You’ll find me touting teamwork on any given night in your local emergency department. Tongue in cheek, I say things like: “What’s gonna work? TEAMWORK!” or “T-E-A-M: Together Everyone Achieves More” (sometimes I follow these statements with a high-kick and/or a wave of faux pompoms!). I’m more serious at other times like in my recent post “No Greater Love” (click here to read). Ultimately though, I love teamwork and it is why I’ve chosen to specialize in Emergency/Trauma nursing. There is just something about being united with a diverse yet, like-minded group dedicated to one purpose – Save this life!
Recently, MBA students from a prestigious business school spent time in our trauma resuscitation bay. Their assignment was to observe teamwork in high stress environments. I served as their host and it didn’t take long to meet their objective. Saturday night, the clock strikes midnight and the action starts:
“Trauma System activated, Trauma Alert: GSW (gunshot wound(s)), Police Drop-off. ETA three minutes.”
An extrication team assembles to meet the arriving police van while the trauma resuscitation team prepares in Trauma Bay #1. Tonight, in addition to my host duties, it is my job to document the real-time events of this life or death battle. I position the students to maximize the best view in the least obtrusive location to enhance their learning goals.
The extrication team rolls by my computer podium. His torso is exposed and I note a single GSW to the chest. I see his head turn from a midline ceiling stare to a lifeless position towards his right. This is what I call a death roll – the moment life, seemingly, detaches from the body.
The patient is intubated and mechanically ventilated by the airway team members. Thready, weak pulses are felt in his femoral arteries by the resident physician performing the primary survey. The log roll team helps identify an additional GSW to his back on the side opposite of his anterior wound. IV and intraosseous access is obtained by nurses just as the resident calls out, “I don’t have a femoral”. The airway physician dives two fingers into the fleshy portion of the neck, lateral to the trachea. She responds, “I don’t feel a carotid”. Three minutes have passed since the patient arrived.
Our expert trauma tech anticipates what’s coming next and, as the trauma attending says the words “we’re opening the chest”, she has a thoracotomy tray ready. I glance back at the students and see wide-open eyes and mouths. These non-medical, business-focused people are witnessing something they’ve never imagined, something they will never learn in a classroom.
Two additional nurses join the team – one pulls four units of blood product from our unit-based blood bank refrigerator. The other sets up a rapid infuser to deliver the much needed red and yellow cells. They remain at this post through the rest of the resuscitation.
The open chest reveals a fibrillating heart. There is no direct wound but the pericardial sac is filled with blood – cardiac tamponade. The surgeon moves quickly to fix this as the primary nurse gives a dose of epinephrine (Adrenalin). The internal paddles are hooked up to the defibrillator. The patient’s aorta is cross-clamped to keep blood flowing only to the most vital organs; this also stems the bleeding below the level of the clamp. The trauma senior resident massages the heart to pump the epinephrine dose through the patient. He feels the heart kick back to life then, can see it beating in an organized and effective rhythm. “We’re going to the OR” says the trauma attending. The OR charge nurse on the sidelines repsonds, “OR 10 is ready”.
I lead the team through a time-out procedure and quickly review all the details of the case. This check and balance process ensures i’s get their dots and t’s get their crosses. Additional blood is obtained for transport and a box with life support medication is atop the bed. The patient rolls, his chest draped in a sterile sheet, from the trauma bay to OR #10. New team members replace those of us now sent to the bench.
When the dust settles, I seek feedback from the student observers. “What did you see?” is met with a transient stunned silence followed by a barrage of questions on the clinical, more technical components. I answer these questions then ask the students specifically about the teamwork aspects. I get thoughtful, insightful reactions:
“It was intense but not chaotic.”
“That guy (trauma attending) is cool and calm. He clearly led the team.”
“Everyone had a job and did it.”
“I was impressed by how you had everything you needed so close by”
“I couldn’t believe how many people where in the room.” (Nursing supervisors, OR and ICU staff, police/ security staff, research assistants, registration personnel, chaplain, etc.)
(and of course) How much does all this cost?
I’ve thought/read a lot about teamwork and recently came across a Harvard Business Review article The Secrets to Great Teamwork (click here for the article) that brought me back to that night. The article provides a teamwork checklist “Does Your Team Measure Up” that I wish I had for the students. It identifies four components of team effectiveness:
Compelling Direction – Are you working together towards a common goal?
Strong Structure – Do you have the right number of people with the necessary skills to meet the team’s goals?
Supportive Context – Do you have what you need to do the job in front of you?
Shared Mindset – Does each member combine/contribute into a common identity?
It is my team’s possession of these attributes that give me a sense of reward, purpose and meaning. This holds true even in the sad times when we lose patients (as we did on that night). The ability to meld together to become a force for good is remarkable.
I count myself fortunate to work on this team.
In fact, I might even say, “It don’t seem work because it’s teamwork!”