Trauma Team Members Research Articles

Understanding Health Care Professionals' Views of Family Presence During Pediatric Resuscitation

To examine the conflicting perceptions that health care professionals hold regarding family presence during pediatric resuscitation. In phase 1, 137 health care professionals completed a 23-item questionnaire about their views on family presence and their perceptions of their opponents' views on family presence. In phase 2, 12 phase 1 respondents were interviewed about the effects that family presence may have on patients' families and on trauma teams. All respondents indicated that legal concerns and risks were important factors during family presence; however, respondents in favor of family presence believed that legal concerns and risks were minimized when patients' families were present whereas respondents who were opposed believed the opposite. Respondents who were opposed assumed that respondents who were in favor of family presence were less sympathetic and concerned about families, trauma teams, and health care providers; respondents in favor of family presence assumed that respondents who were opposed were overly preoccupied with legal concerns and potential risks involved with family presence during pediatric resuscitations. All respondents believed that patients' families and trauma teams are affected by family presence. Specifically, respondents in favor of family presence believed that families and trauma team members are positively affected whereas opponents believed the opposite. These findings provide a deeper understanding of the views of health care professionals and how these views might affect the delivery of family-centered care.

Clinical handover in the trauma setting: a qualitative study of paramedics and trauma team members

BackgroundClinical handover between paramedics and the trauma team is undertaken in a time-pressured environment. Paramedics are often required to handover complex problems to a multitude of staff. There is evidence...

Assessing clinical handover between paramedics and the trauma team

Introduction The aim of effective clinical handover is seamless transfer of information between care providers. Handover between paramedics and the trauma team provides challenges in ensuring that information loss does not occur. Handover is often time-pressured and paramedics’ clinical notes are often delayed in reaching the trauma team. Documentation by trauma team members must be accurate. This study evaluated information loss and discordance as patients were transferred from the scene of an incident to the Trauma Centre. Methods Twenty-five trauma patients presenting by ambulance to a tertiary Emergency and Trauma Centre were randomly selected. Audiotaped (pre-hospital) and videotaped (in-hospital) handover was compared with written documentation. Results In the pre-hospital setting 171/228 (75%) of data items handed over by paramedics to the trauma team were documented and in the in-hospital handover 335/498 (67%) of information was documented. Information least likely to be documented by trauma team members (1) in the pre-hospital setting related to treatment provided and (2) in the in-hospital setting related to signs and symptoms. While 79% of information was subsequently documented by paramedics, 9% ( n = 59) of information was not documented either by trauma team members or paramedics and constitutes information loss. Information handed over was not congruent with documentation on seven occasions. Discrepancies included a patient's allergy status and sites of injury ( n = 2). Demographic details were most likely to be documented but not handed over by paramedics. Conclusion By documenting where deficits in handover occur we can identify points of vulnerability and strategies to capture this information.

Effects of Nationwide Training of Multiprofessional Trauma Teams in Norwegian Hospitals

Norway has 50 trauma hospitals serving a geographically disperse population (4.6 million) and many have low trauma case loads. We showed that personnel find functioning as a team especially challenging, and developed a 1-day training course, arranged locally at each hospital, focused on team training in communication, leadership, and cooperation during simulated patient treatment. This study evaluates the effects of training on participants' knowledge, confidence, and perceived trauma team performance, controlling for hospital size and the participants' previous experience. Anonymous, written questionnaires were answered by 4,203 participants (28% physicians, 55% nurses) in 44 hospitals before and immediately after training courses, and by 1,368 trauma team members in 26 of the hospitals 6 months after their last training course. Outcome measures were knowledge and confidence concerning the respondent's own role, and evaluation of trauma team performance in live trauma resuscitations. There was a significant increase in self-reported knowledge and confidence among all participants. Community hospitals and participants without recent trauma experience had the lowest preintervention scores, but reached levels comparable to participants at the other hospitals after training. The effects increased after 6 months, with trauma team performance evaluated as having improved, even by team members who had not participated in the training. Practical team training in hospitals improved the participants' perceived knowledge and confidence, which continued to increase for 6 months after training independent of participants' experience level, suggesting that small hospitals may reach levels comparable to major hospitals.

