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An integrated ABCDE approach to managing medical emergencies using CRM principles

02 December 2014
Volume 6 · Issue 12



There is increasing recognition of the vital role of non-technical skills in managing medical emergencies. An ABCDE approach has been very successful in training healthcare professionals in technical skills. Using a similar structure is likely to enhance successful application of their non-technical counter parts in clinical practice whether it is in the hospital or pre-hospital setting.

Aim and Methods:

To further promote safe patient care, teaching and learning aids currently used to implement crisis resource management skills, non-technical skills and human factors were identified and grouped in a way that facilitates memorisation.


Tools are available in the form of lists, tables and algorithms to identify behavioural markers of different components of non-technical skills and aspects of crisis resource management (CRM) and human factors. They require the need to memorise a list of items or a checklist. We have successfully used a visual aid representing these key CRM principles as a radial diagram, combined with a flow chart representing ABCDE approach for technical skills. Grouping them together in a format to embed in memory, combined with a visual aid representing the application nature of the principles, is likely to complement the existing tools in matching the learning style of more healthcare professionals. This inherently promotes the more widespread use of the principles, and hence has the potential to enhance patient safety.


The proposed radial diagram, alongside the mnemonic alphabetical grouping, can be used to introduce the CRM principles and to provide effective feedback. This mnemonic is likely to help embed the CRM principles and enable recall in clinical practice to increase patient safety. The effectiveness of this aid could be tested using simulation of medical emergencies while training multiprofessional teams.

There is increasing recognition that the successful management of medical emergencies, in the hospital or pre-hospital care setting, depends on the non-technical skills as well as the technical skills of the people involved. The inseparable nature of these two sets of skills in determining the outcome is especially evident where the demands outweigh the available physical and/or psychological resources, and the situation reaches a crisis point. A crisis is defined in the Oxford dictionary as a time of great difficulty or danger where an important decision must be made. For the purpose of crisis resource management (CRM) in the medical context Lighthall (2008), uses the definition:

‘An unplanned life-threatening event in which there is a mismatch between the ambient level of resources and those that a patient needs to regain stability.’

In their excellent account of the origin and evolution of CRM in health care education and in the provision of health care across multiple domains and a detailed working knowledge, Fanning et al (2013) describe CRM as:

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