Ideas Needed -Safety Seminar

[I_Money]

I'm going to get some flak for this. I don't think the medical staff should have much of a say in the go/no-go decision process and should have even less clout in questioning those decisions after the fact. It runs in the same vein as a pilot questioning method of care, we would never do it nor should we. We (pilots) don't have the knowledge or experience to make any sort of quality judgement call, same goes for the medical staff vs aviation stuff(s). Does your operation let medical staff sit up front and help with checklists and whatnot? While I think it is a good to get folks involved and let them "see" the flying, I think it is bad practice to start blurring the lines of responsibility and authority. Just like a pilot doesn't sit in the back and push meds or run the vent, medical staff shouldn't be overly involved in the operation of the aircraft.

Now, how do you do this without creating a rift between pilots and medical staff? I really don't know. There are some really big egos out there, on both sides of the cockpit door and this kind of thing is just prime for heads to butt

The person who actually approached me on this subject was a pilot - so it is a pilot driven initiative that so far is receiving great reception from all. HEMS is a unique operation that really intertwines flight and medical crews - I am not sure if medical crews being involved in flight operation came about post accident, however I believe such things as using medical crew to spot for hazards and the 3 to go, 1 to say no rule were. My idea is to enhance their knowledge to be more effective in this role. This isn't to empower medical staff to confront pilots on the decisions they are making, but is more to allow them to follow in thought patterns, ask questions and work in two separate fields as a harmonious team. To answer your question in many operations on the flight out medical member sits upfront to assist with the pilot.

I do know of a few EMS operators that have had policies of having the pilot/flight crew not made aware of specific patient demographics or injuries, so as to not have a go/no-go decision influenced in any way by that information.

Most programs do not give any patient information until the flight has been accepted and helicopter is in route.

 

[moxiepilot]

In a medical helicopter group I belong to we were talking about enhancing team work. Currently every program has a 3 to go, 1 to say no policy however in our think tank today we questioned if medical crews understand enough of the aviation side to be able to be useful team member. We are exploring the possibility of creating a seminar that covers topics that that will allow non pilots to follow the pilot decision making. So far we have:

- Weather/Weather Reporting
- Inflight Hazards
- Emergency Procedures
- Basic ATC/Airspace/Navigation
- Avionics/GPS
- Preflight/weight and balance

Do you have any other ideas?

How about a topic that covers the regulation that the PIC makes the decision of a go/no-go decision, not 3 people. External pressure is a nice way to get people killed.

 

[I_Money]

Moxie - all the programs are saying is for the flight to go everyone has to be in agreement it is safe, if one person has a reservation about the flight safety they can refuse, cancelling the flight and not fear retribution. The notion that you and other pilots are so resistant to input of concerns from other parties is quite frankly scary -

 

[Dugie8]

It's not fear of input or not considering input from medical staff. This is what I am talking about. The second a discussion comes up about the PICs ultimate authority and responsibility for the flight in EMS the medical side gets up in arms about it.

This is akin to a FA canceling a flight because of TS enroute.

I don't know if the medical side views EMS pilots as entry level or early career positions but I have never had my decisions or my peers under more scrutiny than flying EMS and that doesn't come from my management. It isn't the scrutiny it's the automatic jump to the conclusion that the pilot did something wrong while never having talked to the pilot(s) about the situation.

That kind of attitude comes from putting medical staff on the same level of authority as the PICs.


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[moxiepilot]

The notion that you and other pilots are so resistant to input of concerns from other parties is quite frankly scary -

Dougie states it well. It's not resistance to accumulate information from other parties it's the fact that the PIC is, in fact - and does not have PIC authority.

I have operators give me their opinion all the time on what they think with regard to the flight mission. If they had authority to cancel my flights many of us wouldn't have a job at this company because no revenue would come in. My point ultimately is let the PIC make the PIC decision - not someone who may or may not have the ability, experience or proper judgement to make a PIC call. That's what you pay us the big bucks for, right?

 

[I_Money]

Isn't that a good reason to educate and foster teamwork?

