Trauma Response Research Articles

Surgical risks and care trends: A cross sectional study of people experiencing homelessness presenting at a free clinic care in Miami-Dade County

BackgroundThe effects of housing insecurity on surgical care are under researched and largely unknown. Thus far, studies on surgery outcomes of people experiencing homelessness either focus on shelter-based patients or do not differentiate whether patients are sheltered or unsheltered, despite significant differences in care needs and health risks. Herein we provide the first report on surgical care trends of people experiencing unsheltered homelessness. MethodsClinical history, medication list, and blood pressure records of 300 people experiencing unsheltered homelessness receiving care at a free mobile clinic were deidentified, downloaded and analyzed in R studio 4.3.0. Participants were asked whether they had undergone surgery and included surgical history for those who had. ResultsOf 300 participants, 18 % (N = 55) had a history of surgery, most common being 1) orthopedics (N = 20), 2) vascular (N = 18), 3) general (N = 6), 4) acute trauma response (N = 5), 5) ophthalmology (N = 4), 6) surgical oncology (N = 2). Post-discharge, 13 % returned with wound site infections and 9 % were readmitted for treatment. Chi Square test showed Hypertension [X2 (1, n = 300)=10.9, p < 0.001] and Type II Diabetes [X2 (1, n = 300)=10.5, p = 0.0012] significantly increased likelihood of needing vascular surgery, particularly lower extremity wound debridement or amputation. ConclusionLittle research has been done assessing surgical care trends for people experiencing unsheltered homelessness. Results indicate possible presence of barriers accessing cancer care and increased risk for vascular disease needing surgical intervention. Future research is needed to understand, address, and overcome current surgical care barriers to help this at-risk and underserved community.

Psychiatry on fire: Climate change and the role of mental healthcare

IntroductionWhat is the psychiatrist’s role on a burning planet? As our world faces the existential ramifications of irreversible climate change, clinicians are contending with what purpose a normalizing institution like psychiatry can have in increasingly abnormal times.Objectives This presentation investigates the role of the modern mental health clinician by examining psychiatry’s current impotence in the face of climate crisis. It will be shown that current approaches are often complicit in psychiatry’s historical depoliticization of mental health and subsequent individualization of social concerns. It will be argued that the only way psychiatry can maintain its ethical obligations to its patients is by taking a courageous sociopolitical stance.MethodsEmerging from a multidisciplinary literature review on the relationship between psychiatry and social crises, this work examines our field’s response to climate change in particular. A focus is made on literature that explores psychiatry’s political obligations, current trends in climate psychiatry, and proposed social psychiatric approaches to the climate crisis.ResultsIt is shown that while ecological collapse tangibly affects our patients, psychiatry often fails to engage socio-politically with the crisis’ root causes. Framing intense reactions to climate change as trauma responses and developing neo-diagnoses such as “ecoanxiety” both risk individualizing inherently social experiences. However, Psychiatrists are also uniquely positioned to speak with authority about social crises and to articulate what a more comprehensive medical response to climate change might look like.ConclusionsGiven climate change’s disproportionate effects on disenfranchised populations, it is increasingly clear that health is inextricable from social circumstances. As a result, political inaction is incompatible with our ethical duty to serve patients’ health, both in the clinic and beyond it.Disclosure of InterestNone Declared

A Retrospective Study on the Outcomes of Injuries From Border Wall Falls.

Objective Our retrospective cohort study focuses on the outcomes of injuries sustained from falls from the USA-Mexico border wall. The purpose of this study is to understand and predict the types of injuries that will be present in patients who fall from the border wall. This can further help trauma response teams to better predict and prepare for the care of these patients. Methods This retrospective cohort study included all patients that were admitted to Desert Regional Medical Center, a trauma I center, after a fall from the border wall that ranged from heights of 15 to 30 feet. The admissions occurred between March 2016 to December 2021. Results Of the 108 patients included, 38.2% (78) sustained at least one lower extremity injury, of which the most common was injury to the calcaneus bone. Additionally, there were several concomitant injuries, of which the combination of lower extremity and lumbar injury was found to be the most common (11.2%). The injury severity score (ISS) was found to not be statistically significant (ɑ=0.05) between groups of patients whose length of stay (LOS) in the hospital was greater than 10 days and less than 10 days. There was 1% fatality (1 of 108) and 92.5% required surgical intervention (100 of 108). Conclusions Patients injured from border wall falls are more likely to sustain lower extremity injuries than injuries to other parts of the body. Additionally, patients with lower extremity injuries sustained lumbar spinal injuries concomitantly, which can be most likely attributed to the axial compression of the spine during these falls. Most of these injuries required surgery and hospital admissions to treat. Understanding the patterns of injury from border wall falls can further help trauma response teams treat patients with efficient management.

