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IntroductionTrauma teams (TTs) are a key tool in trauma care, as they bring a multidisciplinary approach to the trauma patient, improving outcomes. Excellent teamwork (TW) requires not only individual skills but also training at non-technical skills (NTS). Although there is evidence supporting TTs, there is little information regarding how they are organized and trained. With this study, we intend to assess the reality of TTs all over the world, focusing on how they are organized and trained.Materials and methodsWe composed a 42-question sheet on Google Forms, in four different languages (English, Polish, Portuguese, and Spanish). The questions regarded the respondents’ background, and their respective hospitals’ trauma patient management, TT features and its training, NTS and TW. The survey was shared on social media, through the International Assessment Group of Online Surgical & Trauma Education community, and the European Society of Trauma and Emergency Surgery. Statistical analysis was performed on Statistical Package for the Social Sciences (SPSS®) version 27.ResultsWe obtained 296 answers from 52 different countries, with 6 having at least 10 answers (Brazil, Portugal, Poland, Spain, Italy, and USA). While the majority of the respondents (97%) agreed that TTs can improve outcomes, only 61% have a TT in their hospital, with 69% of these being dedicated TTs. General surgery (76%), trauma surgery (68%), and anesthesia (66%) were the three most common specialties in the teams. Teams performed briefings and debriefings with a frequency of, at least, “often” in only 49% and 38%, respectively. Only 50% and 33% of the respondents stated that their hospital provided trauma management courses focusing on individual technical skills, and TT training courses, respectively. The Advanced Trauma Life Support (85%), the Definitive Surgical and Anesthetic Trauma Care (38%), and the European Trauma Course (31%) were the three trauma management courses of choice. Regarding TT training courses, the European Trauma Course (52%) and local/in-house (42%) courses were the most common ones. Most participants (93%) stated that NTS were highly important in trauma care. However, only 60% of the respondents had postgraduate training on NTS and TW, and only 24% had this type of training on an undergraduate level.ConclusionThe number of TTs worldwide does not match their relevance in trauma care. Institutions are not providing enough trauma courses, particularly TT training courses and NTS teaching. Implementing TT should include promotion of team courses, as well as team briefings and debriefings.

Background Traumatic injuries are a leading cause of deaths in Norway, especially among younger males. Trauma-related mortality can be reduced by structural measures, such as organization of a trauma system. Many hospitals in Norway treat few seriously injured patients, one of the reasons for development of the Norwegian trauma system. Since its implementation, there has been continuous improvement of this system, including trauma team training. Regular trauma team training is compulsory, with the aims of compensating for lack of experience and maintaining competence. The purpose of this study was to present an overview of current trauma team training activities in Norway. Methods For this observational study, the authors developed an online questionnaire and mailed it to local trauma coordinators from 38 Norwegian hospitals—including four trauma centers and 34 acute hospitals with trauma function. The study was performed during April–June 2020, with a two-month response window. Trauma team training frequency was assessed in four predefined intervals: < 5, 5–9, 10–15 and > 15 times per year. The response rate was 33 of 38, 87%. Results All responding hospitals conducted regular trauma team training. The frequency of training increased significantly from 2013 to 2020 (Chi square test, Chi 2 8.33, p  = 0.04). All hospitals described a quite homogenous approach. The trauma centres trained more frequently as compared to the acute care hospitals (Chi square test, Chi 2 8.24, p  = 0.04). Conclusions All responding hospitals performed regular trauma team training using a homogenous approach, which is in line with previous assessments. We observed a minor improvement in frequency compared to prior assessments. Our findings suggest that Norwegian trauma teams likely maintain their competence through team training. All hospitals followed the current recommendations from the National Trauma Plan.