If you analyze accidents recently - don't you agree there has been some bad decisions?

Dec 2011 FL - Night IFR, no flight plan filed altitude between 200-700 feet.
Nov 2011 IL - Ran out of fuel
Aug 2011 MO - Ran out of fuel
Aug 2010 AR - Flight into IMC, possible ETOH

 

[moxiepilot]

you may be agreeing with me or perhaps we agree with each other, it just might be lost in translation. Teamwork is one thing. Allowing someone who is not the PIC to make the decision for the PIC about a flight undermines the authority of PIC.

Accidents happen, but the flight crew doesn't get blamed now do they? The PIC does. Let me keep my authority to make the flight decisions and I'll let you keep your authority to make medical decisions.

 

[dustoff17]

Isn't that a good reason to educate and foster teamwork?

If you analyze accidents recently - don't you agree there has been some bad decisions?

Dec 2011 FL - Night IFR, no flight plan filed altitude between 200-700 feet.

At the end of a long day, storms coming, trying to get back to base for shift end....my bet is the entire crew agreed on this one.

Nov 2011 IL - Ran out of fuel
Aug 2011 MO - Ran out of fuel

Do you think the med crew was even aware of how low the fuel was? Was it a discussion in the aircraft? I think it was not. In the MO flight, the med crew knew they were diverting for fuel but there is NO way they knew the fuel was that low. The PIC knew but this was not a crew decision here. PIC only and a bad one at that...

Aug 2010 AR - Flight into IMC, possible ETOH

ETOH? Sorry.....

While I agree that the "concept" or "theory" of 3/1 is good, its' application is bad. The med crew needs to have input but the PIC should have the final word. And whether to put in an IV should be left to the med crew.

How about this: Fly to a scene, delayed on the ground for an hour, sun sets, Nurse "not comfortable" flying at night: What's the next move? Stay on the highway for the night and get an ambulance? How about no ambulance.....at what point can the PIC make the decision?

Consider the crash in OK in 2010; ALL of the crew was in agreement to hotdog at tree top level, ALL of the crew thought it was cool and ALL of the crew "trusted the pilot". Almost all of the med crews at the base had flown in this manner, with this pilot. If only one nurse or medic had said "no", they might all be alive. The pressure to accept the decision of the PIC is already there, even if you don't want to talk about it in a classroom setting.....

 

[I_Money]

At the end of a long day, storms coming, trying to get back to base for shift end....my bet is the entire crew agreed on this one.

Your bet is wrong - this was an organ procurement flight, departing from the hospital to pick up the organ.

Do you think the med crew was even aware of how low the fuel was? Was it a discussion in the aircraft? I think it was not. In the MO flight, the med crew knew they were diverting for fuel but there is NO way they knew the fuel was that low. The PIC knew but this was not a crew decision here. PIC only and a bad one at that...

It was discussed on the ground before departing that his initial fuel calculation was off and he weighed up options. The idea of this course would be to make the medical crews more aware of such operational issues.

ETOH? Sorry.....

Possibly been drinking...

While I agree that the "concept" or "theory" of 3/1 is good, its' application is bad. The med crew needs to have input but the PIC should have the final word.

No one is saying the pilot does not have the final word - all we are saying is that an educated team is going to enhance safety of the flight.

How about this: Fly to a scene, delayed on the ground for an hour, sun sets, Nurse "not comfortable" flying at night: What's the next move? Stay on the highway for the night and get an ambulance? How about no ambulance.....at what point can the PIC make the decision?

You example is illogical and has no application to the debate on hand.

Consider the crash in OK in 2010; ALL of the crew was in agreement to hotdog at tree top level, ALL of the crew thought it was cool and ALL of the crew "trusted the pilot". Almost all of the med crews at the base had flown in this manner, with this pilot. If only one nurse or medic had said "no", they might all be alive. The pressure to accept the decision of the PIC is already there, even if you don't want to talk about it in a classroom setting.....

