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



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



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



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.

Business

Crew Resource Management For Ems Finished