Process Modeling of ABCDE Primary Survey in Trauma Resuscitations: A Crucial First Step for Agent-Based Simulation Modeling of Complex Team-Based Clinical Processes.

Abstract

Trauma teams are ad hoc, multidisciplinary teams that perform complex patient care and medical decision making under dynamic conditions. The ability to measure and thus understand trauma team processes is still limited. Agent-based simulation modeling (ABSM) can be used to investigate complex relationships and performance within a trauma team. However, the foundational work to support such efforts is lacking. The goal of this work is to develop a comprehensive process model for the primary survey in trauma that can support ABSM. A process model for the primary survey of patients with blunt traumatic injuries was developed using Advanced Trauma Life Support guidelines and peer-reviewed publications. This model was then validated using video recordings of 25 trauma resuscitations in a level 1 trauma center. The assessment and treatment pathway followed in each video were mapped against the defined pathway in the process model. Deviations were noted when resuscitations performance did not follow the defined pathway. Overall the process model contains 106 tasks and 78 decision points across all domains, with the largest number appearing in the circulation domain, followed by airway and breathing. A total of 34 deviations were observed across all 25 videos, and a maximum of 3 deviations were observed per video. Overall, our data offered validity support for the blunt trauma primary survey process model. This process model was an important first step for the use of ABSM for the support of trauma care operations and team-based processes.