Don't be these ways

Paramedics and doctor outside ambulance

In Crew Resource Management by LeSage, Dyer and Evans, situational awareness is defined as "the extent to which individual's understanding of the immediate environment mirrors reality." Understanding implies that the individual is processing information, making predictions about what will occur and choosing an appropriate course of action. Selecting the appropriate course of action requires decision making. The process of decision making begins with fluctuations in dopamine. Dopamine, the common neural currency of the mind, helps regulate all emotions. We should note that emotions reflect an enormous amount of invisible analysis. Taber's defines emotion as “A mental state or strong feeling affect usually accompanied by physical changes ." Mental states (fear, hate, love, anger, grief, joy) "constitute the drive which brings about the emotional or mental adjustment necessary to satisfy instinctive needs." How does this relate to safety?

Standard systematic approaches to risk management use administrative, engineering, and behavioral controls; in other words, rules, stuff and getting people to choose appropriate behaviors. We can write rules and buy equipment, but how do we get people, or more importantly, how do we get ourselves, to choose appropriate behaviors?  Situational awareness, a key component of safety management systems, will not be achieved if information is not shared among personnel to create a unified perception of the reality of the ever-changing risks we endure. People in an unfriendly or hostile environment will not openly share information. If information is not shared, the "understanding of the immediate environment" will be incomplete and decision-making will be impaired. To create a workplace that fosters information sharing, we must eliminate the four "don't be these ways": bad manners, bullying, burnout and blues.

Think about this. If you perceive others as rude, disrespectful, sullen, over-bearing or hyper-aggressive, or others perceive you as such, how likely will you have a basic emotional platform from which you will openly communicate? If you have coworkers you want to avoid in a neutral environment like headquarters, how will you interact with them in a stressful multi-casualty event? How will you communicate while moving a stretcher? I witnessed a major cultural transformation in an organization that mandated manners. During my initial visits, this was an account with terrible losses and high turnover. People looked grumpy and didn't speak to each other casually. Among other substantial loss control measures, personnel were instructed to address each other by surnames: Mr. Jones, Mrs. Smith, Miss Doe. Mirrors were placed over drinking fountains. People saw how grumpy they looked. After several months I returned, the losses were better, but I was really surprised by the change in attitudes. People were speaking to each other pleasantly and sharing information about street closures, alternate routes, and patient access issues. Eliminating bad manners improved the workplace. People were overtly happier! Think of dopamine as "happy juice". We select behaviors which cause dopamine to be released. We like behaviors that make us feel good. So, learning is dopamine dependent. The next impediment to be removed is bullying, which we will cover in the next Vitals.

Paramedics and doctor outside ambulance
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