The inaugural run of our “Trauma Team Course” took place in April 2017 and contained a mix of high-fidelity simulation scenarios, expert demonstrations and skills stations. It was a big undertaking and I’d like to thank everyone involved, especially our fellow co-writers and Faculty Dr Shirin Brady, Dr Dean Kerslake, Dr Richard Lyon and Dr Nicola McCullough. The day ran without any discernible technical glitches and finished well on time!
The bespoke nature of the course means that it’ll continue to evolve over the next few years as the Trauma Team roles and processes become more formalised. Thanks for all your feedback. In response to this, the time allocated to the skills stations is being increased to allow more hands-on practice.
The next run of the course will be on Friday 25th August and we’ll be publicising it in and around the ED over the next few weeks.
In the meantime, here are the main learning points that participants gleaned from the April course (many of which will be relevant to other centres):
- Role allocation prior to pt arrival is very helpful. However, REMEMBER TO REALLOCATE as situation changes e.g. for RSI; once task completed by Team member or if patient deteriorates.[Note: We will likely introduce a standardised pre-brief checklist and more clearly define roles as institute a full ‘Trauma Team’]
- Team members please inform Trauma Team Lead if you feel you would be more effective performing another role/task.
- Be aware of how to source local guidelines on anticoagulant reversal in critical bleeding.
- Vascular Access: Consider early subclavian access with sheath introducer where appropriate.
Subclavian access skills station
- Hands-off leadership can help enhance situational awareness; not only of the Team Lead but also of other participants (through sharing mental models at set points).
- Hands-off leadership may have to be sacrificed in certain circumstances e.g. When TTL is the only one with requisite skills or experience to perform a certain intervention e.g. resuscitative thoracotomy. Consider nominating someone else to remain hands-off for overview whilst this is taking place.
- Crowd control: All of the team should be cognisant of when too many staff present in Resus might be worsening patient care. Consider which steps you would take to address this before the situation arises. Inform Team Lead if you feel it is happening.
Resuscitative thoracotomy skills station.
Crowd control would be very pertinent if this was a real patient/clinical scenario
- Identify Names, Specialties and (Specific) Grades for all those entering Resus. We might mandate this in the future before staff can become involved in patient care e.g. check-in with Scribe/whiteboard to document all staff present.
- Scoops: We need a department one (preferably plastic variety) to aid efficiency in transferring trauma patients after cutting off their clothing e.g. if they arrive from other services on a spinal board.
- ASK FOR MORE STAFF IN RESUS if you feel the situation requires it. This may include 2 Consultants, 2 Senior Nurses or Registrars. Consider whether effective task reallocation amongst staff will reduce/negate the need for more staff first.
- Make sure all verbal communication in Resus is the most effective it can be. With multiple specialties present, the heightened noise level can be distracting. Try to minimise non-essential chatter. Practice Closed-Loop communication.
Craig
Craig Walker
Co-Lead, Medic One Sim Team
EM & ICM Consultant
NHS Lothian
@CW_EM_ICM