How Trauma Video Review Augments Team Performance Under Pressure

The margin for error is razor thin during trauma resuscitation. Life and death decisions are made in seconds, not minutes, and the effectiveness of a trauma team during a resuscitation can define the trajectory of a critically injured patient. Teamwork under pressure is essential in this high-stakes environment. 

Trauma Video Review (TVR)¹ is a clinical performance improvement tool that captures high-resolution video and audio from trauma resuscitations to analyze team dynamics, communication, and technical execution in real time. TVR offers an objective, unbiased look at team performance by capturing trauma resuscitations with high-resolution, synchronized video and audio. Unlike traditional observation or retrospective chart review, it provides a complete and accurate record of events as they unfolded. In fact, recent research confirms that trauma video review outperforms prospective real-time data collection² as well as data collection from the electronic medical record³—both in accuracy and the depth of insights it uncovers. 

The Critical Role of Team Performance in Trauma Resuscitation 

Optimal performance during trauma resuscitation hinges on a combination of both technical and non-technical skills in the trauma bay. The best teams demonstrate fluid communication, strong leadership, rapid decision-making, and seamless coordination. These non-technical skills⁴ often make the difference when time is short, and resources are strained. 

Trauma teams and hospitals are increasingly using TVR to inform simulation training, drive targeted interventions, and guide continuous quality improvement. By watching resuscitations unfold in real time with accurate data, teams can identify bottlenecks, clarify roles, and refine positioning to improve efficiency and outcomes. 

Transforming Team Performance in Trauma Resuscitation  

Peer-reviewed studies using TVR have surfaced recurring themes that shape high-performance trauma teams. 

1. Communication and Handoff 

A clean, structured handoff from EMS to the trauma team sets the tone for resuscitation. TVR has shown that lapses in information transfer can delay key decisions or lead to redundant actions. 

A 2021 study⁵ analyzing 99 trauma activations found that while EMS handoffs were generally efficient, they were often interrupted—primarily by the trauma team—and had a median completeness score of just 11 out of 20 using the MIST framework.⁶ Notably, trauma teams with higher non-technical skills (as measured by the Trauma Non-Technical Skills scale⁴) received more complete handoffs, highlighting a direct link between handoff quality and team performance. 

These findings suggest that improving the structure and delivery of EMS handoffs can significantly enhance non-technical performance and coordination in trauma settings, resulting in high-performing trauma teams. 

2. Movement Matters 

Trauma teams often underestimate how much unnecessary movement impedes the trauma bay. TVR shows that excessive movement, such as repositioning or shifting personnel, can disrupt procedures and increase risk. 

A 2025 prospective analysis⁷ of 77 trauma activations found that trauma resuscitations began with a median of 17 people in the room, with frequent foot traffic—median 12 entries and 17 exits per case. This movement was independently associated with longer times to resuscitation (TOR) and lower T-NOTECHS scores, indicating that excessive personnel flow may impair team performance and efficiency. 

These findings underscore the need to examine other environmental and behavioral factors that influence trauma team coordination and outcomes. 

3. Time is Everything 

Trauma teams that transition quickly from EMS handoff to critical interventions achieve better outcomes with fewer delays. TVR has consistently shown that prolonged time in the trauma bay is linked to reduced efficiency and slower decision-making. 

A 2023 study⁸ examined how trauma team performance impacts the timeliness of care for hypotensive trauma patients in hemorrhagic shock, finding that stronger leadership, communication, and situational awareness were linked to faster care transitions. Larger team sizes were associated with delays, and each point decrease in team performance scores led to measurable increases in time to critical interventions. 

Another 2023 multicenter trial⁹ involving hypotensive trauma patients found that intraosseous (IO) access demonstrated a significantly higher success rate (93%) and faster time to resuscitation initiation compared to peripheral IV (67%) and central venous catheter (59%) access. The findings support prioritizing IO access as a method in emergency trauma care for severely hypotensive patients due to its superior success rate and efficiency. 

These findings support the need for targeted strategies to streamline trauma resuscitation timelines. 

4. Technique and Execution 

Even well-practiced procedures benefit from scrutiny. Tube thoracostomy efficiency, for example, can vary widely in execution, especially under different patient conditions. 

A 2023 study¹⁰ used TVR to evaluate tube thoracostomy performance in emergency departments, finding that procedures in hemodynamically unstable patients were completed more quickly but with lower performance scores. Despite faster execution, malpositioning was the most common complication across all cases, indicating significant variability in procedural quality. 

These results highlight how patient factors and situational pressures impact technical execution, reinforcing the value of TVR as a tool to identify gaps and standardize training. Just as environmental factors like movement influence team performance, procedural consistency is critical to improving trauma outcomes. This underscores the need to explore both behavioral and technical factors to optimize care delivery. 

5. Identifying Adverse Events 

TVR also uncovers system-level issues that can lead to adverse events. These are often missed in traditional morbidity and mortality (M&M) conferences or chart reviews. 

A 2024 narrative review¹¹ examined adverse events in trauma resuscitation, their contributing factors, and mitigation methods, focusing on TVR using the Trauma Black Box® and standardized assessment tools like Safety Threats and Adverse Events in Trauma (STAT) taxonomy and T-NOTECHs. 

