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
Objectives
At the end of the workshop, participants should be able to:
1.Define Crisis Resource Management and know its
importance and uses.
2.Understand the basic principles of Crisis Resource
Management.
3.Apply the principles of CRM in a simulation activity.
4.Identify one’s and the team’s areas of improvement and
strengthening.
Principles in Crisis Resource Management
(in Disasters)
Reynaldo O. Joson, MD, MHA, MHPEd, MSc Surg
Facilitator
•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 Disasters)
Reynaldo O. Joson, MD, MHA, MHPEd, MSc Surg
Facilitator
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
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 - 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 - 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 - 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 - 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 - 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 - Concept
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 - 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 - 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 - 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 - Concept
In medicine,
CRM - not limited to anesthesia
•
•
•
•
•
Anesthesia CRM
Emergency Medicine CRM
Pediatric CRM
Critical Medicine CRM
Others
Crisis Resource Management - Concept
As currently being used,
crisis resource management (CRM)
broadly defined as
To repeat for
summary
and
retention!
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 -
To repeat for
Concept
summary
and
retention!
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
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
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 – Basic Principles
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 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 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 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 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 Principles
Seven key behaviours as originated from Crew
Resource Management:
1.Know your environment
2.Prepare and plan
3.Call for help early
4.Take a leadership role
5.Allocate attention wisely and use all available
resources
6.Prioritize and distribute the workload
7.Communicate effectively
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 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 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 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 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 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 Principles
To simplify things, I suggest using the following package
or framework:
•
•
•
•
•
•
•
•
Leadership
Situational awareness
Planning
Decision making
Communication
Coordination
Collaboration
Task management
Crisis Resource Management – Application in a simulated
activity (a simulated mass casualty incident in Manila
Doctors Hospital)
Crisis Resource Management – Application in a simulated
activity (a simulated mass casualty incident in Manila
Doctors Hospital)
Crisis Resource Management – Application in a simulated
activity (a simulated mass casualty incident in Manila
Doctors Hospital)
Crisis Resource Management – Application in a simulated
activity (a simulated mass casualty incident in Manila
Doctors Hospital)
Crisis Resource Management – Application in a simulated
activity (a simulated mass casualty incident in Manila
Doctors Hospital)
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.
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.
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.
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).
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.
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:
Steps in the Response to
MCI (Surge of Patients) –
MDH Response Plan
Creation of an incident
command
Key Players
Persons authorized to
create the incident
command (ERO, Hospital
Chief Safety Officer,
Hospital Director) and
members of the incident
command (Medical
Director, Nursing Director,
Communication Officer,
Security Officer, etc.)
Key Non-technical Skills
to Practice and Enhance
Leadership
Situational awareness
Planning
Decision making
Communication
Coordination
Collaboration
Task management
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:
Steps in the Response to
MCI (Surge of Patients) –
MDH Response Plan
Control of disaster
Key Players
Heads and members of
disaster response and
control teams (triage
teams, medical teams,
evacuation teams,
transport teams,
operating room teams,
communication teams,
traffic control teams,
security teams, etc.)
Key Non-technical Skills
to Practice and Enhance
Leadership
Situational awareness
Planning
Decision making
Communication
Coordination
Collaboration
Task management
Crisis Resource Management – Application in a simulated
activity (a simulated mass casualty incident in Manila
Doctors Hospital)
General Steps in the Control of Disaster in Response to MCI
based on MDH Response Plan:
Steps in the Response to
MCI (Surge of Patients) –
MDH Response Plan
Triage
Key Players
Staff trained and
assigned to do triaging
at the ER and at the
holding areas (Green,
Yellow, and Red Areas)
Key Non-technical Skills
to Practice and Enhance
Leadership
Situational awareness
Planning
Decision making
Communication
Coordination
Collaboration
Task management
Crisis Resource Management – Application in a simulated
activity (a simulated mass casualty incident in Manila
Doctors Hospital)
General Steps in the Control of Disaster in Response to MCI
based on MDH Response Plan:
Steps in the Response to
MCI (Surge of Patients) –
MDH Response Plan
Treatment
Key Players
Staff assigned to do the
medical care of the
injured patients
(physicians, nurses,
institutional workers,
recorders, etc.)
