title: Trauma teams and time to early management during in situ trauma team training.
abstract: OBJECTIVE
  To investigate the association between the time taken to make a decision to go to surgery and gender, ethnicity, years in profession, experience of trauma team training, experience of structured trauma courses and trauma in the trauma team, as well as use of closed-loop communication and leadership styles during trauma team training.
  
  
  METHODS
  In situ trauma team training. The patient simulator was preprogrammed to represent a severely injured patient (injury severity score: 25) suffering from hypovolemia due to external trauma.
  
  
  METHODS
  An emergency room in an urban Scandinavian level one trauma centre.
  
  
  METHODS
  A total of 96 participants were divided into 16 trauma teams. Each team consisted of six team members: one surgeon/emergency physician (designated team leader), one anaesthesiologist, one registered nurse anaesthetist, one registered nurse from the emergency department, one enrolled nurse from the emergency department and one enrolled nurse from the operating theatre.
  
  
  METHODS
  HRs with CIs (95% CI) for the time taken to make a decision to go to surgery was computed from a Cox proportional hazards model.
  
  
  RESULTS
  Three variables remained significant in the final model. Closed-loop communication initiated by the team leader increased the chance of a decision to go to surgery (HR: 3.88; CI 1.02 to 14.69). Only 8 of the 16 teams made the decision to go to surgery within the timeframe of the trauma team training. Conversely, call-outs and closed-loop communication initiated by the team members significantly decreased the chance of a decision to go to surgery, (HR: 0.82; CI 0.71 to 0.96, and HR: 0.23; CI 0.08 to 0.71, respectively).
  
  
  CONCLUSIONS
  Closed-loop communication initiated by the leader appears to be beneficial for teamwork. In contrast, a high number of call-outs and closed-loop communication initiated by team members might lead to a communication overload.
authors.affiliation: Department of Nursing, Umeå University, Umeå, Sweden Department of Surgical and Perioperative Sciences, Anaesthesiology and Intensive Care, Umeå University, Umeå, Sweden.
authors.forename: Maria
authors.initials: M
authors.lastname: Härgestam
authors.affiliation: Department of Statistics, Umeå School of Business and Economics, Umeå International School of Public Health, Umeå University, Umeå, Sweden Department of Public Health and Clinical Medicine, Epidemiology and Global Health, Umeå University, Umeå, Sweden.
authors.forename: Marie
authors.initials: M
authors.lastname: Lindkvist
authors.affiliation: Department of Social Work, Umeå University, Umeå, Sweden.
authors.forename: Maritha
authors.initials: M
authors.lastname: Jacobsson
authors.affiliation: Department of Nursing, Umeå University, Umeå, Sweden.
authors.forename: Christine
authors.initials: C
authors.lastname: Brulin
authors.affiliation: Department of Surgical and Perioperative Sciences, Anaesthesiology and Intensive Care, Umeå University, Umeå, Sweden.
authors.forename: Magnus
authors.identifier: http://orcid.org/0000-0003-2935-7161
authors.initials: M
authors.lastname: Hultin
mesh_terms: D000328:Adult; D000066491:Clinical Decision-Making; D005260:Female; D006801:Humans; D015601:Injury Severity Score; D033183:Interdisciplinary Communication; D007857:Leadership; D008297:Male; D008875:Middle Aged; D010348:Patient Care Team / Q000458:organization & administration*; D016544:Patient Simulation; D012537:Scandinavian and Nordic Countries; D013997:Time Factors; D014193:Trauma Centers / Q000458:organization & administration*; D014947:Wounds and Injuries / Q000601:surgery*
keywords: ACCIDENT & EMERGENCY MEDICINE; ANAESTHETICS; MEDICAL EDUCATION & TRAINING; TRAUMA MANAGEMENT
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