Combining clinical judgement and formalised risk assessment techniques in anaesthesiology : lessons from bushfire emergency management

The underlying thinking in bushfire management has much to offer anaesthetists. Although it is imperative to develop improved methods of predicting the risk of perioperative patient morbidity and mortality, we must avoid them being used in a way that can undermine both individual clinical judgment on a case-by-case basis and the effectivenessof the methods themselves. This requires all concerned to be aware of the reliability and validity of the algorithms used to provide such predictions as well as the quality of the data upon which they are based. Like fire behaviour analysts, anaesthetists should still be free to trust their knowledge, expertise and experience. When experienced fire fighters sense a conflict between what the evidence on the ground is telling them and what a predictive fire map is saying, they use their understanding of limitations of the fire analysts’ predictions to inform their own professional judgment.