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Crew Resource Management For Ems Finished


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CRM for the fire, and EMS providers

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Crew Resource Management For Ems Finished

  1. 1. Crew Resource Management John S. Halbrook BA, REMT-P, Pilot
  2. 2. Objectives <ul><li>Identify crew management problems </li></ul><ul><li>Compare EMS problems to the aviation industry </li></ul><ul><li>Look at how CRM solutions fit into common EMS problems </li></ul><ul><li>Apply new solutions to EMS </li></ul>
  3. 3. Cockpit Resource Management <ul><li>Decision Making </li></ul><ul><li>Assertiveness </li></ul><ul><li>Mission Planning </li></ul><ul><li>Communication </li></ul><ul><li>Leadership </li></ul><ul><li>Attitude </li></ul><ul><li>Situational Awareness </li></ul><ul><li>DAM CLAS </li></ul>
  4. 4. Aviation Case Study Where did CRM come from?
  5. 5. The Problem <ul><li>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 </li></ul>
  6. 6. Air Florida Flight 90 <ul><li>January 13 th 1982 </li></ul><ul><li>The Pilot failed to switch on the internal anti-icing system. Used reverse thrust in a snow storm, and failed to abort take off </li></ul>
  7. 7. Air Florida Flight 90 <ul><li>During Taxi the cockpit voice recorder picked up this conversation. </li></ul><ul><li>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” </li></ul><ul><li>Captain: “Well, it satisfies the Feds” </li></ul>
  8. 8. Air Florida Flight 90 <ul><li>Was there a problem here? </li></ul><ul><li>Did the first officer recognize the problem? </li></ul><ul><li>Why did this accident occur? </li></ul><ul><li>Have you ever known a Senior EMS provider to discount the input of a junior one? </li></ul>
  9. 9. United Airlines Flight 173 <ul><li>During the approach only two of the landing gear lights illuminated </li></ul><ul><li>The crew circled figuring out what to do </li></ul><ul><li>The aircraft crashed </li></ul>
  10. 10. United Airlines Flight 173 <ul><li>The Light bulb was burnt out </li></ul><ul><li>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….” </li></ul><ul><li>Do EMS providers ever overlook major health conditions with out noticing the critical issues? </li></ul>
  11. 11. Eastern Flight 401 <ul><li>During an emergency situation the auto pilot was set </li></ul><ul><li>The pilot bumped the stick and sent the jet into an unperceivable dive </li></ul>
  12. 12. Eastern Flight 401 <ul><li>The cockpit voice recorder captured the following. </li></ul><ul><li>Stockstill: ”We did something to the altitude” </li></ul><ul><li>Loft:&quot; What?” </li></ul><ul><li>Stockstill: ”We're still at 2000 [feet], right?” </li></ul><ul><li>Loft: ”Hey — what's happening here?” </li></ul><ul><li>Who was flying the airplane </li></ul><ul><li>Have you ever wondered… Who’s attending to the patient? </li></ul>
  13. 13. Awareness
  14. 14. Situational Awareness <ul><li>Evaluating high Risk Situations </li></ul><ul><li>Recognizing Changing conditions </li></ul><ul><li>Recognizing your limitations </li></ul><ul><li>Recognizing equipment limitations </li></ul>
  15. 15. Clues to your level of awareness taken from Flight safety international <ul><li>Failure to meet targets </li></ul><ul><li>2. Use of Undocumented Procedures </li></ul><ul><li>3. Departure from SOP </li></ul><ul><li>4. Violating Minimums </li></ul><ul><li>5. No One Flying the Airplane </li></ul><ul><li>6. No one looking out the window </li></ul><ul><li>7. Communications Breakdown </li></ul><ul><li>8. Unresolved Discrepancies </li></ul><ul><li>9. The “BAD FEELING” </li></ul>
  16. 16. How to Maintain Awareness <ul><li>Experience </li></ul><ul><li>Training </li></ul><ul><li>Spatial Orientation </li></ul><ul><li>Keeping up Physical Skills </li></ul>
  17. 17. Awareness and stress <ul><li>This graph represents how your abilities change based upon the stress of the situation </li></ul>
  18. 18. Communications
  19. 19. Communications <ul><li>Transmitted & Received </li></ul><ul><li>Modes of Communication </li></ul><ul><ul><li>Verbal 7% </li></ul></ul><ul><ul><li>Body Language 35% </li></ul></ul><ul><ul><li>Vocal Tone 55% </li></ul></ul><ul><li>Process </li></ul><ul><ul><li>Sender </li></ul></ul><ul><ul><li>Message </li></ul></ul><ul><ul><li>Receiver </li></ul></ul><ul><ul><li>Feedback </li></ul></ul>
  20. 20. Communications <ul><li>The concept of CRM fosters a climate where freedom to respectfully question authority is encouraged </li></ul>
  21. 21. The communication process <ul><li>Opening or Attention getter </li></ul><ul><ul><li>“ Hey Chief” or “Captain smith” </li></ul></ul><ul><li>State your concern </li></ul><ul><ul><li>“ Were Low on Fuel” or “I think we may have fire extension into the roof” “The Patient doesn’t look good” </li></ul></ul><ul><li>State the problem as you see it </li></ul><ul><ul><li>“ I don’t think we have enough fuel to fly around the storm” “I don’t think she’s breathing well” </li></ul></ul><ul><li>State the solution </li></ul><ul><ul><li>“ Lets divert to another airport” “Lets Intubate” </li></ul></ul><ul><li>Obtain agreement (or buy –in) </li></ul><ul><ul><li>“ Does that sound good to you captain?” </li></ul></ul>
