Paramedic non-technical skills: aviation style behavioural rating systems

Abstract

The Department of Health (DH) estimated that in 2000, approximately 10% of patients were harmed in some way while being cared for by the NHS. This equates to 850 000 patients and approximately £2 million in extended bed stays (DH, 2000). These adverse events are found in all areas of health care. For example, it is estimated that errors in surgery can be attributed to poor communication between members of the surgical team in 43% of cases (Gawande et al, 2003). In addition, cognitive and diagnostic errors contributed to 27% of claims against a healthcare organization (Wilson, 1999). Such errors, once analyzed, often show no lack of technical knowledge or skills on the part of the clinicians, and instead may be attributed to a failure in the non-technical skills of the clinicians and clinical team involved. Non-technical skills are defined as the cognitive (thinking) and social (team working) skills that, when combined with technical knowledge and skills, allow a practitioner to deliver safe and effective patient care (Flin et al, 2008). They help to reduce the frequency of errors and reduce the chance of adverse events. There appears to be little published literature detailing errors made by paramedics or discussing their non-technical skills. Generally, errors made by paramedics in the UK are highlighted through complaints from either hospital clinicians, patients’ families, or patients themselves. These complaints could result in lengthy investigations and often place stress on the ‘offending’ paramedic. It could also be argued that few lessons are learnt by the investigating organization or the profession as a whole. Once the error has occurred, it is too late for the patient, and a pro-active error avoidance approach is required.