Trauma Team Members Research Articles

Multispecialty resident physicians’ perceived preparedness for mass casualty events (MCEs) at an urban level I trauma center prior to the coronavirus disease 2019 (COVID-19) era

PurposeCoronavirus disease 2019 (COVID-19) has underscored how ill-prepared healthcare systems are for mass casualty events (MCEs,) especially as MCEs increase worldwide. We hypothesized that resident physicians (RPs) across multiple specialties are underprepared for MCE.MethodsTwo similar surveys were conducted to assess awareness of disaster plans (DPs) and individual’s roles and responsibilities therein. Initially, we surveyed exclusively trainees who are trauma team members (TTMs,) including physician assistants (PAs), residents from emergency medicine (EMRs) and general surgery (GSRs.) Subsequently, we surveyed multi-specialty RPs, except GSRs and EMRs, and their program directors/associate program directors (PDs/APDs.) RPs’ awareness, knowledge of, and confidence in hospital MCE response plans were assessed, and barriers encountered were queried. Data were consolidated except with respect to PDs/APDs, who were queried only in the second survey. The Fisher exact test for multiple-group comparisons was used. Alpha = 0.05.ResultsFor the first survey, the response rate was 74% (123/166), whereas 34% (129/380) responded to the second survey. Combined, the response rate was 46% (252/546.) Considering the RPs only for the two surveys combined, 103 (53%) respondents reported no awareness of institutional MCE response plans, 73% (n = 143) did not know/were unsure whether they were expected to contact someone, and 68% (n = 134) reported no formal MCE/disaster management (DM) training over the prior year. Additionally, the median response reported for level of knowledge of the MCE response plan among all RPs was “not at all,” with a significant difference observed between those aware of the plan and those who were not (p < 0.001). The median response reported for confidence level of RPs in MCE/DM training, excluding GSRs and EMRs (TTMs,) was “not at all,” with significant differences between surgical and non-surgical specialty RPs (p = 0.031), and between junior and senior RPs (p = 0.027). PDs/APDs (n = 12) reported “time” as the main barrier to implementation.ConclusionsRPs across all surveyed specialties reported low levels of knowledge and minimal training regarding MCE/DM. Incorporation of MCE/DM preparedness into residency training in all specialties involving direct patient care is essential. Curricular restructuring will be required for meaningful participation of RPs in MCEs.

Red line the red line: Optimizing emergency medicine physicians and surgeons collaborative roles on trauma teams.

It has long been the standard for surgical and EM teams to both be present upon patient arrival and work together for the sickest trauma patients, yielding improved outcomes. It is important to dismantle divisive perceptions, confront system constraints, and promote new strategies that optimize the engagement of trauma team members. The focus should be on the patient, whose injury care starts with prevention and extends seamlessly through prehospital, hospital and rehabilitation.The authors address several myths that impact collaborative teamwork among emergency medicine physician and surgeons.Leaders, especially at GME sites, need to foster collaborative relationships, rather than adversarial. The red line mentality is a divisive construct that should be dismantled.

Point of Care Ultrasounds Obtained by Novice Physician Assistant Residents (POCUS ON PAR).

