Advances in Human Factors in Complex Trauma and Emergency Anaesthesia and their Implementation into Military and Civilian Trauma Systems

Mercer, Simon Jude (2020) Advances in Human Factors in Complex Trauma and Emergency Anaesthesia and their Implementation into Military and Civilian Trauma Systems. Doctoral thesis (PhD), Manchester Metropolitan University.

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Abstract

The role of human factors in healthcare was introduced into the mainstream medical literature following two important seminal reports, ‘To Err is Human’ from the United States and ‘An Organisation with A Memory’ from the United Kingdom. This subsequently led to work conducted by the University of Aberdeen into defining the role of non-technical skills in the Operating Theatre for Anaesthetists, Surgeons and Scrub Practitioners. This thesis is an overview of work that I have undertaken in both Military and Civilian settings exploring and defining the importance of human factors in the management of complex trauma and emergency anaesthesia. I have undertaken original research investigating the barriers that exist to challenging seniors and have created guidelines for the management of non-iatrogenic airway injuries. This thesis also discusses a novel project that I have been involved in, the development of the ‘Trauma WHO’, which is a simple checklist designed to improve patient safety during their pathway in complex trauma. I will describe how this was developed, tested in a field hospital in Afghanistan and is now embedded into military practice and some civilian centres. This thesis also describes further knowledge assimilation in the form of two published peer reviewed systematic reviews exploring the importance of human factors in the emergency department and operating theatre and the management of non-iatrogenic trauma to the airway. Additionally, I have selected five papers for inclusion that demonstrate a translation of knowledge into different trauma arenas where the importance of human factors is essential and now embedded. The implications of this thesis are that advances in human factors in complex trauma and emergency anaesthesia that were originally developed in the military setting have now been refined and adopted into certain areas of the NHS. The impact of these advances in guidelines for the management of penetrating airway injuries, streamlining communication and flattening hierarchies by awareness of barriers to challenge have been recently witnessed in the expert and successful management of seriously injured patients. Further work to promote these advances is still required to encourage further adoption in other major trauma centres in England.