Article Figures & Data
Figures
- Figure 1
Delphi study overview. AE, adverse event.
Tables
- Table 1
Demographic characteristics of participants
Profession n (%) Trauma surgeon 11 (50.0) Emergency medicine physician 5 (22.8) Nurse 4 (18.2) Anesthesiologist 1 (4.5) Respiratory therapist 1 (4.5) Years in practice, mean (SD) 8.2 (6.6) Country of practice n (%) Canada 15 (68.2) USA 7 (31.8) - Table 2
Final taxonomy of adverse events that occur during acute trauma resuscitation
Airway and breathing Failure to identify need for supplemental oxygen.
Unanticipated loss of airway.
Unintentional delay in intubation (>5 min).
Unsuccessful intubation attempt.
Malpositioned endotracheal tube.
Aspiration event.
Ventilator malfunction.
Failure to identify need for chest tube.
Failure to perform surgical airway when indicated.
Administration of paralytics prior to all teams ready.
Failure to discuss, anticipate, or treat hemodynamic instability prior to intubation.
Circulation Failure to obtain peripheral or central venous access within 5 min of first attempt.
Failure to draw bloodwork within 10 min of arrival.
Delay of >10 min to blood product administration (once blood is called for).
Delay to administration of blood products to set up rapid infuser.
Greater than 1 L crystalloid bolus given in presumed hemorrhagic shock.
Failure to administer blood products or initiate vasopressors with ongoing shock (SBP <90).
Failure to activate massive transfusion protocol (if more than 2 units of blood products required).
Failure to control ongoing external bleeding.
Failure to identify/treat worsening hemodynamics or level of consciousness.
Failure to administer TXA in presumed hemorrhagic shock and injury <3 hours.
Failure to give platelets or fresh frozen plasma if >6 units of blood product given in trauma bay (ie, only pRBC given).
Primary resuscitative line is subdiaphragmatic (ie, femoral line, tibial IO) in patients with positive FAST or open book pelvis
EMS handover Failure or delay to activate trauma team.
Inaccurate or incomplete medical history report.
Team member(s) absent for EMS handover.
Patient assessment begins before EMS handover in stable patients.
Management of injuries Medication error.
Failure to treat hypothermia.
Failure to apply or incorrect application of pelvic binder in the setting of open book pelvic fracture.
Failure to offer effective analgesia/sedation to patients.
Failure to reduce fracture/dislocation in setting of pulseless limb.
Failure to provide patients with unique hospital ID or bracelet within 5 min of arrival.
Failure to administer hypertonic saline or mannitol in setting or presumed head injury with lateralizing signs or unilateral pupil deficit.
Assessment of injuries Failure to maintain cervical spine precautions (if indicated).
Failure to get X-rays before departure from trauma bay (if indicated).
Failure to complete primary survey before departure from trauma bay.
X-ray misinterpreted.
FAST misinterpreted.
Incomplete exposure of patients.
Failure to calculate GCS.
Failure to measure temperature.
Failure to assess circulation and function in injured limbs.
Disposition Delay more than 15 min waiting for CT.
Delay more than 15 min waiting for OR (if emergent OR).
Transfer to CT scan with hemodynamically unstable patients.
Procedure related Technical errors.
Equipment failure/missing.
Failure to perform an indicated resuscitative procedure.
Iatrogenic injury during procedure.
Knowledge deficits concerning equipment location.
Performing FAST examination interferes with ability to obtain initial intravenous access.
Bodily fluid exposure or needlestick injury to healthcare team member.
Team communications and dynamics Unclear responsibility and roles.
Patient care activities delayed or not completed due to task overload/competing priorities.
Team member unavailable.
Concurrent conversations preventing team leader communication.
Ineffective team leadership/unclear authority of team leader.
Failure to use closed-loop communication.
Clinical team members distracted by non-clinical-related tasks (ie, answering phone).
Inadequate personal protective equipment.
Trauma team leader leaves position to participate in patient care without delegating interim leader.
Patient monitoring and access Inadequate monitoring (ie, loss of telemetry, pulse oximetry for >3 min).
Failure of patient-monitoring equipment (ie, patient monitor, EtCO2, temperature probe).
Oxygen supply runs out.
Loss of all central/intravenous access.
Delay in assessment or treatment due to agitated or combative patients.
EMS, emergency medical services; EtCO2, end-tidal carbon dioxide; FAST, focused abdominal sonography in trauma; GCS, Glasgow Coma Scale; ID, identification; OR, operating room; pRBC, packed red blood cells; SBP, systolic blood pressure; TXA, tranexamic acid.
