]OCRNAL OF EMERGEJ\CY NURSING

support. Massage facilitates relaxation and decreases anxiety. It may also stimulate endorphin production via our largest organ, the skin. Reflexology can be used to decrease pain, as we may have witnessed in a patient with a cluster headache. Using the patient's participation in visualization, imagery, or relaxation before and during an uncomfortable procedure gives the patient a more participatory role. This process may facilitate a smoother treatment process, unlike the antagonizing effects of fear: increased heart rate, increased blood pressure, and decreased cooperation. Patients have commented that they find it helpful to have a focus during a threatening procedure and that they feel more in control while visualizing or relaxing.

The bases for some of these modalities will not be new concepts for nurses. Touch, for example, is an el­ement that has long been an important aspect of nursing care. Central to many of the modalities is the use of awareness and intention, which may be likened to empathy, listening, and advocating. Some­times amidst the technology and chaos of the ED en­vironment these skills are given less merit, but they can easily be used to enhance our professional care.

For information about holistic nursing and train­ing for some of the modalities available, contact the American Holistic Nurses Association, PO Box 2130, Flagstaff, AZ 86003-2130; telephone (800) 278-AHNA. -Barbara A. Young, RN, BSN, Emergency Nurse, Board Certified Holistic Nurse, Certified Massage Therapist, St. John, US Virgin Islands

The EMS system works Dear Editor:

On July 24,1998, my brother was involved in a se­rious crash and survived thanks to many people in emergency services. He was flying a 2-seated gyro­copter when something went wrong and he literally fell 500 feet out of the sky. By all theories he and the passenger should be dead, but the people at the place they were flying and the system saved their lives. They were at a small airport in Mentone, Ind, which is about 55 miles west of Fort Wayne, the nearest trauma cen­ter. It was a bright, sunny Friday afternoon-a dramat­ic change from the previous days, which had been filled with torrential downpours and thunderstorms. My brother and his passenger had just taken off from the runway when that terrible something went wrong and they crash-landed in a soybean field about three quarters of a mile from the end of the runway. Other pi­lots were flying that day; no one knows for sure who saw them crash, but someone alerted the authorities.

To their benefit, an emergency physician from Colorado was flying that day and ran to them with a

484 Volume 24, Number 6

trauma pack. Who would have thought that someone would be carrying a backpack with IV fluids and other emergency equipment? The EMS system was initiat­ed immediately, and numerous volunteer first respon­ders, EMT-Bs, and EMT-Ps arrived in due time. At the insistence of the physician, both my brother and his passenger were transported by helicopter to Parkview Regional Trauma and Emergency Center in Fort Wayne. My brother had sustained a right open femur fracture, left open ankle, tibia, fibula dislocation, left hand crush injury, L 1-3 spinous process fractures, stable pelvic fracture, and numerous lacerations and abrasions. Remarkably, he did not have a head injury, although his helmet was split from the top complete­ly through the side. He was in surgery within 2% hours of the call and in the surgical ICU later that night. He had also sustained some pulmonary contu­sions, which became evident later that night when he required intubation.

Within 48 hours of the crash, my brother was extu­bated and talking about the events, in pain but alive. Now, 4 weeks later, he is back in the Chicagoland area, closer to home and on the road to recovery. He will walk again and, we hope, regain the use of his hand in time. As a fellow emergency nurse, I wish to give my humble thanks to all the people who had a hand in saving his life and the life of the passenger. Clearly, without the EMS system my brother would be dead, but in addi­tion a flight crew, emergency nurses, emergency physician, trauma surgeon, orthopedic surgeons, and a multitude of other nurses helped save the life of my brother, and I am thankful to each and everyone of you.-T Smith, RN, MS, FNp, Naperville, m

Abuse questions integrated into health screening Dear Editor:

I am writing to share information about what our emergency department/urgent care is doing to pro­vide proactive women's health care. When we obtain a health history, we also include questions about recent Papanicolaou (Pap) smears and mammograms. Many patients assume that they have had a Pap smear dur­ing pelvic examinations, when, in fact, they have sim­ply been screened for infections. Also, because some of our patients do not take advantage of primary care, they never get a mammogram. These very personal questions are also a good introduction to asking about domestic violence. These questions were simply added to our automated charting database. The nurse has the option to choose the following: Pap smear >2 years; Pap smear <2 years; mammogram, never; mam­mogram >2 years; mammogram <2 years; domestic abuse-current; domestic abuse-history of; or do­mestic abuse-denies. We will refer the patient to