The Trauma Team
The trauma team is a multi-disciplinary group of health care providers that render care to patients who have been seriously injured. Each member has specific roles and responsibilities that are carried out under the direction of the trauma team leader.
The trauma team leader is an experienced physician or surgeon that makes all of the diagnostic and therapeutic decisions during a trauma resuscitation. Usually this is a senior surgical or emergency medicine resident, fellow or attending. This person stands at the foot of the bed, away from direct patient contact. The team leader must be able to oversee all of the activity by the other practitioners. He or she is direct communication with the team, recorder, and in phone contact with the OR, CT scan, and ancillary services. The leader directs procedures to be performed, dictates what diagnostic tests will be done in what order, and directs personnel to complete specific tasks. The leader records the major findings and treatment plan in the medical record.
One physician has the responsibility of performing the primary and secondary survey. This practitioner stands on the right side of the patient near the head and calls out physical findings loudly so that the recorder and team leader can here the results. It is important for this physician to perform the entire exam so that no areas are missed. After their exam is completed he or she should document the exam in the admission note.
The airway team consists of one or two practitioners that are only concerned with airway maintenance during the resuscitation. This is usually a anesthesia or emergency medicine resident and/or attending. Nurse anesthetists and rarely critical care surgeons can also fill the role. The team also includes a respiratory therapist. The airway team prepares and maintains all of the equipment necessary for managing an emergent airway. The team assesses the airway along with the primary physician and provides adjuncts such as oxygen as needed. If intubation is needed the airway team temporarily takes over command from the team leader to gives orders for medications and intubation maneuvers. In patients who do not need intubation, the airway team has a role of talking to the patient, relieving fears, answering questions, and obtaining personal information such as the medical history.
One or two trauma nurses are positioned next to the patient on either side. The initial responsibilities of the nurses include initiating ECG, oximetry, and blood pressure monitoring. Intravenous access is quickly assessed and inadequate or missing IV’s are converted to large bore free flowing lines. All clothes are removed and placed into a bag and valuables are collected and catalogued. The trauma nurse is responsible for hanging fluids and setting rates as determined by the team leader. They have the responsibility of checking blood and assuring that it is administered properly. They may assist in blood draws and administer medications such as tetanus prophylaxis and antibiotics. Experienced trauma nurses seldom need much direction, and are adept at anticipating tasks and accomplishing them with a high skill level.
A x-ray technologist has the responsibility of performing all of the radiographs as ordered by the team leader. They are responsible for positioning the patient, insuring that jewelry and other artifacts are clear from the field, and that all practitioners are adequately covered from exposure. The technologist works closely with consultants such as orthopedics to get the necessary radiographs without wasted radiation.
The recorder is often a nurse, however in multiple patient scenarios anyone who is familiar with the flowsheet can record. All aspects of the resuscitation are recorded to keep a complete record of assessments and treatments. In addition to vital signs and exam findings, the flow sheet should record decisions and events, such as, "orthopedics contacted," or "patient vomited." This allows a clear and full picture of what happened during the resuscitation for review at a later time. The team leader has a responsibility to review the trauma flow sheet for accuracy after the resuscitation is over.
A chaplain or a social worker is an indispensable part of the trauma team. This person can be a minister from any denomination who acts as a liaison between the family, patient and the rest of the trauma team. The initial responsibility of the chaplain is to positively identify the patient and to make contact with the patient’s family. They act as the primary first contact of the family and will relay basic information to family members before they arrive in the hospital. Of course, the chaplain also has the role of spiritual leader for the patient and family and frequently fills the role of counselor. A formal chaplain’s note, with information about family contacts is very helpful to physicians taking care of the patient after the trauma bay.