Coda Change How a Crisis Resource Management failure led to a full-blown medical emergency
Jun 25, 2021
The podcast dives into a critical examination of a medical emergency caused by failures in Crisis Resource Management during childbirth. It highlights the importance of effective communication and leadership in high-pressure situations. Personal accounts from the Hills family reveal how a lack of situation awareness and resource mismanagement led to severe complications for their newborn, Christopher. The discussion emphasizes the need for healthcare workers to adopt the principles of CRM to prevent future tragedies.
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CRM Critical in Avoiding Deaths
- Over 70% of avoidable deaths in healthcare involve breakdowns in CRM principles.
- CRM is vital to managing emergencies effectively and preventing harm.
Personal Story of CRM Failure
- Tamara and Garry share their personal experience of CRM failures during their son's birth.
- Misjudgments and poor communication led to a severe brain injury for their son Christopher.
Ignored Fetal Distress Warned Signs
- Persistent fetal tachycardia was ignored, and poor actions like stopping heart rate monitoring worsened the situation.
- A critical part of the crisis was the midwife's poor communication and failure to escalate timely.