Accordingly, there is a need to develop team-based train­ing strategies that address these non-technical skills as a spe­cic strategy to counteract medical error and improve patient safety. Simulation-based team-training has its origins in high-risk industries, such as civilian and military aviation, and has been used effectively in health to train teams in sur­gery, critical care and emergency medicine, improving patient safety and decreasing error rates [4–6]. Team training is not a “one-size” intervention, and training applications need to be adapted and developed to suit domain-specic needs [6–8].

failure to assign tasks and lack of effective leadership and supervision were a contributing cause in nearly half of fatal accidents between 1983 and 1985 [14]. In 1984, Billings and Reynard published a review of seven years of data and over 35,000 reports in the ASRS in an attempt to better understand and classify the nature of consequential cockpit errors. The majority of events could be attributed to either human or sys­tem factors: at the system level, over 70% of reported inci­dents involved faulty information transfer [12]. Although information quality was typically not the culprit, failure to effectively communicate key data to the personnel responsi­ble for tactical decision-making frequently led to erroneous decisions with dire consequences. Reported human factor error included failure of ight crews to effectively manage resources, plan for contingencies, question authority and request clarication [12]. Whether or not human error resulted in a consequential accident depended largely on the environment in which the error occurred—as an example, the authors point out that an altitude error is more likely to result in an accident when the plane is close to the ground. Furthermore, errors were found to be more consequential if they occurred during periods of high workload or non- routine operations [12]. In contrast, technical problems including aircraft malfunction and equipment failures were compara­tively rare, and in general had a less signicant impact on aircraft accidents. Billings concluded:

Following the NASA workshop, and in response to recom­mendations made in the wake of the Tenerife investigation, aviation and aerospace moved quickly to develop CRM-based team training programs tailored to suit specic industry needs. Since that time, CRM training has undergone a signicant evolution as it became integrated into the fabric of aviation safety culture and cockpit training. First- generation CRM pro-

100years ago. These partnerships helped advance care both during peacetime and during times of conict.”

Utilizing the NBA sports analogy, it is important to identify how we dene “team.” In basketball, there are typically 15 players, but only 5 on the court at a time. This provides sev­eral available players and depth at each of the ve playing positions. The same is true for trauma care. Depending on the severity of the trauma and the specic designation of the facility, the trauma team can be modied to meet the needs

executive ofcers. It is this auxiliary staff that are responsible for ltering and relaying accurate information so that deci­sions can be made. Data about resources, policy, unit morale, operational capability, and site mission are all incorporated and analyzed into a congruent information feed that allows the Commander to observe, orient, decide, and act (OODA).