In Safe Hands – Flying High

Recently I was sitting on Qantas flight contemplating the 23 hour journey ahead of me to London when the Captain’s voice came over the speaker system with a cheery greeting. Often I tune out at this stage as I busy myself with seatbelts, headsets and claiming elbow room from my close neighbour! But the name of the Captain stopped me in my tracks – ‘Good afternoon, ladies and gentlemen, this is Captain Richard De Crespigny speaking.’ The name may not be familiar to you, but to me it sent my mind back four years to November 2010 when the same pilot brought stricken flight QF32 back safely from the brink of what could have been one of the worst air disasters.QF32_1

QF32 was an A380 airbus with 469 passengers and crew on board which had just left Singapore on the final leg of the long haul flight from London. Four minutes into the flight an engine blew up, caught fire, severing a number of vital electrical and hydraulic systems within the wing. The resulting catastrophic emergency tested the experience and teamwork of the flight crew to their limits in trying to assess the damage and its consequences for the plane. The good news was that the flight crew were able to land the plane safely back in Singapore. What makes this a somewhat personal story is that I should have been on that flight, but extended my stay in UK by a day, thereby missing this near disaster.

Hearing Captain De Crespigny’s cheery welcome last week got me thinking about what he and his crew must have gone through managing the emergency four years ago. It also made me consider the parallels between the teamwork required in the cockpit during that emergency and similar situations in an operating theatre when good teamwork and communication are vital components of a safe outcome for the patient. I have just watched a recreation of the events on QF 32 and struck me was the calm leadership of Captain De Crespigny as he delegated jobs to his flight crew whilst he took over flying the plane. In one of the many interviews you can view on You Tube, he tells of importance of using his hearing to ascertain how well the engines were working – not relying on the myriad of controls at his disposal, many of which were showing alarms and therefore unreliable. How many times do we in an operating theatre rely on watching monitors rather than use our eyes and ears to tell us the condition of a patient?

One of the roles he delegated during the emergency was to his First Officer who took fifty five minutes to investigate each one of the hundred alarms that had been triggered, with each alarm having its own checklist to work through! Ignoring any one element of the checklist could have meant disaster for the plane and its passengers. How often you see teams going through the motions of our ‘Time Out’ checklist without really engaging with each aspect and how that may put our patients at risk?

The other aspect that struck me watching the recreation was the teamwork of the flight crew and the contributions each made to working out solutions for the many problems they faced. None were afraid to speak up and all were encouraged by the Captain to contribute their thoughts to finding solutions. Are there parallels we can draw between the flight crew and teams in the operating room? How easy or challenging is it for you to speak up if you witness unsafe practices or to voice concern about the way in which surgery is progressing? Hierarchical barriers which once plagued the cockpit are still in evidence in many surgical teams. What can be done about this? We know from the reading reports following adverse events that poor communication and dysfunctional teams are often the root cause of such events. Non-technical skills such as teamwork and communication are just as important to the safe outcome for the patient as the technical expertise the surgical and nursing teams possess.

In my next blog I will describe an initiative with which I have recently been involved aimed at improving multidisciplinary surgical teamwork and communication.

Until then – ‘sit back, relax and enjoy the flight’ – I certainly did.

Cheers
Menna

You can view a recreation of the events that took place on QF32:

‘Airbus A380 (Qantas Flight 32) – Engine on Fire – The Titanic in the Sky Seconds from Disaster’