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

Re-storying and visualizing the changing entrepreneurial identities of Bill Gates and Richard Branson.

The storytelling in textual and visual re-constructions of Bill Gates and Richard Branson by their organizations produces entrepreneurial identities bound into particular social power-knowledge relations. Our purpose is to examine how these organizations, and their critics, mobilize storytelling in acts of re-storying (enlivening) or re-narrating (branding a monologic) practices using Internet technologies to invite viewers to frame the world of entrepreneurship. We use visual discourse and storytelling methods to analyze how Microsoft and Virgin Group use various kinds of entrepreneurial images and textual narratives to re-narrate and produce particular brands of capitalism. These organizations' scoptic regimes of representation are contested in counter-visualizing and counterstory practices of external stakeholders. We suggest that the image and textual practices of storytelling have changed as both entrepreneurs court philanthropic and social entrepreneur identity markers. Our contribution to entrepreneurial identity is to apply double and multiple narrations, the appropriation of another's narrative words (or images) into another's narrative, and relate such storytelling moves to visuality