Air Medical Resource Management Thoughts

Recently I was fortunate enough to present Safety classes at HAI’s Heli-Expo in Dallas and AMTC in Charlotte. What awesome experiences they both were allowing me to meet some super people.   Toward the end of each class I asked for assistance from the participants as I am conducting a study into the risk personality types and general risk tolerance of helicopter pilots and more specifically air medical crew members. I believe, and preliminary findings are supporting this, that this study could easily lead to a better understanding of cockpit communications and improved CRM/AMRM, especially in the Helicopter Air Ambulance Industry where non pilot crew members are an integral part of the flight crew.

If you are either a helicopter pilot or an air medical crew member, your participation would be invaluable. I have been conducting this study for over a year now so if you have already taken it, thank you so much. If you would like a copy of your report for the Risk Type Compass just let me know when you have completed it and I can send it to you. If you have a crew or team take it, provide their names once they are complete and I can even send a team report.  If you have any questions please feel free to contact me directly.

Thank You and please complete BOTH STEPS below;

Step 1. Click here (https://www.surveymonkey.com/r/Helicopterrisks) to take the Demographics Survey.  Study Instructions — To participate, start with taking this short survey to help me gain some basic demographics. At the end you will be asked to provide an email address to connect the survey with the questionnaire. If you DO NOT wish to provide your email address and name, you may replace them in both the survey and Risk Type questionnaire with a unique PIN number of your choosing. It should be at least 4 digits long and exactly the same in both the survey and questionnaire so that when they are both complete we can match them up for statistical comparison. However, if you would like your results I will need your email address and name, but that is the only thing they will be used for. Also if you want your results of the Risk Type Compass please email me to let me know that.

Step 2. Click here  (http://www.psy-key.com/) to take the online Risk Type Compass®.    Please follow the instructions below and again use the same unique PIN, or your email and name, as you did in the survey.

Enter access code: RTCKCPILOTS then click continue.

Follow the on-screen instructions

Completing just the survey does not provide enough information and will be discarded without the Risk Type Compass being completed. The survey and questionnaire together should take between 20 to 30 minutes so please ensure that you have sufficient time to devote to uninterrupted completion of the assessment.

Thanks ahead of time for your participation. I appreciate it very much and I am excited about how we can use this data to enhance training and safety.

If you have any questions or want to know more, please contact me below.  If you call please leave a message if I do not answer, as I may be out on a flight myself.  I will get back with you as soon as possible.

 

If there is anything else I can do for you or your flight program, please let me know.

 

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A diverse team at work at an accident scene.  Every individual here, EMT's, firefighters, bystanders, ground and air responders bring different personalities to the scene and have to find a way to work together.

A diverse team at work at an accident scene. Every individual here, EMT’s, firefighters, bystanders, ground and air responders bring different personalities to the scene and have to find a way to work together.

Air Medical Resource Management (AMRM) or Crew Resource Management (CRM) is something that is done daily, on every flight, and every transport. AMRM/CRM is how we communicate and make decisions in the helicopter or vehicles with our crew members, and how we communicate with others that impact the flight or transport like mechanics, communication specialists, administrators, emergency room personnel and the patient.

AMRM/CRM Training is the yearly requirement. The difference is significant and the confusion is something that I hear and see often when talking to individuals about AMRM. There are a lot of people who feel AMRM is something that we do once a year in a classroom and then we are done with that requirement for another year. This came to my attention recently when I was asked in an email for my opinion on whether or not AMRM is the training we get every year. The writer states;

“many people say that this knowledge is just part of AMRM and already covered. I think the application of this knowledge is AMRM, but not how the knowledge is acquired. What is your thought on whether AMRM includes the knowledge acquisition?”

Here is my response.

I think a lot of people, especially administrators, feel that AMRM is another task needed to meet FAA and certification requirements.  When treated as a task or required class it is nothing more than knowledge without application.  It is the application of that knowledge that is so important.  AMRM and CRM are ways of communicating not a class on communication.  You stated “I think the application of this knowledge is AMRM, but not how the knowledge is acquired.”   You are absolutely correct in the statement that the application of the knowledge gained is AMRM. But the second half of the statement can actually be labeled as AMRM TRAINING.  It seems we always want to shorten things and in this case AMRM training simply gets shortened to AMRM.  Therefore most people equate AMRM with the training or way of gaining knowledge and as instructors we tend to forget to focus on teaching how to apply that gained knowledge. 

So to answer your last question, AMRM does not include the knowledge acquisition per se, but instead is the actual application of that knowledge.  Here is another way to look at it.  I can bring a video on how to play soccer and teach a class on it but we are not playing soccer until we go out and apply that knowledge.  AMRM is not the same as AMRM training for the same reason. 

AMRM and CRM are integral in an organization with a strong safety culture. AMRM training is a small but important part of AMRM that should never be treated as just another yearly requirement or catch phrase. It is the application of that training that becomes a way of life for a group of professionals that not only talk the talk but walk the walk of safety.