The integration of Point of Care Ultrasound (POCUS) into the care of trauma patients, specifically the E-FAST, has improved the accuracy of initial diagnoses and improved time to surgical intervention in critically ill patients. Physician assistants (PAs) are critically important members of any military trauma resuscitation team and are often team leaders in a pre-hospital setting. They may receive training in ultrasound but there are little data to support their use or evaluate their effectiveness in using POCUS. We designed a study to evaluate the image quality of an E-FAST Exam performed by Emergency Medicine Physician Assistant (EMPA) Fellows and Emergency Medicine (EM) Interns following identical training. Our hypothesis is that image quality obtained by EMPAs will be non-inferior to those images obtained by EM Interns. This is a prospective single-blinded study comparing the image quality of E-FAST exams performed by first year EM interns and first year EMPA fellows. All participants completed standard POCUS training prior to enrollment in the study. A total of 8 EMPAs and 8 EM first year residents completed 10 recorded E-FAST exams to be used as study images. Participants also viewed a 15-question slide show containing images of positive (6) and negative (9) E-FAST exams and recorded their interpretations. Images were reviewed by expert reviewers who were blinded to which images were collected by which group. An image quality score was recorded for each view as well as an overall image quality score. Image quality was rated on a 1 to 5 image quality scale. For overall image quality, the mean score for EMPAs was 3.6 ± 0.5 and for EM residents was 3.2 ± 0.5 with statistical significance favoring better image quality from the EMPAs. The time to completion for the EFAST exam for EMPAs was 4.8 ± 1.3 minutes and for interns it was 3.4 ± 1.4 minutes (P value = 0.02). There was no difference in image interpretation quiz scores between the groups (mean score 92% among interns and 95% among PAs). POCUS is an imaging modality which is very portable and relatively inexpensive which makes it ideal for military medicine. PAs are essential members of military trauma teams, and often run an initial trauma resuscitation. Being able to correctly identify patients who have free fluid early in the course of treatment allows for more correct evacuation criteria to ensure the sickest patients get to care the fastest. Although there are limited data to support POCUS use by non-physicians, our data support a growing body of evidence that it is not the profession or baseline medical education that determines an individual's ability to use and incorporate ultrasound into bedside and clinical practice. Our study shows that with training and experience PAs or other members of the military health care team can use the EFAST to better care for trauma patients.

Clinicians’ experience with technology within the physical environment of trauma rooms: a focus group study

PurposeThis study aims to investigate how trauma team members perceive technological equipment and tools in the trauma room (TR) environment and to identify how the technological equipment could be optimized in relation to the TR’s space.Design/methodology/approachA total of 21 focus group sessions were conducted with 69 trauma team members, all of whom worked in Level I TRs from six teaching hospitals in the USA.FindingsThe collected data was analyzed and categorized into three parent themes: imaging equipment, assistive devices and room features. The results of the study suggest that trauma team members place high importance on the availability and versatility of the technological equipment in the TR environment. Although CT scans are a usual procedure necessity in TRs, few facilities were optimized for easy access to CT-scanners for the TR. The implementation of cameras and screens was suggested as an improvement to accommodate situational awareness. Rapid sharing of data, such as imaging results, was highly sought after. Unorthodox approaches, such as the use of automatic doors, were associated with slowing down the course of actions.Practical implicationsThis study provides health-care designers with the knowledge they need to make informed decisions when designing TRs. It will cover key considerations such as room layout, equipment selection, lighting and controls. Implementing the strategies will help minimize negative patient outcomes.Originality/valueLevel I TRs are a critical element of emergency departments and designing them correctly can significantly impact patient outcomes. However, designing a TR can be a complex process that requires careful consideration of various factors, including patient safety, workflow efficiency, equipment placement and infection control. This study suggests multiple considerations when designing TRs.

Initial Assessment of Trauma Patients

Introduction: The initial assessment of trauma patients is a critical and time-sensitive phase in the realm of emergency medicine. This presentation outlines the fundamental components and principles of conducting an effective initial assessment, which is essential for promptly identifying life-threatening injuries and ensuring timely interventions for patient stabilization.&#x0D; The primary objective of the initial assessment is to swiftly detect and address imminent life-threatening conditions. This process adheres to a structured approach, often following established protocols such as Advanced Trauma Life Support (ATLS).&#x0D; Commencing with the evaluation of the patient's airway, breathing, and circulation (ABCs), healthcare providers prioritize the maintenance of a patent airway, adequate respiration, and a stable circulatory system. Any life-threatening issues identified during this phase demand immediate intervention.&#x0D; Simultaneously, healthcare providers perform a concise yet comprehensive patient history and physical examination, gathering information about the injury's mechanism, the patient's medical background, and any pertinent details. This collected data serves as the foundation for subsequent assessments and treatment plans.&#x0D; The secondary survey, a more detailed and systematic examination, follows the initial assessment. This phase involves a thorough head-to-toe evaluation aimed at detecting injuries that may have been initially overlooked. Diagnostic procedures, including imaging studies and laboratory tests, may be initiated during this phase to further assess and diagnose injuries.&#x0D; The initial assessment places specific emphasis on identifying and managing conditions with rapid and potentially lethal deterioration, such as tension pneumothorax, cardiac tamponade, and massive hemorrhage.&#x0D; Throughout the assessment process, effective communication among the trauma team members is paramount to ensure a coordinated and efficient response. This includes making triage decisions and facilitating swift patient transport to the most appropriate care facility, all of which contribute to optimal trauma patient management.&#x0D; In conclusion, the initial assessment in trauma patients is a dynamic and systematic process designed to swiftly identify and address life-threatening injuries. By recognizing these injuries promptly, initiating timely interventions, and gathering critical patient information, healthcare providers and emergency responders play a vital role in ensuring the best possible outcomes for trauma patients. Training in these procedures is essential to equip healthcare teams with the skills and knowledge needed for successful trauma patient management.

