Trauma team structure
The trauma team structure will vary according to factors such as the time of day, availability of staff, hospital resources and skill set of the responders3. This section will describe the makeup and roles in the ‘ideal’ setting and in modified circumstances where only limited resources are available. The level of training or seniority is not a fixed recommendation and it is recognised that, at a practical level, ‘emergency clinician’ may equate to ‘emergency registrar’ and ‘anaesthetist’ to ‘anaesthetic registrar’, etc. The assignment of roles in a trauma team need to flexibly focus on optimising the net capabilities of those present and available, rather than being restricted by seniority or craft group4.
Trauma team positions
As general guidance, the ideal trauma team should consist of the following:
Team leader: ED clinician or doctor with the highest level of trauma care skills
- Controls and manages the resuscitation. Hands off!
- Must be clearly identifiable in that role
- Allocates roles to other members of the team
- Ensures that preparation for the patient’s arrival is complete
- Stands at the foot of the bed
- On arrival of the patient, ensures all involved listen to the handover by EMS staff, ensuring no one begins working on the patient until complete (hands off, hand over)
- Directs the resuscitation, makes critical decisions and prioritises care5
Airway specialist: Anaesthetist, but if none available then it should be the person most experienced in airway management. Consider the assistance of a GP anaesthetist, MICA paramedic or others
- Ensures adequate preparation of airway equipment
- Responsible for assessing and managing the airway and ventilation
- Counts the initial respiratory rate. Administers oxygen therapy, performs suction, inserts airway adjuncts, performs endotracheal intubation (RSI)
- Maintains cervical spine immobilisation and controls the log roll
- Takes an initial history (AMPLE: Allergies, Medications, Past medical history, Last eaten, Events leading).
Airway assistant: A theatre assistant should assist in this role; if not, then Nurse 1 can assume this role
- Assists in preparing equipment for advanced airway intervention
- Assists during interventions (applying cricoid pressure, passing tools to the airway specialist)
Doctor 1-assessment: Emergency clinician/surgeon
- Undertakes the primary survey
- Reports clinical findings clearly to the team leader and scribe
- Conducts FAST exam if suitably qualified and no ultrasonographer present
- May be required to perform procedures dependant on whether Doctor 2 is present and on skill set and training
Doctor 2-procedure: Emergency clinician/doctor if available; if not then this role can be divided between Doctor 1 / Nurse 1 or 2 / paramedic, dependant on skills
- Performs procedures dependant on skill set and training (finger thoracostomy, chest drain insertion)
- Gains intravenous (IV) or intraosseous (IO) access and draws bloods
- Has nasogastric tube (NGT) and in-dwelling catheter (IDC) insertion tubes ready
- Conducts the secondary survey
Nurse 1-monitoring: ED nurse / ward nurse / paramedic
- Cuts off clothing on the right side
- Places monitoring equipment on the patient (three-lead ECG, blood pressure, SpO2, defibrillation pads if necessary)
- Takes temperature
- Assists with advanced airway interventions as necessary6
- Assists with procedures (NGT / IDC / chest drain) as necessary or medical care as directed by the team leader
Nurse 2-circulation: ED nurse / ward nurse / paramedic
- Cuts off clothing on the left side
- Attempts IV cannulation or IO access, take bloods including BSL (if no doctor available to do this)
- Commences IV fluid therapy via a warmer if necessary
- Draws up drugs and administers medications as necessary (morphine, anaesthetic induction agents)
- Sets up external warming and ensures the patient is kept normothermic during resuscitation
Scribe: ED nurse / ward nurse / paramedic
- Collates all information and records it on trauma charting
- Keeps an accurate record of time of arrival, interventions and events
- Records drug dosages, time of administration and amounts
- Prepares paperwork for inter-hospital transfer if necessary
- Gathers the patient’s belongings and documents a record of their possessions
Others: Remain outside the area of principal activity and wait to be called by the team leader to assist.
Radiographer
- Takes x-rays as directed by the team leader; if trained, may perform the FAST exam
Specialists: General surgeon / orthopaedic surgeon
Assists with the secondary survey and advanced procedures as directed by the team leader
Modified trauma team positions
Where there are limited resources then individuals in the team will need to assume more than one role. It is important that all staff work collaboratively and communicate effectively.
