The trauma team and initial management of the critically injured patient

Recent conflicts in Afghanistan and Iraq have driven the development and refinement of the trauma team based approach to complex injury. This has arguably contributed to the remarkable outcomes seen, with many casualties recovering from seemingly un survivable injuries. Many concepts developed by the military have subsequently been adopted by civilian healthcare providers. Human factors and non-technical skills play a vital role in the initial management of the critically injured patient and can be taught and practiced alongside more traditional clinical skills. The trauma team leader performs a vital role within the trauma team, assimilating and communicating information and taking decisions at certain key points. These decision points can be predicted in advance and include whether to perform early CT imaging and early surgical intervention for control of exsanguinating haemorrhage. Effective communication underpins all of the work of the trauma team and should be conducted in a standardized fashion in order to reduce error.