SMACC: Cliff Reid on How to be a Hero

HOW TO BE A HERO

DR CLIFF REID

CONFLICTof

INTEREST

INTERESTin

CONFLICT

ENVIRONMENTTEAM

PATIENT

SELF

“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 compassThe right thing

Help others Difficult circumstances

Personal riskNo personal gainOvercoming fear

Persist despite setbacks

accepting consequences

Prof PHILIP GEORGE ZIMBARDO

20 %

Image used under Creative Commons from Michael Foran

Image used under Creative Commons from Michael Foran

20 %

IT MIGHT NOT WORKI DON’T WANT TO CREATE A VEGETABLE

I HAVEN’T BEEN TRAINEDNO-ONE ELSE WAS DOING ITSOMEONE MIGHT COMPLAIN / SUEIT MIGHT GO WRONG

I MIGHT START BUT NOT BE ABLE TO FINISH

clinical

ethical

practical

medicolegal

0835 anaesthetised0837 SpO2 75%, cyanosed0839 SpO2 40%0841-3 bradycardiac joined by ENT Surgeon, & other Anaesthetist at least 3 Nurses present Intubation attempted

0845 Continued attempts to intubate0900 SpO2 90% achieved via SGA09.10 ‘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

WHO ARE YOU ?

HOW TO BE A HERO

WHAT DO YOU STAND FOR?

WHAT ARE YOU NOT PREPARED TO ACCEPT?

BECOME READY

HOW TO BE A HERO

SIMULATION

IMPLICATIONS

OPPORTUNITY

HOW TO BE A HERO

SITUATIONAL AWARENESS

DISCONTINUITY DETECTOR

DECISION

HOW TO BE A HERO

KEEP GOING

HOW TO BE A HERO

POSITIVE SELF TALK

MINDFULNESSMETACOGNITION

VALUES / MORALSCOGNITIVE 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