The majority of people reading this sentence will never have to make a true life or death decision. But for those who deal with deteriorating patients on a daily basis, these decisions can come thick and fast, and without proper training health professionals run the risk of making fatal mistakes. This is where Senior Lecturer, School of Nursing, Midwifery, Health Sciences and Physiotherapy Dr Steve Hardman comes in.
For many, the process of defibrillation and resuscitation is only ever seen in movies or television shows. Dramatic flatline tones and hectic shouts accompany the rubbing together of electrified paddles and the familiar “clear!” that precedes the bucking of a previously unconscious body and, hopefully, the steady beeping of a heartbeat returning.
“The outcomes for cardiac arrest aren’t what people think,” Dr Hardman says, “in a hospital you’ve got about a 25 per cent chance of survival, outside of a hospital setting it drops to roughly 5 per cent.”
Even with highly trained health professionals, even with all the modern technology available, even in the most perfect of conditions at the best possible time, the outcomes are unnerving to say the least. But for Dr Hardman this reinforces the need for programs like The University of Notre Dame Australia’s Advanced Life Support Courses (ALS1) and (ALS2).
“What we like to emphasise in ALS is not letting patients get to the point they are in cardiac arrest,” Dr Hardman says. “Students get airway management skills, A to E (Airway, Breathing, Circulation, Disability, and Exposure), clinical deterioration, initial assessment, management skills, and importantly they get a lot of simulation to try and get those skills embedded.”
Embedding the required skills presents a challenge to anyone learning and teaching healthcare. Putting skills into practice has long been understood to be an effective way of retaining learnt skills, but in life-or-death situations practice is not really an option.
“It’s a very hands-on course,” Dr Hardman says, “We want our students to not only be able to deal with an escalating situation, but to recognise someone who's getting sick, their level of clinical deterioration, and then enact some intervention.”
To add to the existing pressures of monitoring patients and introducing measures to stop deterioration, the need for clear, concise, and authoritative leadership becomes all too clear when you see just how much a team needs to do within a short space of time. Organisation and management skills may not seem as important on the patient side of things, but for medical teams it can be the difference between a positive and negative outcome. This is where Dr Hardman says the human element comes in.
“The big focus in ALS2 particularly is how to lead a team. Your job as a team leader is to reverse cardiac arrest. It's about stepping into that position of control, stopping people doing the wrong things, tasking them up appropriately to get the right things done, because ultimately that improves the outcome for the patient.
Under stress it’s harder to think rationally, so we teach how to deal with stress and use the tools at your disposal to come to well-informed, correct decisions.
Really, when stepping back from the nitty gritty details that are so important for this kind of work, Dr Hardman teaches confidence. Not only confidence in the tools at hand, but within the students themselves. As he says before leaving to teach another class, “competence increases confidence”, and arguably the opposite is also true, confidence married with knowledge and practical experience increases competence and, in this field especially, competence can truly be the key to saving lives.
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