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LawrenceMarshallGillman· SandyWidderEditors
Trauma Team Dynamics
ATrauma Crisis Resource Management Manual
SecondEdition
Trauma Team Dynamics
Editors
Trauma Team Dynamics
A Trauma Crisis Resource Management Manual
Second Edition 2025
Editors
Lawrence MarshallGillman University of Manitoba Winnipeg, MB, Canada
Sandy Widder University of Alberta Edmonton, AB, Canada
ISBN 978-3-031-86311-0 ISBN 978-3-031-86312-7 (eBook)
https://doi.org/10.1007/978-3-031-86312-7
© Springer Nature Switzerland AG 2016, 2025 This work is subject to copyright. All rights are solely and exclusively licensed by the Publisher, whether the whole or part of the material is concerned, specically the rights of translation, reprinting, reuse of illustrations, recitation, broadcasting, reproduction on microlms or in any other physical way, and transmission or information storage and retrieval, electronic adaptation, computer software, or by similar or dissimilar methodology now known or hereafter developed. The use of general descriptive names, registered names, trademarks, service marks, etc. in this publication does not imply, even in the absence of a specic statement, that such names are exempt from the relevant protective laws and regulations and therefore free for general use. The publisher, the authors and the editors are safe to assume that the advice and information in this book are believed to be true and accurate at the date of publication. Neither the publisher nor the authors or the editors give a warranty, expressed or implied, with respect to the material contained herein or for any errors or omissions that may have been made. The publisher remains neutral with regard to jurisdictional claims in published maps and institutional afliations.
This Springer imprint is published by the registered company Springer Nature Switzerland AG The registered company address is: Gewerbestrasse 11, 6330 Cham, Switzerland
If disposing of this product, please recycle the paper.
To our families, friends, and colleagues. None of this would be possible without you.
—Lawrence M.Gillman

Foreword

Trauma, an enduring global challenge, continues to claim countless lives and inict immeasur­able suffering. While signicant progress has been made in trauma care, with a proliferation of worldwide training programs and the establishment of trauma systems in various nations, the pivotal aspect of how trauma providers collaborate and care for critically injured patients remains paramount.
Trauma resuscitation, which is inherently multidisciplinary and perpetually high-stakes, hinges on the effectiveness of teamwork, communication, and coordination. Care of the multi­ply inured trauma patient is ever changing and the ability to accurately diagnose as well as provide care to these patients is profoundly inuenced by the collaborative efforts of the trauma team. It is indisputable that seamless cooperation among healthcare professionals can mark­edly enhance the quality of trauma resuscitation, directly impacting patient outcomes.
The exceptional compilation of chapters in this second edition of “Trauma Team Dynamics” builds upon the foundations laid by its predecessor, and it brings fresh perspectives, insights, and expertise to the eld of trauma resuscitation. The distinguished editors, recognized as international leaders in their respective domains, have meticulously assembled a diverse ensemble of acclaimed authors.
This collective effort culminates in what can be unequivocally hailed as a quintessential textbook on trauma team dynamics. What sets this textbook and its associated course, STARTT (Standardized Trauma and Resuscitation Team Training), apart is its unique focus on what has traditionally been described as nontechnical skills. These skills, however, are absolutely essen­tial for effectively coordinating and communicating with the diverse array of trauma providers, which includes, but is not limited to, emergency medical providers, nurses, respiratory thera­pists, emergency department technicians, emergency room physicians, traumatologists, and a host of different surgeons.
“Trauma Team Dynamics” and the associated STARTT course provide the essential ground­work for facilitating and enhancing trauma team dynamics, giving healthcare professionals the tools and insights necessary to excel in their roles. This second edition will serve as an invalu­able resource for healthcare providers, educators, and students alike, offering guidance and inspiration as they navigate the complex landscape of trauma care. I believe that the wisdom contained within these pages will foster an environment where every trauma resuscitation team can truly excel, ultimately saving more lives and mitigating the impact of this relentless global epidemic.
Departments of Surgery and Medicine Schulich School of Medicine and Dentistry Western University London, ON, Canada
NeilG.Parry
vii

