Communication Crisis Resources Management

Communication is very important because it’s the only way we can effectively work together on anything…

We make sure that we prepare the following: referral letter case notes blood results drug chart imaging

Who do you need to inform of the transfer. Ambulance – blue call Who do you need to inform of the transfer?.. Ambulance – blue call ? receiving hospital – unit tel. no. relatives / next of kin

Important considerations: plan for return journey motion sickness problem coat / jacket mobile phone 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

Important considerations: 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)

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

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…

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.

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

STrApp

Communication with LAS

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

Departure