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Air Ambulance: Are the systems making us safer?

Posted 4 years 142 days ago ago by Admin

I was so lucky, when I first began flying helicopter EMS in 1999 when my first director of ops told me that he would rather me turn down a flight and go back to sleep, than push weather limits. However, the go/no-go decision was still my sole decision to make. At the time, I probably did not appreciate my director’s sentiment as much as I should have.

Opposite that sentiment, I was recently eating dinner with a senior pilot who’d been in the air ambulance business for more than 30 years. Over a beer, he explained the process of how flights were accepted back in the early days.

The initial phone callout provided crew with patient location and injury type. The pilot would assess weather using limited sources, (as compared to today) and make a go/no-go decision. If the weather was bad, they were encouraged to go “stick their nose in it” to see if the pilot could find a way to complete the flight. “There was a time when pilots were incentivized to figure out a way to complete flights and were paid a bonus for each completed patient flight.” He went on to say that he could not remember the exact amount, but it was something like $50 per flight. I incredulously asked, “Let me get this straight, pilots were paid $50 to figure out how to complete a flight?”

Additionally, back in the early days, pilots may have viewed the medical crew as “walking baggage” with little-to-no input on whether or not to accept the flight.

No “I” in team.

Fast forward 30 years and the decision-making process from start to finish is no longer only on the shoulders of the pilot, but more of a team effort. Don’t get me wrong, regulations state the pilot-in-command still has ultimate authority regarding aeronautical decision making, but the modern-day air ambulance pilot has far more resources to aid in making decisions.

The most common safety initiative has been the introduction of the FRAT (Flight Risk Assessment Tool). This process takes the decision making beyond the pilot and into other team members and supervisors to help him/her make decisions.

Many operators have also created a robust operational control center (OCC), which creates another tool box for the pilot and crew to access during a flight. OCCs, typically staffed 24/7/365, may include a pilot, maintenance, and medically trained communications specialists as well as up-to-the-minute weather information. The goal of an OCC is to provide pilots with the information they need when they need it prior to, or during, a flight in order to aid the decision-making process, thereby making safety a team effort.

Accident rates in air ambulance have been cut by more than half since the 1980s as systems have been improved, but we still have several accidents every year. With proper training, a team effort, and more resources than ever, HAA should continue to be one of the safest sectors of our industry.