The Patient Journey in Trauma Care
Expert
:
Aline Baron (Grenoble, France), Michael Casaer (Leuven, Belgium), Brigitta Fazzini (London, United Kingdom), Carmen Lopez Soto (London, United Kingdom), Tobias Gauss (Grenoble, France), Alberto Sandiumenge (Barcelona, Spain)
Start
Virtual simulation with ...
a virtual patient
a monitor
what you can see (if available) :
- BP, pulse, SpO2, ICP, EtCo2, RR
- Physical exam
- Biology
- Radiology
- e Fast
- CT
what you can do :
- add équipment (peripheral IV, central IV line, arterial line, thoracic drain, urinary cath...
- ask for treatment
You are an emergency physician in a trauma center
You are working in a level-1 trauma center ICU, with specific haemorrhage control and TBI pathway preactivation possible, massive transfusion protocol, complete spectrum of advanced resuscitation, surgery, critical care and radiology (including interventional), Standard operating procedure and trained staff.
THE CASE
A hiking accident
YOU ARE ON CALL in this trauma ICU. A colleague has accepted the secondary transfer of a 64 year old male. Fall from 15m while hiking. Because of the long transfer time to Level-1 and patient in shock, initial management in peripheral hospital, no trauma unit. Initial GCS 10, M5, degloving of the right hemiscalp, head injury, pupils normal, facial trauma, shock, with systolic SAP 90mmHg, hypoxic Spo02 90%, possible thoracic trauma. Patient has been intubed, is sedated, hemodynamics still shaky, no theatre, 2 units of red blood, no plasma, CT scan with no injection (fear of renal impairment and pelvic Xray normal, pelvis no contrast), image transfer not available
00:30
Anticipation
00:30
Anticipation
00:30
Anticipation
Anticipation : the pre briefing
Prior to the patient arrival... share a mental model
Team assembly and role clarification
Clinical Information Review
Anticipatory Planning
Goal Alignment
Systematic review of pre-hospital information
This cognitive preparation reduces decision-making latency when the patient arrives
Explicit statement of immediate care priorities and expected outcomes
Identifying all present team members, confirming role assignments
Anticipation : cognitiv aids
...and use cognitiv aids
Why use them ?
How to use them well :
What are cognitive aids ?
- Our memory is not perfect under stress
- They help us not forget important steps and avoid tunnel effect
- Studies show: teams miss only 11% of steps WITH aids vs 43% WITHOUT aids
- Less experienced providers perform better with cognitiv aids
- Simple tools to help during emergencies : checklists, algorithms, step-by-step guides
- Like a "recipe" for treating trauma patients
- And tomoroww, machine learning and ai to predict trauma severity, suggest optimal resource allocation
- Train the team before using them
- One person can read the checklist aloud
- Keep them easy to see and reach
Using cognitiv aids is SMART, not weak !
Greig PR, Zolger D, Onwochei DN, Thurley N, Higham H, Desai N. Cognitive aids in the management of clinical emergencies: a systematic review. Anaesthesia. 2023 Mar;78(3):343-355. doi: 10.1111/anae.15939. Epub 2022 Dec 14. PMID: 36517981; PMCID: PMC10107924.
Anticipation : the close loop communication
... a game changer !