Refreshing, necessary exposure to the problem with exposure therapies for trauma: Commentary on Rubenstein et al. (2024).

In this invited commentary, I address what I see as the major contributions Rubenstein et al. (2024) have made to challenging the hegemony of exposure therapies for trauma-exposed persons. These include a thorough review of the history of the rise of exposure therapies, the identification of posttrauma responses as forms of anxiety disorders, and an extensive discussion of the neurobiology of the trauma response. Additionally, Rubenstein et al. expose the very high dropout rates in studies of exposure therapies and ways in which many traumatized people have not found them helpful. This article brings the so-called "gold standard" back to its rightful position as one possible, occasionally helpful way of assisting some, but not all, traumatized people. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Teachers’ Perceptions, Awareness, And Responses to Students with Childhood Trauma

The purpose of this correlational study was to explore the relationship between trauma training, education, experience and teacher self-efficacy, and teachers’ self-reported perceptions of student behavior, awareness of trauma symptoms, and response to behaviors of students with trauma history. All participants were K-12 teachers currently employed in a large, urban district in the northeast United States. Three multiple regression analyses were conducted; each analysis used the predictor variables educator trauma training, education, experience, and self-efficacy scores. This research study found a significant positive correlation between teachers’ sense of self-efficacy and trauma awareness and responses when teaching traumatized children.

Smoking primes the metabolomic response in trauma.

Smoking is a public health threat because of its well-described link to increased oxidative stress-related diseases including peripheral vascular disease and coronary artery disease. Tobacco use has been linked to risk of inpatient trauma morbidity including acute respiratory distress syndrome; however, its mechanistic effect on comprehensive metabolic heterogeneity has yet to be examined. Plasma was obtained on arrival from injured patients at a Level 1 trauma center and analyzed with modern mass spectrometry-based metabolomics. Patients were stratified by nonsmoker, passive smoker, and active smoker by lower, interquartile, and upper quartile ranges of cotinine intensity peaks. Patients were substratified by high injury/high shock (Injury Severity Score, ≥15; base excess, <-6) and compared with healthy controls. p Value of <0.05 following false discovery rate correction of t test was considered significant. Forty-eight patients with high injury/high shock (7 nonsmokers [15%], 25 passive smokers [52%], and 16 active smokers [33%]) and 95 healthy patients who served as controls (30 nonsmokers [32%], 43 passive smokers [45%], and 22 active smokers [23%]) were included. Elevated metabolites in our controls who were active smokers include enrichment in chronic inflammatory and oxidative processes. Elevated metabolites in active smokers in high injury/high shock include enrichment in the malate-aspartate shuttle, tyrosine metabolism, carnitine synthesis, and oxidation of very long-chain fatty acids. Smoking promotes a state of oxidative stress leading to mitochondrial dysfunction, which is additive to the inflammatory milieu of trauma. Smoking is associated with impaired mitochondrial substrate utilization of long-chain fatty acids, aspartate, and tyrosine, all of which accentuate oxidative stress following injury. This altered expression represents an ideal target for therapies to reduce oxidative damage toward the goal of personalized treatment of trauma patients. Prognostic and Epidemiological; Level IV.

Insertional effect following electrode implantation: an underreported but important phenomenon.

