When attendants learn to collaborate … pilot an Airbus A320

For the occasion, they kept their blue coats in the locker room of the Parisian Necker-Infants Malades Hospital. This Friday afternoon, six members of the ENT surgical team met with French leader Aviasim in a flight simulation. Team Building Sequence or Leaving Works Council? Both: These seasoned emergency therapists are perfecting their joint time management. Surgeons, anesthetists, nurses, department heads and even professors, here they are driven by an Airbus A320 to test their response to unforeseen situations. And perfect their ability to run the race against time in times of emergency.

The two teams were immersed in the cockpit. Each pair shares the roles of pilot and co-pilot. After a ten-minute briefing on the details of the navigation instruments, Araik, an anesthesiologist, and Nicholas, the surgeon, were ready to begin the first tandem. Following them are Francois, head of the department, and Gina, nurse anesthetist. And then Lesett, the operating room nurse, and Manuela, the anesthesiologist. The simulator has two professional instructor pilots present. One acts as an air traffic controller, the other as a parser. The scenario will be the same for everyone: take a flight between Paris and Lyon… at a time when disasters follow each other.

Strict in control, you have to make a quick decision, when, the passenger’s oxygen mask falls off, causing panic on board, a passenger falls ill, the toilet catches fire or an engine breaks down. The breakup forced each pair to land in a hurry, even if it meant cutting down a few trees before landing on a field!

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Business reflex, creates some slip. “Are we allowed to operate? Uh, to land!”, Corrects Gina by contacting the control tower. Their ability to do (“Tell them everything’s fine,” Leset points the parser straight at the Airbus nose), demonstrates their restraint in the storm.

From this epic half hour when it was necessary to arbitrate the priority, Nicholas comes out swimming. “It’s more stressful than the operating room!” He shouted. However, they are all experienced caregivers, specializing in pediatric laryngo-tracheal endoscopy, a subtle procedure involving the removal of a foreign body from the respiratory tract. It’s the baby’s famous mistake that chokes on a peanut. Necker makes it a specialty: “We perform 75% of 500 to 600 such operations per year in France on children under 3 years of age,” underlined Bryak Thierry, one of three ENT surgeons, along with Francois Simon. And Barbara Cadre, who started the course. And 30% of these operations are performed in emergencies: “The signal is fast, but it is at risk,” Francois Simon noted.

This requires flawless coordination in the short term: the anesthesiologist and the surgeon must work together on the baby’s respiratory tract, one to ventilate him, the other to operate on him. Ultimate risk: young patient suffocation. “This extreme possibility, fortunately very rare, is not the reason we propose this structure,” Briak assures Thierry, who appreciates the perfect control of gestures throughout the service. The goal of this piloting session is to further enhance teamwork and coordination, especially in emergency situations to improve the quality and safety of patient care.

The six trainees are curious, but not surprised. All of them spontaneously make the connection between flight safety and the operating room: failure, when they occur, is mainly associated with human factors. During the pre-take-off briefing, Barbara Cader recalls the textbook incident that was taught in the medical faculty, the death of a patient during a minor sinus operation.

Analysis of the tragedy situation led to a terrible conclusion: around the operating table, technical skills were irresistible. Emergency professionals refer to what they call “attentive tunneling” as a result of the deadly spiral: under stress, everyone makes quick decisions with the situation and adapts to the risk of neglecting adaptation in the normal way. Caregivers continued to intubate the unfortunate woman without considering a tracheotomy… yet the material was prepared by the nurses in the operating room.

According to this case study, each of the participants became aware of their own reflection and first measured an unexpected joint management challenge. Especially since a laryngo-tracheal endoscopy brings together a dozen operators in the operating room. Since Necker Hospital is also a university center, about half of these areopagasses are made up of students who are trained in situ. This adds complexity to the discussion and time management, since you have to do both work and interpretation. “We are not communication experts,” admits Briak Thierry. Aviation has been teaching the art of collaboration to its team since 1980.

The simulator test sheds new light on how to organize oneself into blocks. Take instructions from the control tower. If emerging flight crews are able to replicate them via walkie-talkie, Briak Theory, during debriefing, highlights inconsistencies between the air traffic controller’s ultra-standard vocabulary and the very precise vocabulary of trainee co-pilots. . In aviation, this method, known as “collection”, is one of the most basic aspects of team communication. All or part of the message is repeated to make sure it is received correctly.

“In the same way, Barbara Cadre emphasizes that this communication loop is essential in the operating room. The order must be repeated. Of course, interventions are not of the same nature as wind where one is particularly afraid to fry in line. But even in the operating room, we can become parasites and waste precious time not understanding each other. “During the epidemic, wearing Ebola masks is mandatory, which suppresses words, does not make it easier to pronounce and repeat instructions,” said Brack Thierry during the epidemic.

Another common procedure among pilots: checklist before takeoff, as essential before surgery. On board the simulator, none of the trainees noticed that two cockpit masks intended for pilot and co-pilot were lost from a list. Opportunity to underline the next time savings as you precisely list the tools you need in the block. The house of improvement is strong. According to a questionnaire conducted by Necker after performing 40 endoscopies between the end of 2021 and February 2022, only 10% of caregivers indicated that they detailed the checklist aloud. It is true that in contrast to an aircraft, the checklist for an operation is almost always a single model.

None of the trainees could detect an audible alarm off during takeoff. Common problem: Focusing on a complex task, the brain ignores unfamiliar signals. “In surgery, situational awareness is one of the pillars of soft skills,” recalls Barbara Cadre. Especially since around an operating table, the situation often develops very quickly. The risk is a misjudgment of this, especially due to the lack of caution related to tunneling, which leads to nose sticking in the handlebars: to deal with this, “you need to have the courage to express your doubts,” Barbara Cader insisted, and until Insist until we have the answer. “

The surgeon emphasizes the importance of verbally describing activities and identifying barriers to work. “When you skate, the arrival of a person during the operation often makes it possible to find a solution,” testified Francois, head of the service. Other trainees confirm. Around the debriefing table, the proposal is introduced, before each intervention, to call an external caregiver to unblock a situation.

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When a child’s life is at stake, you also need to know how to make quick decisions. The main cognitive bias that threatens the operating team is habitual bias – “we’ve always done it”, where the situation has evolved – and loyalty to authority. Faced with unexpected situations, the challenge is to free yourself from your emotions and re-focus on the truth. Also pay attention to accuracy in the exchange of information, says Barbara Cadre: “When you tell a nurse on duty to” do 1 adrenaline, “does” do “mean preparation or injection? And “1” is equivalent to 1 milligram or an ampoule ?, he explains

He further suggests, to save a few moments, everyone knows the first names of the other members of the team. The last key skill in managing priorities in a team: leadership, which requires listening and mutual trust. It is about sharing the purpose and inviting everyone to express their doubts and ideas. This is especially the role of briefings. In this regard, the trainees agreed to offer a ten-minute team meeting in the morning – and not just one-on-one between the surgeon and the anesthetist – to review all patients for the day. Organizing upstream to predict an emergency means saving precious seconds at a crucial moment.

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