What do I mean when I talk about preparing myself for a resuscitation. There are the obvious things, I put on my gloves and other protective equipment but more importantly I prepare myself mentally to respond to the challenge.
Human factors play a key role in any crisis situation including the intubation and resuscitation of a critically ill patient. The aviation industry first picked up on the importance of human factors in aviation disasters in the 1970’s. This lead to the development of crew resource management (CRM) which evolved into Crisis resource management as the concept spread to other sectors, including medicine.
Crisis resource management training addresses the non-technical skills necessary for effective teamwork. Emergency Medicine Australasia published a useful review of CRM in emergency medicine last year (2012 Feb;24(1):7-13)
Here’s a quick video from Stoney Brook medical Center (USA). They give demonstrate nicely the power of CRM to help create order in chaos. They’ve boiled CRM down to 5 main ideas that anyone can use.
1. Recognize this is serious and call for help.
2. Close the loop in communicating.
3. Establish a leader.
4. Use resources appropriately.
5. Step back and do a global assessment.
A key principle of CRM is using the resources that are available. In my mind the bare minimum for an intubation team consists of 4 members.
- Airway Assistant
- Drug Delivery/Hemodynamics
- Pulse Ox watcher/external laryngeal manipulator/cricoid pressure(?)
Other team members may be required depending on the scenario, for example in line stabilization in trauma. All roles should be verbalized and defined during the preparation phase. In addition roles and actions during a failed intubation scenario should be assigned. Who will pass the LMA? Who will perform cricothroidotomy? Briefing the team on plans B and C puts them in a state of cognitive readiness to act if the need arises.