Purpose Trauma team activation (TTA) is thought to be essential for advanced and specialized care of very severely injured patients. However, non-specific TTA criteria may result in overtriage that consumes valuable resources or endanger patients in need of TTA secondary to undertriage. Consequently, criterion standard definitions to calculate the accuracy of the various TTA protocols are required for research and quality assurance purposes. Recently, several groups suggested a list of conditions when a trauma team is considered to be essential in the initial care in the emergency room. The objective of the survey was to post hoc identify trauma-related conditions that are thought to require a specialized trauma team that may be widely accepted, independent from the country’s income level. Methods A set of questions was developed, centered around the level of agreement with the proposed post hoc criteria to define adequate trauma team activation. The participants gave feedback before they answered the survey to improve the quality of the questions. The finalized survey was conducted using an online tool and a word form. The income per capita of a country was rated according to the World Bank Country and Lending groups. Results The return rate was 76% with a total of 37 countries participating. The agreement with the proposed criteria to define post hoc correct requirements for trauma team activation was more than 75% for 12 of the 20 criteria. The rate of disagreement was low and varied between zero and 13%. The level of agreement was independent from the country’s level of income. Conclusions The agreement on criteria to post hoc define correct requirements for trauma team activation appears high and it may be concluded that the proposed criteria could be useful for most countries, independent from their level of income. Nevertheless, more discussions on an international level appear to be warranted to achieve a full consensus to define a universal set of criteria that will allow for quality assessment of over- and undertriage of trauma team activation as well as for the validation of field triage criteria for the most severely injured patients worldwide.

BackgroundThe aim of this study was to compare the effect of the change in TTA protocol from a two-tier to one-tier, with focus on undertriage and mortality.Material and methodsA before–after observational cohort study based on data extracted from the Stavanger University Hospital Trauma registry in the transition period from two-tier to a one-tier TTA protocol over two consecutive 1-year periods (2017–2018). Comparative analysis was done between the two time-periods for descriptive characteristics and outcomes. The main outcomes of interest were undertriage and mortality.ResultsDuring the study period 1234 patients were included in the registry, of which 721 (58%) were in the two-tier and 513 (42%) in the one-tier group. About one in five patients (224/1234) were severely injured (ISS > 15).Median age was 39 in the two-tier period and 43 years in the one-tier period (p = 0.229). Median ISS was 5 for the two-tier period vs 9, in the one-tier period (p = 0.001). The undertriage of severely injured patients in the two-tier period was 18/122 (15%), compared to 31/102 (30%) of patients in the one-tier period (OR = 2.5; 95% CI 1.8–4.52). Overall mortality increased significantly between the two TTA protocols, from 2.5 to 4.7% (p = 0.033), OR 0.51 (0.28–0.96)ConclusionA protocol change from two-tiered TTA to one-tiered TTA increased the undertriage in our trauma system. A two-tiered TTA may be beneficial for better patient care.

PurposeAn injury severity score (ISS) ≥ 16 alone, is commonly used post hoc to define the correct activation of a trauma team. However, abnormal vital functions and the requirement of life-saving procedures may also have a role in defining trauma team requirement post hoc. The aim of this study was to describe their prevalence and mortality in severely injured patients and to estimate their potential additional value in the definition of trauma team requirement as compared to the definition based on ISS alone.MethodsRetrospective analysis of a trauma registry including patients with trauma team activation from the years 2009 until 2015, who were 16 years of age or older and were brought to the trauma center directly from the scene. Patients were divided into a group with an ISS ≥ 16 vs. ISS < 16. For analysis a predefined list of abnormal vital functions and life-saving interventions was used.Results58,723 patients were included in the study (N = 32,653 with ISS ≥ 16; N = 26,070 with ISS < 16). From the total number of patients that required life-saving procedures or presented with abnormal vital functions 29.1% were found in the ISS < 16 group. From the ISS < 16 group, 36.7% of patients required life-saving procedures or presented with abnormal vital signs. The mortality of those was 8.1%.ConclusionsDefining the true requirement of trauma team activation post hoc by using ISS ≥ 16 alone does miss a considerable number of subjects who require life-saving interventions or present with abnormal vital functions. Therefore, life-saving interventions and abnormal vital functions should be included in the definitions for trauma team requirement. Further studies have to evaluate, which life-saving procedures and abnormal vital functions are most relevant.

