Title: Crew Resource Management
1Crew Resource ManagementThe Command Officer
Proven Tool for a Safer Scene Control
Bob Bartosz Photo
Partnering for Safe Leadership Ruidoso, NM May 7,
2008 Battalion Chief John Tippett Montgomery
County Fire Rescue Service (MD)
2What do we hope to accomplish today?
- Interactive discussion.
- Preserve good traditions.
- Acquaint you with new
- approach to command
- control.
- Provide tool you can
- use beginning today.
Safety Based Culture Non-Punitive Approach to
Error
3Is there a problem with the way we do business?
4Acceptable Losses?
- 105 fatalities to date
- 2006 Statistics
- 106 firefighters died while on duty in 2006. 77
volunteer, 29 career. - 6 multiple fatality incidents, 17 killed.
- 22 killed during brush, grass, or wildland
firefighting. - 36 died at the scene of a fire.
- 15 died responding to or returning from emergency
incidents. - 9 died engaged in training activities.
- 20 died after the conclusion of their on-duty
activity. - 50 died from heart attacks.
- 19 killed as a result of vehicle crashes.
5Reasons Costs
- Better protection, aggressive tactics, lighter
weight construction and improved handling
capabilities of heavy apparatus are putting
firefighters at greater risk. - Non-fatal firefighter injuries and prevention
efforts cost anywhere from 2.8 billion to 7.8
billion per year. (NIST Report on Consequences of
Fire Fighter Injuries - 2005)
6Why isnt technology enough?
7Normalization of Deviance
8becomes our nemesis
9Error Management
- To err is human
- Marcus Tullius Cicero
- 106-43 B.C.
1 Fatality
10 Lost Time Injuries
100 Minor Injuries
1000 No Loss Accidents 10,000 UNSAFE ACTS!
10Human Factor Error CausesGordon Duponts Dirty
Dozen
- Lack of Communication
- Complacency
- Lack of Knowledge
- Distraction
- Lack of Teamwork
- Fatigue
- Lack of Resources
- Pressure
- Lack of Assertiveness
- Stress
- Lack of Awareness
- Norms
11Who Carries the Load?
12When Things Go Wrong . . .
How It Is Now . . .
How It Should Be . . .
You are human
You are highly trained
and
and
Humans make mistakes
If you did as trained, you would not make mistakes
so
so
Lets also explore why the system allowed, or
failed to accommodate your mistake
You werent careful enough
so
and
You should be PUNISHED!
Lets IMPROVE THE SYSTEM!
13Layers of Defense Trap Crew Errors
Use All Resources
Maintain Situational Awareness
Follow SOPs
High Level of Proficiency
14You may not know where the holes are
Use All Resources
Follow SOPs
Maintain Situational Awareness
High Level of Proficiency
James Reasons Swiss Cheese
15When the holes line up
Use All Resources
Follow SOPs
Maintain Situational Awareness
DISASTER!
High Level of Proficiency
James Reasons Swiss Cheese
16Crew Resource Management
- What it is
- Where it came from
- How it works
- Why we should use it
- How we know it works
17What Is Crew Resource Management?
- Force multiplier
- Uses all resources
- Enhances supervision
- Improves safety
- Raises level of
- awareness for
- those engaged
18- Crew Resource Management (CRM) is a tool created
to optimize human performance by reducing the
effect of human error through the use of all
resources.
19Where Did It Come From?
- Aviation Community
- Air Crashes Dominated Industry Attention
- Technology Only Went So Far
- 1970s Dr. Robert Helmreich and CVRs
20Error Management
- Helmreichs Error Management Model
AVOID
TRAP
MITIGATE
21How Does It Work?
- Six Principles
- Communication
- Decision-Making
- Task Allocation
- Teamwork
- Situational
- Awareness
- Debrief
22(No Transcript)
23Communication
- Barriers and bias block effective communication
- Standard language benefits all
- Practice active listening
- Divide duties to prevent overload
- Minimize distractions
- Establish Inquiry/Advocacy patterns
- Clear, Concise, Complete
- Respectful
- Bishops Assertive Statement
24Communication
- Active Listening
- Face individual(s)
- Maintain eye contact
- Only one person speaks at a time
- Formulate reply after other person speaking
finishes talking
- Distractions
- Turn down radio(s)
- Phones on vibrate
- No multi-tasking during periods of high stress
- Ambient noise
- Adjourn to quiet location
25Sterile Command Post
- Everyone needs to be all business when its
time for business. - IC sets the tone for the CP.
Photo by Carlos Alfaro
26Todd Bishops Assertive Statement
- How to talk up
- the chain of command
- If you are a subordinate
- use the technique
- If you are a supervisor
- LISTEN FOR THE PROCESS!
