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HEMS Scenario Based Training, The Need for Reality

Posted 13 years 153 days ago ago by Admin

By Stu Buckingham - It wasn’t too many years ago that most helicopter operators in the US conducting EMS operations would hire a pilot, then in company training validate that pilot to commercial standards per the Federal Aviation Regulations, and quickly send him to a field base to conduct EMS operations for a customer without so much as telling him what the EMS mission he was about to perform was all about. It wasn’t a FAA requirement to train to the mission, but it was a requirement to train the pilot to operate the aircraft safely while conducting the mission, whatever that mission might be. That is where a major problem lied and many operators didn’t realize it was an issue that needed to be dealt with.

For the new pilot though arriving at an assigned medical base, most got caught up very quickly in the whirlwind of learning a new aircraft, a new area of operations, and these new passengers who were now also required crewmembers. Often times he was also unknowingly exposed to the politics of competitive issues between medical organizations and what that meant to his performance as an EMS pilot. This competitiveness related directly to his capability to provide a quick response time for a flight request which logically defied the principles of operating the aircraft safely. Launching an aircraft in the middle of the night to an unknown location in unknown weather in minimum time, often in just minutes, and not being unable to properly prepare for the flight as trained, created a stress level many pilots did not want to deal with.

Was it any wonder a company’s turnover rate for pilots hovered in the double digits for many years as operators struggled to keep up with the demand for more pilots to fill their aircraft seats in an ever expanding HEMES industry? The aviation operators kept providing pilots with minimum training and hopefully the pilots would figure out the world of EMS without killing themselves doing it. To the credit of the helicopter pilots who were sitting in those seats, many did figure it out. Unfortunately, some didn’t.    

But the question today facing the industry is this. What was missing from the training or knowledge of the mission in those pilots that did not make it that needs to be corrected now?  That is a very hard question to answer but here are some thoughts about it.

When an accident occurs the National Transportation Safety Board does a thorough analysis of the subject aircraft and its mechanical history. The NTSB will also do an analysis of the pilot’s aviation background. This is mostly limited to the airman’s current certificates and ratings, recent duty time, last training dates, and accumulated flight hours in category and class of aircraft the pilot was rated in. Looking at this, the logical question that begs to be asked is – did the pilot receive training appropriate to the mission being performed and if he did, could this accident have been avoided by successfully completing that training? The picture is now starting to come together on why some of these accidents have occurred and what can be done to correct the situation.

HEMES operations over the last 30 years are relatively new to the field of aviation compared to aviation operations in general. Because of the industry’s expansion, the FAA has just recently taken an active interest in providing operational guidance that is specific to the HEMES industry. Some of the areas that have been given FAA guidance are the pilot’s mission risk assessment procedures, company-wide operational control centers, and an emphasis on Air Medical Resource Management (AMRM) training. But the FAA has still not involved themselves in regulating what type of HEMES training needs to be accomplished to successfully prepare the prospective EMS pilot for the mission. It is still falling upon the operators to create and implement a training program that will accomplish this. Today more and more operators are turning to HEMES scenario-based training as a major step in providing the much needed pilot and crew member training to successfully accomplish the mission. In review of the FAA requirements to prepare a pilot to conduct a Part 135 mission, an operator needs to train on subjects that are mostly aviation and aircraft systems related. This is proving to be not enough to successfully do the mission today. Looking back at some of the industry accidents, it could have been possible to prevent some had realistic HEMES scenario based training focusing primarily on pilot judgment and decision making been in place.

In scenario based training the pilot and crewmember educational process begins with a solid foundation of piloting skills, aeronautical knowledge, EMS related aviation knowledge, AMRM to include team procedures, and historical information on accident prevention. As a side note this criteria has now become the basis for our safety culture within this industry.  

A successful scenario based program would include elements of the following list. This is in addition to the FAA requirements already in place for aeronautical and aircraft systems pilot training. The curriculum below mirrors in part EMS pilot training standards already in place through CAMTS (Commission on the Accreditation of Medical Transport Services) and a Recommended Practice of the AMSAC (Air Medical Safety Advisory Council)    

EMS Specific Pilot Training

Pilot Ground Training-EMS Specific Operations

- Judgment and Decision making

- Risk Assessment and Management

- Human Factors Management

- Preflight and in flight stress management - all phases of flight –

- Workload Management and Delegation

- Cockpit Distractions and Task Saturation – Multi-tasking

- Situational Awareness

- Air Medical Resource Management (AMRM)

- Inadvertent Instrument Meteorological Conditions Procedures

- Shift change and crew briefing procedures

- Flight requests - types of and response procedures

- Pre-launch and en-route communications, weather checks, & A/C procedures

- High recon, low recon, landing, shutdown, patient loading and unloading procedures

- Wind considerations – en-route and at destination

- Post flight procedures - aircraft and mission requirements

- Crew de-brief procedures

- Flat Light and White Out training


If the company is fortunate to have a flight simulator/flight training device or contract with a simulator provider the following subjects must be part of that curriculum as well. If possible interactive sessions with pilots and medical crews should be incorporated into the scenarios that are being presented.


Flight Simulator/Flight Training Device Flight Training (if available)

- Judgment and Decision making

- Workload Management and Delegation

- Cockpit Distractions and Task Saturation – Multi-tasking

- Situational Awareness

- Flight controls and hydraulic system.

- Operating limitations.

- Emergency and malfunction procedures

- IIMC Procedures 

Just as operators of large commercial aircraft have learned over the years, the more realistic the training, the better the outcome will be when an actual event happens. The advantage of having simulators for training unlike an actual aircraft in a training role, the simulator can be taken to finality and the lessons of failure to perform properly can be learned without damage to the aircraft or occupants of the aircraft.


In the first part of this year, the renowned US Airways pilot Capt C B “Sully” Sullenberger retired from Part 121 commercial flying to concentrate his efforts on establishing effective scenario based training for pilots. He is acutely aware of what is lacking in preparing pilots for a real world mission and believes that because of his recent experience on the Hudson River his voice will be heard in the places in needs to be heard in. There needs to be that same type of effort in place throughout the entire HEMES industry to properly train our current and future EMS pilots. If not, then there will always be those few that will not “get it” quick enough and we will read about the results of that failure to perform and wonder what we could have done to prevent this from happening again.

---Stu Buckingham currently is a line pilot for Omniflight Helicopters Inc. He has been a dual rated pilot since 1973 and an EMS helicopter pilot since 1990. During his career he has been a HEMES base manager, a base safety officer, a base training officer, an assistant chief pilot, a regional manager, and a Part 135 Director of Operations for a HEMES operator. He is also a NEMSPA member and serves on the Board of Directors.