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Table of Contents
ORIGINAL ARTICLE
Year : 2022  |  Volume : 15  |  Issue : 1  |  Page : 19-22

Trauma team training: A key to success


1 Assistant Professor, College of Medicine, Ajman University; Adjunct Assistant Professor, College of Medicine, Sharjah University; GIT and Trauma Senior Specialist Surgeon, Sheikh Khalifa Medical City Ajman, United Arab Emirates
2 Intern, Al Qassimi Hospital, Ajman, United Arab Emirates
3 Consultant General Surgeon, Sheikh Khalifa Medical City Ajman, United Arab Emirates
4 Specialist General Surgeon, Sheikh Khalifa Medical City Ajman, United Arab Emirates
5 General Practitioner, Sheikh Khalifa Medical City Ajman, United Arab Emirates

Date of Submission28-Jun-2021
Date of Acceptance24-Sep-2021
Date of Web Publication25-Mar-2022

Correspondence Address:
Amer Hashim Al Ani
Adjunct Assistant Professor, College of Medicine, Sharjah University, Assistant Professor, College of Medicine, Ajman University, GIT and Trauma Surgeon Sheikh Khalifa Medical City Ajman
United Arab Emirates
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/hmj.hmj_40_21

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  Abstract 


Background: Worldwide, trauma constitutes 10% of all causes of death. In the United Arab Emirates, trauma is the second leading cause of death for both national and expatriate populations, accounting for over 20% of all fatalities. Trauma affects all age groups, especially adolescents and young adults. Most trauma cases are preventable. Morbidity and mortality can be decreased after trauma by adopting a systematic approach towards trauma victims. Simulation-based training is beneficial in that it allows us to amplify a variety of real-life situations without compromising patient safety. Objectives: This study aims to assess the impact of trauma team training (TTT) on the performance of the trauma team and the time spent by the patient in the emergency department. Methods: In Sheikh Khalifa Medical City of Ajman, the TTT program was started early in 2016 for all members of the trauma team including (trauma team leaders, hand on surgeons, emergency room physicians, airway nurses, IV access nurses, documenting nurses and circulatory nurses) in addition to personnel recruited during trauma management like (anaesthetists, orthopaedic surgeons, blood bank physicians, radiology technicians, intensive care unit nurses, theatre nurses, laboratory and blood bank technicians, etc.). The 1-day training program, concentrated on the discipline of each member of the trauma team during simulated patient treatment, and his role in the team. Assessment of the impact of TTT on the performance of the trauma team was done by interrogating the participants in this training. The time spent to resuscitate the patient in the emergency department was measured before and after the training of the trauma team personnel. Results: After the TTT was employed, the results showed that there was a decrease by approximately 75% in the meantime of performance from 220.8 min to 54.48 min. This was in accordance to the patient's stay in the ER which decreased significantly from 9 to 827 min pre-training to 14–206 min post-training. Conclusion: Training reinforces the already learned skills, corrects and minimise mistakes. Implementation of TTT is of utmost importance to be adapted in every trauma centre to achieve optimal performance and benefit to the patient.

Keywords: Questionnaire, team, training, trauma


How to cite this article:
Al Ani AH, Riad ZK, Ahmed HM, Aboughosiba H, Abuhussein N, Abdulhakim H, Kabeer N, Ibrahim M, Atasi A, Banday V, Makki M, Tamer A, Qassem N. Trauma team training: A key to success. Hamdan Med J 2022;15:19-22

How to cite this URL:
Al Ani AH, Riad ZK, Ahmed HM, Aboughosiba H, Abuhussein N, Abdulhakim H, Kabeer N, Ibrahim M, Atasi A, Banday V, Makki M, Tamer A, Qassem N. Trauma team training: A key to success. Hamdan Med J [serial online] 2022 [cited 2022 May 28];15:19-22. Available from: http://www.hamdanjournal.org/text.asp?2022/15/1/19/340817




  Introduction Top


Trauma remains the most common cause of death worldwide for all individuals between the age group of 1 and 44 years. It is the third most common cause of death regardless of age. Globally, more than nine people die every minute from injuries or violence. Road traffic accidents are the primary cause of fatal injuries, accounting for 67% of all deaths from trauma. In the United Arab Emirates, trauma is the second leading cause of death for both national and expatriate populations, of which 6,681 causalities were attributed to road traffic accidents. Trauma is more prevalent in males, especially those at young ages. The productive years of work lost are greatly attributed to mortality from trauma because the younger population are more commonly involved in traumatic accidents.[1]

Measures to guarantee patient safety, which include teamwork training must be conducted in any health-care industry. This was recommended by the Institute of Medicine (2000) and has ever since resulted in fewer patient errors.[2] Effective health-care delivery provided by trauma teams can be enhanced through teaching and training multidisciplinary team members on the essential elements of crisis resource management.


