How to maximise the success of your work through deft handling of unavoidable and unnecessary risks, you can read here:
1. Some Risks Cannot Be Eliminated
Before we elucidate how to keep risks in check, we need to consider first what risks we are likely to encounter. As we go along, we will learn that these are quite numerous.
1.1. Inevitable Risks in Aviation
The cruising altitude of 10 000 metres and more poses a risk in itsself. If a technical issue occurs, pilots cannot simply pull over, brake and secure the vehicle. In addition, adverse weather conditions, such as thunderstorms, heavy rain, and strong gusts of wind, as well as fog, are considerable risks.
Moreover, risks comprise the aeroplane itsself, the geographical location of the airport (for example, close to a metropolis, or in the mountains), as well as the density of the traffic in the respective airspace. The pilots themselves bring their own risks on board, as well. These are, for instance, stress, or private and professional issues, a compromised fitness, or any medication, which they might have taken.
1.2. The Emergency Medical Service Is a High-Risk Work Environment
As in aviation, the work takes place around the clock and in any weather condition. Fog or torrential rain won´t make the dangerous rides towards the scene with flashing blue lights any easier. Nor will they facilitate the job itsself if the place of action is in the open.
Particular scenes, such as construction sites, crash sites, which are not secured yet, or ambiguous situations after violence has been exerted, carry specific risks. Alledgedly unspectacular surroundings, such as a narrow and steep staircase, or poor lighting, as well as the dirt, or sharp-edged metal pieces at a scrap yard add to the aforementioned.
The patients themselves are sometimes at risk, too. This is the case, for example, if they could vomit and aspirate whilst their consciousness is compromised. We must know how to handle critical conditions, as well as patients who endanger themselves, or others.
Last but not least, every team member brings his or her own risks. This might be a momentaneously disturbed sleeping pattern. This won´t alleviate a call in the middle of the night, after yet another disruption of the REM sleep.
We don´t look for risks whilst we carry out our work, but we have a higher goal. On our way towards it, we encounter inevitable risks. We are aware of this and keep these as small as possible.
2. Avoidable Risks
We need kowledge, skills, and attitude in the emergency medical service also to circumvent avoidable risks safely. With respect to the topics of the two items below, the attitude towards risk behaviour is especially important.
2.1. How to Recognise Risk Behaviour
The Five Hazardous Attitudes in Aviation
In studies, five different hazardous attitudes have been detected, which can influence decisions and, thus, lead to fatal consequences. In order to counteract these, simple sentences have been compiled as so-called antidotes.
Pilots are trained to recognise these five attitudes in their considerations concerning a particular situation in order to avoid them. If necessary, they should memorise the antidote actively.
We will look at the five hazardous attitudes below, including their antidotes:
Anti-Authority
Some people don´t like instructions, or that someone tells them what to do. It is, however, important to question rules which are obviously false. Antidote: Follow the rules. They are usually right.
Impulsivity
Some people feel the impulse to do something quickly and without prior thinking quite often. Then, they do the first thing which comes to their mind. Antidote: Not so fast. Think first.
Invulnerability
Accidents happen to others, not me. These people know that deadly air crashes occur. Despite of this they constantly block out the fact that they could become involved in an accident. Antidote: It could happen to me.
Macho
Some pilots think that they are better than others might think. On the one hand, they want to prove this to themselves by showing risky behaviour. On the other hand, they want to impress others with that. Contrary to common belief, female pilots are just as prone to such a behaviour. Antidote: Taking chances is foolish.
Resignation
Some pilots think that things happen due to certain circumstances, or that others should take action. They feel powerless and believe that they cannot make any difference when they act. Antidote: I am not helpless. I can make a difference.
2.2. The Famous Pushing of the Safety Margins
Safety Margins Are in Place in the Emergency Medical Service
We establish safety margins in many ways. This begins with our personal protective equipment. It is all about our safety when we wear jackets and trousers with the required reflective stripes and properly zipped safety footwear with special soles, etc. You won´t believe how many colleagues neglect these standards.
Also several sets of the same consumable supplies create safety margins. For example, we carry more than one ampoule kit with identical contents in case of several consecutive calls, or a mass casualty incident.
In addition, our knowledge and skills provide us with a safety layer. We have to train both consistently in order to keep them up to date. In doing so, we diminish the risk of becoming stressed during a call due to a lack of abilities and making mistakes because of that.
Why Do We Tend to Push the Safety Margins?
The list of safety margins and the possibilites to push them is long. If we experience for too long that we are able to finish our jobs without any consequences despite a lack of knowledge and with poorly maintained equipment, we will become too complacent to mind our safety margins.
If we act like this, we will lose our respect for the risks, from which our safety margins prevent us.
