1. A Structured Trauma Team Approach to the Initial Management of Trauma

2. Aims of Session Discuss a Structured Trauma Team Approach Practice a Structured Trauma Team Approach Familiarisation with clinical simulation These slides remain the intellectual property of NSW ITIM & the SCSSC. V3: 2010

3. Outline Establish setting Bat phone call Discuss preparation in pause & discuss fashion Bring in patient & commence scenario Consider trying different ambo handover methods or different 1* survey approaches to emphasise points Practice team update if necessary to emphasise benefits of team communication Finish by debriefing with video playback These slides remain the intellectual property of NSW ITIM & the SCSSC. V3: 2010

4. The Setting Metropolitan / Regional Hospital Facilities: –General surgery / orthopaedics / anaesthesia / ICU / 24hr OT all available –Neurosurgery / cardiothoracic surgery / interventional angiography not available Investigations available –X-Rays, FAST, CT, pathology – 24hrs These slides remain the intellectual property of NSW ITIM & the SCSSC. V3: 2010

5. Bat Phone Call –I: 20 yr old male. –M: High speed MBA rider vs car –I:Unconscious –Hypotensive initially – responded to fluid –S:HR 90, RR 10, SBP 70 ↑ 90 after fluid –GCS 3, BSL 10, SaO2 92%RA –T:Intubated, Collar, 1000mls Hartmanns –A:Unknown –M:Unknown –B:Unknown –O:Arriving in 10 minutes These slides remain the intellectual property of NSW ITIM & the SCSSC. V3: 2010

6. Discussion Points Benefits of effective preparation Benefits of IMIST whiteboard Trauma Call How do you organise the team? How do you identify team members? Do you establish an initial team plan? Where should you do the Ambulance handover? Who should do the Primary Survey? These slides remain the intellectual property of NSW ITIM & the SCSSC. V3: 2010

7. Team Approach Rapid Primary Survey talking out loud Simultaneous assessment & resuscitation Summarise & confirm findings at end of 1* Survey Team Leader coordinates management decisions Communicate, communicate, communicate… These slides remain the intellectual property of NSW ITIM & the SCSSC. V3: 2010

8. Team Updates & Decisions Summarise & confirm initial findings as a team in an ABCDE fashion….. –Team Leader talk to team –Confirm findings & get feedback & suggestions –LIMITS mnemonic checklist Clinical decision making as a team –Team Leader outlines management plan & gets feedback –Team Leader articulates final plan Re-evaluate ABCDEs regularly as a team –Throughout the resuscitation and particularly if patient condition changes or after interventions These slides remain the intellectual property of NSW ITIM & the SCSSC. V3: 2010

9. Organise Your Team….. –I: 20 yr old male. –M: High speed MBA rider vs car –I:Unconscious –Hypotensive initially – responded to fluid –S:HR 90, RR 10, SBP 70 ↑ 90 after fluid –GCS 3, BSL 10, SaO2 92%RA –T:Intubated, Collar, 1000mls Hartmanns –A:Unknown –M:Unknown –B:Unknown –O:Arriving in 10 minutes Plan A? These slides remain the intellectual property of NSW ITIM & the SCSSC. V3: 2010

10. Debriefing Questions What happened? How did you feel? How did the team function? What did you learn? What would you change? These slides remain the intellectual property of NSW ITIM & the SCSSC. V3: 2010

11. Summary of Case High speed MBA Pre-hospital hypotension from splenic injury Pulmonary contusion & closed head injury Deterioration secondary splenic rupture These slides remain the intellectual property of NSW ITIM & the SCSSC. V3: 2010

12. Key Points – Structured Approach IMIST Pre-notification on whiteboard Preparation –Roles –Identification –Initial patient specific plan - mental model Ambo Handover - on trolley unless moribund Primary Survey by TL or delegate Parallel ABCDE assessment & resuscitation Summarise 1* findings & plan Mx as a team Continually re-evaluate ABCDEs as a team Early decision making if tertiary transfer required Communicate, communicate, communicate…... These slides remain the intellectual property of NSW ITIM & the SCSSC. V3: 2010