Cardiac arrests are associated with significant mortality and are often unexpected and extremely stressful for the practitioners involved. Cardiopulmonary resuscitation is arguably one of the most important skills for medical practioners. Previous research has shown that the non-technical skills of the team leader is directly related to technical performance of the team, particularly under stressful situations1. Non-technical skills has previously be defined as ‘the cognitive, social and personal resource skills that complement technical skills and contribute to safe and efficient task performance’2.
This blog article will draw from the literature and advanced life support guidelines to summarise 4 main categories of non-technical skills (leadership, communication, teamwork and task management) that can be readily adapted by the junior doctor and aspiring leaders of cardiopulmonary resuscitation.
Leadership
The team leader
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Should be easily identifiable to the team
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Does not necessarily need to be the most senior but should be clinically experienced
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Delegates clear roles to the team
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Should remain hands off and adapt a global perspective
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Should gather information, interpret it and make executive decisions
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Should demonstrate situational awareness, flexibility and adaptability to the evolving challenges and changes in patients conditions
Communication
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Remember the Cs of effective communication – cite names, be clear, concise and closed loop
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Avoid information overload
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Information delivery should not delay the initiation of vital life support measures (ie. compressions, defibrillation)
Teamwork
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Know each other’s names and role (wear name tags and role stickers) – role confusion and not knowing each other’s name can delay the communication of vital information
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Act with composure and control
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Recognise if others need assistance and offer support where appropriate (eg. physical fatigue from compressions)
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Maintain a positive morale and treat other members respectfully
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Involve other speciality teams early (eg. Cardiology for a presumed acute coronary syndrome)
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Think widely about the team (eg. non-clinical support staff who can transport urgent bloods or clerical staff who can obtain medical records from other hospitals)
Task Management
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Plan, prepare & prioritise
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Prepare yourself – consider HALTS (hungry, angry, late, tired or stressed). These are all factors that can affect clinical performance.
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Prepare the environment (remove hazards, remove clutter, prepare necessary equipment)
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Prepare the team
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Resource management
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Avoid task fixation
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Recognise when it’s time to consider a plan B
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Follow protocol and well established guidelines (eg. ALS recommendations)
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Utilise cognitive aids – Anxiety that comes with resuscitation can seriously impact your memory recall (use the ALS flowcharts, Malignant hyperthermia task cards, Anaphylaxis box)
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Verbally communicate well recognised principles such as the 4 Hs and Ts and the COACHED algorithm for safe defibrillation
In summary, leadership, communication, teamwork and task management are 4 core principle non-technical skills that should be adapted by junior doctors in resuscitation teams. Practise utilising and encouraging others to adapt these skills whenever you are faced with a deteriorating patient or in a resuscitation situation. See the below references for further information.
Additional Resources:
Please refer to the following YouTube resources that explore crisis resource management and a real-time demonstration of advanced life support.
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References:
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Krage R, Zwaan L, Tjon Soei Len L, et al Relationship between non-technical skills and technical performance during cardiopulmonary resuscitation: does stress have an influence? Emergency Medicine Journal 2017; 34:728-733.
- Flowerdew L, Brown R, Vincent C, Woloshynowych M. Development and validation of a tool to assess emergency physicians’ non-technical skills. Ann. Emerg. Med. 2012; 59: 376–85.e4].
