Alinier G, Newton A A model to embed clinical simulation training during ambulance shift work. International Paramedic Practice. 2013; 3:(2)33-38

Carbo AR, Tess AV, Roy C, Weingart SN Developing a high-performance team training framework for internal medicine residents: the ABCs of teamwork. Journal of Patient Safety. 2011; 7:(2)72-6

Fanning RM, Goldhaber-Fiebert SN, Udani AD, Gaba DM Crisis Resource Management. In: Levine AI, DeMaria Jr S, Schwartz AD, Sim AJ (Eds). New York: Springer Science & Business Media; 2013

Ferguson SL TeamSTEPPS: integrating teamwork principles into adult health/medical-surgical practice. Medsurg Nursing. 2008; 17:(2)122-5

Gaba DM, Howard SK, Fish KJ, Smith BE, Sowb YA Simulation-based training in anaesthesia crisis resource management (ACRM): a decade of experience. Simulation & Gaming. 2001; 32:(2)175-93

Gaba DM Crisis resource management and teamwork training in anaesthesia. British Journal of Anaesthesia. 2010; 105:(1)3-6

Goodman A The Development of the Qatar Healthcare System: A Review of the Literature. International Journal of Clinical Medicine. 2015; 6:(03)177-85

Henriksen K, Battles JB, Keyes MA TeamSTEPPS™: Team Strategies and Tools to Enhance Performance and Patient Safety. In: Henriksen K, Battles JB, Keyes MA, Grady ML (eds). Rockville, MD: Agency for Healthcare Research and Quality; 2008

Hicks CM, Bandiera GW, Denny CJ Building a simulation-based crisis resource management course for emergency medicine, phase 1: results from an interdisciplinary seeds assessment survey. Academic Emergency Medicine. 2008; 15:(11)1136-43

HMC. Hamad Medical Corporation Annual Report. 2015. http// (Accessed 22 March 2017)

Clinical Practice Guidelines, 2016. Doha, Qatar: Hamad Medical Corporation Ambulance Service; 2016

Holzman RS, Cooper JB, Gaba DM, Philip JH, Small SD, Feinstem D Anaesthesia crisis resource management: real-life simulation training in operating room crises. Journal of Clinical Anaesthesia. 1995; 7:(8)675-87

Howard SK, Gaba DM, Fish KJ, Yang G, Sarnquist FH Anaesthesia crisis resource management training: teaching anaesthesiologists to handle critical incidents. Aviation, Space, and Environmental Medicine. 1992; 63:(9)763-70

Hunt EA, Shilkofski NA, Stavroudis TA, Nelson KL Simulation: translation to improved team performance. Anesthesiology Clinics. 2007; 25:(2)301-19

Hussin AH, Ali FM, Reka H, Gjebrea O Tracking access, utilization and health system responsiveness to inform evidence-based health care policy: the case of Qatar. Journal of Local and Global Health Perspectives. 2015; 2:1-16

Jankouskas T, Bush MC, Murray B, Rudy S, Henry J, Dyer AM, Sinz E Crisis resource management: evaluating outcomes of a multidisciplinary team. Simulation in Healthcare. 2007; 2:(2)96-101

Kamrava M Royal factionalism and political liberalization in Qatar. The Middle East Journal. 2009; 63:(3)401-20

Leonard M, Graham S, Bonacum D The human factor: the critical importance of effective teamwork and communication in providing safe care. Quality and Safety in Health Care. 2004; 13:i85-i90

Logarajah S, Alinier G An integrated ABCDE approach to managing medical emergencies using CRM principles. Journal of Paramedic Practice. 2014; 6:(12)620-5

MDPS Quarterly bulletin: Population & Social Statistics-The fourth quarter 2016. 2016. http// (Accessed 21 March 2017)

Murray WB, Foster PA Crisis resource management among strangers: principles of organizing a multidisciplinary group for crisis resource management. Journal of Clinical Anaesthesia. 2000; 12:(8)633-8

O'Connor M A review of factors affecting individual performance in team environments: theories and implications for library management. Library Management. 2006; 27:(3)135-43

Pian-Smith MC, Simon R, Minehart RD, Podraza M, Rudolph J, Walzer T, Raemer D Teaching residents the two-challenge rule: a simulation-based approach to improve education and patient safety. Simulation in Healthcare: journal of the Society for Simulation in Healthcare. 2008; 4:(2)84-91

Rall M, Gaba DM, Howard SK, Dieckmann P Human Performance and Patient Safety, 6th edition. : Elsevier; 2005

Ramani S, Krackov SK Twelve tips for giving feedback effectively in the clinical environment. Medical Teacher. 2012; 34:(10)787-91

Reznek M Emergency Medicine Crisis Resource Management (EMCRM): pilot study of a simulation-based crisis management course for emergency medicine. Academic Emergency Medicine. 2003; 10:(4)386-9

Scharfenort N Urban development and social change in Qatar: the Qatar National Vision 2030 and the 2022 FIFA World Cup. Journal of Arabian Studies. 2012; 2:(2)209-30

Shah Y, Alinier G, Pillay Y Clinical handover between paramedics and emergency department staff: SBAR and IMIST-AMBO acronyms. International Paramedic Practice. 2016; 6:(2)37-44

Souza JP, Gülmezoglu AM, Carroli G, Lumbiganon P, Qureshi Z The World Health Organization multi-country survey on maternal and newborn health: study protocol. BMC Health Services Research. 2011; 11:(1)

Study: Qatar's weight problem dates back three decades. Doha News. 2014. http// (Accessed on 23 August 2015)

World Health Organization. Qatar: WHO Statistical Profile. 2013. http// (Accessed on 20 December 2015)

Crisis Resource Management in emergency medical settings in Qatar

02 August 2017
Volume 7 · Issue 2


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.

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.

Subscribe to get full access to International Paramedic Practice

Thank you for visiting International Paramedic Practice and reading our archive of expert clinical content. If you would like to read more from the only journal dedicated to those working in emergency care, you can start your subscription today for just £48.

What's included

  • CPD Focus

  • Develop your career

  • Stay informed