Jul 26 2021

Air Medical crew in the front seat? Posted 2 years 275 days ago ago by Admin

“Is having a medical crew member in the co-pilot seat a positive or negative safety issue?’  That’s a question a flight nurse put to the helicopter air medical community a while back.  How would you answer that question?

If I had to offer an answer, my first thought would be that we can learn a lot from the way the Australians operate their air medical helicopters.  In 2013, I was invited to speak at the equivalent of their air medical transport conference held in Melbourne that year.  My wife and I arrived two-weeks prior to the conference and we were given tours of several of their HEMS bases in Sydney. We were surprised to learn that to fly HEMS in Australia you have to be able to legally fly IFR.  In many programs they don’t employ a second pilot but they have what they call a ‘Crewie’ (short for crewman) to fill that role. 

A Crewie is a medical person, typically a paramedic, who sits in the co-pilot’s seat and is trained to co-pilot standards except for the actual hands-on stick-and-rudder skills.  We were told that before a Crewie can operate in that capacity, they must attend a pilot’s ground school course to learn what a pilot has to learn.  Doing so, gives them insight as to how their actions or inaction can affect the safety of the flight.  Once they pass the ground school, they are given training in the helicopter to learn how to become a competent co-pilot. 

We can learn from the Brits as well.  There was a TV program in Britain called Helicopter Heroes that ran from 2007 to 2015.  The program followed the lifesaving work of the Yorkshire Air Ambulance.  As the helicopter flew to the scene of an accident, the cockpit view revealed a paramedic occupying the co-pilot’s seat.  They can be seen helping the pilot with map reading and conferring with the pilot on aspects of the flight as it progressed.

When I flew single pilot IFR (SPIFR) in in a Bell 222 in San Diego back in 1982, there were times one of our medical crew would occupy the empty co-pilot’s seat.  We did not, however, train them to help out the pilot.  They were, in essence, there for the ride.  Thinking back, I wonder if we missed an opportunity there?

Paradoxically, in my experience flying in the two-pilot environment, flying with a relatively inexperienced fully-trained pilot acting as co-pilot can, at times, create added workload on the pilot in command because the captain has to monitor what the co-pilot is doing as well as pay attention to his job of flying the aircraft.  The added responsibility of having to keep an eye on a second person up front has the potential to cause a higher than normal workload on the captain which is something to consider.

Looking on the flip-side, let’s say you trained one of your medical crew, using good crew resource management to interact in concert with the captain, to read a checklist, or an instrument approach plate and you also teach them how to interpret the flight instruments.  A crewman similarly trained could not only help unload the pressure on the captain to accomplish these necessary tasks, but also be an extra set of eyes to act as a backup to the pilot’s situational awareness by ensuring they both have the same mental model of what has transpired, what is happening now and carry that perception forward to what will happen in future.  For these reasons I would argue there are definite benefits to involving the crewperson sitting in the front with the pilot. 

Sitting up front and not in the back would also serve to give the medical crewperson a better perspective, an appreciation of what the pilot contends with while managing a flight.  It would also drive home the importance of the ‘sterile cockpit rule,’ where nothing other than relevant conversation should take place in critical stages of flight, like during takeoff and landing and perhaps when preparing for and during an instrument approach.

In my view, in visual metrological conditions, (VMC), having someone up front would be fine. We used to do that all the time in San Diego in known VMC conditions to act as a second et of eyes up front.  But if you want a team member to perform crew duties to help the captain, it goes without saying that it depends on the level of training, skill and competency level of the person you allow to occupy the co-pilot’s seat. 

Another consideration is you must determine their willingness to participate in that role. I can imagine there may be a medical crew member who would not be comfortable helping the pilot with his aeronautical duties, unwilling to accept such a big responsibility. That’s a fair concern, especially when operating in IFR conditions or in marginal weather when the pilot may be in most need of a helping hand to lighten his load.

I have flown over 30 years in a two-crew cockpit when flying abroad.  As an airline transport pilot, ATP, flight examiner in the aircraft and the Level-D flight simulator evaluating over 20 nationalities of pilots in the two-crew capacity, I know first-hand the value of having another trained person up front to help share some of the workload.  So the question, “Is having a medical crew member in the co-pilot seat a positive or negative safety issue?’ certainly has valid arguments both ways.  What are your thoughts on the subject? 

About Randy:
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].