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GESTION DES ERREURS ET DES RISQUES DANS L'AIDE MÉDICALE URGENTE

A. Van Daele and L. Ait Ameur
Le Travail Humain
Vol. 73, No. 4, Décision et risques en santé / Decision and health risks (octobre 2010), pp. 299-318
Stable URL: http://www.jstor.org/stable/40985163
Page Count: 20
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GESTION DES ERREURS ET DES RISQUES DANS L'AIDE MÉDICALE URGENTE
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Abstract

This article presents a research project which aims to examine error management in emergency medical assistance, placing it within the broader framework of risk management. The data mainly come from the activity of operators at an emergency call desk who deal with requests for emergency medical care and decide what type of assistance to send to victims. The results show that operators make errors, particularly violations. The operators tolerate these violations and many errors are left undetected. Most of the errors that are detected are not rectified by the operators themselves, but mostly by third parties. Any protection put in place against errors, particularly against any risks, was observed. Despite the errors, the system was considered safe, at least during the observed period. Error and violation management has its place in risk management activity. The discussion attempts to model this activity, which is based on trade-offs between security objectives (managing external and internal risks that could lead to the death of casualties due to lack of adequate assistance) and economic objectives (limitation of system costs associated with the implementation of unnecessary or excessive assistance). Arbitration tends to be for the benefit of safety and the objective is not to optimize assistance sent to individual victims but rather to provide assistance to all victims. Arbitration in favour of security is revealed through three main activity characteristics: 1) in the medium-term, protection against errors and especially against risks, aimed at avoiding the most dreaded events and to anticipate unwanted events depending on the evolution of the situation (first safety net); 2) in the short-term, production (and tolerance) of violations that occur as risks taken (accepted) to improve target performance; and 3) recovery of errors or violations (or consequences) not managed by the operators themselves, but instead left to others (second safety net). The discussion also opens perspectives on approaches to security which focus on the situation under study. L'article présente une recherche dont l'objectif est d'étudier la gestion des erreurs dans l'aide médicale urgente, en replaçant celle-ci dans le cadre plus large de la gestion des risques. Les données sont principalement des traces de l'activité d'opérateurs qui depuis une centrale, traitent des appeb téléphoniques concernant des demandes d'aide médicale urgente et décident des secours à envoyer aux victimes. Les résultats montrent que les opérateurs produisent des erreurs et des violations. Toutes les violations sont tolérées. Beaucoup d'erreurs ne sont pas détectées. La plupart des erreurs détectées ne sont pas récupérées par les opérateurs eux-mêmes mais le sont majoritairement par des tiers. Des protections contre les erreurs et surtout contre les risques sont observées. Malgré les erreurs et les violations, le fonctionnement du système est sûr, du moins dans la période observée. En fait, la gestion des erreurs et des violations prend place dans une activité de maîtrise des risques. La discussion tente de modéliser cette activité et ouvre des perspectives en matière d'approches de la sécurité à privilégier dans la situation étudiée.

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