Appropriate individual education, training, and baseline qualifications are a requisite starting point for building the successful trauma team. However, individual qualifications alone are not enough; indeed, poorly coordinated or even conflicting experts in their field may produce inferior patient outcomes when compared to a well-rehearsed team whose individuals, while competent, may be mediocre by comparison. Emergency physicians, trauma surgeons, anesthesia providers, additional consultants, nursing staff, respiratory therapists, and medical technicians (like the Navy Hospital Corpsman) must converge upon the patient in a well-choreographed effort to save a life. No single specialty can do it all, and trauma is indeed a team sport [14]. A team is essentially defined as a small group of people with corresponding complementary skills, all working together to achieve a common goal. Effective teams are scalable and dynamic, performing both independent behaviors as well as interdependent and coordinated series of tasks [15].

Again, a full discussion of principles such as leadership, adaptability, and assertiveness is included in earlier chapters. Many of these characteristics are not easily taught but must be developed through experience, introspection, and careful study. Thus, there is a need for simulations, drills, reviews, and feedback. Indeed, some principles, most notably leadership and decision making, are the focus of advanced study in many fields. While some have argued that traits such as leadership and adaptability are innate, growing evidence [16] suggests that even among those not so inclined, these skills can at least to some degree be learned. In many ways, leadership will “declare” itself in a trauma team, and team members will adapt to its presence (or absence) over time. Anyone who wishes to exert leadership within a trauma team should expect not only to know his or her field well but should also commit to continuously revisiting the study of leadership in adversity, human behavior, and communication.

Maintaining good situational awareness, as well as a healthy appreciation for how quickly the clinical (or operational) situation can change (adaptability), is critical, especially in a combat or mass casualty environment. The trauma team must not only anticipate the likely course of a specific injury but also respond seamlessly when the information changes—especially for the worse—and must do so in a non-accusatory manner if trust and communication are to be reinforced. Situational awareness generally involves three (or four) levels: perception, comprehension, and projection. Perception encompasses monitoring, cue detection, and simple recognition and leads to an individual awareness of current objects, events, people, systems, and environmental influences. Comprehension involves integration of the many varied perceived components, as well as an appreciation for how these factors may influence individual or team goals, objectives, and outcomes. Projection is achieved through taking the knowledge gained from perception and comprehension, and then extrapolating their likely impact on the patient or operational environment in a timely manner [17]. Personnel and supply status, the likelihood of additional incoming casualties, operating room availability, blood supply, en route care capability, evacuation assets, weather conditions, and current tactical or security situation must all be within the “scan” of the modern trauma team’s situational awareness, particularly when making patient care decisions in a deployed environment [18]. The trauma environment, much like the combat setting, implies dynamic conditions that routinely change in a split second, and therefore, situational awareness must become a product of the team, whereby “distributed cognition” becomes the team’s expected norm, significantly augmenting their previous performance.

Good communication naturally lends itself to distributed situational awareness, augmented trust, and teamwork. Familiarity as a team can also lead to the ability to “read” unspoken communication factors; body language, task distribution, command structure, team history, and individual personality considerations all play a role. It is broadly documented that errors in communication are responsible for approximately 60–80 % of all healthcare errors. Communication between team members must be clear and unambiguous and is most effective when members feel respected and empowered to participate [19].

Communication must be in a language that all team members can understand and not be “profession specific” (sometimes interpreted as condescending). Ideally, the communicator will make eye contact, will stop distractions or other tasks if possible, and will check understanding on the part of the intended receiver (e.g., by having them repeat back the information or request that was passed), all while minimizing any emotional factors. Unequivocal (“autocratic”) communication from a defined trauma team leader has been shown to contribute to improved team coordination, ATLS adherence, and secondary survey [11] performance and is often called for during stressful phases of initial evaluation and resuscitation. Conversely, once the patient has been stabilized and admitted, the multidisciplinary trauma/critical care team (intensivists, nurses, respiratory and physical therapists, pastoral care, interpreters, and many others) can ideally operate under a more collaborative governance [19].