Zusammenfassung Hintergrund Die Bereitstellung spezialisierter Schockraumteams zur Schwerverletztenversorgung ist nach den Vorgaben der S3-Leitlinie Polytrauma/Schwerverletztenversorgung der AMWF obligat und die Zusammensetzung durch das Weißbuch Schwerverletztenversorgung festgelegt. In jeder Versorgungsstufe wird das Basisteam aus den 4 Disziplinen Orthopädie und Unfallchirurgie, Anästhesie, Radiologie und der Notfallpflege der Notaufnahme zusammengesetzt, mit weiteren Anpassungen je nach Versorgungsstufe des Krankenhauses. Ziel der vorliegenden Studie ist die Untersuchung der gelebten Realität bei der Zusammensetzung der Schockraumteams. Methodik Bei der prospektiven, multizentrischen Beobachtungsstudie wurden in 12 überregionalen Traumazentren in Deutschland und der Schweiz insgesamt 3753 Patienten nach Unfällen in der Notaufnahme behandelt, darunter 964 Patienten (26 %) nach vorangegangener Schockraumalarmierung. Ergebnisse In 94,7 % der Schockraumversorgungen waren alle 4 der geforderten Disziplinen anwesend; im Durchschnitt waren 6 Personen an der Schockraumversorgung beteiligt. Die 48-h-Mortalität betrug 3 % der über den Schockraum versorgten Patienten; bei allen verstorbenen Patienten waren während der Schockraumversorgung alle 4 Disziplinen anwesend. Bei Patienten mit mindestens einem Alarmierungskriterium der Kategorie A waren bei 97,7 % der Versorgung ein vollständiges Team aus 4 Disziplinen an der Versorgung beteiligt. Diskussion In fast 98 % der Fälle, in denen Alarmierungskriterien der Kategorie A vorliegen, sind alle 4 der im Weißbuch geforderten Disziplinen zur Patientenversorgung im Schockraum anwesend. Dies geht mit einer mittleren Ressourcenbindung von 6,6 Personen einher. Das Fehlen einer oder mehrerer Disziplinen bei der Schockraumversorgung scheint die frühe Mortalität der Schwerverletzten nicht signifikant zu beeinflussen. Graphic abstract

Die Traumateamalarmierung (TTA) in den Schockraum (SR) findet bei gestörten Vitalwerten bzw. schweren Verletzungen (A-Kriterien) oder nach gefährlichem Unfallhergang (B-Kriterien) statt. Wegen geringer Spezifität und knapper Personalressourcen wird die TTA bei B‑Kriterien infrage gestellt. Folgen wären steigende Untertriage und damit die Gefährdung von Patienten. Mangels Daten ist unklar, ob angepasste SR-Teams eine Lösung für das Problem wären.Ziele der Studie waren die Beschreibung von SR-Patienten anhand ihrer TTA-Kriterien und die Erhebung der entsprechenden Notfallinterventionsraten im SR.Über ein Jahr wurden alle TTA eines überregionalen Traumazentrums prospektiv erfasst, nach Alarmierungskriterien (A-, B‑ und Nullkriterien) kategorisiert und deskriptiv vergleichen. Nullkriterien waren TTA, bei denen weder A‑ noch B‑Kriterien erfüllt waren. Behandlungsdaten wurden gemäß dem Standardbogen des TraumaRegister DGU® dokumentiert. Notfallinterventionen waren Intubation, Thoraxdrainage, kardiopulmonale Reanimation, Transfusion, Gerinnungssubstitution, externe Beckenstabilisierung und operative Blutstillung.Eine TTA wegen A‑, B‑ und Nullkriterien erfolgten in jeweils 19,5 %, 51,2 % und 29,3 %. Die mittlere Verletzungsschwere (ISS ± Standardabweichung) betrug bei A‑Kriterien 20,6 ± 21,3 und war damit signifikant höher als bei B‑ (8,0 ± 7,1) und Nullkriterien (5,6 ± 8,2). Die Notfallinterventionsrate bei A‑, B‑ und Nullkriterien lag bei jeweils 75 %, 6 % und 2,1 %.Die Unterscheidung nach TTA-Kriterien ergab Patientenkollektive mit unterschiedlicher Verletzungsschwere und Notfallinterventionsrate. Dieses Ergebnis rechtfertigt Überlegungen zur Anpassungen der Teamzusammensetzung aufgrund von TTA-Kriterien, solange sichergestellt ist, dass durch angepasste Teams kritische Zustände erkannt und behoben werden können.

