Checklists: If surgical teams don't comply, what hope do divers have?
- Thread starter GLOC
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OP
I know. He and I were at the Tech Diving Network conference, Germany this weekend and were discussing the HF work I am doing, something he considers very important.
He led one of the teams (NZ one) which was part of Atul Gawande's WHO Safe Surgical Checklist research programme which showed massive benefit in terms of patient mortality and morbidity.
A consistent and simple design is something which appears to be something elusive, but there are bigger issues than just design which need to be resolved, not least the culture and the perception that checklists are for novices.
I don't know anything about surgery checklists, and I am not a rebreather diver. I have, however, given a lot of thought to the use of predive checklists, both for recreational diving and for technical diving, and I have a lot of experience with similar systems used for grading student work in academic assessments. That has led me to develop a theory about why they are not more common.
Using the broadest possible definition of a checklist, the potential user will make a subconscious comparison of the need for the list to the amount of effort required to use it, then decide whether or not to take that time. If using the list is perceived to create a burden in excess of the need, then it will not be used. This means that a checklist that is perceived to be excessive is worse than a simpler checklist, because the simpler checklist is more likely to be used.
In education systems, you see this in scoring guidelines for assessments. Complex scoring systems are absolutely ignored by assessors, meaning assessment results are usually based on the whim of the assessor. Studies of the results of such systems show absolutely bizarre ratings for student performances, ratings that have no relationship to the guidelines on which they are supposedly based. The most proficient systems (used by people like the College Board) use very simple scoring guidelines and rely on training the judgment of the assessors.
In recreational SCUBA, even the PADI BWRAF is viewed by most people as being too burdensome, and it is usually ignored entirely. I think that is because it has some items that are so very routine (BCD, Releases) that people don't feel like bothering, and so in skipping the whole thing, they also ignore the important items and leave their air turned off. Although the list contains items that are not perceived to be worth the effort, it does not include one item that is very important--the instrument by which you will measure your dive, usually a computer. (Did you remember to put it on your wrist? Is it set to the proper gas mixture?)
So I am generally in favor of the use of lists, but they have to be constructed very carefully.
Using the broadest possible definition of a checklist, the potential user will make a subconscious comparison of the need for the list to the amount of effort required to use it, then decide whether or not to take that time. If using the list is perceived to create a burden in excess of the need, then it will not be used. This means that a checklist that is perceived to be excessive is worse than a simpler checklist, because the simpler checklist is more likely to be used.
In education systems, you see this in scoring guidelines for assessments. Complex scoring systems are absolutely ignored by assessors, meaning assessment results are usually based on the whim of the assessor. Studies of the results of such systems show absolutely bizarre ratings for student performances, ratings that have no relationship to the guidelines on which they are supposedly based. The most proficient systems (used by people like the College Board) use very simple scoring guidelines and rely on training the judgment of the assessors.
In recreational SCUBA, even the PADI BWRAF is viewed by most people as being too burdensome, and it is usually ignored entirely. I think that is because it has some items that are so very routine (BCD, Releases) that people don't feel like bothering, and so in skipping the whole thing, they also ignore the important items and leave their air turned off. Although the list contains items that are not perceived to be worth the effort, it does not include one item that is very important--the instrument by which you will measure your dive, usually a computer. (Did you remember to put it on your wrist? Is it set to the proper gas mixture?)
So I am generally in favor of the use of lists, but they have to be constructed very carefully.
Some people by their nature just love checklists--BWRAF isn't extensive enough for them--and others seem to find any checklist too burdensome. I would imagine rebreathers attract the kind of people who, like pilots and maybe surgeons, are generally good with checklists. The kind of people who hate checklists are probably the ones who would most benefit from them.
Why not write your own?
As mentioned the Megalodon checklist is pure insanity. Its around 50 items long in 6 or 7 point font and almost assuredly written by a lawyer. I ended up writing my own and vetting it on RBW and CCRx.
The Kiss checklist I got from Edd is actually decent even if the words are a bit confusing to me (the terminology is different than mine)
I still use both although I don't always put actual marks on the page, I do work through the steps in order though.
I think there's actually some merit in MOD1 courses having a full on extensive manufacturer's build checklist but having one of the classroom exercises be to write a prejump checklist as a group.
wnissen
Contributor
So this checklist may not fit the "advanced" part of the forum but I have run through several recreational Monterey shore dives and it has served me well. I have a separate packing list, this is the "doing" list. I feel like the minimal amount of time it adds to the assembly is more than repaid by the savings of not having to re-do and/or replace missed steps, not even counting the increase in safety.
Day before
- scoplamine patch
- inspect tank / reg o-ring
- convert tanks to DIN
- Check conditions
- Lay tarp
- 1 L fluids
- sunscreen
- defog mask
- insert whistle, SMB, lights
- attach cylinder strap and tether
- (DIN only) Slight open of valve to flush
- attach first stage and low-pressure inflator (1), clip (2), and strap (3)
- face SPG into BCD
- turn on valve, watch pressure rise
- breathe both second stages
- Check BCD overflow if needed
- 5 lb. tank weights (aluminum)
- Determine weighting, insert other weights
- Agree on dive plan:
- route
- turn pressure
- Bags, other equipment
- bathroom break
- bathing suit
- wetsuit (neck hole in front!)
- boots
- kit (right arm first, check hose routing)
- check alternate (octo) stowage / tether
- earplugs
- gloves
- hood
- mask / snorkel
- fins
- bags / additional gear
- BCD inflator
- Releases
- Weights secure
- Air - breath both second stages while watching
- Final buddy check
SORTED
- Signal for descent
- Orient to reference
- Regulator in
- Time
- Elevate and vent BCD
- Descend
- stow earplugs
- watch SPG for sticking
- replace dust cap
- 1 L fluids
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The Chairman
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EireDiver606
Contributor
6 steps to build or 6 steps from a built unit to splash? They are very different things that manufacturers and checklist writers are barely cognizant of (IMHO)
The meg one is my first draft, I can't find my second draft electronically at the moment. The only real difference is that I switched to onboard dil so there another gas to analyze. I also added a field pos/neg check after opening to turn it on (2 lines up from the bottom). It's still more of a build checklist than a splash checklist.
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