Crew resource management is among the new educational topics within emergency medical services.
What is it? Crew resource management, also known as CRM, is a team-oriented aviation concept. This idea has been adopted by dynamic, high-stress industries to reduce errors and improve provider and patient safety.
Regardless of how mundane you perceive a call to be, it is still dynamic. It has the potential to hurt you, your partner, team and the patient.
CRM originated in the aviation industry during the 1980s to address numerous errors secondary to breaks in communication among crew members.
The case specifically mentioned as the breaking point to implementation was a landing gear malfunction that resulted in a crash that killed all the crew and passengers on board.
During the investigation, it was determined the flight attendants were directed to prepare the passengers for a belly landing. The flight crew was hyper focused on the mechanical problem and lost track of time.
The flight attendants also failed to notify the cabin crew that passengers were ready for the landing. Ultimately, the plane ran out of fuel and crashed a few miles from the airport.
Does this happen in EMS? Yes.
How many times have we seen someone get tunnel vision and fail to complete a rapid trauma assessment because of a graphic burn injury or fracture? All the time.
Crew resource management includes everyone from dispatch to the emergency room staff.
If we implement the program and use it appropriately, we can:
- Improve teamwork
- Improve communication and problem solving
- Promote input from all team members regardless of level of certification or experience
- Decrease the likelihood of a sentinel event
This mindset has been taught in both Advanced Cardiac Life Support (ACLS) and Pediatric Advanced Life Support (PALS) since the 2005 American Heart Association (AHA) update.
You can’t terminate a resuscitation until the team leader asks everyone if they agree or if there is something else we need to try.
There are five elements to crew resource management:
Situational awareness — Being constantly aware of our surroundings and looking for changes. When those changes present themselves, do we accept the risk or do we need to remove ourselves from the situation?
Decision-making — Making informed decisions that are communicated to all members of the team. What is an informed decision? It is based on your training, experience and the information shared with you by team members. Finally, what do protocols tell you to do for a given situation?
Task management — Knowing your limitations and those of your team. When appropriate, put team members in positions to improve a weakness. Whether you like it or not, it is your responsibility as a paramedic to mentor and develop your EMTs.
Teamwork — Being a leader, which is easy for most of us within our industry. But you also need to learn to be a good follower. You can’t always be in charge — you also must be able to take direction.
Communication — Sharing your thoughts with teammates. It’s hard enough being the new guy or gal. Do not make it harder for them. Our industry is not the best when it comes to ensuring new providers have the needed support of their team and/or agency, regardless of how trivial the question.
Educating about crew resource management
Since teaching full time at a local college, I have noticed millennials and Generation Z do not always look for answers on their own. They would rather ask someone instead of reading provided information.
My administrative assistant spends half her day answering emails from prospective and current students. She responds to the email with the documentation.
Within minutes, she gets another email from the same individual asking the question again because he or she does not want to take the time to read and discover the answer.
I have the same issue at the beginning of every semester, starting a 8 a.m. the first day of the class. Students receive an announcement every 15 minutes for an hour and a half on topics ranging from my expectations of them, completing online assignments and professional communication.
When I get an email regarding information I have already provided, I respond and direct them to read the associated announcement. This forces them to answer their own questions. It’s also rare to get a follow-up email with the same question.
The purpose is not to stop the student from asking questions, but rather to learn to obtain information without relying on someone else. I am establishing that I am the leader, and he or she is the follower.
The other reason I do this is to correct a weakness society has created — the inability to seek information on our own.
Asking questions is a good thing
It’s important to ensure the student isn’t afraid to ask questions.
Whenever a student asks me about a subject I did not already address or about the material, I always answer the email or question with the requested information.
Then I conclude the email or conversation with statements that ensure the student knows he or she can ask questions without fear, such as:
- “Thank you for asking.”
- “Thank you for asking for clarification.”
- “Thanks for asking about the expectations.”
There are countless things you can do within your training programs or agencies to create this environment.
Embrace crew resource management so we can decrease errors within our industry.
I instill the CRM mindset during initial EMS education, and it is up to agencies to ensure that mindset grows within our new providers and is not stifled. This includes ensuring your veterans are on the same page, or nothing will change.