2. Facilitator First Screen: Call Nurse engages with PC Please choose the appropriate action: o Facilitate Cesarean Section o Input Call Team Information o Customize System Settings

3. REQUIREMENT: The Facilitator shall remind Team members what actions must be performed to successfully Notify surgical team: surgeon, anesthesia, pediatrician, nurses. REQUIREMENT: The Facilitator shall allow one person to simultaneously summon the entire first call CS Team within 3 minutes of the decision to do a CS CONFIRM FIRST CALL MEDICAL PERSONNEL The following medical personnel will be summoned on the first call: o OBSTETRICIAN: Name of Obstetrician 1 (Primary contact #s) o ANESTHESIOLOGIST: Name of Anesthesiologist 1 (Primary contact #s) o NURSE: Name of Nurse 1 (Primary contact #s) o PEDIATRICIAN: Name of Pediatrician 1 (Primary contact #s) CONTINUE CHANGE

4. REQUIREMENT: The Facilitator shall provide contact information for the medical personnel scheduled to be on call CHOOSE FIRST CALL MEDICAL PERSONNEL Please click in the circle next to an individuals name to select or deselect that individual: OBSTETRICIANS ON CALL Name of Obstetrician 1 (Primary contact #s) o Name of Obstetrician 2 (Primary contact #s) ANESTHESIOLOGISTS ON CALL Name of Anesthesiologist 1 (Primary contact #s) o Name of Anesthesiologist 2 (Primary contact #s) NURSES ON CALL Name of Nurse 1 (Primary contact #s) o Name of Nurse 2 (Primary contact #s) o Name of Nurse 3 (Primary contact #s) PEDIATRICIANS ON CALL Name of Pediatrician 1 (Primary contact #s) Continue

5. REQUIREMENT: The Facilitator should include a set of pre-recorded messages to use when summoning the Team REQUIREMENT: The Facilitator shall *appropriately* prompt and permit the charge nurse to enter Initial Summons Data REQUIREMENT: The Facilitator’s pre-recorded messages shall be in simple English CHOOSE SUMMONS MESSAGE INFORMATION Please choose the appropriate information to include in the initial summons message: PATIENT STATUS o Scheduled: Arrive within 20 min o Urgent: Arrive within 15 min o Crash: Arrive within 10 min PATIENT NAME {Type block} REASON FOR CS o Reason 1 o Reason 2 o Reason 3 o Other: {Type Block} PATIENT LOCATION o Location 1 o Location 2 Continue

6. REQUIREMENT: The Facilitator shall remind Team members what actions must be performed to successfully notify surgical team CONFIRM FIRST CALL PERSONNEL AND MESSAGE Click on the circle next to information in order to select or deselect it: TEAM o Name of Obstetrician o Name of Anesthesiologist o Name of Pediatrician o Name of Nurse PATIENT STATUS o Urgent: Arrive within 15 min PATIENT NAME o Jane Doe REASON FOR CS o Fetal Intolerance ASSEMBLY LOCATION o OR 1 SENDCHANGE

7. REQUIREMENT: The Facilitator shall, if summoned team member does not respond affirmatively within 3 minutes of summons, immediately suspend all subsequent summons to the team member, notify the charge nurse, and summon the next corresponding team member. *******FIRST CALL TEAM NOTIFIED******* CONFIRM ALTERNATE MEDICAL PERSONNEL These ALTERNATE medical personnel will be notified in the case that one or more members of the first call team does not respond: o OBSTETRICIAN: Name of Obstetrician 2 o ANESTHESIOLOGIST: Name of Anesthesiologist 2 o NURSE: Name of Nurse 2 o PEDIATRICIAN: None CONTINUE CHANGE

8. REQUIREMENT: The Facilitator shall store and provide information on alternate team members (2 nd call, 3 rd call) in the event that one or more individuals on the initial contact list (1 st call) is unable to respond *******FIRST CALL TEAM NOTIFIED******* SELECT ALTERNATE MEDICAL PERSONNEL Please click in the circle next to an individuals name to select or deselect that individual: OBSTETRICIANS ON CALL Name of Obstetrician 1 o Name of Obstetrician 2 ANESTHESIOLOGISTS ON CALL Name of Anesthesiologist 1 o Name of Anesthesiologist 2 NURSES ON CALL Name of Nurse 1 o Name of Nurse 2 PEDIATRICIANS ON CALL Name of Pediatrician 1 CONTINUE