Training Operating Room Teams in Damage Control Surgery for Trauma: A Followup Study of the Norwegian Model

Because the hospitals in Norway are mostly rural community hospitals that see life-threatening trauma only infrequently, we developed a course in damage control surgery based on a live porcine model in 1999. The course also focuses on teamwork and leadership training based on crew resource management principles. The aim of this study was to evaluate the direct educational benefit from the course and whether participants had used the damage control techniques in their subsequent daily practice. A total of 103 participants completed 2 questionnaires about the self-efficacy for damage control surgery, the first at completion of the course and the second at least 6 months after the course. There was a significant increase in the number of trauma team members who felt comfortable performing damage control surgery (from 17% before the course to 62% at followup; p < 0.001). Almost half the surgeons and operating room nurses reported using damage control techniques in their subsequent practice. Participants considered the focus on team-oriented training important. Four of every five participants thought this course had improved their ability to handle severely injured patients. This study shows that a team-oriented operative trauma course is not only beneficial in the short term, but the principles and techniques learned are subsequently applied by the graduates in their daily practice. Course content and structure, particularly the emphasis on integral operating room teams working together, is especially suitable for the rural setting.

Trauma team radiation exposure: The potential need for dosimetry monitoring

Australian radiation regulations require routine monitoring of health-care workers who might receive a whole-body effective radiation dose in excess of 1 mSv/year. In Australian hospitals, routine monitoring with a dosimeter is recommended for levels beyond 300 microSv/year. We aimed to determine the potential radiation exposure to trauma team members and whether routine personal radiation dosimetry should be recommended. An anthropomorphic mannequin with a radiation detector was placed at five locations around the resuscitation bed. Three sets of standard trauma-series X-rays were performed, and the exposure was measured and averaged at each location. These data were then extrapolated to estimate the potential radiation equivalence at the level of the thyroid gland for staff working in each of the locations over a 1 year period with and without personal protective equipment. The total dose ranged from 1.2 to 20.5 microSv for a single trauma patient. The highest recorded dose was at the location of the circulation doctor during pelvic X-ray. Based on these data, it would take only 15 trauma patients per year for a team member to be potentially exposed to the level at which routine dosimetry is usually recommended, should no personal protective equipment be used. The use of a lead gown and a lead gown with a thyroid collar reduced exposure by four- and ninefold, respectively. We have demonstrated the possibility of significant ionizing radiation exposure for unprotected trauma team members. Dosimeter use by trauma team personnel needs to be reviewed based on local protocols and patient numbers.

Universal Precaution Compliance by Orthopaedic Trauma Team Members in a Major Trauma Resuscitation Scenario

We determined the compliance rates of orthopaedic trauma team members in applying universal precautions in major trauma resuscitation scenarios and the availability of universal precautions in accident and emergency (A&E) departments throughout England. A national telephone survey was implemented contacting the first on-call orthopaedic surgeon and A&E departments in hospital trusts accepting major trauma throughout England. A questionnaire was employed to ascertain current practice, experience and availability of universal precautions when managing a major trauma patient. Overall, 112 first on-call orthopaedic surgeons and 99 A&E departments responded. There was good compliance for using gloves (99%) and aprons (86%). There was poor compliance in using eye protectors (21%), face masks (18%), shoe covers (4%) and head caps (4%). Trainees applied universal precautions according to the level of risk they subjectively perceived. All A&E departments had gloves and aprons but the availability of the other universal precautions was less. Of trainees, 76 reported that all universal precautions were not readily available in the A&E department. Orthopaedic trauma team members are very compliant in using gloves and aprons, but should be more compliant in using eye protectors. It is questionable whether face masks, head caps and shoe covers need to be used in all trauma scenarios. In general, universal precautions should be more available in the A&E departments. There should be better communication between A&E departments and the trauma team regarding the availability of universal precautions.

Human‐information interaction in time‐critical settings: Information needs and use in the emergency room

AbstractTrauma centers are stressful, noisy, and dynamic places, with many people performing complex tasks, and with no technological aids to support their operations. This paper describes research that uses an emergency room as a natural laboratory for investigating information behavior and information sources of trauma team members. Data from interviews, focus groups, and videotaped trauma resuscitations revealed specific information needs in four distinct phases of a trauma event. The most commonly utilized information sources include the patient, vital signs monitor, x‐rays images, and other team members. Additionally, data indicated inefficiencies in teamwork and communication. Results from this study can be used to derive system requirements for the design of decision and communication support systems for trauma teams.

