Train the rescuers

Abstract

We congratulate Nathanson et al. for their timely editorial [1], and share their regret that lives continue to be lost to preventable errors. Twenty years ago, the death in similar circumstances of Elaine Bromiley led to the creation of the charity we now represent.

The reasons why skilled and conscientious practitioners make such errors are well-established. We know that human beings under stress are prone to ‘mind lock’ – rigid fixation on a diagnosis or course of action – and confirmation bias, where contradictory data (such as an abnormal capnography trace) are ignored, while corroborative information (such as breath sounds) is favoured. Sense of time dissipates and memory recall becomes difficult. These are fundamentally human responses and no amount of training will prevent them.

However, there is a common thread in all these tragedies, which is too often overlooked. In nearly all cases, senior colleagues arrived to assist within minutes, but these rescuers failed to cut through the ‘mind lock’ and followed the primary caregiver down the wrong, fatal, path. The role of rescuer is critically important but almost completely undefined. It is something few if any of us are formally trained in, yet it is in dire need of a formal, structured and, above all, standardised approach. In short, if we're going to train our way out of this problem, we need to train the rescuers.

Some of the attributes that make a good rescuer can be found in guidelines from the Association of Anaesthetists for implementing human factors in anaesthesia [2]. Much of it is counterintuitive (for example, the advice to stand back and analyse rather than pile in and do something) or counter-cultural (using checklists rather than relying on memory). Yet these seeds are sown on barren ground. How often does the Quick Reference Handbook sit on a shelf uselessly while a crisis is unfolding?

Specific rescuer training would reinforce these skills, while also achieving the aim of rehearsing rare scenarios, all of which is easily done in a simulator. Above all, such training should be standardised nationally, so that everyone involved in an incident, rescuer and rescuee, knows exactly how it will play out. This is a big challenge, but one that falls to our profession alone.

Finally, while we recognise the value of teams training together, the costs are enormous and insisting on this counsel of perfection too often leads to teams not training at all. Pilots are required to take a simulator assessment every 6 months, in which they rehearse their responses to rare emergencies in exactly the way envisaged by Nathanson et al., and they do so individually. Aircrews do not train as teams, yet no-one has died from an accident on a British commercial aircraft for 35 years.

Would that we could say the same for anaesthesia.