Deep brain stimulation has revolutionized the treatment of movement disorders and is gaining momentum in the treatment of several other neuropsychiatric disorders. In almost all applications of this therapy, the insertion of electrodes into the target has been shown to induce some degree of clinical improvement prior to stimulation onset. Disregarding this phenomenon, commonly referred to as 'insertional effect', can lead to biased results in clinical trials, as patients receiving sham stimulation may still experience some degree of symptom amelioration. Similar to the clinical scenario, an improvement in behavioural performance following electrode implantation has also been reported in preclinical models. From a neurohistopathologic perspective, the insertion of electrodes into the brain causes an initial trauma and inflammatory response, the activation of astrocytes, a focal release of gliotransmitters, the hyperexcitability of neurons in the vicinity of the implants, as well as neuroplastic and circuitry changes at a distance from the target. Taken together, it would appear that electrode insertion is not an inert process, but rather triggers a cascade of biological processes, and, as such, should be considered alongside the active delivery of stimulation as an active part of the deep brain stimulation therapy.

Evaluating emergency response at a hospital near the Gaza border within 24 h of increased conflict

BackgroundFrontline hospitals near active hostilities face unique challenges in delivering emergency care amid threats to infrastructure and personnel safety. Existing literature focuses on individual aspects like mass casualty protocols or medical neutrality, with limited analysis of operating acute services directly under fire.ObjectivesTo describe the experience of a hospital situated meters from hostilities and analyze strategies implemented for triage, expanding surge capacity, and maintaining continuity of care during attacks with limited medical staff availability due to hazardous conditions. A focus will be placed on assessing how the hospital functioned and adapted care delivery models in the event of staffing limitations preventing all teams from arriving on site.MethodsA retrospective case study was conducted of patient records from Barzilai University Medical Center at Ashkelon (BUMCA) Medical Center in Israel within the first 24 h after escalated conflict began on October 7, 2023. Data on 232 admissions were analyzed regarding demographics, treatment protocols, time to disposition, and mortality. Missile alert data correlated patient surges to attacks. Statistical and geospatial analyses were performed.ResultsPatients predominantly male soldiers exhibited blast/multisystem trauma. Patient surges at the hospital were found to be correlated with the detection of incoming missile attacks from Gaza within 60 min of launch. While 131 (56%) patients were discharged and 55 (24%) transferred within 24 h, probabilities of survival declined over time reflecting injury severity limitations. 31 deaths occurred from severe presentation.ConclusionInsights gleaned provide a compelling case study on managing mass casualties at the true frontlines. By disseminating BUMCA's trauma response experience, strategies can strengthen frontline hospital protocols optimizing emergency care delivery during hazardous armed conflicts through dynamic surge capacity expansion, early intervention prioritization, and infrastructure/personnel protection measures informed by risks.

Rethinking the tiered trauma team response: A case-series study in a regional trauma centre.

To reduce perceived unnecessary resource use, we modified our tiered trauma response. If a patient was not physiologically compromised, surgical registrar attendance was not mandated. We investigated the effect of this change on missed injury, unplanned representation to ED, diagnostic imaging rates and staff satisfaction. A retrospective case series study assessing the 3-month period before and after the intervention was conducted. Logistic regression analyses were used to examine the association between ordering of computerised tomography (CT) and ED length of stay (LOS), injury severity (ISS), age, surgical review and admission. A staff survey was conducted to investigate staff perceptions of the practice change. Free text data were analysed using inductive content analysis. There were 105 patients in the control and 166 in the intervention group and their mean (SD) ISS was the same (ISS [SD] = 4 [±4] [P = 0.608]). A higher proportion of the control group were admitted (56.3% vs 42.2% [P = 0.032]) and they had a shorter ED LOS (274 min [202-456] vs 326 min [225-560], P = 0.044). The rate of missed injury was unchanged. A surgical review resulted in a 26-fold increase in receipt of a whole-body CT scan (odds ratio = 26.89, 95% confidence interval = 3.31-218.17). Just over half of survey respondents felt the change was safe (54.4%), and more surgical (90%) than ED staff (69%) reported the change as positive. The removal of the surgical registrar from the initial trauma standby response did not result in any adverse events, reduced admissions, pathology and imaging, but resulted in an increased ED LOS and time to surgical review.

Trauma-Informed Evangelism: Cultivating Communities of Wounded Healers

Trauma-Informed Evangelism: Cultivating Communities of Wounded Healers

Trauma-Informed Evangelism: Cultivating Communities of Wounded Healers

Trauma-Informed Evangelism: Cultivating Communities of Wounded Healers

Telehealth Delivery of the Child and Family Traumatic Stress Intervention is Associated With Reduced Posttraumatic Stress in Children and Caregivers.

