Crisis Resource Management in Emergency Medical Settings in Qatar

Abstract

The principles of Crisis Resource Management (CRM) aim to mitigate the risks associated with a potential crisis and improve patient safety. Effective teamwork and communication are key CRM elements in emergency care medicine. This article will explore their importance in the context of pre-hospital emergency care in Qatar, which is provided by the national Ambulance Service (HMCAS). The national and organizational environments are culturally very diverse which presents particular challenges that can impede the CRM principles, and ultimately affect patient care. This is especially worrying if emergency care practitioners (EMC) are not forthcoming with their concerns and allow patients to be endangered. To partly counteract the individual cultural diversity within the organization, HMCAS recognized the importance of trying to inculcate a different organisational culture promoting an environment whereby practitioners can speak up, irrespective of culture, nationality, or the presence of more senior or experienced colleagues. To that effect CRM principles are a core element of the HMCAS EMC practitioners’ orientation programme and continuing professional development (CPD) courses. Special emphasis is made on the key principles of teamwork and communication, and in relation to mutual support, feedback, and speaking up when concerns arise. 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. Introduction Crisis Resource Management (CRM) had its humble beginnings with the training of airline pilots in the 1960s, prior to being quickly extended to include the whole crew (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 even 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) practitioners to speak up. Being vociferous in such situations and giving productive input will translate to providing effective care to patients. EMC practitioners should be 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. This article explores the emergency medical service (EMS) environment in which EMC is performed in the State of Qatar. Furthermore, the importance of working as a unified team in the context of CRM in pre-hospital care is highlighted.