Communication Crisis Resources Management

Organisation  Prepare typed referral letter for receiving hospital including photocopies of:  case notes (PC, Dx, Rx, key events – GI bleed, MI...)  blood results  drug charts  imaging (CD-ROM)  Inform relatives of departure and details of destination hospital & ward (make sure you know where you are going!)  Book ambulance and brief crew  Telephone numbers of referring and receiving units  Plan for return journey prior to outset – often ambulance crews are diverted elsewhere

Organisation  Nausea (transfer team / antiemetics)  Coat / jacket Mobile phone (call for help, warn receiving hospital of problems ...) Money / food / drink

Problem solving in the complex environment Uncertainty Singularity of the situation Information overload or lack of information Time pressure Risk Plurality of goals Presence of many players

Use CRM model Crew resource management was developed by the aviation industry in the late 1970’s by aviation psychologists after an analysis of airplane crashes showed that human error was involved in 85% of events

CRM model in Anaesthesia and ICU 1. Anticipation/planning 2. Communication 3. Leadership/assertiveness 4. Awareness and utilization of all available resources 5. Distribution of workload and mobilization of help 6. Routine re-evaluation of situation 7. Awareness and utilization of all available information 8. Effective coping with disruptions/distractions

CRM model in Anaesthesia and ICU Anticipation/planning Is there mains power in ambulance? Plug in all infusions Still assume all will fail and take manual bolus drugs (metaraminol/midazolam…) Check suction actually works Oxygen supply – plug in and take own cylinder Ambu bag Tie everything in and down (ETT, IV access)

Improve your CRM INTERPERSONAL SKILLS COMMUNICATION Remember: Things said are not things heard and things heard are not things understood Use checks to ensure understanding – ask them to repeat command to check understanding and acknowledge whether this is correct ‘Actively’ listen

Improve your CRM COGNITIVE SKILLS PLANNING Planning is a mental process requiring effort – ensure this is your only task Always consider the worst case scenario Always plan with alternatives and factor in a sufficient buffer of time, resources and staff. Mental rehearsal:- delayed in traffic, O2 runs out, batteries die…

STrApp

Communication with LAS New! October 2017

North West London Critical Care Network Transfer Bag Gezz Van Zwanenberg et al. Journal of the Intensive Care Society 2016;1751143716658912 Copyright © by The Intensive Care Society

John Cockram British Crime Manager Assume Nothing. Believe Nobody. Check Everything. John Cockram British Crime Manager

Stop to re-intubate or doing anything else invasive. If something goes wrong you can do little in the back of a moving ambulance. Stop to re-intubate or doing anything else invasive.

Departure