[two_third]<\/p>\n
When I think of boating safety I think of things like wearing a personal flotation device (PFD), avoiding getting hit by the boom, and knowing how to call for help. \u00a0I hadn\u2019t really made these connections to patient safety until recently, when I got back home after three weeks on a sailboat in the inland waters of Washington and British Columbia (you get lots of lessons in safety!).<\/p>\n
Check the conditions (weather and tides): <\/strong>Small craft, especially, must be mindful of the winds and tides. We avoid large open bodies of water during high winds, and prefer not to fight the tide. Those of us on sailboats keep a close eye on depth.\u00a0 If there\u2019s gale blowing or we\u2019re going to scrape the bottom, we don\u2019t go.\u00a0 What is the patient\u2019s condition \u2013 is it stable, changing, unknown? Has he or she received preoperative meds? How\u2019s the glycemic control? \u00a0How about the caregiver team \u2013 exhausted, stressed, not sure about the plan, or rested and knowledgeable?\u00a0 What are the other environmental conditions \u2013 equipment and supplies all there?\u00a0 Is the lighting optimum? Distractions minimized or eliminated?<\/p>\n Create and file a trip plan: <\/strong>Boaters should always create a plan and tell critical people where they are going and when they\u2019ll return, and include information such as the name and type of vessel, how many people are aboard, etc. That sounds like a preoperative checklist to me:\u00a0 What are we going to do, where are we going, and when will we return = what is the procedure?\u00a0 What is our vessel and how many people are on board = who is in the room and what is each person\u2019s role?<\/p>\n Wear a PFD:<\/strong> Unfortunately, my captain generally does not wear a PFD in calm, inland waters.\u00a0 His rationale is that the water is calm, he\u2019s not doing anything risky, he\u2019s never fallen in, and he is unlikely to. We are still working on changing this behavior. To me this sounds very similar to a surgeon opting not to mark the surgical site (\u201cI know it\u2019s the right arm\u201d \u2013 and does he mean non-left or correct? — \u201cand I\u2019ve never operated on the wrong site before\u201d) or a nurse or lab technician not checking a patient\u2019s ID band (\u201cI know it\u2019s Jim \u2013 I\u2019ve been taking care of him for a week\u201d). We naturally cling to the false belief that nothing bad happens in a situation we\u00a0believe<\/em> is low-risk.\u00a0 Being on a boat \u2013 a small object floating on an environment that doesn\u2019t support human life – is an inherently risky situation.\u00a0 Surgery is inherently risky, as is administering medications, drawing blood for a test, or having surgery.<\/p>\n Know how to do \u2018man overboard\u2019 rescues and other vital actions. <\/strong>Does\u00a0everyone<\/em> on board know how to do important things like operate the radio, successfully do a man overboard rescue, etc.? Have you practiced until you can do it automatically? \u00a0I felt confident using the radio (having practiced once) until I answered it while we were in the middle of anchoring and found later that I had turned it off.\u00a0 If I got that flustered during a low-stress situation, how would I perform if someone fell over and I had to call for help?\u00a0 Would I even remember the name of my boat, let alone how to find my latitude and longitude?\u00a0 Would I remember every step in a complex set of actions, each of which is critical? \u00a0In patient safety we talk about\u00a0practicing <\/em>team skills and communication skills such as SBAR, using simulation, etc.\u00a0 In my one experience using health care simulation, I was unpleasantly surprised at my very poor communication skills. In a real situation we won\u2019t be able to do it if we don\u2019t\u00a0practice<\/em> again and again.\u00a0 Hopefully I\u2019ll never have to deal with the man overboard situation, but unless I practice, success is highly unlikely.<\/p>\n Teach your crew how to be good (safe) crew members:<\/strong> In addition to knowing vital skills (e.g., handling lines and sails, navigation), the crew must be comfortable raising concerns and asking questions. Don\u2019t put them into situations they can\u2019t handle, and be sure to manage transitions safely.\u00a0 On my trip, because my captain has always welcomed my questions, I felt free to pipe up a lot:\u00a0 \u201cDo you see that big log dead ahead?\u201d (\u201cYep, I see it.\u201d) \u201cThe depth-sounder says 50 feet but I can see rocks.\u201d (\u201cPut it in reverse!) \u201cWhat is that weird smell coming from near the engine compartment?\u201d (\u201cI\u2019ll go investigate\u2026it\u2019s the head, not the engine.\u201d) Imagine the provider who bullies the rest of the health care team when they raise concerns about surgical site, oxygen saturation, equipment, or the patient \u201cjust not looking right.\u201d<\/p>\n