Advanced Trauma Life Support ATLS Student Course Manual 2018

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APPENDIX E n ATLS and Trauma Team Resource Management
Team members should communicate all information
to the team leader. Communication or discussion
between team members that does not involve the team
leader can lead to confusion and conflicting decisions
about next steps.
table e-1 criteria for trauma team
activation
CATEGORY
CRITERIA
Participating in the Debriefing
Feedback has been shown to correlate with overall team
performance outcomes. Team member should remain
for debriefing in nearly all circumstances. Debriefing
gives team members a chance to discuss how the patient
was managed and particularly to identify areas of
good practices as well as any actions that should be
undertaken before they are part of the team next time.
Debriefing also gives the whole team opportunities
to consider different or alternative courses of action
or management.
DELIVERING Atls® WITHIN
A TEAM
Mechanism of
Injury
Specific Injuries
• Falls > 5 meters (16.5 feet)
• High-speed motor vehicle
accident
• Ejection from vehicle
• High-speed motor vehicle
collision
• Pedestrian, bicyclist, or motorcyclist
vs. vehicle > 30 kph (18 mph)
• Fatality in same vehicle
• Injury to more than two
body regions
• Penetrating injury to the head,
neck, torso, or proximal limb
• Amputation
• Burn > 15% BSA adults, 10% BSA
children or involving airway
• Airway obstruction
Specific patient management strategies are outlined
in the ATLS® Student Manual. This section describes
the specific roles trauma team members assume while
delivering care according to those principles.
Patient Arrival
n TABLE E-1 presents examples of criteria for trauma
team activation, although these will vary by institution.
The team leader receives the handover, ensures that
all important information is transferred swiftly to the
team members, and establishes the most important
aspects of the handover using the ABCDE approach
to prioritize the injuries identified by prehospital
providers. At some point an AMPLE history must be
taken, although complete information about the patient
may not be available at handover.
Airway Control and Restriction of
Cervical Spine Motion
Securing an airway is often the role of the anesthetist/
anesthesiologist or an emergency room physician
trained in airway techniques (Doctor A). Doctor A
should as a minimum have basic airway skills and
understand the indications for definitive airway
management. Ideally, Doctor A is familiar with and
competent to place a laryngeal mask airway (LMA)
Physiological
Derangement
• Systolic < 90 mm Hg
• Pulse > 130
• RR < 10 or > 30
• GCS score < 14/15
• Chest injury in patient older than
70 years
• Pregnancy > 24 weeks with torso
injury
or endotracheal tube using appropriate drugs when
required for the patient.
When cervical spine injury is suspected, the doctor
will establish the airway while restricting cervical spine
motion. This procedure requires an airway assistant
to stabilize the neck and restrict spinal motion during
intubation. The anesthetic assistant supports doctor A
by providing appropriate equipment, intubation drugs,
and assistance.
Doctor A, who is in charge of the airway, informs
the team leader at regular intervals of the steps being
taken to secure the airway. If at any point the airway
becomes difficult to establish, Doctor A should inform
the team leader immediately.
Breathing with Ventilation
The first responsibility of Doctor B is to quickly assess
breathing and establish that ventilation is satis-
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