The Impact of Sensory Stimuli on Healthcare Workers and Outcomes in Trauma Rooms: A Focus Group Study.

This study investigated issues related to noise, lighting, and temperature in trauma rooms that impact patient care and staff performance. Uncontrolled sensory stimuli can hinder healthcare delivery quality in trauma rooms. High noise and temperature levels can increase staff stress and discomfort as well as patient discomfort. Conversely, proper lighting can decrease staff stress levels and reduce burnout. Sensory overload in trauma rooms is a crucial concern, but no studies have been conducted on this issue. Using a convenience sampling method, 65 trauma team members (e.g., surgeons, physicians, nurses) from six Level I trauma centers in the United States were recruited to participate in 20 focus groups. Focus groups were semi-structured and 1 hr long. Staff covered issues related to communications and disruption from noise sources (e.g., equipment, conversations). Having control over lighting allows staff to change light intensity and facilitate their work during the resuscitation. A well-maintained temperature can provide patient comfort or reduce risk of hypothermia, given that patients can lose body heat rapidly due to loss of blood. Excessive sensory stimuli can result in disrupted communication, fatigue, and stress, making staff susceptible to errors. Staffs' control over environmental conditions may lead to a more efficient, comfortable, and safer environment. Technology should be reliable and flexible to facilitate this.

The ABCDE approach: Evaluation of adherence in a low-income country

BackgroundEarly recognition and initial treatment of trauma patients prevents deterioration and buys time for making a definitive diagnosis. The “Airway, Breathing, Circulation, Disability and Exposure” (ABCDE) approach should be used whenever an injury is suspected. It provides quick identification and management of life-threatening problems. Still, there is limited knowledge regarding adherence to the ABCDE approach. This research aims to assess the adherence of the trauma team members to the ABCDE approach in the management of major trauma patients and the factors affecting it. MethodThe study is a cross-sectional hospital-based study conducted in the trauma and resuscitation rooms of major governmental hospitals in Khartoum in the period from Jan.30, 2022, to Mar.29, 2022. It was done among the medical staff dealing with major trauma cases. Data were collected by observation using a modified standardized checklist for assessing the ABCDE approach and via a self-administered questionnaire for identifying the factors affecting adherence. Total coverage of all major trauma cases resuscitation (n = 50) was done. Also, a sample size of 158 medical staff was covered for the questionnaire. The data was analyzed in Statistical Package for the Social Science (SPSS) V.23. ResultsThe mean percentage of adherence to the ABCDE approach was 37.9 % (SD 15.44). When the ABCDE sequence was not followed, the ACB was the commonest sequence. Also, adherence had no significant relation with any patient or staff-related factor. The main present obstacles to adherence to the ABCDE approach were overcrowding in the room and unprepared facilities. While the major present facilitator was the clinical experience. ConclusionThe adherence rate was low, but initiation of the ABCDE approach was rapid. The factors participating in low adherence rates were usually facility or population-based factors. We recommend further studies, further training and embedment of guidelines, and the provision of larger trauma rooms with adequate supplies.

