Trauma Team Roles and Responsibilities

PURPOSE:            To establish guidelines for staff roles and responsibilities during trauma resuscitation of the critically injured patient.

Trauma Team Leader (MD1)

A.             Assigned to the Trauma chief resident/Emergency Medicine Resident present or EM Attending depending upon assigned rotation schedule. *Trauma Alert Red and Pediatric Trauma Alert Red patients will be managed by the Trauma Attending or Pediatric Surgery Attending with the assistance of Emergency Medicine Service.

B.             Designated as Trauma Team Leader in charge of trauma resuscitation and decision-making under the guidance of the Trauma Attending or EM Attending depending on rotation schedule.

C.             Responsible for:

·           Overall patient evaluation and management.

·           Ensuring completion of primary and secondary surveys.

·           Communicating assessment findings to recording RN.

·           Determining priority of procedures and necessary tests.

·           Determining need for and timing of operative intervention when indicated and contacting the OR.

·           Determining the need for appropriate consultations.

·           Making physician assignments.

·           Dismissing ancillary personnel when services are no longer needed.

·           Deactivating Trauma Alerts when appropriate.

·           Ensuring traffic control.

D.             The Trauma Team Leader may assume or delegate the role of evaluation and management depending on patient acuity.

·           The Trauma Team Leader maintains responsibility at all times.

·           The Trauma Team Leaders’ role may not be delegated to first-year residents.

Emergency Medicine MD (Airway MD)

A.             Assigned to the EM resident, Anesthesiology Attending or Trauma Resident.

B.             Responsible for:

·           Airway management and assuring cervical spine immobilization.

Primary MD (MD2)

A.             Assigned to second-most Senior Resident, preferably second-year or higher.

Responsible for:

·           Assisting Trauma Team Leader in patient evaluation and management.

·           Performs primary and secondary assessment.

·           Performing necessary procedures under the direction of the Trauma Team Leader.

·           Writing orders.

Primary Patient Care Nurse (RN 1)

A.             Prepares Trauma Resuscitation area prior to patient arrival, and ensures that needed equipment/supplies are readily available.

B.             Responsible for ensuring documentation from admission to time of disposition or report to oncoming RN including:

·           Notification and response times of all medical and ancillary personnel.

·           EMS/Air Medical report.

·           Mechanism/time of injury & patient history.

·           Vital signs; cardiac rhythm strips.

·           Ongoing assessment/re-evaluation.

·           Procedures performed by physicians.

·           Nursing process.

C.             Directs nursing team members as needed and assumes overall nursing responsibility for patient to include:

·           Assists with initial assessment.

·           Confirming labs are obtained and sent.

·           Ensures patient is placed on Cardiac monitor.

·           Monitors VS – Gives 5 minute updates.

·           Ensures PIVs are functional & insertion of additional IV’s as needed.

·           Obtains Labs from arterial puncture.

·           Accompanying patient outside the ED, as needed.

·           Ensuring initial notification of family and providing ongoing clinical updates.

·           Notifying Capacity Command Center of bed requirement as soon as possible.

Circulating Nurse/EM Paramedic (RN 2/Medic)

A.             Responsible for:

·           Assisting with initial assessment.

·           Obtains first manual BP pressure.

·           Assists with medication administration.

·           Assisting physicians with procedures.

·           Assisting in removal of patient clothing.

·           Inserting additional peripheral IV’s and drawing labs.

·           Assisting with nursing procedures (e.g. nasogastric tubes, Foley catheters).

·           Assisting with administration of colloids/crystalloids (via fluid warmer, as needed).

·           Paramedics will not administer colloids.

Emergency Department Nursing Care Technician (NCT)

A.             Responsible for:

·           Assisting in set-up of trauma resuscitation area.

·           Obtaining blood from Blood Bank as instructed.

·           Obtaining IV fluids and blankets from warmer.

·          Assisting in removal of patient clothing.

·           Processing lab specimens.

·           Obtaining additional supplies as directed by nurses.

·           Ensuring patient has an arm/wrist identification band.

·           Processing patient clothing/valuables.

·           Assisting with CPR, as needed.

·           Assisting with patient transport.

Respiratory Therapy (Resp)

A.            Assists with airway management.

B.             Ventilates patient.

C.             Prepares, monitors, and documents all required aspects of mechanical ventilation.

D.             Assists during patient transport.

Radiology Technologist (X-Ray)

A.          Responsible for obtaining radiography studies in a timely manner as ordered.

Pharmacy (Rx)

A.      Obtains and administers medication as ordered by the physician.

B.    Assists with code drug administration

C.    Assists with calculating drug doses

Supply Tech (ST)

A.    Gathers supplies needed for trauma resuscitation as needed.

The following staff play an important role in the care of our patients but are expected to be behind the line in trauma resuscitation unless the situation dictates otherwise.

Trauma Attending/Trauma Fellow (EM Attending if Trauma Alert)

A.          Provides guidance and oversees trauma resuscitation.

B.          Performs and/or assist with procedures

Anesthesiology Attending/Resident/CRNA

A.          Provides airway support if needed

B.          Assists with mobilization and transport to OR when necessary

C.    Liaise with trauma attending/fellow/chief to optimally manage OR resources

Emergency Department Charge Nurse

A.             Pre-notifies physicians, primary patient care nurse, circulating nurses and financial counselor of impending arrival.

B.             Responsible for:

·   Delegating responsibility of checking equipment and supplies within the Trauma Resuscitation area.

·           Assisting with traffic control.

·           Acting as family liaison as needed.

·           Disseminating prehospital patient report to appropriate MD’s/RN’s.

Scribe or Documenting Nurse

A.          Responsible for:

·          Documents Resuscitation.

·          Assists with crowd control.

·          Assists with procedures as needed.

Patient Registration Assistant (PRA)

         A.          Responsible for:

                       ·    Identifying patient from EMS run sheet, Air Medical records, and/or                                            patient’s family and updates computer when possible.
                       ·        Securing patient valuables in ED safe.

ED Access Associate (EDAA)

A.          Responsible for:

·         Pre-notifying Radiology, Respiratory Therapy, Operating Room, Blood Bank,   etc. prior to patient arrival.

·   Preparing patient stickers, ID bracelets and (if downtime) lab slips, X-ray requests, EKG requests.

 

Published 3/5/14

Updated 10/11/22