Advanced Trauma Life Support ATLS Student Course Manual 2018

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APPENDIX E n ATLS and Trauma Team Resource Management
manage change were inhibitors to good communication
within teams. Variation in status, power, education,
and assertiveness within a team can contribute to poor
communication. Joint professional training and regular
team meetings facilitate communication for multiprofessional
teams.
In addition, different clinical professions may
have issues in communicating related to variations
in how information is processed analytically vs
intuitively. Furthermore, there is greater valuing of
information among those of the same clinical group,
and stereotyping may occur between members of
different clinical professions. To reduce such biases,
clear expectations should be set for the trauma team.
In the context of a team managing major trauma:
••
Communication between a team member and
team leader should be direct and only two way.
••
The team member should relay information,
and the team leader should confirm that he or
she heard and understood the information.
••
Time-outs at 2, 5, and 10 minutes may allow for
discussion or review of findings.
••
All communication should take place at normal
voice level.
••
Communication should not become extended
discussions over the patient. Complex
decisions may require discussion between
team members but should always be conducted
calmly and professionally. Hold discussions a
short distance away from the patient, especially
if he or she is conscious.
Managing Conflict
The trauma team should function as a cohesive
unit that manages the patient to the best possible
outcome. In the majority of cases, all members
of the team manage the patient to the best of their
ability. Unfortunately, as in any field of medical care,
controversy and conflict do arise. Examples of sources of
conflict include:
••
Making a difficult decision about whether a
patient requires an urgent CT or immediate
laparotomy.
••
Determining the best treatment for bleeding
from a pelvic fracture: interventional radiology
or pre-peritoneal pelvic packing.
••
Deciding the appropriate use of balanced
resuscitation versus the standard use of
resuscitative fluids and blood.
••
Determining the end points of resuscitation.
••
Deciding whether to activate the massive
transfusion protocol.
••
Determining when to stop resuscitating a
trauma patient because further resuscitative
measures may be futile.
These are all difficult situations to address while
managing a severely injured trauma victim, and the
ways in which they are handled will vary depending
on local standards and resources. It is impossible to
provide a single solution for each of these examples, but
general guidelines for addressing conflict are helpful.
Remember that all team members should have
the opportunity to voice suggestions about patient
management (during time-outs). Yet the team leader
has ultimate responsibility for patient management.
All actions affecting the patient should be made in his
or her best interests.
Many conflicts and confrontations about the management
of trauma patients arise because doctors are
unsure of their own competencies and unwilling or
reluctant to say so. If doctors do not have the experience
to manage a trauma patient and find themselves in
disagreement, they should immediately involve a more
senior physician who may be in a position to resolve
the situation with a positive outcome for both the
patient and the team. Trauma team leaders tend to be
senior doctors but, depending on resources, more junior
doctors may be acting as trauma team leaders. In this
situation, it is vital to have a senior doctor available for
support in making challenging decisions.
Discussions between doctors may become more
difficult to resolve when doctors strongly believe that
their system of doing things is the one that should be
followed. In such cases it can be helpful to involve a
senior clinician, such as a trauma medical director.
They may be in a position to help with decisions,
particularly where hospital protocols or guidelines
are available.
Ethical dilemmas may also cause conflict among
members of the trauma team. Examples might include
the decision to end resuscitation of a severely injured
patient or to resuscitate patients with blood or blood
products when the patient’s religious views do not
permit such action. Remember that expert advice is
available on these matters. The trauma team leader
or a designated deputy can seek further information
or support that can identify the best decision for
the patient.
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