The treatment of a patient with multiple injuries demands a team approach. The team must be able to evaluate the patient swiftly arrive at decisions quickly and efficiently in regard to performing lifesaving procedures.
Every team has a final decision maker, the team leader. This should be the individual most experienced in performing procedures to maintain the airway, manage shock from multiple causes, manage emergent situations affecting cardiac output , diagnose and treat intrathoracic or intraabdominal hemorrhage, and make appropriate decisions regarding the early management of central nervous system and extremity trauma.
Mostly, this role would be taken bye the general surgeon with an interest and background in the care of the multiply injured patient. Whosoever is in this position, effective leadership is the key to coordinating the activities.
The team leader is responsible for
- Assessing the patient’s status
- Determining the need for specific diagnostic tests and delegate these to team members.
- Coordinating the activities of assisting technicians and specialty consultants.
- Making critical treatment and triage decisions, inclusive of setting limits on operating time and blood loss when multiple options from the consultant are available .
The team leader must be familiar with team members’ skills and capabilities for facilitating an optimal outcome.
Constitution of Team:
Members must be identified and their duties known and well rehearsed long before the arrival of the trauma victim. Team members generally consist of on-call surgeons, emergency physicians, primary care physicians, and nurse anesthetists. Prearranging duties and positions around the patient after arrival facilitates the resuscitation phase.
The team leader is at the head of the patient and is responsible for airway management, protection of the cervical spine, and nasogastric tube insertion while directing the activities of the other team members.
The physician on the patient’s right performs intravenous access, Foley catheter insertion, and tube thoracostomy or peritoneal tap when indicated.
Second physician on patient’s left side, this individual can begin the initial survey or assist with venous access. Rehearsal of these roles minimizes confusion and limits noise during the resuscitation phase.
Physicians provide important feedback to the team leader and must refrain from making independent clinical decisions without direction from the leader.
Trauma team nurses record vital signs and report them to the team leader. They also administer drugs and fluids, draw or assist in obtaining blood samples, and assist with tube thoracostomy or peritoneal lavage.The nursing team is also responsible for removal of the victim’s clothing and assisting with the primary and secondary survey. They also monitor vital signs, manage body temperature and maintain records
The radiology technician is responsible for supplying high-quality chest, lateral cervical spine and anteroposterior pelvic films without adding confusion or noise to the resuscitation process.
Respiratory technicians should be available to assist with supplemental oxygen and suction, setting up ventilators, and monitoring pulse-oximetry, again without adding noise or confusion.
The definitive care setting where patient is transported must have adequate laboratory facilities to perform quick and accurate hematologic and blood chemistry determinations, arterial blood gas analysis, and alcohol and drug screens. There must be facility of emergent blood product support service.
This team approach requires a discussion of problems, review of poor outcomes, dissemination or development of new protocols, and improvement of rapport. This group meeting should take place on a monthly basis and can also function in the quality assurance mode for the trauma program. The trauma nurse coordinator is responsible for the collection of data to monitor the program.
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