Last weekend, I saw the film Sully (https://www.youtube.com/watch?v=mjKEXxO2KNE).
For those of you not aware, Sully tells the story of the so-called “Miracle on the Hudson” (http://www.nytimes.com/2009/01/16/nyregion/16crash.html?_r=0), where Captain “Sully” Sullenberger managed to pull off a controlled water landing on the Hudson river in the middle of New York after simultaneous loss of both engines due to a bird strike 3 minutes following take off. This was only the fourth time in the jet era that this maneuver had been pulled off successfully. All 155 passengers and crew were saved and Captain Sully was quite appropriately hailed as a hero.
The majority of the film concentrates on the aftermath of the ill fated US Airways Flight 1549 and the subsequent investigation into the incident. In the movie, when asked to explain why the crash happened, Tom Hanks who plays the titular Captain Sully, utters the lines “It’s not a crash, it was a forced water landing”. This small detail is important. This was what, in the field of medical quality and safety, we would call a “near miss”. A near miss is an event that could have resulted in a seriously adverse outcome but which was ultimately avoided. Investigations, like the one into Flight 1549, are essential to understanding the complex interplay of human, environmental and technical factors that led to the near miss. Identifying areas of potential weakness and strengths that can be targeted in order to avoid future such incidents is fundamental to the study of risk minimisation.
As in aviation, in the field of anaesthesia, this concept of risk minimization is paramount. Actually, there are a lot of parallels between aviation and anaesthesia besides the fact they both start with the letter “A”. Like the pilot, an Anaesthetist is a highly trained individual with up to 10 years of training after medical school, who steers your course while you sleep. You never get to see the complexity, the work and the equipment behind the cockpit door all dedicated to keeping you safe. Like an aeroplane crew, we too work as a theatre team – with the equivalent of a pilot, a co-pilot, and many other crew members. And like flights, you don’t really notice when you have a good one. A smooth flight is just a normal flight. But boy do you notice when you have a bad one.
Anaesthesia also has the same 3 phases as an aeroplane flight – Take off, cruising and then landing. And like an aeroplane flight more than 99% of the time it goes well. Anaesthetists are experts in the field of preoperative assessment and optimization. Meaning that we put in as much effort into making you ready for your operation as during the operation itself. But unfortunately, no matter how well prepared you are, or how much experience you have, things can always go wrong. Birds can always fly into your engines leaving you with no thrust at 2800 feet and only minutes to react.
But as Anaesthetists, we have learnt from the safety management systems adopted by our aviation colleagues. As a consequence, we have developed safety checklists, quick reference emergency manuals and crew resource management techniques. We drill uncommon emergency scenarios over and over in simulation labs so that the rare becomes the familiar. All of this means that like the “Miracle on the Hudson”, when an anaesthetist guides you through a high-risk surgery or anaesthetic, it’s not really a miracle. Rather, it is the fortunate culmination of a system with all the right elements designed to protect you as a patient.
Because of this, you should trust your anaesthetist and put your safety in their hands knowing that they are a well trained professional who is dedicated to ensuring your safety during surgery. So sit back, fasten your seat belt, secure your tray table and most of all enjoy the flight.
This has been your captain speaking…
Toff, N. J. (2010). Human factors in anaesthesia: lessons from aviation. British Journal of Anaesthesia, 105(1), 21–25. http://doi.org/10.1093/bja/aeq12