There Is No I in Team

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We have all heard the cliché "there is no "I" in team." Teamwork is of great importance in any workplace, especially in the emergency department (ED). The following events, which took place in my high-acuity trauma center, illustrate the importance of teamwork and its eminent success within minutes.

The radio room telephone rang in the ED and the mobile intensive care nurse picked up the phone. The paramedic told her, "We have a 29-year-old man involved in a motor vehicle accident. He was the driver of the vehicle, head-on collision. There is significant damage to the car. His Glasgow Coma Scale score is 4–6–4, and he is confused. He has decreased tidal volume with labored breathing. There is a chest wall contusion from the steering wheel; the patient is hypotensive and tachycardic. The estimated time of arrival to your hospital is 8 minutes."

The nurse hung up the phone and notified the trauma team to expect the patient in 8 minutes. That left us only a few minutes to gather necessary resources. As I looked around the room, I observed the following:

Although the ED physician was preparing for a possible intubation, a call was made to the surgery team to prepare the operating room for a possible surgical emergency. Several nurses had gathered, each with their own responsibilities. There were 2 nurses to start intravenous catheters, a nurse to apply the blood pressure cuff and cardiac leads, and a nurse to document the resuscitation. The radiology technician was in the background, knowing that a radiograph would likely be needed; the radiology department was contacted to ensure the readiness of a computed tomography scan. The electrocardiogram technician was ready to perform an electrocardiogram for any cardiac damage to the patient’s chest caused by the impact with the steering wheel. A nursing attendant was sent to pick up blood from the blood bank in case the patient required it. We all gathered anxiously in front of an empty gurney waiting for the patient to arrive, knowing only the gist of his problem and not knowing what other injuries he may have as a result of the accident. A I looked at the team of professionals around the empty gurney, I was confident that we were prepared for anything and that we could handle any instability in the patient’s condition.

The patient was wheeled through the door in the ED, and the staff members visually assessed him and anticipated his needs. I could see that the team was well cultivated in the life-threatening condition of the distressed patient, who required immediate stabilization; the team was on the same page with the plan of care for this patient, and all team members knew their role.

The patient was transferred to the gurney. The paramedic relayed his report aloud as the staff listened while synchronously working, knowing the tasks that must be performed.

The patient had labored breathing and was intubated by the emergency physician. While 2 nurses started intravenous catheters in each arm, the patient was hooked up to a monitor. Hypotension was recognized and another nurse infused liters of fluid in a matter of minutes. The patient’s blood was drawn and his levels were checked within seconds; units of universal packed red blood cells for transfusion were ready to be used if the blood results were low. While all this was happening, the radiology technician managed to squeeze through the crowd to get a chest radiograph. A pneumothorax was discovered; in response, surgeons quickly inserted a chest tube. A nurse checked vital signs every few minutes to assess the response of each task.

Amazingly, oxygenation was restored through intubation, and blood pressure was normal after fluid transfusion. Blood levels were checked every 5 minutes to ensure the patient was not bleeding profusely, and the patient was rushed to the computed tomography scanner to check for further internal injuries.

As I looked around the room, keeping track of the minutes that passed as everyone performed their role, I realized the great amount of teamwork necessary for this patient’s survival. The patient’s initial instability before arriving at the ED and the patient’s stability minutes after the ED resuscitation efforts prove that teamwork equals success. I am thankful to be working in an environment where healthcare professionals respect each other, are knowledgeable and competent in their individual roles, and are able to work quickly and efficiently under pressure. The teamwork, dedication, and enthusiasm for saving lives that I encountered during this day of work remind me of why I became a nurse.