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The Motherly Instinct of Trouble Shooting


The other day I was laid up sick in bed and listening to the soundtrack of my house. It included little feet running, cartoons playing, and of course babies crying. Besides realizing my wife was Wonder Woman, I noticed that she could almost immediately tell what the baby needed by its cry. I thought to myself, "My wife has become a master of little human trouble shooting!"

A few days later I was on a critical care assignment with multiple drips, ventilator, and arterial line. I realized that in some odd way I had been tending to the alarms of the equipment in the same fashion as a mom tends to her children. I knew the tones of each piece of equipment, and exactly how to rectify the issue.  However, as soon as I nursed one alarm to sleep, another would start.

Two years ago at Lifestar, I was noticing  that our scene times for critical care assignments could at times go longer than seemingly necessary. While some of these were complicated and warranted, others were your garden variety transport. These scenarios compelled me to analyze our processes - specifically how our tams went about switching equipment over. I set up two IV pumps with two infusions, and randomly asked providers to swing by while on shift, and swap the drips over from one pump to another. I recorded them performing this task... over ... and over again! I reviewed the videos and studied  each move that they made. I noticed that they were able to perform the task super quick! However, when they went to hit "start" and initiate the infusion, they ran into alarms such as "fluid side occluded" or "check air sensor". The average time to swap just two infusions was almost 15 minutes! Not because of the initial task of swapping the drips, but the process of trouble shooting.




So what did we do?

Our Critical Care Coordinator and I set up an entire training simulation centered on trouble shooting equipment. The group would sit in a half circle around our mock hospital room and watch our teams run the simulation. Recognizing that most of the trouble shooting occurred during the initial transition from hospital equipment to transport equipment, we felt that this was a great place to start. We did things like loosening connections on the vent circuit, removing the diaphragm from the ventilator, and displacing the driving piston on the IV pump. Initially the team would get frustrated, they would start to fumble and make simple mistakes. Some of the actions they would perform to fix a situation would actually cause further problems down the road. This was great! We had successfully created a simulation that brought to fruition the realistic complications that can occur on an assignment.


As you can see in the picture above, the observers will make silent notes from their “foot of the bed” view. This proves to be an excellent training exercise not just for the people running the simulation, but those watching from the outskirts as well.

As we would debrief the scenario, discussions would echo “What if we did it this way” or “I have an idea to avoid that problem in the future.” Not only did this simulation model teach an organized approach to troubleshooting, it also inspired the providers to go back to their station and really get to know the nuts and bolts of their equipment.

 My philosophy is “If you can reproduce the problem, you can fix it in the future.” I encourage all clinicians to take whatever equipment they use, print out a manual on all the different errors that can occur for that specific model, and attempt to reproduce as many as possible. There is nothing more aggravating than alarms, beeps, and tones from angry equipment echoing throughout your transfer. This stressor can cause good providers to get tunnel vision and forget to monitor patient needs. A solid foundation of trouble shooting can help reduce this stress, maintain quality patient care, and nurse your alarms back to sleep.


nurse alarm back to sleep




Tyler Christifulli (@christifulli88) is a Critical Care Paramedic and

Training Supervisor for Lifestar EMS, located throughout southern Wisconsin.

He is the creator and producer of the Lifestar Training & Education Center podcast.

Coming up on 10 years in EMS, Tyler is focused on innovating the ways in which we teach emergency medicine.

Tyler will be a regular contributor on the FlightBridgeED Blog Team.

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