If we lose our ability to judge and our diligence, we are prone to continue this behaviour until we need just the skills we haven´t trained for a long time, or have to use the equipment, which we have left in the rescue vehicles, sprain our ankle whilst walking uphill in our open safety shoes, or step onto a sharp-edged intem wearing inadequate footwear.
On the one hand, safety margins are being pushed due to complacency, and on the other hand because of the inability to tell pure luck from real knowledge and skills.
3. Risk Management Within CRM
3.1. Risk Management as Part of Threat and Error Management
It makes sense to teach risk management in CRM classes in connection with threat and error management. First, we need to define errors and threats and look at their potential interrelation.
Errors
We detect a noticeable result when someone has made an error or communicated something wrongly.
Threats
Threats come from the outside without anyone making a mistake. We can foresee some of them, for instance, adverse weather conditions in aviation, whilst others occur unexpectedly.
Interrelations Between Errors and Threats
Threats complicate the situation, which, in turn, may trigger mistakes. Then again, mistakes can become threats to the team concerned, or others.
Risks, Mistakes, and Threats
On the one hand, risks represent threats which may lead to mistakes. On the other hand, we are more likely to make an error due to the stress caused by a risk.
3.2. We Use the Following CRM Principles Actively
Situational Awareness
If we mind our team, and the patient, the relatives, but also all information, with which the entire situation provides us, actively and continuously, we are more likely to recognise any risks within it. Moreover, we will detect them also earlier.
A Shared Mental Model of the Situation
It is always important during a call that all team members know exactly what is going on. This holds true for the working diagnosis and the planned therapy in the same way it does for a potentially risky situation.
Should a call become impossible to conclude due to a threat of violence or even its beginning, we need to retract jointly and quickly, if necessary, without our equipment. In doing so, we must not leave anyone behind, for example someone who had just been preparing medication in deep concentration.
Communication and Speak Up
As a team, we need to communicate risky aspects of a situation clearly so that everyone understands them and also what we are going to do. In goes without saying that every team member should point out any potential risk actively. All others should take this information seriously and evaluate it jointly, which might have to happen rapidly.
Decision-Making and Setting the Goals
Particularly under stress, decision-making aids have stood the test. A good example is FOR-DEC (facts, options, risks and benefits, decision, execution, check). Using it, we set our goals and determine our steps towards it confidently and in a structured manner, even in a risky situation.
4. Sophisticated Concepts in Aviation
The various causes of risks and hazards, as well as risk behaviour have been analysed intensely over the years. In order to keep them in check successfully, sophisticated techniques are applied in aviation.
4.1. Aeronautical Decision-Making, a Special Field
Not only the American Federal Aviation Administration, FAA, deals with how to handle risks as an area of expertise within aeronautical decision-making, ADM. It is described in detail in a dedicated handbook of the authority .
4.2. Measures to Handle Risks
Several checklists are available to pilots, with which they can assess every single risk and looming danger. This starts with their own state of health, and continues with the current state of the aircraft, as well as all the external circumstances. Finally, the checklists deal with factors, which put pilots under pressure. The aforementioned items are gathered on a checklist with the acronym PAVE as its title. We will examine this checklist as an example below:
- P for Pilot-in-command (PIC), the pilot who is responsible for the flight
- A for Aircraft: in this part, all items concerning the aircraft itsself are mentioned, ranging from technical details to the question whether this aircraft is suitable for the planned flight (its range, lenght of the runway, etc.)
- V vor enVironment: all circumstances are assessed here, for instance, the weather, the terrain, and the time of the day
- E for External pressures: containing expectations which the pilots have of themselves, or which others have, time constraints
When the pilots have assessed all risky factors with respect to how dangerous they are, they apply additional checklists. Using those, they decide how to deal with the risks in order to optimise the safety of their flight.
5. What Risks Does Your Work Entail?
5.1. What Risks Can You Identify?
Now think about your own workplace and your work as a whole. Are there any particular risks? With which of those have you occupied yourself for a long time already?
If you like, write down systematically, which risks you have identified and what causes them. Depending on the nature of your workplace, these may be risks of injuries, or accidents, but also defective pieces of work, which might endanger others.
5.2. What Have You Already in Place and What Would You Establish in Addition?
What measures have you already established successfully? Which ones could you add after this read? Irrespective of your field of expertise, I wish you every success and safe work activites at all times!
6. Blog in April an May: Aeronautical Decision-Making
In the article above, we have already learned about the importance of aeronautical decision-making in the context of handling risks. In the next blog article, we will start to work with the theme ADM in more detail. In doing so, we will first deepen how to deal with risks in aviation before we will unveil further aspects of ADM in May.
Author: Eva-Maria Schottdorf
Date: March 31st, 2023
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