Training multiprofessional trauma teams in Norwegian hospitals using simple and low cost local simulations

Norwegian hospitals' trauma teams are seldom exposed to severely injured patients. We developed and implemented a one-day multi-professional training course for hospital trauma teams in order to improve communication, cooperation and leadership. Training courses were held in 28 Norwegian hospitals with learning objectives: improved team work, common understanding of treatment priorities and principles, communication skills, and threats to efficient communication. Two trauma teams in each hospital had two consecutive simulations in their hospital's own emergency room, as part of the course. Simulation was based on real cases, with a low-fidelity mannequin as patient. Participants completed questionnaires before and after the training course. A total of 2,860 trauma team members participated in the courses, of which 1,237 took part in the simulation. Independent of hospital size, the participants reported leadership and communication to be major obstacles during their last real trauma team participation. Immediately after the training, all participants reported highly fulfilled educational expectations and a high perception of learning, and taking part in the practical simulation improved the evaluation. Nurses scored their outcome significantly higher than physicians. Participants from minor hospitals reported as great a benefit from the training as personnel from major hospitals. Local team training is a feasible approach and team simulation offers an excellent opportunity to practise demanding and infrequent challenges. The simulation format makes it possible to integrate training on interpersonal skills as well as communication and leadership under stress. Continued requests for such training in Norway support this conclusion.

Multiple-trauma management

Staff attitude plays a pivotal role in quality management. The objective of the present study was to further define how interdisciplinary emergency hospital staff experience their daily work and the extent to which the professional speciality and training of an individual influences his/her assessment of multiple-trauma team performance. The clinical staff involved in multiple-trauma emergency management of a university hospital was asked to answer a confidential questionnaire. Factorial analysis was used to identify 8 major dimensions from a total of 53 items. The questionnaire was returned by 128 team members. All professional groups were most dissatisfied with the dimensions 'education and training', 'work sequence between specialities' and 'communication between specialities'. Assessment of the quality of in-hospital emergency-trauma management differed significantly between professional specialities (ANOVA, F=5.2; P=0.028); surgeons gave the highest ratings for all but one dimension. Having taken an Advanced Trauma Life Support (ATLS) course influenced significantly the total rating of multiple-trauma treatments of anaesthetists and surgeons (F=5.5; P=0.024). The perceptions of interdisciplinary trauma team members without the completion of an ATLS training course were that they did not communicate enough with each other and that there were differences between their expectations and reality. The differences and the communication deficits were overcome in team members who had passed an ATLS course.

Orthopedic Trauma

Orthopedic trauma is frequently encountered by critical care nurses as trauma team members providing care to the severely injured. Through actual case examples, the role of the critical care nurse and orthopedic trauma management is reviewed. Focus is on unstable pelvic fractures, extremity fractures, compartment syndrome, rhabdomyolysis, mangled extremities, gunshot-wound fractures, and damage-control orthopedics.

Paediatric trauma teams in Australia

Trauma teams have been associated with improved survival probability of paediatric trauma patients. The present study seeks to estimate the use of trauma teams in Australian paediatric tertiary referral centres and describe their medical composition, leadership and criteria for activation. Australian paediatric tertiary referral centres were identified. A structured questionnaire assessing the presence, composition and means of activation of a trauma team was mailed to the 'Director, Emergency Department' of all identified hospitals. Three months later, all hospitals were contacted by telephone to complete and verify data collection. Questionnaires were distributed to eight hospitals. Seventy-five per cent had an established trauma team. Hospitals without a trauma team claimed to have insufficient doctors to form a team and insufficient trauma caseload to justify a team. All trauma teams were potentially activated by prehospital paramedic data (field triage) and required a combination of anatomical, physiological and mechanistic criteria for activation. The two methods of mobilizing a trauma team were by dispatching a common call onto individual pagers (66%) or a specific trauma pager (33%) carried by trauma team members. Fifty per cent of hospitals had a two-tier, stratified trauma team response. All teams consisted of emergency, surgical and intensive care unit registrars. Trauma team leaders were emergency medicine specialists/registrars (33%), surgical registrars (33%) and non-defined (33%). Consultant surgeons were not members of any trauma team. Eighty-three per cent of trauma teams consisted of more junior members after hours. Fifty per cent of hospitals did not have a surgical registrar on site outside of business hours. Eighty-eight per cent of hospitals engaged in some form of trauma audit. Trauma teams are utilized by most Australian paediatric tertiary referral centres, with fairly uniform medical composition and criteria for activation. Paediatric surgeons presently have limited leadership roles and membership of Australian paediatric trauma teams.

