Diversity and ethics in trauma and acute care surgery teams: results from an international survey
Authors: Cobianchi Lorenzo , Dal Mas Francesca , Massaro Maurizio , Biffl Walter , Catena Fausto , Coccolini Federico , Dionigi Beatrice , Dionigi Paolo , Di Saverio Salomone , Fugazzola Paola , Kluger Yoram , Leppäniemi Ari , Moore Ernest E. , Sartelli Massimo , Velmahos George , Woltz Sarah , Angelos Peter , Ansaloni Luca ,   the Team Dynamics Study Group, Abdelmalik Abubaker , Abebe Nebyou Seyoum , Abu-Zidan Fikri M. , Adam Yousif Abdallah Yousif , Adamou Harissou , Agrusa Antonino , Akin Emrah , Alexandrino Henrique , Ali Syed Muhammad , Almeida Pedro Miguel , Amico Francesco , Ammendola Michele , Andreuccetti Jacopo , Aparicio-Sanchez Daniel , Ardito Antonella , Argenio Giulio , Askevold Ingolf Harald , Atanasov Boyko Tchavdarov , Augustin Goran , Awad Selmy Sabry , Bagnoli Carlo , Bains Lovenish , Balalis Dimitrios , Baldini Edoardo , Baraket Oussama , Barone Mirko , Barreras Jorge Arturo , Bellanova Giovanni , Biancuzzi Helena , Bignell Mark Brian , Bini Roberto , Bissacco Daniele , Boati Paoll , Bottari Andrea , Bouliaris Konstantinos , Brillantino Antonio , Buonomo Luis Antonio , Buscemi Salvatore , Calu Valentin , Campo Dall’Orto Riccardo , Campostrini Stefano , Carvas Joao Miguel , Casoni Pattacini Gianmaria , Celentano Valerio , Ceresoli Marco , Chirica Mircea , Cianci Pasquale , Cillara Nicola , Cimbanassi Stefania , Cioffi Stefano Piero Bernardo , Colak Elif , Conti Luigi , Dantas Costa Silvia , D’Acapito Fabrizio , Damaskos Dimitrios , Das Koray , Davies Richard Justin , De Beaux Andrew Charles , De Simone Belinda , Demetrashvili Zaza , Demetriades Andreas Kyriacou , Denicolai Stefano , Di Buono Giuseppe , Di Carlo Isidoro , Diaconescu Bogdan , Dibra Rigers , Dios-Barbeito Sandra , Dogjani Agron , Domanin Maurizio , D’Oria Mario , Duran Munoz-Cruzado Virginia , East Barbora , Ekwen Gerald Takem , Elbaih Adel Hamed , Escalera-Antezana Juan Pablo , Esposito Giuseppe , Farre Roser , Ferrario di Tor Vajana Antonjacopo , Cordeiro Fonseca Vinicius , Forfori Francesco , Fortuna Laura , Fradelos Evangelos , Fraga Gustavo P. , Fransvea Pietro , Gachabayov Mahir , Garcia Vazquez Alain A. , Ghannam Wagih Mommtaz , Gioco Rossella , Giraudo Giorgio , Giuffrida Mario , Giulii Capponi Michela , Gomes Carlos Augusto , Teixeira Gonsaga Ricardo Alessandro , Gonullu Emre , Goosen Jacques , Goranovic Tatjana , Griffiths Ewen Alexander , Haidar Muad Gamil , Hamid Hytham K. S. , Harddastle Timothy Craig , Healey Andrew J. , Hecker Matthias , Hernandez Garcia Edgar Fernando , Huaman Eduardo Cancio , Hutan Martin , Ioannidis Orestis , Isik Arda , Ismail Azzain Mahadi Hamid , Ismail Nizar , Jang Ji Young , Kaafarani Haytham M. A. , Kalipershad Sujala Niatarika Rajsain , Kaplan Lewis J. , Kara Yasin , Karamagioli Evika , Karamarkovia Aleksandar , Kavalakat Alfie J. , Kechagias Aristotelis , Kenig Jakub , Khan Jim S. , Khokha Vladimir , Klappenbach Roberto , Kobe Yoshiro , Kong Victor , Korkolis Dimitrios , Kurihara Hayato , Kuriyama Akira , Landaluce-Olavarria Aitor , Licari Leo , Litvin Andrey , Loftus Tyler J. , Lohsiriwat Varut , Lopes Moreira Claudia Cristina , Lostoridis Eftychios , Luna Agustín Tovar , Luppi Davide , Machain Gustavo Miguel , Maegele Marc , Maggiore Daniele , Maier Ronald V. , Manangi Mallikarjuna , Manetti Andrea , Mantoglu Baris , Mariani Federico , Marinis Athanasios , Sbalcheiro Mariot Evandro Antonio , Marseglia Giuseppe Roberto , Martellucci Jacopo , Martines Gennaro , Martinez Perez Aleix , Mascagni Pietro , Massalou Damien , Melo Renato Bessa , Miceli Luca , Mingoli Andrea , Mishra Tushar S. , Mohamedahmed Ali Yasen Y. , Mohan Rajashekar , Morales-Garcia Dieter , Mustafa Sami Mohamed