Developing Crew Resource Management Training for your Department
By Brian Ward
Crew Resource Management is the effective management or use of all available resources to mitigate a situation while minimizing errors, improving safety and increasing performance, according to the IAFC's definition.
In order to achieve these goals, five factors have been identified as major components in accidents including the failure of teamwork, situational awareness, communication, decision making skills, and establishment of barriers. Each of these items is vital to the success of any fireground, EMS or specialty team incident. These factors must be examined, training created to emphasize them, practiced before the alarm and continuously reinforced after the initial training to be effective.
The first — and arguably most important — component is situational awareness. Everything on an emergency incident functions and revolves around SA, including what we base our fireground decisions on. SA is commonly referred to as what we see or the "Big Picture." While that is part of it, it encompasses a lot more. In Gary Klein and Caroline E. Zsambok's "Naturalistic Decision Making," SA is broken down into three levels:
1. Perception of the Elements in the Environment
CRM was originally introduced in the 1970s in the aviation industry after several incidents revealed that flight crews were lacking in at least one of the five areas highlighted in this article. One of the most tragic incidents was United Flight 173, which crashed near Portland, Ore., in 1978.
The plane had been circling for an hour while the crew tried in vain to sort out an apparent landing gear problem, before it ran out of fuel and crashed in a suburb, killing 10 people on board. During this incident, the co-pilot repeatedly warned about low fuel but the pilot either did not comprehend what was happening or ignored the lesser experienced and "inferior" co-pilot.
It has been stated that some pilots back then ruled with an iron fist and that what they said was the bottom line, which could have been part of the problem. In the ensuing investigation, it was found that the landing gear was perfectly normal and was locked in place at the time of the crash. A landing light bulb being burnt out was the source of the problem.
As CRM gained success in the aviation industry, it spread into the military, where the U.S. Navy requires annual training for all their pilots. The U.S. Naval Safety Center cited that after training two-thirds of its maintenance personnel (approximately 1,200 employees) in CRM principles, they saw maintenance ground damage costs drop by 66 percent and occupational injuries decrease by 27 percent.
In addition, the U.S. Coast Guard has implemented CRM training and reduced their on-the-job injuries by 74 percent. Several other industries have developed their own CRM training including the shipping, medical, and railroad industries.
Do we as firefighters sometimes get fixated on the little things and miss the big picture? As with many in the aviation industry in the 1970s, the answer sadly is that we do, highlighting the need for CRM in the fire service
Brian will be presenting on Crew Resource Management at the Gwinnett County Leadership and Safety Conference, Jan. 28-31, 2010. Click here for details.
2. Comprehension of the Situation
3. Projection of Future Status
For the fire service this translates into:
1. How we perceived the incident
2. Being able to understand the incident and how the incident factors are interrelated into accomplishing our goals of the incident
3. The use of foreseeability to predict the future factors of the incident
If SA is not the most important item on the incident, then communication is. Without the effective use of communication nothing seems to get accomplished. The IAFC describes communication as the cornerstone of CRM. There are six key areas to communication: sender, receiver, message, medium, filters and feedback.
It is best to use face-to-face when possible, but via radio is the only option most of the time. Regardless of which method is used, the six key areas must be understood and used in order for communication to work, which in turn will assist in getting the job done.
Within these six key areas there are some other items that need to be addressed for effective communication. The first is simply being clear and concise; say what you mean and be sure to give enough detail without overloading the individual's working memory space. Here is a prime example of how even great leaders can make this same mistake, from Gary Klein' "Sources of Power: How People Make Decisions."
During World War II, Winston Churchill gave the order to the British Navy not to engage with warships that were larger and that could destroy individual ships. What he meant was do not try and take on ships larger than theirs and lose. Consequently, one of his admirals had surrounded an enemy warship but let it go due to the fact that it was larger and he did not want any trouble with his superiors.
This was not the intent of Churchill’s letter to the admiral, but without being clear and concise this is what can happen. As history holds, the same enemy warship that was let go destroyed some of Britain’s ships and played a large role in hampering its efforts during the war.
As we discussed earlier, SA is vital to how we make decisions. One study I recently read examining military fighter pilots showed that their decisions were directly based on how they perceived the situation. So while they may make the right call for their perception of the incident, it doesn't mean their perception of the situation was correct.
