Some years ago, I was part of a trauma team preparing to RSI a patient with head and chest injuries. The plan for this patient included bilateral thoracostomies immediately after intubation. The TTL made that crystal clear. Or at least he thought he did. He asked “someone” to make sure the kit was ready: scalpel, Spencer-Wells and, of course, a finger.
After induction, it became clear that no Spencer-Wells were immediately available. The procedure was delayed while we found them. Fortunately, no patient harm arose, but we had created an avoidable delay at a critical moment. The TTL had mistaken announcing the plan for confirming that the team was ready.*.
Communication is a big theme in TTL training. One habit you will frequently hear in resus is directing a request into the room without identifying who should act on it. At times of stress, we seem to rely on two familiar team members. They appear in every resus room around the world. Their names are “Somebody” and “Anybody”.
“Can somebody phone blood bank and request the second major haemorrhage pack, please?”
“Can anybody find another scalpel?”
The problem is that neither request has a clear owner. Several people may respond, or everyone may assume that someone else is doing it. We call this “shooting arrows”: firing a request into the air and hoping it lands where you need it. A better approach is to take aim, give a specific task to a specific person, and check that the message has landed. Name the person. State the task. Check understanding.
“Simon, please get another scalpel from the store room and give it to Sarah.”
“I’ll get a scalpel from the store room and give it to Sarah.”
“That’s right, thank you.”
That check-back or closed loop conversation, gives you an opportunity to correct any misunderstanding. But knowing that someone has accepted a task is not the same as knowing it has been done. Ask them to report completion, or tell you if there is a problem.
“Sarah has the scalpel.”
If Simon is already occupied with something more urgent, he should say so. A named request is an opportunity to establish ownership, not a reason to silently abandon another critical task. As TTL, model this yourself and help others do the same. If you hear a request directed at “Somebody” or “Anybody”, turn it into a clear allocation: **“Alex, can you take that task “. Then get an acknowledgement. If you don’t know someone’s name, identify them clearly by role and get their attention. Introductions and visible name labels make this easier.
Give the task an owner, confirm understanding and check the outcome.
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- Yes – it was me as an early career TTL who failed to brief the kit list for thoracostomy correctly. That’s why this blog is here.
Further reading
- Closed loop communication in the trauma bay: identifying opportunities for team performance improvement through a video review analysis. CJEM, 2022. A study of real trauma resuscitations showing how communication loops frequently remained incomplete when requests were not directed to specific team members
- AHRQ TeamSTEPPS: Communication tools A practical guide to named task allocation and closed-loop communication, including checking that instructions have been understood.
- Härgestam et al. Communication in interdisciplinary teams: exploring closed-loop communication during in situ trauma team training. BMJ Open, 2013. A trauma simulation study highlighting the gap between knowing about closed-loop communication and using it in practice.
- Carley S. TTL Tip 22: Graded Assertiveness. St Emlyn’s. 16 October 2026.
- Carley S. TTL Tip 17: No chat below 10,000. St Emlyn’s. 29 July 2026.
- Carley S. TTL Tips 12: Thinking ahead. St Emlyn’s. 29 May 2026.
- You can find the full Trauma Team Leader Tips series here.
