Traumatology Talks: Continuing the conversation
The lead-up to the first meeting of the Traumatology Talks Working Group (TTWG), on 22 March 2024, stretches back to 2018. That’s when ACEM connected with Karabena Consulting through the Lowitja Institute to study cultural safety in ED settings through the lens of both service users and service providers and including an audit of ACEM’s cultural safety material.
One of the outcomes this partnership produced was the Traumatology Talks: Black Wounds, White Stitches report, published in December 2020.
In this report, the term traumatology (the study of wounds and injuries caused by accidents or violence and the surgical therapy needed to repair the damage) was brought into the context of the lived experience of Aboriginal and/or Torres Strait Islander people. Traumatology in this context describes intergenerational trauma resulting from genocide, forced separations and removal with epigenetic, telomeric and associated biological changes that are exacerbated by re-traumatising events, poor social and cultural determinants of health, and narratives of desperation, disadvantage, marginalisation and vulnerability.
The TTWG is an ACEM-led, inter-professional, national group formed to develop a set of deliverables, based on the recommendations in the Traumatology Talks report, for consideration by ACEM’s Indigenous Health Committee.
““We need to make our departments and ourselves safer for our community.””
FACEMs Dr Ryan Dashwood and Dr Charley Greentree, co-chairs of the TTWG, said the purpose of the working group is to focus on and continue the work of those before them, as well as translating the recommendations, which will ultimately improve the care of patients in all emergency settings. The TTWG’s initial focus is on what social emergency care (specialisation for First Nations) as a discipline could look like and how it could be experienced and integrated into emergency medicine in Australia. The working group is exploring partnerships, curriculum design and implementation models and discussing what all emergency medical professionals can do to help improve the care of Indigenous patients.
Dr Dashwood said the key findings of the research undertaken to date highlight the need to get beyond past failures in care. To better support this vision, he said the TTWG is keen to work with all members of the ACEM community to use a strengths-based narrative for progress. This would entail examining the system and environments and acknowledging the previous and current impacts on the health of patients and communities.
‘We have a motivated group of people from across the country, many contributing despite existing demands for cultural loading in their substantive roles. ACEM and the TTWG are aware of the need for momentum and output, but also the need to work on keeping the team safe whilst moving forwards,’ Dr Greentree said. ‘There are many possible outcomes from this work.’
She said the working group plans to reach out to the ACEM membership for their input on social emergency care for First Nations people presenting to emergency departments in Australia.
“‘(Social emergency care) keeps us focused on person-centred principles of care, how we connect and has such great potential to benefit and improve care.’”
‘A lot of the principles of social emergency care are not new to emergency physicians,’ Dr Greentree said. ‘It keeps us focused on person-centred principles of care, how we connect and has such great potential to benefit and improve care.
‘It will be especially beneficial to the Indigenous community, who already live with a more holistic approach to health. The entire person needs to be considered to provide appropriate health care.’
The ‘entire person’ means more than their symptoms, pathophysiology or clinical history, and encompasses their social connection and situation, their roles and responsibilities, and their relationships. Dr Greentree said these include the ‘caring and healing relationships with us, emergency clinicians’.
‘Social emergency care extends to environmental health, considering factors such as housing, food security, sanitation, being loved and having purpose, employment,’ she said. ‘It is all connected.’
The importance of a trauma-informed approach
The TTWG has now held four meetings and is working on how SEC can be learned, practiced intentionally and integrated into workforces, workplaces and the broader culture by emergency physicians and their colleagues.
“‘We are interested in what research and experience can be translated to our practice. We will be reaching out to the ACEM community to scope out what members already know and do in their practice.’”
Dr Dashwood said that one of the key components is ‘to use a trauma-informed approach to care in emergency medicine matters’.
‘This means helping us (clinicians) understand that previous lived experiences, both direct and from generations before, affect patients’ behaviours, communication, engagement and outcomes. It takes us considering what else is important to the person presenting to us in our emergency departments,’ he said.
‘We are considering the models and experience of social emergency care (or social emergency medicine) in other colonised countries (e.g., USA and Canada). Their research has shown the benefits to the Indigenous populations and the extension of benefits beyond this population, including staff delivering care.
‘We are interested in what research and experience can be translated to our practice. We will be reaching out to the ACEM community to scope out what members already know and do in their practice.
‘We will use this to move forward with designing supportive education and training for the emergency medicine community as a way of healing, a way of improving health care for Aboriginal and Torres Strait Islander communities. For all communities.’
The full Traumatology Talks report can be read here.