9. REQUIREMENT: The Facilitator shall, if a summoned team member does not respond affirmatively within 1 minute of a summons, immediately summon the team member by another means, if available. *******FIRST CALL TEAM NOTIFIED******* **Unconfirmed personnel have been summoned by alternate means** TEAM RESPONSE STATUS Obstetrician 1: NO RESPONSE Anesthesiologist 1: NO RESPONSE Nurse 1: NO RESPONSE Pediatrician 1: NO RESPONSE TIME UNTIL ALTERNATES ARE NOTIFIED 1 min 59 sec CS PREPARATION MENU

10. REQUIREMENT: The Facilitator shall be capable of receiving responses from Team members confirming that they have received the summons and that they are on the way to the hospital *******FIRST CALL TEAM NOTIFIED******* **Unconfirmed personnel have been summoned by an alternate means** TEAM RESPONSE STATUS Obstetrician 1: CONFIRMED Anesthesiologist 1: CONFIRMED Nurse 1: UNAVAILABLE *ALTERNATE NOTIFIED* Nurse 2: NO RESPONSE Pediatrician 1: NO RESPONSE TIME UNTIL ALTERNATES ARE NOTIFIED 45 sec CS PREPARATION MENU

11. REQUIREMENT: The Facilitator shall be capable of receiving responses from Team members confirming that they have received the summons and that they are on the way to the hospital *******FIRST CALL TEAM NOTIFIED******* *******ALTERNATES NOTIFIED AS NECESSARY******* TEAM RESPONSE STATUS Obstetrician 1: CONFIRMED Anesthesiologist 1: CONFIRMED Nurse 1: UNAVAILABLE *ALTERNATE NOTIFIED* Nurse 2: CONFIRMED Pediatrician 1: NO RESPONSE *NO ALTERNATE* CS PREPARATION MENU

12. REQUIREMENT: The Facilitator shall remind team members what actions must be performed to successfully confirm surgical team TEAM RESPONSE STATUS Obstetrician 1: CONFIRMED Anesthesiologist 1: CONFIRMED Nurse 2: CONFIRMED Pediatrician 1: NO RESPONSE *NO ALTERNATE* CS PREPARATION MENUASSIGN ROLES

13. REQUIREMENT: The Facilitator shall remind team members what actions must be performed to successfully assign roles and brief surgical team ASSIGN TEAM ROLES AND RESPONSIBILITIES No Pediatrician is available. Please reassign standard Pediatrician roles to other team members by clicking on the circle next the appropriate person: Pediatrician Responsibility 1: o Obstetrician 1: CONFIRMED o Anesthesiologist 1: CONFIRMED o Nurse 2: CONFIRMED Pediatrician Responsibility 1: o Obstetrician 1: CONFIRMED o Anesthesiologist 1: CONFIRMED o Nurse 2: CONFIRMED CONFIRM ROLES

14. System Design Concepts Meet the Requirements Prevent errors Smooth flow Team Members Receives Notification Message on PDA

15. ALERT! CS is Required Name: Jane Doe ID: 1234567890 Classification : Urgent Location: OR 2 Reason for CS : Fetal Intolerance Arrive within: 15 min Are you available? Yes No Members Receives Notification Message on PDA Scroll & select or Use stylus REQUIREMENT26: The Facilitator shall be capable of receiving responses from team members confirming that they have received the summons and that they are on the way to the hospital. Initial Summons Data 2min 45sec Countdown time to respond

16. ALERT! CS is Required Identity: Angelina Jolie Age: 30 Urgency : Urgent Arrive within: 15 min Location: OR 1 Are you available? Yes No The system will add you in a Member list. OK Cancel If Select “Yes” REQUIREMENT81: The Facilitator shall remind Team members what actions must be performed to successfully Confirm surgical team. Initial Summons Data

17. ALERT! CS is Required Initial Info Identity: Angelina Jolie Age: 30 Urgency : Urgent Arrive within: 15 min Location: OR 1 Are you available? Yes No The system will summon the next personnel. OK Cancel If Select “No” REQUIREMENT81: The Facilitator shall remind Team members what actions must be performed to successfully Confirm surgical team. Initial Summons Data

18. 1 minutes After Notification REQUIREMENT66 :The Facilitator shall, if a summoned Team member does not respond affirmatively within 1 minute of a summons, immediately summon the Team member by another means, if available. REQUIREMENT24: The Facilitator shall deliver the Initial Summons Data to the summoned Team members in both text and voice modes. Press 1= Available Press 2= Unavailable OR CS is Required Patient’s name is…… Age … Press 1 if available, otherwise…… ALERT! CS is Required Name: Jane Doe ID: 1234567890 Classification : Urgent Location: OR 2 Reason for CS: Fetal Intolerance Arrive within: 15 min Are you available ? Yes No Initial Summons Data