  Methods Top


The 1-day program of trauma team training (TTT) intent was to teach every member of the team how to optimally utilise the resources in managing trauma cases and develop individual knowledge and skills. The 1st h of the day consists of an introduction to trauma, orientation to the simulations and a review of the institution's trauma system. This was followed by live simulation scenarios accompanied by a video camera to record the event and to display the performance of each member during the act. The training program was concluded by a debriefing and sharing of lessons learned from the practice. Two parameters were used to evaluate the effect of training on the participants' knowledge, confidence and performance. The first was a written questionnaire applied to be answered by the participant. The 2nd was measuring the time from the moment the patient reaches the emergency room (ER) till the patient attains the final destination (ward, intensive care unit [ICU] and theatre). One hundred trainees were selected to be enrolled in this evaluation and one 100 trauma cases were evaluated before and after trauma training.


  Results Top


Out of 100 participants recruited in this study, 42 were female and 58 were male. Among them, 36 were physicians and 64 were nurses [Figure 1].
Figure 1: Participants recruited in this study according to their occupation

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Taking into account the experience of each participant in the field of trauma, the majority had 5–10 years of experience and the minority had <5 years of experience [Figure 2].
Figure 2: The length of experience in years of each participant in the field of trauma

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Prior to the training program, certain objectives were set to be addressed in our lectures and simulated training. The questionnaire provided following the training program assessed different aspects of TTT. Participants were asked if the objectives were met and 56 strongly agreed, 36 agreed, 6 were neutral and 2 disagreed only.

The lectures reviewed the basic principles of trauma management and reviewed the most updated literature. 64 found the lectures informative, 34 agreed and 2 were neutral.

After the application of the TTT on simulated patients, 64% strongly agreed that the exercise was useful and were satisfied with what they learnt [Figure 3].
Figure 3: Was the trauma team training experience useful to the participant after its application on simulated patients. Opinion of participants

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TTT also reduced the meantime of performance from 220.8 min before training to 54.48 min after training. The aim of this study (measuring the meantime in resuscitation before and after training) showed that there is a decline in time of resuscitation. The range before training was between 9 and 827 min; this was changed to a range between 14 and 206 min after TTT [Figure 4].
Figure 4: The range of mean time in resuscitation before and after trauma team training

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  Discussion Top


The 'Golden hour', i.e. the 1st h after trauma, is a crucial factor in the management of a trauma patient. The optimal use of this time significantly reverses the possibility of life-threatening conditions. Proper management of trauma requires a multidisciplinary team. Each person in the team has a designated role that has to be fulfilled by each team member.[3] This can be achieved when all the members of the team are trained to work simultaneously regardless of occupation or speciality, thus constructing a set-up that is close to a real-life situation. This allows for proper communication and interactions as well as eliminating conflicts that can surface in real-life situations.

In addition, training must establish a systemic approach to minimise the time to resuscitation of a trauma patient.[4] In our study, the time for resuscitation was ranging from 9 to 827 min before the training program was commenced and 14–206 min after training sessions were delivered.

Communication is the key in team performance to allow for establishing common objectives, prioritising and achieving them most effectively. In a study conducted in 2017, closed-loop communication during trauma training was investigated which resulted in efficient task completion.[5]

Trauma is a medical problem where time plays a big role in its management and consequences. Patient prognosis may range from minor outcomes to life-long repercussions. While TTT programs have widely shown to decrease the time to critical interventions, a meta-analysis conducted in 2019 showed that the decline in time has not reflected in a reduction in mortality. This is in alliance with the fact that Advanced Trauma Life Support training has not shown a decrease in morbidity and mortality. Another study showed that, while the overall mortality rate in trauma patients did not decrease significantly in the post-training period, patients with a low Glasgow Coma Scale score (3–8) had a statistically significant decrease in mortality from 58.51% pre-training to 37.10% post-training.[6]

The impact of trauma training positively reflects on the team member's performance. The development of non-technical skills (communication, leadership and self-confidence, etc.,) during training is an important aspect that must be targeted in all training programs.[7] A dysfunctional team adds a greater risk for poor patient outcomes. Such failures may be attributed to deficits in non-technical skills.[8]

TTT conducted in Denmark showed that participants were more competent after training, in the following fields-teamwork skills, clear communication and leadership while handling a patient.[9] This was also reflected in our questionnaire results which showed that 98% of the participants agreed that training has improved their self-confidence and was more comfortable to manage trauma patients after the course. This further suggests the need to implement such training programs more frequently in hospitals to achieve optimal performance among the trauma team.[10] In order to achieve the best-case scenario when handling a trauma case, it is not only enough to evaluate whether the right diagnosis was reached or not;

However, also how resources were utilised to reach the final diagnosis and management of a trauma patient. In fact, the key to successful management of a patient involves prompt commencement of the ideal tests and procedures.[11]

Proper utilisation of resources can be subdivided into three categories:

  1. Human resources: The emergency response team should be up to date on how to deal with all types of disasters. For instance, in our research, a lecture was presented before training on the management of trauma with the most updated literature. The survey conducted after TTT showed that 98% of the participants found it to be informative and improved their skills in managing trauma cases
  2. Facilities and systems – A proper communication system between emergency service personnel and hospitals is required before receiving a trauma case to construct a plan and be equipped to encounter the arriving trauma patients. This should ideally be followed by a well-trained doctor who is able to skillfully assess the incoming patients in triage and allocate each patient to his/her designated zone. In our institute, we have an active trauma alert system that is stimulated just before the trauma patient reaches the hospital
  3. Equipment and material imaging modalities, laboratory tests and medications should be judiciously chosen whilst taking into consideration patient safety, costliness, accessibility and effectiveness.


