The Second Rule of PHARM

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NAP4 publication of airway related deaths in UK calls it Non Technical Skills

Martin Bromiley, pilot and husband of Elaine , his first wife who died due to a failed airway during elective anaesthesia, calls it Human Factors. He wrote part of the introduction to NAP4.

I call it the Second Rule of PHARM : KNOW YOUR PEOPLE

These primary school students were visiting my RFDS base  on an excursion and I was asked to show them something from our daily work. Its never too early to teach emergency airway skills in my opinion!  But to teach 3rd graders to use a video laryngoscope and bougie is not as easy as you might think? You must understand the perspective of the people you are teaching and make a direct connection. This is all about KNOWING PEOPLE. These kids were all strangers to me when I first met them but as you can see by the end of my 15 minute session, I had engaged them in a very specific hand-eye coordination task. They loved it.

As a prehospital and retrieval practitioner, knowing the people you work with as a retrieval team, the pilot or driver, the nurse or paramedic or doctor, is only the beginning of the SECOND RULE. You must know the common agencies you will work with and come across and the people in them. From the remote hospital nursing staff, to the local police officer, to the remote volunteer firefighter …all these people within the sphere of the retrieval and prehospital service you work day or night you are going to meet them and have to pull together as an improvised team to save a life. Here is a great example from Londons Air Ambulance Service of effective team work, human resource management in a prehospital critical care scenario

You can be the best intubator in the world, you can maybe have such skill that you can place subclavian CVCs with your eyes closed. None of that TECHNICAL SKILL matters in a true crisis at 4am, down a ditch by the side of the road, when you have three critical patients trapped in a rolled over car and its only your retrieval team and the local police officer at the scene. Its even harder when the people you are dealing with are actively making things harder for you! KNOWING HOW TO HANDLE DIFFICULT PEOPLE, is an even greater skill!

Watch this training video from Cliff Reid and his GSA HEMS training crew as they put some new retrieval doctors through their paces , dealing with DIFFICULT SITUATIONS AND PEOPLE!




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