Hoyt D B, Shackford S R, Fridland P H, Mackersie R C, Hansbrough J F, Wachtel T L, Fortune J B
Department of Surgery, University of California, San Diego.
J Trauma. 1988 Apr;28(4):435-40. doi: 10.1097/00005373-198804000-00003.
Since the initial hour after injury is the most crucial time for trauma patients, resuscitation technique is of vital importance. Standardized courses for first-hour management (ATLAS) have been widely accepted. A teaching format based upon video recording of every resuscitation has been developed. Tapes are reviewed by the staff and by the individuals involved in a particular resuscitation. In a weekly resuscitation review conference, actual footage is presented to the trauma team members, specific aspects of a resuscitation are critiqued, and supplemental didactic information is presented. Legal problems have been avoided by making the review and conference a part of the quality assurance process. Patient anonymity is preserved by positioning the video camera at the foot of the resuscitation bed. Tapes are erased after each conference. Video recording allows analysis of: 1) priorities during the resuscitation; 2) cognitive integration of the workup by the team leader; 3) physical integration of the workup by the team leader; 4) team member adherence to assigned responsibilities, resuscitation time, errors or breaks in technique; and 5) behavior change over time. In 3 1/2 years, more than 2,500 resuscitations have been recorded. Over a 3-month period, average resuscitation time to definitive care decreased for age- and injury severity-matched patient groups cared for by one team. Resuscitations have become more efficient and adherence to assigned responsibilities better. Weekly review of resuscitation contributes to improved technique and trauma care.
由于受伤后的最初一小时对创伤患者最为关键，复苏技术至关重要。标准化的首小时管理课程（ATLAS）已被广泛接受。一种基于对每次复苏进行录像的教学形式已被开发出来。录像带由工作人员以及参与特定复苏的人员进行审查。在每周一次的复苏审查会议上，会向创伤团队成员展示实际录像，对复苏的具体方面进行评判，并提供补充的教学信息。通过将审查和会议作为质量保证过程的一部分，避免了法律问题。通过将摄像机放置在复苏床的床尾来保护患者的匿名性。每次会议后录像带都会被删除。录像记录有助于分析：1）复苏过程中的优先事项；2）团队领导者对检查的认知整合；3）团队领导者对检查的实际整合；4）团队成员对分配职责的遵守情况、复苏时间、技术失误或中断；以及5）随时间的行为变化。在3年半的时间里，已经记录了超过2500次复苏。在一个为期3个月的时间段内，由一个团队护理的年龄和损伤严重程度匹配的患者组，其到确定性治疗的平均复苏时间有所缩短。复苏变得更加高效，对分配职责的遵守情况也更好。每周对复苏进行审查有助于提高技术水平和创伤护理质量。
