Attention
The more our brains are preoccupied with focusing on a task, eg. laryngoscopy, cannulation, securing our safety harness in a helicopter, and so on, the less able to pick up new cues we become. We may therefore have limited situational awareness. Situational awareness is the ability to perceive what’s going on, understand what it means, and project that meaning into the future so you know what to do about it. This can all be compromised by distraction or cognitive overload.
Example: While loading a patient into a helicopter, no-one notices a tracheal tube being dislodged.
Solution – role allocation with clear team communication. The doctor is responsible for the tube and clinical situational awareness while the paramedic supervises the loading process.
Watch the following video:
The video demonstrates the following principles:
1. Critical care paramedic supervises the loading procedure and leads the team.
2. Doctor maintains control of the airway and clinical oversight
3. Closed loop communication is used
4. Team situational awareness: ‘eyes off patient’/‘eyes on patient’
5. OBSERVE approach to patient scan:
OBservations on monitor;
Subject (patient);
Endotracheal tube;
Respiratory circuit and connections;
Ventilator pressures cycling, no alarms;
External lines/infusions
Team Situational Awareness
Our team situational awareness (SA) at any one moment is determined by our state of vigilance and attentional focus. We can therefore predict a decreased SA if we’re about to execute a task on which we need to focus. This is the time to warn our team mates so they can take over supervising the patient. Helpful terminology is:
Doc: “I’m about to……My eyes are off the patient”
Paramedic: “Understood. I have eyes on (the patient)”
Watch this video which demonstrates this principle as the HEMS doctor decides to write her notes, taking her eyes off the patient:
The video demonstrates the following principles:
1. OBSERVE approach to patient scan:
OBservations on monitor;
Subject (patient);
Endotracheal tube;
Respiratory circuit and connections;
Ventilator pressures cycling, no alarms;
External lines/infusions
2. Closed loop communication is used
3. Team situational awareness: ‘eyes off patient’/‘eyes on patient’
Crisis Management
The following video shows the team managing an unexpected clinical crisis in flight. Note how the doctor and paramedic continually communicate their shared mental model, use closed loop communication where appropriate, and anticipate future needs. This shows good shared team situational awareness.
The video demonstrates the following principles:
1. Team situational awareness: ‘eyes off patient’/‘eyes on patient’
2. Closed loop communication is used – ‘we have a desaturation’….’confirmed, we have a desaturation’
3. OBSERVE approach to patient scan:
OBservations on monitor;
Subject (patient);
Endotracheal tube;
Respiratory circuit and connections;
Ventilator pressures cycling, no alarms;
External lines/infusions
4. Team shared problem solving / shared mental model: ‘the plan is…..next we will try……’
5. Reference to Emergency Action Checklists
Greater Sydney Area HEMS 