This past week, we conducted the first ARHT case-based learning session for the duty crew!

While “case-based learning” may seem like a bunch of educational jargon…it can be rephrased to “sit around the table, discuss a previous job and consider the “what if” “.

I think at this point I was trying to convince people that I wasn’t full of BS!

We assembled the team for the day which included the crewman, paramedic and doctor for a 45-50 minute session in the board room.  A huge thanks to Russell C, Leon, and Scott O. who all participated and they generated a great discussion about several aspects of this case. (next time we’ll be looking to get our pilot involved too!)

I had the opportunity to facilitate the session which was based on a relatively straight forward job that I had selected. The job involved a patient with a head injury and the focus was on the management of traumatic brain injury in the pre-hospital setting. But amazingly, the discussion covered tons of ground and we discussed all different aspects from before we leave the base, to the time we arrive at the hospital. Much of the discussion focused on CRM ideas which was very interesting.

Our team’s paramedic and crewman in deep thought! We must have just been getting to the interesting part! At least the team isn’t asleep…

Here’s a summary of our lively discussion!

Pre-job briefing: unless it was a water job (or extra equip is required) that this could/should be done en route
On scene time: Something we need to address as a team given some growing evidence that scene time doesn’t impact mortality in blunt trauma
Decision making for RSI: time to hospital played considerable role in whether to perform an RSI
Role assignment in RSI: crewman should probably be tasked with RSI checklist and scene management rather than involved in being hands-on during RSI. The doctor should hand the bougie & endotracheal tube to paramedic though  good discussion resulted about this and may be situation dependent
Team position in flight: discussion whether person who intubated should remain at head of bed (even if it was MD) during flight. Consensus that if patient is requiring infusions etc…then MD should be at the side, with paramedic at the head and crewman to his right.

We’ll be looking to roll out a few more sessions in the new year.

Some feedback from the session regarding logistics

• Using previous jobs to generate discussion is good
• Focus will be on picking jobs at random to improve learning but this will NOT be a means of quality assurance or control
• Short sessions will be the goal: 20-30 minutes
• Getting the whole team together is best, that includes the pilots!
• All members felt this was a valuable exercise and would participate in future sessions

Again, thanks to the duty crew that day and Scott O for the pictures. See you all in the New Year.