As suggested by the World Health Organisation, providing more training programs in areas where precision is needed such as ICU and emergency is beneficial. This was one of our objectives in the training program and was evident by the 96% of participants who agreed that TTT prepared them to utilise resources effectively.

The trauma registry helps us understand the magnitude of the problem. It allows a city or country to appraise the efficacy of trauma care and implement policies to develop aspects that may be followed. Not only that but also long-term surveillance of trauma registry can theoretically allow us to implement preventive tactics towards decreasing the incidence of trauma in the city and/or country.

Administrative databases alone are not sufficient to exemplify trauma on a population-based sample.[12]

The quality and integrity of the trauma registry are crucial for its success. Experienced personnel must handle the data entry process and must be knowledgeable of the inclusion criteria.[13]

Standardizing data collection among trauma centres can become a means by which trauma centres are assessed and evaluated. On that grounds, improving the quality of database registration must be one of the goals of TTT.


  Conclusion Top


This study highlighted the cruciality of TTT, as it had a positive influence on the knowledge, self-confidence and performance of trauma team members. It decreased the time interval spent between the arrival to ER and the final destination of the trauma patient. Seventy per cent of participants strongly recommended applying TTT in other trauma centres.

Ethical clearance

The study was approved by the institutional Ethics Committee of Ministry of Health and Prevention/ Research Ethics Committee. Approval No (MOHAP/DXB-REC/ OOO/No. 138/2020).

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Sakran JV, Greer SE, Werlin E, McCunn M. Care of the injured worldwide: Trauma still the neglected disease of modern society. Scand J Trauma Resusc Emerg Med 2012;20:64.  Back to cited text no. 1
    
2.
Capella J, Smith S, Philp A, Putnam T, Gilbert C, Fry W, et al. Teamwork training improves the clinical care of trauma patients. J Surg Educ 2010;67:439-43.  Back to cited text no. 2
    
3.
Couperus K, Young S, Walsh R, Kang C, Skinner C, Essendrop R, et al. Immersive virtual reality medical simulation: Autonomous trauma training simulator. Cureus 2020;12:e8062.  Back to cited text no. 3
    
4.
van Olden G, Meeuwis J, Bolhuis H, Boxma H, Goris R. Advanced trauma life support study: Trauma resuscitation time. Eur J Trauma 2003;29:379-84.  Back to cited text no. 4
    
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Härgestam M, Lindkvist M, Jacobsson M, Brulin C, Hultin M. Trauma teams and time to early management during in situ trauma team training. BMJ Open 2016;6:e009911.  Back to cited text no. 5
    
6.
Petroze R, Byiringiro J, Ntakiyiruta G, Riviello R, Briggs S, Razek T, et al. Can focused trauma education initiatives reduce mortality or improve resource utilization in a low-resource setting? J Surg Res 2013;179:236.  Back to cited text no. 6
    
7.
Murphy M, McCloughen A, Curtis K. The impact of simulated multidisciplinary trauma team training on team performance: A qualitative study. Aust Emerg Care 2019;22:1-7.  Back to cited text no. 7
    
8.
Yates AR, Blankenship AC, Schwartz RM, Fernandez RP. Multidisciplinary review of cardiopulmonary arrest in a heart center. Pediatr Crit Care Med 2013;14:S103.  Back to cited text no. 8
    
9.
Ostergaard H, Ostergaard D, Lippert A. Implementation of team training in medical education in Denmark. Postgrad Med J 2008;84:507-11.  Back to cited text no. 9
    
10.
Fernandez R, Rosenman E, Olenick J, Misisco A, Brolliar S, Chipman A, et al. Simulation-based team leadership training improves team leadership during actual trauma resuscitations. Crit Care Med 2020;48:73-82.  Back to cited text no. 10
    
11.
Smith A, Ouellet J, Niven D, Kirkpatrick A, Dixon E, D'Amours S, Ball C. Timeliness in obtaining emergent percutaneous procedures in severely injured patients: How long is too long and should we create quality assurance guidelines? Can J Surg 2013;56:E154-7.  Back to cited text no. 11
    
12.
Moore L, Clark D. The value of trauma registries. Injury 2008;39:686-95.  Back to cited text no. 12
    
13.
Shaban S, Eid HO, Barka E, Abu-Zidan FM. Towards a national trauma registry for the United Arab Emirates. BMC Res Notes 2010;3:187.  Back to cited text no. 13
    


    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4]



 

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