The Resus Lottery

Resus is very busy with sick patients. How do you organise your team and prioritise the management of these patients?

Address specifically:

1. How do you maintain your situational awareness, keeping an overview of the situation and prioritising your time between the patients? Think in terms of gathering information, anticipating and updating the team.

2. How will you identify potential red flags which could negatively impact on patient safety?

The alert phone rings again:

Mechanism: 15 year old girl thrown from horse.
Injuries suspected: head and pelvic injuries.
Signs: P120 SBP 110 GCS 14/15
Treatment given: Collared and boarded; pelvic belt in situ. 500ml IV NaCl.

ETA: 10 minutes

You call a paediatric trauma alert.

Five members of the trauma team have arrived (in addition to yourself): A second ED middle grade, an ITU SpR, an orthopaedic SHO, a paediatric SpR and an ED nurse. The ED middle grade suggests that they take over the rest of resus and leave you to get on with leading the paed trauma.

The resus nurse asks you who is fit enough to leave resus.

a) How do you prioritise the management of these patients to ensure minimal risk to patient safety whilst maximising your resources? Consider the competing demands and the potential areas of conflict. How would you cope if you received yet another alert call?

b) In many departments this would constitute a major incident. Utilising your knowledge of human factors and situational awareness in particular, is there any way you could have better prepared your team? Consider whether this is a situation which could be planned for.

Consider how you could improve the situational awareness of your own team if your local resus room was at maximum capacity and you were expecting another alert.

Are there any resources you could use?