The Impact of Screening for Perioperative ICU Admission in Geriatric Hip Fracture Patients: A Retrospective Analysis.

Hip fracture patients are a subset of trauma patients with high peri-operative mortality. To mitigate the mortality risk, the use of predictive scoring systems (e.g., RSI or Nomograms) for risk stratification and monitoring of high-risk patients in the intensive care unit (ICU) has been proposed. Screening patients for ICU admission with relatively low-cost tools may achieve high-quality, low-cost care. The aim of this study was to assess the effectiveness and feasibility of screening postoperative hip fracture patients for ICU admission. This is a retrospective single-site study comparing two groups ofpatients, before and after implementation of a hip fracture postoperative screening intervention in a level 1 trauma center in the United States. All hip fracture patients > 55 years of age admitted to the hospital between January 2021 and May 2023 were included. Trauma team members assessed and screened patients postoperatively in the post-anesthesia care unit (PACU), ordering standardized tests, including laboratory tests, a chest x-ray, and electrocardiogram (EKG). Assessment of the effect of the intervention included a comparison of a number of major adverse events (MAEs), mortality, planned and unplanned ICU admissions, ICU length of stay (LOS), and hospital LOS between pre- and post-intervention groups. Propensity score (PS) estimates were used to compare outcomes between the matched participants in the sample. A predictive model for ICU admission for the overall sample was estimated, and discriminative ability was assessed with an area under the curve (AUC) receiver operator characteristics (ROC) analysis. Lastly, feasibility was assessed by compliance with screening intervention and charges per patient related to the intervention. The sample consisted of 290 patients in the pre-intervention and 180 patients in the post-intervention groups, respectively, with a mean age of81.4 ± (9.9) years. There was a significant increase (p<0.01) in planned ICU admissions (OR=2.387, 95% CI (1.430, 3.983)) after screening protocol implementation. There was no significant difference between the pre-intervention group and post-intervention group in the number of MAEs (p=0.392), mortality (p=0.591), ICU LOS (p=0.617), and hospital LOS (p=0.151). When the PS-matched sample (n=424) was analyzed, there was a significant decrease (p=0.45) in unplanned ICU admissions (OR=6.40, 95% CI (0.81, 50.95)) after protocol implementation. Anticoagulants, emergency department (ED) respiratory rate (RR), injury severity score (ISS), number of comorbidities, substance use disorder (SAD), peripheral artery disease (PAD), and chronic obstructive pulmonary disease (COPD) were significant predictors of ICU admission (p=0.002, 0.022, 0.030, 0.034, 0.039, 0.039, and 0.042), respectively, and, demonstrated the discriminative ability between high and low risk for ICU admission (AUC=0.597, 0.587, 0.581, 0.578, 0.513, and 0.587, respectively). The screening intervention was achievable with 99% compliance (Kappa estimate 0.94) among trauma team members with an average charge of $282 per patient. The addition of a postoperative screening intervention for hip fracture patients > 55 years of age is achievable and decreases unplanned ICU admissions in matched samples. Presenting clinical indicators and comorbidities are associated with ICU admission and provide sufficient discriminatory ability as criteria for ICU admission.

Resuscitative endovascular balloon occlusion of the aorta (REBOA) may also have a place outside major trauma centers - A case report from a Finnish rural hospital

The recent adoption of endovascular and hybrid methods in the management of massive bleeding following trauma to the torso and junctional areas has been a major advance in trauma care. Resuscitative endovascular balloon occlusion of the aorta (REBOA) is one tool to tackle immediate exsanguination in such cases. To take advantage of such methods, rapid femoral artery access is crucial. In rural hospitals a trauma surgeon, vascular surgeon and interventional radiologist may not be in the hospital during on-call hours. Furthermore, gaining femoral arterial access is an infrequent procedure for a trauma surgeon working outside major trauma centers. Therefore, it might be difficult to acquire and maintain the requisite skills. However, a consultant anesthesiologist is a member of the trauma team and always on call in our hospital. An experienced anesthesiologist is a valuable asset in ultrasound guided arterial punctures and in inserting intravascular introducer sheaths, as was the case in our patient. To our knowledge, anesthesiologists do not commonly participate in the actual placement of arterial introducer sheaths for REBOA catheters in trauma teams. We wish to bring to notice this hidden asset when a team that does not routinely include a vascular surgeon or an interventional radiologist is treating a seriously injured trauma patient. We report on a patient who had sustained a shrapnel injury to the groin with massive blood loss. To stop further bleeding and to stabilize hemodynamics, we used REBOA to gain proximal control of the bleeding. As a result, the patient avoided surgical retroperitoneal exposure and a dry surgical field was created. We conclude that REBOA may also have a place in rural hospitals, and that, if necessary, trauma team members may adopt novel roles in the treatment of hemorrhage.