This study evaluated whether telehealth delivery of the Child and Family Traumatic Stress Intervention (CFTSI) was associated with posttraumatic stress symptom reduction for children exposed to potentially traumatic events and their caregivers. The Child and Family Traumatic Stress Intervention is a brief (5-8 session), evidence-based, trauma-focused mental health treatment developed for implementation with children and caregivers in the early phase of the trauma response. Within traditional in-person outpatient settings, CFTSI has demonstrated effectiveness in reducing posttraumatic stress symptoms and reducing or interrupting Posttraumatic Stress Disorder in trauma-exposed youth and their caregivers, including those with extensive trauma histories. For the present study, 9 agencies that provided CFTSI via telehealth in 2020 and 2021 provided data for analysis. The sample included 129 racially and ethnically diverse caregiver-child dyads who completed CFTSI via telehealth. Paired samples t-tests revealed significant reductions in child and caregiver posttraumatic stress symptoms from pre-to post-CFTSI. Effect sizes were large and consistent with or stronger than prior studies of CFTSI implemented in person. Preliminary findings also indicated high levels of caregiver satisfaction. Current findings are particularly noteworthy given the chronic trauma exposure in the sample. The Child and Family Traumatic Stress Intervention delivered via telehealth is a viable treatment option which can increase flexibility for clinicians, families, and organizations.

The Impact of Sharing Recovery Stories in Public: Stigma, Trauma Response, and the Need for Multiple Pathways

There is increasing pressure on members of the substance use recovery community to share stories of their recovery process with health care professionals and the public to educate and destigmatize. This study examines the process and impact of this public sharing on recovery community members. This qualitative study used semi-structured, online interviews with 26 members of the recovery community who were recruited through a New England-based recovery community organization and social media. Sharing recovery stories in public is complex as 96% of participants reported both positive and negative experiences in sharing. Participants perceived that sharing could combat stigma through education about multiple recovery pathways and engender external validation. Perceived or anticipated impacts included facing different levels of stigma in and outside of the recovery community as well as potential trauma responses. Public sharing necessitated preparation or training, of which 92% had not received formal training. Recovery community members and organizations understand they have expert knowledge about recovery pathways that they can share to change perceptions of providers and the public. Substance use educators can work with and for the recovery community to provide guidance and resources to prepare for public, outgroup sharing to mitigate stigma and potential trauma response. Future research should consider a more diverse sample and a focus on in-group cultural consensus modeling, listing, and building inventories of “what to do” or “what not to do” when sharing traumatic experiences.

Luchando Junt@s Por Una Familia Unida (Fighting Together for a United Family): Rebuilding the Cohesive Self of Immigrant Parents and Community Healing after a Family Separation in the United States – A Self Psychology Perspective

AbstractThe Zero Tolerance policy implemented by the Trump administration resulted in the separation of thousands of Central American families seeking asylum at the U.S. Southern border. This policy has had a devastating impact on the mental health of parents and their children. While most of the literature on forced immigration family separation, and reunification focuses on children’s traumatic responses, it is essential to expand the literature to include the impact on parents, who can help mitigate the negative consequences of adverse events and traumatic stress on their children. When parents are not provided with adequate culturally sensitive healing interventions, their distress, and emotional needs may affect their ability to effectively support their children. Using a self psychology lens, this theoretical article sheds light on the psychological experiences of Central American parents who endured forced family separation. It also contributes knowledge to self psychology theory and its integration into group work with Central Americans. This article draws from the literature, my clinical experience with immigrants and refugees, and my work with Central American asylum-seeking families impacted by the “zero tolerance” immigration policy to argue that self psychology provides a lens for understanding the impact of the government’s empathic failure on parents upon entering the United States that led to a blow to parents’ cohesive self. Parents’ cohesive self can be restored with sufficient collective twinship, mirroring, and idealizing experiences, which in self-psychology are paramount psychological needs to be met for building and maintaining a strong self.

Systematic analysis of MASP-1 serves as a novel immune-related biomarker in sepsis and trauma followed by preliminary experimental validation.

