Safety has become a continued focus in EMS, especially as it revolves around communication. The techniques found in Crew Resource Management (CRM) have helped develop a framework to improve safety through effective communication. The term Crew Resource Management was coined in the late 70s by the airline industry and was developed as a solution to a series of preventable incidents. We’ve adapted it in EMS, along with many other lessons from the airline industry, to help improve patient and provider safety.
CRM’s core principles require everybody to be responsible for safety and empowers individuals to speak up without compromising authority. If a potential patient or scene safety issue is discovered by even the most junior member of the crew, it is expected that he/she will bring that to the attention of leadership. If leadership refuses to correct the issue, that junior member is expected to step outside the typical chain of command and correct it. There are countless examples of errors where crew members recognized a potential issue but did not speak up, and CRM is designed to avoid these.
It is not how CRM works but rather how do we teach it and incorporate it into our everyday practice; and more importantly how do we measure its success. In order for us to follow CRM we must fully integrate into every aspect of our practice, each provider must understand its core principles and must feel empowered to use them.
Measuring its success is where most resources fall short. We can look at the success of CRM in two separate ways. First, we can look at errors, protocol deviations, and equipment failures due to neglect – pre-and post-implementation of CRM as one measurement. Although CRM may not be the only cause of an improvement in these measures it would be a strong indication of the effectiveness of CRM’s implementation.
Secondly, we can look at overall team performance both before and after implementation. We can place our providers in simulated scenarios that require individuals to both recognize and alert others to potential safety issues. We can use objective criteria such as time to recognition and how long before leadership is alerted to measure how well our teams are working together. We may not have a baseline to judge against but it certainly gives us an indication that our teams are functioning well. We could also get an outside perspective on how well our teams are functioning. By using patient satisfaction surveys that ask questions about teamwork we can gain the perspective of our patients in better understanding if our teams are functioning well.
CRM, like many other safety initiatives, requires buy-in from every member of the organization, but it is also something that we can start to teach immediately. We don’t necessarily need to wait for some formal rollout or standard operating procedure to be developed to empower our providers to speak up. We should be training this during our new employee orientation, ongoing employee development, and during remedial training after an incident. The more we discuss it and the more we look for spots at which it could be helpful, the easier it will be to gain widespread provider buy in. We should all look for opportunities to implement Crew Resource Management at our organizations and work on developing best practices that we can share with the EMS community.