19. ALERT! CS is Required Initial Info Identity: Angelina Jolie Age: 30 Urgency : Urgent Arrive within: 15 min Location: OR 1 Are you available? YesNo 3 minutes has passed. The next alternate personnel was summoned. OK 3 minutes After Notification REQUIREMENT64: The Facilitator shall, if a summoned team member does not respond affirmatively within 3 minutes of summons, immediately suspend all subsequent summons to the Team member, notify the charge nurse, and summon the next corresponding Team member. Initial Summons Data 0min 00sec

20. Program Ends Thank you for your cooperation. Good bye

21. Confirmation Finishes & Loading Menu Screen Please head to the hospital. Loading Preparation Menu

22. Menu 1.Initial Summons Data 2.Function Specific Data 3.Full Patient Chart 4.Assigned Roles 5.Member Status Assemble Location : OR2 Team Preparation Menu Show all the information that the member need to know Reminder of the assemble location REQUIREMENT82: The Facilitator shall remind Team members what actions must be performed to successfully Assemble team.

23. Preparation Menu Basic CS data Role specific data Full chart Assigned Roles Member lists Initial Summons Data Name: Jane Doe Age:24 ID:1234567890 Location:OR2 Reason for CS: Fetal Intolerance Team Preparation Menu 1: Initial Summons Data menu In case of the member want to check the summons data again. Indicates the which direction to scroll

24. CS Data for “Nurse” Current Medication: None Allergies: NKDA Health during pregnancy: No major problems Past major illness: None Contraction interval: X min Contraction duration: X sec Team Preparation Menu 2: Function Specific Critical Data REQUIREMENT34: The Facilitator shall provide patient briefing data to the surgical team. menu REQUIREMENT33: The Facilitator shall be able to be programmed to provide customized, function-specific Critical Patient Data.

25. Team Preparation Menu 3: Full Patient Medical Data Patient Medical Data Name: Jane Doe Age:24 / G:2 / P:0 EGA:37 Reason for CS: Fetal tolerance Current Medication: None Allergies: NKDA Health during pregnancy: No major Problems Past Major Illnesses:None Membrance Rupture: Time/Color/Amount menu In case the member want to check the medical data other than their main interest.

26. Team Preparation Menu 4: Assigned Roles. Assigned Roles 1. OB Practitioner Name Initial Role Dr. 2. Surgeon Name Initial Role Dr. REQUIREMENT83:The Facilitator shall remind Team members what actions must be performed to successfully Assign roles and brief surgical team menu

27. Team Preparation Menu 5: Member’s Status Member Status 1. OB Practitioner Name Status_ Dr. Arrived Dr. On the way 2. Surgeon Name Status_ Dr. Unavailable Dr. Not responded menu Make the member maintain better situation awareness

28. Failures To Prepare Team Weather delay  Power failure.  Storms.  Floods.  Down trees.  Traffic signals out.  Traffic delay.  Accident.  Injuries require physician/technician attention. Weather solution  Alternative routes to provide redundant pathways to hospital to avoid, possible, flooding, downed, trees, traffic signal outages, traffic delays. Physician / technician call immediately charge nurse to alert backup person if help at accident scene is required.

29. Failures To Prepare Team System failure  Hard drive/device failure.  Program crashes.  Time out area no signal received. System solution  Backup system daily.  Automatic save feature of transactions every minute once CS initiated.  Continuous real time printout of all transactions communications and processes (teletype).  Have redundant computer system ready to take over for down system.

30. Failures To Prepare Team System failure  Program crashes during calling. System solution  Nurse resorts to paperback up and calls each person on the team left to notify.

31. Failures To Prepare Team Human causes  Multiple births  Multiple Physician/technician illness or unavailable. Human solution  Multiple areas that can be readied within 5 minutes to accommodate mother and staff for procedure.  Multiple movable patient monitoring devices.  Multiple anesthesia carts.

32. Failures To Prepare Team Human causes  Multiple Physician/technician illness or unavailable Human solution  Multiple anesthesia packs with all of the types of anesthesia necessary for doctor.  Increase cross training of nurses and doctors to increase the resource pool in case of an extreme need case.

33. Requirements Discussion The Facilitator shall remind Team members what action must be performed to successfully Dress/scrub surgical team The Facilitator shall remind Team members what action must be performed to successfully Address team Activities of Daily Living (ADL)