Call Out (Direct Order) Team leader gives a clear, specific order to an identified team member "Sarah, give 1 liter of normal saline wide open"
Check-Back (Confirmation) The team member verbally confirms they heard and understood the order "Got it - 1 liter NS wide open"
communication
Close the Loop (Completion) Team member reports when the task is done, leader acknowledges "Liter of NS running wide open"
"Thanks, Sarah"
Patient arrival
Handover
2025/10/28 - 14:25
$periph|=|1
Peripheral line
KIT
4 hours after the accident
$central|=|1
Central line
$art|=|1
ART line
Physical exam, DIAGNOSTICS
?$central|=|1
?$periph|=|1
?$art|=|1
$SAD|=|1
Urinary cath
$drainthoG|=|1
Left
Thoracic drain
$drainthoD|=|1
Right
Thoracostomy
CT
results available
Drugs
Fluids / Blood products
?$drainthoG|=|1
?$drainthoD|=|1
16
?$SAD|=|1
Part 1
Part 2
00:30
00:30
00:30
00:30
00:30
The first 24 hours
KIT
2025/10/28 - 17:25
$central|=|1
Central line
7 hours after the accident
$art|=|1
ART line
Physical exam, DIAGNOSTICS
?$central|=|1
?$periph|=|1
?$art|=|1
$SAD|=|1
Urinary cath
$drainthoG|=|1
Left
Thoracic drain
$drainthoD|=|1
Right
?$ICP|=|1
$ICP|=|1
ICP monitor
Drugs
FLUIDS
?$drainthoG|=|1
?$drainthoD|=|1
16
20
?$SAD|=|1
part 1
part 2
00:30
KIT
2025/10/28 - 17:25
$central|=|1
Central line
7 hours after the accident
$art|=|1
ART line
Physical exam, DIAGNOSTICS
?$central|=|1
?$art|=|1
$SAD|=|1
Urinary cath
$drainthoG|=|1
Left
Thoracic drain
$drainthoD|=|1
Right
?$ICP|=|1
$ICP|=|1
ICP monitor
Drugs
FLUIDS
?$drainthoG|=|1
?$drainthoD|=|1
16
20
?$SAD|=|1
part 1
part 2
ICU admission 24 - 48h
What are the ongoing priorities?
01:00
Overnight the ICP raises to 25mmHg for at least 5’
00:30
The Patient Journey in Trauma Care
600
Let's have a break
XX
CT Head
SAT & Chest
48 h after the accident
KIT
2025/10/30 - 10:25
$central|=|1
Central line
48 hours after the accident
$art|=|1
ART line
?$central|=|1
Physical exam, DIAGNOSTICS
?$art|=|1
$SAD|=|1
Urinary cath
$drainthoG|=|1
Left
Thoracic drain
$drainthoD|=|1
Right
?$ICP|=|1
$ICP|=|1
ICP monitor
Drugs
FLUIDS
?$drainthoG|=|1
?$drainthoD|=|1
16
20
?$SAD|=|1
00:30
72 h after the accident
00:30
00:30
KIT
2025/10/31 - 14:25
$central|=|1
Central line
3 days after the accident
$art|=|1
ART line
?$central|=|1
Physical exam, DIAGNOSTICS
?$art|=|1
$SAD|=|1
Urinary cath
$drainthoG|=|1
Left
Thoracic drain
$drainthoD|=|1
Right
?$ICP|=|1
$ICP|=|1
ICP monitor
Drugs
FLUIDS
?$drainthoG|=|1
?$drainthoD|=|1
20
?$SAD|=|1
16
00:30
00:30
00:30
What probabilistic ABX therapy ?
What is your take on preventive ABX therapy?
How likely is Pulmonary Embolism?
How do you prevent PE?
00:30
What dose?
What is your take on Cava filters?
5 days after the accident
KIT
2025/11/03 - 8:25
$central|=|1
Central line
5 days after the accident
$art|=|1
ART line
?$central|=|1
Physical exam, DIAGNOSTICS
?$art|=|1
$SAD|=|1
Urinary cath
$drainthoG|=|1
Left
Thoracic drain
$drainthoD|=|1
Right
?$ICP|=|1
$ICP|=|1
ICP monitor
Drugs
FLUIDS
?$drainthoG|=|1
?$drainthoD|=|1
20
?$SAD|=|1
16
00:30
00:30
00:30
00:30
00:30
10 days after the accident
KIT
2025/11/08 - 14:25
$central|=|1
Central line
10 days after the accident
$art|=|1
ART line
?$central|=|1
?$art|=|1
$SAD|=|1
Urinary cath
$drainthoG|=|1
Left
Thoracic drain
$drainthoD|=|1
Right
?$ICP|=|1
$ICP|=|1
ICP monitor
Drugs
SOLUTES
?$drainthoG|=|1
?$drainthoD|=|1
20
?$SAD|=|1
16
Neuroprognostication: Art vs Science
Take home messages :
Comunicating with the familly
EoL care
Curative vs Palliative care
EOL care is a clinical decision
Outcome predictors in TBI
Incorporating patient values into their EoL care
What to families expect from us?
