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Aviation & Medicine--safety last? 5/29/2013 5:19:27 AM
An anonymous reporting system can aid safety I picked the symbol for this post with some care. Crossed bandages over a rather distressing wound renders all kinds of images: a medical coverup of treatment gone horribly wrong; a gaping scar that refuses to heal; too little care taken to address an alarming medical problem. It could also be crossed rotor blades, the airfoil of a helicopter, and the Air Medical aviation business. The matchup of medicine and aviation saves countless lives every day in this country. But both operations, flying and healing, have a persistent, nagging, almost shameful safety record. Both entities are beset with ongoing errors in the conduct of their operations. Both entities look high and low for solutions to this conundrum, that those seeking to help patients often harm them instead.
I flew Air Medical aviation for many years. In that time I was witness to many of the sins of omission and commission that plagued the Air Med business, often–too often– putting a helicopter in the dirt, and harming or killing crews and patients. At the same time I saw the errors and omissions on the medical side of the business, mistakes that humans or the system we’ve created often make. Both sides of the business, Air and Medical have dealt with the problem in their own way. Still mistakes occur. Between 2002 and 2005, for example, 55 Air Medical accidents killed 54 crewmembers and patients, and seriously injured 18 others. On the medical side, last year alone an estimated 1.5 million patients were injured by medication errors alone, and nearly 90,000 patients died from some of those errors. In a recent piece for the New York Times, My Near Miss, a contribution by Dr. Daniel Ofri reveals one of his close calls during his residency, a missed head bleed in an older patient that could have been disastrous but wasn’t, simply because another person caught his error. Ofri claims that medicine still has too little transparency, too much hubris when it comes to self reporting, so too few errors are passed along between practitioners to fully address the dilemma.
One of the solutions to flying mistakes and challenges is an anonymous reporting system established by the National Transportation safety Board, (NTSB). The system allows pilots to self-report when regulations are inadvertently broken, airspace violated, aircraft operations are unsafely performed or unsafe practices are witnessed. The NTSB system could work in a hospital setting as well, to allow physicians to self-report without fear of repercussions from colleagues, family, employer or medical board. In aviation, the NTSB system isn’t perfect, but it’s a resource that has likely ushered in changes that have made a difference. Peer reviews have been part of medicine for a long time, but they happen after the fact, and often inculcate a doctor just by inference to patient and procedure under review. An anonymous venue could be an added layer of protection.
Safety is a rather ephemeral goal; we know we’re safe only when nothing happens. So in either case, aviation or medicine, systems to eliminate errors will work if they’re put in place and used, whether we know they’re working or not.
