paper could save your life
now I know that sounds like one of those
lofty TED goals but I actually I mean it
very literally let me explain
so I’m a paramedic an advanced care
paramedic to be precise which means we
have a few more interventions and drugs
sure we have a few more ways to save
your life but we also have more ways to
accidentally kill you and it’s awkward I
know I know the key word is accidentally
I would never mean to do that but the
reality is paramedics we share in the
nearly 400,000 people who die each year
from a preventable medical error
conceptualized another way that’s to
sold-out 747 flights crashing and
killing everyone on board every single
day of the year if that were to actually
happen in aviation there would be
outrage I mean it would be beyond a
tragedy would be an unnatural disaster
and yet that’s precisely what’s
happening every day and every year in
healthcare now I think patients deserve
better and I think we can deliver I want
to tell you about one procedure in
particular called intubation and what
some colleagues and I are doing to make
it just a little bit safer so for
anybody who’s not familiar intubation is
essentially where you get a tube put
into your lungs to help you breathe
let’s say you’re having an asthma attack
and your oxygen levels are too low or
you’ve been knocked unconscious from an
accident and you’re not breathing you
might get intubated the concept is
pretty simple open a mouth take a tube
put it into the lungs make sense one of
the problems though is that when you
open the mouth there are actually two
openings one leads to the lungs the
other leads to the stomach the one to
the stomach it’s very easy to see and
the one that leads to the lungs is a lot
more difficult
hard but not impossible
it just requires extra focus extra
attention and as humans we’ve actually
evolved to become very good at solving
problems or actually one problem at a
time while we give that one problem the
attention it deserves we tend to become
hyper focused on it to the exclusion of
everything else around us
it’s called tunnel vision and it’s human
nature it doesn’t just have to be
intubating somebody it happens to
everybody I’m sure you guys can remember
a time that you were focused on doing
something important
say sending a text reading the best part
of a book or even just playing a video
game I want you to think back to one of
those moments and then remember a time
where somebody tried to talk to you
while you were doing that uh-huh did you
hear them or did the sound come in one
year and go right out the other if it
even came in at all if you’re that other
person did you feel like they were
listening to you or did that person keep
repeating themself over and over again
till they finally just begged you to
please pay attention I’m guilty of it
and I know a few here probably are too
so why is that why is it that we can’t
seem to pay attention to more than one
thing at a time evolved as we are well
it’s because multitasking is a made-up
concept it actually just doesn’t exist
the brain can’t do it now I know what
you may be thinking of course we can
multitask we do it all the time we do it
every day we’re so proud of it that we
put it on our resumes we brag about it
in job interviews course we multitask
well the reality is is that not only are
we lying when we do that we’re actually
advertising a terrible habit you see
first of all when we think we’re
multitasking we’re actually not
we’re just rapidly switching from one
task to another still you might think
well that still makes me more efficient
right wrong not only does it kill your
efficiency it actually takes your IQ and
drops it a lot on par with
staying up all night or smoking a bunch
of pot and so instead of doing one thing
really really well we end up doing
several things with the IQ of about an
eight-year-old child think of that the
next time you reach to text while
driving and remember that there’s
suddenly a stoned adult or an
eight-year-old child driving your car
food for thought because multitasking is
more than just inefficient it actually
can be dangerous personally I wish that
somebody would say that in a job
interview and explain why instead of
multitasking they prefer to do one thing
at a time really really well now do you
notice how I have no slides up it’s not
because I’m lazy I am lazy but it’s
actually because I’m selfish and rather
than speak to a roomful of
eight-year-olds I’d rather you paid
attention to me but I will show one it’s
the obligatory grandfather slide so this
is my grandfather in addition to being a
huge role model of mine he was a pilot
of 40 years and in that time he had his
fair share of close calls in the air I
once asked him over dinner
how is it that you stay calm in an
emergency what do you do when things
seem out of control and when there’s
chaos in the cockpit he explained to me
very simply I slow things down I slow
things down that made no sense to me at
the time I thought well it’s an
emergency you have to speed things up
there’s no time that would be more
important than in a crisis in the air I
mean you’d have to be an expert
multitasker right well I wish I could
tell him that I finally understand what
he means that the secret to efficiency
is actually to slow things down it also
turns out to be the secret to saving
lives I’d like to bring you back to that
intubation procedure so when we go to
intubate somebody we take our fancy
laryngoscope and we lift the patient’s
tongue and we try to find hopefully the
the correct opening to the lungs and
while we do that while we’re paying the
attention it deserves we become
tunnel-visioned
and we may miss important things
happening around us such as the
patient’s vital signs crashing that
would be one of those fatal and
preventable medical errors so how do we
avoid that do we multitask do we try to
intubate and monitor the patient at the
same time because then we’ve got an
eight-year-old doing both and that
sounds really crappy so in the worst
case scenario we may take the tube and
put it into their stomach by accident
which would also be a fatal medical
error so we’re stuck we know that
focusing is tunnel-vision and that’s bad
and multitasking well that’s bad too so
what do we do how does anyone maximize
their problem-solving and avoid that
fatal tunnel vision well no one can
really or actually no one can
NASA studied this in the 1970s after a
series of airline disasters they tried
to come up with a radical new method of
decision making and leadership their
goal was to save human lives by sort of
protecting the aviation industry from
human nature itself
they called it crew resource management
