Trauma-Informed Care in the Emergency Department: Training and Recommendations

In the fast-paced environment of the emergency department (ED), emergency medicine providers encounter patients from diverse backgrounds, each with unique medical needs and life experiences. Among these patients, a significant portion may have experienced physical or mental trauma having lasting effects on their overall health and well being. Given that over 60% of US adults report trauma-related Adverse Childhood Experiences alone, as highlighted in The International Journal of Emergency Medicine, it is no surprise that emergency departments treat millions of individuals who suffer from some form of trauma every year.

Recognizing the impact of trauma and adopting a trauma-informed approach to care is crucial for providing effective and compassionate treatment. In this blog, we explore the definitions and principles of trauma-informed care (TIC) in the ED setting and provide recommendations for implementation.

Definition and Principles of Trauma-Informed Care:

The Substance Abuse and Mental Health Services Administration (SAMHSA) defines trauma-informed care as an organizational structure and treatment framework guided by the “Four R’s”: realization of trauma’s impact on people and groups and paths for recovery; recognition of the signs of trauma in patients, families, staff and others; response guided by knowledge and effective system to deliver trauma-informed care; and intentional resistance against re-traumatization.

In this helpful infographic, SAMHSA outlines 6 core principles crucial to the delivery of trauma-informed healthcare in both organizational and clinical practices, as follows:

• Safety: Creating a safe and supportive environment where patients feel physically and emotionally secure.
• Trustworthiness and Transparency: Building trust through clear communication and transparency in interactions.
• Peer Support: Recognizing the importance of peer support and connection in healing from trauma.
• Collaboration and Mutuality: Involving patients in their care decisions and fostering collaborative relationships.
• Empowerment, Voice, and Choice: Respecting patients’ autonomy and empowering them to make informed choices about their treatment.
• Cultural, Historical, and Gender Issues: Addressing cultural stereotypes and biases, provides gender-responsive services, utilizing traditional cultural connections for healing, and acknowledging historical trauma.

Implementing Trauma-Informed Care

To effectively implement trauma-informed care that addresses the six core principles outlined above, emergency medicine organizations must prioritize a number of important areas including:

• Training and Education: Provide comprehensive training to all staff members, including physicians, nurses, technicians, and administrative staff, on trauma-informed care principles. According to SAMHSA’s Concept of Trauma and Guidance for a Trauma-Informed Approach, Substance Abuse and Mental Health Services Administration, this should include understanding the impact of trauma, recognizing signs of trauma, and approaches for creating a safe and supportive environment, communication best practices, among others.
• Screening Protocols: Develop standardized screening protocols to identify patients who have experienced trauma. Examples of evidence-based screening tools include Trauma Screening Questionnaire (TSQ) or the Adverse Childhood Experiences (ACEs) questionnaire. These tools have been validated in various healthcare settings and can help identify individuals who may benefit from trauma-informed care interventions
• Trauma-Informed Environment: Create a physical environment in the emergency department that is conducive to trauma recovery. Examples include warm welcoming signage and artwork, minimizing noise, providing comfortable seating areas, ensuring privacy and offering educational materials and resources to patients about trauma, coping strategies and available support services.
• Patient Involvement in Care: Empower patients by offering them choices and control over their care whenever possible. This can include involving them in decision-making processes, explaining procedures clearly and obtaining informed consent before any interventions.
• Cultural Sensitivity: Recognize and respect the cultural, ethnic and linguistic diversity of patients who present to the emergency department. The Ohio Department of Child and Family Services tip sheet A Culturally Responsive Trauma-Informed Care Approach offers recommendations on how to ensure that services are culturally competent and accessible to all individuals, regardless of background.
• Collaboration with Community Resources: Establish partnerships with local community organizations and support services that specialize in trauma recovery. This can facilitate referrals for ongoing care, counseling and other support services beyond the emergency department setting.
• Staff Support and Self-Care: Offer support and resources for staff members to address their own experiences with secondary trauma and burnout. Providing regular debriefing sessions, access to counseling services and promoting self-care practices can help prevent compassion fatigue among healthcare providers. Find additional recommendations on how to support staff as part of Trauma-Informed Care here.
• Continuous Quality Improvement: Implement mechanisms for ongoing evaluation and improvement of trauma-informed care practices in the emergency department. This can involve collecting feedback from patients, conducting regular staff training sessions and reviewing protocols based on best practices and emerging research.
• Leadership Support and Commitment: Organizational leadership support and commitment to trauma-informed care practices are fundamental to implementation of successful trauma-informed healthcare. This includes allocating resources, establishing policies that prioritize trauma-informed care, and fostering a culture of empathy and understanding within the healthcare team. Find additional leadership support recommendations from SAMHSA here.

Recap

Delivering effective trauma-informed care in the emergency department requires a multifaceted approach. Recognizing the prevalence and impact of trauma, emergency medicine providers must take proactive steps to address patients’ unique needs with empathy and cultural sensitivity. Through ongoing education and training, implementation of trauma-informed patient practices, leadership support and other critical elements, emergency medicine departments can advance trauma-informed care, improving outcomes for trauma survivors and promoting resilience in our communities.