An interesting analogy could be a bombing run in the Vulcan days. Basically, either pilot could carry out the bombing run visually, or the navigator (radar) [equivalent to the wartime bomb aimer] could carry out the bomb run with reference to radar alone. If the co-pilot was carrying out a visual bomb run, then the whole crew followed his instructions. Similarly, the nav radar directed the whole crew for a radar bomb run. So you see, the crew had a temporary director who was given and handed back control as required.
I think you are unnecessarily complicating the issue. You clearly state that there is already a handover drill, so why do you need anything more? If you have taken over control of monitoring and administering the appropriate drugs, surely there is no question but that you remain in sole charge. If the other anesthetist is more senior, your boss, or whatever, it must matter not. He may monitor everything and you may even discuss the minute to minute running of the case, but YOU, as the man 'in control' are the only one allowed to DO anything. If the more senior or your boss decides that he should take control, then the full handover brief should be given, you step back and revert to monitoring his actions.
This should all be agreed as a standard protocol that EVERYBODY MUST FOLLOW without variance, except in an extreme emergency. I would suggest that everyone in your dept should sit down together and hammer out the protocol. We've done similar a number of times in our surgery - it's the equivalent of a military SOP [standard operating procedure].
Another thing used worldwide in every aircraft are the Flight Reference Cards. These are series of cardboard [usually laminated] cards printed with all the checks required to operate the aircraft, including emergencies. It is normal [SOP] for multi crews to follow these checklists for all phases of flight, using the challenge and response system, where one crew member reads the checks and the other(s) respond with the correct words. It acts as an exact reminder of the check to be carried out, and it is a double check,in that an incorrect or unusual response would trigger a comment. Single crew aircraft can use them as reminders to ensure that everything is done correctly. Having been through your website, I believe that the principle of checklists could be adapted for you work in theatre.
Happy for you to send me a private message or e-mail if you want to discuss further [I can give you my telephone numbers if you wish to chat]. I would also be willing to discuss in depth the value of developing checklists with you.
FJJP
Last edited by FJJP; 21st May 2004 at 23:16.