Page 47 - JSOM Spring 2026

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The TeamSTEPPS (Agency for Healthcare Research and Qual- is at risk of attrition, especially during periods of low patient
ity, Rockville, MD, USA: Team Strategies and Tools to Enhance volume. Regular refresher sessions are necessary to prevent a
Performance and Patient Safety) approach (not to be con- loss of proficiency and ensure readiness for diverse scenarios. 24
fused with our STEP) is validated in healthcare settings. Team
STEPPS is used to enhance communication within Army med- Maintenance routines, including equipment inspections as
ical teams, leveraging its proven efficacy in improving patient part of the zero-point survey (see below), are crucial for ensur-
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safety. In addition to noise discipline and common-sense mea- ing equipment availability and functionality and for avoiding
sures such as mutual respect and clear, concise communication, serious incidents that could negatively affect casualty care.
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three critical communication techniques are employed among These checks should be integrated into the unit’s daily routine
FRSD members during trauma resuscitation. These techniques to maintain operational readiness.
include the “call-out,” which facilitates simultaneous informa-
tion dissemination and task anticipation; the “check-back,” Effective layout of equipment enhances efficiency during re-
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which ensures accurate message transmission and receipt; and suscitation. Even well-maintained equipment that every team
the “two-challenge rule,” which empowers every team mem- member is familiar with will be of limited use when it is not
ber to address safety concerns assertively. These strategies pro- within reach. Ill-thought-out positioning of core equipment
mote effective communication and coordination, essential for can result in unnecessary delays of life-saving interventions or
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successful trauma resuscitation outcomes. Examples for these impede team members’ movement during the resuscitation.
communication techniques can be found in Appendix 2. Core tools such as IV/IO (intravenous/intraosseous) kits,
medication trays, and airway equipment should be readily ac-
Equipment cessible and positioned according to a predetermined layout.
Equipment management within a trauma resuscitation team Adjustments may be necessary based on available space and
involves three key elements: familiarization, maintenance, and the nature of the facility. Standardized toolkits (Appendix 2)
layout. and a basic layout scheme (Figure 2) facilitate consistency, pre-
paredness, and rapid access to life-saving equipment.
Familiarization with the equipment is paramount, as team mem-
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bers may encounter unfamiliar tools in a deployed setting. Every Process
team member must familiarize themself with the equipment pro- “Process” is a universal and central component for teams op-
vided. After initial familiarization, newly acquired knowledge erating in high-stress, high-stakes environments. As such, it

TABLE 2 Example for Individual Team Member Roles and Responsibilities in an 8-person Resuscitation Set Up (Single Patient Scenario)
Role Typical Specialty/MOS Positioning Responsibility/Assignment
Trauma team EM physician/ Foot of the bed • Leads team through resuscitation.
leader Surgeon • (May help with eFAST, advanced procedures)
Recording nurse ICU-nurse Next to TTL • Documentation
• Safety
• Reads/confirms CPG/procedural checklist as needed
Airway manager CRNA Head of the bed • Assess Airway
• Basic airway maneuvers (suctioning, oxygen, nasopharyngeal airway,
oropharyngeal airway)
• Intubation, ventilation
• Glasgow Coma Scale and disability assessment
• Ballistic/Secondary Survey head to clavicle
• Communicating with patient (explain/calming, etc.)
Primary assist EM nurse Patient’s right chest • Exposure right arm/chest
• Obtain manual BP if “Secondary assist” is unable to do so
(left arm injured, amputated, etc.)
• Attach patient to Monitor (electrocardiogram leads, oximeter,
BP cuff)
• Right arm IV access
• Medications/blood transfusion
• Assist with procedure set-up
Secondary assist Medic Patient’s left chest • Exposure left arm/chest
• Manual BP left arm.
• Access (IO/IV)
• Blood transfusion
• Assist with procedure set-up
Proceduralist EM physician / Right side of patient • Exposure right leg/pelvis
Surgeon / Orthopedic (legs) • Ballistic survey/Secondary survey (from clavicle down)
Surgeon • Advanced trauma procedures (including eFAST, chest tube, etc.)
Procedure assist LPN Left side of patient • Exposure right leg/pelvis
(legs) • Set-up/assist with procedures
Blood runner Operating room tech/ Between blood storage • Operate Rapid Infuser
detachment sergeant / location and rapid • Deliver ordered blood products
field medical assistant infuser • Assist with transfusion
BP = blood pressure; CPG = clinical practice guidelines; CRNA = certified registered nurse anesthetist; eFAST = extended focused assessment
with sonography in trauma; EM = emergency medicine; ICU = intensive care unit; IO = intraosseous; IV = intravenous; LPN = licensed practical
nurse; TTL = trauma team leader.

STEP Method for FRSD Trauma Teams | 45