PHEM curriculum unit B.5 · Cross-cutting theme B: Team Resource Management
The DipIMC is blueprinted against phase 1 of the UK Pre-hospital Emergency Medicine (PHEM) curriculum. This page covers unit B.5, Employ effective team working.
Below are 2 free practice questions from the DipIMC.Ninja bank, in the Part A single best answer format. Every answer names the textbook page, guideline or statute it was written from, so you can check it rather than take it on trust. The bank holds 9 questions on this unit.
Question 1 · Law, Ethics & Human Factors · Easy
Shortly after a pre-hospital rapid sequence induction the patient desaturates. The team leader troubleshoots while an assistant reads aloud, step by step, from a laminated card headed post-induction desaturation. Within a service suite of documents that guide practice, what is that card?
AA standard operating procedure
BAn emergency action checklist
CA procedural aide-memoire
DAn organisational policy
EA clinical practice guideline
Show answer
Answer: B
An emergency action checklist
The ABC's chapter on clinical governance describes a suite of documents that guide practice. Emergency action checklists are intended to provide an immediate emergency reference for the rapid and safe management of life-threatening complications of treatment or interventions; mirroring aviation systems, they are intended to be easy to read by an assistant so that the operator can problem-solve systematically. The book's Table 36.1 lists post-induction desaturation among its example checklists, alongside post-induction hypotension, hyper- or hypocapnia and ventilator alarms. A procedural aide-memoire also assumes prior knowledge and aids rapid recall, but of an essential procedure rather than of an emergency; the book's commonest example is a pocket-sized cardiac arrest algorithm. Standard operating procedures give operational detail, instructions and advice on implementing specific clinical care or operational tasks, such as induction of anaesthesia. Organisational policies provide the authoritative framework within which the service works. Published clinical practice guidelines, such as those from the Faculty of Pre-Hospital Care, NICE or JRCALC, should be interpreted in the context of the service and, where appropriate, incorporated into its policies or procedures.
Where this comes from
ABC of Prehospital Emergency Medicine
Ch. 36 Clinical Governance · Clinical effectiveness: emergency action checklists · p. 198“They are intended to provide an immediate emergency reference for”
Ch. 36 Clinical Governance · Clinical effectiveness: emergency action checklists · p. 198“intended to be easy to read by an assistant”
Ch. 36 Clinical Governance · Clinical effectiveness: procedural aides-memoires · p. 198“They assume prior knowledge of the relevant underpinning polices and procedures”
Ch. 36 Clinical Governance · Clinical effectiveness: standard operating procedures · p. 197“SOPs provide operational detail, instructions and advice on”
Ch. 36 Clinical Governance · Clinical effectiveness: organisational policies · p. 197“provide an authoritative framework within which the service works”
Ch. 36 Clinical Governance · Clinical effectiveness: clinical practice guidelines · p. 197“should be interpreted in the context of the prehospital service”
law-060 · Law, Ethics & Human Factors · Human Factors · Easy · v2
Question 2 · Law, Ethics & Human Factors · Easy
A helicopter emergency medical service (HEMS) team reviews a roadside job at which the scene changed rapidly. The clinical governance lead notes that dynamic risk assessment, as described in the ABC of Prehospital Emergency Medicine, relies on generic risk assessments, documents that guide practice and training, and also requires four 'learnable' skills. Which option lists those four skills?
ALeadership, assertiveness, situational monitoring and team debriefing
BCommunication, assertiveness, task allocation and mutual support
CLeadership, communication, decision making and team debriefing
DLeadership, communication, situational monitoring and mutual support
EAssertiveness, communication, situational monitoring and debriefing
Show answer
Answer: D
Leadership, communication, situational monitoring and mutual support
The ABC's chapter on clinical governance describes dynamic risk assessment as the continuous assessment of risk carried out in a rapidly changing environment (its Figure 36.3 is the evaluate–select–assess–control loop that ends in 'stop' when the risk is not proportional to the benefit). It relies on the existence of generic risk assessments, documents that guide practice and training, and it also requires effective leadership, communication, situational monitoring and mutual support — all 'learnable' skills. They map directly onto a pre-hospital scene: someone must lead and set priorities, information must be passed and confirmed, every team member must keep watching the scene and the patient for change, and team members must back each other up, including by speaking up. The distractors mix in real non-technical skills (assertiveness, task allocation, decision making, debriefing) that the ABC does not list in this sentence; they are good practice, but they are not the four the book names. The point for practice is that dynamic risk assessment is a team activity, not one person's private judgement.
Where this comes from
ABC of Prehospital Emergency Medicine
Ch. 36 Clinical Governance · Risk management: dynamic risk assessment · p. 199“relies on the existence of generic risk assessments”
Ch. 36 Clinical Governance · Risk management: dynamic risk assessment · p. 199“effective leadership, communication, situational monitoring and mutual support”
law-233 · Law, Ethics & Human Factors · Human Factors · Easy · v2