Vital Times 2021 - 89

HISTORY OF ANESTHESIA
RETHINKING " NORMAL ACCIDENTS " IN ANESTHESIA:
How Dr. David Gaba Translated
Crisis Management Principles
from Aviation to Anesthesiology
Albert Lin, MD | Winner of the 2021 CSA History of Anesthesia Essay Contest
" Hey, doc, uh, am
I supposed to feel
this hot? "
I jumped up, nervously
reassured my patient, and
scanned the vitals monitor
for any abnormalities.
My patient stared ahead
stoically, glassy-eyed, trying hard to conceal his fear. His
heart rate and blood pressure appeared normal, although
he was more tachycardic than I remembered.
" I'm really sweating here, doc, " he said, panic rising in
his voice. " Aren't you going to do something? " Trying to
suppress my own rising panic, I frantically scanned the
anesthesia machine for clues, noticing this time that
the end-tidal CO2 had steadily crept up to 55 mmHg.
I called for additional help, instructed the circulating
nurse to retrieve dantrolene, and informed the surgeon
of the situation, all while trying to speak directly into the
microphone clipped onto my scrubs.
The mannequin in front of me blinked twice, then
exclaimed, " That's a wrap! You're done. " The room lights
came on, and I let out a sigh of relief. My " patient " - a
programmable polymer mannequin powered by a
simulation computer-turned out to be voiced by David
Gaba, MD, who had invented the first prototype of this
mannequin in 1986.1 Thanks to Dr. Gaba's pioneering
work in simulation-based learning and OR crisis
management, anesthesia simulation training is now
widely offered - and considered essential - in residency
programs across the country.
In the lobby of Stanford's Center for Immersive
Simulation-Based Learning, a glass cabinet near the
main entrance prominently displays Dr. Gaba's first
simulation mannequin prototype, which he created with
research fellow Mary Maxwell, MD, and medical student
Abe DeAnda, Jr.1 Dr. Gaba traces much of his passion
for simulation and quality improvement back to his
childhood in Kansas City, MO, and his early fascination
with NASA's Apollo program.2 At the time, NASA often
used simulation to train its astronauts for spacewalks
and accident prevention drills.
" I was one of those kids who audiotaped the TV
broadcasts of all the Apollo missions, " Dr. Gaba said.2
" And Alan Shepherd's historic flight was launched on my
seventh birthday. "
1 Gaba DG. Pioneers and Profiles A Personal Memoir by David Gaba. In: Levine AI, eds. The Comprehensive Textbook of Healthcare Simulation. New York: Springer Science +
Business Media; 2013:18-21.
2 Chutkow P. A Safer OR. Yale Medicine. 2003;Summer:34-38.
Annual Publication 2021 | 89

Vital Times 2021

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