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HOW TO BE A HERO




    DR CLIFF REID
CONFLICT
   of
INTEREST
INTEREST
   in
CONFLICT
SELF
ENVIRONMENT
    TEAM
   PATIENT
“Made the decision pretty much
  immediately that we needed to
secure his airway. Leaving him with
 an unsecured airway really wasn't
going to be an option - things were
     only going to get worse”
“Made the decision pretty much
  immediately that we needed to
secure his airway. Leaving him with
 an unsecured airway really wasn't
going to be an option - things were
     only going to get worse”
HEROIC?
Heroes do the right thing in difficult
circumstances, often weathering
personal risk to help others with no
expectation of personal gain.
They are guided by a
strong moral compass and
  persist despite setbacks
often overcoming fear to
achieve a goal, accepting
the consequences of their
actions.
Strong moral compass
         The right thing
             Help others
 Difficult circumstances
           Personal risk
        No personal gain
        Overcoming fear
Persist despite setbacks
Prof PHILIP GEORGE ZIMBARDO
20 %
Image used under Creative Commons from Michael Foran
20 %
Image used under Creative Commons from Michael Foran
IT MIGHT NOT WORK
I DON’T WANT TO CREATE A VEGETABLE
I HAVEN’T BEEN TRAINED
NO-ONE ELSE WAS DOING IT
SOMEONE MIGHT COMPLAIN / SUE
IT MIGHT GO WRONG
I MIGHT START BUT NOT BE ABLE TO FINISH
clinical

ethical

practical

medicolegal
0835 anaesthetised
0837 SpO2 75%, cyanosed
0839 SpO2 40%
0841-3 bradycardiac
       joined by ENT Surgeon, & other Anaesthetist
       at least 3 Nurses present
       Intubation attempted

0845 Continued attempts to intubate
0900 SpO2 90% achieved via SGA
09.10 ‘abandon the procedure and ‘wake the patient
up’
09.13-09.29 reminfentanil stopped
            spontaneous breathing began

                                  with permission of Prof Harmer & Bromiley family
“It is hard to understand why Dr
A, and those with him,
persevered in trying to intubate
the trachea....he would have
resorted to a surgical access to
the airway.
He still does not know why he did
not do so”
“Theatre staff, when
    interviewed, all seemed
surprised that [a surgical airway]
      was not performed.”
BYSTANDER
  EFFECT
"All that is required for evil
to prevail is for good men to
do nothing."

             ~Edmund Burke
"It violated everything I
personally believed in and all
I'd been taught about the
rules of war."

                  ~Joe Darby
COGNITIVE RESILIENCE

   POSITIVE SELF-TALK

     MINDFULNESS

    METACOGNITION
HOW TO BE A HERO
   WHO ARE YOU ?

WHAT DO YOU STAND FOR?

  WHAT ARE YOU NOT
 PREPARED TO ACCEPT?
HOW TO BE A HERO
   BECOME READY

    SIMULATION

    IMPLICATIONS
HOW TO BE A HERO
    OPPORTUNITY

 SITUATIONAL AWARENESS

DISCONTINUITY DETECTOR
HOW TO BE A HERO


     DECISION
HOW TO BE A HERO
    KEEP GOING

  POSITIVE SELF TALK
    MINDFULNESS
   METACOGNITION
VALUES / MORALS
COGNITIVE READINESS
       RECOGNITION
           DECISION
COGNITIVE RESILIENCE
I think a hero is an ordinary
     individual who finds
 strength to persevere and
       endure in spite of
  overwhelming obstacles.



                       ~ Christopher Reeve
references at resus.me/smacc-2013

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How to-be-a hero

  • 1. HOW TO BE A HERO DR CLIFF REID
  • 2. CONFLICT of INTEREST
  • 3. INTEREST in CONFLICT
  • 4. SELF ENVIRONMENT TEAM PATIENT
  • 5.
  • 6.
  • 7. “Made the decision pretty much immediately that we needed to secure his airway. Leaving him with an unsecured airway really wasn't going to be an option - things were only going to get worse”
  • 8. “Made the decision pretty much immediately that we needed to secure his airway. Leaving him with an unsecured airway really wasn't going to be an option - things were only going to get worse”
  • 10.
  • 11. Heroes do the right thing in difficult circumstances, often weathering personal risk to help others with no expectation of personal gain.
  • 12. They are guided by a strong moral compass and persist despite setbacks
  • 13. often overcoming fear to achieve a goal, accepting the consequences of their actions.
  • 14. Strong moral compass The right thing Help others Difficult circumstances Personal risk No personal gain Overcoming fear Persist despite setbacks
  • 15. Prof PHILIP GEORGE ZIMBARDO
  • 16.
  • 17.
  • 18.
  • 19. 20 %
  • 20.
  • 21. Image used under Creative Commons from Michael Foran
  • 22. 20 % Image used under Creative Commons from Michael Foran
  • 23.
  • 24.
  • 25. IT MIGHT NOT WORK I DON’T WANT TO CREATE A VEGETABLE I HAVEN’T BEEN TRAINED NO-ONE ELSE WAS DOING IT SOMEONE MIGHT COMPLAIN / SUE IT MIGHT GO WRONG I MIGHT START BUT NOT BE ABLE TO FINISH
  • 27. 0835 anaesthetised 0837 SpO2 75%, cyanosed 0839 SpO2 40% 0841-3 bradycardiac joined by ENT Surgeon, & other Anaesthetist at least 3 Nurses present Intubation attempted 0845 Continued attempts to intubate 0900 SpO2 90% achieved via SGA 09.10 ‘abandon the procedure and ‘wake the patient up’ 09.13-09.29 reminfentanil stopped spontaneous breathing began with permission of Prof Harmer & Bromiley family
  • 28. “It is hard to understand why Dr A, and those with him, persevered in trying to intubate the trachea....he would have resorted to a surgical access to the airway. He still does not know why he did not do so”
  • 29. “Theatre staff, when interviewed, all seemed surprised that [a surgical airway] was not performed.”
  • 31. "All that is required for evil to prevail is for good men to do nothing." ~Edmund Burke
  • 32. "It violated everything I personally believed in and all I'd been taught about the rules of war." ~Joe Darby
  • 33.
  • 34. COGNITIVE RESILIENCE POSITIVE SELF-TALK MINDFULNESS METACOGNITION
  • 35.
  • 36.
  • 37. HOW TO BE A HERO WHO ARE YOU ? WHAT DO YOU STAND FOR? WHAT ARE YOU NOT PREPARED TO ACCEPT?
  • 38. HOW TO BE A HERO BECOME READY SIMULATION IMPLICATIONS
  • 39. HOW TO BE A HERO OPPORTUNITY SITUATIONAL AWARENESS DISCONTINUITY DETECTOR
  • 40. HOW TO BE A HERO DECISION
  • 41. HOW TO BE A HERO KEEP GOING POSITIVE SELF TALK MINDFULNESS METACOGNITION
  • 42. VALUES / MORALS COGNITIVE READINESS RECOGNITION DECISION COGNITIVE RESILIENCE
  • 43.
  • 44. I think a hero is an ordinary individual who finds strength to persevere and endure in spite of overwhelming obstacles. ~ Christopher Reeve