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This study aims to discover how leadership emerges in a hospital’s trauma team in a simulated trauma care situation. Instead of investigating leadership from a leader-centric perspective, or using a metrics-based approach to reach generalizable results, the study aims to draw from post-heroic theories by applying leadership-as-practice and sociomaterial perspectives that emphasize the cultural-historical context and emergent nature of leadership.

The study was conducted in a Finnish central hospital through ethnographic observations of 14 in situ trauma simulation trainings over a period of 13 months. The data consist of vignettes developed and written from field notes. The analysis was informed by the cultural-historical activity theory.

Leadership in a trauma team during an in situ simulation training emerges from a complex system of agencies taking place simultaneously. Contextual elements contributed to the goal. Clarity of roles and task division, strong execution of leadership at critical points, active communication and maintenance of disciplined communication helped to overcome difficulties. The team developed coordination of the process in conjunction with the care.

The study considers trauma leadership to be a practical phenomenon emerging from the trauma team’s sociomaterial context. The results can be used to develop non-technical skills training within the field of simulation-based medical training.