or CRM for short now the principles are
pretty simple really the instead of
tunnel vision they aim to promote
situational awareness
instead of multitasking the goal is to
task multiple people with one thing each
there’s a little bit more to it but in a
nutshell those are the main principles
and they work the 1970s had the all-time
highest level of airline disasters and
deaths in history after the introduction
of crew resource management
they went to an all-time low turns out
that those same principles can work in
other industries as well such as
healthcare several years ago the World
Health Organization undertook a
groundbreaking study in which they added
simple checklists prior to routine
surgery now why checklists
the checklists are an integral part of
crew resource management they recognize
that in a complex process like flying or
surgery a simple mistake or oversight
can have fatal complications and so they
aim to take the ego out of that process
and replace it with passenger or patient
safety by recognizing that no one can or
should be tasked to do it all simple
concept simple checklist added prior to
routine surgery death rates from
complications while they were cut in
half and that’s where we come back to
this little piece of paper so this is an
intubation checklist it’s full
disclosure I did make this particular
one some colleagues and I it used to be
in an app that I made but it turns out
when somebody’s dying in front of you
it’s poor for him to pull out your phone
it doesn’t go over very well so
everything old is new again we went back
to a piece of paper but this isn’t an
original idea I just want to be honest
about that if you google it there’s lots
of them out there being used in
emergency departments and paramedic
services around the world so how does it
work well I’d like to take you back a
few years to when I was a newly minted
advanced care paramedic and we responded
to the basement suite of a house for an
82 year old gentleman who was severely
short of breath we came downstairs and
he was leaning on his kitchen counter
pouring sweat and struggling to breathe
he had been there all night and he was
on the verge of death now I may have
been new but I knew that he was sick and
that we were gonna have to intubate him
right away
and so I hurriedly gathered all of my
stuff and and I started thinking okay
he’s we’ve only got seconds here we’ve
only got seconds I’ve got to gather
everything I can as quickly as I can
and then there was this voice in the
back of my head slow things down and so
for the first time in my career I pulled
out the little intubation checklist that
we had made and I tried to remember okay
what’s that crew resource management
stuff right okay tasks multiple people
right empower people to speak up if they
see a problem clear communication okay
gonna do all those things okay so it
went a little something like this
so I’m gonna go in with the Macintosh
four blade and a bougie I’d like you to
put pressure on the trachea when I ask
and I’d like you to pass me the tube
when I need it to another colleague I
said can you watch the oxygen levels
count them down if they start declining
while we’re intubating and if they get
to 85% that’s it we’re gonna stop no
matter how close I am to being done you
tell me we have to breathe for the
patient again
clear communication empowering
situational awareness so that I can
focus on the task at hand and then I
took the checklist and passed it to
another colleague we spent 30 seconds
max going through it you see it doesn’t
replace knowing when how or why to do
something it supports it and it takes
the ego out and sure enough step seven
or something there the suction which I
forgot I somehow always forget the
suction suction turned on and in hand
went ahead and attempted to intubate now
I was able to actually get a pretty good
view of what I hoped was the opening to
the lungs and was ready to pass the tube
when the patient puked a lot now
normally had I not gone through the
checklist and had the suction there that
could have been a terrible episode in
which we would have had to scramble for
the suction and I would have had to stop
intubating and his oxygen levels would
have probably decreased even more but
thankfully suction was there in hand I
was able to clear the airway hearing all
the while that we were still in the safe
zone for his oxygen levels maintaining
situational awareness while being able
to focus on the task at hand now that
particular patient we intubated him
successfully carried him up the stairs
and off to the hospital he not only
survived but made a full recovery which
is great as for me I’ll be honest I was
feeling pretty good after that I mean
that was one of the first times I had
used this and I thought yeah this
checklist thing it’s pretty good
screw research management stuff is great
and I walked out back to my ambulance
feeling pretty
and I ran into my partner who in front
of a crowd of people said to me never in
35 years have I ever seen anyone do
anything so ridiculous he was referring
to the checklist to the thing that I
thought just helped save this guy’s life
and yet to him it was totally foreign he
was still of the mindset that you know
to be good at something was to do it all
yourself
and fair enough that’s his perspective
this was mine you know it’s it’s an
interesting thing that these principles
are now central to aviation crew
resource management is is the benchmark
of training internationally but it’s
still very disruptive to emergency
medicine and para medicine and the
concepts are even more foreign to
society as a whole I mean we have this
fixation that faster equals better and
multitasking equals efficiency when in
reality if we want to be the best we can
be at whatever we do we just need to
slow things down if that’s true in an
emergency when seconds count and a life
is literally at stake it’s even more
true in our personal lives I’ll be
honest if I had taken my own advice and
slowed things down when packing for this
trip I wouldn’t have forgotten to bring
an intubation checklist which I did
thankfully a friend drove some up
yesterday for me so I should practice
what I preach and I’m getting better at
it but at the end of the day it’s not
about this piece of paper because even
though this piece of paper or one like
it may save your life one day the
concepts behind it and adding checklists
to your own life may just change it in
the meantime and while I’d love to think
that we could convince everyone of that
all at once that sounds an awful lot
like multitasking so let’s just slow
things down and instead do a really good
job of trying to change one mind at a
time thank you very much [Music]