Trauma Team Training
Take Home Clinical Points
Essential CRM skills
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Know your environment
Anticipate and plan
Effective team leadership
Active team membership
Effective communication
Be situational aware
Manage your resources
Avoid and manage conflicts
Be ware of potential errors
Trauma Apps
• I Phone Westmead Trauma App
– https://play.google.com/store/apps/details?id=air.
au.com.lpn.WestmeadApp&hl=en
• Android Westmead Trauma App
– https://itunes.apple.com/au/app/westmeadtrauma/id785943004?mt=8
Airway
Airway Pearls
• Plan your Airway Intervention
– Equipment
– Team Briefing (Plan A, B and C)
– ‘Checklist’
• Goal is to Oxygenate and Ventilate (not intubation)
• Optimise Haemodynamics and Oxygenation Prior to
induction
• Anticipate a difficult airway (team brief as above)
• A Neutral position is slightly flexed at the neck so
put a towel or SAM splint behind the head
Checklist
Example
ITIM – Difficult Airway Management 1
Failure to Intubate
Call for Help
Maintain Cricoid (if
used) and Inline
Place Oral Airway
and 2 person BVM
with 100% O2
Attempt to
Ventilate and Keep
Sats>90%
ITIM – Difficult Airway Management 2
Optimise Position,
Use Adjuvant(s) for
Intubation
Are the SATS>90%
with the BVM??
Yes
No
Attempt to Ventilate
using LMA
Unable to keep
Sats<90%
Surgical Airway
Able to keep
Sats>90%: If yes
Proceed to Right
Make 2nd attempt at
Intubation
Consider Waking the
patient or obtaining
further resources
Consider Surgical
Airway
Drugs for RSI - Discussion
• RSI is usual Technique for Trauma Intubation
• Dose reduce Sedative Agent = Thiopentone (if
used) 0.5mg – 2mg /kg (rather than 5mg/kg)
• Consider Ketamine 1mg -2mg/kg or
Midazolam 0.05mg – 0.1mg/kg
• Fluid prior to induction may be appropriate
(vasopressors are not usually appropriate)
• May need to increase dose of Suxamethonium
• Need to allow all drugs more time to act
• Propofol is (generally) NOT recommended
Abdomen Protocols
Haemorrhage
Where is the Bleeding
• ‘PLACES’
– Pelvis
– Long Bone
– Abdomen
– Chest
– Externally and Epistaxis
– Scalp
Chest Protocols
Sternal Injury
Penetrating Chest Injury
Code Crimson
and
Massive Transfusion
Massive Transfusion
• Prof Koutts Protocol (October 2012) – Is available
on the Westmead intranet
• Consider 1g Tranexamic Acid Early (within 3 hours)
Principles of Massive Transfusion
Penetrating Abdominal Wounds
Head Injury
Neuroprotective Measures
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Head up 30 degrees
IV Fluid (Relative Hypervolaemia)
Avoid Hypotension and Hypoxaemia
Reduce ICP and maximise Cerebral Perfusion
Pressure (CPP) (Monroe Kellie Doctrine)
– CO2 30-35
– No tight ties, conservative C spine precautions
– Drugs – Induction, Sedation and Paralysis
– ICP Monitoring (invasive) and Seizure Meds:
• recent evidence suggesting against
Hypertonic
Saline
Continued to next slide…
Trauma Call Criteria
Cognitive Aids
5 Cs OF COMMUNICATION
1.Clarity
Give and receive instructions & information (be specific, be succinct, avoid
jargon, CLOSE LOOPS)
2.Coordination
(use people’s names, confirm you hear instructions, relay information via
leader)
3.Cohesion
(clarify goals, share information, invite input, summaries and updates,
acknowledge effort, speak calmly, use humour)
4.Concern to be freely expressed
use graded assertiveness attention /enquiry /clarify /demand)
5.Conflict to be avoided/ managed
(clarity, consensus, decision)
GRADED ASSERTIVENESS
1. Bring to Attention:
2. Enquire (make an enquiry or offer an alternative as a
suggestion):
”Are you going place an IV in that fractured arm?”
3. Clarify
“ I feel uncomfortable about this, please explain what you are
doing”
4. Demand a Response or Take Control of the Case:
“ Sir you MUST LISTEN” KEY PHRASE
“Stop – you must listen to me”
Alternative Mnemonic
**CUSS = ‘Concern’, ‘Unsure’, ‘Safety’, ‘STOP!’
CONFLICT RESOLUTION:
4 STEP NEGIOTIATION PROCESS
1.State what actually happened or what you
observed (be specific)
2.State how you feel about it and find out their
perspective
3. Say what you want to happen next
4. Agree on the next step
Time critical situations may require an abbreviated approach.
Authority: Deliver directive
No authority : Graded assertiveness
7 NON-TECHNICAL TEAM TASKS
1.Assemble right team - skill mix / numbers / phone consults
2.Plan & prepare - organisational / patient specific / plan A & B
&C
•Equipment (type/location/working order/ training)
•Colleagues (names, skill mix, roles, brief team)
•Situational awareness (pt load & mix, anything else that will
impact on your resources)
3.Manage resources - make decisions / allocate tasks / get
help
4.Manage people - roles & goals / familiarity & trust / update
5.Communicate effectively – CCCCC
6.Monitor & evaluate - cross check / team update & confirm /
documentation
7.Support each other - awareness of roles & support &
feedback