DMore than 11 million business trips require emergency ambulance services each year. Given the large number of people, you should be able to rely on the high professionalism of your assistants. But it also has shortcomings, which often endanger patients. In the medical field, error management is still neglected. Rescue service personnel face special challenges. Local conditions are often confusing, severe weather conditions, conflicting information from witnesses, and the need to act under time pressure, making rescue services a high-risk workplace. Many, if not everything, such as patients’ lives, depend on effective communication. In this respect, rescue services are similar to other high-risk workplaces, such as aviation or the chemical industry. For a long time, both fields have known that communication errors can have serious consequences. Usually, only minor misunderstandings lead to serious errors. Experts talk about the Swiss cheese model, small mistakes-serious consequences.
There is almost no research on the frequency of errors in rescue services, and certainly no research on the quality of communication within the team. Given the various challenges, this is understandable. Research on the subject conducted under the direction of the author is now in the journal ProLogis One Published, the results revealed would be a disturbing understatementThe results of the investigation should be a wake-up call to those responsible for organizing rescue services.
The study interviewed more than 700 nurses (two-year training), nurses (three-year training) and emergency doctors. In terms of age, gender distribution and work experience, the interviewees represented employees of the German rescue service. More than two-thirds of people reported that patients were harmed by their own mistakes, with 5% of cases causing considerable harm. There are reports of permanent disability or even death.
Complaints about communication difficulties
The blatant lack of an established structure for handling errors is worrying. Less than half of the interviewees were able to talk openly about mistakes with their bosses. One-third of respondents worry that they will be sanctioned if they openly resolve the deficiencies. Cultural habits such as rigid hierarchies are important factors that encourage errors. This is what the analysis of aviation disasters shows. For Asian airlines, subordinates often dare not refute their superiors. The rescue service in Germany is not much better.
Each task puts doctors and nurses under pressure. Shockingly, respondents often report communication barriers under stressful situations. This ranges from confusing facts and explanations to admitting that you cannot express yourself accurately. The level of communication within the team can be checked by adhering to established standards that have proven indispensable in other high-risk areas. This includes cyclic communication (closed loop communication) to avoid misunderstandings and misunderstandings. Messages and instructions will be sent directly to the team members, and then the team members will repeat them out loud. After the task is completed, the implementation status must be reported. Only a few respondents abide by the basic rules of circular communication. In addition, not even half of the interviewees directly called the referee’s name.
In a complex emergency system, such a lack of professionalism should not be expected. He found an explanation in the structure of the rescue service. In many places, it is set in the assembly point system. Paramedics and paramedics drive ambulances and only meet with emergency doctors in emergency locations. Usually you don’t know each other, let alone the names of other team members. The assistance staff (nursing staff, nursing staff) are provided by related organizations such as the Red Cross or Malta. Medical services are usually provided temporarily by resettlement companies. This structure negates the fact that good emergency medicine can only succeed in a well-trained team. Many people in charge still believe that the assistant will do first aid when he arrives, and the doctor will be responsible when he arrives. However, this does not meet the requirements of rescue services.
Participants participating in the study know all this and always require joint training, especially in proper communication. They also need proper culture and error handling. Today, every airline thinks so. Now is the time for the people responsible for rescue services in the federal states and ministries to quickly correct their grievances.
The author is a medical ethicist and chief physician of the First Medical Clinic of Ketterer Hospital Offenbach.
