information repository image repository discussion group interactive trauma professional resources about trauma.org search trauma.org directory related sites new content
RESUSCITATION
 

 

The Trauma Team

 

The ATLS is designed such that the lone doctor can safely look after a multiply injured patient. Tasks are performed in sequence, one after the other. This 'vertical organization' is the least efficient method of proceeding, and where more than one member of staff is available, a team approach is usually employed. This 'horizontal organization' has been shown to lead to significant reductions in resuscitation times.

The trauma team is ideally made up of a group of doctors, nurses, operating department assistants, radiographers and other support personnel who have no o ther commitment that day than to receive and treat trauma patients. Obviously this is a very expensive arrangement, and most hospitals cannot afford this level of cover. If the doctors involved are residents, senior consulting staff should be immediately available if necessary. Many centres now have their trauma teams led by consultants.

The Core Trauma Team is that group of professionals that receives and treats the patient. This includes :

Team Leader
Anaesthetist
Anaesthetic Assistant
General Surgeon
Orthopaedic Surgeon
Emergency Room Physician
Two Nurses. (Three if no anaesthetic assistant)
Radiographer
Scribe (Nurse or doctor)
Additional staff outside of this group need to be mobilized to provide ancillary services.
Porters - to run samples to the lab, collect blood etc.
Haematologist and Biochemist to receive and process samples.
Blood Bank
Other staff, while not necessarily involved in every trauma call, need to be available to the trauma team immediately :
Neurosurgeon
Thoracic Surgeon
Plastic Surgeon
Radiologist
Certain areas need early notification of the trauma victim.
CT Scanner
Intensive Care
Theatres
The core trauma team comprises 10 people working around a single patient. It is vital that everyone knows their place and their tasks, and has the skills, equipment and support to accomplish these. The trauma room should be quiet so that the voice of the team leader can be heard and assessments from team members can be relayed back to him. Vital signs should be called out every five minutes and these must be heard by everyone.

With practice and exposure the trauma team becomes an efficient machine that is exciting and compelling to watch or be part of.

Trauma Team Tasks.

The Team Leader

The Team Leader should not touch the patient. Instead he acts as conductor of the orchestra. Responsibilities of the team leader :

  1. Obtain history from paramedics.
  2. Direct team members in their actions.
  3. Establish priorities for investigation and management.
  4. Order or authorize investigations and procedures.
  5. Keep track of whole state of the patient.
  6. Receive and interpret all results of investigations
  7. Order fluid or blood administration.
  8. Supervise spinal manoeuvres.
  9. Consult with other specialities.
  10. Decide on appropriate disposition.
  11. Talk to relatives.
  12. Write in the notes.
  13. Record audit information.
  14. Dismiss and debrief team members.
  15. Educate trauma team.
The trauma team leader should be the most experienced team member present before the patient arrives in hospital. The leader's role should not be superseded by late arriving members or passing senior staff. This avoids confusion for the team members of who to take direction from and who to report to.

Anaesthetist

The anaesthetist has a central role in the trauma team. Responsibilities are :

  1. Airway Control
  2. Cervical Spine Control
  3. Ventilation
  4. Monitoring of vital signs.
  5. Monitoring of fluid and drug administration.
  6. Analgesia
  7. Provide anaesthesia for surgical procedures.
General Surgeon

The general surgeon focusses on assessment of the thorax, abdomen and head if no neurosurgeon is on the core trauma team. Responsibilities are :

  1. Pimary Survey
  2. Assessment of thorax and abdomen, head and facial injuries. Log roll.
  3. Thoracostomy or thoracotomy.
  4. Diagnostic peritoneal lavage.
  5. Urinary Catheter
Orthopaedic Surgeon

  1. Intravenous access.
  2. Assessment of spine, pelvis.
  3. Application of external fixator.
  4. Assessment of limb injury.
  5. Dressing of wounds and stabilization of fractures.
  6. Urinary Catheter.
Emergency Room Physician

  1. Intravenous access.
  2. Venous and arterial blood samples.
  3. Thoracostomy.
  4. Urinary Catheter.
  5. Assist with diagnostic peritoneal lavage.
Some overlap is necessary between the general surgeon, orthopaedic surgeon and emergency department physician to ensure that tasks continue simultaneously and no time is lost and no hands wasted.

Nursing staff

If their is no anaesthetic assistant on the trauma team, one nurse should be solely dedicated to the anaesthetist. Otherwise nurses should attach themselves individually to each hands-on surgeon or ED physician and assist in their tasks. The nurses should not have to leave the resuscitation room to fetch equipment or run samples to the labs. Ancillary staff should be outside the main resus area to provide this.

Radiographer

The radiographer should immediately start with the trauma series of X-rays, in the order Cervical Spine, Chest and Pelvis, unless directed otherwise by the team leader. Once these have been processed, other views may be required by evidence of other injuries. The radiographer should also act as liaison to the CT scanning department.

Scribe

The scribe is responsible for the full record of the trauma call. A separate individual, either doctor or nurse should be allocated to the roll. They should be situated near the team leader so that all information passing through the leader is then passed to the scribe. Records must include :

  • Time of arrival.
  • Mechanism of injury.
  • Personnel present at call
  • Physical findings
  • Vital signs. Urine output. Glasgow Coma Scale.
  • Results of X-rays and other investigations.
  • Fluids administered.
  • Drugs administered.
  • Previous Medical History.
  • Summary of injuries.
  • Disposal of patient.

The aim of the trauma team is to provide a safe and efficient evaluation of the patient. Identify all injuries and instigate definitive management of such injuries. The golden hour starts at the time of injury. So most trauma teams will have about 30 minutes to accomplish this and should work towards achieving this goal.