The integration of TVR with standardized tools is a promising method for improving trauma team performance, detecting adverse events, and enhancing patient safety by capturing the full context of errors, including team dynamics and environmental factors. 

The Trauma Black Box: Technology That Transforms Teamwork 

The Trauma Black Box is an advanced audiovisual platform that captures synchronized data and multiple inputs during trauma resuscitations to provide a comprehensive and detailed view of team performance. It analyzes this data to identify patterns, trends, and gaps in team dynamics that might otherwise go unnoticed, offering valuable insights into trauma care.¹² 

This insight supports more effective debriefing and training by moving beyond memory and subjective impressions to focus on what actually happened. The Trauma Black Box promotes a culture of continuous improvement while protecting both patients and providers through anonymized, evidence-based feedback. 

Leading trauma surgeons and trauma centers across North America are already using this innovative tool to redefine what high-functioning trauma care looks like¹³ and gain important trauma insights.¹⁴ 

Final Thoughts 

TVR is a powerful tool that is transforming trauma team performance by providing objective feedback that leads to faster time to intervention, fewer errors, and improved patient outcomes. In trauma resuscitation, every second and every action truly count, and TVR equips teams to get better, faster, and safer with data-driven insights. 

If your trauma center is committed to enhancing performance under pressure, explore how the Trauma Black Box can support your team’s growth. Request a demo today and start the conversation. 

Recommended Reading 

1. Dumas, R.P. (2024, July 18). Trauma Care Breakthrough: Enhancing Performance Improvement Through Trauma Video Review [blog]. Surgical Safety Technologies. https://www.surgicalsafety.com/blog/trauma-care-breakthrough-enhancing-performance-improvement-through-trauma-video-review 

2. Rees, J.R., Maher, Z., Dumas, R.P., et., al. (2022). Trauma video review outperforms prospective real-time data collection for study of resuscitative thoracotomy. Surgery;172(5), 1563-1568. https://pubmed.ncbi.nlm.nih.gov/35927077/  

3. Dumas, R.P., Chreiman, K.M., Seamon, M.J., et., al. (2018). Benchmarking emergency department thoracotomy: Using trauma video review to generate procedural norms. Injury;49(9), 1687-1692. https://pubmed.ncbi.nlm.nih.gov/29866625/  

4. Steinemann, D., Berg, B., DiTullio, A., et., al. (2012). Assessing teamwork in the trauma bay: introduction of a modified "NOTECHS" scale for trauma. Am J Surg;203(1), 69-75. https://doi.org/10.1016/j.amjsurg.2011.08.004  

5. Nagaraj, M.B., Lowe, J.E., Marinica, A.L., et., al. (2023). Using Trauma Video Review to Assess EMS Handoff and Trauma Team Non-Technical Skills. Prehosp Emerg Care;27(1), 10-17. https://pubmed.ncbi.nlm.nih.gov/34731071/  

6. Shertz, M. (n.d.). MIST Report: A simple way to convey information [blog post]. Crisis Medicine. https://www.crisis-medicine.com/mist-report-a-simple-way-to-convey-information/  

7. Succar, B., Lunardi, N., Gopal, K., et., al. (2025). Trauma video review analysis: Increased provider movement impedes trauma team performance. The American Journal of Surgery;240, 116121. https://www.americanjournalofsurgery.com/article/S0002-9610(24)00673-1/abstract  

8. Maiga, A.M., Vella, M.A., Appelbaum, R.D., et., al. (2024). Getting out of the bay faster: Assessing trauma team performance using trauma video review. J Trauma Acute Care Surg,96(1), 76-84. https://pubmed.ncbi.nlm.nih.gov/37880840/  

9. Dumas, R.P., Vella, M.A., Maiga, A.W., et., al. (2023). Moving the needle on time to resuscitation: An EAST prospective multicenter study of vascular access in hypotensive injured patients using trauma video review. J Trauma Acute Care Surg;95(1); 87-93. https://pubmed.ncbi.nlm.nih.gov/37012624/  

10. Marinica, A.L., Nagaraj, M.B., Elson, M., et., al. (2023). Evaluating emergency department tube thoracotomy: A single-center use of trauma video review to assess efficiency and technique. Surgery;173(4), 1086-1092. https://pubmed.ncbi.nlm.nih.gov/36740501/  

11. Nazir, A., Shore, E.M., Stoneman, C.K., et., al. (2024). Enhancing patient safety in trauma: Understanding adverse events, assessment tools, and the role of trauma video review. Am J Surg;234, 74-79. https://www.sciencedirect.com/science/article/pii/S0002961024002642  

12. Dumas, R.P. (2025, March 4). Redefining Trauma Care: Best Practices for Conducting Trauma Video Review [blog]. Surgical Safety Technologies. https://www.surgicalsafety.com/blog/redefining-trauma-care-best-practices-video-review 

13. Surgical Safety Technologies. (2025). Maximizing the Value of Trauma Video Review [webinar]. https://www.surgicalsafety.com/events-webinars/maximizing-the-value-of-trauma-video-review  

14. Surgical Safety Technologies. (2025). Black Box Platform™ Insights – Dr. Ryan Dumas [video]. https://www.surgicalsafety.com/resources/black-box-platform-insights-dr-ryan-dumas