TableĀ 1

Scenario characteristics and targeted human factors elements for latent safety threat identification

ThemeScenario descriptionScenario characteristicsHuman factors elements prone to LSTsHuman factors rationale
Surgical airwayA patient arrives with considerable facial trauma requiring immediate airway management. The scenario is designed such that all techniques to manage the patient's airway are ineffective except for a surgical airway (eg, cricothyroidotomy)Low opportunity
High acuity
Manikin
Individual skill/knowledge and team InteractionTrauma team members must escalate to surgical airway (an infrequent occurrence) without unnecessary delay. Cognitive biases against this course of action must be overcome individually and collectively
Tool/technologyInfrequently used equipment must be collected and used appropriately
Blunt trauma requiring activation of the mass transfusion protocol (MTP)A patient arrives with an open book pelvic fracture (and a misplaced pelvic binder) who becomes haemodynamically unstable, requiring a rapid administration of blood products among other interventionsMedium opportunity
High acuity
Manikin
Physical environment and layoutThe MTP process requires some staff to physically navigate the hospital to deliver paperwork and retrieve blood products
Organisational characteristicsInterdepartmental coordination is required to execute a mass transfusion protocol
Medical cause for traumaA patient arrives after falling down a flight of stairs due to a syncopal event. The patient suffers a cardiac arrest on arrival requiring the team to consider underlying medical conditions in addition to critical injuriesMedium opportunity
High acuity
Manikin
Individual skill/knowledge and team interactionAs individuals, and as a team, there is a need to look beyond obvious blunt trauma and haemorrhage considerations and consider underlying medical causes
Penetrating injuries and agitated patientA patient with penetrating stab wounds walks into the ED, with a knife in the abdomen. The patient is haemodynamically unstable and requires expedient transfer to the operating theatre for surgical interventionMedium-High opportunity
High acuity
Standardised patient
Individual Skill/knowledge and team interactionTrauma team members must rapidly manage penetrating injuries that could rapidly lead to destabilisation. Literature shows delays or insufficient control of haemorrhage are a common error in trauma resuscitation1 3 4 6 7
Organisational characteristicsRapid mobilisation of operating theatre resources for critically injured patients presents logistical challenges related to resource allocation, patient transport and interdepartmental communication
TaskTask of treating an alert and agitated patient that may actively resist or question treatment is complex and also interferes with team communication