Traumas...how does your room operate?

[DayDreamin ER CRNP]

I work in a Level 1 trauma center ER and we are looking to "re-do" a lot of the trauma processes and are in the process of forming "trauma teams" to focus primarily on traumas vs "just" being an ER nurse.

Some of the docs are asking the nurses why the rooms and traumas are running smoothly. I have some opinion but I am a relatively new nurse with only a small amount of trauma experience. What I see is a lot of chaos and a lot of unnecessary questions and not a lot of "doing" sometimes.

Currently, we have a TT that is made up of a primary nurse, a secondary nurse, a scribe, an infuser, a "procedure" nurse, a tech and an MD. We also have ancillary depts that come in (x-ray, resp, etc.). Each of those listed has her own job in the room. When a level is called out, the TT reports to the assigned room and prepares for the patient.

As it is now, the pt is wheeled in from EMS and we swarm the patient like a NASCAR pit crew. We are all barking questions at the pt and we even have a registration clerk that comes in to attempt to ID and register the pt.

Often, the EMS medic gives report so someone in the room and it is sometimes not loud enough to be heard or there is so much unnecessary info given we tune out.

I mean, we are asking the pt whether or not the pt smokes or drinks alcohol and what surgeries he/she has had and a lot of this info is just not relevant for a primary assessment. Of course, I'm refering to pts that can actually communicate - not the level 1s that cannot. Even those aren't always handled efficiently sometimes.

So how does your ER / Trauma room operate? Can you give me a "cliff notes" version of what happens step-by-step?

thanks!

[VICEDRN, BSN, RN]

First of all, we have decided recently to do and say nothing until the ems report is completed. When ems is done talking, any questions are asked and their tough book is signed, no one is supposed to talk or do anything else until then. In reality, we often start undressing the patient and hooking up the monitor at the same time.