Vital Times 2021 - 90

Dr. Gaba went on to study biomedical engineering and
artificial intelligence at Northwestern University before
attending medical school at Yale in 1976. His MD thesis
at Yale investigated the adverse effects of defibrillation,
an inquiry he continued in animal models after joining
Stanford's anesthesiology faculty in 1984. That same
year, Dr. Gaba read Charles Perrow's Normal Accidents:
Living with High-Risk Technologies, a book that would set
the course of his professional life.2
Perrow was a Yale sociologist who sat on the Kemeny
Commission that investigated the Three Mile Island
accident of 1979. In his book, Perrow analyzed a series
of high-profile catastrophes using root cause analysis of
system errors. As Dr. Gaba read Perrow's theory of how
accidents emerged from the accumulated mistakes of
everyday operations, he immediately thought, " this is just
like anesthesia. " 1 His team initially considered using an
animal model to study decision-making in the OR, with a
plan to " bring people here, make bad things happen [to
the dog], and to see how the anesthesiologists respond. " 1
The impracticality and ethical concerns with using
animals, however, quickly ruled out this option.
Drawing upon his lifelong love for aviation and space, Dr.
Gaba turned his focus to creating a simulator. He and Dr.
DeAnda, Jr. cobbled together their first prototype using
programmed vital signs and a reservoir bag attached to a
plastic trachea. After securing a $35,000 research grant
from the Anesthesia Patient Safety Foundation, the pair
introduced their first functioning simulator, the CASE 1.2,
in 1988.1
Between 1990 and 1992, Dr. Gaba produced his secondgeneration
simulator (CASE 2.0) with John Williams,
another medical student who happened to be a talented
electrical engineer. Together, they created a robust
cardiovascular modeling algorithm that could generate
real-time pressure waveforms that correlated to ECG
samples from a stored library.1 Iterations of this algorithm
are still used today at Stanford's simulation center.
During this time, Dr. Gaba also became interested in
the principles of Cockpit Resource Management (CRM),
which focused on high-pressure decision-making
in commercial aviation.1 In 1987, the PBS science
documentary series NOVA aired an episode titled " Why
Planes Crash, " which investigated three recent airline
crashes. Citing pilot error as the primary cause of
plane crashes in 60 to 80 percent of cases, the show
explored CRM as a promising solution. It also featured
a NASA psychologist from the Ames Research Center,
which happened to be down the street from Stanford in
Mountain View, CA.
After watching the special, Dr. Gaba visited Ames to
discuss decision-making and teamwork psychology
with leading experts in the field. These discussions
led to the development of an analogue course for
anesthesiologists called Anesthesia Crisis Resource
Management (ACRM), which was introduced in 1990 to
very positive reception. The accompanying textbook,
Crisis Management in Anesthesiology, is a landmark text
on patient safety. Dr. Gaba also led efforts to establish
simulation centers at the Palo Alto Veterans Affairs
Hospital and at Stanford University in 1995 and 2010,
respectively.3 Today, both institutions host cutting-edge
simulation courses for guests from around the world.
As an anesthesia resident learning modern medicine, I
stand on the shoulders of giants who came before me.
Dr. Gaba is no exception. He was the first to introduce a
comprehensive simulator system into medical training,
and in doing so, drastically improved patient safety
outcomes. He also introduced the terms " crisis resource
management " and " team resource management " into
common anesthesiology parlance, greatly advancing
how anesthesiologists think about error prevention
in the OR. Patients and anesthesiologists everywhere
have benefited tremendously from Dr. Gaba's legacy of
simulation-based learning.
3 Cooper JB, Issenberg BS, DeVita MA, Glavin R. Tribute to David Gaba on the occasion of his retiring as editor-in-chief of simulation in healthcare: Simulation in Healthcare: The
Journal of the Society for Simulation in Healthcare. 2016;11(5):301-303.
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