How to exert great teamwork and set priorities dynamically, as well as fascinating details about three more key points, you can read here:
Before We Delve into the Last Five CRM Key Points
If you would like, please to return to the second part of this series. Then, look again at the Key Points inserted below and apply them to your own workplace.
- 6. Mobilise All Available Resources
- 7. Communicate Effectively - Speak Up
- 8. Use All Available Information
- 9. Prevent and Manage Fixation Errors
- 10. Cross and Double Check (Never Assume Anything)
Perfectly prepared for the final spurt, we will now concern ourselves with the last five Key Points. As in the second part of the series, we will realise that some Key Points are interrelated with one other. Why? The headlines will carry the numbers of the Key Points again.
11. Use Cognitive Aids
11.1. What Mnemonics Have We Got?
Mnemonics exist at almost every workplace and are adjusted to it. They comprise checklists, as well as acronyms, which help us not to omit a relevant item, but also personal notebooks, which contain what we cannot remember easily.
11.2. Examples of Mnemonics in the Emergency Medical Service
Checklists
Checklists are in place for routine tasks, such as reloading all equipment into another vehicle if one has to be taken to the garage. Even with such a task it can be consequential if an important piece of equipment is forgotten but desperately needed during the next call.
The preclinical work encompasses procedures which are associated with many risks, such as the induction of general anaesthesia and intubation of a patient who is not fasting. Now, the team must not be misled by the perceived pressure for time, but it has to prepare all the necessary equipment in an orderly manner and carry out all steps correctly.
Acronyms
The most famous is SAMPLER to compile a complete anamnesis. It has also been adapted to German:
- S for symptoms
- A for allergies
- M for medication the patient takes regularly
- P for past medical history
- L for last ins and outs, f. ex., last meal
- E for events, anything that has caused the actual emergency. or is relevant with respect to it
- R for risk factors, for instance, smoking, or obesity
Further Mnemonics
In the vehicles, but also in the personal pockets of the team members, there are more mnemonics, for example, tables for the correct dosage of medications, pedriatic tables containing height and weight together with the corresponding dosages and measures, as well as personal collections of important items.
11.3. The Benefit of Mnemonics
Of course, we need to know our solid basic knowledge by heart. We use mnemonics in complex situations, or when dosages according to special schemes are required.
In the middle of the night, when we biologically should be asleep, it is much safer to set up a perfusor with medication that supports the circulation using a dosing table. In doing so, we minimise the risk of a potentially dangerous wrong dosage.
Pressure of time induces stress, and, therefore, hampers clear thinking. Also then we benefit from our mnemonics in order to enhance patient safety.
12. Re-evaluate Repeatedly (10-for-10 Concept)
12.1. The Case Is Dynamic
In the middle of a fire in a flat located in a residential building, the patient was standing at the window. The adjacent room was already on fire. Still, the door to the room, in which she was standing, withstood the flames. The firefighters were experiencing some difficulty as they were trying to place the aerial ladder. Eventually, a simple aluminium ladder was placed against the wall of the building. This was done at the very last moment.
The situation changed dramatically, the door was engulfed by the fire in the very moment the patient went onto the ladder and started to climb down to us. She has lost all her belongings in the fire, but managed to save her life. We took her to the nearest hospital due to smoke poisoning.
Not only in such circumstances a sudden change of the situation can occur. Almost any patient, of whom we take care, can deteriorate suddenly, develop massive pain, experience dyspnea, lose consciousness, or may need resuscitation.
Therefore, it is important that we reevaluate the situation repeatedly. We think ahead and plan for potential developments. You have certainly noticed that this refers to the second Key Point: Anticipate and plan. Below, we will see how the allocation of attention and the setting of priorities help us in dynamic circumstances.
12.2. The 10-for-10-Concept Reoccurs
As with the application of the fifth Key Point "distribute the workload", the 10-for-10-concept also helps us with the re-evaluation. As a team, we go over the current state of affairs "in ten seconds for the next ten minutes". We consider what may happen next, and how we need to act. Then, we distribute the tasks and start working on them as soon as no team member has any more questions.
12.3. Benefits of a Repeated Re-evaluation
A repeated re-evaluation allows us to stay focused and to detect any change of the case already with the first signs. So, we can start early to take action as required in the new situation.
13. Use Good Teamwork, Coordinate with and Support Others
This seems to be simple at first. We need to ask ourselves, though, whether we succeed during every single call. When have we disregarded a team member?
