Emergency OT Preparation
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Direct answer
Trauma compresses every routine into minutes: an emergency theatre is one that is already ready, not one that gets ready. Its fixed kit includes a rapid-sequence induction setup with working suction and a difficult airway cart, two large-bore infusions with a rapid infuser or pressure bags and warmed fluids, a defibrillator with pads attached, emergency drugs drawn or immediately to hand, a chest drain and cricothyroidotomy set, and a telephone line to the blood bank with the massive transfusion protocol (MTP) number. The technician's contribution is speed with sequence — table, diathermy, suction, warming blanket and imaging ready while the anaesthetist induces — because in a ruptured aorta or a postpartum haemorrhage the door-to-control interval is the survival variable.
What you must remember
- Ready state, always: an emergency OT stays stocked, checked and unoccupied between cases — a theatre that must be "cleared" first is not an emergency theatre.
- Airway corner: RSI-ready anaesthesia machine, suction tested at the catheter, difficult airway cart sealed and checked, cricothyroidotomy set within arm's reach.
- Access and infusion: two large-bore cannulae possible, rapid infuser or blood-warming device primed, pressure bags hung, and a fluid warmer running — cold resuscitation is its own complication.
- MTP activation: a single phone call or form triggers blood-bank release of packed cells, plasma and platelets in a fixed ratio (the 1:1:1 concept), with the first cooler tracked to the theatre door.
- Emergency drugs: adrenaline, atropine, amiodarone, calcium, sodium bicarbonate, tranexamic acid (within the first three hours in trauma per international practice), and the full crash cart checked shift-wise.
- Procedure trays staged: chest drain set, pericardiocentesis, cricothyroidotomy, urethral catheterisation and a laparotomy pack opened-ready but unopened until needed.
- Team and communication: trauma call composition known to everyone; a designated recorder; brief and debrief as standard — the WHO checklist's accelerated form still runs even in urgency.
- Imaging and blood: mobile X-ray or C-arm cleared to move in, cross-match sample sent on arrival, and group O negative blood's location known for the dire minutes.
Twenty minutes' notice: a polytrauma laparotomy
The call comes from the emergency department: haemodynamically unstable blunt trauma, 20 minutes out. The theatre turns on its routine. Table positioned and strapped-ready, warming blanket spread, suction x2 running with one line at the head. The anaesthesia machine was checked this morning; the technician reconfirms oxygen supply, suction at the mouth, and the RSI tray — induction agent, suxamethonium, prepared fluid — as the anaesthetist gowns. MTP is activated now, not later: the blood bank confirms the cooler's contents and its runner.
While the anaesthetist induces with cricoid pressure, the technician preps the diathermy with its return pad on a dry, uninjured thigh, opens the laparotomy pack onto the mayo, and stages the cell salvage if used. The first blood cooler arrives and is checked by two people against the patient's identity. What follows is quiet choreography: instruments passed before they are asked for, counts still performed even here — retained packs in a crisis theatre are no rarity — and the recorder logging times and blood products. Afterwards, the debrief names what worked and what delayed; the room is restocked to ready-state before anyone takes a break.
Where students slip
The exam answers that fail are the serene ones. "Call the blood bank when the patient arrives" is too late — MTP activation is part of the call that announces the patient. "Counts are skipped in emergencies" is wrong: they are adapted (the count happens, documented after or against X-ray at closure) because crisis theatres are exactly where retained items occur. "Warm the fluids later" ignores that hypothermia worsens coagulopathy — the triad of trauma's third leg, with acidosis and coagulopathy, is temperature. Candidates also forget the checklist: even a trauma case gets a compressed sign-in and sign-out, because wrong-site and wrong-patient errors do not respect urgency. Finally, "who activates MTP" has a named answer in every hospital — usually the operating surgeon or the anaesthetist by phone — and the technician must know that number by heart, not by directory.
Frequently asked questions
What is the massive transfusion protocol?
A pre-agreed pathway where one activation call makes the blood bank issue red cells, plasma and platelets in set ratios (near 1:1:1), delivered in coolers to the theatre until stood down.
Why are fluids and blood warmed in trauma resuscitation?
Hypothermia worsens coagulopathy and worsens outcomes; warming interrupts the lethal triad of hypothermia, acidosis and coagulopathy.
Are instrument counts performed during emergency surgery?
Yes — adapted rather than abandoned; counting continues, and any discrepancy at closure is resolved or documented with an X-ray before leaving theatre.
Which tray must be immediately reachable in an emergency OT?
Alongside the difficult airway cart: chest drain, cricothyroidotomy and rapid laparotomy sets, plus urethral catheterisation — staged, sealed and checked daily.
What checklist applies to emergency cases?
The WHO surgical safety checklist in accelerated form — sign-in items verified during induction, a short time-out before incision, and sign-out with counts and specimen checks.