References
The zero point survey and egg-timer model combined for crew management
Abstract
Managing a complex scene and a critically unwell patient at the same time is a challenge for any paramedic, in terms of both personal preparation and crew resource management. While modern paramedicine requires new solutions to situated challenges, a good starting point is to review existing frameworks to seek ways of maximising the safety of the care delivered by paramedics. This paper provides a synthesis of the theoretical egg-timer model of disparity combined with a practical framework called the zero point survey as cohesive tools for operational paramedics to optimise their performance while experiencing high-stress situations. This synthesis provides a valuable aide mémoire for strategies to improve personal performance, leadership and teamworking in relation to the care of a critically unwell patient. Such models fit within current practice, and have the potential to lead to safer paramedic care through the practical application of human factors theory, with team management skills and psychological interventions to improve patient outcomes.
You arrive at the scene of a road traffic collision, where a motorcyclist is trapped under the front wheels of a car and has noisy breathing. The driver of the car is agitated and complaining of chest and neck pain, and requires urgent assessment and c-spine immobilisation, while the fire service reports they are on their way.
Managing scenes like this requires sustained, high-level communication between crew members, ongoing complex decision-making and a sound understanding of crew resource management (CRM) principles. However, in such a chaotic scene and with limited resources, it is not unusual for one or all of these elements to be missing, which couple potentially lead to adverse patient outcomes.
World Health Organization (WHO, 2020) figures demonstrate that a significant number of adverse events affect patient care, even in controlled, low-risk environments such as hospitals. In comparison, out-of-hospital settings are high-risk environments in terms of patient safety, owing to fast-paced, unpredictable circumstances coupled with the increasingly complex interventions being provided by paramedics (Hagiwara et al, 2019).
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