NREMT EMT 1: Scene Size-Up and Safety - Situational Awareness and Crew Resource Management, CRM

Situational Awareness and Crew Resource Management (CRM)

Situational awareness is like being a quarterback on a football team – you need to know the game plan, the players, and the field conditions to make smart decisions. In emergency medicine, situational awareness means understanding the situation, the patient, and the resources available to make the best decisions. Crew resource management (CRM) is like a well-coordinated team effort – it's about working together to achieve a common goal.

Key Steps / Core Facts

• Scene size-up: Quickly survey the scene to identify hazards, patients, and resources. (Look for "red flags" like bleeding, burns, or smoke.)
  • Why it matters: To prioritize patients and resources.
  • Example: A patient with a severe head injury needs immediate attention.
• Patient assessment: Gather information about the patient's condition, including vital signs and medical history. (Use the OPQRSTI mnemonic: Onset, Provocation, Quality, Region, Severity, Time, Insurance.)
  • Why it matters: To understand the patient's condition and make informed decisions.
  • Example: A patient with a heart rate of 40 beats per minute needs CPR.
• Crew resource management: Communicate effectively with your team to allocate resources and make decisions. (Use the "Situation, Background, Assessment, Recommendation" (SBAR) framework.)
  • Why it matters: To ensure everyone is on the same page and working together.
  • Example: A paramedic needs to communicate with the driver to navigate through traffic.
• Communication: Clearly convey information to patients, families, and other healthcare providers. (Use simple language and avoid jargon.)
  • Why it matters: To ensure everyone understands the situation and can provide effective care.
  • Example: A patient's family needs to know their loved one's condition and treatment plan.
• Decision-making: Make informed decisions based on the situation and available resources. (Use the "4 Ps" framework: Patient, Problem, Plan, and Priorities.)
  • Why it matters: To provide effective care and allocate resources efficiently.
  • Example: A patient needs to be transported to a hospital with a trauma center.
• Debriefing: Review the situation and identify areas for improvement after the call. (Use the "What, So What, Now What" framework.)
  • Why it matters: To learn from experiences and improve future responses.
  • Example: A paramedic needs to review the call to identify areas for improvement.
• Crew resource management ratios: Ensure the right number of personnel are assigned to the call. (Use the "1:1" or "2:1" ratio for basic life support.)
  • Why it matters: To ensure adequate care and safety.
  • Example: A patient needs two paramedics to provide care.
• Communication devices: Use communication devices effectively to stay in touch with dispatch and other teams. (Use the "10-4" and "10-20" codes.)
  • Why it matters: To stay informed and coordinate responses.
  • Example: A paramedic needs to communicate with dispatch to report their location.
• Crew resource management protocols: Follow established protocols for common situations. (Use the "ALG" framework: Assess, Locate, and Gather.)
  • Why it matters: To ensure consistency and effectiveness.
  • Example: A patient needs to be transported to a hospital with a stroke center.

What Laypeople Can Do

• Call 911: If someone is injured or ill, call 911 or your local emergency number.
• Check for danger: Before approaching the patient, check for hazards like oncoming traffic or fire.
• Shout and tap: If someone is unresponsive, shout their name and tap their shoulder to try to rouse them.
• Provide basic care: If trained, provide basic care like CPR or the Heimlich maneuver.
• Stay with the patient: If you're with the patient, stay with them until help arrives.

Common Mistakes

• Mistake: Not conducting a scene size-up before approaching the patient.
  • Fix: Quickly survey the scene to identify hazards and prioritize patients.
• Mistake: Not communicating effectively with the team.
  • Fix: Use clear and concise language to ensure everyone is on the same page.
• Mistake: Not following established protocols.
  • Fix: Follow established protocols for common situations to ensure consistency and effectiveness.
• Mistake: Not staying with the patient.
  • Fix: Stay with the patient until help arrives to provide support and information.
• Mistake: Not reviewing the call after the fact.
  • Fix: Review the call to identify areas for improvement and learn from experiences.

Quick Practice Scenarios

1. A patient is experiencing chest pain and shortness of breath. What should you do first? Answer: Call 911 and check for danger. Reason: To ensure the patient receives immediate medical attention and to prioritize their safety.

2. A patient is unresponsive and not breathing. What should you do first? Answer: Shout their name and tap their shoulder. Reason: To try to rouse the patient and assess their level of consciousness.

3. A patient is experiencing a severe allergic reaction. What should you do first? Answer: Administer epinephrine (if trained) and call 911. Reason: To provide immediate relief and ensure the patient receives medical attention.

Last-Minute Exam Cram

• Normal heart rate: 60-100 beats per minute.
• Normal blood pressure: 90-120/60-80 mmHg.
• CPR compression depth: at least 2 inches.
• CPR compression rate: 100-120 compressions per minute.
• Agonal breathing is NOT normal breathing – start CPR.
• Always follow established protocols for common situations.
• Never leave a patient unattended.
• Always communicate effectively with the team.
• Review calls after the fact to identify areas for improvement.
• Normal body temperature: 98.6°F (37°C).
• Normal respiratory rate: 12-20 breaths per minute.
• Normal oxygen saturation: 95-100%.
• Always prioritize patient safety.
• Never assume a patient's condition is stable.