Photo credit: BBC.com
On August 15, 2019, a Ural Airlines Airbus A321 jet carrying 226 passengers and 7 crew took off from Moscow en route to Crimea. Shortly after becoming airborne, the jet hit a flock of gulls that totally disabled both engines. The pilots had to quickly decide what to do, as the plane had only reached an altitude of about 800 feet.
After initially thinking he could return to the airport, Captain Damir Yusupov realized that an emergency landing away from the airport was needed, and he located a cornfield. The pilots did several things to minimize the risk of fire and injury during the landing:
-The supply from the fuel tanks, which were full, had to be cut off from the engines.
-Not put the landing gear down, since with the wheels down the risk is high that flying debris will rupture the fuel tanks.
-Touch down first with the tail section, quickly kill the speed, while not dipping the nose of the plane or letting the engines hit the ground.
Sound tricky? Indeed. The pilot says he was confident about landing the plane because he had practiced the complicated set of maneuvers many times in flight simulators. In this case, everyone on board survived and injuries were mostly bumps and bruises, with only one passenger requiring hospitalization.
The airline industry has done a good job using simulators to train pilots and crew for conditions that they may encounter in flight. We call these situations “high risk, low volume,” and we encounter similar situations in healthcare as well.
The airlines know bird strikes are not uncommon and can even bring down planes, as we saw so dramatically in the Hudson River in 2009. Engine failure at 30,000 feet is different than at low altitude, since at high altitude the pilots typically have time to troubleshoot the issue and come up with a plan. However, bird strikes often happen shortly after takeoff, as birds congregate near the airport, leaving little time for pilots to land the plane safely. Even for the Hudson landing, Captain Sullenberger had about 3 minutes from the time the geese hit the engines to when the plane landed in the river – and that plane had achieved about three times the altitude as the Russian plane.
The comparisons between the airline industry and healthcare are not perfect. In healthcare we are caring for humans with unique physiological systems who exist in complicated families. However, there are many similarities between our two worlds: teams that haven’t worked together come together daily; crises demand quick recognition and response; there is legal, ethical, and financial risk when mistakes are made.
In healthcare we have also come to realize that simulation has a role in helping us prepare for situations that we rarely see and in situations that need a quick, coordinated response. Disaster simulations help staff learn how to safely assess and extricate patients. Maternity units simulate crash C-sections. Intensive care units simulate patients who become septic, have arrhythmias, and suffer from cardiac arrest. If there is a bad situation that can arise, odds are good that someone has developed a simulation about it.
Although the healthcare literature supports the idea that simulation – when done well – can improve patient safety, there are some caveats. First, simulation has become a discipline in and of itself. Nurse educators in all settings have learned that simulations have to have clear objectives, meaningful debriefing, and that we must be aware of psychological safety for our participants. Simulation is also very resource intensive in terms of personnel, money, and space. Many institutions would like to do more with simulation but lack the resources. As a system, we need to figure out how to combine resources effectively.
As a nurse, I’ve seen simulation evolve dramatically during my time in healthcare. For example, CPR manikins can now measure how effective my chest compressions are, leading to better CPR.
Think about your own practice. What ways does your organization use simulation to improve patient safety? Do you see additional opportunities that aren’t being used yet?
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