Siddig , Naimzada Mukhammad David , Negoi Ionut , Nguyen Christine , Nidaw Melkamu Kibret , Nigri Giuseppe , Ogundipe Habeeb Damilola , Oliveri Cristina , Olmi Stefano , Pagani Leonardo , Palomba Giuseppe , Pantalone Desire , Panyko Arpad , Paolillo Ciro , Papis Davide , Pararas Nikolaos , Pata Francesco , Paterson-Brown Simon , Pavone Giovanna , Pecchini Francesca , Pellino Gianluca , Pelloni Maria , Peloso Andrea , Perea del Pozo Eduardo , Goncalves Pereira Rita , Monteiro Pereira Bruno , Lizarazu Perez Aintzane , Perrone Gennaro , Pesce Antonio , Petracca Giovanni , Piccoli Micaela , Piccolo Daniele , Picetti Edoardo , Pikoulis Emmanouil , Pintar Tadeja , Pirozzolo Giovanni , Podda Mauro , Previtali Pietro , Privitera Francesca , Punzo Clelia , Quiodettis Martha Alexa , Qvist Niels , Rahim Razrim , Reinisch-Liese Alexander , Rodriguez-Luna Maria Rita , Roizblatt Daniel , Roscio Francesco Pietro Maria , Rossi Stefano , Ruta Federico , Sakakushev Boris Evgeniev , Salamea Juan Carlos , Sall Ibrahima , Sammartano Fabrizio , Sanchez Arteaga Alejandro , Sanchez-Cordero Sergio , Sasia Diego , Sawyer Robert G. , Seretis Charalampos , Serradilla-Martin Mario , Shelat Vishal G. , Shlyapnikov Sergei , Simoes Romeo Lages , Siribumrungwong Boonying , Slavchev Mihail , Solaini Leonardo , Soldini Gabriele , Soreide Kjetil , Spada Florian , Stahel Philip , Sydorchuk Larysa , Sydorchuk Ruslan , Syed Ali Muhammad , Tallon-Aguilar Luis , Tan Jih Huei , Tan Edward , Tarasconi Antonio , Tartaglia Dario , Tartaglia Nicola , Taylor John , Tebala Giovanni Domenico , Teixeira Gonsaga Ricardo Alessandro , Teuben Michel , Tolonen Matti , Tomasicchio Giovanni , Triantafyllou Tania , Trigiante Giuseppe , Turrado-Rodriguez Victor , Tutino Roberta , Uccelli Matteo , Ugarte-Sierra Bakarne , Ukkonen Mika , Vassiliu Panteleimon G. , Verde Juan Manuel , Veroux Massimiliano , Vilallonga Ramon , Visconti Diego , Waledziak Maciej , Wannatoop Tongporn , Widmer Lukas Werner , Wilson Michael Samuel James , Wong Ting Hway , Xenaki Sofia , Yu Byungchul , Yule Steven , Zakaria Andee Dzulkarnaen , Zambrano Diego A. , Zese Monica 
Published: August 2022

Abstract
Background
Investigating the context of trauma and acute care surgery, the article aims at understanding the factors that can enhance some ethical aspects, namely the importance of patient consent, the perceptiveness of the ethical role of the trauma leader, and the perceived importance of ethics as an educational subject.

Methods
The article employs an international questionnaire promoted by the World Society of Emergency Surgery.

Results
Through the analysis of 402 fully filled questionnaires by surgeons from 72 different countries, the three main ethical topics are investigated through the lens of gender, membership of an academic or non-academic institution, an official trauma team, and a diverse group. In general terms, results highlight greater attention paid by surgeons belonging to academic institutions, official trauma teams, and diverse groups.

Conclusions
Our results underline that some organizational factors (e.g., the fact that the team belongs to a university context or is more diverse) might lead to the development of a higher sensibility on ethical matters. Embracing cultural diversity forces trauma teams to deal with different mindsets. Organizations should, therefore, consider those elements in defining their organizational procedures.

Level of evidence
Trauma and acute care teams work under tremendous pressure and complex circumstances, with their members needing to make ethical decisions quickly. The international survey allowed to shed light on how team assembly decisions might represent an opportunity to coordinate team member actions and increase performance.