The Pediatric Surgery Chief Resident shall assume the role of Team Leader. If a Surgical Attending or Pediatric Emergency Room Attending is present, then the Chief Resident shall work with the Attending to lead the resuscitation.
In the absence of the Pediatric Surgery Chief Resident(ie: nights and weekends or during the day when the Pediatric Surgery Chief is unavailable or scrubbed), the Adult Trauma/On-call Chief Resident shall be the Team Leader for alerts. If the Adult Trauma/On-call Chief Resident is unavailable for the alert, then he or she shall notify the Pediatric Surgery Chief Resident, who will evaluate the patient as quickly as possible.
If the Team Leader is the Adult Trauma/On-call Chief Resident, he or she will remain present at the alert until the resuscitation is controlled AND until he or she has discussed the patient in detail with the Pediatric Surgery Chief Resident or Attending. It is crucial that assessments and decisions are made with direct input from a senior level surgeon and that "hand-off" is seamless.
The Team Leader and other surgery residents will make every effort to work with the Pediatric Emergency Room attendings. The Chief Resident should maintain the role of Team Leader throughout the resuscitation. It is not appropriate for the Chief Resident to leave until the patient has been discussed with the Surgical Attending or the Pediatric Surgery Chief Resident. Unless the Trauma/On-call Chief, Pediatric Surgical Chief Resident, and Pediatric Surgery Attending are all unavailable, it is not appropriate for a junior surgery resident to serve as the Team Leader. It is anticipated that the Pediatric Emergency Room attending will assume responsibility for the alert in those cases.
The Team Leader shall make an effort for the junior resident on the Pediatric Surgery service to perform the primary survey and other elements of the resuscitation to the extent that he or she is capable.
A pediatric trauma consult must be responded to promptly by a senior surgery resident or attending. If a senior surgery resident or attending is not immediately available, then a junior resident may initiate the consultation. A junior resident is not alone appropriate to perform a trauma consult. If the Pediatric Surgery Chief Resident is not immediately available, then Trauma/On-call Chief Resident may be asked to review the consult directly and discuss it with the attending. The Pediatric Surgery Attending on-call should be contacted directly with problems related to response to a consult.