Getting ready for the interview
Getting ready for the interview
Getting ready for the interview
Getting ready for the interview
Getting ready for the interview
Check comprehension
Conclusion
References / Pre Briefing & communication
• Steinemann S, Bhatt A, Suares G, Wei A, Ho N, Kurosawa G, Lim E, Berg B. Trauma team discord and the role of briefing. J Trauma Acute Care Surg. 2016 Jul;81(1):184-9. doi: 10.1097/TA.0000000000001024. PMID: 26953754; PMCID: PMC4915979. • Greig PR, Higham HE, Nobre AC. Cognitive aids in the management of clinical emergencies: a systematic review. Anaesthesia. 2023;78(6):680-691. • Roberts NK, Williams RG, Schwind CJ, et al. The impact of brief team communication, leadership and team behavior training on ad hoc team performance in trauma care settings. Am J Surg. 2014;207(2):170-178. • Georgiou A, Lockey DJ. The performance and assessment of hospital trauma teams. Scand J Trauma Resusc Emerg Med. 2010;18:66. • Agency for Healthcare Research and Quality. TeamSTEPPS 2.0: Team Strategies and Tools to Enhance Performance and Patient Safety. 2014. • Härgestam M, Lindkvist M, Brulin C, Jacobsson M, Hultin M. Communication in interdisciplinary teams: exploring closed-loop communication during in situ trauma team training. BMJ Open. 2013 Oct 21;3(10):e003525. doi: 10.1136/bmjopen-2013-003525. PMID: 24148213; PMCID: PMC3808778 • Bhangu A, Notario L, Pinto RL, Pannell D, Thomas-Boaz W, Freedman C, Tien H, Nathens AB, da Luz L. Closed loop communication in the trauma bay: identifying opportunities for team performance improvement through a video review analysis. CJEM. 2022 Jun;24(4):419-425. doi: 10.1007/s43678-022-00295-z. Epub 2022 Apr 12. PMID: 35412259; PMCID: PMC9002216. • El-Shafy IA, Delgado J, Akerman M, Bullaro F, Christopherson NAM, Prince JM. Closed-Loop Communication Improves Task Completion in Pediatric Trauma Resuscitation. J Surg Educ. 2018 Jan-Feb;75(1):58-64. doi: 10.1016/j.jsurg.2017.06.025. Epub 2017 Aug 2. PMID: 28780315. • Fornander L, Garrido Granhagen M, Molin I, Laukkanen K, Björnström Karlsson K, Berggren P, Nilsson L. The use of specific coordination behaviours to manage information processing and task distribution in real and simulated trauma teamwork: an observational study. Scand J Trauma Resusc Emerg Med. 2024 Dec 10;32(1):128. doi: 10.1186/s13049-024-01287-x. PMID: 39658788; PMCID: PMC11629511. • Salik I, Ashurst JV. Closed Loop Communication Training in Medical Simulation. 2023 Jan 23. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 Jan–. PMID: 31751089.
32
Riverside Hospital
2025/10/28 - 11h30 CT Scan
2025/10/28 - 11h30 Report
Cerebral
Cervical spine
Thorax / Abdomen / Pelvis
2025/10/28 - 15h - report
2025/10/28 - 14h45
Cerebral
Cervical spine
Thorax Abdo pelvis
2025/10/28 - 15h - report
2025/10/28 - 14h45
Cerebral
Cervical spine
Thorax Abdo pelvis
2025/10/28 - 19h - report
CT Head
SAT & Chest
2025/10/28 - 15h - report
2025/10/28 - 14h45
Cerebral
Cervical spine
Thorax Abdo pelvis
2025/10/28 - 19h - report
CT Head
SAT & Chest
2025/10/28 - 15h - report
2025/10/28 - 14h45
Cerebral
Cervical spine
Thorax Abdo pelvis
2025/10/28 - 19h - report
CT Head
SAT & Chest
?$drainthoD|=|1
?$drainthoG|=|1
?$central|=|1
$drainthoD|=|1
Right
Thoracic drain
$central|=|1
$drainthoG|=|1
Left
Right eye
Left eye
Right eye
Left eye
Right eye
Left eye
https://radiopaedia.org/cases/pneumonia-ultrasound-1
Right eye
Left eye
Age of the patient
Time of the injury
Mechanism of injury
Injuries found or suspected
Signs / symptoms
Treatments
SITUATION
BACKGROUND
ASSESSMENT
RECOMMANDATION
Provide basic details of the patient, the accident mechanism the location
Give a brief overview of the patient, including clinical details like initial state
Communicate relevant clinical finding : vital signs, examination...
