Page 45 - JSOM Spring 2026

In addition to basic trauma resuscitation skills, medical pro- maintaining the blood supply for transfusions. The set-up for
viders such as surgeons, emergency medicine physicians, and the single-patient resuscitation is shown in Figure 1a.
CRNAs may perform advanced interventions (Table 1). These
often require assistance from the team, necessitating general The underlying principle of clearly defined roles and respon-
familiarity with these procedures among all team members. sibilities should also guide the management of mass casu-
alty scenarios. By consolidating certain roles and expanding
Team Organization the scope of responsibilities for individual team members,
To execute complex tasks in an organized and timely man- the eight-person resuscitation team can be reconfigured into
ner, a team needs to assign roles/responsibilities based on each two four-person teams capable of resuscitating four patients
team member’s skill set and cultivate effective communication. in parallel (Figure 1b). The specific team structure may vary
depending on the skill sets of individual personnel, and such
Roles and Responsibilities adjustments should be planned and rehearsed in advance.
Assigning clear roles and responsibilities is critical for the
swift and effective management of high-stress, high-stakes In mass-casualty scenarios involving more than four patients
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situations. Trauma scenarios demand seamless coordination for a full (20-person) FRSD, leaders will have to assign per-
and rapid decision-making, and having designated roles en- sonnel based on need (severity of injury/type of procedures
sures that each team member knows their specific duties and required). Key elements that are required to allow this type of
functions. In high-pressure situations, clear roles help stream- team adaptability to multi-casualty scenarios include triage,
line communication, reduce chaos, and enhance overall team the above mentioned “skill redundancy” (multiple team mem-
efficiency. This clarity is vital for prioritizing tasks, minimizing bers being trained in the same skill and various roles), reallo-
errors, and maximizing the chances of positive patient out- cation of staff as resuscitations progress, close communication
comes. Additionally, in emotionally charged and challenging between team leaders and recruitment of ancillary staff from
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circumstances, well-defined roles provide a sense of structure other units (medics, 18 Deltas, etc.) if available.
and focus, fostering a supportive environment for the entire
trauma team as they work collaboratively to save lives. Communication
Effective communication is indispensable for teams operating
The allocation of roles and responsibilities, as outlined in Ta- in dynamic, high-stress environments, enabling coordinated
ble 2 and illustrated in Figure 1, is based on a single-patient execution of complex tasks. Establishing a “common lan-
scenario in a split FRSD comprising 10 personnel. In a full guage” among team members is essential for optimal team
FRSD configuration with 20 personnel, this set-up would en- functioning. 19
able the simultaneous resuscitation of two patients.
One critical communication aspect in high-stakes situations is
In the single-patient scenario, two team members are not di- noise discipline, which minimizes distractions, strengthens fo-
rectly involved in the resuscitation process. Typically, the oper- cus, and enhances situational awareness. This principle is rec-
ating room technician prepares the operating room for damage ognized across various high-stress environments, such as the
control surgery while resuscitation continues. The remaining surgical operating theatre and aviation, where regulations
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team member may manage crowd control at the entrance to mandate noise discipline during critical flight phases to en-
the resuscitation area and initiate communication with trans- sure crew focus and safety. Similarly, maintaining noise disci-
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port or higher levels of care, in consultation with the TTL, pline during trauma resuscitation fosters a culture of precision
usually the general/trauma surgeon or emergency medicine and attentiveness vital for patient safety and resuscitation
physician. Another critical task is assisting the blood runner in success.

TABLE 1 Basic and Advanced Traum a Resuscitation Skills
Level Miscellaneous skills Hemorrhage control Airway and breathing Circulation
Basic FRSD Trauma • Operate monitor • Direct/indirect pressure • Operate airway suction • Intraosseous-access
Resuscitation Skills • Perform primary and techniques device placement
secondary survey • Tourniquet application • Operate oxygen bottles/ • Peripheral intravenous-
• Set up medication • Pressure dressing application devices access placement
injections and infusions • Wound packing • Supraglottic airway • Arterial line set up
• Operate blood analyzer placement • Operate rapid blood
• Cervical collar placement • Nasopharyngeal and transfusing/warming
• Pelvic binder placement oropharyngeal airway equipment
• Logroll placement • Manual blood pressure
• Splinting (traction splint) • Needle chest measurement
decompression • Set up blood
• Bag-mask ventilation transfusion
• Operate chest tube system
Advanced FRSD Trauma • Sedation, analgesia, and • Vascular ligation • Intubation • Resuscitative
Resuscitation Skills paralysis • REBOA • Ventilator operation thoracotomy
• Fracture or joint • Cricothyrotomy • Central venous line
dislocation reduction • Finger thoracostomy placement
• eFAST • Chest tube placement • Arterial line placement
• Lateral canthotomy
• Fasciotomy
eFAST = extended focused assessment with sonography in trauma; FRSD = Forward Resuscitative Surgical Detachment; REBOA = resuscitative
endovascular balloon occlusion of the aorta.

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