ITIM Trauma Team Training

The New South Wales Institute of Trauma and Injury Management (ITIM) and the Sydney Clinical Skills and Simulation Centre (SCSSC) have been in partnership since 2006. The partnership aims to maximise access to trauma training, with an emphasis on teamwork, for frontline clinical staff who manage trauma across NSW.

Major activities

The Trauma Team Training (TTT) Course is a one-day, multiprofessional, multidisciplinary simulation-based course that addresses teamwork skills and clinical practice relevant to trauma management. The course has been conducted for 250 participants to date.

The course aims to:

1. Expose trauma teams to simulated cases of serious trauma and provide them with an opportunity to rehearse early management of these cases focusing on their response and interaction as a team.
2. Instruct teams in the specific behavioural skills and attitudes relevant to effective trauma teamwork including: team leadership/followship; principles of "crisis management"; team communication; negotiation and conflict resolution and safety attitudes.
3. Revise general principles of trauma management according to recognized best practices in NSW.
4. Revise specific management of key trauma conditions including head injury, major hemorrhage and multi-trauma.

The TTT (My Hospital) Course is the TTT course contextualised for an individual hospital's trauma service. This involves incorporation of an individual hospital’s trauma system (e.g. triage system, role allocation, communication pathways, algorithms,) into the existing TTT course. This enables the team to be trained according to both generic principles of trauma care and also the specific system that operates within its institution. This course was successfully piloted for the Westmead Hospital trauma service in 2009 and will continue in 2010.

TTT Paediatrics Course is the TTT adapted for an paediatric audience, in collaboration with the Paediatric Emergency Team Course sponsored by the Greater Eastern Southern Child Health Network (2006-present). This was first piloted in 2009.

The Modular Trauma Team Training course is a flexible learning program that is designed to compliment existing hospital-based trauma education programs. It brings together an educational component - containing a core curriculum, multimedia training materials and instructors' notes – and quality improvement tools – designed to assist teams evaluate and improve the quality of their trauma services. It too emphasises teamwork and is designed to be delivered in a flexible manner using a range of training formats (seminar, workshops, simulations) depending upon the resources and scheduling options available to the local groups. This program was developed in 2009 and will be piloted at several hospitals across NSW in 2010.

The Trauma Assessment, Resuscitation and Transport (TART) program is a more comprehensive program comprising the TTT course, a skills-based course and a lecture series. Piloted 2009, Wagga.

Strategy

Each year, the partnership tackles new objectives building on achievements form the previous year.

The program began with the core training course (TTT) in 2006 then expanded in a stepwise manner by:

1. increasing the pool of instructors who are certified to teach the TTT course
2. contextualising the course for individual hospital’s trauma services to maximise its effectiveness
3. running the course in rural hospitals
4. developing a course for paediatric trauma management
5. developing a modular version that can be provided to an even larger audience
6. concurrently developing web-based educational resources via the ITIM website
7. linking with other partners who are also providing trauma education including:
   • GESCHN Paediatric Emergency Team Course
     
   • Westmead "Tiny Tots Trauma" course
     

Working Party

• Danny Cass, formerly CEO ITIM
• Patricia McDougall, Executive Manager, ITIM
• Paul Middleton, Emergency Specialist, Medical Advisor, ITIM
• Matthew O’Meara, Director Emergency Sydney Children’s Hospital
• Duncan Reed, Director Trauma Gosford Hospital, TTT Course Director
• Stephanie O’Regan, Simulation Coordinator Simulation Division, SCSSC
• Glenn Sisson, Trauma Education Manager ITIM
• John Vassiliadis, Emergency Physician RNSH, SCSSC
• Leonie Watterson, Anaesthetist, RNSH, Director Simulation Division, SCSSC
• Sue Wulf, Technical Operations Manager, Simulation Division, SCSSC

The program by year

Round 4 (2009 - 2010): Currently underway

This year's focus is upon expanding the access to courses by adapting the course content to paediatric trauma and rural areas along with expanding access to training through the modular program.

Outcomes:

• TTT Course (metropolitan) Five courses (60 places) offered to the urban area health services NSW.
• TTT My Hospital Course. This has involved incorporation of one specific hospital’s trauma system (triage, role allocation, algorithms, communication pathways) into the uniformly run TTT course. This enables the team to be trained according to both generic principles of trauma care and also the specific system that operates within its institution. A contextualised course was successfully piloted in collaboration with the trauma services team from Westmead Hospital. This was the focus of a poster accepted for the SimTect Healthcare conference 2009.
• Paediatric Trauma Team Training Course developed and piloted for the paediatric hospitals (Dec 2009).
• Trauma Assessment, Resuscitation and Transport (TART) skills day and educational evening in association with CareFlight NSW Ltd piloted at Wagga Wagga Base Hospital for 30 people (July 2009). This comprised a skills day and an educational evening (to increase the access to trauma education). It was run in conjunction with the Rural Trauma Team Training (TTT) course There was an opportunity with the onsite course to provide a mentorship to both the rural clinical leaders and the educational / simulation team.
• TTT Modular trauma training program developed.
• Wireless simulation to be evaluated. The SimMan 3G has been added to the training resources available for the purpose of piloting and evaluating a range of wireless applications. These include internet-based training and wireless enabled simulated scenarios of patient transfers and management in remote environments.
• Trauma research will be conducted focussing on evaluation of the training programs.

Round 3 (2008 – 2009): Completed

This round focused on consolidation and faculty recruitment and development to ensure the continuation of the programme. Area health services were encouraged to recruit senior clinicians and local trauma champions to participate in the team training program with a view to increasing the pool of instructors and providing cultural change mentorship within the workplace.

Outcomes:

• Urban area health services courses (60 places).
• Faculty Training Day.

Round 2 (2007 – 2008): Completed

Following the success of the five introductory courses, the program was consolidated and positively evaluated.

Outcomes:

• Dr Duncan Reed (Emergency Specialist, Gosford Hospital) was appointed as director of the Trauma Team Training course.
• Staff from five urban area health services (Northern Sydney / Central Coast, South Eastern Sydney / Illawarra, Sydney South West, Sydney West and Hunter / New England) completed one course each for 6 doctors and 6 nurses (60 places in total).
• The program was evaluated and refined:

Round 1 (2006 – 2007): Completed

The aim for this year was to introduce the concept of team training in trauma to the area health services.

Outcomes:

• A working party was established to oversee the program.
• A multi-professional, multidisciplinary, simulation-based course was designed and piloted.
• Key instructors completed the Trauma Instructor Training course.
• Staff from five urban, area health services (Northern Sydney / Central Coast, South Eastern Sydney / Illawarra, Sydney South West, Sydney West and Hunter / New England) completed allocated one course each for 6 doctors and 6 nurses (60 places in total).
• An oral presentation based reporting on this program was accepted for the SimTect Healthcare conference 2007. [Ref: O'Regan S, Watterson L, Lown S. Trauma team training: non technical skills training for multi-professional teams [oral presentation].SimTecT. Sydney Medical Simulation Centre& NSW Institute of Trauma and Injury Management;17 April 2007].