Emergency room (ER) is a department of the hospital that treats various conditions, illnesses, and injuries. The conditions, illnesses, and injuries treated in an ER are broken bones, stomach pains, strokes, heart attacks, and more. The trauma units are typically accessed through the emergency department but have their own beds and unit in the emergency department. Trauma units handled brain injuries, severe car crashes, assaults, gunshots, stab wounds, severe falls, and severe burns. Trauma centers offer more extensive care than emergency departments. Knowing which patients need a trauma center versus an emergency room could be the difference between life and death for these patients.
Trauma centers provide a comprehensible level of trauma care. There are five levels of trauma centers, and the highest level is level one. The American College of Surgeons, trying to improve trauma care, came up with a consultation/verification program in 1987. The level of the trauma center is determined by the verification status by the American College of Surgeons.
In order to be a Level One trauma center, which is the highest level of trauma centers according to the American College of Surgeons, the following qualifications need to be met:
• There must be a trauma/general surgeon in the hospital 24 hours a day.
• If there is a surgical resident in the hospital 24 hours a day, then the attending surgeon can be on call from outside the hospital and be able to get to the hospital within 15 minutes if called in.
• There must be an anesthesiologist and full OR staff available in the hospital 24 hours a day and a critical physician 24 hours a day.
• If an anesthesia resident or CRNAs takes in hospital night calls, then the anesthesiologist can pull call if they are within 30 minutes of the hospital.
• An orthopedic surgeon, neurosurgeon, radiologist, plastic surgeon, and oral/maxillofacial surgeon must be immediately availability.
• There must be more than 1200 trauma admissions per year.
• The leading physician must do at least 16 hours of trauma-related CME per year.
• The centers must participate in research and have at least 20 publications.
In a Level Two, the hospital must have:
• 24-hour coverage by an in-hospital general/trauma surgeon and an anesthesiologist.
The main difference between Level One and Level Two is that Level Two does not have to do the publications.
A Level 3 does not require as much as Level One and Level Two trauma centers. They do not have to have an in-hospital general/trauma surgeon 24 hours a day in a Level Three, but a surgeon must be on call. An Anesthesia and OR staff must be within 30 minutes of the hospital and be on call. In Level Three, the hospital must have transfer arrangements to transfer trauma patients if they require services not available at the hospital.
There are five Level One trauma centers in the state of Georgia, and they are as follows:
August University Medical Center in Augusta, Grady Memorial Hospital in Atlanta, Medical Center Navicient Health in Macon, Memorial Health University Medical Center in Savannah, and Wellstar Atlanta Medical Center in Atlanta. There are eight Level Two hospitals in Georgia, and they are as follows: Doctors Hospital of Augusta in Augusta, Floyd Medical Center in Rome, Northside Gwinnett Medical Center in Lawrenceville, Northeast Georgia Medical Center in Gainesville, Piedmont Athens Regional in Athens, Piedmont Columbus Regional in Columbus, WellStar Kennestone Hospital in Marietta and WellStar North Fulton Hospital in Roswell. There are eight Level Three hospitals in Georgia, and they are Cartersville Medical Center in Cartersville, Crisp Regional in Cordele, Fairview Park Hospital in Dublin, Hamilton Medical Center in Dalton, John D. Archbold in Thomasville, Piedmont Walton in Monroe, Redmond Regional in Rome, and WellStar Cobb Hospital in Austell. There are eight Level Four trauma centers, three Pediatric Centers, with one of the Pediatric Center hospitals being a Level One and the other two are Level Two. There are two burn centers in Georgia and are verified by the ACS.
The purpose of the emergency room is to treat critically ill patients and to prevent cardiac arrest in patients presenting with signs of physiologically instability. Patients arriving at the emergency department of a hospital are processed by the Triage System. Patient presenting in a critical condition are coded red and immediately admitted to the emergency room. Patients classified as less critical but whose condition may worsen, with signs of physiological instability, are also admitted to the emergency room. This reflects the operating principles of the emergency room based on the prevention of cardiac arrest. All patients admitted to the emergency room have an emergency room chart.
Guide, 2019) Tuckman in his Model of Group Development provides easily identifiable stages that a groups performance can be measured against, making it useful for monitoring performance, Figure 2 shows Tuckman’s model. Ranking group performance against this scale can provide leaders with a clear understanding of how the group are functioning, allowing them to implement policies to change this if performance is unsatisfactory (Pettinger, 2007). Within organisations, the theory can be loosely applied to creating teams by grouping familiar individuals with the aim that they will reach the norming and performing stage of the model quicker. For short and simple tasks this is an extremely effective way of organising groups, due to the increased short term productivity. However there are significant issues with grouping individuals in this manner, particularly when tasks become more complex, and ultimately the model should mainly be used for monitoring the progress of groups (Pettinger, 2007). Figure 3: Belbin’s Team Roles (PrePearl Training Development, 2019) A more functional approach of grouping individuals is to utilise Belbin’s Team Theory (Belbin, 2017). Belbin identifies 9 key roles that must be fulfilled within a group to ensure success, the roles are summarised in Figure 3. The roles cover a wide spectrum of skills that need to be present within a group to ensure success, and becomes essential when tasks are lengthy and complex. Organisations can find the Belbin roles each individual fits through a questionnaire, and thus balanced groups can be formed covering all the roles. However, like with Fiedler’s contingency model, the theory when translated to practice can often become very impractical for organisations to implement regularly. This is largely because the organisation is constrained by the personalities of their employees, their may be an abundance of one personality type and an absence of another, the only solution is to hire externally to fill the missing roles within teams. This can result in an extensive payroll for an organisation and huge financial implications as they cannot legally dismiss employee’s if they have too many of one personality type. The importance of Belbin roles in a team became apparent for Group 1 on the first day of the outdoor management course, the group had 5 people who filled the completer finisher and implementor roles, however had no-one filling the resource investigator or monitor evaluator role, the group ran out of time and did not complete the task successfully. Obviously running out of time was not the sole cause of the groups failure, however if someone had been monitoring time and performance then the group may have realised their option was unfeasible and could have found an alternative solution. One solution for lack of Belbin roles is to assign specific roles to individuals, this was implemented heavily on the outdoor management co