Catalytic effect of multisource feedback for trauma team captains: a mixed-methods prospective study

ObjectivesTo evaluate the impact and feasibility of multisource feedback compared with traditional feedback for trauma team captains (TTCs).DesignA mixed-methods, non-randomised prospective study.SettingA level one trauma centre in Ontario, Canada.ParticipantsPostgraduate medical...

Trauma Team High-Fidelity Simulation Training in a Rural Level III Trauma Center: An Interprofessional Experience.

Emergency department trauma resuscitation requires teamwork and high-stakes clinical decision-making. Rural trauma centers with low trauma activation volumes must ensure that resuscitations are efficient and safe. The purpose of this article is to describe the implementation of high-fidelity, interprofessional simulation training to foster trauma teamwork and role identification for trauma team members responding to trauma activations in the emergency department. High-fidelity, interprofessional simulation training was developed for members of a rural Level III trauma center. Subject matter experts created trauma scenarios. An embedded participant led the simulations using a guidebook that outlined the scenario and learner objectives. The simulations were implemented from May 2021 through September 2021. Postsimulation survey results identified that participants found training with other professions valuable and that knowledge was gained. Interprofessional simulations enhance team communication and skills. Combining interprofessional education with high-fidelity simulation creates a learning environment that optimizes trauma team function.

Self-efficacy and application of skills in the workplace after multidisciplinary trauma masterclass participation: a mixed methods survey and interview study

PurposeThe most complex injuries are usually least often encountered by trauma team members, limiting learning opportunities at work. Identifying teaching formats that enhance trauma skills can guide future curricula. This study evaluates self-assessed technical and nontechnical trauma skills and their integration into novel work situations for multidisciplinary trauma masterclass participants.MethodsThis mixed methods study included participants of a multidisciplinary 3-day trauma masterclass. Ratings of trauma skills were collected through pre- and postcourse questionnaires with 1-year follow-up. Qualitative semi-structured interviews 9 months postcourse focused on the course format and self-perceived association with technical and nontechnical skills applied at work.ResultsResponse rates of pre- and postcourse questionnaires after 1 day, 3 months, and 1 year were respectively 72% (51/71), 85% (60/71), 34% (24/71), and 14% (10/71). Respondents were surgeons (58%), anesthesiologists (31%), and scrub nurses (11%). Self-efficacy in nontechnical (mean 3.4, SD 0.6 vs. mean 3.8, SD 0.5) and technical (mean 2.9, SD 0.6 vs. mean 3.6, SD 0.6) skills significantly increased postcourse (n = 40, p < 0.001). Qualitative interviews (n = 11) demonstrated that increased self-efficacy in trauma skills was the greatest benefit experienced at work. Innovative application of skills and enhanced reflection demonstrate adaptive expertise. Small-group case discussions and the operative porcine laboratory were considered the most educational working formats. The experienced faculty and unique focus on multidisciplinary teamwork were highly valued.ConclusionCourse participants’ self-assessed work performance mostly benefited from greater self-efficacy and nontechnical skills. Future trauma curricula should consider aligning the teaching strategies accordingly.

