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Words Have Consequences

Posted 4 years 131 days ago ago by Randy Mains

I recently read a troubling story on the Facebook page titled When Seconds Count. It was written by a concerned air medical pilot who recounted something the lead pilot had said in their weekly safety meeting. In regard to newly arrived uniform ball caps embroidered with the words “FLIGHT CREW” on the back strap, the lead pilot said, "You may be the medical crew, but according to the FAA, because you are not directly involved with the operation or safety of flight, you are not considered part of the flight crew." 

The FAA shares a much different view. If the lead pilot read page 4 of the FAA’s Aviation Circular 00-64 on AMRM, under the heading “BACKGROUND,” he would have seen that the FAA acknowledges the importance that the medical crew plays in ensuring the safety of every flight. The FAA writes: “Preventing accidents is the responsibility of everyone involved and takes the dedicated involvement of all of the aviation and medical professionals involved in the operation to provide the public the safest possible air ambulance service.”

The FAA is saying that the medical crew is directly involved with the safety of the flight, a fact I would think is self-evident and wouldn’t need to be said.  I would argue that even a layman to aviation would acknowledge that those aboard an air medical helicopter play a vital role in the safe operation of that aircraft.  

The pilot recalling that incident said the meeting was interrupted by an alert tone dispatching them on a flight. Once over the scene, the LZ commander motioned the pilot to descend vertically to the pavement below when the words, "Stop!" came through his headset.

He stopped the descent responding, "What’ve you got?" 

The paramedic says, "I see a state trooper looking a lot like he's running away from an impending helicopter crash." 

The pilot asked, "Can you see any obstructions below.”

The flight paramedic and flight nurse reported seeing nothing.  The pilot radioed to the LZ commander, "Is the area below us clear?" LZ command motioned him to move forward about 30 feet before setting down.  

Once safely on the ground and shut down, the pilot walked to the rear of the helicopter and saw a cable running across the highway almost directly above the tail rotor.

This pilot’s story, as it relates to the lead pilot proclaiming the medical crew are not part of the flight crew, reminds me of the early history of CRM in the airlines when 60 airliners crashed from 1968 to 1976, not due to stick-and-rudder skills but due to human factors according to an NTSB taskforce formed to investigate that alarming rash of accidents. When crew resource management was first introduced captains initially felt their captain’s authority was being eroded and doggedly resisted CRM.  These days all that’s changed and CRM is treated like a religion in the airlines. Modern captains understand they are still the ultimate decision-makers, however they must accept input from all team members who may have vital information that can affect the safety of the flight. Statements like the lead pilot made in the pilot’s story serve to create a them-and-us mentality which, like a cancer, will destroy a cohesive team.  

When I was asked to write the AMRM chapter for the Air Medical Physician’s textbook, I wanted a one sentence, high-concept definition of AMRM as a mental checklist for all team members. I call it my AMRM / CRM mantra, which is: AMRM is a team member’s awareness of how their action or inaction affects the safety of the flight, a team member being ANYONE who can have an influence on the safe operation of that flight.

Words have consequences. The lead pilot was technically correct in the definition of “Flight Crew” (as those he carries are termed “Medical Crew”) but from a safety standpoint we are talking semantics because the medical crew’s role is no less vital to the operation and safe outcome of the flight as was so well illustrated in this pilot’s story.  I personally have had my life saved several times by a flight nurse, paramedic or passenger who saw something I did not, or made a suggestion that helped my decision-making process.   

This incident brings me to the way AMRM training is often practiced in America.  Following the letter of the law and not the spirit of the law, the yearly AMRM requirement can, as you know, be satisfied simply by sitting at a computer and answering questions.  The airlines learned early on that computer training alone does not change behavior and that having a trained facilitator in the room does.  It is mentioned nine times in the FAA’s aviation AC 00-64 on AMRM. In Europe, for example, single-pilot helicopter operations can satisfy the CRM requirement by having the pilot do his CRM training by computer alone. That is not the case under the European Aviation Safety Agency (EASA) regulations if flying single-pilot with medical crewmembers on board. Air medical crews must satisfy the same requirement that two-crew (pilot and copilot) must accomplish, which includes a CRM course run by a trained facilitator.

So, why is facilitation important? Well, imagine if in this program, when the next AMRM class was given and run by a trained facilitator, the subject of this particular incident could be addressed by the team. The facilitator could then ask the class why this type of comment by the lead pilot might cause resentment.  Then the group could talk it out and hopefully resolve the issue, something that cannot be done on a computer.  Perhaps the lead pilot, when he or she made this comment, did not stop to consider that his or her statement would cause such consternation and resentment among the team members as to cause a severe rift in team cohesiveness.

Let me close by recounting a story told to me in one of my AMRM classes highlighting an extreme and highly dangerous example of a team member. A flight nurse who had had an earlier argument with the pilot, decided to “show the pilot” she was no longer going to be an integral—and indeed vital—member of the team.  When on approach to a street landing zone, she did not mention the wire she’d spotted and let the pilot fly into it!  Luckily no one died.  Absolutely crazy to be sure (and in my mind a firing offence) but it shows how important every member is in that aircraft to ensure a safe outcome to each and every flight.  

I like what the pilot recalling this incident on the Facebook page noted at the end of his story: “Air medical companies are now requiring their pilots to exercise Crew Resource Management to the fullest extent available. Makes sense to me.”  

I couldn’t agree more.

Randy Mains is an author, public speaker, and a CRM/AMRM consultant who works in the helicopter industry after a long career of aviation adventure. He currently serves as chief CRM/AMRM instructor for Oregon Aero. He may be contacted at [email protected].