Dysregulated immune response in trauma and sepsis leads to the abnormal activation of the complement and coagulation systems. Mannose-binding lectin (MBL)-associated serine protease-1 (MASP-1) activates the lectin pathway of the complement system and mediates proinflammatory and procoagulant reactions. However, the potential effects of MASP-1 in trauma and sepsis have not yet been explored. We obtained five sepsis, two trauma, and one sepsis and trauma RNA-sequencing dataset from the Gene Expression Omnibus (GEO) database and conducted a comprehensive evaluation of the expression pattern, biological functions, and diagnostic value of MASP-1 in trauma and sepsis. Additionally, we investigated the association between MASP-1 expression and clinicopathological characteristics of trauma and sepsis. Furthermore, we collected clinical specimens to preliminarily validate the expression level and diagnostic efficacy of MASP-1 as well as the correlation of MASP-1 with clinical features of trauma and sepsis. Subsequently, we conducted a correlation analysis among MASP-1, immune cell infiltration, and immune and molecular pathways. Finally, we mechanistically analyzed the relationship among MASP-1, specific immune cells, and pivotal molecular pathways. MASP-1 expression was significantly upregulated in the trauma/sepsis samples compared to the control samples in the GEO datasets. MASP-1 exhibited excellent diagnostic values (AUC > 0.7) in multiple datasets and at multiple time points and could efficiently distinguish trauma/sepsis samples from the control samples. Moreover, MASP-1 expression was significantly positively correlated with the severity of the disease (APACHE-II, CRP, and neutrophil levels). These results were further validated by real-time quantitative polymerase chain reaction and enzyme-linked immunosorbent assay. Functional enrichment analysis revealed that MASP-1 primarily promotes trauma and sepsis via the immune-related signaling pathway. MASP-1 was significantly correlated with the infiltration of specific immune cells (such as B cells, CD8 T cells, neutrophils, macrophages, and infiltrating lymphocytes) and immune and molecular pathways (such as checkpoint, HLA, IL6/JAK/STAT3 signaling, necrosis, T-cell co-inhibition, and T-cell co-stimulation). Finally, analysis of the transcription and single-cell data revealed that MASP-1 was specifically expressed in T cells, and further correlation analysis revealed a close correlation between MASP-1 expression, proportion of CD8 T cells, and IL6/JAK/STAT3 signaling scores. Our results suggest that MASP-1 can serve as an immune-related biomarker for the diagnosis and disease severity of trauma and sepsis. It may activate the IL6 JAK-STAT3 signaling pathway and promote CD8 T-cell depletion to trigger traumatic sepsis.

Trauma-informed music therapy with adult survivors of intimate partner violence and sexual assault: A scoping review

Trauma is a phenomenon that shapes our lives and can manifest in symptoms both overt and hidden. There are myriad causes and activators of trauma: it is pervasive, and therapists can presume that the people we see in sessions have experienced one or more traumas. Across cultures, neurobiological responses to trauma are shared: dysregulation of affect, changes in neurological functioning and processing, and prolonged stress reactions are common outcomes experienced by people from around the world. Intimate partner violence (IPV) and sexual assault (SA) create traumatic symptoms and responses in survivors; these can be debilitating and life-altering events. Music as a therapeutic modality offers survivors a way to process the effects of past and present traumatic events in a way that does not rely solely on cognitive processing or for survivors to relive memories that activate more stress or cause retraumatization. The purpose of this scoping review was to identify salient and current trends in music therapy that integrate a trauma-informed approach to working with women-identifying survivors of IPV and SA. Findings indicate a lack of continuity in theoretical and practical approaches. A theme of resiliency arose, and therapeutic experiences of songwriting, clinical improvisation, and active music making emerged as primary foci for clinical work.

A Mixed-Methods Evaluation of a Program for Promoting Trauma-Informed Responses among Criminal Legal System Professionals

Many people involved with the United States criminal legal system have experienced trauma, the long-term effects of which can challenge capacity to recover, often resulting in an increased risk of contact with the criminal legal system. Training programs can help professionals improve their understanding of trauma and implement trauma-informed responses. Limited research exists on the impact of trauma-informed response training for criminal legal professionals (e.g., corrections officers, court personnel, and law enforcement), and less is known about the effectiveness of the train-the-trainer (TTT) model in this context. In this article, we describe a four-phase, mixed-methods evaluation of a trauma-informed response training program delivered in the context of a 16-h TTT event to 28 criminal legal professionals in the southwest United States. We examine pre- and post-training knowledge acquisition, training experience, and impact on participant behaviors and attitudes 60 days post-training. Results provide preliminary support for the positive impact of trauma-informed response training for criminal legal professionals. We discuss future directions for research on the effectiveness of trauma-informed response training for criminal legal professionals, including, critically, whether trauma-informed training contributes to improved outcomes for individuals involved with the criminal legal system.

