1. Communication, human factors and planning

2. 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

3. Background- Why? Elaine Bromiley case 2005
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.

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

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

6. 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

7. 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

8. 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

9. 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

10. 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

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

12. Use check lists

13. STrApp

15. Communication Effective communication is important
Some skills listed here

16. 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

17. 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”.

18. 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

19. 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

20. 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

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

22. The end
Thanks for listening Any questions