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

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 operation

Elaine Bromiley case

SETTING STANDARDS

Dedicated 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.

DASUNANTICIPATED 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

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

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.TStandardisation of

equipment, its location and its use

Informed, educated staff

Efficient, effective TEAMWORK

THANK YOU FOR

LISTENING

DAVID FAULKNER

S.O.D.P