Administration and Leadership, Airway & Respiratory, Training

Why Crew Resource Management in EMS Is a Must

Issue 2 and Volume 38.

Years ago, the National Highway Traffic Safety Board moved away from calling motor vehicle collisions “accidents” because nothing’s really an accident. Collisions and other catastrophes are most often the result of human error, the merging of multiple unanticipated occurrences or issues that should have been foreseen by the individuals or agencies involved.

All you have to do to see how disasters can be avoided is watch any “accident” clip on YouTube. Examples include trucks over-steering or making sudden, sharp turns that cause their loaded trailers to topple, and operators driving too fast for conditions or being tired and using poor judgment.


An Everyday Occurrence
We see these things every day in EMS and fire rescue operations, and we’re often the victims of them. We witness trucks with heavy loads being escorted slowly through town by police vehicles or front and rear escorts with warning flags and lights, but we then passively accept an engine or ladder truck racing through town at high speeds. Prime examples of EMS circumstances that can be avoided or corrected before harming or killing someone include flying aeromedical missions in bad weather, failing to slow down when roads are wet or icy, and allowing five firefighters to be positioned on a roof weakened by heat and fire.

Fatigue is also a major factor in many so-called accidents. I remember one such incident when I worked 10 hours at my regional EMS director job and then worked a 12-hour shift as a paramedic on a Friday night. I hoped for a slow shift so I could catch a few ZZZZs and recharge my batteries, but instead we were running all night. It was my turn to drive toward the end of the shift, and I drove through two consecutive red lights before my partner, also tired, noticed it and told me to pull over. I was driving like an intoxicated person whose judgment was impaired, but I was too disoriented to realize or acknowledge it.

Countless incidents like mine happen every day, and the unfortunate thing is we know they’re occurring and we fail to take steps to eliminate them. As an EMS operations director, I couldn’t stop my employees from holding down other jobs after they left my service. So I wrote a standard operating procedure that gave the crews the authority and responsibility to politely “flag” their partner and stop them from driving the remainder of the shift. There was no disciplinary action required unless the “disabled” driver failed to comply.


Passionate about Safety
When two engines lost thrust after a flock of geese struck US Airways Flight 1549 on Jan. 15, 2009, it could have resulted in a fatal “accident.” However, the actions of pilot Captain Chesley B. “Sully” Sullenberger III and his crew took the incident from being potentially disastrous to heroic. Sullenberger, who is internationally recognized for the emergency water landing of US Airways Flight 1549 in the Hudson River, is a humble, consummate professional. His quick thinking, years of training, rapid actions and focus on pre-determined and rehearsed tasks saved everyone on board.

Sullenberger graduated from the U.S. Air Force Academy with the Outstanding Cadet in Airmanship Award. He served as a fighter pilot for the U.S. Air Force from 1975–1980. After a long, distinguished career in the Air Force, he became an airline pilot with Pacific Southwest Airlines, later acquired by US Airways.

Before he retired in March 2010, Sullenberger was an active and ardent safety advocate, selected to perform accident investigation duties for the U.S. Air Force, and serving as an Air Line Pilots Association (ALPA) representative during a National Transportation Safety Board investigation.

More importantly, Sullenberger was instrumental in developing and implementing the crew resource management (CRM) course used by US Airways. He has taught the CRM concept throughout the world and helped many professionals adapt it for their industry. The International Association of Fire Chiefs (IAFC) did so in 2003 in an epic document that should be read by all emergency personnel. (See for more).

Since his March 2010 retirement from US Airways, Sullenberger has authored the  New York Times best-selling books Highest Duty: My search for what really matters and also Making a Difference: Stories of vision and courage from America’s leaders.

Safety in Your Area
What must be emphasized is that it was not just Sullenberger and his crew’s actions that day that saved 155 people on the plane and perhaps thousands had they crashed into downtown Manhattan. Rather, it was his lifelong study and belief in accident avoidance and CRM that saved the day.

Nothing happens by accident, and it’s critical that we all learn how to avoid “accidents” before they occur. I encourage you to read Sullenberger’s books and the IAFC’s Crew Resource Management document, and adopt principles of high reliability organizations at your agency. It will improve your operational efficiency, increase your ability to resuscitate patients, and keep you, your crews, and members of your community alive.