Background Trauma is a leading cause of mortality and disability in low- and middle-income countries (LMICs). Among African nations, Ethiopia has one of the highest trauma fatality rates at 26.7% per 100,000 population, significantly exceeding rates in many other LMICs. Most trauma cases occur in the capital, Addis Ababa. Despite this significant burden, the effectiveness and quality of trauma care in Addis Ababa vary widely across hospitals, driven by disparities in available resources and the knowledge levels of trauma team members. Objective This qualitative study aimed to explore trauma team members’ perceptions of the effectiveness of the current trauma care system in Addis Ababa, Ethiopia. Methods This study used a qualitative phenomenological design to analyze trauma care team members’ perceptions of the current trauma care system in Addis Ababa, Ethiopia. The population included trauma team members, healthcare personnel, hospital leaders and coordinators from nine hospitals. The data were collected through semi-structured interviews and focus group discussions. The study used the Colaizzi approach and ATLAS.ti 23 software for data analysis. An inductive-deductive strategy, alternating between data analysis and emergent concepts and theories to identify patterns. Memos and display matrices were generated for in-depth analysis. Results This study identified several challenges with the trauma care system in Addis Ababa, Ethiopia, including a lack of effective leadership, coordination, and teamwork spirit; insufficient referral connections in the trauma care system; knowledge gaps among health-care professionals; and poor organization of the emergency room and trauma center. In addition, participants perceived that factors such as insufficient pharmaceutical and medical equipment and ineffective ambulance services may have contributed to the increased number of deaths and disabilities among trauma patients in the country. Conclusion The qualitative report highlights the gaps in Ethiopia's emergency trauma care system and recommends strategies for improvement, including clear leadership, policies, resources, communication, and continuous training.

This review describes the evidence exploring the use of a two-tier trauma team activation system, reviewing the background, history, data available and potential benefits and downsides. The current evidence suggests that a two-tier system may be a lean, cost-effective system, focussed on patient outcome, which could be implemented throughout the UK. Despite its current use in some hospitals, there is limited data from similar systems supporting this in a UK setting. Specific activation criteria need to be validated to ensure appropriate activation of trauma teams, ensuring optimal patient outcome and ensuring best practice.

Background There is widespread consensus on the importance of safe and secure communication in healthcare, especially in trauma care where time is a limiting factor. Although non-verbal communication has an impact on communication between individuals, there is only limited knowledge of how trauma team leaders communicate. The purpose of this study was to investigate how trauma team members are positioned in the emergency room, and how leaders communicate in terms of gaze direction, vocal nuances, and gestures during trauma team training. Methods Eighteen trauma teams were audio and video recorded during trauma team training in the emergency department of a hospital in northern Sweden. Quantitative content analysis was used to categorize the team members’ positions and the leaders’ non-verbal communication: gaze direction, vocal nuances, and gestures. The quantitative data were interpreted in relation to the specific context. Time sequences of the leaders’ gaze direction, speech time, and gestures were identified separately and registered as time (seconds) and proportions (%) of the total training time. Results The team leaders who gained control over the most important area in the emergency room, the “inner circle”, positioned themselves as heads over the team, using gaze direction, gestures, vocal nuances, and verbal commands that solidified their verbal message. Changes in position required both attention and collaboration. Leaders who spoke in a hesitant voice, or were silent, expressed ambiguity in their non-verbal communication: and other team members took over the leader’s tasks. Discussion In teams where the leader had control over the inner circle, the members seemed to have an awareness of each other’s roles and tasks, knowing when in time and where in space these tasks needed to be executed. Deviations in the leaders’ communication increased the ambiguity in the communication, which had consequences for the teamwork. Communication cannot be taken for granted; it needs to be practiced regularly just as technical skills need to be trained. Simulation training provides healthcare professionals the opportunity to put both verbal and non-verbal communication in focus, in order to improve patient safety. Conclusions Non-verbal communication plays a decisive role in the interaction between the trauma team members, and so both verbal and non-verbal communication should be in focus in trauma team training. This is even more important for inexperienced leaders, since vague non-verbal communication reinforces ambiguity and can lead to errors.