For a trauma team to run effectively there must be an identifiable leader who will direct the resuscitation, assess the priorities and be responsible for critical decisions. ²⁸ Good communication between the trauma team members is vital, as is ensuring that local senior staff are aware and can provide additional support if required.

Once the initial assessment and resuscitation is underway, it is important to plan the next steps in immediate management. Priorities for care must be based on sound clinical judgment, patient presentation, and response to therapies. Awareness of limitations in resources as well as training in the emergency field is vital. If escalation of care to senior staff is warranted, then do so early in the patient care episode. Do not wait until the patient deteriorates to ask for assistance.

Frontline clinical staff should initiate contact with ARV early in the patient care pathway or, more importantly, as soon as it is identified that the patient meets the major trauma transfer criteria (please see separate ARV inter-hospital major trauma transfer guidelines).

This is important as the patient may have sustained injuries beyond the clinical skill set of the hospital or urgent care center. ARV can be contacted at any time throughout the patient care episode to offer clinical advice and consultation.

ARV coordinators can facilitate a three-way conversation between the referral health service, specialist resources, and ARV consultant to discuss optimal management of the patient. The decision of when to transfer an unstable patient should ideally be made by the transferring and receiving clinicians in collaboration with the retrieval service. Clear communication is crucial; the transmission of vital information allows receiving clinicians to mobilize necessary resources while the inadvertent omission of such information can delay definitive care. Information should be conveyed in both verbal and written form (via the patient record) and should include the patient’s identifying information, relevant medical history, pre-hospital management, evaluation, and treatment (including procedures performed and imaging obtained).

There are many different types of structured handover tools. The IMIST-AMBO model is recommended when communicating clinical handovers of patients. ¹⁶ Consistent use of this model ensures a standardized clinical handover is being performed every time.

• Identification: Introduce / identify clinician/self & their role, intro of the patient – age, sex, name.
• Retrieval: Reason for retrieval, from which referrer.
• Mechanism of Injury / presenting complaint: Specific explanation of the patient’s presenting problem and history of presenting complaint.
• Injuries / Interventions: Information relating to injuries. Complete top to toe summary. Include what interventions have been performed to help stabilize the patient – e.g. Size 8 ETT.
• Signs / Symptoms: Overall assessment of the patient, requires details of the current vital signs and GCS.
• Treatments / Trends: Identifies the treatment that was required – e.g. sedation / paralysis and how the patient’s condition has changed. Point of transition of responsibility and accountability for patient care.
• Allergies: Include what type of reaction.
• Medication: Patients’ usual medication.
• Background History: Patient’s medical history, functional status.
• Other information: Relevant social information, advanced care directive. ¹⁶

It is important that additional communication with the ARV coordinator is initiated when there is:

1. Significant deterioration in: conscious state, blood pressure, heart rate, respiratory status, oxygenation.
2. Major clinical developments such as significantly abnormal diagnostic tests and new clinical signs.
3. The need for major interventions prior to the retrieval team arriving (for example, intubation or surgery). This will ensure the retrieval team is prepared, the patient receives the appropriate care en route and the patient is referred to the correct facility.