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While on your night float rotation, you and other members of the surgical team are called to the emergency department (ED) in response to the activation of the trauma team. As the patient is being wheeled into the trauma bay, the paramedics inform you that the patient is a 56-year-old female who was a restrained driver in a motor vehicle crash (MVC). She rear-ended a stopped car going at a speed of approximately 45 mph. There was no loss of consciousness at the scene and the patient appears alert. The paramedics report that the patient has obvious deformities of her proximal upper right arm and distal left thigh. You hear your senior resident announce that she is going to begin the primary survey.

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1. Why was it appropriate to initiate a trauma activation in this patient?

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2. What is your role during this trauma? Where should you stand?

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3. What is the goal of the trauma primary survey?

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Trauma Primary Survey

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Answers
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  1. Per CDC guidelines, the trauma team should be activated if 1 or more specific anatomic, physiologic, and mechanistic criteria are met as illustrated by Table 2-1. The patient in this scenario meets criteria for trauma team activation given her involvement in a high-speed MVC and likelihood of her having at least 2 proximal long bone fractures.

  2. Although minor variations may exist from institution to institution, the trauma team at most academic medical centers consists of a team leader, an airway specialist, primary and secondary surveyors, and ED nurses. Note that depending on the nature of the injury, other specialized staff (ie, orthopedic surgery or neurosurgery) may also be present. It is imperative that members of the trauma team are aware of their roles to ensure that the best care possible is given to the traumatically injured patient. Trauma team members and their respective job descriptions are listed below and a diagram of their position with respect to the patient is illustrated in Figure 2-1:

    • Team leader (trauma surgery attending or the senior surgical resident until the attending arrives):
      • Obtains history from Emergency Medical System (EMS) staff
      • Directs team members on how and when to perform their respective tasks
      • Orders the administration of drugs, fluids, or blood products
      • Performs or assists with any lifesaving procedures
      • Determines the patient's disposition (ie, additional imaging, OR, ICU)
      • Discusses the patient's status with the family members
    • Airway specialist (2 people—anesthesiologist, ED attending, or senior residents of either specialty with 1 person serving as an assistant):
      • Controls the airway, ensuring patency
      • Performs any airway interventions, excluding the performance of a surgical airway
      • Maintains cervical spine stabilization
    • Primary surveyor (surgical resident):
      • Performs the primary survey, relaying all pertinent findings to the team
      • May perform the secondary survey, relaying all pertinent findings to the team
      • Performs or assists in ...

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