Crew Resource Management For Ems Finished

Crew Resource Management John S. Halbrook BA, REMT-P, Pilot

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

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”

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?

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?

Situational Awareness Evaluating high Risk Situations Recognizing Changing conditions Recognizing your limitations Recognizing equipment limitations

Clues to your level of awareness taken from Flight safety international Failure to meet targets 2. Use of Undocumented Procedures 3. Departure from SOP 4. Violating Minimums 5. No One Flying the Airplane 6. No one looking out the window 7. Communications Breakdown 8. Unresolved Discrepancies 9. 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?”

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...

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

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

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)

Crew Resource Management For Ems Finished

More Related Content

What's hot (20)

Viewers also liked (18)

Similar to Crew Resource Management For Ems Finished (20)

Recently uploaded (20)

Crew Resource Management For Ems Finished