September 13, 2012 by EmerJencyWEBB
Got to hone the skills tonight with hypotensive GSW to the chest.
During my residency, I’ve had the chance to witness great leaders in action and poor leaders in action. It’s not a science, and more often than not, it is the act of keeping things clear and simple that holds the team together.
1. Good leaders prep their team before a critically ill patient arrives.
- Nobody likes the unknown. The time between EMS making first contact with the ED and their arrival, especially for critical patients, is filled with anxiety, conjecture, gossip among medical staff. Poor communication of the patient’s anticipated problem, level of stability, and anticipated immediate actions on arrival only fuels the fire.
2. Good leaders establish roles early and verbally prior to patient arrival to the ED
- This means, every critical patient. This means every time, even if your team has heard it all before.
- Who’s doing the IV? Who’s hooking up the patient to the monitor? Who’s recording? Who will be performing CPR?
- Flesh all these roles out (including your own) as early as possible, and if feasible, before patient arrival to the ED
(Maybe we should have a mandated physician driven resus “Time Out”, similar to what is used prior to Safe Surgery that encorporates points 1 and 2 when critical patients are presenting via EMS)
3. Anticipate future actions verbally for the group
- You can’t keep the game plan in your head
- This also makes sure everybody stays on the same page, and understands where the group as a whole is headed
- For example: “Once this unit of blood is in, we’ll reassess, and if the patient has stabilized, let’s get everything packed for transport to CT. If not, then we will be going to the OR”
4. Speak loudly, don’t yell. Speak clearly, don’t mumble.
5. Manage extraneous people and noise
- Delegate responsibilities to the individuals who do not have a job, or if the environment is becoming chaotic due to crowding, ask the extras to leave the room.
- Don’t be afraid to be the noise police. The best resuscitations are usually quiet resuscitations.
- It is amazing how low-grade chatter in the resuscitation bay multiplies and builds on itself. In the hustle and bustle of medical and trauma resus, it can peak to a level that is not conducive to patient care.
6. Maintain a sense of calm
- Easier said than done, but your nurses, aides, and techs will mirror your behavior
If you have any other ideas on what makes a good team leader, post your thoughts below.