CRISIS MANAGEMENT - VALIDATION OF AN ALGORITHM BY ANALYSIS OF 2000 INCIDENT REPORTS

Anaesthetists are called upon to manage complex life-threatening crise s at a moment's notice. As there is evidence that this may require cog nitive tasking beyond the information-processing capacity of the human brain, it was decided to try and develop a generic crisis management algorithm analogous to the ''Phase I'' immediate repsonse routine used by airline pilots Such an algorithm, based on the mnemonic ''COVER AB CD, A SWIFT CHECK'', was developed and refined over 3 meetings, each a ttended by 60-100 anaesthetists and aviation psychologists. It was val idated against 1301 relevant incidents among the first 2000 incidents reported to the Australian Incident Monitoring Study. It proved suffic iently robust and safe to recommend its general use as an initial resp onse to any incident or crisis which occurs when a patient is breathin g gas from an anaesthetic machine. It requires a limited knowledge bas e and is easily learnt and rehearsed during the anaesthetist's working day. It will provide a functional diagnosis in over 99% of cases and will correct 62% of the problems in 40-60 seconds. In the remaining 37 % it will allow the anaesthetist to proceed with a ''sub-algorithm'' c onfident in the knowledge that some important step has not been missed . In just over 30% of incidents this will be for a problem familiar to all anaesthetists (e.g. laryngospasm, bradycardia), in just over 6% i t will be for a less common, more complex, but finite, set of problems (3% cardiac arrest, 1% air embolism, 1% anaphylaxis, 1% for the remai ning desaturations); in less than 1% diagnosis and correction will req uire a more complex checklist (eg. for malignant hyperthermia, pneumot horax). The next stage, the development of specific sub-algorithms and a structured team approach for ongoing problems, is in progress.