Variation of in-hospital trauma team staffing: new resuscitation, new team

BackgroundNon-technical errors, such as insufficient communication or leadership, are a major cause of medical failures during trauma resuscitation. Research on staffing variation among trauma teams on teamwork is still in their infancy. In this study, the extent of variation in trauma team staffing was assessed. Our hypothesis was that there would be a high variation in trauma team staffing.MethodsTrauma team composition of consecutive resuscitations of injured patients were evaluated using videos. All trauma team members that where part of a trauma team during a trauma resuscitation were identified and classified during a one-week period. Other outcomes were number of unique team members, number of new team members following the previous resuscitation and new team members following the previous resuscitation in the same shift (Day, Evening, Night).ResultsAll thirty-two analyzed resuscitations had a unique trauma team composition and 101 unique members were involved. A mean of 5.71 (SD 2.57) new members in teams of consecutive trauma resuscitations was found, which was two-third of the trauma team. Mean team members present during trauma resuscitation was 8.38 (SD 1.43). Most variation in staffing was among nurses (32 unique members), radiology technicians (22 unique members) and anesthetists (19 unique members). The least variation was among trauma surgeons (3 unique members) and ER physicians (3 unique members).ConclusionWe found an extremely high variation in trauma team staffing during thirty-two consecutive resuscitations at our level one trauma center which is incorporated in an academic teaching hospital. Further research is required to explore and prevent potential negative effects of staffing variation in trauma teams on teamwork, processes and patient related outcomes.

Trauma Teams in Aotearoa New Zealand-a national survey.

Improved survival of trauma patients has been shown when a multidisciplinary trauma team is available. The aim of this study is to investigate the composition of trauma teams, trauma call criteria and the role of anaesthetists in trauma care across New Zealand. A survey was distributed using the modified Dillman's technique. Data was collected and aggregated using an online platform. The survey consisted of two streams of questions depending on trauma team availability. Trauma nurse specialists were the first contact point and if not available, direct contact with the hospital was made for completion of the survey. Seventy-five percent of hospitals had a trauma team and trauma call system and correlated to size of the hospital. The number of trauma team members ranged from six to 17, with a median of 10. Trauma call activation criteria encompassed physiological criteria, injury pattern and injury mechanism criteria. Physiological criterial of GCS, heart rate, blood pressure and respiratory rate were universally used. Sixty-two percent of trauma teams had involvement of anaesthetists. Trauma teams in New Zealand are common in regional and tertiary trauma hospitals. There is a wide variation in member numbers and criteria to trigger a trauma call. Anaesthetist involvement was in over half of trauma teams with regional variation noted. There is potential for trauma team composition and activation criteria to be standardised in New Zealand.

Who's Who in the Trauma Bay? Association between Wearing of Identification Jackets and Trauma Teamwork Performance: A Simulation Study.

Trauma is the leading cause of under-45 mortality worldwide, and the leading cause of years of life lost. To manage the severe trauma patients, trauma teams require both improved technical and nontechnical skills, such as communication, leadership, teamwork, and team resource management. The objective of this study was to measure the impact of the identification of trauma team members on teamwork performance. The hypothesis was that wearing identification jackets was associated with better teamwork performance. The study was conducted from 2015 to 2019 at the Percy Army Training Hospital, a trauma center in the Ile-de-France region. In 2016, the protocol for receiving severe trauma patients was modified, including the obligation to wear identification jackets. Thus, each member of the trauma team wore a jacket identifying his or her function. This study was carried out by analyzing videos of medical simulation sessions during the reception of trauma patients in the trauma bay. The study compared the teamwork performance before 2016, a period with no identification jackets wearing, with the teamwork performance after 2016, a period with identification jackets wearing. The Team Emergency Assessment Measure (TEAM)Scale was used. This TEAM scale is a benchmark measure of teamwork performance, particularly adapted to the context of trauma. A total of 48 participants were included in the study. Six videos of medical simulation sessions "arrival of severe trauma patients" were analyzed and divided into two groups. A first group of three videos with no identification jackets wearing was the GROUP ID(-). A second group of three videos with identification jackets wearing was the GROUP ID(+). An 11-item TEAM scale was used to rate each video for a total of 33 scores per group. The distribution of the median scores for the GROUP ID(+) was significantly different from the distribution of the median scores for the GROUP ID(-) (P = 0.001). These results were consistent with those of other single-center studies conducted in operating theaters and in emergency departments, where clearly identifying the roles of each member of the medical teams was associated with less communication errors. The main limits of this study were its single-center nature and a limited data sample. In this single-center simulation study, wearing identification jackets was associated with an improvement in the trauma team performance TEAM scores. Further studies are needed to confirm these results but they already encourage the consideration of nontechnical skills in the management of severe trauma patients.

