Comparison of self-reporting of deficiencies in airway management with video analyses of actual performance. LOTAS Group. Level One Trauma Anesthesia Simulation.

We compared the performance deficiencies of airway management captured by three types of self-reports with those identified through video analysis. The three types of self-reports were the anesthesia record (a patient record constructed during the course of treatment), the anesthesia quality assurance (AQA) report (a retrospective report as a part of the trauma center's quality assurance process), and a posttrauma treatment questionnaire (PTQ), which was completed immediately after the case for the purposes of this research. Video analysis of 48 patient encounters identified 28 performance deficiencies related to airway management in 11 cases (23%). The performance deficiencies took the form of task omissions or practices that lessened the margin of patient safety. In comparison, AQA reports identified none of these performance deficiencies, the anesthesia records identified 2 (of 28), and the PTQs suggested contributory factors and corrective measures for 5 deficiencies. Furthermore, video analysis provided information about the context of and factors contributing to the identified performance deficiencies, such as failures in adherence to standard operating procedures and in communications.

Task complexity in emergency medical care and its implications for team coordination. LOTAS Group. Level One Trauma Anesthesia Simulation.

To elicit components of task complexity in emergency medical care, a study was conducted to contrast one medical procedure with two levels of task urgency in trauma patient resuscitation. Videotapes of actual resuscitation were reviewed to extract task characteristics of the procedure. Two levels of urgency were compared in the following areas: patient status, technical difficulty of tasks, the amount of available patient monitoring information, and the pace of work. Four components of task complexity in emergency medical care were identified: multiple and concurrent task, uncertainty, changing plans, and compressed work procedures and high workload. These components of task complexity pose challenges to team functions and can lead to problems in team coordination, such as conflicts in goals, tasks, and access to the patient. Training to increase explicit communications and improvements in the design of work procedures are necessary in order to meet the challenges of task complexity.

Training nursing staff in airway management for resuscitation. A clinical comparison of the facemask and laryngeal mask.

The place of the laryngeal mask in emergency airway management by nonanaesthetists has yet to be established. We have compared the tidal volume achieved by nurses during hand ventilation using standard resuscitation equipment with a facemask, with or without a Guedel airway, and following placement of a laryngeal mask in the same patients. The tidal volumes measured while using the laryngeal mask were significantly greater (p < 0.01) than those measured during facemask ventilation.