1. Communication Crisis Resources Management

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

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

4. 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

5. Important considerations: plan for return journey motion sickness problem coat / jacket mobile phone money / food / drink

6. 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

7. 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

8. 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

9. 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)

10. 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

11. 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…

12. 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.

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

14. STrApp

16. Communication with LAS

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

18. Departure