We are all human and make bad decisions, but working together I believe we can have a better outcome. Hopefully other people will learn from this tragedy. Just to share what this pilot left behind (from a memorial):

Daddy,
I'll never forget the story you told me of the little boy you flew who was so sick and looked up at you and asked, "are you a super hero?" You of coarse smiled and said no. But then the little boy smiled back and said, "you are to me"
I thank God everyday that I got to have a real superhero for a daddy. I know your still watching the skies like always.
I love you with all my heart.
- Amber Harrison

 

[moxiepilot]

No one is saying the pilot does not have the final word - all we are saying is that an educated team is going to enhance safety of the flight.

Sure...mob mentality to the rescue.

While this thread has diverged from the original intent (which is usually the case with any thread) hopefully you have some good suggestions for topics of discussion. Obviously, to some pilots one of those topics is that the PIC is the PIC, independent of solicitation of other team input. Additionally, it is being pointed out cases where input from non-pilots does not make the outcome better.

The main point though I am looking an answer to is:

What scenario is there that a non-pilot medic supplies information to the PIC that ultimately changes the PIC decision to go or no-go? "oh, look - tornado?" Seriously. What information does non-pilot flight crew offer that changes a PIC decision?

 

[I_Money]

Moxie the point isn't to necessarily change the go-no go decision. But if the weather is reported marginal and the pilot reports that a pirep says it is better than reported then the medical crew understand what exactly that means. Or maybe if the weather is marginal the medical crew can request a pirep. An example of how welcoming the HEMS crews are to input, we were coming into a school play ground that was pretty tight, I saw power lines on the left side of the aircraft (remember helicopter pilots sit on the right) and just said 'are we aware of the power lines to the left?'. The pilot put the helicopter in a hover, stated that he was aware of the ones behind and to the left of the helicopter - we all confirmed there were no further power lines and proceeded to land. Upon touch down the pilot thanked me for my extra set of eyes and pointed out that even as a ride a long passenger I contribute to the safety and if I see any hazard let him know. How much effort was needed on his part to hoover and for everyone to confirm all power lines (the biggest danger to HEMS) were acknowledged? Remember my counterpart on this project is a HEMS pilot - she thinks it is a great idea.

 

[Dugie8]

To get back on topic


What kind of policy do you have with regards to people around the aircraft both on scene at an airport or in the pad? Is everyone primed to keep patients and passengers under positive control to keep them from being injured or damaging the aircraft??

Weatherturndown.com. Do you use it? If so whom enters the turn down and what information do you enter?

Does the med crew know what color the nav lights should be? How to ID unsecured panels? What to look for on the ground under the aircraft in terms of leaks?

Is there positive command when it is safe to open the doors? Sterile cockpit rules?


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[MikeD]

Moxie the point isn't to necessarily change the go-no go decision. But if the weather is reported marginal and the pilot reports that a pirep says it is better than reported then the medical crew understand what exactly that means. Or maybe if the weather is marginal the medical crew can request a pirep. An example of how welcoming the HEMS crews are to input, we were coming into a school play ground that was pretty tight, I saw power lines on the left side of the aircraft (remember helicopter pilots sit on the right) and just said 'are we aware of the power lines to the left?'. The pilot put the helicopter in a hover, stated that he was aware of the ones behind and to the left of the helicopter - we all confirmed there were no further power lines and proceeded to land. Upon touch down the pilot thanked me for my extra set of eyes and pointed out that even as a ride a long passenger I contribute to the safety and if I see any hazard let him know. How much effort was needed on his part to hoover and for everyone to confirm all power lines (the biggest danger to HEMS) were acknowledged? Remember my counterpart on this project is a HEMS pilot - she thinks it is a great idea.

In rotary-wing, the med crew is much more an integral part of the flying itself when airborne, as compared to fixed-wing, where they are much more mission-crew only when airborne. The two entities, though having missions that are similar, operate different with different mindsets.

