3 Leadership, teamwork and resuscitation aids
Pointers for effective team leading
1. A leader must firstly be identified – either a willing volunteer or a pre-appointed senior clinician could assume this role. If possible, pre-allocation of roles, especially the team leader role, can avoid delay and consternation when an actual resuscitation is encountered.
2. Confidence comes from practice and is vital for a resuscitation team leader. It comes from knowing the resuscitation guidelines (or other protocols) well enough to apply them automatically. Do as much clinical work as you can under an experienced team leader whom you respect. Confidence also comes from good quality, practical, integrated, scenario-based training (see Box 3.1).
3. Self-confidence is also derived from knowing where to access the information you need during the management of an emergency. It is important to know where to get the information, the relevant algorithms and resuscitation aids, as well as how they work. Do not be pressured into trying to recall information, dosages and causes. It will be far more accurate and consistent to refer to resuscitation aids (see Box 3.2).
4. The leader should delegate functions to each team member in accordance with their expertise, experience and abilities. This can either be done immediately as the team forms around the patient or at the beginning of the shift in an ED.
5. Management by objectives is an age-old leadership tool which can neatly be applied in the resuscitation setting. The objectives for the resuscitation or medical procedure (e.g. rapid sequence intubation), as well as how these will be achieved, must be clear to all concerned. These should be voiced during the actual resuscitation so that everyone involved knows what is intended, or which algorithm is being followed, or what is being prepared and anticipated.
6. Managing by measurement is another leadership strategy which, when translated into ED practice, dictates that the ultimate goal beyond a single resuscitation is to improve performance by learning from experiences, mistakes and successes. The only way to improve quality is to measure everything that is being done, so that this can be assessed and reflected upon to identify gaps, errors, and areas for improvement. The time taken to perform interventions, the sequence of events, all results, drug and defibrillator energy dosages should be recorded to help the team leader keep track of progress, and to document a detailed synopsis of the resuscitation for the clinical records. This is vital for meaningful review and research purposes.
