Most of you will have seen this BBC show linked to by Life in the Fast Lane a few weeks ago. If so I can heartily recommend you watch it now.
There’s a lot of talk about how modern warfare has pushed forward the boundaries of medical care, and how trauma care in Iraq and Afghansitan is seeing people survive who would likely never survive in a civilian setting.
To me it seemed that the emphasis was on science and technology being the key factor in saving the lives. The now popular 1:1:1 transfusion stuff got a prominent role.
However I think they missed a great opportunity to point out what I suspect is the really key feature of survival – the team work/logistics of it all.
I don’t mean to dismiss 1:1:1 transfusion; while I don’t think it’s “proved” in any way yet, it has usefully put a focus on thinking about what we’re doing in resuscitation and I imagine it will turn out to be pretty close to the truth eventually.
What I find much more interesting (and eminently more translatable to civilian settings) is the team work and logistics on display in military settings.
One of the very best things Scott Weingart has promoted (and there are many to choose from!) was the idea of logistics over strategy in resuscitation. Be sure you’ve listened to the episode before your next resuscitation.
Here comes my OBM (opinion-based-medicine):
- the most important part in saving lives in such a resuscitation are the logistics and how the team makes decisions.
I have observed and partaken in many chaotic and dysfuncitonal resuscitations. And I’ve taken part in some wonderful ones. Part of this is leadership – a clear leadership, where those involved listen and trust the decisions of the person at the foot/side/head of the bed.
For a team to work the way it does in Camp Bastion (or somewhere like Shock Trauma in Baltimore) takes a lot of practice. And not just on every trauma that comes in but in simulated settings, with feedback and video recordings and timings and all that.
It takes time set aside to think through what the team will do in different situations, and which items take priority in a resus. This is way beyond the rather silly moulages we do in ATLS. It involves putting together all the isolated individual skills that we learn in books, on courses or on all the excellent blogs and podcasts, and putting together all these skills with other docs and nurses and staff and making sure we can pull it off smoothly.
For example, I know how to do a FAST exam. Technically I know how to do one, and I have performed a number of them to try and put into practice, but if we want to do it properly (and remember in the UK/Ireland, we don’t seem to be that great at this yet) then we need to practice getting a FAST done while all the ABCs are happening at the same time, not just in the dry, sterile algorithmic fashion that we all learned.
In my (fairly) limited training so far, I’ve not seen much of this. The idea sounds great but in practice, we’re all busy and never really manage to get enough people in the same place at the same time to manage to get it done. In fact the only time we do manage to get all the same people in the same place at the same time is when we have a major trauma rolling in the door in 5 minutes…
And I’m not quite sure that’s good enough.
(Incidentally I see Amit Mani has something relevant to this on his Blog too)