13.1. Training During Simulation Sessions, Application in Practice
As you may know, not only pilots perform realistic scenarios in a simulator regularly. Also in medicine, simulation is established in more and more specialist fields.
During the simulation of scenarios, the focus is espescially on the teamwork, which is then discussed in a detailed debriefing session.
In practice, we manage the application of the techniques we have learned if we stick to them continuously. In addition, constructive debriefings after our calls help us to elucidate single aspects of our work as a team. To what information have we paid attention? Have we lost any of it? Should we have done a task earlier, or in a different way?
13.2. Great Teamwork and Crew Resource Management
Logically, the concepts of Crew Resource Management, such as leadership, workload management, and decision-making, are the foundation of our teamwork. If we have internalised CRM well and use it consequently, we ensure high-quality teamwork.
The 15 CRM Key Points by Rall and Gaba are a formulation of teamwork principles which are mainly used in clinical settings. However, one can learn a lot from these for one´s own teamwork in a different area of expertise.
13.3. What We Achieve with Great Teamwork
Along with a constructive and concentrated working atmosphere, we manage first and foremost to knot the safety nets which help us to prevent inevitable mistakes from reaching our patients. The same holds true for further high-risk work environments, such as aviation, maritime shipping, or the railway. That way, we maximise the safety of our patients, the experts in other fields the safety of their passengers, but also of those who live close to air routes, water routes, or tracks.
Associated with the knotting of the safety networks is the interrelation of the Key Points with one another, as well. Also those ensure with their interrelations that we have several layers of safety nets.
14. Allocate Attention Wisely
We are all familiar to complex situations, which can get out of hand easily if we don´t act confidently. This spans everyday situations, in which we are still having a long to-do list ahead of us, whilst we are currently preparing a meal, are running the washing machine at the same time, and the phone is ringing simultaneously, but also flights in turbulent weather when all of a sudden a warning light flashes.
14.1. How We Profit from Wisely Allocated Attention
If we allocate our attention wisely, this helps us to stay concentrated and to focus on the essential. We differentiate the important facts from subordinate items, structure the complex situation better and are able to put our actions into an order.
In aviation, the famous sentence: "aviate, navigate, communicate"prevails. Distractions of all kinds should be avoided, and the attention directed towards the essential, namely to fly the aeroplane.
14.2. The Interplay with Other Key Points
To allocate our attention wisely, helps us with the re-evaluation of the situation, as well as with setting our priorities according to evolvement of the circumstances. During emergency calls, but not only there, we have to consider all pieces of information (Key Point 8), whilst several courses of action take place simultaneously.
In addition, we have to recognise fixation errors and prevent them (Key Point 9), as well as to double check everything and never assume anything (Key Point 10). We manage these tasks more easily, especially if a lot is happening at once, if we allocate our attention wisely.
15. Set Priorities Dynamically
Highly concentrated, you are structuring the preparations and the proceeding for a pre-Christmas dinner as you suddenly hear a muffled sound and your child starting to cry in the adjacent room. You lay down your pen immediately, go quickly but calmly to the room assuring that you will be there in a second. Fortunately, your child has only stumbled and is crying due to fright and not injured. You calm your child and return to your initial work later.
15.1. We React to Changing Circumstances Swiftly
If we are used to setting our priorities dynamically, we are capable of reacting to changing circumstances quickly and with the correct actions. We are not surprised easily so that we don´t become stressed and we avoid not to know how to proceed further.
We are well aware that we must not fixate on the initial situation, but have to reckon with sudden changes. With growing experience, we learn what concrete chances can occur, the number of those that still surprise us becomes smaller and smaller.
15.2. The Connection to Other Key Points
The wise allocation of our attention, as well as re-evaluation help us to set priorities dynamically if a situation changes. Furthermore, we can call for help earlier (Key Point 3) if we address a new problem immediately.
In the Next Blog Article We Will Occupy Ourselves with Tasks in Advent
The Christmas party in your company, or your sports club is round the corner? You have taken on a decisive role in the organisation, or are going to help during the frolicsome celebration? To show respect for huge tasks is not a weakness, but it helps us to prepare well and to concentrate on the execution. In addition, you have your toolbox at hand after having read this series. So, don´t be scared, your Christmas party will be a great success!
Author: Eva-Maria Schottdorf
Date, November 27th 2022
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