A pilot watched us do a sim…

For me, a highlight of working through this pandemic has been the “First Class Lounge” laid on by Project Wingman. It’s a lovely little space set up at the back of our hospital canteen full of comfortable seating, ambient music, and friendly airline crew in full uniform serving the coffees.

Initially, I assumed the staff must have been cabin crew plying their usual trade in NHS hospitals instead of aeroplanes. However, when I struck up a conversation with a particularly affable bloke as he made my flat white, I realised I was speaking to a pilot. An actual pilot.

Most aviation folk have been furloughed or made redundant due to COVID-19. Project Wingman was set up to give crew members from every UK airline an opportunity to contribute to the national effort. Check out their Mission here.

What a goldmine of educational goodness is suddenly at our disposal! Pilots have always been the pace-setters when it comes to human factors and simulation training. With that in mind, I invited Captain Alexander Jolly to observe one of our in-situ simulations.

The sim scenario was a deteriorating patient progressing to PEA cardiac arrest. Reversible causes were hyperkalaemia and hypothermia. No curveballs. The team leader was an experienced EM registrar.

Captain Jolly kindly emailed me with some feedback later that day.

Hi Robbie,

Firstly, I’d like to thank you for inviting me to one of your sim sessions in A&E, it was an absolute privilege to see you guys at work and the way it was conducted was nothing short of incredibly professional. 

A little background on my flying experience – 12 years of commercial aviation experience with over 7000 hours operating the Airbus at LHR, flying to 100+ destinations across Europe and the M.East. I have been an airline captain for over 4 years.

With this being my first observation, my aim was to simply get a feel for the hospital environment and to see how the team interacted during the diagnosis and subsequent response. I was struck by the similarities between the ALS algorithm and how we deal with a technical failure in flight. Lots of great teamwork and you could tell how experienced and calm the clinical lead was during the exercise.

My takeaways from the first sim:

Workload management and Comms – Brilliant communication by the lead, you could also tell there were several team members who were very keen to participate in various tasks such as reciting 4 H’s and 4 T’s – good opportunity to catch your breath and ask them? I often struggle to recite one or two acronyms – by asking open questions I not only empower my teammates, but it also helps to check my/their understanding.

Situational Awareness –  During a PPP (plane, path, people) review post-failure, which is similar to ABCDE, I like to use the severity scale 1-10 and ask my colleagues what they think the score is. Good way of raising SA especially if you differ drastically, it could highlight an issue with workload management.

Problem solving & decision making – Whenever a technical failure has been dealt with and a decision has been made, it is quite often a good time to ask if you have missed anything as part of a review. I like pressure testing decisions “Give me a good reason why we shouldn’t divert?” or “have we considered the three legged stool – passengers, regulatory, commercial?”

Finally, I recall head of resus spotted a discrepancy in the amount of compressions. I wanted to know how actions like this are monitored in real time? In flight, once we get to a certain altitude, normally below minimum safe altitude, the focus is on monitoring each others actions as it is safety critical. I wonder with the luxury of a spare team member, should they be given the role of providing live observational feedback?

Thanks once again for the opportunity Robbie,

Kind regards

Wow.

These guys should not be making us caffeinated beverages. They should be helping us train. Watch this space.

Robbie
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