Preface: Trauma as a Team Sport

The American College of Surgeons Advanced Trauma Life Support (ATLS®) Course has revo­lutionized trauma care by offering a standardized, reproducible, and universal approach to trauma patient management. ATLS® however focuses on management by a solo practitioner, which is rarely the case in modern trauma care. The introduction of a trauma team, no matter how small, brings with it new challenges and dynamics. To date no text (including the ATLS® manual) has addressed the unique dynamics created by a multidisciplinary trauma team and strategies to optimize them.
Further, morbidity and mortality reviews reveal that the majority of medical errors are non­technical in nature, stemming from faulty decision-making, asynchronous information gather­ing, lack of situational awareness, and ineffective communication and team leadership. Reviews of accidents from other high-risk industries, including the airline industry, have had similar ndings. This led NASA (National Aeronautics and Space Administration) and the airline industry to develop crew (now crisis) resource management (CRM) training. Medicine has begun adapting this training especially within the realms of anesthesia and critical care. Trauma surgery has been slower to utilize this work however simulation based training is increasing in popularity. These team-based training strategies address “nontechnical” skills to counteract human error and improve team and patient safety.
CRM is integral to the way that we manage ourselves, team members, and patients during emergency situations. It is essentially the ability to translate knowledge of what needs to be done into effective actions during a crisis situation. There are numerous publications on trauma diagnosis, management, and treatment of injuries, but little literature exists on communication within the trauma resuscitation, and how communication can be utilized to improve teamwork and crisis management, and potentially improve patient resuscitation outcomes.
This book is in no way meant to replace ATLS® training, but instead build on ATLS® prin­ciples and highlight how they can be applied by a multi-disciplinary trauma team. This text­book represents a unique standalone reference for others trying to teach or learn these Trauma Team Dynamics. Authored by an international group with a broad expertise in trauma, critical care, emergency medicine, nursing, respiratory therapy, and pre-hospital care (including NASA and United States military afliated experts), we feel it forms a comprehensive, multi­disciplinary manual for all trauma team members including pre- and out-of-hospital personnel, emergency and critical care physicians, trauma surgeons, nurses, and respiratory therapists, as well as their respective trainees.
Part I highlights the history of CRM including its beginnings with NASA and the airline industry, and its evolution to other high-risk industries including medicine. It goes on to intro­duce us to the guiding tenants of CRM and how they can be applied practically in a trauma setting. These concepts continue to be woven throughout the text as we highlight the impor­tance of CRM principles while following the trauma patient from the scene, through pre­hospital care and transport, to the trauma bay and nally to denitive care.
In Part II we discover the structure of the modern trauma team, including pre-hospital per­sonnel, highlighting the roles of the various trauma team members and design of the typical trauma bay. We also briey explore the logistics of trauma system design and important quality control issues.
ix
x
Part III begins with a review of ATLS® and resuscitation principles and then offers a practi­cal and comprehensive approach to damage control resuscitation not seen in other texts. It goes on to discuss the complexities of trauma decision-making and ends with a practical highlight of common trauma bay procedures.
Part IV stresses certain challenges in the trauma management of specic patient populations including the pregnant patient, the head injured patient as well as the patient with multiple medical comorbidities and the elderly.
In Part V we discuss conventional and point of care imaging in the trauma patient including an in-depth look at basic and advanced trauma ultrasound, and new emerging techniques.
Part VI takes trauma to the battleeld, the mountain-top and beyond with discussions on tactical and battleeld medicine, trauma in austere environments and even space. In the course of this discussion we emphasize the unique challenges of chemical, biological, and nuclear injuries and how these affect both the patient and the trauma team.
Finally, crisis resource management skills are best taught through a crisis simulation cur­riculum and therefore Part VII offers practical tips and guidance on CRM curriculum design, debrieng, and evaluation.
It is our sincere hope that this text serves as a catalyst to improve communication in the trauma bay, improve multidisciplinary training of team members, and ultimately improve patient care. Trauma truly is a Team Sport and its time to nally teach it as such.
Winnipeg, MB, Canada LawrenceM.Gillman
Preface: Trauma as a Team Sport

