“Event Management in Emergency Situations” by Toni Imprescia, RN for OPENPediatrics

[MUSIC PLAYING] Event Management in Emergency
Situations by Toni Imprescia. Hi. My name is Toni Imprescia. I’m a Clinical Educator at Boston Children’s
Hospital in the cardiac intensive care unit. In order to provide the best care for patients
during an emergency situation, there must be effective interdisciplinary teamwork between
doctors, nurses, and other health care providers. Teamwork must be maximized during a crisis
situation for the patient to receive the best care. Role clarity. Role clarity means establishing clear rules
for every member of the team. This will increase the efficiency and accuracy
of the team during the crisis. First, an event manager, or leader, needs
to be established. The event manager will organize a team by
assigning clear roles, instead of assigning tasks. The event manager can delegate areas of responsibility,
such as assigning a doctor to the airway. Once the airway is assigned to another doctor,
he will ask for an update in a timely manner so that appropriate interventions can be provided. All communication during a crisis should be
directed through the event manager. And the event manager needs to verbalize very
clear goals to the team. For instance, an event manager might say:
“this is a Post-operative Tetralogy of Fallot repair patient, in cardiac arrest. We have an airway. We will defibrillate with two Joules per kilogram
and provide effective chest compressions. Prepare 0.01 milligrams of epinephrine.” By stating this, the event manager assures
that the entire team understands the plan and is working towards the same goals, thus
avoiding confusion and wasted time. Also crucial is that the event manager provides
updates to the team. An update might include something such as:
“we have defibrillated once and have provided chest compressions for two minutes with no
return of circulation. Now, give one dose of epinephrine.” This helps to keep the team on the same page. It is also crucial for the event manager to
voice uncertainty to the team and be open to the team for ideas as to what might have
put the patient in this situation. The event manager may ask something to the
effect of: “does anyone have any ideas of what might be causing this emergency?” Also important for the event manager during
the crisis is that they try not to get involved in the technical aspects of managing the resuscitation
whenever possible. Although the event manager is often the most
senior doctor present and the temptation may be for that person to manage the airway or
perform other procedures, it is essential that the event manager delegate these tasks
whenever possible, allowing for global view of the situation, avoiding errors of fixation. When a team member takes on a responsibility,
she should be clear about this. For example, the team member may say– I have
the defibrillator attached to the patient. It is charged to two Joules per kilogram. Are you ready to defibrillate? Individual participants also have the responsibility
to remain aware of the whole situation. A team member may notice or know something
about the patient that the event manager does not. It is her responsibility to tell the event
manager. For example, the team member may say, the
laboratory just reported a potassium level of 8 from a specimen drawn right before the
patient developed ventricular fibrillation. This information is crucial for proper treatment
and management of the emergency situation. Team members need to offer assistance and
information to help the Event Manager. And this communication should always be respectful. In addition, team members should provide updates,
to the event manager, on tasks. For example, the nurse may report: “I have
given 0.01 milligrams per kilogram of epinephrine.” And this way, the event manager and other
team members know that the medication was actually given. Finally, during a crisis, if a team member
does not know how to perform a task that they’ve been assigned to do, they should find someone
else to be able to perform that task. During a crisis, it’s not the time to develop
a new skill set. Newer models of crisis management call for
the event manager to be located in a central position, sharing information with and accepting
feedback from participants. In this model, everyone’s role is important.

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