The Checklist Manifesto_ How to Get Things Right - Atul Gawande [18]
He told me he had been working in Klagenfurt for six years when the girl came in. She had not been the first person whom he and his colleagues had tried to revive from cardiac arrest after hypothermia and suffocation. His hospital received between three and five such patients a year, he estimated, mostly avalanche victims, some of them drowning victims, and a few of them people attempting suicide by taking a drug overdose and then wandering out into the snowy Alpine forests to fall unconscious. For a long time, he said, no matter how hard the hospital’s medical staff tried, they had no survivors. Most of the victims had been without a pulse and oxygen for too long when they were found. But some, he was convinced, still had a flicker of viability in them, yet he and his colleagues had always failed to sustain it.
He took a close look at the case records. Preparation, he determined, was the chief difficulty. Success required having an array of people and equipment at the ready—trauma surgeons, a cardiac anesthesiologist, a cardiothoracic surgeon, bioengineering support staff, a cardiac perfusionist, operating and critical care nurses, intensivists. Almost routinely, someone or something was missing.
He tried the usual surgical approach to remedy this—yelling at everyone to get their act together. But still they had no saves. So he and a couple of colleagues decided to try something new. They made a checklist.
They gave the checklist to the people with the least power in the whole process—the rescue squads and the hospital telephone operator—and walked them through the details. In cases like these, the checklist said, rescue teams were to tell the hospital to prepare for possible cardiac bypass and rewarming. They were to call, when possible, even before they arrived on the scene, as the preparation time could be significant. The telephone operator would then work down a list of people to notify them to have everything set up and standing by.
With the checklist in place, the team had its first success—the rescue of the three-year-old girl. Not long afterward, Thalmann left to take a job at a hospital in Vienna. The team, however, has since had at least two other such rescues, he said. In one case, a man had been found frozen and pulseless after a suicide attempt. In another, a mother and her sixteen-year-old daughter were in an accident that sent them and their car through a guardrail, over a cliff, and into a mountain river. The mother died on impact; the daughter was trapped as the car rapidly filled with icy water. She had been in cardiac and respiratory arrest for a prolonged period of time when the rescue team arrived.
From that point onward, though, everything moved like clockwork. By the time the rescue team got to her and began CPR, the hospital had been notified. The transport team delivered her in minutes. The surgical team took her straight to the operating room and crashed her onto heart-lung bypass. One step followed right after another. And, because of the speed with which they did, she had a chance.
As the girl’s body slowly rewarmed, her heart came back. In the ICU, a mechanical ventilator, fluids, and intravenous drugs kept her going while the rest of her body recovered. The next day, the doctors were able to remove her lines and tubes. The day after that, she was sitting up in bed, ready to go home.
3. THE END OF THE MASTER BUILDER
Four generations after the first aviation checklists went into use, a lesson is emerging: checklists seem able to defend anyone, even the experienced, against