Crew Resource Management For Ems Finished

Crew Resource Management John S. Halbrook

BA, REMT-P, Pilot

Course By:John S. Halbrook

www.HalbrookAssociates.com

Objectives

• Identify crew management problems• Compare EMS problems to the aviation industry

• Look at how CRM solutions fit into common EMS problems

• Apply new solutions to EMS

Cockpit Resource Management

• Decision Making• Assertiveness• Mission Planning• Communication• Leadership• Attitude• Situational Awareness

DAM CLAS

Aviation Case StudyWhere did CRM come from?

The Problem

• Analysis of airline accidents over 20 years show approximately 70% were a direct result of inadequacies related to aircrew coordination, workload management, and decision making

Air Florida Flight 90

January 13th 1982The Pilot failed to switch on the internal anti-icing system. Used reverse thrust in a snow storm, and failed to abort take off

• During Taxi the cockpit voice recorder picked up this conversation.

First Officer: “It’s a losing battle trying to de-ice these things. It

gives you a false feeling of security, that’s all it does”

Captain: “Well, it satisfies the Feds”

• Was there a problem here?• Did the first officer recognize the problem?

• Why did this accident occur?

•Have you ever known a Senior EMS provider to discount the input of a junior one?

United Airlines Flight 173

• During the approach only two of the landing gear lights illuminated

• The crew circled figuring out what to do

• The aircraft crashed

United Airlines Flight 173

• The Light bulb was burnt out

• The NTSB ruled the following: “The failure of the captain to monitor properly the

aircraft's fuel state and to properly respond to the low fuel state…. His inattention

resulted from preoccupation with a landing gear malfunction….”

• Do EMS providers ever overlook major health conditions with out noticing the critical issues?

Eastern Flight 401

• During an emergency situation the auto pilot was set

• The pilot bumped the stick and sent the jet into an unperceivable dive

Eastern Flight 401

The cockpit voice recorder captured the following.

• Stockstill: ”We did something to the altitude”

• Loft:" What?”• Stockstill: ”We're still at 2000 [feet], right?”

• Loft: ”Hey — what's happening here?”

• Who was flying the airplane• Have you ever wondered… Who’s attending to the patient?

Awareness

Situational Awareness

• Evaluating high Risk Situations• Recognizing Changing conditions• Recognizing your limitations• Recognizing equipment limitations

Clues to your level of awarenesstaken from Flight safety international

1. Failure to meet targets2. Use of Undocumented Procedures3. Departure from SOP4. Violating Minimums5. No One Flying the Airplane6. No one looking out the window7. Communications Breakdown8. Unresolved Discrepancies9. The “BAD FEELING”

How to Maintain Awareness

• Experience

• Training

• Spatial Orientation

• Keeping up Physical Skills

Awareness and stress

This graph represents how your abilities

change based upon the stress of the

situation

Communications

• Transmitted & Received• Modes of Communication

• Verbal 7%• Body Language 35%• Vocal Tone 55%

• Process• Sender• Message• Receiver• Feedback

Communications

• The concept of CRM fosters a climate where freedom to respectfully question authority is encouraged

The communication process

• Opening or Attention getter• “Hey Chief” or “Captain smith”

• State your concern• “Were Low on Fuel” or “I think we may have fire extension into the roof” “The Patient doesn’t look good”

• State the problem as you see it• “I don’t think we have enough fuel to fly around the storm” “I don’t think she’s breathing well”

• State the solution• “Lets divert to another airport” “Lets Intubate”

• Obtain agreement (or buy –in)• “Does that sound good to you captain?”

Attitudes

Attitude Problem

The Aviation Issues

• I’m the Pilot• The Plane is mine• Your not as good as me

• You haven't been doing this as long as I have

The EMS Issues

• I’m the Paramedic• See that X That’s where you sit

• EMT’s are to be seen and not heard

Attitudes

• Impulsive• Anti Authority• Macho• Resignation• Invulnerability

Attitude Vs Antidote

• Antiauthority: Don’t Tell Me!

• Impulsivity: Do something quickly

• Macho• Resignation: What’s

the Use?• Invulnerability: It

won’t happen to me!

• Follow the Rules, They are usually Right

• Not so fast, Think First

• Taking Chances is foolish

• I’m not helpless, I can make a difference

• It could happen to me...

Decision Making

Decisions, Decisions, Decisions

D.E.C.I.D.E.

• Detect the need to make a decision• Evaluate your options, considering the goals of your flight

• Choose the options that best meet your goals

• Implement that choice• Detect the changes that result from your decision

• Evaluate the result and your need to make further decisions

Decision Making

• Begins with Good Situational Awareness• Evaluate Situation

• What needs to be corrected?• What resources do you have?• How can the resources be best used?

• Consider consequences of possible actions

• Make decision, inform all involved• Evaluate decision, repeat as needed

You make the wrong decision once, you make the right decision forever

Factors Affecting Decision Making Capability

• Fatigue• Stress• Medication and Health• Alcohol• Personality

Assertiveness

Assertive Behavior

• Intended to be the middle ground• Best of aggressiveness (without the put-down negatives)

• Best of non-assertiveness (without loss-of-self)

• Conviction that one’s position can be expressed strongly without dominating the other

In the Cockpit

• As a crew member, you have the right to assure that your life will not be compromised by any action/inaction, miscommunication, or misunderstanding.

• Assertive behavior in the cockpit does not challenge authority; it clarifies position, understanding or intent, and as a result enhances the safe operation of the flight.

Mission Planning

Aviation Planning

• File a Flight plan• Review applicable policies

• Everyone is on the same page, everyone knows the plan and the emergency procedures

EMS Planning

• What does EMS do to plan for patient care

Leadership

• No matter what position you occupy in the crew you must learn to become a leader in that position

• What makes a leader?• Leader is a person whose ideas and actions influence the thought and behavior of others

• accomplished through the use of examples, persuasion, and an under standing of the goals and desires of the group

Leadership Skills

• Regulating the information flow• Includes using and accepting non-confrontational “key phrases” and gradually escalated action if required•“I’m uncomfortable” or “Knock it off”

• Directing and coordinating crew activities

• Motivating crew members• Decision making

Bottom Line

• The pilot, copilot, and engineer for a CREW, are not three individuals with separate and unrelated duties and interests

• The importance of CRM is to get the individual crew members to work together to achieve the objectives of the mission in a safe manner

Case Study #1

Case Study #3

Case Study #2

Conclusion

Crew resource management can be defined as a management system which makes optimum use of all available resources-equipment-

procedures, and people-to promote safety and enhance the efficiency

of flight operations (Patient Care)

Add MeGroup think

QuickTime™ and a decompressor

are needed to see this picture.

Crew Resource Management For Ems Finished

Business

Redesigning EMS Handout - ND EMS A

EMS Technology Assessment Template - Home | NHTSA EMS

Acceptance of EMS items...EMS logo in accordance with specification in the EMS manual and EMS House Style EMS Module 1 OHT 1.11

EMS Instructor Guidance OHIO APPROVED CURRICULUM...• EMS systems • History of EMS • Roles/ responsibilities/ professionalism of EMS personnel • Quality improvement • Patient

SUCCESS STORY - content.steward.org · SUCCESS STORY The Health Challenge • Sudden cardiac arrest. The Treatment • Stabilized by survive, and only a 12% chance of EMS crew. •

GB EMS-N/GH, EMS-K/GHK, EMS-R/GHR Warm Air Heater Module

Degaussing Devices and Systems - Vallon · Degaussing line EMS with A series high-performance coil and separate Low Frequency Generator EG2440 on motor-driven carrier for semi-finished

EMS Systems. Emergency Medical Services (EMS) Systems Define EMS systems. Describe History of EMS. Describe Roles/responsibilities of EMS personnel

VEMS User's Manual - Brigham Young University User’s Manual EMS Enterprise 7.0 EMS Professional 13.0 EMS Campus 4.0 EMS Legal 7.0 EMS Workplace 7.0 EMS District 7.0

QUIKCLOT EMS 4X4 DRESSING AND EMS ROLLED … EMS 4X4 DRESSING AND EMS ROLLED GAUZE QuikClot® EMS 4x4 Dressing QuikClot® EMS 4x4 Dressing is a 4-ply, 4-inch x 4-inch, soft, white,

Squad ReviewSquad Review · • Mesa, Arizona EMS. • 70 000 911 calls/year70,000 911 calls/year • 19 Fire Stations, 202 Paramedics, 171 EMT-B’s • Typical crew:Typical crew:

Bringing Science to the Pit Crew: High-Functioning EMS CPR Teams

CERTIFICATO N. EMS-1480/S CERTIFICATE No. - CPG Lab · materials and finished products for industry. consultancy services on environment, safety and hygiene. progettazione ed erogazione

Virtual EMS User Guide - Trinity College EMS User Guide EMS Workplace 5.1 EMS Campus 2.1 EMS Enterprise 5.1 EMS Legal 5.1 Dean Evans & Associates, Inc

EMS System report 3-19 - Home Page | NWCEMSS€¦ · Mod Exam ave. scores EMS 210 EMS 211 EMS 212 EMS 213 EMS 216 Cum GPA written Prep Resp/Card Med Emerg only Trauma; Sp. Pop. Seminar

Crew Resource Management in International Helicopter …d-scholarship.pitt.edu/7616/1/Lambert_HEMS_CRM_ETD_2009.pdf · Crew Resource Management in International Helicopter EMS Systems:

When You’re Finished Changing, You’re Finished€¦ · finished changing, you’re finished.” At Penn Arts and Sciences, we certainly haven’t finished changing. As we look

School Shootings: An EMS Perspective Clifford Neal, D.O., FACEP, FACOP Regional EMS Medical Director Seven Mountains EMS Council Tactical EMS Physician

EMS 100, 200: SAUTER EMS and EMS Mobile...EMS 100, 200: SAUTER EMS and EMS Mobile SAUTER EMS has proven its effectiveness for more than a decade as a professional solution for vis-ualizing

KRM LOTO inside the box and further locked by responsible individuals in crew with their own padlocks until each person task is finished ... • Locking Mechanism