Leading the trauma call

Pre-arrival: assemble the trauma team and allocate the roles (airway, nurse, surgeon, scribe, runner). Check the equipment (suction, airway trolley, chest drain, blood products, ultrasound). Brief the team on the mechanism and the expected injuries. Order the group-and-crossmatch and activate the massive transfusion protocol given the hypotension.^[2] On arrival: take the MIST handover from the paramedics (Mechanism: high-speed motorcycle crash; Injuries: deformed right thigh, decreased GCS; Signs: GCS 10, SBP 80; Treatment: splinted, IV fluids, oxygen). Move the patient to the resus trolley with the cervical spine protected.^[2] Primary survey (I stand at the foot of the bed and direct): C — catastrophic haemorrhage: assess the thigh, apply a tourniquet or a splint if bleeding. A — airway with c-spine: assess patency; GCS 10 is borderline — prepare for RSI with c-spine in-line. B — breathing: high-flow oxygen, auscultate, assess for the five life-threatening chest injuries. C — circulation: two large-bore IVs, bloods, blood products (not crystalloid), activate MTP, FAST scan. Assess the pelvis. D — disability: GCS 10, pupils, glucose. The falling GCS is the indication for the definitive airway. E — exposure: fully expose, keep warm, log roll.^[1] Disposition: if the FAST is positive and the patient remains unstable, the destination is the operating theatre for damage-control surgery. If stabilised, the whole-body CT. I communicate each decision to the team and call for the specialty help early.^[1]