The Effect of a Multidisciplinary Trauma Team Leader Paradigm at a Tertiary Trauma Center: 10-Year Experience

Background. To illustrate the impact of the implementation of a multidisciplinary TTL program in 2005 on the mortality of trauma patients in a level 1 trauma center as well as admission rates and length of stay. Methods. Retrospective observational study of all trauma patients included in the provincial trauma database at the Montreal General Hospital between 1998 and 2015. The primary outcome studied was in-hospital mortality. The secondary outcomes studied were hospital and intensive care unit (ICU) rates of admission and hospital and ICU length of stay. Results. 24,107 patients were included. We observed a statistically significant reduction in mortality of 1.25% or a relative reduction of 16% (p value = 0.0058; rate ratio 0.844 (95% CI 0.747–0.952)). ICU admissions were also significantly reduced where we observed a statistically significant absolute reduction of 4.46% or a relative reduction of 14% (p value = 8.38 × 10−7; rate ratio 0.859 (95% CI 0.808–0.912)). The ICU length of stay was increased by 0.91 days or 19.03% (p value = 0.016 (95% CI 0.167–1.655)). There was no observed change in overall length of stay (13.97 days pre-TTL and 12.91 post-TTL (p value = 0.13; estimate −1.053 (95% CI −2.424–0.318))). Conclusions. This article suggests that multidisciplinary TTL model may be beneficial in the care of trauma patients. Further subgroup analysis may help determine which patients could benefit more.

Head, Neck and Dental Emergencies

Head, Neck and Dental Emergencies is a welcome addition to the popular pocket reference Oxford paperback series. The Second Edition is a revised and upgraded version of the original which was published in 2005. As is evident from the title, the genre revolves explicitly around trauma and other critical conditions involving the major organs residing above the collar bone. The book imparts an in-depth view into the medical and dental aspects of emergencies encountered primarily in the Oral and Maxillofacial setting. The editor, Dr. Mike Perry, is a consultant Maxillofacial Surgeon and Trauma team leader at the University Hospital of North Staffordshire, United Kingdom, who, along with a handful of noteworthy contributors, aptly bestow extensive expertise throughout the course of the book.

Trauma team leaders in Canada: A national survey

Introduction The availability, composition and activation criteria for trauma teams vary across different health care systems, but little is known about these features in the Canadian health system. The aim of this study is to provide a description of the current trauma team available in Level 1 and 2 centres across Canada. Methods In 2017, using a modified Dillman technique, a survey was sent to 210 health professionals across all Canadian trauma care facilities, including questions that focused on (1) the presence and the composition of a trauma team, (2) the established criteria to activate this team and (3) the initial patient care. Results Overall, 107 (57%) completed surveys were received. Only 22 (11.7%) were from Level 1 or 2 centre and considered for compilation. Seventeen respondents have a trauma team in their centre, and they all shared their criteria for activating their team (1–27 different indications). The suspected injuries, the judgment of the emergency physician, the systolic blood pressure, the Glasgow Coma Score and the respiratory rate were the most frequently mentioned items. In the presence of a pre-hospital care warning, the initial assessment of a severely injured patient is exclusively completed by a member of the trauma team for only 35.1% of the respondents. For 11.8% of respondents, trauma team coordinates airway management. For 64.7% of participants, the trauma team leader is the dedicated care provider to accompany patients until the final destination. Conclusions The results suggest a great variability across Canada, regarding the roles assumed by the trauma team but also regarding the activation criteria leading them to take action.

Establishing an evaluation tool for trauma team leader performance during trauma resuscitation

Introduction: Trauma training is an important part of medical and surgical education.Evaluation of training is an essential part of medical education. A formal valid assessmentmethod for trauma training is not available. The purpose of this study is to establish a formaland scientifically-based Trauma Team Leader Evaluation Tool.Methods and Results: A literature review was conducted on the assessment of traumateam leaders. The available published studies were reviewed and assessed, as well asreferences on the principles and practice of assessment methods used in medical education.Input on points of assessment was obtained from trauma team leaders at the HamiltonGeneral Hospital. An evaluation form was formulated with five domains, each containing fiveitems. Definitions of the domains and items were clarified and attached to the form. The formwas reviewed and revised by trauma team leaders of adult trauma and education leadersin pediatric trauma at Hamilton General Hospital and Health Science Education ProgramMcMaster University and then finalized based on the discussed suggestions.Conclusions: Assessment of trauma team leader performance is an important part oftrauma training and feedback. Developing an assessment tool involves a comprehensiveprocess that needs review, input, and participation from various sources related to trauma.More work to validate the tool will be needed to evaluate its utility.