 

[Flying Rancher]

We also initiate the 3 go one to say no policy. Granted I have only been flying EMS fix wing for about a year, but our company is tied directly with a hospital and we use their EMS employed personal. If at anytime the medical crew feels uncomfortable with the flight we will discontinue it and return home, whether or not I feel it is safe. The main reason is 1. we are a team and all input and concerns are addressed regardless and 2. if you cause any problems with the crew or hospital we will probably be on the unemployment line because if the hospital refuses to fly with you then you are no good for the company. And YES this has happened to one of our pilots and it has been over 20 years ago when this had happen with him and the hospital refuses to fly with him regardless of how much time has passed. So he has been black balled in the hospital, for what reasons nobody knows, but they will not fly with him. So it is also important that the med crews and pilots are an important crew that must work and respect each others decisions and input.

 

[MikeD]

The main reason is 1. we are a team and all input and concerns are addressed regardless and 2. if you cause any problems with the crew or hospital we will probably be on the unemployment line because if the hospital refuses to fly with you then you are no good for the company.

Curiously, in a situation where med crew doesn't go on a mission by their own call, and that decision is detrimental to the patient, when your call had been that it was safe to go; does the hospital assume all liability for that decision?

 

[Dugie8]

The real sad thing. Sending and accepting hospitals take no responsibility on the calibre of operation they put patients on, especially when the med crew has no affiliation with either facility

A fact that a savvy victim's survivor may exploit fruitfully one day.


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[dustoff17]

Your bet is wrong - this was an organ procurement flight, departing from the hospital to pick up the organ.

I know what the flight was about, it doesn't change my point. My bet was that the crew AGREED to take the flight. They all gave a "go", no one said that they didn't want to go because of the weather.

It was discussed on the ground before departing that his initial fuel calculation was off and he weighed up options. The idea of this course would be to make the medical crews more aware of such operational issues.

I'm in agreement with you here. I'm stating that, as it is used, a Med Crew's approval is slanted because they don't currently have all the info - I like the idea of tying them in more.

Possibly been drinking...

got it. That's a sad deal......

No one is saying the pilot does not have the final word - all we are saying is that an educated team is going to enhance safety of the flight.

Couldn't agree more.

Daddy,
I'll never forget the story you told me of the little boy you flew who was so sick and looked up at you and asked, "are you a super hero?" You of coarse smiled and said no. But then the little boy smiled back and said, "you are to me"
I thank God everyday that I got to have a real superhero for a daddy. I know your still watching the skies like always.
I love you with all my heart.
- Amber Harrison

I'm not bashing this crash, I'm saying that most Med Crews has the tendancy to go along with the PIC, sometimes to a fault. And, while his daughter had some fine words, Al seems to have lost focus on the big picture. He wasn't thinking of his family during this flight. He was a great guy and a hero to some but he got reckless. We all have reckless moments, I just hope mine is at home and not in the air.

 

[Blackhawk]

I don't know that it has gotten too far off topic. I can't imagine having a safety seminar and this topic not coming up even if it were not a formal subject as it is so integral to this mission.
I would add that when discussing subjects try to keep them geared toward the audience. For example, this audience will not be able to understand performance charts, but discussing some of the things that affect engine and airfoil performance (WAT- weight, altitude, temperature), would be helpful.

 

[I_Money]

I know what the flight was about, it doesn't change my point. My bet was that the crew AGREED to take the flight. They all gave a "go", no one said that they didn't want to go because of the weather.

But my point was not an air ambulance crew but an air taxi transporting a medical crew who likely got the belts and doors safety briefing.

 

[trafficinsight]

I suppose I would teach what they would see "out the window" that is relevant to a go/no go decision or a decision to continue, turn back, or divert. I don't know much about helicopters but perhaps things like fuel capacity and range, bad things to look for on the a/c while walking up to it, weather concerns, requirements for landing sites, spotting traffic... there's a lot of things you could teach them that would help you as the flight crew make a decision.

If you already have a 3 to go/1 to say no policy then this education can help you make the decision to go when someone might otherwise say no go because they don't understand. I just can't see where educating someone is going to make things worse.