Trauma Team Member Roles

The following is an example of how to allocate roles in a trauma team. Different hospitals may have other configurations depending on resources and availability of staff. It is essential however, that every team member is aware of their role and responsibilities. The team should complete their tasks in parallel with the team leader providing overall supervision.

All team members should identify themselves on arrival to the team leader. Name badges should be visible. Stickers with role identification can be useful. Appropriate PPE should be worn by all.

Team leader

Who

• Usually the ED SMO, however a more junior member of the team can team lead provided there is active senior supervision.

Key roles

• Decisions
• Direction
• Destination
• Documentation

Responsibilities

• The team leader is responsible for directing the actions of the team and keeping the team updated on the ‘big picture’ (also called maintaining situational awareness).
• Ensure team is complete and roles allocated prior to patient arrival
• Obtain essential history from pre-hospital care providers
• Ensure team members perform their roles in a timely fashion and request regular updates on findings/progress
• The team leader must task specific people to specific tasks. For example, “John would you gain IV access” and not “would someone gain IV access”.
• Monitor vital signs
• Frequent summarization of progress and goals of the team
• Prioritise injuries and the investigation and management thereof
• Facilitate passage of patient to definitive care and radiology
• Reach agreement with the trauma team members on treatment plan and timeframe
• Contact other specialities (e.g. Orthopaedics, Neurosurgery etc)
• Liaise with blood bank and initiate Massive Haemorrhage Protocol as required in coordination with the Transfusion Coordinator
• Speak with relatives
• Ensure appropriate documentation is completed by team members

When possible this should be a ‘hands off’ role.  The team leader should avoid performing tasks unless this is absolutely necessary, as this risks the team leader becoming task-focused and losing situational awareness.

Changing the team leader during the incident should be avoided unless this is necessary. However, if this needs to occur it is important that there is a clear handover process and that all team members are aware that the team leader has changed.

Airway doctor

Who

• Must have advanced airway skills
• Usually an ED registrar or ICU/anaesthetic registrar

Key roles

• Airway management

Responsibilities:

• Prepare all airway equipment and RSI drugs prior to patient arrival
• Communicate with the patient if conscious
• Perform rapid airway assessment, commence oxygen if required
• Ensure in-line stabilisation of the cervical spine if required
• Perform intubation if required.
• Follow appropriate intubation checklist (if exists)
• Evaluate neurological status – GCS and pupillary response
• Monitor ECG and vital signs
• Place a gastric tube (orally if the nasal route is contra-indicated)
• Place arterial line if indicated and airway secure

Breathing/assessment doctor

Who

• ED registrar usually

Key roles

• Perform primary and secondary survey

Responsibilities:

• Perform primary survey
• Perform eFAST if indicated
• Assist procedure doctor if key tasks completed
• Perform secondary survey

Circulation/procedures doctor

Who

• ED registrar or trauma/surgical registrar

Key roles

• Perform any immediate interventions
• Gain IV access + take bloods + order investigations
• Order/administer medications
• Arrange trauma radiology

Responsibilities:

• Stop external bleeding with pressure
• Apply additional haemostatic measures as required eg: limb traction, pelvic binder, tourniquets
• Insert large bore cannulae (eg. 14g/16g in antecubital fossae) or IO lines
• Take trauma bloods
• Start fluid resuscitation
• Perform procedures as indicated
  • Finger or tube thoracostomy
  • Reduce fractures/dislocations/apply splints
  • Urinary catherisation
  • Insert arterial line
• Order medications as required (eg: analgesia, antiemetics, ADT, antibiotics)
  • Administer RSI medication
• Order radiological investigations

General surgery doctor

Who

• Surgical registrar

Key roles

• Confirm the primary and secondary survey findings.
• Liaise with surgical consultant and theatre staff

Responsibilities:

• Repeat/review primary secondary survey
• During logroll, examine back +/- rectal examination if indicated
• Assist with or perform procedures
• Liaise with surgical consultant and theatre/anaesthetics
• Obtain consent for procedures or operations

Airway nurse/assistant

Who

• ED nurse or anaesthetic technician

Key role

• Assist airway doctor to manage airway

Responsibilities

• Prior to patient arrival check and prepare
  • airway equipment
  • oxygen & suction
  • intubation equipment – ventilator/capnograph
  • intubation drugs
• Assist with intubation
  • Secure ETT and attach to ventilator/capnography

Circulation nurse(s) / Transfusion Coordinator

 Responsibilities

• Prior to patient arrival
  • Prime IV lines, rapid infuser
  • Liaise with Team Leader and Blood Bank to ensure prompt supply of blood products
  • Prepare analgesia
• On patient arrival
  • Switch timer on
  • Assist with patient transfer onto bed
  • Cut clothes off
  • Attach monitoring
  • Perform initial obs (place saturation probe on as 1st action) – BP, HR, RR, temp, GCS, O₂
• Ongoing care
  • Administer IV fluids/blood, drugs
  • Once MHP has been activated, ongoing communication with the blood bank team
  • Perform ECG
  • Set up arterial line monitoring
  • Assist with procedures
  • Apply splints / dressings
  • Prepare patient for transfer to CT/theatre/ICU
  • Ensure transfusion documentation/checklists maintained

Nurse coordinator

Who

• Charge nurse, duty nurse manager, trauma coordinator

Key roles

• Coordinate nursing staff
• Liaise with team leader
• Communicate with family
• Liaise with clerks, orderlies, radiology, theatre ICU

Scribe

Who

Nurse

Key role

• Documentation

Responsibilities

• Document
• Team members present
• Time of arrival
• Vital signs
• AMPLE history
• Medications given
• IV fluids/blood administered
• Interventions performed

Social Worker

 Key role

• Family support, communication and assistance

Responsibilities

• Greets family when they arrive and escorts them to designated area, or supports them during the resuscitation
• Talks to the family regarding events surrounding the trauma
• Supports and assists family members