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Crisis resource management in relation to empowering people to speak up in emergency medical service clinical practice settings

02 February 2017
Volume 9 · Issue 2


Teamwork and effective communication have been identified as key principles in Crisis Resource Management (CRM) in the context of emergency care medicine. The aim of CRM is to ultimately improve patient safety and prevent at-risk situations or events. These principles optimise patient safety and benefits.

Pre-hospital emergency care in Qatar is provided by the national Ambulance Service (HMCAS). Their operations are labour intensive, and depend on the professional readiness and communication of their culturally diverse practitioners. Structures within HMCAS are hierarchical, which may be a deterrent to effective communication in Qatar. Emergency medical care (EMC) practitioners may not be forthcoming with their concerns to the detriment of patient safety. These factors can create an environment which is not conducive to effective communication, and may inherently suppress free expression of speech in emergency situations and day-to-day working practices.

Managers should therefore be encouraged to create an environment whereby practitioners can speak up, irrespective of culture, nationality, or the presence of more senior or experienced colleagues.

CRM principles are well incorporated as part of the EMC's orientation programme and specialised professional development courses. Regular training involving all role players (including supervisors) in different settings, and appropriately simulated scenarios that call for application of CRM principles is required to further improve the quality of EMC service in Qatar.

Crisis Resource Management (CRM) had its humble beginnings in the training of airline pilots in the 1960's (Howard et al, 1992). Teamwork and effective communication were subsequently identified as essential principles of CRM in the clinical context (Gaba, 2001). These components were then adapted and adopted into the training of many medical practitioners (Holzman et al, 2005). These principles therefore intend to encourage teamwork, situation awareness, and effective communication through empowering people to speak up in an emergency scenario. The aim of CRM is to ultimately improve patient safety and prevent at risk situations or events.

Researchers in pre-hospital emergency medical care have identified teamwork and effective communication as essential components in the delivery of high quality and safe patient care (Leonard et al, 2004). Moreover, the team leaders have been identified as an important link in fostering a positive teamwork environment. These leaders are encouraged to inspire the emergency medical care (EMC) practitioner to speak up. Being vociferous in such situations and giving productive input will translate to providing effective care to the patient. EMC practitioners are also advocates of patient safety and are therefore encouraged to follow the “Concerned, Uncomfortable, Safety” (CUS) principle and two-challenge rule (Hunt et al, 2007). These principles, if utilised correctly, minimise patient risks and maximise patient benefits.

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