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TRAUMA
TEAM
Just as every district hospital needs to be
prepared for a situation where there are many patients with
competing needs, the staff also need to be skilled at dealing
with multiply injured or critically ill patients requiring
the care of many people at the same time. A “trauma team” that
is experienced in working together in times of stress and urgency
is also an important part of the disaster plan.
Identify the different jobs to be undertaken in an emergency
and ensure that all members of the team know what those roles
are and are trained to perform their own role. The area in which
emergency patients are received should be organized so that
equipment and materials are easy to find. It is helpful to make
a map showing where in the room/area people need to be stationed
and the jobs that are associated with the different positions.
Team leader
A team leader should be designated to take charge in a disaster
or trauma situation. Ensure that all members of the team know
who the leader is.
In the event of a major disaster, the leader should oversee
the implementation of the disaster plan and delegate specific
tasks.
In
the case of an individual trauma case, the team leader is usually
responsible for the following activities:
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Perform
the primary survey and coordinate the management of airway,
breathing and circulation |
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Ensure
that a good history has been taken from the patient, family
and/or bystanders |
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Perform
the secondary survey to assess the extent of other injuries |
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Consider
tetanus prophylaxis and the use of prophylactic or treatment
doses of antibiotics |
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Reassess
the patient and the efforts of the team |
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Ensure
patient documentation is completed, including diagnosis,
procedure, medications, allergies, last meal and events
leading up to the injury |
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Communicate
with other areas of the hospital and staff members |
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Communicate
with other people and institutions outside the hospital |
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Prepare
the patient for transfer |
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Liaise
with relatives. |
Information should flow to and through the leader:
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Know
and use the names of the other members of the team and ensure
that they have heard and understood directions |
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Check
back with members of the team to make sure designated
tasks have been completed: for example, “How is the airway?”,
“Are you having any trouble bagging?”, “Have
you had to suction much?”, “Is the second IV
started?” |
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Ask
for input from the team, but ensure that all directions
come from only one person. |
If only a small number of people are available, each team member
will have to assume a number of roles. If there is only one
person with airway management skills, for example, that person
must manage the airway as well as acting as the leader. If there
is more than one person with airway skills, one can be assigned
to manage the airway and the other to act as the leader. It
is difficult to perform emergency tasks while at the same time
keeping an eye on the overall situation, so recruit as much
help as you can. Practise often and communicate clearly.
In an emergency, stay calm and speak clearly.
Members of the trauma team
Members of the team are responsible for:
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Accepting the authority of the leader: this is not a time
for consensus decision making |
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Speaking to and through the team leader |
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Clearly
and concisely reporting back to the leader once a task
is completed: for example, “IV line established in the
right antecubital fossa using a 14 gauge cannula”. |
If
teams are involved in planning disaster and trauma management
and regularly practise implementing the plan, they will be more
effective and less stressed when a real event happens. Taking
turns in acting out different roles within the trauma team will
help each person to have a greater understanding of the roles
of other team members and the demands of each role.
Trauma management is covered in depth in Unit 16: Acute Trauma
Management and in the Annex: Primary Trauma
Care Manual.
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