One of the best things about my military career has been the variety of assignments that I have experienced. When I retired from the Army I started a small consulting business utilizing my training in leadership, team and personality training experience and built upon my final assignment as the Chief of Leadership Training for  the Army Reserve’s Readiness Training Command.  Unfortunately it did not take off well and in a short time I was looking for an actually paying job.  Fortunately with a Sunday morning phone call the day before I would have accepted a full-time job an old Army buddy asked me if I was interested in flying again.   A couple of months later I started flying helicopters again although this time it was for a hospital instead of the Army and I was able to put to use flying skills I had learned in the Army that I did not think I would ever use again.  Now, over 6 years later I am bringing skills from both of these divergent lives together in something called Crew Resource Management (CRM) or Air Medical Resource Management (AMRM) training.

CRM and AMRM are both fancy names for team communications skills.  This is nothing new and has been around for quite some time.  What I believe is different is my approach to it.  You see for the past six years I have continued my quest to gain experience and knowledge in the areas that I pulled together originally to do business as a consultant; communications, team dynamics, conflict resolution, interaction styles, group decision-making and the like.  I have attended workshops and certification courses, earned a master’s degree in Education, and become certified in a diverse collection of personality assessment tools. Assessment tools that look at a person’s core values and behaviors, cognitive/decision-making processes, emotional intelligence, conflict/interaction modes, need for inclusion or control, and more.  More important than an assessment though is the ability to bring an understanding of how to apply the theories behind these assessments without worrying about the results.

While I personally like talking  and discussing CRM/AMRM, I have always felt that the HEMS industry in general are focusing on the wrong part of CRM/AMRM while many individuals see AMRM as just another mandated class turned into a yearly requirement.  What we are in fact trying to deal with is the difficult task of combining several individual personalities into one crew without giving them the knowledge( or even talking about it in a meaningful way) of how to do this.  The problem I see here is a lack of training and understanding in how much individual personality types affect a crew decision.

Advisory Circular 00-64 is the FAA’s Recommendation to the HEMS industry of what should be talked about in AMRM.  While not an overly large document, they spell out what topics should be addressed without mandating how to actually go about it.  But within the 18 page (approximately 6000 word) circular, is just one sentence and a smattering of inferences that talk about personality types.  The very next paragraph has all of two sentences on group dynamics, which should be addressed as much as individual personality types.  The topics of these two paragraphs influence almost every other topic of discussion in the circular.  So that you do not need to go look it up here are the two paragraphs or three sentences.  (Go here to see the actual AC 00-64)

Understanding of Basic Personality Types.  The type of personality defines “what” is important to an individual and significantly influences the way one makes a decision.

Understanding of Group Dynamics. The “group” may have its own way of making decisions. The group should be aware that perhaps their “informal” structure does in fact work in a formal organization.

My contention is simple here; I believe that these two paragraphs should be the focal point of a meaningful AMRM/CRM program and not just an “Oh, by the way…” This program is not about an annual “check the block” requirement that has to be met.  This program is not about how to fly, how to drive, how to administer to a patient, or how to be a communication specialist or a mechanic.  This program is not about pilots, ambulance drivers, medics, nurses, doctors, mechanics, comspecs, or administrators.  This program is about people.  About individual personalities that HAVE to come together as a group and deal with their varied and unique personalities in a meaningful way so the group dynamics on the crew can be such that they complete each and every patient transport, reposition, static display and demonstration safely.

This past fall I decided that I was going to stop standing on the sideline and became an AMRM instructor for the company I fly for.  More importantly this coming fall at the 2014 Air Medical Transportation Conference in Nashville TN, I have been selected to give two presentations on incorporating personality type and group dynamics as the focal point and not an afterthought of a meaningful AMRM/CRM training program.   The first one will be a six-hour pre-conference workshop incorporating a personality assessment and looking at how personalities affect the crew dynamics.  The second will be a one hour  education session and discuss how personalities affect team building in this industry. I recognize that this is a very new approach to an industry wide training program and a lot of education needs to be done yet. While I may not know where or how this will look 5 years from now, I do know that individual lives are at stake and it is those individual personalities that will either make a safe team or fail in that attempt depending on how they approach team dynamics.  I also know that we can no longer afford to have everyone learn about how they might best fit into a team through trial and error.

We as an industry cannot expect everyone to learn and treat the topic of AMRM the same way, although that is the goal.  It was one thing when we mainly concerned ourselves with one profession.  Pilots in general tend to be similar in personality or have figured out how to deal with training and certifications as just the way it is.  AMRM encompasses a whole new group of professionals that do not normally deal directly with the requirements of flight and yet they have been made an active and meaningful part of the crew.  Medical crew members have learned to speak a different language and have very different backgrounds and experiences from professional pilots. Likewise when actually performing the tasks they are hired to do, they often have very little time to focus on the flying business.

Thankfully, using a simple model of personality as a bridge between the various groups of professionals involved allows for a common language that can easily be learned.  The one thing we all have in common in the air medical industry is that we are all different.  As an aviation unit operations officer for the US Army I was once told that I had a personality conflict with an individual that I absolutely had to work with daily, and that I should get over it.  So instead of ignoring this or writing it off as something for you to get over, I am proposing that we stop ignoring the individual personalities that are present in any team or crew.  Stop telling your teams that there is no “I” in team – The “I” is every individual team member.  What we should be teaching them is how we can turn a group of “I’s” into a cohesive team that they can proudly refer to as “we”.  Especially when they get done with a flight or transport, and in their post transport debrief can claim that “WE made a great decision tonight”.