A qualitative assessment of Ukraine’s trauma system during the Russian conflict: experiences of volunteer healthcare providers

BackgroundThe Russian Federation’s invasion of Ukraine is characterized by indiscriminate attacks on civilian infrastructure, including hospitals and clinics that have devastated the Ukrainian health system putting trauma care at risk. International healthcare providers responded to the need for help with the increasing numbers of trauma patients. We aimed to describe their experiences during the conflict to explore the gaps in systems and care for trauma patients to refine the Global Trauma System Evaluation Tool (G-TSET) tool.MethodsWe conducted qualitative key informant interviews of healthcare providers and business and logistics experts who volunteered since February 2022. Respondents were recruited using purposive snow-ball sampling. Semi-structured, in-depth interviews were conducted virtually from January-March 2023 using a modified version of the G-TSET as an interview guide. Interviews were transcribed verbatim and deductive thematic content analysis was conducted using NVivo.FindingsWe interviewed a total of 26 returned volunteers. Ukraine’s trauma system is outdated for both administrative and trauma response practices. Communication between levels of the patient evacuation process was a recurrent concern which relied on handwritten notes. Patient care was impacted by limited equipment resources, such as ventilators, and improper infection control procedures. Prehospital care was described as highly variable in terms of quality, while others witnessed limited or no prehospital care. The inability to adequately move patients to higher levels of care affected the quality of care. Infection control was a key issue at the hospital level where handwashing was not common. Structured guidelines for trauma response were lacking and lead to a lack of standardization of care and for trauma. Although training was desired, patient loads from the conflict prohibited the ability to participate. Rehabilitation care was stated to be limited.ConclusionStandardizing the trauma care system to include guidelines, better training, improved prehospital care and transportation, and supply of equipment will address the most critical gaps in the trauma system. Rehabilitation services will be necessary as the conflict continues into its second year.

Cumulative trauma: The intersection between continuous security threats and the COVID-19 pandemic among Israeli older adults.

Research on cumulative traumatic events and their consequences for older adults have yielded inconclusive findings, especially when the traumatic events are different types of events and happen simultaneously. To explore older adults' perceptions of cumulative trauma, specifically exposure to continuous security threats via living in a war zone and COVID-19. Seventeen in-depth, open-ended, and semistructured interviews were conducted with older adults living near Israel's border with Gaza. We used ATLAS.ti software to perform thematic analysis. Various perceptions of continuous security-related stress and COVID-19, indicative of categorical differences in the perceptions of the two, were found. Namely, the characteristics, difficulties, and emotions that accompanied each of the two abovementioned traumas revealed three trajectories: negative cumulative; positive cumulative; and unrelated. We suggest conceptualizing cumulative trauma responses as an intersecting trajectory model, between the effects of previous traumatic events and those of the current one, reflecting a combination of individuals' resilience and vulnerability. Suitable policies/practices in which each specific traumatic event is seen alone, as well as in tandem with others, should be implemented. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

A Discourse of Hate: A Content Analysis of Responses to Queer Representation in Online Social Media

This study examined public responses to Elle Magazine’s Facebook post titled “30 LGBTQ+ Celebs You Really Should Know” to reveal common rhetoric towards lesbian, gay, bisexual, transgender, queer and/or questioning, intersex, asexual, and two-spirit (LGBTQIA2S+)-based discussion on social media. A content analysis of 100 comments uncovered several themes in negative reactions to queer representation in the media sphere including: preferred ignorance, lack of understanding, blatant distaste, religious bias, the view that queer identity is unnatural, an illness, an identity crisis, a trend, and a trauma response. Of the 100 comments examined, 86 responses were negative. The most prevalent theme was preferred ignorance, where respondents favoured keeping queer representation out of public discourse.&#x0D;