Clearly, the skill of


the paramedics and doctors played a critical part.


However, there is no doubt that the human factors training we all received had a huge impact on the outcome of this job. In aviation this training is called CRM (crew resource


management) but in the medical world it is now generally referred to as TRM or team resource management.


But is TRM truly relevant in medicine? Well if you take the basic premise that by default, human beings are predisposed to making mistakes and that the principal of CRM/TRM is to understand human behaviour in order to reduce or mitigate the mistakes we make then, yes, TRM is very relevant. Te Department of Health report, An organisation with a memory, states that research-based estimates suggest that in NHS hospitals alone adverse events in which harm is caused to patients occur in around 10 per cent of admissions or at a rate of over 850,000 a year and cost the service an estimated £2 billion a year in additional hospital stays alone, not taking account of the wider human or economic costs. Many of these adverse events are caused by human error. Terefore, any programme that can potentially reduce these errors must be looked at seriously.


Lesson from aviation


One of the main issues medicine faces is how to effectively introduce TRM and here it is helpful to look at the aviation experience. Aviation has been held up as one of the gold standard industries with regard to the study of human factors and the implementation of an effective programme of teaching. CRM has indeed been very successful but how it has been implemented in aviation has contributed to its success. First of all CRM is mandatory in civil and military aviation. Crew members have to undertake induction courses and annual recurrent training. In addition, the CRM aspects of carrying out crew duties are now also assessed on an annual basis. Tis assessment of ‘non-technical skills’, as the CRM aspects are called, can lead to removal from duty if the appropriate


AUTUMN 2011


standard is not met.


Another crucial aspect of CRM training in aviation is that all CRM trainers have to have formal instructor qualifications. Tese qualifications are approved and audited by the Civil Aviation Authority. CRM instructors are required to instruct on at least three courses per year and every third year one of the courses they teach has to be assessed by an examiner. In this way instructor standards can be monitored and maintained.


It is important though that the aviation model is not followed blindly. Te study of human factors consists of a wide and diverse range of subjects, and while an understanding of all the subjects is a requirement, some aspects of human factors are more relevant to some industries than others. What is required is for a training organisation to have an in depth look at the department or organisation that requires the training and tailor that training to their specific needs.


It should also be understood that it has taken since the mid-90s to get to the level of human factors understanding that we have in aviation now. Today all new entrants to aviation are exposed to human factors training at a very early stage of their careers. As well as introducing TRM into hospital departments today, I would advocate incorporating the study of TRM in medical undergraduate studies.


Tere is absolutely no doubt that an understanding of human factors and using procedures based on human factors error management will reduce the number of harmful errors made within an organisation. Tis can mean financial savings and reduced stress levels among well-intentioned workers. But most importantly, in the medical world, patient safety will improve and lives will be saved.


nCaptain Andy Rooney is a HEMS pilot with 16 years previous military experience. In addition, he is a director of DART Training Solutions, a company that provides TRM courses exclusively to medical clients. Contact: darttrm@gmail.com


15


“First thing I hear is ‘she’s not breathing’; the second is ‘we’re not strapping in, GO’”


PHOTOGRAPH: NIALL COTTON PHOTOGRAPHY


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