Victorian State Trauma System

Major Trauma Guidelines & Education – Victorian State Trauma System

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Teamwork and Communication

For the trauma team to be effective it is vital that all members of the team are aware of their role, communicate effectively and are able to operate within an atmosphere of mutual trust and respect. The structure of the trauma team will need to be fluid and adaptable to the resources available at each facility.

Dealing with issues

Graded assertiveness

Teaching people to speak up and creating the dynamic where they will express their concerns is a key safety factor (32). Occasionally the team members may not agree with the leader’s management plan, or the team leader may go silent and appear to be cognitively stuck. Members can use this as an opportunity to practice graded assertiveness. This is a communication technique that can allow anyone to challenge any action or behaviour that they think is inappropriate (33, 34).

One way to remember it is to use the PACE mnemonic:

Probe: ‘Do you know that…?’
Alert: ‘Can we go back to the start and repeat the primary survey?’
Challenge: ‘Please stop what you are doing while we check … …’
Emergency: ‘Stop what you are doing and put down the scalpel.’

 

No one team member should be afraid to point out a risk, a concern or an actual or potential error.

 

Five-step advocacy

An alternative approach is the advocacy approach:
1. Get attention – ‘Excuse me, doctor!’
2. Raise your concern – ‘There is no end-tidal CO2 trace.’
3. State the problem as you see it – ‘I’m concerned that the intubation was unsuccessful.’
4. Suggest a solution – ‘Why don’t we remove the ETT and go back to bagging the patient?’
5. Obtain an agreement – ‘Does that sound like a safe thing to do?’

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