How to Prepare and Protect Health-Care Teams During COVID-19: Know Thyself

  
By W. David Freeman, Lioudmila V. Karnatovskaia & Brynn K. Dredla

First Online: 27 October 2020

How does one prepare and protect oneself during a pandemic? In this issue of Neurocritical care, Rajendram et al. [1] discuss the important topic of crisis resource management (CRM) in the COVID-19 pandemic. While there has been an explosion of COVID-19 basic, translational, and clinical science articles, few have touched on the fundamental cognitive psychology and organizational approach principles that protect health-care workers (HCW) during a COVID-19 surge. SCCM has provided preparedness statements and checklists, but these articles do not touch on other important principles covered in CRM [2,3,4]. The principles of CRM are pulled from various disciplines such as military triage, massive casualty/disaster management, flight industry, simulation, and behavioral psychology [2, 5, 6]. In retrospect, a discussion on CRM as it applies to neurocritical care is long overdue—especially in regard to fellowship and other training programs. While the authors primarily focus on stroke patient workflow in the COVID-19 pandemic for neurointensive care unit teams, the article is germane to other patient populations and complex patient care teams.

Why is CRM an important topic right now? Principles of CRM include situational awareness, triage and prioritization, role clarity, Kahneman’s System 1 and 2 cognitive heuristics and biases, cognitive overloading errors, and the process of debriefing to help create a learning system that is adaptable, sustainable, and safe [1, 2, 5, 6]. These are a foundational psychological approach to protecting HCWs from harm during the COVID-19 pandemic, and future pandemics.

These principles are important and will remain that way—because despite maximal efforts, patients with Ebola and COVID-19 (and future pandemics) will still die. And despite proper donning and doffing procedures for PPE, some HCW will contract illness. It is no surprise then that during the surges in New York and Italy, depletion of resources of PPE, personnel, or expertise was associated with higher rates of HCW infection [7]. Because the loss of a single health-care team member strains the entire system, CRM is needed to protect not only the HCW, but all of the patients they serve.

How do CRM principles help health-care teams in 2020 and beyond? First, CRM principles should build a strong foundation for high-performance teams based on trust [7, 8] and coupled with important psychological/physiologic needs as outlined by Maslow [9,10,11], and illustrated in Fig. 1. CRM principles build on a foundation of psychological/physiologic safety first; if HCW become sick, they become a burden to the system and change from a generator of resources to a consumer of resources. CRM requires a multilayered organizational approach for health-care teams to succeed [12].

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