Followership in complex trauma

Recent conflicts in Iraq and Afghanistan have highlighted the importance of human factors in complex trauma management. A reorganisation of trauma services in England has led to the creation of Major Trauma Centres and Major Trauma Collaboratives, with dedicated Trauma Teams. Much attention has been devoted to the role of team leader and leadership skills, with the human factor concept of followership largely overlooked. This article examines the importance of followership in the trauma team, scrutinising several different followership styles. Followership should be highlighted during trauma team training, promoting the practice of good followership to support the team leader and improve patient care.

Using full immersive simulation to prepare trauma teams to work in a major trauma centre

A reconfiguration of trauma services in the UK has led to the development of trauma networks with major trauma centres. This article describes the use of fully immersive simulation to train whole trauma teams in both a traditional simulation centre setting and ‘in situ’ in the clinical environment. Carefully designed scenarios that are driven by experienced faculty allow modern trauma management concepts, such as damage control resuscitation and massive transfusion to be explored within a hospital’s own organisational structure. Human factors specific to the trauma team can also be explored as part of a video-assisted debrief.

In-situ simulation

‘In-situ’ simulation or simulation ‘in the original place’ is gaining popularity as an educational modality. This article discusses the advantages and disadvantages of performing simulation in the clinical workplace drawing on the authors’ experience, particularly for trauma teams and medical emergency teams. ‘In-situ’ simulation is a valuable tool for testing new guidelines and assessing for latent errors in the workplace.

Human factors in contingency operations

The UK Defence Medical Services are currently supporting contingency operations following a period of intensive activity in relatively mature trauma systems in Iraq and Afghanistan. Among the key lessons identified, human factors or non-technical skills played an important role in the improvement of patient care. This article describes the importance of human factors on Role 2 Afloat, one of the Royal Navy's maritime contingency capabilities, and illustrates how they are vital to ensuring that correct decisions are made for patient care in a timely manner. Teamwork and communication are particularly important to ensure that limited resources such as blood products and other consumables are best used and that patients are evacuated promptly, allowing the facility to accept further casualties and therefore maintain operational capability. These ideas may be transferred to any small specialist team given a particular role to perform.