Yesterday’s video highlighted members of the trauma team at a medium size teaching hospital. Today, I will discuss who actually needs to be on the team.
The decisions leading to the composition of your trauma activation team are complex ones. The key is to look at your needs during a typical trauma resuscitation, and look at the resources available within the ED and the hospital as a whole.
The trauma resuscitation team can consist of as few as 4 to as many as 15 or more people! The first item to consider is who is available to go to a trauma activation? If your ED staff is small, the team will be small, or you will have to draw personnel from other areas of the hospital.
The absolute minimum personnel are:
- 1 Physician
- 1 Nurse
- 1 Scribe
- 1 Assistant (can be physician, nurse, or other)
Using the minimum contingent will force the use of ATLS the way it is classically taught, with the physician sequentially going through the entire process. Additional physicians and nurses allow overlapping portions of the evaluation and treatment and will also speed up the resuscitation process.
An ideal team for a non-teaching hospital is:
- 2 Physicians
- 2 Nurses
- 1 Scribe
- 2 Assistants
This allows for the physicians and nurses to split their responsibilities (airway, exam, IV access, monitoring) and assures adequate help with patient safety, evaluation and restraint.
Additional personnel can be added from outside the ED to provide a better interface with other hospital services. Examples include:
- OR representative – communicates with the OR charge nurse to enable rapid access to an OR if needed
- Lab representative – interfaces with blood bank to provide access to blood products
- ED nurse – acts as an interface between the resuscitation room and services in the rest of the ED (supplies, calls to consultants, etc.)
- Anesthesiologist or CRNA – to provide support of the difficult airway
- ICU nurse – can provide additional nursing support or take other roles
- Ultrasound tech – may perform FAST if the resuscitation physicians do not have this skill
- Pediatric intensivist / pediatrician – assists with management of small children
Tomorrow: trauma teams in the teaching hospital