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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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Crew Resource Management For Ems Finished Crew Resource Management For Ems Finished Presentation Transcript

  • 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?
  • Awareness
  • 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
  • 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 Me Group think
  •