You identify cardiac arrest. The call for help has been sounded. You begin allocating tasks to get good basic life support happening and the defib connected. A medical registrar appears, puts her hand on the femoral area to feel for a pulse and asks “What’s the story?”
Your management is briefly interrupted to give THE STORY. The med reg joins the team, you identify a non-shockable rhythm and the team gets iv access, and you start to go through the Hs and Ts. The anaesthetist appears. He feels for a femoral pulse and asks “What’s the story?”
You give him THE STORY, he intubates the patient, you reach for the ultrasound, and then someone you don’t recognise appears saying he’s the “Resuscitation Training Officer”. He feels for a femoral pulse and asks “What’s the story?”
At this point you remember you have to sit your final fellowship exam this afternoon and you haven’t studied, all your teeth have fallen out, and you don’t have any clothes on. “Thank goodness” you tell yourself, “I’m only dreaming”.
You then wake up, wipe the cold sweat from your brow, and thankfully remember you work in an environment where cardiac arrests are managed ‘in house’. The disruptive type of asynchronous team assembly that appears in your nightmares is confined to an area of spacetime that you can no longer access.
But teams are necessary. Anaesthetists, paediatricians, surgeons and others should be welcome in your resus room when their complementary skills and knowledge can help the patient. So how do we avoid multiple handovers of THE STORY so that we can lead the team without unnecessary interruption?
One solution is the Resus Marshal. An appointed team member whose responsibilities include:
– Identify team members as they arrive
– Crowd control – ensuring non-contributors are ‘behind the line’
– Handover the background information (THE STORY) so the team leader doesn’t have to keep doing it
Crowd control is one component of managing the environment – part of the Zero Point Survey (along with safety, space, light, heat and noise).
The role of Resus Marshal could be integrate with other functions, perhaps as part of the Safety Officer‘s role, although ideally the Safety Officer should be free of distractions. The Resus Safety Officer was discussed here and crowd control was included on my proposed Resus Room Safety Officer Checklist.
However you split the roles, and whatever title you choose to give them, it makes sense to put someone other than the Team Leader in charge of crowd control and updating newcomers with THE STORY. Otherwise, leading the resuscitation can be a nightmare, even with your underwear on.
The idea of the Resus Marshal came from a Resuscitology Case Discussion. The term ‘Resus Marshal’ was coined by the Resuscitology Team after considering multiple alternatives, some of which were quite ridiculous.