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Enhancing crisis team performance


Lina Kolesnikova explores the merits of the crisis resource management (CRM) team training process first developed by the aviation sector 

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  It's important for the entire crew to be vigilant and work together during a flight. CRM training empowers crew members to use their cognitive, social and personal resource skills when making decisions. Image: jazzia/123rf

During the 1970s, several high-profile air crashes around the world prompted NASA to investigate the common factors. In 1977, during the ‘Tenerife disaster’, five aircraft were diverted to the island following a bombing incident at their original destination. Las Palmas airport, being the only airport on the island and a small one at that, had to divert the aircraft to its only taxiway to wait until they could then take off again. In dense fog, a collision involving a KLM aircraft and a Pan Am plane occurred on the runway following a misunderstanding between captains and crew as one decided to take off while the other had just come in to land, resulting in a death toll of 583. In 1978, United Flight 173 crashed at Portland, Oregon in the USA, as a result of miscommunication over fuel exhaustion, killing two crew members and eight passengers.
 
NASA investigators calculated that more than 70 per cent of air crashes were caused by human error as a result of poor teamwork and a lack of leadership, rather than equipment failure or poor weather. However, as crews were originally trained to follow the directives of their captain and not deviate from their decisions, a way forward that allowed for teamwork from all corners of the cockpit was required, with the added recognition that the captain is not always right, nor always to blame. 
 
The aviation sector, supported by the International Civil Aviation Organisation (ICAO), developed standards for training the whole aircraft crew that would eventually form the bedrock of aviation safety. Initially setting a target of ten years to change the culture at United, Ed Soliday, United Senior Staff Executive and Director of Safety remarked: “We actually began to see the changes in six years.”
 
The term CRM, for crew resource management originally, was first applied to the process of training pilots to reduce errors by making better use of human resources in the cockpit, with a focus on group dynamics, interpersonal communications and decision-making.
 
Subsequently, those in the field of medicine were inspired by NASA’s findings. 
 
CRM could be very useful to any team and could be applied to work processes by those working in high risk crisis or disaster situations – such as firefighters, rescue services, or police officers – for communicating effectively during the response.
 
Generally speaking, CRM refers to the non-technical skills – cognitive, social and personal resource skills – that are required for effective teamwork in a crisis situation, where responders operate under time constraints and lack information. These non-technical skills apply to preparing for the crisis, anticipating a future state, communicating effectively, making a decision in the heat of the moment and reflecting on lessons learned. CRM skills can help decisions to be made effectively and teams to be managed successfully in a crisis. This is especially so for teams made up of strangers, a common occurrence for many rescuers, medical personnel and so on. CRM is about shared decision-making and appropriate team management.
 
When we are in a crisis, there are many individual, team and environmental factors that can affect the performance of complex tasks. These factors not only influence the outcome but can result in large scale human error and a total failure in performance. However, CRM can be applied to address each of the three factors. 

Individual factors can include tiredness, anger and stress so it is important to make physical self-checks before dealing with a crisis. In medical CRM, the checks are abbreviated to IMSAFE – illness, medication, stress, alcohol, fatigue, eating and elimination. Another mnemonic that can help before dealing with complex crises is HALTS – hungry, angry, late, tired and stressed. Both IMSAFE and HALTS provide a checklist for physical and mental readiness.

Team factors may include poor distribution and identification of roles, poor communication skills and a fragile relationship between members of a team.

The environmental factors could include loud noises and interruptions, bad or non-functioning equipment, working with new equipment and unfamiliar places.

Rall and Gaba (2005) identified 15 key principles of CRM:
 
·      Know the environment
·      Anticipate and plan
·      Call for help early
·      Practise leadership and follow the team leader
·      Distribute the workload efficiently
·      Mobilise all available resources
·      Communicate effectively
·      Use all available information
·      Prevent and manage fixation or first impression bias
·      Perform double checks
·      Use cognitive aids and prevention of cognitive biases
·      Repeatedly reassess
·      Use the power of teamwork
·      Focus your attention wisely
·      Define priorities dynamically

CRM provides a very sound and reliable training tool because it is verified and used all over the world in the aviation and medical sectors. Each principle can be applied easily to communication in a crisis and in all other areas of crisis management, especially where teamwork is involved. 
 
There are plenty of free courses, printed and electronic materials on the subject of CRM, which can be used by organisations and individuals to prepare more effectively for the future crises. 
 
Remember that crises test your human capabilities as well as your technical abilities. 

Lina Kolesnikova, 02/03/2021
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