ATLS meets The Trauma Team

ATLS meets The Trauma Team
A match made in Heaven or a
disaster for both
Ros Roden
Cape Town
April 2016
• What can ATLS provide?
• What does the Trauma Team need?
• A bit of fun!
Ros Roden – Chair of ATLS UK 2006-2013
• Course Director
• ATLS Provider
• Trauma Team Leader
• Trauma Team Member (what I do most!)
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Write the content
Edit the manual
Lead the programme
Lead the trauma team
Be the primary survey doctor
From Yorkshire!
Famous for
-
Cricket
Beer
The Brownlee brothers
Terriers
And of Course ATLS!
• “When I can provide better care in the field with limited
resources than my children and I received at the
primary facility, there is something wrong with the
system and the system has to be changed.”
• “I can describe this experience as coming out of a
hostile dark hell into civilization.”
--Dr. James Styner
Core Principles of ATLS
• Preparation
• Performance
• Feedback (Pendleton Plus)
ATLS - Preparation
• Knowing you need to know it
• Knowing it (ATLS provider)
• Knowing your capabilities
(Do no further harm)
• Finding ways to widen your skills
(ATLS Instructor)
• Maintaining your skills
(ATLS Re-verification)
ATLS - Performance
• A.B.C.D.E.
• Treat the Greatest Threat to Life First.
• Time is of the Essence
• Re-evaluation
ATLS – Feedback
• How was it (headline)?
• What did I do well? What difference did I
make?
• What could I do better next time? – why
does it matter?
• Take home messages for me
But at the end of the day it‟s a vertical
system designed for one doctor.
Or is it …………..?
The Trauma Team approach is now
recognised as the optimum mode of
providing best trauma care in most
developed countries.
Can ATLS fit this model?
Core principles of ATLS
• Preparation
• Peformance
• Feedback (Pendleton Plus)
Core principles of the Trauma Team
• Preparation
• Peformance
• Feedback (Pendleton Plus)
The Trauma Team - Preparation
• A system we know
• One safe way allows different team
members to work together
• One safe way allows team members to
play different roles
The Trauma Team - Preparation
• Know the teams capabilities
(who to call for additional skills)
• How can be improve our skills
(ATLS Team Training)
• How can we maintain our skills to a similar
standard and be updated
(ATLS re-verification)
The Trauma Team - Performance
• Physician 1 manages A/D
– With assistant 1
• Physician 2 manages B/C
– With assistant 2
• Team Leader
• Scribe
The Trauma Team – Deploying others
A+D
Anaesthetists/Anaesthetist with special skills
Neurosurgeons
B
General Surgeons/Thoracic Surgeons
C
Vascular Surgeons
Trauma Surgeons/Orthopaedics
Interventional Radiologists
Secondary Survey
Speciality input
The Trauma Team - Communication
• The Team communicates using the
ABCDE approach
• The Team Leader facilitates “time outs”
• Each Team member knows their role and
their responsibilities and boundaries.
The Trauma Team - Performance
The Team Leader recognises the greatest
threat to life and directs the team to treat
that effectively, calling help if needed.
The Trauma Team - Performance
Time is of the essence – the Team Leader
ensures that all team members work
simultaneously on tasks to achieve
treatment goals
The Trauma Team - Performance
The Team Leader directs the team to
frequently re-evaluate the patient as trauma
is a changing condition
The Trauma Team – Feedback
(Pendleton Plus)
• Headlines from the team
• What went well? Why was that important?
• What can be improved for next time as a
team/individuals?
• Take home messages for everyone.
Pendleton Plus – Dealing with
Difficult Decisions or Conflict
• What‟s gone well so far – why has it
helped – have we dealt with priorities?
• What is going wrong – why does it matter?
• What are the options for improving the
situation?
Pendleton Plus – Speaking with
Relatives (Team Leader/members)
• What are the good things I can tell you
and why are they important?
• What are we still worried about and how
are we trying to deal with this?
• Important messages so far.
So!
ATLS is a vertical concept but it can be done
horizontally too.
(And you can‟t do it horizontally until you
know how to do it vertically)
What about Other Teams?
Core Principles
Do they work?
Lets see!
Preparation
Performance
Feedback
Does your team pass the ATLS
Team Test?
• Ours does!
Summary
ATLS is a “one doctor” vertical system which
can be used to fit a horizontal “team doctor”
approach.
The principles are the same!
What‟s coming
10th Edition ATLS Manual (Spring 2017)
• Trauma Team Chapter
• Team Video
• Presentation/Group Discussion
(You heard it here first!)
Where Equestrian Teams
are Concerned
• A is for „orses
• B is for „Best ask the horse what went
wrong‟
• C is for „Could do better next time!‟
• D is for „Definitely need more preparation‟
Thanks!