A trauma team is a multidisciplinary group of healthcare workers under the direction of a team leader that works together to assess and treat the severely injured. [1] This team typically meets before the patient reaches the trauma center. Upon arrival, the team does an initial assessment and necessary resuscitation, adhering to a defined protocol. [2]
Trauma teams can consist of the following: [3]
Other specialties can be added depending on the nature of the injury. For example a neurosurgeon will attend if there is a serious head injury; However, added members should not draw away from the functioning and responsibilities of the core team. [2] Many hospitals will have neurosurgeons, orthopedic surgeons, plastic surgeons, cardiothoracic surgeons, and physicians from other specialties on standby. [4] [7] All staff should be trained in Advanced Trauma Life Support techniques. Each hospital will have a list of criteria that require the activation of the trauma team, such as a fall of over 6 meters or a fracture of 2 or more bones.
There is no single universal list that dictates trauma team activation across different facilities. Each individual trauma center should generate its own criteria that are specifically designed for the location, available resources, and the patients. These criteria should also be easy to understand and readily available to the necessary individuals. Trauma team activation should be closely monitored and evaluated constantly to adapt to the changing healthcare field and regulations.
Hospitals should clearly define when the team must be assembled, who is to respond, and how they will be notified. Most trauma centers have multiple tiers, meaning not every member of a trauma team needs to respond to every emergency. [8]
Trauma teams are important to reduce mortality of patients. Its multi-faceted approach incorporates a variety of medical fields both in the hospital and out of the hospital in the form of Emergency Medical Services. Trauma teams reduce the time between the emergency department arrival and other necessary steps to treat patents such as CT scans and operating rooms. Patients who have traumatic injuries but are not treated by the trauma team have increased mortality. [9]
Trauma teams are assessed in multiple ways: by video, simulators, and third party observers. All three are used to identify errors and improve care. Video is one of the most efficient methods of review because trauma team members can see the errors being done in real time. Some common errors noted from video review are failure of team coordination, poor communication, and failure to do certain tasks. One downfall of video review is its inability to review vital signs without a specific vital sign monitor recording. Confidentiality can also be an issue with video review because patient consent is difficult to obtain.
Simulators can be an effective learning tool as well. A benefit of using simulators is the ability to stop mid procedure. Doing so offers the team an opportunity to pause while no lives are at stake, providing a learning environment that feels safer and more open. The simulator itself can be a downfall as it may be difficult to use.
Observation by third party is effective when assessing one team member, but can be less effective if one observer is expected to monitor all members. It may also yield biased data. [9]
First aid is the first and immediate assistance given to any person with either a minor or serious illness or injury, with care provided to preserve life, prevent the condition from worsening, or to promote recovery until medical services arrive. First aid is generally performed by someone with basic medical training. Mental health first aid is an extension of the concept of first aid to cover mental health, while psychological first aid is used as early treatment of people who are at risk for developing PTSD. Conflict first aid, focused on preservation and recovery of an individual's social or relationship well-being, is being piloted in Canada.
Emergency medicine is the medical speciality concerned with the care of illnesses or injuries requiring immediate medical attention. Emergency physicians specialize in providing care for unscheduled and undifferentiated patients of all ages. As first-line providers, in coordination with emergency medical services, they are primarily responsible for initiating resuscitation and stabilization and performing the initial investigations and interventions necessary to diagnose and treat illnesses or injuries in the acute phase. Emergency medical physicians generally practice in hospital emergency departments, pre-hospital settings via emergency medical services, and intensive care units. Still, they may also work in primary care settings such as urgent care clinics.
Emergency medical services (EMS), also known as ambulance services or paramedic services, are emergency services that provide urgent pre-hospital treatment and stabilisation for serious illness and injuries and transport to definitive care. They may also be known as a first aid squad, FAST squad, emergency squad, ambulance squad, ambulance corps, life squad or by other initialisms such as EMAS or EMARS.
An emergency department (ED), also known as an accident and emergency department (A&E), emergency room (ER), emergency ward (EW) or casualty department, is a medical treatment facility specializing in emergency medicine, the acute care of patients who present without prior appointment; either by their own means or by that of an ambulance. The emergency department is usually found in a hospital or other primary care center.
A trauma center, or trauma centre, is a hospital equipped and staffed to provide care for patients suffering from major traumatic injuries such as falls, motor vehicle collisions, or gunshot wounds. A trauma center may also refer to an emergency department without the presence of specialized services to care for victims of major trauma.
Battlefield medicine, also called field surgery and later combat casualty care, is the treatment of wounded combatants and non-combatants in or near an area of combat. Civilian medicine has been greatly advanced by procedures that were first developed to treat the wounds inflicted during combat. With the advent of advanced procedures and medical technology, even polytrauma can be survivable in modern wars. Battlefield medicine is a category of military medicine.
Airway management includes a set of maneuvers and medical procedures performed to prevent and relieve airway obstruction. This ensures an open pathway for gas exchange between a patient's lungs and the atmosphere. This is accomplished by either clearing a previously obstructed airway; or by preventing airway obstruction in cases such as anaphylaxis, the obtunded patient, or medical sedation. Airway obstruction can be caused by the tongue, foreign objects, the tissues of the airway itself, and bodily fluids such as blood and gastric contents (aspiration).