Key Non-technical Skills
to Practice and Enhance
Leadership
Situational awareness
Planning
Decision making
Communication
Coordination
Collaboration
Task management
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.
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.
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
Crisis Resource Management – Application in a simulated activity
(a simulated mass casualty incident in Manila Doctors Hospital)
Checklist – Leadership (Example)
Parameters and indicators Leadership
There was a clearly identified and
recognized team leader.
The team leader knew the mission of
his team.
The team leader demonstrated skills
in situational awareness.
The team leader demonstrated skills
in problem-solving and decisionmaking.
The team leader demonstrated skills
in planning for the response
(inclusive of contingency plans).
Yes / No / (±)
Remarks
Crisis Resource Management – Application in a simulated activity
(a simulated mass casualty incident in Manila Doctors Hospital)
Checklist – Leadership (Example)
Parameters and indicators Leadership
The team leader was calling the shots
(was in command).
The team leader demonstrated skills in
effective communication with his team
members.
The team leader demonstrated skills in
coordinating his team members.
The team leader demonstrated skills in
making his team members collaborate
with each other.
The team leader was able to accomplish
his mission effectively and efficiently
through optimal teamwork.
Yes / No / (±)
Remarks
Crisis Resource Management – Application in a simulated activity
(a simulated mass casualty incident in Manila Doctors Hospital)
Checklist – Leadership (Example)
Parameters and indicators Leadership
The team leader was able to
accomplish his mission effectively
and efficiently with minimal errors.
The team leader was able to
accomplish his mission safely.
Other parameters and indicators of
good leadership that were needed
and observed. (Add here.)
Yes / No / (±)
Remarks
Crisis Resource Management – Application in a simulated activity
(a simulated mass casualty incident in Manila Doctors Hospital)
Checklist – Task Management (Example)
Parameters and indicators – Task
Management
All the members of the response
team knew their primary tasks even
before the response.
Tasks were planned guided by the
situational awareness.
Tasks were communicated
effectively to all concerned
members of the response team.
Tasks were properly distributed to
all members of the response team.
Tasks were accomplished effectively
and efficiently through optimal
teamwork.
Yes / No / (±)
Remarks
Crisis Resource Management – Application in a simulated activity
(a simulated mass casualty incident in Manila Doctors Hospital)
Checklist – Task Management (Example)
Yes / No / (±)
Parameters and indicators – Task
Management
There was coordination among the
members in the accomplishment of
the task.
There was collaboration among the
members in the accomplishment of
the task.
Tasks were accomplished effectively
and efficiently with minimal errors.
Tasks were accomplished safely.
Other parameters and indicators of
good task management that were
needed and observed. (Add here.)
Remarks
Principles in Crisis Resource Management
(in Disasters)
Reynaldo O. Joson, MD, MHA, MHPEd, MSc Surg
Facilitator
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
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)
Principles in Crisis Resource Management
(in Disasters)
Reynaldo O. Joson, MD, MHA, MHPEd, MSc Surg
Facilitator
•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 Disasters)
Reynaldo O. Joson, MD, MHA, MHPEd, MSc Surg
April 16, 2012
MDH
Thank you
forMBFI
yourHall
attention!
For queries:
rjoson2001@yahoo.com
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Pre-convention Workshop
on
0918- 804-03-04
Crisis Resource Management in Disasters
Website:
Philippine
College of Emergency Medicine, Inc.
http://hospitalsafetypromotionanddisasterprepared
ness.wordpress.com/2012/04/09/principles-inMDH Emergency Medicine
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