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A Blurb From Bruce

A Blurb from Bruce: Do You Autopsy?





An autopsy, also known as medical obduction, is a surgical procedure used to perform a thorough and comprehensive examination of a dead body.  This is done to determine the cause and mechanism of death and to evaluate the presence of any disease or injury.  As part of my continuing medical education, I have participated in a number of pseudo-autopsy activities (cadaver lab, etc.) and have to come realize the dramatically relatable and close allegorical correlation that it has to the growing niche of EMS and Critical Care leadership.  The process of an autopsy could be a safe model to follow during the analysis of any type of leadership failure.

In 1999 the Institute of Medicine published a title page with this slogan – “To Err Is Human: Building A Safer Health System”.  This report correctly stated that “health care [is] not as safe as it should be – and can be” (Institute of Medicine, 1999).  The question begs – why? - and what does an autopsy have to do with any of this anyway?

At some point during their career, EMS and Critical Care providers are subjected to this nasty truth.  However, through diligent and safe practice, we do our best to limit “the err”.  I have often said, yes, the error is bad, but not learning from the error is far worse.  To prevent errors from reoccurring, we can morbidly turn to the autopsy model; by this I mean do we thoroughly examine the failure or error and determine the cause and mechanism by which it happened?  In addition, are we probing further to ascertain the presence of any more diseased or disease prone areas?  Areas that have failed or areas that are prone to failure can be regarded with equal importance.  Similar to autopsy, this can provide for (most of the time) a definitive rationale for the cause of death, or body system failure.  Additionally, an autopsy can confirm not only the causation of systemic collapse, but also specific data on each individual organ (that which supports the system).  Taking this out of the realm of death and applying this similar logic to a professional scenario, you can quickly discover that a more robust evaluation is possible.

It is often said that systems are completely unfixable – unless there is massive overhaul - the tables turned upside down and the entire infrastructure demolished.  For the most part, I would politely disagree.  Even though an autopsy can be painfully intricate, the resulting data is an impressive cash cow of really good information that, after a rigor-laden analysis, can be applied towards a reachable and realistic solution.

Great – now we have a solution; but, what’s next?  Keep following the autopsy model – publish a report based on the data learned and begin the process of changing behaviors or practice.  This is very similar to the database of human demise – we pull data from this bank and make recommendations that allow for a healthy and sustaining life.  Do this in professional leadership and WOW – you’re onto something big.  Don’t believe it – do it.  What’s the worst, you fail?  If so, do another autopsy…




Bruce Hoffman is a critical care nurse, paramedic and current graduate student.  He works as both a clinician and educator in Connecticut, Massachusetts and Maryland, with background in the division of critical care (ICU, ER, Cardiology, and Flight).  He enjoys professional gigs in clinical and distance medical education, advocacy, leadership, consultation and blogging.  He is a frequent and national lecturer for a host of Emergency Medical Services and Critical Care continuing education programs. He remains a member of his hometown ambulance service where he has served in a variety of administrative and operational roles. In his spare time, Bruce enjoys spending time with his wife Stephanie as well as traveling, hiking and biking.


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