Major trauma is any injury that has the potential to cause prolonged disability or death. There are many causes of major trauma, blunt and penetrating, including falls, motor vehicle collisions, stabbing wounds, and gunshot wounds. Depending on the severity of injury, quickness of management, and transportation to an appropriate medical facility may be necessary to prevent loss of life or limb. The initial assessment is critical, and involves a physical evaluation and also may include the use of imaging tools to determine the types of injuries accurately and to formulate a course of treatment.
An emergency physician is a physician who works in an emergency department to care for ill patients. The emergency physician specializes in advanced cardiac life support, resuscitation, trauma care such as fractures and soft tissue injuries, and management of other life-threatening situations.
A paramedic is a healthcare professional, providing pre-hospital assessment and medical care to people with acute illnesses or injuries. In Canada, the title paramedic generally refers to those who work on land ambulances or air ambulances providing paramedic services. Paramedics are increasingly being utilized in hospitals, emergency rooms, clinics and community health care services by providing care in collaboration with registered nurses, registered/licensed practical nurses and registered respiratory therapists.
Advanced trauma life support (ATLS) is a training program for medical providers in the management of acute trauma cases, developed by the American College of Surgeons. Similar programs exist for immediate care providers such as paramedics. The program has been adopted worldwide in over 60 countries, sometimes under the name of Early Management of Severe Trauma, especially outside North America. Its goal is to teach a simplified and standardized approach to trauma patients. Originally designed for emergency situations where only one doctor and one nurse are present, ATLS is now widely accepted as the standard of care for initial assessment and treatment in trauma centers. The premise of the ATLS program is to treat the greatest threat to life first. It also advocates that the lack of a definitive diagnosis and a detailed history should not slow the application of indicated treatment for life-threatening injury, with the most time-critical interventions performed early.
ABC and its variations are initialism mnemonics for essential steps used by both medical professionals and lay persons when dealing with a patient. In its original form it stands for Airway, Breathing, and Circulation. The protocol was originally developed as a memory aid for rescuers performing cardiopulmonary resuscitation, and the most widely known use of the initialism is in the care of the unconscious or unresponsive patient, although it is also used as a reminder of the priorities for assessment and treatment of patients in many acute medical and trauma situations, from first-aid to hospital medical treatment. Airway, breathing, and circulation are all vital for life, and each is required, in that order, for the next to be effective: a viable Airway is necessary for Breathing to provide oxygenated blood for Circulation. Since its development, the mnemonic has been extended and modified to fit the different areas in which it is used, with different versions changing the meaning of letters or adding other letters.
Blunt trauma, also known as blunt force trauma or non-penetrating trauma, describes a physical trauma due to a forceful impact without penetration of the body's surface. Blunt trauma stands in contrast with penetrating trauma, which occurs when an object pierces the skin, enters body tissue, and creates an open wound. Blunt trauma occurs due to direct physical trauma or impactful force to a body part. Such incidents often occur with road traffic collisions, assaults, sports-related injuries, and are notably common among the elderly who experience falls.
Focused assessment with sonography in trauma is a rapid bedside ultrasound examination performed by surgeons, emergency physicians, and paramedics as a screening test for blood around the heart or abdominal organs (hemoperitoneum) after trauma. There is also the extended FAST (eFAST) which includes some additional ultrasound views to assess for pneumothorax.
R Adams Cowley Shock Trauma Center is a free-standing trauma hospital in Baltimore, Maryland and is part of the University of Maryland Medical Center. It was the first facility in the world to treat shock. Shock Trauma was founded by R Adams Cowley, considered the father and major innovator of trauma medicine.
Emergency nursing is a specialty within the field of professional nursing focusing on the care of patients who require prompt medical attention to avoid long-term disability or death. In addition to addressing "true emergencies," emergency nurses increasingly care for people who are unwilling or unable to get primary medical care elsewhere and come to emergency departments for help. In fact, only a small percentage of emergency department (ED) patients have emergency conditions such as a stroke, heart attack or major trauma. Emergency nurses also tend to patients with acute alcohol and/or drug intoxication, psychiatric and behavioral problems and those who have been raped.
The following outline is provided as an overview of and topical guide to emergency medicine:
Trauma surgery is a surgical specialty that utilizes both operative and non-operative management to treat traumatic injuries, typically in an acute setting. Trauma surgeons generally complete residency training in general surgery and often fellowship training in trauma or surgical critical care. The trauma surgeon is responsible for initially resuscitating and stabilizing and later evaluating and managing the patient. The attending trauma surgeon also leads the trauma team, which typically includes nurses and support staff, as well as resident physicians in teaching hospitals.
Damage control surgery (DCS) is surgical intervention to keep the patient alive rather than correct the anatomy. It addresses the "lethal triad" for critically ill patients with severe hemorrhage affecting homeostasis leading to metabolic acidosis, hypothermia, and increased coagulopathy.
Pre-hospital emergency medicine, also referred to as pre-hospital care, immediate care, or emergency medical services medicine, is a medical subspecialty which focuses on caring for seriously ill or injured patients before they reach hospital, and during emergency transfer to hospital or between hospitals. It may be practised by physicians from various backgrounds such as anaesthesiology, emergency medicine, intensive care medicine and acute medicine, after they have completed initial training in their base specialty.
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