CRASHED Pre Hospital Reflective Model
The “CRASHED” model is a pre-hospital reflective care practice which stands for Communications, Response, Actions, Subsequent Actions, Hospital, Evaluation and Ethics and Discussion. It was created by a group of pre-hospital care students and influenced by the works of nursing theorist Patricia Benner and medical author Christopher Johns. These students wanted to create a model that was not only intended to be used by nurse practitioners but one that also focused on the specific and unique needs of pre-hospital staff as well. Most pre-hospital care providers have a tendency to not want to remember particular experiences and this model encourages and motivates them to do so in order to learn through reflective practice. Believe it or not, using a structured reflection method such as the CRASHED model is essential to the professional development of your pre-hospital care career and on-going education.
If you're a pre-hospital professional, nurse or Paramedic, or studying to be one, there are quite a few ways you can utilise the CRASHED model to your advantage, but before you take a look at the model, there are a few phrases and terms you need to get familiar with. When using the CRASHED model, keep in mind that being directly involved with an experience or situation and having to quickly think prior to acting is known as “reflection-in-action”. When a participant is removed from the situation but still gaining knowledge from it, this is known as “reflection-on-action”. Lastly, reflecting on an occurrence after is has happened is known as “reflection upon reflection” and is key to knowing exactly what to do if a similar situation arises in the future.
The model itself is extremely simple and composed of a few questions for each category in a logical sequence making it easy for students to recall in order to assess a certain educational experience and share occurrences with various levels of staff. For example, the first category, communications, includes questions pertaining to the communication ability of yourself as well as those who gave you direction and worked with you. When it comes to response, there are four different questions to be answered to note how you were able to handle and respond to any issue that you may have run into. There are also questions regarding transportation and pre-hospital care techniques along with information pertaining to the events that happened once you reached the hospital. Lastly, there are questions that are meant to evaluate the overall ethics of your care and then a few to evoke discussion among both your peers and management. By answering these questions you're able to reflect and identify which professional areas you may need to work on to advance your skill set and further your career. Some of the inquiries you might feel only need one word answers while others might require you to explore the situation more in depth. Both are totally acceptable. It's up to you to only share what you feel comfortable sharing, but it's best to be completely honest to allow those you work with to grasp the entirety of the situation and come to terms with it yourself.
We all know that the best way to learn in our industry is through experiences and that's exactly what the CRASHED model focuses on. Remember this acronym to perform a retrospective analysis on Communications, Response, Actions, Subsequent Actions, Hospital, Evaluation and Ethics and Discussion, all of the aspects that will make you a better.
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References and Further Reading:
With a special thank-you to the authors:
for their valued and dedicated contribution through the crashed model of reflection and application to pre-hospital education and development.
It was originally
published in June 2001 (Holland, Todd, Kinsella: Ambulance UK)