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We conducted a study in a pediatric trauma center to elicit design requirements for the TraumaPen system-a mixed paper-digital interface using a digital pen and a wall display-to support situation awareness during trauma resuscitation. In this paper, we describe the field research that informed the initial system prototype and then present findings from two studies in which the prototype was used to further explore the application area. Our results showed the potential for digital pen technology in supporting teamwork in the dynamic and safety-critical setting of the trauma bay, but also revealed several limitations of this technology. We conclude by discussing challenges and requirements for the use of paper-digital interfaces in assisting fast-paced, collaborative work processes.