R. V. Burke1,2, N. E. Demeter1, C. J. Goodhue1, H. Roesly2, T. P. Chang1,2, A. Rake1,2, E. Cleek1, I. Morton1, J. S. Upperman1,2, A. R. Jensen1,2 1Children’s Hospital Los Angeles,Los Angeles, CA, USA 2University Of Southern California,Keck School Of Medicine,Los Angeles, CA, USA
Introduction: The initial management and stabilization of a critically injured patient requires a large multi-disciplinary team working as a single cohesive unit. Severely injured (ISS>25) children present to freestanding Pediatric Trauma Centers at a relatively low frequency. Major trauma resuscitations in this setting occur infrequently, and as such, team familiarity is lacking. Thus, we implemented simulated trauma resuscitations to assess teamwork, confidence, and communication in the trauma bay. We hypothesized that simulated trauma resuscitations would help identify key components of an effective trauma team.
Methods: Cross-disciplinary trauma team members were recruited from a free-standing Level I pediatric trauma center in Los Angeles County. A demographic survey was administered to participants, and a semi-structured guide was used to lead the focus group. Discussions explored team members’ experiences during trauma activations and simulations. Thematic content analysis was supported using Atlas.ti analytical software examining the following constructs: confidence, leadership, cooperation, communication, situational awareness, and opportunities for improvement.
Results: After institutional review board approval, ten focus groups were conducted between July-August 2014 with a total of 55 participants. Of the 55 participants, 32 (57%) had participated in one of the simulated trauma scenarios followed by debriefing. Participants had an average of 10.3 years of trauma experience and 42 (76%) were female. Provider discipline breakdown was: three surgeons, 12 ED physicians, eight respiratory therapists, 12 ED nurses, five IV nurses and 14 PICU nurses. Themes emerging from the analysis included: characteristics of a strong leader during a trauma, factors impacting trauma team members’ confidence, and effective communication as a key component during trauma response. Participants recommended continued simulations to enhance trauma team trust and efficiency.
Conclusion: Results from this study will be used to design future simulations and refine current protocols to improve trauma response within a freestanding children’s hospital. Results from this study are applicable to other trauma centers as simulated trauma resuscitations provide an opportunity to explore teamwork, confidence, and communication among trauma team members.