EM · Trauma team leadership
Trauma team leadership
The trauma team activation, composition and leadership: the pre-arrival briefing, the paramedic MIST handover, the allocated roles, the standing-back team leader who directs the primary survey, the decision points of theatre versus CT, the crisis resource management, and the post-trauma debrief.
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Red flags
- The trauma team leader who performs procedures loses the situational awareness of the resuscitation
- The paramedic MIST handover must be taken before the patient is moved — it guides the team's preparation
- The unstable trauma patient goes to the operating theatre, not the CT scanner — the team leader makes this call
- A team without allocated roles is a crowd — the pre-arrival briefing assigns the roles
- The trauma without a debrief is a trauma whose lessons are lost
- The authority gradient is steep by default — the leader must actively flatten it by inviting the question and the dissent
- The fixation error anchors a team on a single diagnosis despite the contradictory evidence — the formal time-out breaks it
- The major trauma network routes the severely injured to the definitive trauma centre, bypassing the lower-acuity hospital
Meet the patient
The pre-hospital call comes through at 02:14. A 25-year-old cyclist has been struck by a truck at 60 km/h and thrown 5 metres — GCS 8 at scene, intubated by the flight doctor, systolic 90, an obviously deformed right leg and bruising across the abdomen. ETA eight minutes. You are the team leader.[3]
Your job in those eight minutes is to turn a crowd into a team: read the roles aloud, check the airway trolley and the blood, warn theatre, and predict the injuries before the trolley comes through the door. The question this patient plants is the one every trauma stem turns on — does the physiology declare source control, or does it tolerate the scanner? Hold that question and the resus falls into place.[4]
References12ShowHide
- [1]Greif R, Bhanji F, Bigham BL, et al. Education, Implementation, and Teams: 2020 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations Resuscitation, 2020.PMID 33098918
- [2]Farquharson B, Cortegiani A, Lauridsen KG, et al. Teaching team competencies within resuscitation training: A systematic review. Resusc Plus, 2024.PMID 39006135
- [3]Galvagno SM Jr, Nahmias JT, Young DA Advanced Trauma Life Support(®) Update 2019: Management and Applications for Adults and Special Populations. Anesthesiol Clin, 2019.PMID 30711226
- [4]Tiel Groenestege-Kreb D, van Maarseveen O, Leenen L Trauma team. Br J Anaesth, 2014.PMID 24980423
- [5]King HB, Battles J, Baker DP, et al. TeamSTEPPS(™): Team Strategies and Tools to Enhance Performance and Patient Safety. 2008.PMID 21249942
- [6]Pai DR, Kumar VH, Sobana R Perioperative crisis resource management simulation training in anaesthesia. Indian J Anaesth, 2024.PMID 38406342
- [7]Alexandrino H, Martinho B, Ferreira L, et al. Non-technical skills and teamwork in trauma: from the emergency department to the operating room. Front Med (Lausanne), 2023.PMID 38116034
- [8]Fanning RM, Gaba DM The role of debriefing in simulation-based learning. Simul Healthc, 2007.PMID 19088616
- [9]Ehlers P, Seidel M, Schacher S, et al. Prospective Observational Multisite Study of Handover in the Emergency Department: Theory versus Practice. West J Emerg Med, 2021.PMID 33856332
- [10]Haslam NR, Bouamra O, Lawrence T, et al. Time to definitive care within major trauma networks in England. BJS Open, 2020.PMID 32644299
- [11]Braithwaite J, Wears RL, Hollnagel E Resilient health care: turning patient safety on its head. Int J Qual Health Care, 2015.PMID 26294709
- [12]Chien DS, Yiang GT, Liu CY, et al. Association of In-Hospital Mortality and Trauma Team Activation: A 10-Year Study. Diagnostics (Basel), 2022.PMID 36292022