What is expected, care priorities...
Right eye
Left eye
Right eye
Left eye
ESICM Munich
Tobias Gauss
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Transcript
The Patient Journey in Trauma Care
Expert : Aline Baron (Grenoble, France), Michael Casaer (Leuven, Belgium), Brigitta Fazzini (London, United Kingdom), Carmen Lopez Soto (London, United Kingdom), Tobias Gauss (Grenoble, France), Alberto Sandiumenge (Barcelona, Spain)
Start
Virtual simulation with ...
a virtual patient
a monitor
what you can see (if available) :
what you can do :
You are an emergency physician in a trauma center
You are working in a level-1 trauma center ICU, with specific haemorrhage control and TBI pathway preactivation possible, massive transfusion protocol, complete spectrum of advanced resuscitation, surgery, critical care and radiology (including interventional), Standard operating procedure and trained staff.
THE CASE
A hiking accident
YOU ARE ON CALL in this trauma ICU. A colleague has accepted the secondary transfer of a 64 year old male. Fall from 15m while hiking. Because of the long transfer time to Level-1 and patient in shock, initial management in peripheral hospital, no trauma unit. Initial GCS 10, M5, degloving of the right hemiscalp, head injury, pupils normal, facial trauma, shock, with systolic SAP 90mmHg, hypoxic Spo02 90%, possible thoracic trauma. Patient has been intubed, is sedated, hemodynamics still shaky, no theatre, 2 units of red blood, no plasma, CT scan with no injection (fear of renal impairment and pelvic Xray normal, pelvis no contrast), image transfer not available
00:30
Anticipation
00:30
Anticipation
00:30
Anticipation
Anticipation : the pre briefing
Prior to the patient arrival... share a mental model
Team assembly and role clarification
Clinical Information Review
Anticipatory Planning
Goal Alignment
Systematic review of pre-hospital information
This cognitive preparation reduces decision-making latency when the patient arrives
Explicit statement of immediate care priorities and expected outcomes
Identifying all present team members, confirming role assignments
Anticipation : cognitiv aids
...and use cognitiv aids
Why use them ?
How to use them well :
What are cognitive aids ?
Using cognitiv aids is SMART, not weak !
Greig PR, Zolger D, Onwochei DN, Thurley N, Higham H, Desai N. Cognitive aids in the management of clinical emergencies: a systematic review. Anaesthesia. 2023 Mar;78(3):343-355. doi: 10.1111/anae.15939. Epub 2022 Dec 14. PMID: 36517981; PMCID: PMC10107924.
Anticipation : the close loop communication
... a game changer !
Call Out (Direct Order) Team leader gives a clear, specific order to an identified team member "Sarah, give 1 liter of normal saline wide open"
Check-Back (Confirmation) The team member verbally confirms they heard and understood the order "Got it - 1 liter NS wide open"
communication
Close the Loop (Completion) Team member reports when the task is done, leader acknowledges "Liter of NS running wide open"
"Thanks, Sarah"
Patient arrival
Handover
2025/10/28 - 14:25
$periph|=|1
Peripheral line
KIT
4 hours after the accident
$central|=|1
Central line
$art|=|1
ART line
Physical exam, DIAGNOSTICS
?$central|=|1
?$periph|=|1
?$art|=|1
$SAD|=|1
Urinary cath
$drainthoG|=|1
Left
Thoracic drain
$drainthoD|=|1
Right
Thoracostomy
CT
results available
Drugs
Fluids / Blood products
?$drainthoG|=|1
?$drainthoD|=|1
16
?$SAD|=|1
Part 1
Part 2
00:30
00:30
00:30
00:30
00:30
The first 24 hours
KIT
2025/10/28 - 17:25
$central|=|1
Central line
7 hours after the accident
$art|=|1
ART line
Physical exam, DIAGNOSTICS
?$central|=|1
?$periph|=|1
?$art|=|1
$SAD|=|1
Urinary cath
$drainthoG|=|1
Left
Thoracic drain
$drainthoD|=|1
Right
?$ICP|=|1
$ICP|=|1
ICP monitor
Drugs
FLUIDS
?$drainthoG|=|1
?$drainthoD|=|1
16
20
?$SAD|=|1
part 1
part 2
00:30
KIT
2025/10/28 - 17:25
$central|=|1
Central line
7 hours after the accident
$art|=|1
ART line
Physical exam, DIAGNOSTICS
?$central|=|1
?$art|=|1
$SAD|=|1
Urinary cath
$drainthoG|=|1
Left
Thoracic drain
$drainthoD|=|1
Right
?$ICP|=|1
$ICP|=|1
ICP monitor
Drugs
FLUIDS
?$drainthoG|=|1
?$drainthoD|=|1
16
20
?$SAD|=|1
part 1
part 2
ICU admission 24 - 48h
What are the ongoing priorities?
