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Dr DuCanto on why we need to train


Words of a volunteer firefighter involved in high risk rescue

“None of us would say we weren’t nervous,” he said. “But when you stop being nervous, that’s the day you’re going to get hurt.”

And Jim goes on to write (editors comment)

This is the reason I relentlessly train in airway management and resuscitation techniques–not to stay nervous, but to remain sharp and focused for when the life-and-death, time-critical situations arise. If you are not continuously training to improve yourself while you occupy a critical position in healthcare, then it’s just a matter of time until fate visits you with a disaster.

8 Comments Post a comment
  1. Too true. Sadly there seems to be more emphasis on the ‘lowest common denominator’ in some of the hospitals or organisations (retrieval services and some other depts stand apart)

    How many times have junior docs had to endure ‘training’ in ALS / fire safety / sharps disposal

    …and yet scant attention is given to simulation in critical procedures, human resource management and ‘logistics over strategy’

    This WILL change – and FOAMed resources like this help, with asynchronous podcasts, videos and case discussions

    But how I wish I could incorporate just ONE scenario onto the end of my weekly anaesthetic list…upskill my fellow doctors and nurses and look critically at the resources/equipment/protocols around us and see if they really work..

    …sadly the response from management is ‘no time’ and pressures mean the staff focus on the usual humdrum work – making dealing with a critical patient or unexpected emergency even harder.

    But will keep trying

    December 14, 2012
  2. Jimmy D #

    Tim (et. al.), you must start gradually with introducing training scenarios into the list–almost like you must do it while no one is looking. Your staff will gradually begin to accept these minor forays into alternate technique land if you are swift, gentle and safe. My staff accepts me doing these because I wore them down over 8 years. But I gradually wore them down.

    Here’s a place to start. Place an LMA or Air-Q for elective surgery. Attain anesthetic depth. Now perform a fiberoptic endoscopy with a bent Levitan to see the vocal cords (but don’t protrude beyond the opening of the mask). Great–now you’ve practiced several things—properly placing and evaluating a LMA/SGA for intubation, the proper technique for guiding a tracheal tube, etc. If you are shy about this, wait until you put the drapes up so that no one can see you.

    The photo is from the “One Man Star Wars Show”, (Charlie Ross) apparently on its way to Australia next summer! May the Force Be With You!

    December 14, 2012
  3. Tim,

    Some ICUs now include a SimMan mannequin on the daily ward round, to challenge the day staff with a combination of bread&butter activities, uncommonly encountered scenarios and emergent interventions. There’s no reason why something similar couldn’t be included on the end of an anaesthetic list (probably not a 12 hour single case escapade finishing at midnight, but you get my point). Maybe a few like-minded colleagues would get in on the act and lessen the burden.

    Good luck

    December 14, 2012
    • Thanks guys, already doing it. But persuading management is a different (and exhausting) issue.

      Must…..maintain……the passion

      FOAMed helps

      December 14, 2012
    • Cara Thomson (@medcat) #

      I think the idea of having sim man on the ICU ward round is a great idea. I am a junior reg in ICU in NZ but am keen to work on scenarios as are many nurses I have talked too. I’m sure we could do this without too much pressure on space or time. Thanks

      December 14, 2012
    • thanks Matt. this is a great idea and can be simply implemented.
      Some Prehospital and retrieval services around the world, start a shift with a team meeting, chat over a cup of warm beverage and then a simulation training session.
      Jim, is right and so are you. Training should be constant, relentless and much a part of daily routine as possible, when you choose to take on critical care responsibilities like resuscitation.

      December 17, 2012
  4. Brian A. Pongracz ACNP #

    I couldn’t agree more with this training/ hands on/ sim man notion. I am a SICU Nurse Practitioner and I can’t tell you how big the crowds are at the codes in my ICU. However, there are only 3-4 people actually doing anything. We lucky few who ARE doing something need to be more insistent about grabbing the gawkers out of the crowd and getting their hands dirty from day one. Every student, resident, nurse, and respiratory therapist should be pulled to the side of the bed in order to do compressions. A good code team calls out every action they perform, from drugs pushed to vital signs observed. We all remember a hell of a lot better when we’ve had our hands ON THE PATIENT, than being five deep in the peanut gallery.

    December 23, 2012

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