Crew Resource Management…and a shocking video of Airbus’ first attempt at automated pilot technology

We just had a great session today with the pilots about crew resource management (or crisis resource management) which essentially is a way of thinking about a high stakes environment, who’s involved and how to manage the factors involved. Often this includes human factors and the goal is to reduce threats & errors.

It’s fascinating to hear from the aviation guys about their progress since we have so much to learn still in medicine. They were asking us if we have anything like “standard operating procedures” or protocols to follow for our acutely sick patients. We replied that we didn’t. We have general algorithms in our minds that we’ve committed to memory but it’s rare for someone to be actually going through a checklist in a crisis situation. The pilots were surprised to learn that we didn’t rely on such protocols or tools. There’s growing discussion about this in medicine in the literature and a recent book “Checklist manifesto” by Atul Gawande have started to address these concepts.

We watched this fascinating but shocking video of the first automated pilot program in an Airbus attempting to land. This is a key example of the value of human input despite the inevitability of human error in any task, as it’s been stated previously, “To err is human” but we just need to learn to manage these incidents.

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One thought on “Crew Resource Management…and a shocking video of Airbus’ first attempt at automated pilot technology

  1. In emergency medicine, the two obvious things that spring to mind for checklists and algorithms are a) procedures, and b) cardiac arrests.

    Procedure checklists are not really controversial and are generally very useful, but (as usual) medicine seems to lag a long way behind aviation with regards to their implementation.

    Cardiac arrest algorithims are probably analogous to what pilots do in emergencies, but the problem for us is that a patient in cardiac arrest is (usually) the equivalent of the aircraft scattered in burning pieces across the Everglades… i.e. it is too late.

    Personally I find that serious/critical illness is much more stressful to manage than cardiac arrest – the line between salvage and disaster is fine, and frequently lies entirely in your hands. I have never really considered use of rigorous checklists in this setting (reverting to repeated assessment/reassessment of A/B/C/D and thinking out loud etc is probably as far as I go, but is there a role for checklists in critically ill patients who need rapid intense resuscitation but haven’t yet arrested?

    For example:

    HUMAN FACTORS CHECKLIST:
    team leader identified
    roles delegated
    unnecessary personnel removed
    equipment appropriately located for team members
    etc etc

    CRITICAL ILLNESS CHECKLIST:
    airway – optimized? (position, adjuncts, consider invasive)
    breathing – oxygenation optimized? consider mode of delivery
    circulation – adequate access? consider I/O, CVL, femoral
    etc etc

    Is there a role for having this stuff written down, visible in resus, and delegating a team member to do a check/response..? Thoughts?

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