Introduction

In the midst of a surge of acutely ill patients, sirens blare, signalling the arrival of another critical patient to the emergency department (ED). The sound activates an internal script for the physician in charge as she plans for a resuscitation. It’s March 2020, in New York City (NYC), and we are here in the Department of Emergency Medicine at Columbia University, serving at the epicentre of the COVID-19 pandemic in the USA.

Emergencies are fundamentally chaotic, but the standard scripts and choreography learnt for patient stabilisation provide a road map for the orderly approach to managing that chaos. Collectively the principles of crisis resource management (CRM) are designed to help teams organise and coordinate efficient and effective care during an emergency.

CRM was derived from crew resource management which was developed to mitigate human factors in aviation safety. Crew or cockpit resource management was conceived in the 1970s in response to the Tenerife disaster and has subsequently become a standard training for aviators.1 Fundamentally, crew resource management is a structured approach to leveraging all resources in a time-sensitive situation in order to minimise errors and optimise performance.2

The primary foci of crew resource management training are (1) direct communication irrespective of hierarchy, (2) defined roles for leaders and followers, and (3) maintaining situational awareness. In healthcare, clinicians have adapted this model, particularly in the fields of anaesthesiology and medical education and simulation, and promulgated the effective principles of CRM: leadership and followership, communication, teamwork, adaptability, resource use and situational awareness.3 This organisational framework allows for safe, effective care in high-pressure situations.

The COVID-19 pandemic arrived in NYC with great force and speed, swelling to over 130 000 confirmed cases in a little over a month. We saw historic increases in patient volumes and admitted four times as …