In any emergency multiple workers will become involved which can produce problems in itself:
• some staff may not know each other;
• no one knows what anyone else is doing;
• activity can become disordered and inefficient;
• basic important treatment can be forgotten. Therefore
• someone needs to take the lead role and coordinate activity in a systematic way such that staff work together as a team;
• the skills of any unknown staff need to be clarified;
• roles need to be allocated which match the skills of the staff concerned;
• specific tasks need to be given to designated people to avoid duplications and omissions;
• when someone is asked to do something it is worth checking that they understand and are happy with what is being asked of them;
• someone needs to document timings and actions;
• someone needs to talk to the patient (and her partner) even if only briefly to keep them calm and informed and help them feel confident and supported.
Although the most senior obstetrician present is likely to become the team leader, this is not always either necessary or appropriate and an anaesthetist or senior midwife may take the lead in some emergencies. Senior personnel need to talk to each other and interchange roles as is dictated by the needs of the clinical scenario. In all situations the team leader should keep a cool head and deal with problems logically and efficiently as this will help keep others calm and will promote a cohesive team.
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