Communicating in Emergencies

Question 1

Describe how to control communication as a human factor.

Answer 1

• Keep everyone on the same page and ensure there are no surprises.
• Maintain situational awareness
• Make sure everyone knows what’s going on
  
  • ‘Shared mental model’
• Establish safe environment so everyone can contribute
• Co-ordinate tasks
• Stabilise emotions

Question 2

Describe how to coordinate tasks in an emergency situation.

Answer 2

• Lots of jobs to be done.
• Need to be done in the right order, by the right person:
  
  • Support airway
  • Assess breathing
  • Assess circulation, insert canula, send blood tests
  • Gather more information, speak to family
  • Documentation
  • Team leadership
  • Phone specialist
  • Prepare medication

Question 3

How do you stabilise emotions in an emergency situation?

Answer 3

• Resuscitation critically ill patients is stressful.
• Use structured communication methods to stabilise emotions:
  
  • SBAR
  • ABCDE

Question 4

Describe factors which may cause a communication failure.

Answer 4

• Physical constraints such as noise - A&E is busy and this can be a problem.
• Lack of familiarity with the team.
• Differing communication styles
  
  • Nurses tend to be trained ‘not to diagnose’ and broad and narrative in descriptions (‘paint the big picture’).
  • Critical care physicians tend to want focussed information and get to the question.
• Authority gradient / hierarchy / power distance - there needs to be an environment where everyone is confident enough to say what they are thinking.
• Use of jargon or abbreviations.
• Cognitive biases and emotional disturbance leading to misinterpretation.
• Cognitive load / focus on other tasks.

Question 5

What are the different communication strategies (models) used for communicating in emergencies?

Answer 5

• ISBAR(D)
• IMIST
• Closed loop communication
• Graded assertiveness

Question 6

How would you speak up in an emergency situation if you felt something wasn’t right?

Answer 6

• Be respectful
• Be assertive
• Don’t ‘hint and hope’
• Focus on the problem, not who is right or wrong

Question 7

Describe ISBAR(D)

Answer 7

• ISBAR(D)
  
  • I = introduction
  • S = situation
  • B = background
  • A = assessment
  • R = recommendation
  • D = decision

Question 8

Describe IMIST

Answer 8

• IMIST
  
  • I = identification / introduction
  • M = mechanism of injury / medical complaint
  • I = injuries / information related to the complaint
  • S = signs and symptoms
  • T = treatment

Question 9

Describe closed-loop communication.

Answer 9

Allocation tasks directly by using names and eye contact. Do not leave any ambiguity about who is supposed to be doing what.

Question 10

Describe graded assertiveness.

Answer 10

• Probe - “Do you know that…?”
• Alert - “Can we reassess the situation?”
• Challenge - “Please stop what you are doing while…”
• Emergency - “STOP what you are doing”