THE UNANTICIPATED

DIFFICULT AIRWAY AND THE

INTRODUCTION OF S.M.A.R.T

ROLES

WHAT IS S.M.A.R.T ABOUT

WHY DO WE NEED S.M.A.R.T

STANDARD SETTING FOR S.M.A.R.T

TRAINING NEEDS FOR S.M.A.R.T

PRESENTATION OBJECTIVES

TO DISCOVER

PRESENTATION OBJECTIVES

TO DISCOVER

S.M.A.R.TSTRUCTURED

MANAGEMENT

AIRWAY

RESPONSE

TEAM

WHAT IS S.M.A.R.T ABOUT

• This course was developed by the "Difficult Airway Society" DAS designed to teach both technical and non-technical skills in airway management.

• The course highlights behaviours and human factors when dealing with an unanticipated difficult airway.

• Illustrates the need for shared information and structured planning to reduce error.

• Provides structured guides to ensure coordinated leadership and management during the difficult airway situation.

WHY DO WE NEED S.M.A.R.T

•Human factors - Humans can be the strongest or weakest part of a team. When dealing with a difficult airway situation, HUMAN FACTORS can create.

LOSS OF SITUATIONAL AWARENESS

LOSS OF PERCEPTION AND COGNITION

FRAGMENTED TEAMWORK

LOSS OF AIRWAY CONTROL

DVDJust a routine operationElaine Bromiley case

SETTING STANDARDSDedicated S.M.A.R.T

rolesTeam Brief

Assign Designated Roles

1st Anaesthetist

ODP / Anaesthetic Practitioner

Theatre Staff One

Theatre Staff Two

Support Worker

1st ANAESTHETIST• Highlights the trigger response

"Difficult Airway" should the need arise to call for help

• Shares information with team members, assigns roles and provides a structured brief concerning anticipated and unanticipated difficult airways

• In the "difficult airway" situation, follows adult DAS algorithm, creating structure and teamwork in the emergency setting.

ODP / ANAESTHETIC Practitioner

• Follows the instructions given by the anaesthetist during the Team Brief

• In a "Difficult Airway" situation, suggests the trigger call is given

• Remains with Anaesthetist and patient at all times following the DAS role for ODP / Anaesthetic Practitioner

THEATRE STAFF ONE

• Follows the instructions provided in the Team Brief

• In the "Difficult Airway" situation, responds to the trigger call "Difficult Airway", presents to the intubating area and performs allocated role, completes paperwork, documenting vital signs, announcing time when saturations fall below 90% and verbalises from the onset "time zero" stating time then on every two minutes.

THEATRE STAFF TWO

• Follows the instructions provided in the Team Brief.

• In the "Difficult Airway" situation, responds to the trigger call by performing allocated role, collects difficult airway trolley and any other stated equipment, fast bleeps 2nd Anaesthetist and surgical colleague and helps ODP / Anaesthetic Practitioner as requested

SUPPORT WORKER• Follows the instructions

provided in the Team Brief.

• Responds to the trigger call "Difficult Airway" by immediately collecting the Fibreoptic Laryngoscope from its designated area.

• On return responds to any other stated tasks

• This role has been incorporated to this hospital due to the remote location of the fibreoptic laryngoscope.

DAS UNANTICIPATED DIFFICULT AIRWAY

ALGORITHM

EQUIPMENT STANDARDISATION

• A "Difficult Airway" trolley will be situated in all Theatre departments.

• The contents of the drawers will be standardised following the sequence A to D as per DAS algorithm.

DIFFICULT AIRWAY TROLLEY

DIFFICULT AIRWAY TROLLEY

EQUIPMENT STANDARDISATION

• Allocated storage area in each department with clear sign recognition

• All grades of staff will be familiar with its location.

• Daily checks will be completed, including equipment and expiry dates, in accordance to an attached content list.

• An allocated person will check the trolley and signature check list completed.

TRAINING NEEDS• Unanticipated difficult

airway training sessions.

• Simulations of "Difficult Airway" situations.

• Training video's of available intubation equipment.

It is our responsibility to ensure that all staff are advised to the

location of the Difficult Airway

equipment

It is our responsibility to ensure that all staff are advised to the

location of the Difficult Airway

equipment

PRESENTATION CONCLUSION

SMART

WHATS IS S.M.A.R.T ABOUT

The creation of structure, teamwork and effective efficiency in an emergency

situation.

WHY DO WE NEED S.M.A.R.T

To overcome the negative effects that can occur due to Human Factors

To ensure error avoidance

To ensure controlled standardised teamwork and avoid crisis

HOW DO WE ACHIEVE S.M.A.R.T

Standardisation of equipment, its location and its use

Informed, educated staff

Efficient, effective TEAMWORK

THANK YOU FOR LISTENING

DAVID FAULKNERS.O.D.P