Where does everyone stand in the Trauma Room?

LearningByMistakes · Oct 22, 2012

I've also seen Trauma Centers use "colored foot prints" on the floor, for where people are to stand, color coded to their job/position.

mmutk, BSN, RN, EMT-I · Oct 22, 2012

I have a pdf of our setup but no image I can post here...

Trauma Resuscitation Team - Positioning

EDA PAMD

TTL, TNP

PMD, PN PATIENT SN, or P

PCT

Scribe

TFRT

MS

KEY:

1. Trauma Team-Leader (TTL): A Senior (PGY-4)

2. Trauma Attending or Fellow (TA or TF) -

3. Primary MD (PMD) - A Second Year Surgical or Emergency DepartmentResident4. Primary Airway MD (PAMD) 5. ED Attending (EDA)- Will be responsible for supervising thePAMD. 6. Primary Nurse(PN)

7. Secondary Nurse SN

Or Paramedic (P)8. Scribe Nurse (Scribe)

9.Patient Care TechnicianPCT) -

10. Radiology Technicians (RT) -

11. Trauma Nurse Practitioner(TNP)-

12. Medical Student (MS)-

Esme12, ASN, BSN, RN · Oct 23, 2012

I work in a small rural hospital in the EMS department. Our hospital runs the local EMS service and we are considered hospital employees. I've noticed when we go down to the ED to help during major traumas, codes, or critical patients, the room is always a cluster with 6 people running around.
There's very little organization, things don't flow well and it's hard to keep tracking of who is supposed to do what and if its actually being done.
When I worked in large cities and went to multiple hospitals, I often saw a large chart high on the wall of the trauma room at the head of the patient. It had a simple drawing of a bed with a patient on it and then different roles next to the bed. The charts were often labeled with "Primary nurse, secondary nurse, scribe" or "RN 1, RN 2, RT, ED Tech, MD, etc".
Along with pictures of where people were supposed to stand, there was also a short list of jobs. Who was in charge of venous access, in charge of meds, in charge of compressions, etc. I think it kept the team working on critical patients organized and kept unneeded people out of the room.
I want to find a copy (or several) of these charts/pictures/diagrams to show to our ED Director to see if we can implement it here. My Google-fu is failing me today. Anyone have copies of or links to this kind of diagram?
Keith

While charts and documents are great.....remember ......you work in a small rural ED. While they see their fair share of trauma....they are not "the experts" AND they don't have med students, interns, residents and fellows of every department in one room. In a large Level one.....roles are assigned making it clear if you aren't on the list.....GET OUT OF THE WAY! A crowd control issue. The "regular staff pretty much KNOW where/what their role is.......the picture on the wall is for the med students, interns, residents jockeying for a better view. Since they change every few weeks it gives them a clear place on where to stand to help and where to stand to be out of the way.

In a small ED the apparent chaos to the casual eye is their version of a well oiled machine. It does appear more chaotic for they don't have as many hands available to designate a specific task to very person and the nurses......especially on arrival, may appear unfocused and disjointed on the patients arrival. Admittedly the "flow" may not be pretty.....it gets the job done. Nurses in rural facilities are Jacks of all trades and have multiple tasks in one situation for there aren't enough to go around.......SO you have multiple people in one small place doing multiple tasks to initially stabilize the patient......it does appear to be, and sometimes is, chaotic.

Improvement processes are great......a word of caution......Sometimes the staff of the ED may not appreciate your efforts to help them improve their process. ED nurses are pretty protective of their territory and may not perceive your efforts as helpful. Some ED's have their processes and protect them as them fiercely.....suggestions to improve the process may not be well received by nursing personnel that are made by non ED personnel.

Departments have improvement processes....improvement processes. Find out what their is. Check with the manager. They may not be receptive to non ED personnel want a process change because they feel it doesn't flow well...... ED nursing is very different from EMS practice.....while this drives you nuts......they ED staff may be perfectly fine.

I wish you the best.

VICEDRN, BSN, RN · Nov 1, 2012

Tell you a story to contrast what ESME says...

When I was a new grad, I pitched a fit at the small rural ER I started at. Too many people running into the code or trauma when they came in. It was like a free for all. Total chaos in the room. They did this because most of the RNs had left big urban hospitals for a quieter life but still missed the excitement as they were only getting codes every three days or so in this hospital.

I got ignored by the staff but the management and my preceptor agreed with me that there should be a uniform response to codes in the ER. I came in one day and my preceptor told me that I had managed to save a life even while not on duty. A code came in, all the nurses ran into it to "help." This meant four RNs in the room with the code and no RNs for the rest of the unit. Seeing the number of nurses in the room, my preceptor left the room and returned to her patients. She sat down at her desk and noticed a call light and a cry for help from a room.

She went into to find a gi bleeder who had just broken his clot loose and put two liters into the hat. She went and told the ER doc and started fluids immediately.

"Be the change you seek." Gandhi

sserrn, BSN · Nov 1, 2012

^^I see your point and agree, but find that this is more often a problem in a large ED. I am FT at a large, busy ED and often the room is so full you can barely move (1 doc, 2 RTs, 3-6 RNs, sometimes lab, sometimes a tech). It actually used to be worse, and then we pretty much got told if you're not on the code team, get out! (Sometimes we still don't do well with that rule, but it's better than it was a few months ago, thank God! Nurses that were supposed to be in triage or fast track would come to the back for a code or trauma, leaving their areas w/o a nurse!)

Anyway, I am prn at two very small rural EDs. While you always must be mindful of your pts waiting to be triaged and your pts in other rooms, if you have 2 RNs (or an RN and a medic) in your ER, it's pretty difficult to run a trauma or code with one or even 2 nurses! With 3 nurses at one of the facilities, usually a trauma or code only requires all 3 nurses for the first 10-15 mins, then after 30-45 mins we can usually get it down to just 1 nurse. And we do really well at getting back out there to watch the other rooms as soon as possible. We tend to have more trouble with this at my large ED. I am usually the first one to step out if the room is congested and there are more than adequate nurses to do what needs done. Even when I am on the code team I find that 2/3 times I just peek my head in and ask if they need me and they usually don't. So I happily go back to my own pts. :-)