By now, we all know the story. There’s even a big Hollywood movie about it, starring the same guy that was deserted on a tropical island with a soccer ball. On January 15, 2009, US Airways Flight 1549 taking off from New York City on its way to Seattle encountered a flock of Canadian geese, resulting in the disabling of both engines of the plane. Captain Chelsea “Sully” Sullenberger of Danville, California, safely ditched the plane into the Hudson River. All 155 passengers and crew members survived. Captain Sullenberger and his crew were hailed as heros, and the incident is now known as the “Miracle on the Hudson“.
Anesthesia has always drawn comparisons to the aviation industry. Besides the obvious metaphors of taking off (induction of anesthesia), flying (maintenence), and landing the plane (emergence), the two industries are strikingly similar in their emphasis on checklists, safety, and an algorithmic approach to critical events. It’s no wonder…both have schedules to keep, both are continually measured for efficiency, and both are dependent on other supporting players to function. And ultimately, both anesthesia and aviation exist to get people where they are going in the safest possible manner.
As an aside, the two industries have also spawned a similar type of humor based loosely in reality…
Anesthesia: “Putting you to sleep is the easy part…waking you up is where the money is.”
Aviation: “Anyone can fly a plane…but landing the plane in one piece…that’s a different story.”
Despite the similarities in training, certification, and continuing education, I had never really considered how similar the QA processes would be. Suffice it to say, when things go bad, they tend to go really bad, really quickly. And it takes quick thinking, decisive judgment, and definitive action to prevent catastrophe. That is what saved all 155 people in this Miracle on the Hudson.
You would think that all’s well that ends well. No lives were lost because of the unquestionably heroic action and inscrutable ability of Captain Sullenberger. But that is not how the QA process works. The purpose of QA is to figure out what went wrong to cause an incident and lead to an outcome and to use this information to prevent the incident from happening again in the future. But what it amounts to is second guessing the situation and playing armchair quarterback or backseat driver to the people that were actually involved in the incident, without ever having been there or experiencing it in real time. Simulations are run in perfect situations and the results are taken as the standard against which the real incident is compared in order to assign blame without taking into account any real-world intangible human factors. It’s too easy to play the game of “What I would have done…” if you know what the problem is, isn’t it?
The same thing exists in anesthesia. Whenever a case is referred for review (for any number of unrelated issues), it doesn’t matter if no harm resulted to the patient or that the patient survived a potentially catastrophic event because of the quick thinking and action of the anesthesiologist and OR team. The QA process is there to assign a relative value…also known as blame. People involved in the this process will claim until they are blue in the face that they are not interested in assigning blame, but the targets of such investigations inherently feel like they are in the hot seat. And indeed, if you don’t speak up for yourself and explain your actions and rationales, then you leave your fate solely up to the process which is intended to assign blame and cover the proverbial backside of the rest of the group. It’s always easier and most efficient to find a scapegoat than to truly solve a systems problem. It is easiest to sit and point fingers rather than put yourself in someone else’s shoes and really understand and really appreciate that person’s valiant efforts.
This is what I was thinking about while I was watching the movie Sully recently. It’s not exactly a movie that I would review for anesthetic implications in my Anesthesia Flix Fix series. But the movie certainly contains many implications that are mirrored in the practice of anesthesia. QA is a necessary evil, but it should be carried out in a thoughtful and respectful manner. Don’t ever expect your anesthesia record to speak for itself, because anything can be reinterpreted to fit someone else’s theory. Demand to be involved in the process if you ever have a case sent for review. Speak up and fill in any gaps in the record that would otherwise require interpretation (aka. guessing/assumption). You are your only and best advocate, so advocate for yourself: Believe me, no one else will.
I want to finish this post by saying that I have the utmost respect for airline pilots. They really do have a very stressful job, getting planefuls of up to 800 people at a time from one place to another. I mean, if something goes wrong, it goes really, really wrong. And generally the only direction that things go when you’re starting off at 30,000 feet is down. That’s some scary stats. I think I’ll stick with putting one person to sleep at a time!
If you’d like to read some of my anesthesia-related movie reviews, feel free to click on over to the Anesthesia Flix Fix series today! Follow us on Twitter or Facebook or by email (signup is on the sidebar to your right!) and never miss out on another post!