8th Annual American College of Surgeons Accredited Educational Institutes (ACS-AEI) Consortium| Volume 160, ISSUE 3, P586-590, September 2016

Immersion team training in a realistic environment improves team performance in trauma resuscitation


      In the US military, it is common for health care teams to be formed ad hoc and expected to function cohesively as a unit. Poor team dynamics decreases the effectiveness of trauma care delivery. The US Navy Fleet Surgical Team Three has developed a simulation-based trauma initiative—the Shipboard Surgical Trauma Training (S2T2) Course—that emphasizes team dynamics to improve the delivery of trauma care to the severely injured patient.


      The S2T2 Course combines classroom didactics with hands-on simulation over a period of 6 days, culminating in a daylong, mass casualty scenario. Each resuscitation team was initially evaluated with a simulated trauma resuscitation scenario then retested on the same scenario after completing the course. A written exam was also administered individually both before and after the course. A survey was administered to assess the participants' perceived effectiveness of the course on overall team training.


      From the evaluation of 20 resuscitation teams made up of 123 medical personnel, there was a decrease in the mean time needed to perform the simulated trauma resuscitation, from a mean of 24.4 minutes to 13.5 minutes (P < .01), a decrease in the mean number of critical events missed, from 5.15 to 1.00 (P < .01), and a mean improvement of 41% in written test scores. More than 90% of participants rated the course as highly effective for improving team dynamics.


      A team-based trauma course with immersion in a realistic environment is an effective tool for improving team performance in trauma training. This approach has high potential to improve trauma care and patient outcomes. The benefits of this team-based course can be adapted to the civilian rural sector, where gaps have been identified in trauma care.
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        • Biddinger P.D.
        • Baggish A.
        • Harrington L.
        • d'Hemecourt P.
        • Hooley J.
        • Jones J.
        • et al.
        Be prepared —The Boston marathon and mass-casualty events.
        N Engl J Med. 2013; 368: 1958-1960
        • Manser T.
        Teamwork and patient safety in dynamic domains of healthcare: A review of the literature.
        Acta Anaesthesiol Scand. 2009; 53: 143-151
        • Thorson C.M.
        • Dubose J.J.
        • Rhee P.
        • Knuth T.E.
        • Dorlac W.C.
        • Bailey J.A.
        • et al.
        Military trauma training at civilian centers: A decade of advancements.
        J Trauma Acute Care Surg. 2012; 73: S483-S489
        • Holcomb J.B.
        • Dumire R.D.
        • Crommett J.W.
        • Stamateris C.E.
        • Fagert M.A.
        • Cleveland J.A.
        • et al.
        Evaluation of trauma team performance using an advanced human patient simulator for resuscitation training.
        J Trauma. 2002; 52 (discussion 1085-6): 1078-1085
        • Hoang T.N.
        • Kang J.
        • LaPorta A.J.
        • Makler V.I.
        • Chalut C.
        Filling in the gaps of predeployment fleet surgical team training using a team-centered approach.
        J Spec Oper Med. 2013; 13: 22-33
        • Williams R.G.
        • Silverman R.
        • Schwind C.
        • Fortune J.B.
        • Sutyak J.
        • Horvath K.D.
        • et al.
        Surgeon information transfer and communication: Factors affecting quality and efficiency of inpatient care.
        Ann Surg. 2007; 245: 159-169
        • Roberts N.K.
        • Williams R.G.
        • Schwind C.J.
        • Sutyak J.A.
        • McDowell C.
        • Griffen D.
        • et al.
        The impact of brief team communication, leadership and team behavior training on ad hoc team performance in trauma care settings.
        Am J Surg. 2014; 207: 170-178
        • Hunziker S.
        • Johansson A.C.
        • Tschan F.
        • Semmer N.K.
        • Rock L.
        • Howell M.D.
        • et al.
        Teamwork and leadership in cardiopulmonary resuscitation.
        J Am Coll Cardiol. 2011; 57: 2381-2388
        • Branas C.C.
        • MacKenzie E.J.
        • Williams J.C.
        • Schwab W.
        • Teter H.M.
        • Flanigan M.C.
        • et al.
        Access to trauma centers in the United States.
        JAMA. 2005; 293: 2626-2633
      1. Access to trauma centers in the US.
        [Internet]. Centers for Disease Control and Prevention, Atlanta (GA)2015 (Available from:)
        • Helling T.S.
        Trauma care at rural level III trauma centers in a state trauma system.
        J Trauma. 2007; 62: 498-503
      2. Lipshy KA, LaPorta AJ. Operating room crisis management leadership training: Guidance for surgical team education [Internet]. Chicago (IL): American College of Surgeons; c2016 [updated 2013 Oct 1; cited 2015]. Available from: