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Principles in Crisis Resource Management (in Disasters). Reynaldo O. Joson, MD, MHA, MHPEd, MSc Surg April 16, 2012 MDH MBFI Hall Pre-convention Workshop on Crisis Resource Management in Disasters Philippine College of Emergency Medicine, Inc. MDH Emergency Medicine.

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principles in crisis resource management in disasters

Principles in Crisis Resource Management(in Disasters)

Reynaldo O. Joson, MD, MHA, MHPEd, MSc Surg

April 16, 2012

MDH MBFI Hall

Pre-convention Workshop on

Crisis Resource Management in Disasters

Philippine College of Emergency Medicine, Inc.

MDH Emergency Medicine

workshop on crisis resource management in disasters

Workshop on Crisis Resource Managementin Disasters

Objectives

At the end of the workshop, participants should be able to:

Define Crisis Resource Management and know its importance and uses.

Understand the basic principles of Crisis Resource Management.

Apply the principles of CRM in a simulation activity.

Identify one’s and the team’s areas of improvement and strengthening.

slide3

Principles in Crisis Resource Management(in Disasters)Reynaldo O. Joson, MD, MHA, MHPEd, MSc SurgFacilitator

Help you understand

what crisis resource management is, its importance, its uses, its basic principles

Give you tips on

how to apply the basic principles in a simulation activity (a simulated mass casualty incident in Manila Doctors Hospital)

slide4

Principles in Crisis Resource Management(in Disasters)Reynaldo O. Joson, MD, MHA, MHPEd, MSc SurgFacilitator

Contents Outline

Crisis Resource Management

Concept

Importance

Uses

Basic principles

Application in a simulated activity (a simulated mass casualty incident in Manila Doctors Hospital)

crisis resource management concept

Crisis Resource Management - Concept

As currently being used,

crisis resource management (CRM)

broadly defined as

a management system

which makes optimum use of all available resources – people, procedures, equipment –

to promote safety and enhance efficiency of operations

during a crisis situation.

crisis resource management concept1

Crisis Resource Management - Concept

A simulated training of a group or groups of people

in handling commonly encountered and anticipated high-risk activities, emergencies and disasters

with the end goals of effective and efficient accomplishment of the needed operations and responses

with emphasis on optimal teamwork (communication, coordination, collaboration), prevention of errors and safety promotion.

(ROJoson’s synthesized concept statement)

crisis resource management concept2

Crisis Resource Management - Concept

History

CRM - first developed by aviation industry late 1970s

Original term used - Crew Resource Management

Another term used - Cockpit Resource Management

crisis resource management concept3

Crisis Resource Management - Concept

Crew Resource Management / Cockpit Resource Management

- about after analysis of plane crashes in US showed human error involved in 85% of events

- essentially a training program that resulted in reduction of human errors and therefore, less airplane crashes

crisis resource management concept4

Crisis Resource Management - Concept

In the 90s,

David Gaba, American anesthetist, training as a pilot,

recognizing similarities in high stake environments of the operating theatre and cockpit,

developed Anesthesia Crisis Resource Management (Anesthesia CRM)

crisis resource management concept5

Crisis Resource Management - Concept

In 1999,

publication - “To Err is Human, Building a Safer Healthcare System” - Institute of Medicine in US

brought CRM into focus as healthcare community began to realize extent of medical error.

publication suggested that it was the faulty systems, processes and conditions that led people to make mistakes or fail to prevent them.

crisis resource management concept7

Crisis Resource Management - Concept

Crisis Resource Management (not Crew Resource Management)

currently a buzzword in

avoiding human factor errors and promoting safety

during emergencies and other high stake environments or critical activities

crisis resource management concept8

Crisis Resource Management - Concept

CRM encompasses concepts of crew or cockpit resource management of aviation industry.

Usage not limited to emergencies and disasters

Can be and is used in non-medical and medical industries in training people to avoid error and improving safety

crisis resource management concept9

Crisis Resource Management - Concept

Essentially a training to promote safety by addressing behavioural and cognitive skills

needed to effectively manage all available resources, especially during a crisis situation.

