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Exercise Helps Colorado Hospital Learn “Trauma is Teamwork”

The 5-year-old boy lies motionless and bloodied on a backboard in a room in the Memorial Hospital Emergency Department. An ambulance brought him in after he jumped from a second-story window during a fire, and he has severe burns over 78 percent of his body.

A trauma team of about 15 people, assembled from various departments throughout the hospital, jumps into action, working together like a well-rehearsed orchestra. Someone inserts a breathing tube. Another person yells out for medications. "We need a chest and pelvis right away," the lead doctor, Andrew Berson, tells the radiologist.

And then, in the middle of the hubbub, trauma system manager Lynn Andersen yells "time out," and the action comes to an abrupt halt. The patient is a mannequin, and this is one of Memorial's monthly trauma training exercises, designed to find flaws in the system and foster better teamwork and patient care.

"Everybody has a role to play and their own responsibilities, and this helps them know exactly what to do," said Dan Lauer, trauma team lead for Memorial's Emergency Department. "Trauma is teamwork."

Both Memorial and Penrose hospitals have Level II trauma operations, the second-highest designation that reflects a hospital's ability to provide critical emergency care through proper staffing, equipment and protocols. And both conduct regular training sessions to fine-tune their operations.

"With our busiest trauma season just around the corner, we're doing at least three mock traumas per month," said Penrose spokesman Johnny Rea. "Some come in the form of mock or simulated trauma scenarios that are unannounced to staff. We conduct impromptu procedure and skills sessions when we have down time in the ED. We'll also train by doing 'scavenger hunts' in the trauma room to find specific equipment and set up in urgent situations."

Memorial started its training sessions in December 2009 and was doing them quarterly until last month, when they went to a monthly schedule. Each time, the team learns something new, and processes are constantly being revamped and upgraded. Lauer said the during one exercise, Memorial's director of support operations, Chris Mitchell, came up with a plan to create a duplicate set of supplies on either side of the trauma treatment table, so team members would be able to access them no matter where they were working in the room.

"It sounds ridiculously simple, but you wouldn't believe what a change it made," Lauer said. "That was huge. Ninety-nine percent of trauma is you have to know where things are."

Other sessions led to a reduction in how long patients spend on the backboards they are placed on in the ambulance. Spending too much time on the backboard can lead to sores, and the boards are just plain uncomfortable, Andersen said. Some were spending hours on the backboards; the average is now nine minutes, she said.

After Wednesday's session on the pediatric patient, the staff went into debriefing mode to discuss what went well and what needed improvement.

"There was good communication between the team," one team member shouted out.

But Berson said the staff needed to do better at acknowledging they heard his orders - a problem that cropped up after he ordered the painkiller Fentanyl for the patient.

"When I order something, I want to know the order's acknowledged," he said.

The team then went into its second exercise, this time working on an eerily life-like mannequin representing an adult male with several gunshot wounds. The mannequin moaned and blinked its eyes. Its chest rose and fell as the doctors and nurses worked feverishly to stabilize the patient and get him down the hall to the operating room.

And what if a real trauma had come through the doors?

"The last time we did this, we had two real traumas roll in," Berson said. "We dropped everything and did it for real."



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