October 2015 | Issue 20
The t in trauma


Byline photo (Custom).JPG

By Lavisha S Punjabi
Class of 2018


It is the moment of truth. I take a step towards the manikin, ready to perform the tracheal intubation. After preparing the requisites, I take a deep breath in and pick up the laryngoscope to begin the procedure under the guidance of the professor. Several minutes in, I find myself struggling to get a good visualisation. As the professor places her hand on the laryngoscope to assist me, I gradually loosen my grip, letting out a long breath full of disappointment…


There is an unquestionable similarity between the management of major trauma and the choreography of a Formula One pit stop. A tenacious team of professionals race against the deceiving nature of time to complete the mammoth task ahead of them. In such circumstances, teamwork naturally becomes vital. However, unlike the pit stop crew, trauma management teams enjoy neither regularity nor predictability because trauma delivers a different blow each time. Not to mention that it is a matter of human life.

The STAR Course (Basic) participants together with local, Thai and Singaporean faculty
Courtesy of Dr Narain Chotirosniramit, Head of Trauma and Critical Care Unit, Chiang Mai University


During the vacation break at the end of the academic year, six students - Brenton Sio, Cherie Seah, Edwin Chew, Koh Jin Kiat, Yeo Wei Ren and myself - had the golden opportunity to learn the value of teamwork in trauma management. Assisting with logistics, we accompanied a team of experienced medical professionals – trauma surgeons, an emergency physician, an anaesthetist and trauma coordinators – from Singapore and a trauma surgeon from Thailand, to Phnom Penh, Cambodia, to deliver a trauma management course.

(L-R): Dr Fong Wee Kim, Consultant Anaesthesiologist at Tan Tock Seng Hospital, conducts a briefing for participants before they begin their practical skills station; Ms Karen Go, Trauma Coordinator at Tan Tock Seng Hospital, demonstrates the use of a leg traction brace, used to realign fractures
Courtesy of Dr Narain Chotirosniramit, Head of Trauma and Critical Care Unit, Chiang Mai University


The course was part of the Skills in Trauma and Resuscitation (STAR) programme, a three-year programme that aims to bolster trauma management competence of the healthcare professionals there. The basic and advanced course was conducted at Calmette Hospital from 20 July to 24 July.

"The management of major trauma patients, like any complex patient, requires great teamwork from doctors and nurses to work well together under tremendous pressure. I hope the students have had a chance to appreciate this aspect in addition to learning about how anatomy and physiology are applied in the injured patient," said Associate Professor Tham Kum Ying, Assi
stant Dean for Years 3 & 5 and Senior Consultant, Department of Emergency Medicine, Tan Tock Seng Hospital.

(L-R): Participants discuss how to save a simulated patient in a mock trauma scenario; participants practise a log roll on a volunteer to check for spinal injuries
Courtesy of Koh Jin Kiat​

Jin Kiat, who volunteered as a simulated patient for a demonstration during the course, said of the experience, "I am amazed by how efficiently the trauma team attended to me – at one point, at least three procedures were performed simultaneously and within a very short period of time. There was absolutely no confusion or hesitation, and that saved precious seconds that could be of utmost importance to a severely wounded patient." 

Complementing this to-the-millisecond-precise teamwork is the systematic framework of evaluation and response in trauma management, universally known as the ABCDE approach, representing airway, breathing, circulation, disability, exposure and environment. This approach ensures that the most life-threatening aspects are addressed at the outset, regardless of the permutation of injuries presenting at the hospital.

"Trauma management is not just about having a good pair of hands, but also having a strong pair of shoulders and a calm, collected mind that can make important decisions under stress," added Jin Kiat.

After the conclusion of the basic course, we were guided on a tour of Calmette Hospital where I recognised familiar faces; the very participants of the course were back in their jobs, serving humanity. It was in that magical moment I realised how immediate and enabling the impact of education can be.

"I learnt that a significant part of medicine is about empowering your colleagues with knowledge so that they are able to make a bigger difference in the lives of others," said Edwin. Cherie added, "The team has truly been an inspiration to me. I definitely wouldn't need to think twice about going again if I have the opportunity to in the future!"

And there we have it, the T in trauma - seamless teamwork, systematic thinking and visionary teachers. To discover the R, A, U, M and A, be sure to join the STAR team on their next trip!


…As my grip loosens on the laryngoscope, the professor warns, "Don't let go. You'll never learn otherwise." For we can never be grateful enough to educators so nurturing as to extend learning opportunities to young students like ourselves, in programmes such as this one. Hold on tight to the handle of your window of opportunity. Hold on tighter to your dreams.