EmergencyPedia

Trauma Team Training (TTT)

This month saw another instalment of the Westmead Hospital Trauma Team Training.

This highly recommended course is a one day simulation workshop for all specialities involved in trauma management at Westmead Hospital.  The TTT course is associated with a recent redesign of the approach to trauma at Westmead which is one of 5 Major Trauma Centres in Sydney.

Having participated in this course in 2009 as a junior registrar I can’t recommend this type of training highly enough to all levels of trainees.  The nursing staff also find the course very useful and we are lucky to have excellent buy in from radiographers, paramedics, social workers and other external departments.  The variety of enthusiastic participants makes the course holistic and increases the fidelity and richness of the simulations experience.  Together the team members learn about Crew Resource Management (CRM) and Human Factors.

Human Factors

Much of the Trauma Team Training course and other similar simulation programs are based around looking at Human Factors.

Mistakes happen.  Occasionally these mistakes cause can cause harm to patients, although most of the time they don’t unless the ‘holes line up’.  This is known as Swiss Cheese Theory in the Aviation literature:

It is important to realise that we are ALL susceptible to human error.

The study of Human Factors teaches us that we are prone to making errors regardless of how junior or senior we are in terms of our experience.

While some accidents aren’t preventable, up to 75% of critical incidents in aviation can be attributed to human error.   Root cause analysis of error in healthcare has shown that poor communication contributes to a large number of adverse events.

These issues are well summarised in the video shown below.

In this video an airline pilot and expert in Human Factors, Martin Bromiley describes his wife’s tragic death after a ‘routine operation’.  His wife had an unanticipated ‘can’t intubate’ and ‘can’t ventilate’ situation and suffered a severe Hypoxic brain injury.  This occurred despite the presence of several experienced anaesthetists and an Ear Nose and Throat (ENT) consultant who continued with attempts to intubate to the exclusion of other options:

Harvard Crisis Resource Management Review

CLICK HERE

Truncated Video on Human Factors

Full Video on Human Factors

In thinking about the issues surrounding the Trauma Team Training course I was asked to discuss some of the issues around Human Factors, Errors, Negotiation and Graded Assertiveness.

Human Qualities and Persuasion Skills are important in order to prevent chaos in Major Trauma scenarios – the default position is chaos in my experience of crisis situations run without effective leadership and management skills.

Errors are more common in increasingly complex and stressful cases.

We suggest you think about management of the TEAM, YOURSELF and the ENVIRONMENT in order to remain in control:

• YOU – Are you H.A.L.T? (Hungry, Angry, Late or Tired)
• ENVIRONMENT – Are you familiar? Noise Levels (patient, team)? Distractions?

The highly functioning TEAM requires good leadership and followership to move forward effectively and efficiently towards shared common goals.  As the team leader it is important to continuously allow for feedback, share your thought processes and summarise at regular intervals.

Teamwork and a functioning team dynamic is important in the chaotic environment of Severe Trauma.  After the case has been treated try to reflect on how the team went in regards to Human Factors.  This debriefing process is important after each Emergency case you attend.

Why is Self Control Important?

Video starring the now famous Sam Worthington:

Graded Assertiveness

C.U.S.S.

• C – CONCERN – I am concerned that we haven’t checked for allergies
• U – UNSURE – I am uncertain that this Augmentin duo forte medicine can be given to someone with a possible penicillin allergy
• S – SAFETY – I am really worried it is UNSAFE to give this patient a penicillin like drug given his known allergy
• S – STOP – Please stop – we need to take a timeout and discuss this further…

Essential C.R.M. Skills for Acute Medicine

Medical Negotiation Skills

Disagreements are inevitable in managing Trauma Cases

“Credibility, authority, and being LIKED are powerful persuasion tools” Cliff Reid (2013)

Suggested Strategies for Negotiation

The 6 Laws of Influence (Ciadini)

• Authority
  • Individuals are more likely to comply with experts/authority
• Reciprocity (“Do us a favour”)
  • If you give something to people, they feel compelled to return the favour.
• Scarcity
  • This is less applicable to medicine – i.e. rare items are more valuabl
• Liking
  • We are more inclined to follow the lead of someone who is similar to us rather than someone who is dissimilar
• Commitment
• Consistency
• Social Proof
  • We view a behaviour as more likely to be correct if others are performing in a similar manner.
  • Video Link:

In conclusion, Human Factors and Team Training will have an increasing role in the future of healthcare education and training.  Challenges will include participant and senior buy in as well as maintenance and long term retention of skills.

Other Essential Viewing on Human Factors (Cliff Reid)