Advanced Trauma Life Support ATLS Student Course Manual 2018

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APPENDIX E n ATLS and Trauma Team Resource Management
factory using the standard, safe ATLS® approach.
Doctor B reports his or her findings to the team leader
and ensures that the team leader has heard them clearly.
If a patient has life-threatening chest injuries, Doctor B
may be required to urgently perform a needle, finger,
or tube thoracostomy.
Circulation with Hemorrhage
Control
If Doctor B identifies no life-threatening problems
when examining the patient’s chest, he or she may then
move on to assess circulation, again by standard ATLS®
techniques. However, if Doctor B is needed to perform
interventions to establish breathing and ventilation,
a third provider may be required to assess and assist
with circulation. Areas of potential hemorrhage should
be identified and intravenous access established with
appropriate fluid resuscitation.
Team members who are assisting the doctors
in assessing breathing and circulation should be
well acquainted with the emergency room layout,
particularly the location of equipment such as central
venous lines, intraosseous needles, and rapid transfuser
sets. They should be competent in setting up and using
these adjuncts.
If a pelvic binder is required limit pelvic bleeding, two
doctors may be needed to apply it. A specialty doctor
arriving to join the team may be helpful in this role,
particularly one trained in trauma and orthopedics. All
doctors who are qualified as ATLS® providers should
be able to safely apply a pelvic binder.
Disability
Doctor A, who is establishing the airway, can usually
determine the patient’s Glasgow Coma Scale (GCS) score
and assess pupil size while positioned at the head of the
patient. For a patient requiring immediate or urgent
intubation, the doctor establishing the airway should
note GCS score and pupil size before administering
any drugs.
Exposure and Environment
It is vital to fully expose the patient, cutting off garments
to fully expose the patient for examination. During
exposure a full visual inspection of the patient can be
undertaken, and any immediately obvious injuries
should be reported to the team leader. This procedure
can be performed by nurse assistants or by medical staff
if appropriate. At this stage, a secondary survey is not
n FIGURE E-2 Dedicated scribes are trained to document all
information accurately and completely.
performed. Following exposure, cover the patient with
warm blankets to maintain body temperature.
Record Keeping
Record keeping is an important role and in some
jurisdictions is performed by a dedicated scribe who
has been trained to document all information in an
appropriate fashion (n FIGURE E-2). When scribes are not
available documentation follows patient care. It is the
team leader’s responsibility to ensure that the scribe
is aware of all important information and findings.
The team leader should also ensure documentation
includes any significant decisions regarding definitive
care or urgent investigations. Many trauma charts
use the ABCDE system, so important information
can be recorded as the team relates its findings to the
team leader.
Ensuring Effective Team
Communication
It matters little how competent the clinical care is if the
trauma team does not communicate effectively and
efficiently. Communication is not just a set of skills to
be performed; it involves a shared experiential context
and a collective understanding of the purpose of the
team’s activity.
Research studies in primary healthcare teams
found that structured time for decision making,
team building, and team cohesiveness influenced
communication within teams. Failure to set aside
time for regular meetings to clarify roles, set goals,
allocate tasks, develop and encourage participation, and
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