A 50 question test is given at the end of the 2 days and a practical exam must be done one-on-one with an instructor. No step can be left out or the candidate fails. I am a good test taker and am not cursed with test anxiety like so many are, so the course went well for me.
But do you ever have a "normal" trauma, an organized situation where what I've learned can be done step by step? No, it is usually chaos with blood and fluids spraying, doctors yelling orders, and family members screaming. This also means that there are other members of a team that can help this patient, it is never really up to just one trauma nurse going through her steps as in TNCC.
I have been a nurse for 19 years, in the ER for 10, but I know I will assess my next trauma patient with new eyes. One of my favorite points that our instructor brought up:
A man comes in with a traumatic amputation of the lower leg. Everyone is trying to stop the bleeding, see if the amputated part was brought in, etcetera. But does the patient have a patent airway and is he breathing? Imagine applying a great pressure dressing and wrapping the severed part correctly only to find that the patient had vomited and aspirated, then asphyxiated while everyone was running about! It reminded me that no matter what horrible development has gone on with a trauma patient's body, none of it matters if you don't have an airway.
So the absolute main point of TNCC and its training is the most basic of principles which hails back to basic life support. A B C!!! Always airway and breathing, even before pulse, since once again, a pulse won't last long if there is no breathing involved.
More nuggets from this wonderful course on another day.
