Trauma team leadership

Podcast – Trauma Team Leadership

Welcome to the St. Emlyn’s podcast Today, we’re diving deep into the critical realm of trauma teams and trauma team leadership. We’ll discuss strategies to optimize efficiency and patient outcomes in the resuscitation room. Drawing insights from a hypothetical trauma case, we aim to equip you with actionable knowledge to improve your practice.

Listening Time – 30:32

Understanding the Modern Trauma System

In recent years, the UK has seen significant reorganization in trauma services. Major trauma centres have become pivotal in this transformation. These centres are designed to handle severe injuries by bypassing local hospitals and directing patients straight to specialized facilities. This new system ensures that patients receive the highest level of care tailored to their needs.

In England, for instance, there are approximately 13 to 14 major trauma centres, with London boasting four due to its dense population. Manchester has three, and along the South Coast, there are centres from Bristol to Brighton, extending down to Plymouth. This geographical spread means that trauma centres receive patients from quite a distance, ensuring that specialized care is never too far away.

The Importance of Trauma Team Leadership

Effective trauma team leadership is crucial in managing severe trauma cases. It’s not just about following protocols but also about making quick, informed decisions to optimize patient outcomes. A key challenge in trauma care is meeting the target of getting major trauma patients into a CT scanner within 30 minutes of arrival. This goal, while ambitious, has significant benefits for patient outcomes.

Hypothetical Case Study: 25-Year-Old Motorcyclist

Let’s walk through a hypothetical case to illustrate effective trauma team leadership. A 25-year-old motorcyclist is brought in by a paramedic crew after a collision with a car. The patient, wearing a helmet, hit the car, flew over the bonnet, and landed on the ground. The paramedics report probable minor head injuries, chest pain with surgical emphysema, abdominal and pelvic pain, and a closed fracture of the right tibia and fibula.

Vital Signs:

  • Pulse: 120
  • Blood Pressure: 150/90
  • Oxygen Saturation: 94% on high-flow oxygen
  • GCS: 15

Interventions by Paramedics:

  • IV cannula insertion
  • Administration of 5 mg morphine
  • Normal saline infusion
  • Vacuum splint application on the lower leg

The handover is complete, and the clock starts ticking. As the trauma team leader, your immediate focus is to assess and manage the patient efficiently.

Structured Approach to Trauma Management

Primary Survey:

  1. Airway (A):
    • The patient is talking, indicating an open airway. However, it’s crucial to continuously monitor for any potential airway compromise.
  2. Breathing (B):
    • The patient’s chest pain and surgical emphysema raise concerns. Despite the absence of immediate extremis, further investigation is warranted. Utilizing an ultrasound machine can quickly assess for pneumothorax or hemothorax, potentially eliminating the need for a chest x-ray.
  3. Circulation (C):
    • The patient’s tachycardia and high-normal blood pressure suggest the possibility of internal bleeding. A quick ultrasound (FAST scan) can help identify free fluid in the abdomen, indicating internal hemorrhage. Additionally, applying a pelvic binder can stabilize potential pelvic fractures and control bleeding.
  4. Disability (D):
    • Assessing neurological status is essential. With a GCS of 15, the patient appears neurologically intact, but continuous monitoring is necessary.
  5. Exposure (E):
    • Thoroughly examine the patient for any other injuries. Maintaining the patient’s body temperature is critical to prevent hypothermia.

Optimising Team Dynamics

Efficient trauma team dynamics are essential. Clear, loud, and structured communication is key. Use first names to foster a collaborative environment and break down hierarchical barriers. For instance, instruct the anesthetist to manage both airway and analgesia, leveraging their skills in pain management.

Concurrent Activity and Task Allocation

In a high-pressure environment, concurrent activity is vital. As a trauma team leader, your role is to ensure that multiple tasks are performed simultaneously. For example, while one team member inserts a chest drain, another applies a pelvic binder, and a third prepares for intravenous access. This approach minimizes delays and streamlines patient management.

Packaging for Transport

Before transporting the patient to the CT scanner, ensure they are appropriately packaged. Use portable monitors and verify that all necessary equipment, such as oxygen and rescue medications, are in place. A pre-transport checklist can prevent any oversights and ensure a smooth transfer.

Collaborative Decision-Making

Trauma team leadership is not about making decisions in isolation. Engage with your team, including radiologists, surgeons, and nursing staff, to gather input and make informed decisions. For instance, if a radiologist identifies a pneumothorax via ultrasound, proceed with chest drain insertion without waiting for a chest x-ray.

Efficiency in the Resuscitation Room

Minimize unnecessary procedures to expedite patient care. For example, avoid routine lateral cervical spine x-rays, chest x-rays, and pelvic x-rays if ultrasonography provides sufficient information. Focus on interventions that directly impact patient outcomes and streamline the path to definitive diagnosis and treatment.

Effective Communication and Leadership

Effective communication is the backbone of trauma team leadership. Use structured handovers, clear task allocations, and constant updates to keep everyone informed. Avoid shouting; maintain a calm and controlled environment to foster teamwork and ensure the patient remains as comfortable as possible.

Adapting to New Protocols

Trauma care is continually evolving. The approach we discussed emphasizes minimizing time in the resuscitation room and prioritizing rapid transfer to the CT scanner. This shift requires a change in mindset, viewing the resuscitation room as an extension of the pre-hospital environment and the CT scanner as the definitive diagnostic tool.


Trauma team leadership is both an art and a science. It requires quick decision-making, efficient task allocation, and seamless communication. By adopting a structured approach, minimizing unnecessary interventions, and fostering a collaborative environment, we can improve patient outcomes and meet the challenging target of getting major trauma patients to the CT scanner within 30 minutes.

Whether you’re in a major trauma centre or a smaller unit, the principles of effective trauma team leadership remain the same. Implementing these strategies will enhance your practice and ultimately save lives.

Good luck with your trauma team leadership efforts. We hope you found this guide insightful and applicable to your practice.

Podcast Transcription

Where to listen

You can listen to our podcast in numerous ways, ensuring you never miss an episode no matter where you are or what device you’re using. For the traditionalists, Apple Podcasts and Google Podcasts offer easy access with seamless integration across all your Apple or Android devices. Spotify and Amazon Music are perfect for those who like to mix their tunes with their talks, providing a rich listening experience. If you prefer a more curated approach, platforms like Podchaser and TuneIn specialize in personalising content to your tastes. For those on the go, Overcast and Pocket Casts offer mobile-friendly features that enhance audio quality and manage playlists effortlessly. Lastly, don’t overlook YouTube for those who appreciate a visual element with their audio content. Choose any of these platforms and enjoy our podcast in a way that suits you best!

Cite this article as: Iain Beardsell, "Podcast – Trauma Team Leadership," in St.Emlyn's, July 8, 2015,

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