Some of the most stressful procedures in clinical medicine occur relatively rarely. One such procedure is the treatment of a patient (often a young person) who has been stabbed in the chest and has arrested in the Emergency Department (ED). Many of us have seen situations where the diverse group of practitioners looking after such emergently sick people have not shared the same mental model and outcomes have not been as good as they could be.
There are multiple courses teaching surgeons and ED physicians how to operatively open a chest in an emergency (and how to decompress a cardiac tamponade). There is ATLS, which gives a broad brushstroke of how teams should work together to look after a patient who has presented after life-threatening trauma. These two things will only get you so far!
How do you get a group of six to ten practitioners with anaesthetic, surgical, and advanced nursing skills to efficiently open a patient’s chest (via a clamshell thoracotomy), relieve a cardiac tamponade, and get digital control on a hole in the right ventricle within five minutes of arrest? Drawing on our skills from devising CALS and REACT, we have produced the answer.
A group of clinicians from a large trauma unit in the United Kingdom came together with CARE LLC to design guidelines and training to address these issues. Designing a simple and robust protocol (rooted in the principles of ATLS) and using modern human-factors-based training, we have devised the “Coventry” Resuscitative Thoracotomy Course. This aims to teach ED staff how to work as a team to resuscitate (using a clamshell thoracotomy) an arrested patient who has undergone chest trauma.
Due to the rapid pace of technological and practical change—twinned with the enormous connectivity of modern medicine—it is essential that we communicate new techniques such as REBOA and integrate them into our guidelines. We have thus designed a networking facility that ensures our protocols remain relevant. This networking ability, supported by our social media presence, allows practitioners to discuss practical solutions and share their knowledge.
We are delighted that you are joining this team and thank you for your interest in the “Coventry” Resuscitative Thoracotomy Course.