Accomplished through development of superior non-technical skills

such as

leadership, situational awareness, communication, and teamwork.

crisis resource management concept10

Crisis Resource Management - Concept

Although technical and non-technical skills are important,

CRM puts more emphasis on the non-technical skills

with assumption that people on the job have the technical skills to start with.

crisis resource management concept11

Crisis Resource Management - Concept

In medicine,

CRM - not limited to anesthesia

Anesthesia CRM

Emergency Medicine CRM

Pediatric CRM

Critical Medicine CRM

Others

crisis resource management concept12

To repeat for summary and retention!

Crisis Resource Management - Concept

As currently being used,

crisis resource management (CRM)

broadly defined as

a management system

which makes optimum use of all available resources – people, procedures, equipment –

to promote safety and enhance efficiency of operations

during a crisis situation.

crisis resource management concept13

To repeat for summary and retention!

Crisis Resource Management - Concept

A simulated training of a group or groups of people

in handling commonly encountered and anticipated high-risk activities, emergencies and disasters

with the end goals of effective and efficient accomplishment of the needed operations and responses

with emphasis on optimal teamwork (communication, coordination, collaboration), prevention of errors and safety promotion.

(ROJoson’s synthesized concept statement)

crisis resource management importance

Crisis Resource Management - Importance

To promote effective and efficient accomplishment of the needed operations and responses

by a group of people

in commonly encountered and anticipated high-risk activities, emergencies and disasters

with emphasis on optimal teamwork (communication, coordination, collaboration), prevention of errors and safety promotion.

crisis resource management uses

Crisis Resource Management - Uses

In commonly encountered and anticipated high-risk activities, emergencies and disasters in medical and non-medical industries

In medical industries –

In hospital and ambulatory centers

In departments with high-risk activities, such as emergency medicine, critical care medicine, operating theatres, etc.

crisis resource management concept14

Crisis Resource Management - Concept

As currently being used,

crisis resource management (CRM)

broadly defined as

a management system

which makes optimum use of all available resources – people, procedures, equipment –

to promote safety and enhance efficiency of operations

during a crisis situation.

crisis resource management basic principles1

Crisis Resource Management – Basic Principles

CRM is a management system.

Management system includes

crisis preparedness and response plans

and

exercises

to enhance optimal responses during an actual crisis.

crisis resource management basic principles2

Crisis Resource Management – Basic Principles

Exercises

- small-scale (such as drills and table-top exercises) or full-scale simulation of crisis situation.

- computer-aided and /or aided by simulated patients, props and manikins.

crisis resource management basic principles3

Crisis Resource Management – Basic Principles

Simulated exercises form the backbone of CRM.

- must bring out behaviors or non-technical skills necessary for an optimal teamwork (communication, coordination, collaboration), prevention of errors and safety promotion.

crisis resource management basic principles4

Crisis Resource Management – Basic Principles

CRM follows a particular educational doctrine

that has been derived from the aviation industry [Crew Resource Management (CRM)]

and

introduced to health sector via the doctrine of David Gaba in Anaesthesia Crisis Resource Management (ACRM).

crisis resource management basic principles5

Crisis Resource Management – Basic Principles

Seven key behaviours as originated from Crew Resource Management:

Know your environment

Prepare and plan

Call for help early

Take a leadership role

Allocate attention wisely and use all available resources

Prioritize and distribute the workload

Communicate effectively

crisis resource management basic principles6

Crisis Resource Management – Basic Principles

Gaba added more key behaviours in anesthesia CRM (see Nos. 8 to 15).

8. Use all available information

9. Prevent and manage fixation errors

10. Cross (double) check

11. Use cognitive aids

12. Re-evaluate repeatedly

13. Use good teamwork

14. Allocate attention wisely

15. Set priorities dynamically

crisis resource management basic principles7

Crisis Resource Management – Basic Principles

In Emergency Medicine CRM, one institution added the following three key behaviours to the seven key behaviours derived from aviation industry:

Triage / prioritization

Efficient management of multiple patients

Effective coping with disruptions / distractions

crisis resource management basic principles8

Crisis Resource Management – Basic Principles

There are various packages of

non-technical skills, behavioural skills, cognitive skills,

so called key principles,

and they vary from one situation to another.

