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
Course By:John S. Halbrook
www.HalbrookAssociates.com
Cockpit Resource Management
• Decision Making• Assertiveness• Mission Planning• Communication• Leadership• Attitude• Situational Awareness
DAM CLAS
Aviation Case StudyWhere did CRM come from?
Course By:John S. Halbrook
www.HalbrookAssociates.com
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
Course By:John S. Halbrook
www.HalbrookAssociates.com
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
Course By:John S. Halbrook
www.HalbrookAssociates.com
Air Florida Flight 90
• 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”
Course By:John S. Halbrook
www.HalbrookAssociates.com
Air Florida Flight 90
• 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?
Course By:John S. Halbrook
www.HalbrookAssociates.com
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
Course By:John S. Halbrook
www.HalbrookAssociates.com
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?
Course By:John S. Halbrook
www.HalbrookAssociates.com
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
Course By:John S. Halbrook
www.HalbrookAssociates.com
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
Course By:John S. Halbrook
www.HalbrookAssociates.com
Situational Awareness
• Evaluating high Risk Situations• Recognizing Changing conditions• Recognizing your limitations• Recognizing equipment limitations
Course By:John S. Halbrook
www.HalbrookAssociates.com
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”
Course By:John S. Halbrook
www.HalbrookAssociates.com
How to Maintain Awareness
• Experience
• Training
• Spatial Orientation
• Keeping up Physical Skills
Course By:John S. Halbrook
www.HalbrookAssociates.com
Awareness and stress
This graph represents how your abilities
change based upon the stress of the
situation
Communications
Course By:John S. Halbrook
www.HalbrookAssociates.com
Communications
• Transmitted & Received• Modes of Communication
• Verbal 7%• Body Language 35%• Vocal Tone 55%
• Process• Sender• Message• Receiver• Feedback
Course By:John S. Halbrook
www.HalbrookAssociates.com
Communications
• The concept of CRM fosters a climate where freedom to respectfully question authority is encouraged
Course By:John S. Halbrook
www.HalbrookAssociates.com
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
Course By:John S. Halbrook
www.HalbrookAssociates.com
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
Course By:John S. Halbrook
www.HalbrookAssociates.com
Attitudes
• Impulsive• Anti Authority• Macho• Resignation• Invulnerability
Course By:John S. Halbrook
www.HalbrookAssociates.com
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
Course By:John S. Halbrook
www.HalbrookAssociates.com
Decisions, Decisions, Decisions
Course By:John S. Halbrook
www.HalbrookAssociates.com
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
Course By:John S. Halbrook
www.HalbrookAssociates.com
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
Course By:John S. Halbrook
www.HalbrookAssociates.com
Factors Affecting Decision Making Capability
• Fatigue• Stress• Medication and Health• Alcohol• Personality
Assertiveness
Course By:John S. Halbrook
www.HalbrookAssociates.com
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
Course By:John S. Halbrook
www.HalbrookAssociates.com
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
Course By:John S. Halbrook
www.HalbrookAssociates.com
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
Course By:John S. Halbrook
www.HalbrookAssociates.com
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
Course By:John S. Halbrook
www.HalbrookAssociates.com
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
Course By:John S. Halbrook
www.HalbrookAssociates.com
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
Course By:John S. Halbrook
www.HalbrookAssociates.com
Case Study #1
Course By:John S. Halbrook
www.HalbrookAssociates.com
Case Study #3
Course By:John S. Halbrook
www.HalbrookAssociates.com
Case Study #2
Course By:John S. Halbrook
www.HalbrookAssociates.com
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)
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