01:00
Overnight the ICP raises to 25mmHg for at least 5’
00:30
The Patient Journey in Trauma Care
600
Let's have a break
XX
CT Head
SAT & Chest
48 h after the accident
KIT
2025/10/30 - 10:25
$central|=|1
Central line
48 hours after the accident
$art|=|1
ART line
?$central|=|1
Physical exam, DIAGNOSTICS
?$art|=|1
$SAD|=|1
Urinary cath
$drainthoG|=|1
Left
Thoracic drain
$drainthoD|=|1
Right
?$ICP|=|1
$ICP|=|1
ICP monitor
Drugs
FLUIDS
?$drainthoG|=|1
?$drainthoD|=|1
16
20
?$SAD|=|1
00:30
72 h after the accident
00:30
00:30
KIT
2025/10/31 - 14:25
$central|=|1
Central line
3 days after the accident
$art|=|1
ART line
?$central|=|1
Physical exam, DIAGNOSTICS
?$art|=|1
$SAD|=|1
Urinary cath
$drainthoG|=|1
Left
Thoracic drain
$drainthoD|=|1
Right
?$ICP|=|1
$ICP|=|1
ICP monitor
Drugs
FLUIDS
?$drainthoG|=|1
?$drainthoD|=|1
20
?$SAD|=|1
16
00:30
00:30
00:30
What probabilistic ABX therapy ?
What is your take on preventive ABX therapy?
How likely is Pulmonary Embolism?
How do you prevent PE?
00:30
What dose?
What is your take on Cava filters?
5 days after the accident
KIT
2025/11/03 - 8:25
$central|=|1
Central line
5 days after the accident
$art|=|1
ART line
?$central|=|1
Physical exam, DIAGNOSTICS
?$art|=|1
$SAD|=|1
Urinary cath
$drainthoG|=|1
Left
Thoracic drain
$drainthoD|=|1
Right
?$ICP|=|1
$ICP|=|1
ICP monitor
Drugs
FLUIDS
?$drainthoG|=|1
?$drainthoD|=|1
20
?$SAD|=|1
16
00:30
00:30
00:30
00:30
00:30
10 days after the accident
KIT
2025/11/08 - 14:25
$central|=|1
Central line
10 days after the accident
$art|=|1
ART line
?$central|=|1
?$art|=|1
$SAD|=|1
Urinary cath
$drainthoG|=|1
Left
Thoracic drain
$drainthoD|=|1
Right
?$ICP|=|1
$ICP|=|1
ICP monitor
Drugs
SOLUTES
?$drainthoG|=|1
?$drainthoD|=|1
20
?$SAD|=|1
16
Neuroprognostication: Art vs Science
Take home messages :
Comunicating with the familly
EoL care
Curative vs Palliative care
EOL care is a clinical decision
Outcome predictors in TBI
Incorporating patient values into their EoL care
What to families expect from us?
