In Dave Grossman’s book On Combat, he presents a graph showing different levels of stress and our bodies change in our fine motor skills. He states that when our heart rates reach up above 140 bpm, we lose almost all critical decision-making ability as well as fine motor skills.

When we are presented with an unusual problem that we don’t know the answer to, or an equipment malfunction that we can’t troubleshoot, the likelihood of stress is inevitable.

Richard Levitan, an ED physician that frequently contributes to podcasts and blogs such as EMCrit and SMACC, presented his theory of being “Stuck on Stupid”.

1. This takes Grossman’s research and applies it directly to the emergency medical field.
2. Levitan specializes in advanced airway management and gives several anecdotes in his presentations regarding airway failure.
3. First pass: unsuccessful? Try something different.
4. No use trying something that doesn’t work over and over again.
6. -http://www.emdocs.net/yellowstone-advanced-airway-course/

If we don’t train ourselves for alternative procedures beyond the familiar ones, how are we going to be able to have deductive reasoning and be able to problem solve? We have to change we train our staff

In an article from Life in the Fast Lane, a group of researchers followed emergency physicians and paramedic students, tracking their advanced airway placement success rates. The study revealed that it took approx. 50 live intubations to become proficient.

1. http://lifeinthefastlane.com/dl-terminated/
2. 50 live intubations is nearly impossible to do during class… What do we do to train our staff/students so that a live, viable patient is not our test run?

Simulation Training

Simulation training can take many forms. There is a mantra in the military, “Don’t practice until you succeed; practice until you can’t fail.”

1. This has several different applications
3. High-risk procedures (i.e. airway management/cardiac arrest care/medication administration)
4. Practice the skills until they are perfect!
5. Add stressors/distractions
7. Critique your performance
8. Record your performance with a mic/video camera
9. Group discussion/debriefing

-By incorporating real-life stressors and possibilities, we eliminate potential stress and poor-decision making.

-Our willingness to train and reflect is a direct representation about how much we care about our patients.

-JEMS article regarding moulage training: http://www.jems.com/articles/print/volume-40/issue-7/features/making-moulage-on-a-very-tight-budget.html