Yes I do see what you are sneaking up on!
Your description of monitoring an operation and
noticing 'something' start to go wrong (with the
resultant adrenaline surge, etc.)is absolutely
right. Unfortunately, in some of the
operating room catastrophes which I have
investigated, no-one noticed that things were
starting to go badly wrong until they had ultimately
badly gone wrong. ("It's not that the heart stopped
suddenly but that he suddenly noted that the heart
had stopped.")
What should have happened, and what, fortunately
does happen, is that the OR team is
diligently maintaining situational awareness and
notes the start of a decline in the patient. The OR
personnel start to operate at a higher level to
reverse, or to prevent further, deterioration.
There may be a further escalation of performance if
there is further deterioration in the patient's
condition. We encourage anaesthetists (and I
think that surgeons are also encouraged) to
recognise the need for extra help and to ask for it.
I guess this is something that's not always
available in the cockpit (!) and sometimes it's not
always available in the OR (solo practitioner,
or small town, or middle of the night, or other
anaesthetists / surgeons up to their elbows, etc.).
I suppose that this is our way of teaching how to
recognise what you are describing as a
physiological threshold. I like the idea of
describing it in physiological terms as it may be
more acceptable to those macho types (surgeons &
anaestehtists and a few nurses!) who deny ever being
psychologically or cognitively stressed.
I'd be interested in hearing your ideas on how to
familiarise crews with their (individual) cognitive
thresholds.
Regards
Jan
----------------------
J.M. Davies MSc MD FRCPC
Professor of Anaesthesia
Department of Anaesthesia
Foothills Medical Centre
1403 29th Street N.W.
Calgary, Alberta
CANADA T2N 2T9
tel: 403-670-4707
fax: 403-670-2425