Crew Resource Management (CRM) is a team-oriented approach for the effective use of personnel to promote the teamwork, communication, and problem-solving to patient safety.  CRM originated in the commercial airline industry because there were numerous errors because of breaks in communication amongst the crew members in the 1980’s and has since been expanded into dynamic, high-stress industries like EMS.

In one example, there was a landing gear malfunction on a commercial airliner.  The landing gear would not come down. The flight team asked the stewardess to prepare the passengers for a belly landing while they attempted to troubleshoot mechanical issue, but they were too focused on the mechanical problem to follow-up with the stewardesses and the stewardesses failed to communicate that they had completed the assignment.  Ultimately, the plane ran out of fuel only and crashed a few miles from the airport killing everyone on board.

Does this type of thing happen in EMS?  Yes, it’s only a matter of time before you see someone get tunnel vision and skip over the primary assessment because they are managing a graphic injury like a tib/fib fracture.  Is that an injury that will kill a patient?  Unlikely.  But failing to address an issue with airway and ventilation will kill a patient very quickly.

The FAA Advisory Rule expands this definition to include software, hardware and humanware in its definition.  The FAA’s specific listing of listing of software, hardware and humanware is meant to emphasize the point that problem solving involves using all available tools.  CRM’s guiding principles include, situation awareness decision-making, task management, teamwork, and communication. It also emphasizes the importance of creating a positive working environment and promoting teamwork and collaboration among all members of the flight crew.

Situational awareness

We are taught starting in EMT class to recognize a dangerous environment and evaluate high-risk situations. This is accomplished by recognizing the changing conditions and determining whether to accept the risk or not. The problem here was the past “scene safety, BSI” mindset. When you were in lab training did you ever assess for safety or just get your checkmarks and move on?  If you got your checkmarks, it is a failure of your instructors to randomly throw a wrench into the scenario and that translated into the prehospital setting resulting in injury.  Situation awareness also includes recognizing your own limitations and the limitations of your partners, resources, and equipment.

Decision-making

We cannot be expected to know all the answers all the time, and it must be a team effort.  It’s okay to admit that you do not know what to do, mind you it should not be an everyday occurrence and if it is you need to do a self-assessment of your abilities and knowledge base.  When you occasionally admit you do not know the answer, you put your peers into a positive brain storming session so that we can decide as a team how to move forward.  Maybe, just maybe someone has already been in this situation and knows what to do, or at least where to start.

This concept has been in embedded in ACLS and PALS courses since 2005.  You cannot terminate resuscitative efforts without asking ALL team members if there is something we are missing or need to try.  This does not atter if someone is new or experienced and level of training also does not matter.

If you would like to learn more about CRM join us in either EMT L2 or ALS L18.

 

Reference:

 

Blanchet, D. (2010, Oct. 31). Crew Resource Management and EMS. Retrieved from https://www.emsworld.com/article/10319135/crew-resource-management-and-ems.