Press Release: 'Below Ten Thousand'

Flying High.



The operating theatre works daily by the premise of ‘surgical precision’.


Every opportunity to work as a holistic team is embraced, not only as an effective way to get things done, but also as a way to maximise patient safety and reduce risk.


Each operation is a choreography of multidisciplinary teamwork, each member an expert in their own field.


Given the intensity of the work and the mandatory desire for a good outcome, surgeons, anaesthetists, nurses and theatre technicians are embracing a new concept in operating theatre team dynamics.


The concept has been developed by nurses at Geelong Hospital. John Gibbs, a Clinical Nurse Specialist in Anaesthetics, studied Crew Resource Management strategies common in the airline industry and found that some dimensions of aeronautical crew resource engineering could solve dilemmas in his operating theatre environment, in particular, the reduction of ambient noise and distractions at sentinel times of anaesthesia.


In collaboration with other staff, he has worked on and improved upon the idea, finally arriving at the prototype concept of ‘Below Ten Thousand’ for the surgical and clinical setting.


'Below Ten Thousand’, in aeronautical terms, refers to the time when a plane is below ten thousand feet.


Naturally, the pilot requires optimum focus and minimum distractions at these critical times. The brainwave was to develop the term as an iconic statement devoid of emotional content and apply it to medical situations where focus on the task at hand is paramount and ambient noise and distractions needs to be reduced.


“It’s pure magic,” John says. “You can have up to five separate conversations in the room when you are trying to navigate quite delicate anaesthetic moments; surgeons discussing a case, nurses sorting out the order of the list, documentation requests from recovery, techs organising equipment, and the anaesthetic team trying to communicate with the patient.


Now, everyone respects the need for unquestioned quiet at the mention of three words, and even better, they have more situational awareness and are more available in the moment to render immediate assistance.”


'Below Ten Thousand' has a flow‐on effect, as well. Surgeons, registrars and scrub nurses, are finding the term useful for instigating multidisciplinary problem‐solving discussions earlier, such as when phenomena start deviating slightly from normal.


 Yet the job is not finished.


“Given that we have found in our research the potential for danger hidden within distraction, and given that distractions are endemic in the operating environment, the next task is to systems engineer our processes to minimise the number of ‘permissive’ distractions in the interest of patient safety.”


“When we started, we thought ‘Below Ten Thousand’ would be just one small thing in isolation.

We seem to have discovered that it is just the start of something big.”








Press Release issued by 'Below Ten Thousand Medical' at 22:30 on 13/02/2014


Below Ten Thousand

An international collaboration

Empowering clinicians in safety culture