1. Communication Crisis Resources Management

2. Organisation
 Prepare typed referral letter for receiving hospital including photocopies of:
 case notes (PC, Dx, Rx, key events – GI bleed, MI...)
 blood results
 drug charts
 imaging (CD-ROM)
 Inform relatives of departure and details of destination hospital & ward (make sure you know where you are going!)
 Book ambulance and brief crew
 Telephone numbers of referring and receiving units
 Plan for return journey prior to outset – often ambulance crews are diverted elsewhere

3. Organisation  Nausea (transfer team / antiemetics)  Coat / jacket
Mobile phone (call for help, warn receiving hospital of problems ...)
Money / food / drink

4. Problem solving in the complex environment
Uncertainty
Singularity of the situation
Information overload or lack of information
Time pressure
Risk
Plurality of goals
Presence of many players

5. Use CRM model Crew resource management was developed by the aviation
industry in the late 1970’s by aviation psychologists after an
analysis of airplane crashes showed that human error was
involved in 85% of events

6. CRM model in Anaesthesia and ICU
1. Anticipation/planning
2. Communication
3. Leadership/assertiveness
4. Awareness and utilization of all available resources
5. Distribution of workload and mobilization of help
6. Routine re-evaluation of situation
7. Awareness and utilization of all available information
8. Effective coping with disruptions/distractions

7. CRM model in Anaesthesia and ICU
Anticipation/planning
Is there mains power in ambulance?
Plug in all infusions
Still assume all will fail and take manual bolus drugs (metaraminol/midazolam…)
Check suction actually works
Oxygen supply – plug in and take own cylinder
Ambu bag
Tie everything in and down (ETT, IV access)

8. Improve your CRM INTERPERSONAL SKILLS
COMMUNICATION
Remember: Things said are not things heard and things heard are not things understood
Use checks to ensure understanding – ask them to repeat command to check understanding and acknowledge whether this is correct
‘Actively’ listen

9. Improve your CRM COGNITIVE SKILLS
PLANNING
Planning is a mental process requiring effort – ensure this is your only task
Always consider the worst case scenario
Always plan with alternatives and factor in a sufficient buffer of time, resources and staff.
Mental rehearsal:- delayed in traffic, O2 runs out, batteries die…

10. STrApp

12. Communication with LAS
New! October 2017

13. North West London Critical Care Network Transfer Bag
Gezz Van Zwanenberg et al. Journal of the Intensive Care Society 2016;
Copyright © by The Intensive Care Society

14. John Cockram British Crime Manager
Assume Nothing.
Believe Nobody.
Check Everything.
John Cockram British Crime Manager

15. Stop to re-intubate or doing anything else invasive.
If something goes wrong you can do little in the back of a moving ambulance.
Stop to re-intubate or doing anything else invasive.

16. Departure