A helicopter was attempting a night shipboard landing during a training mission. The landing deck already contained another helicopter which had just landed, and which was on the left side of the approaching aircraft. The pilot in command who was seated in the right seat, attempted to maneuver onto the deck without assistance in obstacle clearance from the other pilot who was sitting in the left seat. The aircraft drifted into the main rotor blades of the parked aircraft. The pilot in the left seat failed to offer assistance in obstacle clearance, despite his location in the left seat, closest to the obstacle.
Non-flying crew members should provide information to the pilot flying concerning obstacle avoidance, altitude, airspeed, and approach angle. Total damage cost exceeded $2.5M.
Emergency Department ExampleA 43 year-old male with a known severe allergy to peanuts presents to the ED with an acute allergic reaction after eating some cookies at a friend's house. He is triaged as emergent and treatment is initiated within minutes of arrival. Despite appropriate therapy the patient's condition worsens. He is given Albuterol via nebulizer and the physician orders Epinephrine 1 mg IV push to be given. The nurse is concerned about the route and dose but does not ask the physician for clarification of the order. The patient is given 1mg of Epinephrine. He immediately becomes hypertensive from the medication and ultimately sustains an Acute Inferior Wall Myocardial Infarction (MI). The patient requires a cardiac catheterization and is subsequently taken for bypass surgery.
The use of a call-out of the medication order (i.e., repeating the order back to the physician) would have alerted the physician to the drug dosage and route of administration error. In turn the physician's response to the call-out would have either corrected the error or prompted the nurse to further action. In the event of the physician's failure to change the drug order, the nurse would engage in advocacy and assertiveness to initiate further planning and decision making.