Tuesday, May 3, 2016

AMRM Training Solutions : Knowledge Test and Discussion Builder.

Feel free to use this test in your safety training sessions, or crew briefings. You may copy and paste, and add or subtract material as desired. We ask that you credit AMRM Training Solutions in your final product. We think the answers should be self-evident; but if you would like to discuss our ideas about the correct answers, leave a comment.

Safety Day – AMRM Training

Created by:
AMRM Training Solutions



Air Medical Resource Management

AM                        PM


Please read each question carefully and circle what you think is the best answer. Some of these questions are purposely designed to foster discussion and interpretation.

1.     According to the Federal Aviation Administration, what percentage of aviation accidents are attributable to human error?

a.    40% to 50%

b.    70% to 80%

c.    100%

2.     In what way does Air Medical Resource Management Training differ from Crew Resource Management Training?

a.    CRM training was originally intended for the major airlines, and more recently has been required for part-135 air carriers as well. CRM is required for everyone on board our helicopters. AMRM training is only pertinent to medical flight team members.

b.    CRM training is more important than AMRM training and carries the weight of law, as it is required by the FAA. AMRM training is voluntary and is designed to make medical flight team members “feel good.”

c.    CRM training is only required for the pilot – the only FAA-acknowledged “crew.” AMRM training is intended for all persons involved with Helicopter Air Ambulances. CRM training is required by regulation. AMRM training is recommended by advisory circular and required for CAMTS certification.

3.      As no policy, procedure, or protocol can cover every eventuality for operations in naturalistic environments, what are the three major considerations for decision making, in order of importance, in the absence of other guidance?

a.    Company, Safety, Patient

b.    Patient, Safety, Company 

c.    Safety, Patient, Company

4.      (Non-clinicians, pilots etc., for the purposes of this question, put yourself in the role of medical flight team member :  the purpose of this question is to spark thought and discussion, and your response may be subject to program factors/protocols) You are on scene with your helicopter, picking up a victim of trauma. The pilot advises that “you need to hurry, as a thunderstorm is rapidly approaching your planned destination – receiving hospital.” As you hear this call come over the radio, you are in the back of an ambulance preparing to intubate. What is your response?

a.    You respond to the pilot, “okay, we are getting ready to tube this guy, we will hurry up and be right with you. Keep the aircraft running!”

b.    You ask the pilot to coordinate with your com- center on other possible hospitals for the patient, advising him that you are preparing to intubate and may be delayed. You are aware that other destination hospitals may not have all the capabilities and resources that your primary destination had, for example level 2 trauma center status.

c.    You tell the pilot that you will be proceeding inbound by ground to your primary destination, and he is clear to depart immediately. You are aware that this will create a significant delay in the patient’s arrival to definitive care – but this is your protocol.

d.    You would not select any of these options. Instead you would opt to :

5.      You were requested for an inter-facility transport from a distant hospital. While enroute and after an extended period of flight, you were cancelled due to the patient expiring. While returning to your base, you are requested for another transport.  You perform a quick check of your fuel state and the fuel required, and verify weather.  Then, after conferring with the crew, you accept the flight. Your ground time at the scene - an MVA on an interstate highway which was shut down for your landing - was extended due to prolonged extrication. Now, in-flight under visual flight rules and with an increasing headwind - and with a patient on board - you realize that your fuel state is lower than you had expected it to be. You determine that you can either; reach your destination with 5 minutes of fuel remaining, you can reach an enroute fuel stop with 10 minutes of fuel remaining, or you can land at a nearby hospital helipad immediately with 20 minutes of fuel remaining. After conferring amongst yourselves on board the aircraft you decide to:

a.    Continue on to the original destination.

b.    Proceed to the enroute fuel stop. 

c.    Land at the nearby hospital helipad.

6.      The medical flight team members have the authority and responsibility to speak up when they are concerned about safety of flight operations.

a.    This is a true statement.

b.    This is not a true statement.  As stated in the FARs, the pilot is the final authority when it comes to flight operations, and his or her decisions are final.

c.    This is a true statement, but the flight team must be aware that the timing of - and the manner in which - questions are asked and statements are made can affect responses and outcomes.

7.      One of the hazardous attitudes covered in class was judged to be the most insidious and dangerous to HAA flight teams by the AMRM instructor. It was…
a.    Invulnerability. A pilot with thousands of hours of experience judges herself to be impervious to any sort of adverse events.

b.    Anti-authority. As HAA pilots are largely self-reliant “lone-rangers”, and are frequently forced to improvise, adapt, and overcome in order to get the job done - over time they tend to bypass  rules and approved-procedures in favor of techniques that work for them personally.

c.    Get-home-it is. This is the most dangerous of all hazardous attitudes in HAA operations because, at the end of the day, we all want to get back to our base. We accept risk as a group.

8.      There is a known positive-correlation between experience-levels and the quality of decision-making. A more experienced leader or team-member has been shown by research to always make better choices.

a.    True. Intuitively we understand that experience improves understanding and the ability to make good decisions. A more experienced team is always going to perform better in a challenging environment, and there is no reason for an experienced leader or team member to include new team-members in the decision-making process. A new team member need never question the decisions of an experienced leader.

b.    False. Research has shown that decision-makers don’t always make better choices with more experience. Because of the demands of a naturalistic environment, the use of heuristics (rules-of-thumb), and choices that satisfy/suffice (satisfice) in a time-critical, high-consequence environment, experience does not always equal the best decision.

9.      Any member of our team may provide a solution to a problem, or help prevent a mishap or adverse outcome.

a.    True, even a non-aviator can provide life-saving information and assistance.

b.    False. A pilot has no business making any observations whatsoever regarding a patient’s condition or care.

10.   Conducting Helicopter Air Ambulance flight operations is inherently dangerous, and I must accept that such danger is part of the job. I don’t concern myself with “what will be.” I leave my fate to chance and hope. I know that inevitably, some number of HAA crews will be killed each year and nothing can be done to change this.

a.    This is an example of realistic thinking. Good for you. You are pragmatic enough to accept what history has repeatedly shown to be true.

b.    This is a classic example of the manifestation of the hazardous attitude known as “resignation.” I can indeed influence my fate, by adhering to the tenets of AMRM and by being an all-in member of this flight team. 

c.    As a medical flight team member, I don’t know enough about flight operations to ask questions, and I don’t feel comfortable requesting education about the flying side of HAA operations.

d.    As a pilot, I understand that “fate is the hunter,” as explained by famous aviation writer Earnest K. Gann. No matter how much I prepare, no matter how thorough and dedicated to my craft I am, I must accept the fact that a mishap is a real possibility. Since I cannot eliminate risk, I will not concern myself with it. 

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