Contents

Part I Trauma Team Preparation
1 A Culture of Safety: Evolution of the S.T.A.R.T.T. Course . . . . . . . . . . . . . . . . . . . 3
Lawrence Marshall Gillman, J. Damian Paton-Gay, Paul T. Engels, and Sandy Widder
2 The Genesis of Crew Resource Management: The NASA Experience . . . . . . . . . 7
David J. Alexander
3 Evidence Supporting Crisis Resource Management Training . . . . . . . . . . . . . . . . 13
Christopher Hicks
4 Trauma Team Development: Leadership and Collaboration . . . . . . . . . . . . . . . . . 19
Brent Hunter and K. Dean Gubler
5 Improving Human Factors, Teamwork, and Communication
in Trauma Care . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25
Peter G. Brindley and Jocelyn M. Slemko
6 Introduction to Leadership: Self- Awareness and Self-Management . . . . . . . . . . . 33
David Kolthoff and Sandy Widder
7 Followership . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 37
Jacqueline Beaumont and Lawrence Marshall Gillman
8 Situational Awareness and Human Performance in Trauma . . . . . . . . . . . . . . . . . 43
Peter G. Brindley and Jocelyn M. Slemko
9 Handovers in Trauma . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 49
Michelle Au and Lawrence Marshall Gillman
10 Engaging Team Members . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 55
Mellissa Ward, Laura Morrison, Cheryl Ffrench, and Debrah Wirtzfeld
11 The Trouble with Teams: Practical Tools for Complex Trauma
Team Dynamics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 65
Christopher Hicks and Andrew Petrosoniak
12 Biological and Psychological Interactions of the Stress Response:
How to Build Resilient Trauma Teams . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 71
Rebecca J. Ryznar, Christian Clodfelder, and Jeffrey Edwards
13 Stress Exposure Training . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 89
Garrett G. R. J. Johnson and Anthony J. LaPorta
14 What Is Mindfulness, and What Role Can It Play in the Mental
Health of Health Professionals . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 97
Rae Paulene Spiwak, Shaan Sareen, Natalie Mota, Justin Gawaziuk, and Sarvesh Logsetty
xi
xii
15 Trauma Video Review . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 103
Michael A. Vella, Ryan P. Dumas, Zaffer A. Qasim, Aekta Andrea Miglani, and Daniel N. Holena
16 Creating a CRM Toolkit . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 111
Lawrence Marshall Gillman and Peter G. Brindley
Part II Trauma Team Design
17 Out-of-Hospital Care from Paramedical to Non-medical Personnel . . . . . . . . . . .121
Ryan Shelton and Matthew Brock
18 Trauma Point-of-Care Ultrasound in Prehospital
and Austere Environments . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .133
Michael Kreiser, Seth Hill, Hunter Barnes, Ryan Shelton, and Amanda Toney
19 Prehospital Trauma . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 143
Michelangelo Bortolin and Jacopo M. Olagnero
20 Transport Medicine. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 151
Michelangelo Bortolin and Jacopo M. Olagnero
21 Trauma Team Structure and Organization . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 161
Eric Walser, Paul T. Engels, J. Damian Paton-Gay, Homer C. Tien, and Patrick B. Murphy
Contents
22 Interprofessional Team Roles . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 171
Elaine Sigalet and Mirette Dubé
23 The Trauma Bay Environment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 177
Rondi Gelbard and Kenji Inaba
24 Trauma Bay Development and Design Designed to Perform:
How Simulation Can Inform the Design of Elite Trauma Resuscitation
Environments . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .185
Andrew Petrosoniak, Frank Panici, and Christopher Hicks
25 Operating Room Setup and Design . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .199
Chad G. Ball and Andrew W. Kirkpatrick
26 Systems-Focused Simulation and Debriefing to Improve Patient Safety,
Quality Care, Environments, and Processes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 205
Mirette Dubé, Shaunna Milloy, Jennifer Jordan, Tona Laerz, Sara Nosworthy, James Huffman, Jonathan Gaudet, Bryan Weber, and Barbara Blackie
27 Quality Improvement and Trauma Quality Indicators . . . . . . . . . . . . . . . . . . . . . . 217
Nori L. Bradley and Sandy Widder
28 Putting It All Together: Quality Control in Trauma Team Training . . . . . . . . . . . 223
Corry J. Kucik, Polly A. Haskins, and William P. Mulvoy III
Part III Trauma Resuscitation
29 Trauma Resuscitation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 233
Paul M. Cantle and John B. Kortbeek
30 Damage Control Resuscitation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 243
Chad G. Ball
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