Crisis Resource Management _CRI_

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Crisis Resource Management _CRI_ Powered By Docstoc
					      Medical Simulation…
See one do one teach one…just not
           on my Mum

           Peter Brindley, MD FRCPC.

   Consultant Physician, Critical Care Medicine
 Assistant Professor and Program Director, CCM
        Medical Lead for Simulation, CH
 Vice-president, Canadian Resuscitation Institute




                                                     Division of
                                               Critical Care Medicine
                                                          Division of
                                                    Critical Care Medicine
         On a serious note-

2000
1800
1600
1400
1200
1000
                                          Deaths
 800
 600
 400
 200
   0
       Medical   Auto   Workplace   Air
More education, right
More realistic education
    What Can Simulation Do?

Teaching knowledge and procedures
Teaching behaviours
– Crisis Resource Management (CRM Training)
– Leadership, communication, dealing with stress
Team training
Improved communication
See yourself at work
Practice without risk
What Can Simulation Do CTD

Our door to delivery times are too slow
Skills beyond knowledge are ignored
 – World’s worst compliment
CRM training is compulsory in other industries
 – Airline, nuclear power, military,
IMG/ staff turnover
Social justice imperative
Building a “safety-net” around patient
 A Modern Educational tool
“Hands-on” (experiential learning)
– Practice mistakes
Modify to learning styles
Reproducible, standardized
– On-call implications
Address the CanMeds objectives
 Includes debrief
?An examination tool
? A licensing/competency tool
A CME tool
           The Laerdal SimMan




Intubatable/modifiable airway/surgical airway/voice/pneumatic lungs
/cardiovert/defibrillate/mimic rhythms/produces urine/
Urology
OB/Gyn
OB/Gyn
Task Trainers CTD
Teaching beyond Knowledge
Crisis Resource Management (CRM)
–   Human factor engineering
–   Dealing with stress/uncertainty
–   Dealing with people
–   Communication
      Examples please…..
Very senior 747 pilot begins taxiing
Copilots know he has not been cleared
Everyone too intimidated to say anything
Two planes collide- hundreds die
                 The ABCs
A
– Airway

B
 – Breathing

C
 – Circulation
       “The New ABCs”
C.
– Crisis management
C.
– Concurrent ABCs
R.
– Resource utilization
Crisis Management
– A) Leadership


Behaviour is contagious.
Be aware of how do you deal with stress
Declare an emergency without looking panicked
Where to stand
Realize when you’re in charge and when not
Realize when a decision is needed.
        Leadership Skills
Impulsive
– “….We must do something, anything”
Invulnerable/Macho
– “….I can intubate anyone”
Anti-authority
– “…Rules are for others”
Resignation
– “…It’s not my problem, what can you do”
Crisis Resource Management
– A) Leadership
– B) Communication

Communication loops
– 3 Cs     Clarity
           Cite names
           Close the loop
  Avoid vague suggestions
Therefore……”John, please intubate
the trachea”
Not…”Perhaps it’s time to intubate”
Crisis Management
– A) Leadership
– B) Communication
– C) Resource Utilization.


Utilize others
Declare priority
Maintain a global perspective
Be proactive not reactive
Prioritize/Delegate
Crisis Management
 – A) Leadership
 – B) Communication
 – C) Resource Utilization
Concurrent A, B, C s
 – A) Airway
 – B) Breathing
 – C) Circulation

Simultaneous diagnosis and therapy
But disconcerting
Requires “sounding the alarm”
Requires a “high index of suspicion”
          R and R Strategy
R & R
 – A) Reassess
 – B) Reevaluate


Why:
–   Fluid nature of illness
–   Initial therapy despite limited info
–   Assessments are crude
–   Fixation errors abound
          Fixation Errors
These occur regardless of level of expertise

Fixation of diagnosis
 – Failure to question diagnosis

– Failure to admit there’s a problem

Fixation of task
 Preventing Fixation errors
Maintaining a global perspective.
– Focus on big picture
      – When moving patients
      – When managing an unstable patient
          Stand on the “T”

Call for help early; may include:
– Cognitive skills (a 2nd opinion)
– Motor skills (a difficult line)
– Equipment
Realize what brain is good and bad at.
WHO is ELVIS??
13 x 39 =
               Other Challenges


Simulated Critical Care Line Calls. Brindley Crit Care 2007
Novel Critical care Education.        Brindley CMAJ 2006
Telephone Simulation                 Brindley Crit Care 2007
Blindfolded Simulation    Brindley et al. pedning ICM 2007
Research


  Insert
Compelling
 Evidence
   Here
     Research challenges
Kelvin’s Curse
– “Anything that can’t be expressed in
  numbers is meagre and inadequate”
Did industry wait?
Not a departure from medical teaching
Some things are simple
      Some things are not
              i.e. “culture change”


“Nothing more difficult than
  introduction of a new
  order:

  The innovator has for
  enemies all those who have
  done well under the old,
  and lukewarm defenders in
  those who may do well
  under the new”.
      Machiavelli,
      The Prince
       Medical Simulation is:
Golden opportunity
– Education, error-reduction, and research
Complementary to traditional education
– High-tech, low-tech, no-tech
Likely to be an expectation
– We can lead or follow
Helps teach “beyond facts”
– CRM, communication, role modeling
Alberta can be a leader
– But challenges remain