ATLS TH 10 EDITION Introducing the Team Approach

ATLS TH 10 EDITION Introducing the Team Approach June 2017

ATLS Meets Trauma Team Training A match made in heaven or a disaster for all? ? Lets see ……

• • Course Director ATLS Provider Trauma Team Leader Trauma Team Member

• “When I can provide better care in the field with limited resources than my children and I received at the primary facility, there is something wrong with the system and the system has to be changed. ” • “I can describe this experience as coming out of hostile dark hell into civilisation. ” --Dr James Styner

ATLS and the Trauma Team • Why? • What? • How?

Why? • Well, you have been asking for something …. . • It’s been missing (content and time). • It’s the direction of travel for most of us.

Mission Statement The UK ATLS Steering Group have worked in collaboration with the American College of Surgeons Committee on Trauma for 4 years to create a Trauma Team Training section of the 10 th edition of ATLS (- And we have the scars to prove it!)

Before I go any further. . • • This is not meant to dilute the ATLS message. This is not a Trauma Team course. You need to be able to do it vertically first. One safe way.

The threat was loss of… • The skill to deliver the ATLS system as an individual sequentially. • the current method of assessment that an individual can do that to a standard. • One safe way.

The New Core Material • 10 th Edition ATLS manual includes an Appendix (Chapter) on Trauma Team Resource Management. • Each chapter now has a short section on special situations for the Trauma Team (chapter additions). • Trauma Team Video (with all star cast) • Guidance for an interactive discussion on the function of the trauma team.

Snapshot of What’s in the Team Chapter • • • Objectives Team Leader Briefing Communication Conflict Resolution Debriefing

ATLS and Trauma Team Resource Management - Objectives • • • Describe configuration of a trauma team. Identify the team leaders roles and responsibilities. Discuss the qualities of good leadership. List the roles and responsibilities of team members. Focus on best communication practices and describe how to manage conflict. Was solely written by UK authors. (. . we have the scars etc!)

“To function well as part of a team, an individual must be familiar with all the steps required to attain the best possible outcome. This appendix demonstrates how a clinician trained in ATLS techniques can function with others to deliver excellent team care with a common goal”

Box E-2 Team Leader Briefing The Trauma Team (i) • Introduce yourself, ensure all team members know you are the leader. • Ask other team members to introduce themselves and establish their skill levels. Establish the nurse assistants are familiar with the environment. • Allocate the role of scribe. • Ensure Team Members adopt universal precaution. • Explain the procedure for taking handover

Contd (ii) • Ensure Team Members know how to communicate important positive and negative findings directly to the Team Leader. • Explain the role of ‘time-outs’. • Emphasise that requests for any additional support needed by team members must be communicated directly to the Team Leader. • Explain the role of additional providers who may arrive after the team has commenced treating the patient.

And a section on communication…. .

Communication for Team Leaders • Taking Hand Over • Running the team • Introducing new members (latecomers) to the team • Speaking to the patient and their family

Good Communication for the Trauma Team • Directed (person to person) • Clear and Concise • Repeats important information and confirms • Voice level but audible • Relevant to the situation • Uses ‘time outs’ for discussion

Not so good (ie. bad) Communication • • Everyone talking at once Lots of questions, no actions or answers Raised voices Contributions which are unsolicited fleeting opinions (UFOs)

Potential Conflict Causing Situations • • • Team members not aware of roles Team members lack competencies UFOs Latecomers joining in “any old where” Difficult clinical decisions/definitive care

Helping Resolve Conflict Be Aware – • Not everyone is the same. • A good team uses everyone’s skills. • Everyone has a voice but only one leader. • Team Leaders need to be role models.

Conflict Resolution and Difficult Clinical Decisions • Remember where you came from ABCDE • Remember the rules of good communication! • Remember what’s best for the patient

And The Team must always remember ATLS Principles…. • • Do no further harm. Treat greatest threat to life first. Time is of the essence. One safe way.

Debriefing The Team (Pendleton Plus) • • What went well. What could have been done differently. What have we learnt for next time. Are there any actions we need to take eg. team resources, equipment, training.

Chapter Additions • 10 th Edition Manual includes a short section at the end of each chapter on how the Trauma team may manage this area. • UK faculty will receive additional information in the form of a more detailed set of Chapter Additions suited to UK practice.

Trauma Team Video • Provide a resource for all UK ATLS centres. • Describe one safe way. • Demonstrate Team Leaders and members roles. • Touch on dealing with conflict.

Trauma Team Video • Screenplay – Ros • Narrators – Steve and Hayley • Trauma Team – Jonathan, Bob, Lara, Harry, Rob • Playing Himself – Stuart • Showing at a cinema near you now!!

Delivery of the Trauma Team Core Content in the ATLS 10 th Edition

Course Directors and Co-ordinator • New course format and timetable. • 45 minute skill station on second day for Trauma Team skills and delivery of core content. • Not assessed in MCQ or Initial Assessment skill stations.

Format of Trauma Team Skill Station • Introduction by Course Director and faculty. • Video (21 minutes) • Interactive discussion to follow focussing on: - Role of Team Leader - Behaviour of Team Members - Communication within the Team - Value of good debrief

ATLS Faculty • All faculty will receive hard copies of the Trauma Team Appendix and Chapter Additions when they sign up to teach on 10 th ATLS. • Please: – Be familiar with the content – Give us your feedback

To Date • ATLS 10 th Edition in print. • Team Training material has been piloted on ATLS Reverification courses and 10 th Edition Pilot. • Further Pilots to follow (there will be more guidance!) • Well received so far

Questions

Summary • New Core Material on the Trauma Team will be available in 10 th Edition. • Not designed to dilute the message of an ATLS Provider Course. • Will form significant contribution to the International programme. • Trauma video