Incidents during out-of-hospital patient transportation

Publisher's copy made available with the permission of the publisher © Australian Society of AnaesthetistsOut-of-hospital patient transportation (retrieval) of critically ill patients occurs within highly complex environments. Adverse events are not uncommon. Incident monitoring provides a means to better understand such events. The aim of this study was to characterize incidents occurring during retrieval to provide a basis for developing corrective strategies. Four organizations contributed 125 reports, documenting 272 incidents; 91% of forms documented incidents as preventable. Incidents related to equipment (37%), patient care (26%), transport operations (11%), interpersonal communication (9%), planning or preparation (9%), retrieval staff (7%) and tasking (2%). Incidents occurred during patient transport to the receiving facility (26%), at patient origin (26%), during patient loading (20%), at the retrieval service base (18%) and receiving facility (9%). Contributing factors were system-based for 54% and human-based for 42%. Haste (7.5%), equipment malfunctioning (7.2%) or missing (5.5%), failure to check (5.8%) and pressure to proceed (5.2%) were the most frequent contributing factors. Harm was documented in 59% of incidents with one death. Minimizing factors were good crew skills/teamwork (42%), checking equipment (17%) and patient (8%), patient monitors (15%), good luck (14%) and good interpersonal communication (4%). Incident monitoring provides sufficient insight into retrieval incidents to be a useful quality improvement tool for retrieval services. Information gathered suggested improvements in retrieval equipment design and use of alternative power sources, the use of pro formae for equipment checking, patient assessment, preparation for transportation and information transfer. Lessons from incidents in other areas applicable to retrieval should be linked for analysis with retrieval incidents.A. Flabouris, W. B. Runciman, B. Levingshttp://www.aaic.net.au/Article.asp?D=200530

The Relationship between Working Conditions and Commercial Pilot Fatigue Development

Fatigue is an important factor in aviation accidents, and effective fatigue management requires understanding the relationship between working conditions and fatigue. Two studies were conducted to clarify the relationship between working conditions and fatigue. In the first study, 59 airline pilots completed a workload questionnaire and the Profile of Mood States (POMS) in the morning and at the completion of their final flight of the day. In the second study, 133 pilots completed a revised questionnaire and the POMS. In both samples, fatigue increased and vigor levels decreased. Regression of fatigue increase upon working conditions indicated that the number of takeoffs and landings during the day were related to fatigue development. Correlation of incident level with both weather and airport difficulty suggest that incident level is a function of weather conditions and airport difficulty. These results argue that fatigue management should be founded upon the demands of working conditions, not merely the simplistic assessment of hours of work