22. A quality improvement project to simplify emergency thoracotomy

Clinical Topic: A multidisciplinary group of trauma team members identified a need to simplify the open thoracotomy tray used in the resuscitation area of our level I trauma center. In the course of conducting mock thoracotomy drills, it became evident that both nurses and physicians in our institution were unfamiliar and confused the majority of the 50 or more instruments contained in the standard OR thoracotomy tray. Since emergency thoracotomies are an infrequent yet high-risk procedure, we decided to modify the tray to facilitate rapid patient care in emergent situations.

Trauma teams in Australia: a national survey.

Trauma teams have been associated with improved trauma patient outcomes. The present study seeks to estimate the use of trauma teams in Australian hospitals and describe their medical composition, leadership and criteria for activation. Australian public hospitals with more than 100 beds, an emergency department and offering surgical services were identified. A survey assessing the presence, composition and means of activation of a trauma team was mailed to the 'Director, Emergency Department' of all identified hospitals. Three months later, all hospitals were contacted by telephone to complete and verify data collection. Questionnaires were distributed to 130 hospitals. After exclusion of hospitals that did not receive patients with traumatic injuries, and dedicated paediatric tertiary referral centres, 111 hospitals remained for analysis. Of these, 56% had an established trauma team, while 71% of hospitals without a trauma team claimed to have insufficient doctors to form one team. Ninety-five per cent of trauma teams were potentially activated by prehospital paramedic data (field triage). For 92% of trauma teams a combination of anatomical, physiological and mechanistic criteria were required for activation. The most common methods of mobilizing a trauma team were by dispatching a common call onto individual pagers (31%) or by paging trauma team members individually (31%). Fifty-eight per cent of trauma team leaders were emergency medicine specialists/registrars, while 8% of trauma teams were led by surgeons/registrars. Consultant surgeons were members of 23% of trauma teams and 74% of trauma teams consisted of more junior members after hours. Some form of trauma audit was engaged in by 64% of hospitals. Trauma teams are yet to be utilized by many Australian hospitals that provide trauma care. Australian surgeons presently have limited leadership roles and membership in trauma teams. Trauma audit can be more widely adopted in Australian hospitals.

Family presence during trauma resuscitation: a survey of AAST and ENA members. American Association for the Surgery of Trauma. Emergency Nurses Association.

The Emergency Nurses Association (ENA) has formally resolved that family presence (FP) during resuscitation and invasive procedures (TR) is the right of the patient and is beneficial for both patients and family members. Furthermore, FP during TR has been implemented at several trauma centers. Because this policy is controversial, a survey was conducted to assess the opinions of members of the American Association for the Surgery of Trauma (AAST) and ENA in regard to FP. A survey instrument regarding FP during TR was mailed to the AAST membership (n = 813) and a random sampling (10%) of ENA members (n = 2,988). Questions regarding membership (AAST vs. ENA), age, gender, years in practice, trauma experience, the patient's right to FP during the primary survey, secondary survey, and invasive procedures, the potential effects of FP on trauma team function, and medicolegal implications were included in the survey. Qualitative and quantitative variables were analyzed by analysis of variance and chi2 analysis, respectively. Responses to questions by using a Likert Scale for degree of agreement were analyzed by using the Kruskal-Wallis test. A total of 1,629 (AAST, n = 368; ENA, n = 1,261) surveys were returned (43.4% response). There were 44 surveys returned as undeliverable (1.2%). The members of the AAST were older, more likely to be male, had been in practice longer, and had greater trauma experience when compared with ENA members (p < 0.001). More AAST than ENA members (97.8% vs. 80.2%) believed that FP during all phases of TR was inappropriate (p < 0.001). Fewer AAST members believed that FP was a patient right when compared with ENA members (p < 0.0001). The AAST members were more likely to believe FP interfered with patient care and increased the stress of trauma team members (p < 0.0001). The majority of AAST and ENA members had experience with FP during TR (55.3 vs. 67.8%; p < 0.001). However, the impressions of their experiences were widely disparate, with 63.6% of ENA and only 17.5% of AAST members, indicating that the experience was beneficial (p < 0.001). Attitudes toward FP during TR are significantly different between AAST and ENA members. Because of these differences in opinion, implementation of an FP policy may create conflicts between trauma team members and may interfere with the effectiveness of the trauma team.

