What Crew Resource Management (CRM) Means to Prehospital Providers

Authors: Wayne Papalski BS, NR-P, FP-C, TP-C and John Siedler NR-P, FP-C

With a career in naval aviation, my every decision—even those life and death situations—is influenced by crew resource management (CRM). CRM procedures encompass the entire operation from brief to post-mission, and they improve mission effectiveness, minimize crew-preventable errors, maximize crew coordination, and optimize risk management. However, these procedures aren’t only for the sky.

As a paramedic, why should you adopt CRM? Because these procedures will increase your crew’s effectiveness by minimizing crew-preventable errors. In short—it will save lives.

 What is CRM?

CRM is a global standard of training concepts that minimize human error to maximize safety and effectiveness. CRM breaks down into these specific behavioral skills:

  • Situational Awareness (SA): The ability to identify the source and nature of problems, extract and interpret essential information, and maintain an accurate perception of the internal/external environment.
  • Assertiveness (AS): The ability, willingness, and readiness to take action; including making decisions and having the courage to act.
  • Decision Making (DM): The ability to use logic and sound judgment to make decisions on available information.
  • Communication (CM): The ability to clearly and accurately send timely information, instructions, commands, and/or meaningful feedback. Active, easily interpreted communication is critical for an effective crew.
  • Leadership (LD): The ability to direct and coordinate the activities of all crewmembers to ensure that the crew works together as a team.
  • Adaptability/Flexibility (AF): The ability to alter one’s course of action contingent on another’s actions and/or as the situation demands.
  • Mission Analysis (MA): The ability to coordinate, allocate, and monitor crew and resources.

In the industry’s current EMS continuing education scheme, we see CRM highlighted briefly in EMS Operations, but this is not enough. The overarching goal should be to make CRM a mandated mindset, instilling a culture of teamwork and safety.

Instilling the CRM Mindset

Many internal and external factors affect good CRM—stress, workload, distractions, fatigue. The crew must remain vigilant in recognizing these factors. However, the biggest factor is attitude.

A CRM attitude starts with initial training and integration, and then improves and increases with annual training, a supportive environment, and improved CRM processes. At its core, CRM is a mindset, a thought-out process to keep our crews safe and efficient.

It’s hard to introduce a new mindset (like not back boarding every trauma patient) when a community has never used it before. That’s why this is done over a period of time in the prehospital world.

Every Team Member Counts

By adopting CRM, everyone on the crew is equal to the completion of the team’s mission. In fact, a well-oiled CRM machine is not impacted by rank, which is present only to maintain structure, order, and positional authority. 

It is easy to say that you respect the probationary paramedic’s opinion, but do you foster a team environment where that individual is accepted? This is CRM: understanding that when working as a crew, rank is just a structure for leadership to help drive the aspect of equality and the basic CRM skills up and down the chain. All skills in CRM require a 100% buy-in and understanding from every individual regardless of rank in order to increase patient and provider safety.

Each crewmember must take responsibility and work toward the following skills:

  • Evaluate the safety of the environment (situational awareness).
  • Take action or do what is right even when it means identifying your own weaknesses (assertiveness).
  • Make the best decision with the information you have (decision making).
  • Communicate clearly and freely with your team/crew (communication).
  • Understand leadership yet understand it can change based off any one of these skills (leadership).
  • Be ready to change and adapt at a moment’s notice (adaptability/flexibility).
  • Analyze best practices and continue to build off what works best for your system (mission analysis).

Embrace the Change

As a naval air-crewman, my advice is to embrace the change: CRM is a critical asset in safety and mission effectiveness. At the end of the day, we are all here to provide the best care for our patients and bring us all home safely. CRM is a powerful tool to help you and your team accomplish that goal.

 

Wayne Papalski – Wayne has over 13 years as a Navy hospital corpsman, SAR medic, and flight paramedic with multiple combat tours to the Middle East. A licensed critical care flight and tactical paramedic, he is still currently an active duty chief petty officer, serving as the lead flight paramedic for Whidbey Island Search and Rescue in Oak Harbor, Washington. When not flying, he spends his free time with his girlfriend, three daughters, and two dogs.

John Siedler: HM2 John Siedler from Jackson, New Jersey enlisted in the U.S. Navy as a Hospital Corpsman in September 2012, after attending college to play baseball for three years.  Prior to attending college, Mr. Siedler began his career in service to his community as an 18-year-old, becoming a firefighter and EMT at Jackson Fire Company #1, his home district, serving as a highly skilled member of the Department and attending courses in Advanced SCBA Air Management, Forcible Entry, Advanced Search and Rescue Tactics, and Rapid Intervention Team training.  After boot camp and Hospital Corpsman “A” school in San Antonio, he was selected to enter the Search and Rescue Corpsman training pipeline. In a young career, Petty Officer Siedler has already accrued over 1000 flight-hours. His personal decorations and nominations include the Navy and Marine Corps Medal for Heroism, three Navy and Marine Corps Commendation Medals, the Navy and Marine Corps Achievement Medal, Good Conduct Medal, Humanitarian Service Medal and Global War on Terrorism Campaign Ribbon.

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