  22. 22. Attitudes
  23. 23. Attitude Problem <ul><li>The Aviation Issues </li></ul><ul><li>I’m the Pilot </li></ul><ul><li>The Plane is mine </li></ul><ul><li>Your not as good as me </li></ul><ul><li>You haven't been doing this as long as I have </li></ul><ul><li>The EMS Issues </li></ul><ul><li>I’m the Paramedic </li></ul><ul><li>See that X That’s where you sit </li></ul><ul><li>EMT’s are to be seen and not heard </li></ul>
  24. 24. Attitudes <ul><li>Impulsive </li></ul><ul><li>Anti Authority </li></ul><ul><li>Macho </li></ul><ul><li>Resignation </li></ul><ul><li>Invulnerability </li></ul>
  25. 25. Attitude Vs Antidote <ul><li>Antiauthority: Don’t Tell Me! </li></ul><ul><li>Impulsivity: Do something quickly </li></ul><ul><li>Macho </li></ul><ul><li>Resignation: What’s the Use? </li></ul><ul><li>Invulnerability: It won’t happen to me! </li></ul><ul><li>Follow the Rules, They are usually Right </li></ul><ul><li>Not so fast, Think First </li></ul><ul><li>Taking Chances is foolish </li></ul><ul><li>I’m not helpless, I can make a difference </li></ul><ul><li>It could happen to me... </li></ul>
  26. 26. Decision Making
  27. 27. Decisions, Decisions, Decisions
  28. 28. D.E.C.I.D.E. <ul><li>Detect the need to make a decision </li></ul><ul><li>Evaluate your options, considering the goals of your flight </li></ul><ul><li>Choose the options that best meet your goals </li></ul><ul><li>Implement that choice </li></ul><ul><li>Detect the changes that result from your decision </li></ul><ul><li>Evaluate the result and your need to make further decisions </li></ul>
  29. 29. Decision Making <ul><li>Begins with Good Situational Awareness </li></ul><ul><li>Evaluate Situation </li></ul><ul><ul><li>What needs to be corrected? </li></ul></ul><ul><ul><li>What resources do you have? </li></ul></ul><ul><ul><li>How can the resources be best used? </li></ul></ul><ul><li>Consider consequences of possible actions </li></ul><ul><li>Make decision, inform all involved </li></ul><ul><li>Evaluate decision, repeat as needed </li></ul>You make the wrong decision once, you make the right decision forever
  30. 30. Factors Affecting Decision Making Capability <ul><li>Fatigue </li></ul><ul><li>Stress </li></ul><ul><li>Medication and Health </li></ul><ul><li>Alcohol </li></ul><ul><li>Personality </li></ul>
  31. 31. Assertiveness
  32. 32. Assertive Behavior <ul><li>Intended to be the middle ground </li></ul><ul><li>Best of aggressiveness (without the put-down negatives) </li></ul><ul><li>Best of non-assertiveness (without loss-of-self) </li></ul><ul><li>Conviction that one’s position can be expressed strongly without dominating the other </li></ul>
  33. 33. In the Cockpit <ul><li>As a crew member, you have the right to assure that your life will not be compromised by any action/inaction, miscommunication, or misunderstanding. </li></ul><ul><li>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. </li></ul>
  34. 34. Mission Planning
  35. 35. Mission Planning <ul><li>Aviation Planning </li></ul><ul><li>File a Flight plan </li></ul><ul><li>Review applicable policies </li></ul><ul><li>Everyone is on the same page, everyone knows the plan and the emergency procedures </li></ul><ul><li>EMS Planning </li></ul><ul><li>What does EMS do to plan for patient care </li></ul>
  36. 36. Leadership
  37. 37. Leadership <ul><li>No matter what position you occupy in the crew you must learn to become a leader in that position </li></ul><ul><li>What makes a leader? </li></ul><ul><ul><li>Leader is a person whose ideas and actions influence the thought and behavior of others </li></ul></ul><ul><ul><li>accomplished through the use of examples, persuasion, and an under standing of the goals and desires of the group </li></ul></ul>
  38. 38. Leadership Skills <ul><li>Regulating the information flow </li></ul><ul><ul><li>Includes using and accepting non-confrontational “key phrases” and gradually escalated action if required </li></ul></ul><ul><ul><ul><li>“I’m uncomfortable” or “Knock it off” </li></ul></ul></ul><ul><li>Directing and coordinating crew activities </li></ul><ul><li>Motivating crew members </li></ul><ul><li>Decision making </li></ul>
  39. 39. Bottom Line <ul><li>The pilot, copilot, and engineer for a CREW, are not three individuals with separate and unrelated duties and interests </li></ul><ul><li>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 </li></ul>
  40. 40. Case Study #1
  41. 41. Case Study #3
  42. 42. Case Study #2
  43. 43. Conclusion <ul><li>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) </li></ul>
  44. 44. Add Me Group think