These just have to be spelled out by the facilitators for the individual situations.

crisis resource management basic principles9

Crisis Resource Management – Basic Principles

Although there are variations,

in a Delphi study performed in 2009 to help determine key training areas for health-care teamwork competency,

the following were generated:

communication

task management

situational awareness

decision-making

leadership

crisis resource management basic principles10

Crisis Resource Management – Basic Principles

In simple and most basic terms,

non-technical skills in health-care industry CRM can consist of:

Non-technical skills

Behavioural skills

Leadership

Communication

Team working (communication, coordination, and collaboration)

Cognitive skills

Situational awareness

Planning

Decision making

Task management

crisis resource management basic principles11

Crisis Resource Management – Basic Principles

It must be emphasized that no one key behaviour sits in isolation from each other but rather they are all interrelated and there are overlaps.

A good team working involves excellent communication skills, task management, planning, and leadership.

Likewise good situational awareness relies on communication, team working, and decision making.

crisis resource management basic principles12

Crisis Resource Management – Basic Principles

To simplify things, I suggest using the following package or framework:

Leadership

Situational awareness

Planning

Decision making

Communication

Coordination

Collaboration

Task management

slide35

Crisis Resource Management – Application in a simulated activity (a simulated mass casualty incident in Manila Doctors Hospital)

slide36

Crisis Resource Management – Application in a simulated activity (a simulated mass casualty incident in Manila Doctors Hospital)

slide37

Crisis Resource Management – Application in a simulated activity (a simulated mass casualty incident in Manila Doctors Hospital)

slide38

Crisis Resource Management – Application in a simulated activity (a simulated mass casualty incident in Manila Doctors Hospital)

slide39

Crisis Resource Management – Application in a simulated activity (a simulated mass casualty incident in Manila Doctors Hospital)

slide40

Crisis Resource Management – Application in a simulated activity (a simulated mass casualty incident in Manila Doctors Hospital)

Let us say that

MDH has decided to conduct a crisis resource management simulated training

to enhance optimal response during a mass casualty incident in Manila Doctors Hospital.

slide41

Crisis Resource Management – Application in a simulated activity (a simulated mass casualty incident in Manila Doctors Hospital)

The prerequisites for the conduct of CRM are

the presence of the MDH MCI preparedness and response plans and

that all key players have read and understood their roles and responsibilities

whenever there will be an MCI and an activation of Code White (MDH response code for surge of patients disaster) by the MDH Chief Safety Officer.

slide42

Crisis Resource Management – Application in a simulated activity (a simulated mass casualty incident in Manila Doctors Hospital)

To plan for the conduct of the simulation CRM,

facilitators should formulate an

instructional design or lesson plan.

slide43

Crisis Resource Management – Application in a simulated activity (a simulated mass casualty incident in Manila Doctors Hospital)

Facilitators should decide

whether full-scale or small-scale simulation exercise (small-scale means portions of the whole response plan and using drills and table-top exercises).

slide44

Crisis Resource Management – Application in a simulated activity (a simulated mass casualty incident in Manila Doctors Hospital)

Facilitators also decide

who are the key players to focus on for the training

and

what are the non-technical skills to bring out among the players.

slide45

Crisis Resource Management – Application in a simulated activity (a simulated mass casualty incident in Manila Doctors Hospital)

General Steps in Response to MCI based on MDH Response Plan:

slide46

Crisis Resource Management – Application in a simulated activity (a simulated mass casualty incident in Manila Doctors Hospital)

General Steps in Response to MCI based on MDH Response Plan:

slide47

Crisis Resource Management – Application in a simulated activity (a simulated mass casualty incident in Manila Doctors Hospital)

General Steps in the Control of Disasterin Response to MCI based on MDH Response Plan:

slide48

Crisis Resource Management – Application in a simulated activity (a simulated mass casualty incident in Manila Doctors Hospital)

