Crew Resource Management Culture for EMS By Gary E. Seidel Fire Chief, Retired Crew resource management (CRM) was created to help emergency medical responders overcome communications issues, poor decision making, inadequate or undefined leadership and poor resource management. The goal for CRM is to empower a team to effectively use all available resources and skill levels to achieve safe and effective patient care, focusing on the following initiatives: Culture: In an effort to instill CRM concepts within the organization, the first step is mission planning. Planning this process appropriately and thoroughly will ensure the entire organization is on the same page with regards to the plan and the emergency procedures. Maximize Situational Awareness: Emergency responders have been taught to recognize their environment and evaluate high-risk situations. This is accomplished by recognizing the changing conditions and determining whether to accept the risk or not. This also includes recognizing your own limitations, equipment limitations and possibly resource limitations. Maximizing situational awareness means you are trained, constantly aware, have evaluated the risks and calculated whether it is a go or no-go situation. In enhanced communications, all voices are equal; Enhance Communications: Employees need to be able to state their concerns as they see them, along with their solution to the issue and allow buy-in from all parties. Developing the abilities of your employees enhances their personal knowledge, which ultimately provides awareness to the entire team, ensuring optimal operations within an emergency. In enhanced communications, all voices are equal; no one has more power than the other. Therefore, if one person voices concern on a mission, the decision could shift from a go or no-go situation. Improve Teamwork: One of the most effective means in developing teamwork is to focus a training program on organizational principles and protocols, as well as standardizing operating procedures. Employees should be taught to interact in ways that foster the team environment, practicing teamwork in simulations so the training becomes instilled into their patient care response. This must be included in all area of EMS training, including basic BLS, ALS, PALS and other courses. In addition, no matter what position an employee occupies within the organization, they should become a leader in their position. Strengthen Decision Making: This concept begins with good situational awareness and the ability to maintain continued evaluation of the situation. Team members should stay focused on what needs to be corrected, what the consequences and possible actions are, what resources are needed and how the resources are best utilized. Then responders can make informed decisions and communicate them to all parties on the emergency scene and evaluate the final decision. Minimize Errors: Utilizing the CRM concepts—maximizing situational awareness, enhancing communications, improving teamwork and strengthening teamwork—will minimize errors. It is impossible to eliminate errors, but when working as a team, using your skills and resources safely and effectively will contribute to minimizing risk. Case Analysis: One example of CRM in EMS is the use of helicopters for medical transports. This is a very effective and critical resource for medical emergencies around the world. The use of this resource requires and incorporates a team which must work in unison to both safely operate the helicopter, as well as provide state-of-the-art medical service to the patient(s). CRM is a system which optimizes personnel, equipment, resources and promotes safety, efficiency and overall effectiveness in patient care. Interested in learning more about EMS? Visit ColumbiaSouthern.edu to learn more about their degree programs in emergency medical services. Bio: Gary Seidel, EFOP, CFO, MPA; is a retired Fire Chief from Hillsboro Fire Department in Oregon and a retired Assistant Chief from Los Angeles Fire Department in California.