The Trauma trainwreck

Hey Falcon I wish you all the very best in gaining heaps of trauma experience.

It is not for the faint hearted and certainly not for me. Did my time in the ER and wanted to run LOL

Do you ever, as a team, have a chance to debrief and discuss these traumas that may seem to go awry?

Hang in there I am sure you are doing a great job and being a wee bit too hard on yourself :)

i've witnessed and been part of some pretty hairy traumas that can get disorganized pretty quickly.

is the resuscitation truly disorganized, or is that just your perspective? i'm not trying to pick on anyone, but if it is true disorganization, this is a problem. while a trauma resuscitation doesn't come of like a well choreographed ballet, it should not be disorganized. there should be a designated team leader, and every one in the trauma bay should have an assigned job or position. if they don't have a job, they don't belong in the trauma bay. in addition, ancillary staff that might be needed (i.e., radiology, respiratory therapy, etc.) should all be outside of the trauma bay and be called in only when needed.

do you ever, as a team, have a chance to debrief and discuss these traumas that may seem to go awry?

absolutely! and adding to this, all trauma's should be debriefed or discussed by the team after the fact. you are not only looking for things that went wrong or could have been improved, but things that worked well that you want to incorporate into future resuscitations.

i'm a novice, less than three-year rn.

i'm not sure that i agree with this statement, particularly if your entire career has been in the emergency department. i think that you are probably selling yourself short here. while you probably do not compare with the 20 year veteran of the trauma bay (an no one expects you to), i think you do need to give yourself more credit.

i find myself in situations in trauma that are seemingly outside my experience...

the first thing you need to realize is that trauma is a team sport. you should never be the only nurse in the trauma bay, at least for the first few minutes after arrival, and never as long as the patient is being actively resuscitated. at any time you feel you are outside your comfort or experience zone, ask someone for help or advice. i personally, and i think most nurses as well, would rather have one of my team-mates ask for advice rather than trying to stumble through.

what experiences may have yielded, new protocols, because when you looked back on the experience with hindsight you knew it could be done better? what are some of the main anticipations and delegations you consider before a particular trauma comes in?

trauma is almost never a surprise. your ems crews should be calling you with early notification that they have a multi system trauma patient, as well as calling you with an updated eta when they are en route. your team should assemble well in advance of the patient's arrival. use these few minutes prior to arrival to make assignments, assemble and prepare anticipated equipment (i.e., blood, chest tube tray, rapid fluid infuser, etc.).

do you need personnel not normally assigned to the trauma team? if so notify them as soon as possible so that they can gather their equipment and arrive before they are needed, not after.

when the patient arrives, remember: trauma is always the patient's emergency, not yours. slow down, take a breath, and collect your thoughts. if you become overwhelmed you don't do anyone any good.

remember the abcs.

education and training are vital. your facility should have policies and/or procedures for trauma. find, read and head these. they were written for a reason.

there are several trauma education courses available. the trauma nursing core course (tncc) and pre-hospital trauma life support (phtls) are both excellent courses. although phtls was developed for ems, with the latest revision (6th edition) i think the content is comparable with tncc, although the skills are directed to the pre-hospital environment.

in closing, i want to reemphasize that you need to have confidence in yourself. educate yourself (both formally, and informally on the job). and never be afraid to ask questions or ask for help if you need it. if you don't, the patient is the one who suffers in the long run.

good luck,

I can't really better chares answer! But I will add that I have worked in a unit where the trauma calls were really badly run. Primarily, because the trauma team didn't work as a team and there was no real leadership. A good trauma call DEPENDS on the teamleader to act as the glue that holds the team together. Often, there are too many egos that get involved and the surgeon wants this and the ortho guy wants that and before you know it there are instructions and orders being thrown around and the main focus, the ATLS, is being ignored.The basics get forgotten and no-one knows if we are at A,B or C, or which survey has been done.I have seen things get missed because there was no secondary survey done. A good team leader won't get involved with the patient and will stand back and direct. As Chare siad, it should come off as a well choreographed ballet and there should no shouting or raised voices. Too many times in the unit I was working on, you could'nt hear yourself think. Each member of the team has a designated job and/or task and the other docs involved need to understand this. From a nursing point of view badly run call is incredibly frustrating as you can quickly become overwhelmed and have too many jobs for one pair of hands, especially if different docs are barking orders at you.

I have worked in a innercity hospital where the trauma calls ran like that well-choregraphed ballet and it was a thing of beauty! The difference was that here, we had a strong trauma team and excellent leaders, some of whom were military and you don't find better trauma docs or nurses anywhere. And thats because they train, train, train until it becomes second nature. So, that meant that we trained our little bootys off and had mock trauma calls and mandatory training. We were all assigned tasks and knew what our roles were. Egos were expected to be left at the door and I have seen the team leader tear a strip of consultant for not following instructions (this was after the code, and I admit I was evesdropping...couldn't help myself!).

So, what do you do about it? I would talk to your team of nurse leaders and express your desire for formalised trauma teaching for the 'less experienced' members of staff and if this could involve the team as a whole on occasion. I am sure you aren't the only one who has noticed a problem! Also, as Chare said, enquire as to whether you can go on a trauma course and read at home. Also, depending on how much time you have on your hands, you could do a nurse-paramedic course. No-one(hey, except the military...but I have covered them!)knows trauma better than paramedics...luckily for them they don't often have to deal with the egos that we do out in the field, not unitl they come through those hospital doors anyway!

i'd echo other posters in saying that the team leader(s) needs to get a grip of the situation and if that means yelling " Stop, there are too many f***ing baby doctors (i.e. House officers and SHOs rather than the Registrar/ Staff Specialist / Consultant who is paged to come for a trauma call) in here I want one from each speciality that's all " or " there's too many doctors in here and not enough nurses " ( both things i've heard Emergency dept doctors say in the middle of trauma calls)

if you are going to let the Bottom Doctors (general surgeon 'trauma' or otherwise) run the show as some people suggest ATLS mandates keep their egos in check , otherwise let / make the emergency dept docos or the anaesthetists run the call ...

I think these posts are really helping, Thanks. I'm feeling more motivated. Especially what jbudd was saying about clearing out the non-essential personnel. I think the last trauma I was primary in must have had 30 people in there.