Lubbert Pieter H W, Kaasschieter Edgar G, Hoorntje Lidewij E, Leenen Loek P H
Department of Surgery, University Medical Center Utrecht, Utrecht, The Netherlands.
J Trauma. 2009 Dec;67(6):1412-20. doi: 10.1097/TA.0b013e31818d0e43.
Trauma teams responsible for the first response to patients with multiple injuries upon arrival in a hospital consist of medical specialists or resident physicians. We hypothesized that 24-hour video registration in the trauma room would allow for precise evaluation of team functioning and deviations from Advanced Trauma Life Support (ATLS) protocols.
We analyzed all video registrations of trauma patients who visited the emergency room of a Level I trauma center in the Netherlands between September 1, 2000, and September 1, 2002. Analysis was performed with a score list based on ATLS protocols.
From a total of 1,256 trauma room presentations, we found a total of 387 video registrations suitable for analysis. The majority of patients had an injury severity score lower than 17 (264 patients), whereas 123 patients were classified as multiple injuries (injury severity score >or=17). Errors in team organization (omission of prehospital report, no evident leadership, unorganized resuscitation, not working according to protocol, and no continued supervision of the patient) lead to significantly more deviations in the treatment than when team organization was uncomplicated.
Video registration of diagnostic and therapeutic procedures by a multidisciplinary trauma team facilitates an accurate analysis of possible deviations from protocol. In addition to identifying technical errors, the role of the team leader can clearly be analyzed and related to team actions. Registration strongly depends on availability of video tapes, timely started registration, and hardware functioning. The results from this study were used to develop a training program for trauma teams in our hospital that specifically focuses on the team leader's functioning.
负责在患者抵达医院后对多发伤患者进行首次救治的创伤团队由医学专家或住院医师组成。我们推测，创伤室的24小时视频记录将有助于精确评估团队运作情况以及与高级创伤生命支持（ATLS）协议的偏差。
我们分析了2000年9月1日至2002年9月1日期间在荷兰一家一级创伤中心急诊室就诊的创伤患者的所有视频记录。使用基于ATLS协议的评分列表进行分析。
在总共1256次创伤室就诊中，我们发现共有387次视频记录适合分析。大多数患者的损伤严重程度评分低于17分（264例患者），而123例患者被归类为多发伤（损伤严重程度评分≥17分）。与团队组织不复杂时相比，团队组织方面的错误（遗漏院前报告、无明显领导、复苏无组织、未按协议操作以及未持续对患者进行监护）导致治疗中的偏差明显更多。
多学科创伤团队对诊断和治疗过程进行视频记录有助于准确分析与协议可能存在的偏差。除了识别技术错误外，还可以清晰地分析团队领导者的角色及其与团队行动的关系。记录很大程度上取决于录像带的可用性、及时开始记录以及硬件功能。本研究结果被用于为我院创伤团队制定一个专门关注团队领导者运作的培训项目。