General Steps in the Control of Disasterin Response to MCI based on MDH Response Plan:

slide49

Crisis Resource Management – Application in a simulated activity (a simulated mass casualty incident in Manila Doctors Hospital)

After mapping out essential steps in response and control plans in MCI, key players who will undergo training, and key behaviour and cognitive skills to teach, enhance and practice,

facilitators then determine what are considered

“good,” “effective and efficient”

leadership, situational awareness, planning, decision-making, communication, coordination, collaboration, and task management in general terms and in each specific step in the response and control plans.

slide50

Crisis Resource Management – Application in a simulated activity (a simulated mass casualty incident in Manila Doctors Hospital)

After the criteria of quality have been determined,

facilitators then formulate specific teaching-learning strategies and activities

(such as drills, table-top exercises, or full-scale exercises)

that will give participants to develop and enhance the key behavioural and cognitive skills.

slide51

Crisis Resource Management – Application in a simulated activity (a simulated mass casualty incident in Manila Doctors Hospital)

Checklists

that can be used to teach and evaluate different behavioral and cognitive skills

- very helpful

slide52

Crisis Resource Management – Application in a simulated activity (a simulated mass casualty incident in Manila Doctors Hospital)

Checklist – Leadership (Example)

slide53

Crisis Resource Management – Application in a simulated activity (a simulated mass casualty incident in Manila Doctors Hospital)

Checklist – Leadership (Example)

slide54

Crisis Resource Management – Application in a simulated activity (a simulated mass casualty incident in Manila Doctors Hospital)

Checklist – Leadership (Example)

slide55

Crisis Resource Management – Application in a simulated activity (a simulated mass casualty incident in Manila Doctors Hospital)

Checklist – Task Management (Example)

slide56

Crisis Resource Management – Application in a simulated activity (a simulated mass casualty incident in Manila Doctors Hospital)

Checklist – Task Management (Example)

slide57

Principles in Crisis Resource Management(in Disasters)Reynaldo O. Joson, MD, MHA, MHPEd, MSc SurgFacilitator

Contents Outline

Crisis Resource Management

Concept

Importance

Uses

Basic principles

Application in a simulated activity (a simulated mass casualty incident in Manila Doctors Hospital)

crisis resource management concept15

Crisis Resource Management - Concept

A simulated training of a group or groups of people

in handling commonly encountered and anticipated high-risk activities, emergencies and disasters

with the end goals of effective and efficient accomplishment of the needed operations and responses

with emphasis on optimal teamwork (communication, coordination, collaboration), prevention of errors and safety promotion.

(ROJoson’s synthesized concept statement)

slide59

Principles in Crisis Resource Management(in Disasters)Reynaldo O. Joson, MD, MHA, MHPEd, MSc SurgFacilitator

Help you understand

what crisis resource management is, its importance, its uses, its basic principles

Give you tips on

how to apply the basic principles in a simulation activity (a simulated mass casualty incident in Manila Doctors Hospital)

principles in crisis resource management in disasters1

Principles in Crisis Resource Management(in Disasters)

Thank you for your attention!

For queries:

[email protected] / Facebook

0918- 804-03-04

Website: http://hospitalsafetypromotionanddisasterpreparedness.wordpress.com/2012/04/09/principles-in-crisis-resource-management-in-disasters/

Reynaldo O. Joson, MD, MHA, MHPEd, MSc Surg

April 16, 2012

MDH MBFI Hall

Pre-convention Workshop on

Crisis Resource Management in Disasters

Philippine College of Emergency Medicine, Inc.

MDH Emergency Medicine

principles in crisis resource management in disasters2

Principles in Crisis Resource Management(in Disasters)

Reynaldo O. Joson, MD, MHA, MHPEd, MSc Surg

April 16, 2012

MDH MBFI Hall

Pre-convention Workshop on

Crisis Resource Management in Disasters

Philippine College of Emergency Medicine, Inc.

MDH Emergency Medicine

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