Getting ready for the interview
Getting ready for the interview
Getting ready for the interview
Getting ready for the interview
Getting ready for the interview
Check comprehension
Conclusion
References / Pre Briefing & communication
• Steinemann S, Bhatt A, Suares G, Wei A, Ho N, Kurosawa G, Lim E, Berg B. Trauma team discord and the role of briefing. J Trauma Acute Care Surg. 2016 Jul;81(1):184-9. doi: 10.1097/TA.0000000000001024. PMID: 26953754; PMCID: PMC4915979. • Greig PR, Higham HE, Nobre AC. Cognitive aids in the management of clinical emergencies: a systematic review. Anaesthesia. 2023;78(6):680-691. • Roberts NK, Williams RG, Schwind CJ, et al. The impact of brief team communication, leadership and team behavior training on ad hoc team performance in trauma care settings. Am J Surg. 2014;207(2):170-178. • Georgiou A, Lockey DJ. The performance and assessment of hospital trauma teams. Scand J Trauma Resusc Emerg Med. 2010;18:66. • Agency for Healthcare Research and Quality. TeamSTEPPS 2.0: Team Strategies and Tools to Enhance Performance and Patient Safety. 2014. • Härgestam M, Lindkvist M, Brulin C, Jacobsson M, Hultin M. Communication in interdisciplinary teams: exploring closed-loop communication during in situ trauma team training. BMJ Open. 2013 Oct 21;3(10):e003525. doi: 10.1136/bmjopen-2013-003525. PMID: 24148213; PMCID: PMC3808778 • Bhangu A, Notario L, Pinto RL, Pannell D, Thomas-Boaz W, Freedman C, Tien H, Nathens AB, da Luz L. Closed loop communication in the trauma bay: identifying opportunities for team performance improvement through a video review analysis. CJEM. 2022 Jun;24(4):419-425. doi: 10.1007/s43678-022-00295-z. Epub 2022 Apr 12. PMID: 35412259; PMCID: PMC9002216. • El-Shafy IA, Delgado J, Akerman M, Bullaro F, Christopherson NAM, Prince JM. Closed-Loop Communication Improves Task Completion in Pediatric Trauma Resuscitation. J Surg Educ. 2018 Jan-Feb;75(1):58-64. doi: 10.1016/j.jsurg.2017.06.025. Epub 2017 Aug 2. PMID: 28780315. • Fornander L, Garrido Granhagen M, Molin I, Laukkanen K, Björnström Karlsson K, Berggren P, Nilsson L. The use of specific coordination behaviours to manage information processing and task distribution in real and simulated trauma teamwork: an observational study. Scand J Trauma Resusc Emerg Med. 2024 Dec 10;32(1):128. doi: 10.1186/s13049-024-01287-x. PMID: 39658788; PMCID: PMC11629511. • Salik I, Ashurst JV. Closed Loop Communication Training in Medical Simulation. 2023 Jan 23. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 Jan–. PMID: 31751089.
32
Riverside Hospital
2025/10/28 - 11h30 CT Scan
2025/10/28 - 11h30 Report
Cerebral
Cervical spine
Thorax / Abdomen / Pelvis
2025/10/28 - 15h - report
2025/10/28 - 14h45
Cerebral
Cervical spine
Thorax Abdo pelvis
2025/10/28 - 15h - report
2025/10/28 - 14h45
Cerebral
Cervical spine
Thorax Abdo pelvis
2025/10/28 - 19h - report
CT Head
SAT & Chest
2025/10/28 - 15h - report
2025/10/28 - 14h45
Cerebral
Cervical spine
Thorax Abdo pelvis
2025/10/28 - 19h - report
CT Head
SAT & Chest
2025/10/28 - 15h - report
2025/10/28 - 14h45
Cerebral
Cervical spine
Thorax Abdo pelvis
2025/10/28 - 19h - report
CT Head
SAT & Chest
?$drainthoD|=|1
?$drainthoG|=|1
?$central|=|1
$drainthoD|=|1
Right
Thoracic drain
$central|=|1
$drainthoG|=|1
Left
Right eye
Left eye
Right eye
Left eye
Right eye
Left eye
https://radiopaedia.org/cases/pneumonia-ultrasound-1
Right eye
Left eye
Age of the patient
Time of the injury
Mechanism of injury
Injuries found or suspected
Signs / symptoms
Treatments
SITUATION
BACKGROUND
ASSESSMENT
RECOMMANDATION
Provide basic details of the patient, the accident mechanism the location
Give a brief overview of the patient, including clinical details like initial state
Communicate relevant clinical finding : vital signs, examination...
What is expected, care priorities...
Right eye
Left eye
Right eye
Left eye