Advanced Trauma Life Support ATLS Student Course Manual 2018
307 APPENDIX E n ATLS and Trauma Team Resource Management challenging aspects of being a trauma team leader. n BOX E-4 provides tips for effectively communicating in such situations. If the team leader needs to leave the patient to speak with the family/friends, he or she must wait until the patient’s condition is adequately stabilized and appoint another team member to continue the resuscitation. If early communication with the patient’s family/ friends is required before the team leader can leave the patient, a member of the nursing staff may be called on to speak with the relatives and keep them updated until the team leader arrives. This approach can also provide an opportunity for the team to start developing a relationship with the family. An early discussion with family/friends may also yield important information about the patient’s medical history or comorbidities that can be communicated back to the team during the resuscitation process. Advance directives or do not resuscitate (DNR) orders should be discussed with the relatives if appropriate. When difficult information and decisions need to be box e-4 tips for communicating with the patient’s family/friends • Try to find a quiet room where everyone (including yourself) can be seated. • Always have another staff member with you. If you have to leave suddenly, he or she can stay with the family. • Introduce yourself and establish who the family members or friends are and what they know already. • Reassure the family/friends that other team members are continuing to care for the patient. • Explain things clearly, and repeat important facts. • Allow time for questions, and be honest if you do not know the answers. • Do not offer platitudes or false hopes. • If appropriate, emphasize that the patient is not in pain or suffering. • Be prepared for different reactions, including anger, frustration, and guilt. • Before leaving the family, explain what will happen next and when they will be updated again. n FIGURE E-1 Communication with family and friends occurs in a quiet, private space. Ideally the team leader, a nurse, and specialty consultants, and faith leaders, may be included when appropriate. discussed with the relatives, it generally is advisable to give the family time and space for thought by moving them briefly to a room adjacent to the resuscitation room (n FIGURE E-1). However, some people prefer to remain with their injured loved one at all times, and their wishes should be respected whenever possible. Although guidelines vary by institution, following are general guidelines related to family/friends being present in the resuscitation room: •• Dedicate a staff member solely to stay with the family/friends and explain what is happening. •• Allow the family/friends to leave and return at any stage. •• Ensure the family/friends knows they can choose not to witness their relative undergoing invasive procedures. •• Allow the family/friends to ask questions and remain close to their injured relative if this does not hinder the trauma team’s work. While remaining sensitive to the family/friends’ concerns, the team leader must remember that the team’s ultimate responsibility is to do its best for the patient. Effective leadership Strong leadership skills can enhance team performance and effectiveness even in challenging situations. Medical practice requires competence as well as n BACK TO TABLE OF CONTENTS
308 APPENDIX E n ATLS and Trauma Team Resource Management proficiency in teamwork and leadership skills. Review of the literature reveals that, across a multitude of publications on the subject, there is no consensus on the definition of leadership. Theories and research into leadership are far from complete, and ideas have changed over time reflecting social, political, economic, and technological influences. However, considerable research evidence suggests that team leadership affects team performance. The work of leadership theorists has broadened the view of leadership, and good leaders are acknowledged to be people who have a wide range of skills, personal qualities, and organizational understanding. Leadership is a relational and shared process, and it is the interactions of people working in collaboration that creates leadership, irrespective of the role they occupy. Qualities and Behaviors of an Effective Team Leader Three major qualities of outstanding leadership have been identified from interviews with leaders. Outstanding leaders: 1. Think systematically, seeing the whole picture with a keen sense of purpose. 2. Perceive relationships to be the route to performance and therefore attend to their team members as partners. 3. Display a self-confident humility that acknowledges their inability to achieve everything and their need to rely on others in the team. Emotional intelligence is considered a prerequisite for effective leadership. Studies on authentic leadership claim that leadership is positively affected by “the extent to which a leader is aware of and exhibits patterns of openness and clarity in his/her behavior toward others by sharing the information needed to make decisions, accepting others’ inputs, and disclosing his or her personal values, motives, and sentiments in a manner that enables followers to more accurately assess the competence and morality of the leader’s actions.” n BOX E-5 lists behaviors that are consistent with effective leadership. Culture and Climate A key attribute of an effective leader is the ability to create the most appropriate culture for the work to be box e-5 behaviors consistent with effective leadership • Showing genuine concern • Being accessible • Enabling and encouraging change • Supporting a developmental culture • Focusing on the team effort, inspiring others • Acting decisively • Building a shared vision • Networking • Resolving complex problems • Facilitating