Sunday, August 21, 2011

Safety deserves more than lip service

Earlier this month, my family and I flew home after a holiday in Newfoundland.  As we boarded the flight in Deer Lake, my 2 sons led the way onto the plane and took the first two seats we had been assigned.  Unfortunately, their seats were in the exit row and, as they were too young to sit there, we moved them to our other assigned seats.  My wife and I took the exit row seats.

The flight attendant arrived to give the exit row passengers instructions on how to open the emergency exit in case of the need to evacuate the airplane.

"Pull down the handle, pull the door inward, then throw it clear outside the airplane.  Are you OK with that?"

She looked expectantly at me and my wife.  I hesitated.

Before the flight attendant had arrived to brief us, I had noticed that the opposite exit row window seat was occupied by an elderly lady, perhaps in her late 70's, and very slightly built.  The emergency exit instructions noted that the door weighed 40 pounds.  I thought it was unlikely that this lady would be able to manhandle a 40-pound door.

The flight attendant was waiting for my reply.

"Are you OK with that," she repeated.

I was unsure what to say.  My wife and I could certainly handle our exit, but I was convinced that the lady opposite couldn't.  Was it any of my business to point this out?  Surely the flight attendant could see the same problem that I did.  Perhaps I was overreacting.  After all, she must have been trained to assess a passenger's ability to help in case of an emergency.

The easiest route would have been to nod my head and let her get on with departure preparations.  But, the situation was so obviously inappropriate, I couldn't let it go.  But, I was unsure how to proceed.  If I explicitly related my concern, I may offend or upset the elderly lady sitting across from me.  The flight attendant was already puzzled at my silence, and I certainly didn't want to upset her.  I tried to drop a hint.

"Well, I'm OK, but I'm not sure everyone else is..."

I glanced across the aisle, and she followed my gaze.  She took the hint.

Or, so I thought.

She caught the elderly lady's attention and asked her "Are you comfortable with that?"

"Oh, yes," was her reply.

I wasn't sure that the elderly passenger had actually understood what the flight attendant was asking her. The question was ambiguous and she may have simply been indicating that she was comfortable in her seat.

"Anyway," the flight attendant assured us, "It's extremely unlikely that we would need to evacuate."

The flight attendant was obviously uncomfortable with addressing the situation.  My impression was that she did not wish to upset the lady in the window seat.  But, her reassurance that an emergency evacuation was unlikely seemed to me to be an acknowledgment that there was a problem.

I was stuck.  Now that I had pointed out this situation, could I let it go unresolved?  Was this my responsibility to pursue, when a crew member did not seem overly concerned?

The answer came from the couple seated in front of the elderly woman.  They had heard the conversation and offered to change seats.  The flight attendant seemed relieved at this resolution.

Some thoughts on this vignette:

The emergency exit briefing procedure reminded me of the preop surgical checklist.  Both can be technically completed by reciting the prescribed list of questions.  However, each procedure achieves its goal of improved safety if all parties openly communicate.  Everyone has to be confident that safety concerns will be acknowledged and addressed.  The intent of the safety checklist must be satisfied.
While the flight attendant seemed to recognize my concern that the elderly passenger couldn't carry out the evacuation procedure, she seemed unsure of how to address this with the lady.  She didn't want to embarrass the lady by singling her out.  Perhaps a formal script would be useful: In case of an emergency, you will need to assist with evacuating the plane.  Are you capable of lifting the 40-pound door and throwing it out of the airplane? Pose this question to all exit row passengers, regardless of their age and size.  
I wondered if I am sufficiently open to hearing safety concerns in the OR.  If other members of the OR team see a problem, yet think I am not receptive to hearing their input (as was my impression of the flight attendant's approach to my concern), they will hesitate to speak up.  
Safety policies should be followed consistently.  Excuses that an adverse event is "extremely unlikely" undermine everyone's commitment to the safety process.

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