Barriers and challenges to multiple-casualty management systems: a single-centre, cross-sectional study at the Nasser Medical Complex, Gaza Strip

BackgroundDuring a multiple-casualty incident, a large casualty caseload adversely affects the quality of care given to patients. From a trauma care perspective, the goal of the hospital emergency department plan is to simultaneously provide severely injured patients with a standard of care that approximates the care given to similar patients under normal conditions. This study highlights the barriers and challenges associated with implementing the emergency plans at the Nasser Medical Complex, Gaza Strip, occupied Palestinian territory, during a multiple-casualty incident, with the aim of facilitating appropriate staff training to address any deficiencies identified. MethodsA self-administered 70-item questionnaire reflecting the local major incident protocol (the Multiple Casualty Management System) was designed by the authors for completion by health-care staff. The questionnaire was divided into eight sections to assess knowledge and awareness and to specify deficiencies. Answers were analysed as frequencies and percentage points in terms of guideline adherence. Descriptive analysis were done on SPSS version 23. Findings70 questionnaires were completed by trauma team members (25 emergency doctors, 25 nurses, 15 surgeons, and five intensive care clinicians). The concepts of mass casualty and triage according to risk were understood by 40 (57%) of 70 participants, with most (65 ;93%) believing that the task of triage was to provide maximum care for the largest number of potential survivors. Only 50 (71%) reported competency in basic emergency skills like direct-current shock, chest tube insertion, cardiopulmonary resuscitation, nasogastric tube, and intravenous catheter insertion. Although 49 (70%) participants found the triage system very important, only 40 (57%) were able to apply it correctly. The biggest challenge was public acceptance of the concept of triage; only 5 (7%) participants believed that patients and relatives would accept a less urgent category. Furthermore, only 11 (16%) participants found that resources and equipment were adequate in case of mass casualty. Communication within the team was another struggle, with 45 participants were considering it unsatisfactory. However, 13 (19%) participants believed that the post-accident strategies with assessment plan to detect positive and negative points and clinical finding after the incident were satisfactory. Participants found the most important obstacles to efficient implementation of the emergency plan to be overcrowding in emergency department (63 [90%]), poor knowledge of the public regarding the importance of hospital triaging (59 [84%]), shortage of medical staff (57 [81%]), scarcity of resources (52 [74%]), ineffective security (52 [74%]), and insufficient staff training (41 [59%]). We also noticed that nearly all the emergency doctors were general practitioners without any specialised training. An emergency residency programme was started after the conclusion of this study, but results on the effects on multiple-casualty incident management are not yet available. InterpretationThis small study identified areas of weakness in the Multiple Casualty Management System, some due to poor resources and others to poor communication within the team or with the public. One important factor identified was the unawareness of the public of the importance of effective triage in this situation. Therefore, these areas should be addressed by staff feedback and training and by public awareness campaigns on the avoidance of overcrowding, the importance of non-threatening behaviour, and the purpose of triage in emergency department. Such interventions might also lead to improvement in day-to-day work at the emergency department, even outside the context of mass incidents. FundingNone.

Closed loop communication in the trauma bay: identifying opportunities for team performance improvement through a video review analysis.