A blend of comforting strategies and a form of team comforting were used during nasogastric tube insertion

Penrod J, Morse Jm, Wilson S . Comforting strategies used during nasogastric tube insertion. J Clin Nurs1999 Jan; 8 : 31 –8. [OpenUrl][1][CrossRef][2][PubMed][3][Web of Science][4] Question How do nurses use...

An algorithm to reduce the incidence of false-negative FAST∗ examinations in patients at high risk for occult injury

Background: The Focused Assessment for the Sonographic Examination of the Trauma patient (FAST) sequentially surveys for the presence or absence of blood in dependent abdominal regions including the right upper quadrant, left upper quadrant, and the pelvis. But it does not readily identify intraparenchymal or retroperitoneal injuries, and a CT scan of the abdomen may be needed to reduce the incidence of missed injuries. We hypothesized that select patients who are considered high risk for occult injuries should undergo a CT scan of the abdomen when the FAST is negative so that occult injuries can be detected. Study Design: An algorithm was prospectively tested for the evaluation of select injured patients over a 3 1 2 -year period. Entrance criteria included adult patients with a blunt mechanism of trauma, a negative FAST examination, and a spine fracture (with or without cord injury), or a pelvic fracture. Trauma team members performed the FAST on patients during the Advanced Trauma Life Support secondary survey. Data recorded included the patient’s mechanism and type of injury, the results of the FAST and CT scan examinations, operative or postmortem findings or both, and patient outcomes. Patients with spine injuries were grouped according to spine level and the presence or absence of neurologic deficit. The patients with pelvic fractures were grouped according to the Young and Resnick classification. Results: One hundred two of 1,490 patients (6.8%) who had FAST examinations were entered into this study. Thirty-two patients (30.5%) had spine injuries, with only one false-negative ultrasound result. Seventy patients (68.6%) had pelvic fractures with 13 false-negative ultrasound results: 11 ring (9 from motor vehicle crashes, 2 from pedestrians struck), 1 acetabular, and 1 isolated pelvic fracture. Nine patients underwent nonoperative management for solid organ injuries, and 4 patients needed surgery. Conclusions: Based on these preliminary data, we conclude that patients with pelvic ring-type fractures should have CT scans of the abdomen because of the higher yield for occult injuries.

Anesthetic Considerations in the Acutely Injured Patient

Summary The maxillofacial trauma patient, with his or her associated injuries, presents various challenges to the trauma team members. This article discussed various anesthetic management techniques demonstrating the importance of a highly skilled anesthesiologist as a member of the trauma team. In rural hospitals, the oral and maxillofacial surgeon with anesthetic and surgical knowledge of the airway may function in multiple roles during the resuscitation of the trauma patient.

Comforting strategies used during nasogastric tube insertion.

Nasogastric tube insertion is a procedure that commonly involves discomfort, yet requires the cooperation of the conscious patient. This study employed qualitative ethology to investigate how comforting strategies were used during the insertion of nasogastric tubes in trauma care. Practitioners used eight direct and indirect comforting strategies in uniquely patterned styles (technical, affective and blended). In addition, a form of 'team comforting' was implemented as multiple trauma team members made a concerted effort to complete the procedure. Further study is needed to explicate how the nurse's style affects the behavioural state displayed by the patient.

Clinical management protocols: the bedside answer to clinical practice guidelines.

Clinical Management Protocols for trauma patients. The goals and process for developing and implementing Clinical Management Protocols are presented. Protocol development and the differences between clinical practice guidelines, critical pathways, and clinical management protocols are discussed. Published literature, experience, and clinical expertise. Utilizing annotated algorithms, the protocols are designed for and driven by patient care based on patient need and require the collaboration of experts and trauma team members.