275 Easy Steps
- Opening/attention (Call the supervisor by name or
rank) - State concern/owned emotion (Im concerned
about) - State the problem as you see it (Someone is going
to get hurt if we) - State a solution (I think we can do it another
way) - Obtain agreement (aka buy-in) (Does this make
sense to you?)
28Critical Decision Making
- Recognize problems
- Continue to fight the fire
- Maintain SA
- Assess hazards
- Assess resources
- Solicit solutions
- Make a decision!
29Klein
- Method
-
- Recognition Primed
- Naturalistic
- Cue Based
30Decision Making
- Cue Based
- Compare existing knowledge base against situation
- Improve base through
- Training
- Experience
- Knowledge
- Case studies
31blink
- Rapid Cognition
- Thin-slicing
- Ability of the unconscious to find patterns in
situations and behaviors based on very narrow
slices of experience. - Automated, accelerated recognition of
identifiable patterns. - Coup doeil - the power of the glance
- - Malcolm Gladwell
32Klein, Gladwell Todays Fire Officer
33Task Allocation
- Know your limits
- Know your crews limits
- Capitalize on strengths
- Seek out experts
- Eat the elephant one bite at a time
34Task Allocation Exercise
- What You Have
- 3 Story MFD
- Fire on 2 floors and through roof
- Type V Construction
- Wood Truss Roof
35Whos On the Way
- BC1
- 28 years, 6 as Ops BC
- 14 years in busiest areas
- EFO Grad
- Bachelors in Fire Protection
- EMS BC
- 16 years, 2 as EMS BC
- 12 years in Suppression ranks
- 2 years as Training Captain
- Associates Degree, EMS
- Fire Prevention AC
- 20 years
- 6 in Ops as FF, Remainder of time in Fire
Prevention - EFO Grad
- Bachelors in Fire Protection
- NIMS Instructor
- Operations AC
- 34 years, 2 as Ops Chief
- 12 as Training DC
- 4 as Arson BC
- 8 as Safety Captain
- Bachelors in Fire Service Management
36Who Gets the Job?
- Fire Attack
- Safety Officer
- Senior Advisor
- Roof Sector
37Teamwork
Photo by Bob Bartosz, Camden Fire Department
38Teamwork
- Leadership
- Authority
- Mandated by rank
- Derived through respect
- Mentoring
- Lead by example
- Admit mistakes
- Be technically competent
- Share knowledge
39Teamwork
- Conflict Resolution
- Focus on issue
- Keep ego in check
- Listen
- Mission Analysis
- 1 Priority
- Continuous
- Risk vs Reward
- Evaluation
40Teamwork
- FOLLOWERSHIP
- Self Assessment
- Physical Condition
- Mental Condition
- Attitude
- Understands human behaviors
41Teamwork
Followership
- Respect authority
- Personal Safety
- Crew Safety
- Accepts authority
- Knows authority limits
- Leader success
- Good communication skills
- Learning attitude
- Ego in check
- Balance assertiveness/authority
- Accept orders
- Demand clear tasks
- Admit errors
- Provide feedback
- Adapt
42How Well Do You Team?
43Situational Awareness
- Point where perception and reality collide
- Reality always wins
- Beware of loss factors
- Ambiguity
- Distraction
- Fixation
- Overload
- Complacency
- Unresolved discrepancy
44Hazardous Attitudes
- Invulnerability
- Anti-authority
- Impulsivity
- Macho
- Resignation
- Air Show Syndrome
- Pressing
45Good Situational Awareness
- Good crew coordination
- Proper task completion
- Understanding
- Smooth ride
- Crisp and appropriate radio calls
- Use of checklists
46Preventing Loss of Situational Awareness
- Crew mental joggers
- What do we have here?
- Whats going on here?
- How are we doing?
- Does this look right?
47Preventing loss of Situational Awareness
- Personal mental joggers
- What do I know that they need to know?
- What do they know that I need to know?
- What do we all need to know?
48Debrief
- Pre-Brief
- Topic
- Decorum
- Facilitate
- Analyze
- Operations
- Human Behaviors
49Why Should We Use CRM?
- Error is a fact of all performance
- Command becoming more complicated
- Command successes are a function of teamwork
- Proven success in multiple industries with
similar structure
50How Do We Know It Works?
- 5th Generation in Aviation Industry
- U. S. Marine Corps Adopting as Basic Philosophy
- Significant Reductions in Injuries and Error
- Commercial Aviation Industry
- U.S. Coast Guard
- U.S. Navy
- U.S. Air Force
- Veterans Administration Hospital System
51Review
- What CRM is
- Where it came from
- How it works
- Why we should use it
- How we know it works
52For More Information
- http//www.iafc.org/associations/4685/files/CRM20
Manual.pdf (downloadable manual) - Okray and Lubnau, Crew Resource Management for
the Fire Service. Penwell Publishing
53Contact Information
- john.tippett_at_montgomerycountymd.gov
- jtippett_at_iafc.org
- 240-832-6563
54