Put simply, having a strong background in SA can help us make the needed decisions within our limited scope of time. In conjunction with SA, we need good communication relayed back to the individual making the decisions. This will enable them to establish their strategies and tactics for the incident by comparing what they are being told from their firefighters to what they see on the outside. Once this has occurred, the leader can make a sound decision that will have a positive outcome or effect on the incident.
Recent studies in the field of Naturalistic Decision Making — making decisions in a natural setting/real-life environment — have brought forward several considerations for training to be designed around including mental simulation, pattern matching, story building and the power of intuition.
Each of these areas plays a part in how we relate what is in front of us to our brain and how we form decisions based off of our knowledge and experience. Nothing can replace on-scene experience. But using scenario-based or tactical decision games is a great way for a firefighter to begin to build patterns and stories of how to operate at an incident. Mental simulation and intuition will only come once we show a complete understanding of how one factor relates to the next, even when it is not directly in front of us.
How often do we actually train on performing as a team? How often do we actually examine what makes us function effectively or fail as a team? As firefighters we train constantly to function as part of a team. But do we always carry that to the field? In addition, one major aspect of teamwork is understanding how to talk to an individual when offering a suggestion or concern. Having and showing mutual respect for all members on the team is essential to the team excelling and practicing leadership-followership techniques.
Barriers or 'Safety Nets'
Barriers or "safety nets" are put in place so that when we make a mistake, there is something there to catch us. No matter who we are, how much training or education we have completed, how much experience we have or how many awards we have won, we are at some point going to make a mistake. The key is to understand our weaknesses and to never repeat the same mistake. Barriers can come in the many different forms. Some of the obvious ones are SOPs/SOGs, effective training and core competency books. There are others that will increase your budget slightly, but are extremely beneficial such as updated equipment and increased technology.
There are many other items that can be incorporated into a barrier. Some may require a little more work than others but items such as Incident Safety Officers established on all scenes, RIC teams established with proper resources and staffing, acting and company officer training, and driver training programs are great examples of proven barriers.
One other area that can be of great benefit is the use of checklists and worksheets to help the officers on scene including the Incident Commander, Safety Officer, Rehab Group Supervisor and RIC Group Team Leader. These can help remind the officer of the tasks to be completed, benchmarks, safety concerns and crew locations.
However, it is important to remember that the checklist is only as effective as the expertise of the individual using it. We must still train and educate the same as before and still allow the officer the discretion to change the plan or the order of the checklist as they see fit.
Applications are the most important aspect of training and help us figure out all the intricate parts of an operation. When we can actually build a story in our head by performing a task or operation, we are better able to retain and recall it than by the traditional means of reading or watching an operation be performed. There are activities that can be preformed in the station or developed by training staff to incorporate CRM components into the training session. The two examples below are low cost and can be conducted mostly with items already in the station.
Allow your officers to perform a mock cardiac arrest in the station. The company should be notified in advance and take the apparatus out of service for about 30 minutes. The firefighters and paramedics will start in their apparatus as if they just pulled up at the incident and then the time starts. They jump off the apparatus, grab their equipment, and start working. There is some stress added with this being a timed event just as we are timed in the field. As the team performs the scenario, some things just flow while others have to be said. Items such as starting IVs, obtaining vitals, and getting all of the equipment ready are signs of a team that has preformed together before. This allows the lead paramedic to worry about the more important items. After the scenario, the officer critiques the crew on what they did well and where they could improve.
Another easy opportunity for training with CRM involves conducting scenario-based fire training. Throw out a problem, a single family dwelling with fire on Side A for instance, put a picture up on the screen or wall and let the firefighter handle the incident. Scenario- based training is some of the best training that firefighters can receive without actually being involved with the real life experience part of it. If the firefighter leading the training wishes to add a sense of stress to the scenario, start timing the incident to force decisions to be made and have the other crew members participate as responding apparatus. Constructive criticism should be provided in a formal manner as well.
Brian Ward is a Training Officer in the Career Development Division for the Gwinnett County Fire Department and the Vice-Chairman of the Metro Atlanta Training Officers. Brian currently serves as a State of Georgia Advocate for Everyone Goes Home and Courage to be Safe Trainer. He is the founder of FireServiceSLT.com and organizer of Gwinnett County Leadership and Safety Conference, with the second annual event taking place Jan. 28-31, 2010. As well as Brian's presentation on CRM, there will be a range of speakers at the event. Find out more details on the conference page.