British journal of anaesthesia
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Anaesthetists in the Defence Medical Services spend most of their clinical time in the National Health Service and deploy on military operations every 6-18 months. The deployed operational environment has a number of key differences particularly as there is more severe trauma than an average UK hospital and injury patterns are mainly due to blast or ballistics. Equipment may also be unfamiliar and there is an expectation to be conversant with specific standard operating procedures. ⋯ This includes current work in the field hospital in Afghanistan and also preparing to work for the Royal Air Force and Royal Navy. We highlight the importance of human factors with reference to the type of case mix seen in the field hospital. We also detail the current pre-deployment training package, which employs multiple educational tools including high-fidelity simulation.
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Situation awareness (SA) is one of the essential non-technical skills for effective and safe practice in high-risk industries, such as healthcare; yet, there is limited research of its significance in anaesthetic practice. In this paper, we review this scant research that focuses on SA as patient monitoring alone and advocate for a more comprehensive view of SA in anaesthetic practice and training that extends beyond monitoring, namely, a distributed cognition approach. We identify further factors influencing anaesthetists' SA and provide a case that resulted in an anaesthetic fatality to illustrate the application of an alternative view of SA in anaesthesia. Distributed SA in anaesthetic practice provides the foundation for further research that may in turn influence the teaching and assessment of this important non-technical skill.
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Communication is a key skill for anaesthetic practice. The 'non-informational' aspects of communication, such as non-verbal elements and the degree to which the style of communication reflects the implied relationship between the sender and the recipient, are relevant to interactions both between anaesthetists and patients and to interactions with other members of staff in the team. Communication and interaction between members of the anaesthesia team in isolation has received less attention than communication in the operating theatre during surgery. ⋯ The handover event also serves as an opportunity to review the care the patient has received and plan for further progress. Anaesthetists and nurses use unspoken and implicit negotiation strategies to achieve the aims of handover without compromising future collaborative work. This is in contrast to the more formalized handover approaches in other safety-critical settings.
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Letter Randomized Controlled Trial
Postoperative sore throat and ketamine gargle.