ObjectivesCommunication among trauma team members in the trauma bay is vulnerable to errors, which may impact patient outcomes. We used the previously validated trauma-non-technical skills (T-NOTECHS) tool to identify communication gaps during patient management in the trauma bay and to inform development strategies to improve team performance.MethodsTwo reviewers independently assessed non-technical skills of team members through video footage at Sunnybrook Health Sciences Centre. Team performance was measured using T-NOTECHS across five domains using a five-point Likert scale (lower score indicating worse performance): (1) leadership; (2) cooperation and resource management; (3) communication and interaction; (4) assessment and decision making; (5) situation awareness/coping with stress. Secondary outcomes assessed the number of callouts, closed loop communications and parallel conversations.ResultsThe study included 55 trauma activations. Injury severity score (ISS) was used as a measure of trauma severity. A case with an ISS score ≥ 16 was considered severe. ISS was ≥ 16 in 37% of cases. Communication and interaction scored significantly lower compared to all other domains (p < 0.0001). There were significantly more callouts and completed closed loop communications in more severe cases compared to less severe cases (p = 0.017 for both). Incomplete closed loop communications and parallel conversations were identified, irrespective of case severity.ConclusionA lower communication score was identified using T-NOTECHS, attributed to incomplete closed loop communications and parallel conversations. Through video review of trauma team activations, opportunities for improvement in communication can be identified by the T-NOTECHS tool, as well as specifically identifying callouts and closed loop communication. This process may be useful for trauma programs as part of a quality improvement program on communication skills and team performance.Supplementary InformationThe online version contains supplementary material available at 10.1007/s43678-022-00295-z.

The impact of design on workflow: a comparative case study of level I trauma rooms

PurposeThis study aims to examine trauma room staff’s perception of factors that influence workflow in trauma care from a physical environment standpoint.Design/methodology/approachA semi-structured focus group method was used. Trauma team members, representative of various roles within a team, were recruited from five Level I trauma centers in the USA, through a convenience sampling method. A total of 53 participants were recruited to participate in online focus groups. The Systems Engineering Initiative for Patient Safety model was used to analyze the findings.FindingsIn addition to factors directly related to the physical environment, aspects of people and technology, such as crowding and access to technology, were found to be related to the physical environment. Examples of factors that improve or hinder workflow are layout design, appropriate room size, doors, sink locations, access to resources such as X-ray or blood and access to technology. Seamless and uninterrupted workflow is crucial in achieving efficient and safe care in the time-pressured environments of trauma rooms. To support workflow, the physical environment can offer solutions through effective layout design, thoughtful location of resources and technology and room size.Originality/valueTrauma rooms are time-pressured and complex environments where seconds matter to save a patient’s life. Ensuring safe and efficient care requires seamless workflow. However, the literature on workflow in trauma rooms is limited.

Endovascular Instead of Open Surgical Repair of Axillosubclavian Artery Injuries: An Evolving Paradigm Shift

Axillosubclavian injuries (ASI) comprise a small proportion of vascular injuries, yet their morbidity and mortality is high. This is often attributable to non-compressible bleeding in the apical thorax, hemodynamic instability, and the anatomically challenging location of these vessels making them difficult to access and control quickly. While the traditional management of ASI was with open surgical repair (OSR), recent years have seen an evolution towards less invasive endovascular repair (EVR). In patients with these injuries, EVR may be a safer alternative that achieves similar immediate results with significantly lower complication and mortality rates than the highly morbid open surgical option. In this article, we review and compare the two approaches, providing an overview of patient selection, anatomic considerations, techniques, postoperative management, and outcomes. With the advent of EVTM and more trauma team members capable of endovascular management of vascular trauma, a paradigm shift towards EVR for ASI is taking place.

Perioperative Management of Polytrauma Patients with Severe Traumatic Brain Injury Undergoing Emergency Extracranial Surgery: A Narrative Review.

Managing the acute phase after a severe traumatic brain injury (TBI) with polytrauma represents a challenging situation for every trauma team member. A worldwide variability in the management of these complex patients has been reported in recent studies. Moreover, limited evidence regarding this topic is available, mainly due to the lack of well-designed studies. Anesthesiologists, as trauma team members, should be familiar with all the issues related to the management of these patients. In this narrative review, we summarize the available evidence in this setting, focusing on perioperative brain protection, cardiorespiratory optimization, and preservation of the coagulative function. An overview on simultaneous multisystem surgery (SMS) is also presented.