Risk exploration of liability for medical damages incurred by ambulances based on SHEL model / 中华医院管理杂志

Objective:To analyze the risk factors of medical damage liability in the ambulance management in China, and provide reference for strengthening such management and improving the pre-hospital emergency system.Methods:The judgment documents released by China Judgment Online from 2013 to 2022 regarding damages incurred by improper ambulance management, were used as the sample. Based on the setting of such elements as software, hardware, environment, and liveware in the SHEL model, the text analysis method was applied to encode the text content at three levels according to " main category-sub category-risk behavior" by means of NVivo 12.0 software.Results:A total of 136 valid sample documents were included, finalizing such four main categories as software, hardware, environment, and liveware. Also finalized were 11 subcategories and 30 risk behaviors. The subcategories included the professional awareness and ability of pre-hospital emergency managers, the professional awareness of medical staff, the professional quality and ability of medical staff, as well as vehicle equipment among others. A total of 187 reference points were identified for coding risk behaviors. Risk behaviors with higher reference points included failure of pre-hospital emergency managers to dispatch vehicles (45), incomplete, malfunctioning, or no backup equipment in vehicles (20), failure of medical staff to take treatment measures in vehicles (18), failure to dispatch accompanying medical staff or stretchers (14), and insufficient medication (14), and fall of patients or medical equipment incurred by sudden braking of the drivers (6) among others.Conclusions:Insufficient ambulance equipment, shortage of human resources in the emergency system, inadequate equipment and medication in emergency vehicles, and safety issues for drivers are risk factors in the management of ambulances in China. It is recommended to expand the first aid talent team and enhance first aid capabilities; Reasonably deploy ambulance vehicles and improve the emergency networks; Develop a list of pharmaceutical equipment and establish an early warning mechanism; Strengthen the multi-party coordination, improve the efficiency of referral, further reduce the probability of risk, ensure the quality of emergency treatment, and enhance the effectiveness of pre-hospital emergency treatment.

Practice of Human Factors Training Based on SHEL Model:Patient Safety Education for First Year Medical Students / 医学教育

Introduction: The theory of Human Factors (HF), which designs work and environment according to human characteristics, contributes to patient safety. However, there are not enough reports of systematic educational practices on HF. Our training was designed and practiced using SHEL, an explanatory model of HF.　Methods: Ten training sessions were conducted on the components of SHEL, including Software: manual design, Hardware: user-friendly medical device design, Environment: work environment design, Liveware (self) : human characteristics, and Liveware (others) : teamwork.　Reflection: The HF training using SHEL may lead to acquiring procedural knowledge of patient safety management, and to better understanding of HF by students. In addition, focusing on daily errors is expected to increase students’ learning motivation.