What we have here is a failure to Resus Communicate…
Inspired by Reid, Brindley, Hicks, & Novak
My Favorite Paper on Resus Communication
Lecture You Must Watch
Resus By Voice
- from flying by voice
- Shared Mental Model
- Resuscitate – Differentiate – Communicate
Tactical Pause (Hick's term)
- Step-Back or SitRep
- aka The Cross-Check- Keep coming back to the global patient picture before diving into any minutiae
- “What am I missing” – team realignment
- Ten-for-Ten1
Close the Loop
- Set a notification -“Put in an art line and tell me when it is done”
Podium Nurse
- 360 awareness
- Assignment of Tasks (3 Cs: Clear Instructions, Cite Names, Close the Loop)
Sterile Cockpit
- 10,000 feet
- Train the team to acknowledge that phrase
- Central Line Kits / Shock Trauma Hallways
Resuscitese
- from Cliff
- Combat Mitigating Language-Efficient and Unambiguous Communication – Directive, Descriptive, Informative
- Belay that
- Acknowledge or Close-the-Loop
- Say Again
- Read Back
- Tally Ho
- Nato Phonetic and [easyazon_link identifier=”076367852X” locale=”US” tag=”emcrit-20″]read this book[/easyazon_link]
Briefings
PreBrief
- Planning: Mission, Defined Roles, and Set the tone
- Zero Point Survey Self-Team-Environment
Debrief
- Learning happens in the debrief
- Hot Debrief – INFO Model
Additional Info
What are your thoughts on resuscitation communication? Tell me in the comments section below.
Now on to the Podcast…
Additional New Information
More on EMCrit
COMM CHECK: More On Resuscitation Communication(Opens in a new browser tab)
Resus.ME: Learning To Speak Resuscitese(Opens in a new browser tab)
EMCrit 274 – Team Leadership with Cliff Reid(Opens in a new browser tab)
Additional Resources
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In technical rescue we use a simple briefing format too ensure a common mental model. It is lead by the team leader just prior to starting an rescue.
1. Here’s what I think we face;
2. Here’s what I think we should do;
3. Here’s why;
4. Here’s what we should keep an eye on;
5. Now talk to me…
I think this is equally useful if you have time to pre brief for a resus.
nice
Mitch, that brief looks mighty familiar. It came from a good friend and mentor, Ken Phillips, who used to head Search and Rescue first at Grand Canyon NP, then for the whole Park Service, which included some complex, high-risk operations. I still carry this briefing card, laminated, in my wallet, nearly a decade after leaving that job. Scott, Ken has a great, if not frustrating, piece of advice for you in your “how do I change the culture” question. You talk about it to every person, every chance you get, and you insist on it every time, no matter how… Read more »
just finished listening–was totally worth the time! thanks Clint
I’m going to a technical rescue course in some weeks. I wonder if I will be able to use it.
I expect that we will not get much information about the situation before we actually stands in a room at the second floor and have to get a stretcher out the window, and at the same time we will have to divert resources to protect the group against assault. …I think I will have to skip your Step 1 in the beginning, just to get a hang and fluency on Step 2, 3, 4 and 5…
Great podcast! Much of what you describe is what was established with the Team StePPs program years ago. I was lucky enough to spend most of my career at a hospital system (University of WA & Harborview) that adopted Team a StePPs & max a commitment to train all healthcare team members. That is key. A system decision & commitment as a way to communicate & approach emergencies. I ran the Code Blue Committee & was able to reinforce many of the concepts in Mock Codes & training. I think we really need to train & practice as teams vs.… Read more »
absolutely! great course, I took it both in person and online. think there is room for a resus-specific version of that course. i mean they have a dentist office version, seems like resus would be a great fit.
Hi Scott, We run a small ER in rural BC, Canada, experiencing all these issues along with infrequent exposure to critical cases, meaning when they did come in we were ‘out of practice’. Our biggest issues were not the motor skills (intubation/chest tube insertion etc.) but more the Crisis Resource Management and communication amongst the team around decision making. I know simulation as an aid to learning has been discussed here before, just to reiterate how valuable we find it for development of exactly this type of communication in the ER and practising the shared mental model. This has really… Read more »
good stuff. have you folks managed to have closed-loop communication continue beyond those sims?
excellent.
thank u scott
Great discussion Scott Love the “podium nurse”. We work in a small team in Broome and the most senior nurse is usually assigned as the “Scribe”. However, this role should be so much more than someone who passively writes down what has happened. Often this is the person with the most system knowledge. I love your concept of the PODIUM NURSE being the person who takes orders, reads them back and checks when the next time point is due – they could simply have a big digital clock / timer built into the desk to allow them to give reminders… Read more »
Great summary. Podium nurse=scribe in these parts. But I like podium better- ideally I/ we have found it works best with a senior nurse in that position as a kind of shadow team leader to give second oversight. Also they can when needed actually take the ‘Orb of responsibility’ (credit to DJP, Darwin) if the TL needs to get stuck in to a task focused procedure, e.g. difficult access/ airway/USS etc (often the case in a ltd resource setting). So, I would say to team, ‘Team, I need to do XXXX, whilst I’m doing that Jemma will be TL until… Read more »
hey buddy
Toffs and combat aviators
: )
s
Great summary. Podium nurse=scribe in these parts. But I like podium monika better!!- ideally I/ we have found it works best with a senior nurse in that position as a kind of shadow team leader to give second oversight. Also they can when needed actually take the ‘Orb of responsibility’ (credit to DJP, Darwin) if the TL needs to get stuck in to a task focused procedure, e.g. difficult access/ airway/USS etc (often the case in a ltd resource setting). So, I would say to team, ‘Team, I need to do XXXX, whilst I’m doing that Jemma will be TL… Read more »
Love the podium nurse moniker- in these parts, the scribe nurse. Best if this is actually the most senior nurse, to act as a ‘shadow team leader’, prompting the TL where needed. They can, when needed, take over as TL say if the TL needs to do a task focused procedure. The TL can hand over the ‘orb of responsibility’ (credit DJP, Darwin), stating clearly to the team that that is what is happening. After a recent paeds resuscitation I wonder if speaking dragonese would be useful? https://www.youtube.com/watch?v=o7CbG0RVLvk Perhaps they would feel more included…….. also https://en.wikipedia.org/wiki/Tally-ho Tally-ho is a very… Read more »
Hi Scott,
Sorry I came to the party late. I just listened to this episode last week and loved the role of the “Podium Nurse”. I have not been able to find any research article that use this term. Could you direct me to some article on the role of this nurse?
Thanks for all the great podcasts!
Nice podcast thanks: covers a lot of what I consider to be core CRM concepts.
Good communication should addressed (use first names), heard (well timed: get team members to check if you are ‘ready to receive’ information), and understood (repeat back to me.)
In addition to NATO phonetics, individual numbers should be said to avoid confusion. eg. please give fifty, five, zero, Roc.
Matt (Gasmonkey, South Africa).
P.S. consider connecting your downpipes from your roof’s gutters to fill your pool with rain water: 3rd world cost saving solution 🙂
thanks Matt
This is AWESOME!!!!
At the Resuscitese topic, the link in “read this book” (seen below) doesn’t direct to a specific book, just for an Amazon search. Which one were you referring to?
link above is working fine, but here is a direct link