Rebreather Forum 3.0 - Consensus Positions

[matt]

Quote: (Originally Posted by Alastair)

Interesting discussion at Eurotek on the consensus statements from rf3. I was really interested in the number of people who said they use checklists. Good proportion of the audience said they did - which surprised me given how little I've seen them used.

What is everyone else's experience?

I have never seen anyone use a check-list. Perhaps this is a modern thing, but they were not popular when I trained.

Matt.

[Soggyfox]

Quote: (Originally Posted by matthewoutram)

I have never seen anyone use a check-list. Perhaps this is a modern thing, but they were not popular when I trained.

Matt.

I use a checklist every dive helps a lot when it's part of the start up routine.

[Peter L]

I use the checklist at home, it's too late if you're trying it on the boat on day trips. Too tired to be safe then.

My last and final check is gas on x 5 and power on by 3, watch cells to setpoint, suit inflate, harness, pre-breathe....

Not all checklists have to be visible to be used...

[ccrdave]

I think everybody uses a checklist but like Peter says they are not always visible or written. personally I think checklists should be learned as a skillset just like bailout or o2 shutdowns. we can do those without a checklist why not predive checks?
I am separating pre dive checks from pre build checks

[matt]

Quote: (Originally Posted by Soggyfox)

I use a checklist every dive helps a lot when it's part of the start up routine.

You got me! I use a check-list every dive in that I follow the prompts!

I didn't think of that as a check-list in this context as it misses too many items, like analyse gas, check flapper-valves, lube-o-ring-of-death, load-sorb, check condition of spacer, confirm battery usage, check cells properly connected, confirm solenoid injector not blocked, pos/neg, OPV-position, back-up hose stowed...the list that I don't have would be enormous if I wrote it down, but in essence it's 5 minutes and forms part of the build. Same for you I guess?

Matt.

[Dave Sutton]

Quote: (Originally Posted by ccrdave)

I think everybody uses a checklist but like Peter says they are not always visible or written. personally I think checklists should be learned as a skillset just like bailout or o2 shutdowns. we can do those without a checklist why not predive checks?
I am separating pre dive checks from pre build checks

Precisely, Dave.

It's funny, but we are beset with a set of expectations set forth by manufacturers and training agencies that ignore the lessons learned by the most common users of checklists, which again would be professional pilots.

In the "complex jet" envoronment, the lesson has been learned that the best way to ensure compliance with a set of tasks is to learn to do them in a particular order that is sensible and does not skip from zone to zone. Start at the top left, and work to the bottom right. Do not take your eyes away from the zone as you check what needs to be checked. After the fact you then refer to a checklist to CHECK that high value items have been done. That's a checklist.

The opposite paradigm is the one that has been essentially abandoned by the aviation industry, and that is to methodically go thru a list of instructions step by step, doing one action at a time, looking at the list between each action, etc. This produces no holistic "view" of the "big picture" and has been proven to be less efficient and has a lower level of actual adherance to the items.

Sadly, the latter is what many manufacturers use as their "checklist". I could cite one top-line manufacturer of rebreathers who has produced a very nice "product", that being a beautifully engraved small plastic "checklist" to be used... that has no "flow" and relies on paradigm "B" above. That's a shame, as it could have been a leading-edge product. It's a result of the manufacturers ansd training agencies not being educated in this area of human performance. That's not surprising: Why would we expect a person (manufacturer) who has an area of expertise in CAD design, CNC machine work, welding, metal forming, etc (manufacturer) to also have world class knowlage of human factors in checklist design? They do not... yet they drive unusable checklists towards the divers and training agencies without any consideration that they are far outside of their area of expertise. It's a shame.

I think, in my gut of guts, that the reason we do not see checklists used on boats is that there are no checklists at present (factory ones) that are actually designed to be used in the field.



Break again to the parallel to aviation: There is a "pre-dispach" checklist done by the engineers (we call them "mechanics here in the Colonies BTW) whereupon they service and place onto the flightline a vehicle that is*serviced* and *ready for pilots*. That's the analogy to the "day before the dive" for a rebreather diver. This is a detailed and methodical check, with no time-based performance goal. The second and completely different "checklist" is the one used by the pilots when they walk into the door and sit down. This is NOT a check of the tire (tyre?) pressures... it's just a simple flow thru the switches, and programming the FMC (flight management computer) for navigation. This is really done "almost but not quite" by memory. This is the analog to the "on the RIB while puking" checklist. 02 and Dil on, Controller on, negative check done, prebreathe for a few minutes, and jump".


Consider this as you develop your procedures. Dave T, it sounds like you have it dead-right.


Dave

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[matt]

Probably just me - but this looks more complicated than a rebreather:

[Dave Sutton]

Airbus... a primitive thing compared to a Falcon.. ;-) Look at all of those extraneous dedicated displays and switches: What a waste of real estate and a distraction to the pilot. they would be integrated into software and non-dedicated displays on a "Modern" jet...



It likely is more complex to operate than a rebreather, but not really by a lot. When I sit down in the left seat of a Falcon 900EX-EASy, the actual job is pretty simple.


Black cockpit: I don't need to check much as the switches are all logic-switches, so no matter where they were set when shut it down, they are all "Off".


