Communication, human factors and planning

Background-Human factors (aka crisis / crew resource management) Analysis of airplane crashes showed human error was involved in 75% Popularised in healthcare following publication of ‘To err is human’ Massive take up in anaesthesia / critical care following the tragic death of Elaine Bromiley To err is human 1999 report saying that as many as 98,000 people die in hospitals every year as a result of preventable medical errors Both public and health care were completely engaged with this concept at the time The errors were a result of bad systems and not incompetent workers

Background- Why? Elaine Bromiley case 2005 https://www.youtube.com/watch?v=VndU2zap_Rg Just a routine operation Essentially: Humans are fallible-i.e human factors Use processes that ensure the inevitable mistakes do not cause harm Emiley Bromiley was admitted to hospital for a routine operation on her sinus After complications she suffered brain damage and died 13 days later An emergency situation occurred at the start of procedure when she developed an airway obstruction following the injection of the anaesthetic drug (very rare) Team became fixated on getting air to her lungs and were closed down to other options Poor communication and leader ship came into play Other team members suggested Tracky and a bed in ITU She died 13 days later Husband who was airline pilot and trained in human factors focussed his energy on what went wrong and has used lessons learned to train in health care He concluded the system had let her down but more importantly the staff were unprotected from their own fallibilities Human factors need to be understood to avoid making mistakes.

Human factors “We are all wrong no matter how good we are and we need people around us to tell us”

A generic set of skills which gives us the ability to deal with complex situations in a logical manner

Call for help early Know your limitations Being assertive is important Know who to call –doesn’t always have to be senior people.Can be anyone in the team Do you need any equipment

Anticipation / planning Planning is a mental process requiring effort 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… Good transfer makes for good planning

Know the environment Know how things work and where things are; or know who can do this – and where they are Be aware of strengths and vulnerabilities of the environment Maintain situational awareness Know where you are going Know the ambulance and ambulance bay Know who you are going with

Situational awareness Know the who what why where when and how Look at the big picture Use an example Loose situational awareness if one part of our brain is overloaded and by concentrating on a single activity we are unable to monitor other activities

Allocate attention wisely Eliminate or reduce distractions Avoid getting fixated Recruit others to help with monitoring Re-evaluate repeatedly Problem in EB case was that they became too fixated on the airway problem and did not focus on anything else

Use all available information Monitor multiple streams of data and information Check and cross check information

Use check lists

STrApp

Communication Effective communication is important Some skills listed here

Communication Remember… Things said are not things heard and things heard are not things understood Use checks to ensure understanding – ask to repeat to check understanding and acknowledge whether this is correct ‘Actively’ listen Good communication is very important

Communication Be clear with request Direct attention Maintain eye contact “Can I have a blood gas please?” “John, can you take an arterial blood gas, and bring me the result please”.

Communication -Team value The team has a huge role in effective communication A functioning cohesive team will support members to show vulnerabilities, to ask questions, make suggestions, be open and honest, and make decisions together etc all of the above

Designate leadership Establish clear leadership Inform team members who is in charge ‘Followers’ should be active in asking who is leading A good leader needs to see the bigger picture Make decisions And hold the qualities of a good leader

Booking your Ambulance You need to be clear when communicating with your own Ambulance company Understand exactly what terms they should be using and what arrangements they have LAS guidance is on our website for your attention www.nenclnetwork.co.uk

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

The end Thanks for listening Any questions