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Crew Resource Management For Ems Finished


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CRM for the fire, and EMS providers

CRM for the fire, and EMS providers

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  • Transcript

    • 1. Crew Resource Management John S. Halbrook BA, REMT-P, Pilot
    • 2. 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
    • 3. Cockpit Resource Management
      • Decision Making
      • Assertiveness
      • Mission Planning
      • Communication
      • Leadership
      • Attitude
      • Situational Awareness
      • DAM CLAS
    • 4. Aviation Case Study Where did CRM come from?
    • 5. 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
    • 6. 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
    • 7. 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”
    • 8. 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?
    • 9. 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
    • 10. 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?
    • 11. 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
    • 12. 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?
    • 13. Awareness
    • 14. Situational Awareness
      • Evaluating high Risk Situations
      • Recognizing Changing conditions
      • Recognizing your limitations
      • Recognizing equipment limitations
    • 15. 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”
    • 16. How to Maintain Awareness
      • Experience
      • Training
      • Spatial Orientation
      • Keeping up Physical Skills
    • 17. Awareness and stress
      • This graph represents how your abilities change based upon the stress of the situation
    • 18. Communications
    • 19. Communications
      • Transmitted & Received
      • Modes of Communication
        • Verbal 7%
        • Body Language 35%
        • Vocal Tone 55%
      • Process
        • Sender
        • Message
        • Receiver
        • Feedback
    • 20. Communications
      • The concept of CRM fosters a climate where freedom to respectfully question authority is encouraged
    • 21. 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?”
    • 22. Attitudes
    • 23. 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
    • 24. Attitudes
      • Impulsive
      • Anti Authority
      • Macho
      • Resignation
      • Invulnerability
    • 25. 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...
    • 26. Decision Making
    • 27. Decisions, Decisions, Decisions
    • 28. 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
    • 29. 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
    • 30. Factors Affecting Decision Making Capability
      • Fatigue
      • Stress
      • Medication and Health
      • Alcohol
      • Personality
    • 31. Assertiveness
    • 32. 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
    • 33. 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.
    • 34. Mission Planning
    • 35. 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
    • 36. Leadership
    • 37. 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
    • 38. 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
    • 39. 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
    • 40. Case Study #1
    • 41. Case Study #3
    • 42. Case Study #2
    • 43. 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)
    • 44. Add Me Group think
    • 45.