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Principles in Crisis Resource Management(in Disasters)
Reynaldo O. Joson, MD, MHA, MHPEd, MSc SurgApril 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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Workshop on Crisis Resource Managementin 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.
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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)
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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)
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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.
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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)
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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
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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
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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)
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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.
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Crisis Resource Management - Concept
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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
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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
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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.
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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.
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Crisis Resource Management - Concept
In medicine,
CRM - not limited to anesthesia• Anesthesia CRM • Emergency Medicine CRM• Pediatric CRM • Critical Medicine CRM • Others
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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.
To repeat for summary
and retention!
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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)
To repeat for summary
and retention!
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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.
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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.
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Crisis Resource Management – Basic Principles
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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.
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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.
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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.
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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.
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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).
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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
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Crisis Resource Management – Basic Principles
Gaba added more key behaviours in anesthesia CRM (see Nos. 8 to 15).
8. Use all available information9. Prevent and manage fixation errors10. Cross (double) check11. Use cognitive aids12. Re-evaluate repeatedly13. Use good teamwork14. Allocate attention wisely15. Set priorities dynamically
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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
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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.
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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
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Crisis Resource Management – Basic PrinciplesIn simple and most basic terms, non-technical skills in health-care industry CRM can consist of:
Non-technical skills
Behavioural skillsLeadershipCommunicationTeam working (communication, coordination, and
collaboration)
Cognitive skillsSituational awarenessPlanningDecision makingTask management
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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.
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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
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Crisis Resource Management – Application in a simulated
activity (a simulated mass casualty incident in Manila Doctors Hospital)
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Crisis Resource Management – Application in a simulated
activity (a simulated mass casualty incident in Manila Doctors Hospital)
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Crisis Resource Management – Application in a simulated
activity (a simulated mass casualty incident in Manila Doctors Hospital)
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Crisis Resource Management – Application in a simulated
activity (a simulated mass casualty incident in Manila Doctors Hospital)
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Crisis Resource Management – Application in a simulated
activity (a simulated mass casualty incident in Manila Doctors Hospital)
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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.
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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.
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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.
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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).
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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.
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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
Key Players Key Non-technical Skills to Practice and Enhance
Creation of an incident command
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.)
LeadershipSituational awarenessPlanningDecision makingCommunicationCoordinationCollaborationTask management
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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
Key Players Key Non-technical Skills to Practice and Enhance
Control of disaster 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.)
LeadershipSituational awarenessPlanningDecision makingCommunicationCoordinationCollaborationTask management
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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
Key Players Key Non-technical Skills to Practice and Enhance
Triage Staff trained and assigned to do triaging at the ER and at the holding areas (Green, Yellow, and Red Areas)
LeadershipSituational awarenessPlanningDecision makingCommunicationCoordinationCollaborationTask management
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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
Key Players Key Non-technical Skills to Practice and Enhance
Treatment Staff assigned to do the medical care of the injured patients (physicians, nurses, institutional workers, recorders, etc.)
LeadershipSituational awarenessPlanningDecision makingCommunicationCoordinationCollaborationTask management
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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.
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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.
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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
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Crisis Resource Management – Application in a simulated activity (a simulated mass casualty incident in Manila Doctors Hospital)
Checklist – Leadership (Example)
Parameters and indicators - Leadership
Yes / No / (±) Remarks
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 decision-making. The team leader demonstrated skills in planning for the response (inclusive of contingency plans).
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Crisis Resource Management – Application in a simulated activity (a simulated mass casualty incident in Manila Doctors Hospital)
Checklist – Leadership (Example)
Parameters and indicators - Leadership
Yes / No / (±) Remarks
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.
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Crisis Resource Management – Application in a simulated activity (a simulated mass casualty incident in Manila Doctors Hospital)
Checklist – Leadership (Example)
Parameters and indicators - Leadership
Yes / No / (±) Remarks
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.)
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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
Yes / No / (±) Remarks
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.
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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
Yes / No / (±) Remarks
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.)
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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)
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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)
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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)
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Principles in Crisis Resource Management(in Disasters)
Reynaldo O. Joson, MD, MHA, MHPEd, MSc SurgApril 16, 2012
MDH MBFI Hall
Pre-convention Workshop on
Crisis Resource Management in Disasters
Philippine College of Emergency Medicine, Inc.
MDH Emergency Medicine
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
/
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Principles in Crisis Resource Management(in Disasters)
Reynaldo O. Joson, MD, MHA, MHPEd, MSc SurgApril 16, 2012
MDH MBFI Hall
Pre-convention Workshop on
Crisis Resource Management in Disasters
Philippine College of Emergency Medicine, Inc.
MDH Emergency Medicine