Introduction

1. Introduction Chapter 1

2. Objectives Define crew resource management. Describe how to achieve collective situational awareness. Describe the humanware component.

3. Introduction (1 of 2) • Questions asked after a major incident where a bad outcome causes an investigation: • Why don’t team members speak up when they perceive something differently from how a group of their peers do? • What are the effects of a hierarchical system on team performance?

4. Introduction (2 of 2) • Questions (continued): • How can barriers be broken down to achieve collective situational awareness during critical events? • How do veterans operate and perceive their surroundings differently from the way novices do? • What are the internal cultural barriers that impede optimal team performance?

5. By the Numbers(1 of 9) • One strategy integrated into emergency service team performance has been CRM. • First developed and implemented by commercial airlines • Many agencies and organizations have attempted to implement programs that rely on CRM principles.

6. By the Numbers(2 of 9) • Of the 11 agencies that received CRM training, only 3 were effectively using CRM after two years. • Lack of commitment by leadership • Lack of follow-up training • Failure to implement nonpunitive methods for dealing with accidents, errors, and members who spoke openly about concerns

7. By the Numbers(3 of 9) • U.S. fire service experiences 100 line-of-duty deaths and 100,000 lost-time injuries per year. • Line-of-duty death: fatality to an emergency worker during the course of responding to, training for, or providing service to the public • Evolution of firefighting tactics means fire fighters are less likely to be killed and injured by flames, smoke, or heat.

8. By the Numbers(4 of 9) NIOSH fire fighter line-of-duty death reports list these contributing factors: Communication failure Poor decision making Lack of situational awareness Poor task allocation Leadership failures

9. By the Numbers(5 of 9) • EMS errors made in patient care could be contained by implementing CRM techniques in high-risk, low-frequency procedures conducted in the field. • The number of medications on EMS vehicles is getting more attention. • U.S. FDA received 20,000 reports of medication errors (prehospital and in-hospital) from 1992–2002.

10. By the Numbers(6 of 9) • Extremes of fire behavior in wildland/urban interface make CRM more valuable. • Buildup of natural fuels, scant controlled mitigation of fire risks, and characteristics of communities lead to situations requiring critical interagency cooperation and communication. • CRM can be effective in overcoming the changing environment.

11. By the Numbers(7 of 9) • The aeromedical industry is still one of the most dangerous professions. • The rate of helicopter crashes is alarming. • Cost-benefit ratio and medical necessity of evacuation by helicopter is still debated. • Safe practices should be universal. • Pilots say the largest barrier to safety is lack of commitment by administrators to provide ongoing training and education.

12. By the Numbers(8 of 9) When the U.S. Coast Guard applied CRM to its air operations, crashes and accidents were reduced by 70 percent. Safety is a human issue affected by: Cultural change Error trapping Ensured high reliability

13. By the Numbers(9 of 9) Source: Adapted from NFPA, Fire Analysis and Research Division, Fire Fighter Fatalities in the U.S., July 2009.

14. Humanware(1 of 7) • Define the issue and deploy “humanware,” software, and hardware to solve the problem. • “Software” implementation: rewriting training manuals or operating guidelines • “Hardware” solutions: building construction modifications • Humanware: people who are part of a team directed to solve a problem

15. Humanware(2 of 7)

16. Humanware(3 of 7) • ICS is used in managing emergency incidents to help identify incident needs and priorities. • ICS lets leaders and managers deploy resources in a structured, objective manner by: • Identifying roles and responsibilities • Outlining clear lines of communication • Limiting span of control • Providing methods for expanding the incident

17. Humanware(4 of 7) Some incidents used an outstanding ICS structure, but injury or death occurred because of poor: Resource allocation Communication Incident management

18. Humanware(5 of 7) • CRM provides behavioral expectations for the humanware involved in the incident. • Highlights areas where team communication breaks down by: • Seeking input • Acknowledging communication • Respectfully providing differing opinions • Resolving conflict • Monitoring a decision

19. Humanware(6 of 7) Implementing CRM provides a safer environment in the field and results in team members having a greater understanding of mission goals and objectives. CRM helps get maximum and safe performance from all personnel.

20. Humanware(7 of 7) • Synergistic situational awareness is possible if all team members understand: • The mission • The dangers • Their strengths and weaknesses • Their role in team communications

21. Preparing for CRM(1 of 3) • CRM concepts are embraced when they are introduced. • CRM requires: • Open and honest communication • Immediate analysis of alternate probabilities • Reliance on each team member’s strengths

22. Preparing for CRM(2 of 3) • Once CRM is adopted, implementation is more difficult. • Preparation includes training personnel in techniques of open communication: • A comprehensive approach to identifying and tracking errors and mistakes • Conflict management training and education • Teaching the power of organizational stories

23. Preparing for CRM(3 of 3)

24. Summary (1 of 2) CRM requires open and honest communication, immediate analysis of alternate probabilities, and a reliance on the strengths that each team member intrinsically brings to the team.

25. Summary(2 of 2) Implementing the principles of CRM can provide a much safer environment in the field and will result in a greater understanding of the mission goals and objectives. An organization that has prepared its employees for CRM also has developed a strong foundation so that the CRM principles will thrive.