change sensitively carried out. The leader must have sufficient knowledge about the culture in which the work is to be done and the capability to foster a culture that encourages, facilitates, and sustains a favorable level of innovation, exploitation of ideas, and collective learning within the team. Climate is a common theme in much of the research into leadership and teamwork. Highly functioning teams have an atmosphere that supports individual contribution and effectively distributes activity across the team. A clear common goal, sufficient composition of the team, and a sense of satisfaction with team achievements are linked to a strong team climate. Roles AND RespoNSIBILITIES of TEAM MEMBERS Although all team members need to understand the team leader’s roles and responsibilities, the concept of “followership” emphasizes the importance of each team member in contributing to trauma care. This section addresses the ways in which trauma team members can best prepare for and contribute to optimal patient care as part of the team. Entering into a trauma team for the first time, or even subsequent experiences as a relatively junior doctor or provider, can be daunting. A good team leader will facilitate the integration of team members into n BACK TO TABLE OF CONTENTS
- Page 310 and 311: Appendix A OCULAR TRAUMA OBJECTIVES
- Page 312 and 313: 259 APPENDIX A n Ocular Trauma In c
- Page 314 and 315: 261 APPENDIX A n Ocular Trauma to t
- Page 318 and 319: Appendix B HYPOTHERMIA AND HEAT INJ
- Page 320 and 321: 267 APPENDIX B n Hypothermia and He
- Page 322 and 323: 269 APPENDIX B n Hypothermia and He
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- Page 328 and 329: Appendix C TRAUMA CARE IN MASS-CASU
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- Page 352 and 353: Pitfall Inadequate security Failed
- Page 356 and 357: Appendix E ATLS AND TRAUMA TEAM RES
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307<br />
APPENDIX E n <strong>ATLS</strong> and <strong>Trauma</strong> Team Resource Management<br />
challenging aspects of being a trauma team leader.<br />
n BOX E-4 provides tips for effectively communicating<br />
in such situations.<br />
If the team leader needs to leave the patient to speak<br />
with the family/friends, he or she must wait until the<br />
patient’s condition is adequately stabilized and appoint<br />
another team member to continue the resuscitation.<br />
If early communication with the patient’s family/<br />
friends is required before the team leader can leave<br />
the patient, a member of the nursing staff may be called<br />
on to speak with the relatives and keep them updated<br />
until the team leader arrives. This approach can also<br />
provide an opportunity for the team to start developing<br />
a relationship with the family. An early discussion with<br />
family/friends may also yield important information<br />
about the patient’s medical history or comorbidities<br />
that can be communicated back to the team during<br />
the resuscitation process.<br />
Advance directives or do not resuscitate (DNR) orders<br />
should be discussed with the relatives if appropriate.<br />
When difficult information and decisions need to be<br />
box e-4 tips for communicating<br />
with the patient’s family/friends<br />
• Try to find a quiet room where everyone (including<br />
yourself) can be seated.<br />
• Always have another staff member with you. If you<br />
have to leave suddenly, he or she can stay with<br />
the family.<br />
• Introduce yourself and establish who the family<br />
members or friends are and what they know already.<br />
• Reassure the family/friends that other team members<br />
are continuing to care for the patient.<br />
• Explain things clearly, and repeat important facts.<br />
• Allow time for questions, and be honest if you do not<br />
know the answers.<br />
• Do not offer platitudes or false hopes.<br />
• If appropriate, emphasize that the patient is not in pain<br />
or suffering.<br />
• Be prepared for different reactions, including anger,<br />
frustration, and guilt.<br />
• Before leaving the family, explain what will happen<br />
next and when they will be updated again.<br />
n FIGURE E-1 Communication with family and friends occurs in a<br />
quiet, private space. Ideally the team leader, a nurse, and specialty<br />
consultants, and faith leaders, may be included when appropriate.<br />
discussed with the relatives, it generally is advisable to<br />
give the family time and space for thought by moving<br />
them briefly to a room adjacent to the resuscitation<br />
room (n FIGURE E-1). However, some people prefer to<br />
remain with their injured loved one at all times, and<br />
their wishes should be respected whenever possible.<br />
Although guidelines vary by institution, following<br />
are general guidelines related to family/friends being<br />
present in the resuscitation room:<br />
••<br />
Dedicate a staff member solely to stay<br />
with the family/friends and explain what<br />
is happening.<br />
••<br />
Allow the family/friends to leave and return at<br />
any stage.<br />
••<br />
Ensure the family/friends knows they can<br />
choose not to witness their relative undergoing<br />
invasive procedures.<br />
••<br />
Allow the family/friends to ask questions and<br />
remain close to their injured relative if this does<br />
not hinder the trauma team’s work.<br />
While remaining sensitive to the family/friends’<br />
concerns, the team leader must remember that the<br />
team’s ultimate responsibility is to do its best for<br />
the patient.<br />
Effective leadership<br />
Strong leadership skills can enhance team performance<br />
and effectiveness even in challenging situations.<br />
Medical practice requires competence as well as<br />
n BACK TO TABLE OF CONTENTS
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