Batteries on, check voltages (two switches)
Test the fire detection system (one switch)
Start the APU so we have generated power and air conditioning (two switches)
Turn on the avionics (one switch).

Ahh... "Power-Up" checklist complete.


Listen to the weather, call ATC on the radio and get the route clearance, program the FMC with the route, pre-tune the radios, calculate the speeds needed for V1, V2, Vr, and Vse, and then go get a cup of coffee from the back. Come back, power the standby hydraulic pump, check trims, check stall warning system, standby pump off. Sip coffee.

"Pre-start checklist complete".


Passengers arrive, point them to the coffee and newspapers.

Start three engines (I have never forgotten this bit). Do I need instructions telling me how?
Bus Tie to isolate
Check oil pressure, hydraulic pressure, and voltages.
Release parking brake
Call for Taxi

"Pre taxi check complete".

Move forward, check brakes, set flaps, check flight control response, and move to position, brief my Number 1 on takeoff procedures (ATC needs, emergency return, etc).

"Pre-takeoff checks complete".


Cleared into position for takeoff... pitot heat and strobes on, APU off, FAST check (Flaps, Airbrakes, Speeds reviewed, Trim checked"...

"Final checklist complete"...


After takeoff: Gear up, Flaps up, Climb power set.

"After takeoff checks complete"



Really... it's that simple. And we are not staring at a checklist. We`are looking at the cockpit. Every moment looking at paper is a moment we are not looking at what counts. (in fact, it's a paperless cockpit... no maps, charts, etc., of any sort).

I instructed on this jet for several years, and was the first FAA and JAA (UK CAA) pilot examiner in it worldwide. One of our largest training challenges was to train "old generation pilots" to come to the new paradigm of "checklist use", which was a sea change from the old school methods. Basically if three engines are running and there are no master caution lights on, she's good to go. Checklists are secondary to LOOKING at things and DOING THE JOB.


Old-school checklist for starting engines (Falcon 900)

Start switch energized two seconds.
N2 at 15 %, with N1 indication seen.
Fuel Lever Open
Ignitors verified
Lightoff observed
Monitor oil pressure
At 51% N2, starter observed off.
Check parameters.


New checklist (Falcon 900EX-EASy)

Start engines in sequence: 2, 3, 1



What do we need to CHECK?

We do not need instructions in HOW to do basic skills...



And to think that I quit flying these full time to fly 1950's generation MiG's instead... <sigh>.



Dave


.

[Soggyfox]

Quote: (Originally Posted by matthewoutram)

You got me! I use a check-list every dive in that I follow the prompts!

I didn't think of that as a check-list in this context as it misses too many items, like analyse gas, check flapper-valves, lube-o-ring-of-death, load-sorb, check condition of spacer, confirm battery usage, check cells properly connected, confirm solenoid injector not blocked, pos/neg, OPV-position, back-up hose stowed...the list that I don't have would be enormous if I wrote it down, but in essence it's 5 minutes and forms part of the build. Same for you I guess?

Matt.

Much the same and the Sentinel has many of your criteria in the checklist already. I usually run fully through the checklist at home when I prep the unit then again as a final double check on the boat.

[GLOC]

Just to bring this one back to the top...

This paper "Simulation-Based Trial of Surgical-Crisis Checklists" has just been published in the New England Journal of Medicine and provides details of a trial using checklists in a high pressure scenario and determining whether there was an improvement of safety by using one. Thanks to Dr Simon Mitchell for pointing it out to me.

The summary from the link above is

Quote:

BACKGROUND

Operating-room crises (e.g., cardiac arrest and massive hemorrhage) are common events in large hospitals but can be rare for individual clinicians. Successful management is difficult and complex. We sought to evaluate a tool to improve adherence to evidence-based best practices during such events.

METHODS
Operating-room teams from three institutions (one academic medical center and two community hospitals) participated in a series of surgical-crisis scenarios in a simulated operating room. Each team was randomly assigned to manage half the scenarios with a set of crisis checklists and the remaining scenarios from memory alone. The primary outcome measure was failure to adhere to critical processes of care. Participants were also surveyed regarding their perceptions of the usefulness and clinical relevance of the checklists.

RESULTS
A total of 17 operating-room teams participated in 106 simulated surgical-crisis scenarios. Failure to adhere to lifesaving processes of care was less common during simulations when checklists were available (6% of steps missed when checklists were available vs. 23% when they were unavailable, P<0.001). The results were similar in a multivariate model that accounted for clustering within teams, with adjustment for institution, scenario, and learning and fatigue effects (adjusted relative risk, 0.28; 95% confidence interval, 0.18 to 0.42; P<0.001). Every team performed better when the crisis checklists were available than when they were not. A total of 97% of the participants reported that if one of these crises occurred while they were undergoing an operation, they would want the checklist used.

CONCLUSIONS
In a high-fidelity simulation study, checklist use was associated with significant improvement in the management of operating-room crises. These findings suggest that checklists for use during operating-room crises have the potential to improve surgical care.

The full report can only be downloaded from the NEJM.

It is obvious that checklists, of the correct type and used in the right place, will improve safety. The challenge in sport diving is writing the correct checklist and getting it adopted by the community. One checklist will not cover assembly, pre-dive checks, emergency drills, disassembly checks as Dave and Paul have pointed out...

Regards