Saturday, August 7, 2010

Marginal Weather Flying ~ Civilian EMS

In previous posts I covered marginal weather flying in the military. Civilian EMS is a whole different ballgame that requires a different mindset.

When I first knew I was going to get a job flying civilian EMS I called a buddy of mine that had flown EMS previously. He gave me the best attitude mindset about the job than any other I've heard. He said, "Dave. That aircraft is not there for just any given patient. It is there for all the patients it may have to serve in the future too. If you make a bad decision and break your aircraft because you pushed weather, or worse hurt or kill yourself and/or your crew because you made a bad weather decision; you just took that aircraft out of service for all the people that will need it down line".

Most of the unknowing public consider civilian EMS as a job for heros, but in reality it is not. Pilots are told to consider their patients as simply a box of rocks they are trying to deliver. There is no sense in risking your life or your crews life for a box of rocks, so if there is any question as to safety; the pilot does what is safe for himself and his/her crew first and foremost. The mindset is similar to what the Red Cross teaches in swimming lifesaving; if you don't have the ability and skill to enter the water and rescue someone, it is better to have one drown instead of two.

All of the above is sometimes easier said than done since we are human. We can find ourselves feeling compassion for our fellow man whether we want to or not. Because of our human condition the company I worked for had a policy that the pilot was not to be told any patient information until after the go/no go weather decision was already made. The idea was that the company wanted their pilots to think with their minds and not with their hearts. When I first heard this policy I thought I would always make an appropriate weather decision regardless of what I knew about the patient. Well, I didn't have any choice because the company, e.g. medical crews and dispatchers were pretty good about sticking to the policy.

Late one night while on shift I personally experienced the wisdom of this policy. The flight phone rang for a flight request to a scene and then on to Little Rock. The weather was really quite lousy, so I turned the request down. After I turned it down the medical crew told me a ground ambulance was beating feet to Little Rock with a pregnant woman and things were going south for the woman and baby fast. At that time a friend's wife was pregnant with what was to be their only child. This friend lived in the area and there was a real possibility that it was his wife needing help. I had the hardest time going back to sleep wondering if it was my friend's wife. Well it wasn't his wife I found out later with a lot of relief, but it was someone's loved one. Since we did not participate I never heard how things turned out for the woman and baby.

A pilot that pushes it too much in civilian EMS and is overly concerned with doing whatever they can to get the job done to help the patient gets tagged as a "Rescue Ranger", which is a bad reputation to have in civilian EMS. A "Rescue Ranger" is considered an accident just waiting for a place to happen.

For the majority of the EMS flights I've flown, I couldn't tell you from one day to the next what the flight involved patient wise. Most of them just all blend together. Then there are some that you never forget; mostly those involving children, and some involving unusual circumstances. For instance one attempted suicide I flew where the bullet took the person's face off of his head without hurting his brain. My medic said, "Man Dave! If you ever find me like that, just finish the job for me." I said, "If I ever find you like that, it's not my job to finish it for you. So, you just better do the job right in the first place." This was the only patient I ever flew that I established a friendship with after the fact. I figured he needed a friend. He had a tough go of it trying to make it through life without a face caused by something he had done.

Anyhow, back to weather. In Korea we knew the area we flew in like the back of our hand. We trained low and flew low much of the time for tactical reasons, plus if the weather forced you lower you were already familiar with the terrain so it felt like home where otherwise a lower altitude could feel like a foreign land over territory that you commonly covered from a high altitude. In aviation, altitude is your friend unless you are in hostile territory where the enemy has the ability to easily shoot you down. Though EMS aircraft have been shot at before by crazies on the ground (I never have that I know of) it is not a significant concern, so we tend to fly at a reasonable altitude. Also in Korea there was quite often a convenient rice paddy always available in most areas if the weather became impossible to deal with. In civilian EMS you most often get to pick what tree you'd like to set it down into if you let it go as far as we could in Korea. The weather can be unpredictable. I have had to make weather precautionary landings. That can be frowned upon, but if the weather is going south fast it is the better option as opposed to crashing. It is always much better to be on the ground wishing you were in the air, than in the air wishing you were on the ground.

In the military we could legally take advantage of the IFR enroute structure if the need arose when there was an IFR enroute structure. Because it takes extra money and equipment to have legal IFR capability, that is often not an option with many civilian EMS flying jobs. There is enough instrumentation to save your bacon if you encounter IIMC and are competent, but you can't intentionally select that option legally unless your aircraft is certified for it and you are IFR current. It is something most pilots would like, but just not available in most cases for various reasons.

On one interesting flight the weather was showing signs of deterioration as we neared our destination of Little Rock. The medic told me, "What ever you do Dave, I don't want to set on the ground with this patient". That was the wrong thing to say... The weather continued to deteriorate. I had established communication with Little Rock approach control about thirty miles out so I could enter their Class C airspace seamlessly with the time approached. I continued to monitor the deteriorating weather situation along with the "extra pressure" from the medic not to do a weather precautionary landing prior to our destination. Well, it soon became obvious that the safe thing to do was the weather precautionary landing regardless of what the medic wanted. I advised Little Rock of my intentions. The controller then offered me several options on different IFR approaches. Though it would have been nice to have been able to accept them, I had to turn him down because even though I had the ability I would not have been legal accepting any of them.

We made our weather precautionary landing and rendezvoused with a ground ambulance that completed the delivery with my med crew. The medical crew often stays with the patient on the ground ambulance in situations like this rather than turn the patient over to a lessor level of care.

There is a lot involved in making a good weather decision. The tools available to help the pilot make a good decision have improved over the years I have flown EMS. There are conditions I've flown through in the early days that I would have never found myself in with the new tools available. For example; I remember one night flight where everything available looked good to go, but I wanted to personally see a weather radar screen before taking off. Just call it a hunch. All we had back then was the weather channel on TV that occasionally cycled a radar screen up. Well, I waited, and waited, and waited for the radar to come up. Finally we just left without seeing the radar. Ceiling and visibility was good that night, but boy did we ever fly through a lot of rain. I probably would have turned that flight down if I had a convenient peek at the radar screen. My medic certainly saved this patient's life having to do an in the field tracheotomy. The receiving physician complemented him on the job he did. So, what do we do when we turn a flight down? Well, if it is night time we go back to bed and go to sleep. They don't call EMS "Earn Money Sleeping" for nothing.

In the company I worked for besides the policy of not telling the pilot what they were requested for prior to making the weather decision, they also have a policy of "three to go, one to say no". If any one of the crew members is uncomfortable with the weather they can call the flight off regardless of whether they are a pilot, nurse, or medic. Some pilots have a tough time with this, thinking it is solely in the pilot's domain to make a weather decision. But, it is simply the way it is and sometimes with good reason; some medical crew have had pilots scare the living hell out of them. Knowing what I know after a little over 6000 hours of total time I'm not very interested in riding in the back with just anyone upfront. Neither am I interested in ever letting my wife be a flight nurse. Now if I were a patient or any of my loved ones were a patient needing air transport, I wouldn't think twice about letting them fly. Both of my sons have had an air medical flight for which I was quite grateful. I can show you the bill on one of them which I have framed. In one good week of flying I can easily make my whole annual salary. C'est la vie!

Sometimes pilots receive pressure to fly when they shouldn't. This can happen in the military too. I remember flying a Colonel once that was a non-aviator and thought pilots had xray vision based on how he acted. The weather was getting worse by the minute and he was practically swearing that it was getting better. I flew to the point where to continue I would have had to make an "educated guess", pull pitch, bust into the clouds and guesstimate when to let pitch out to get by the mountain blocking our way along with the inclement weather. Actually there would not have been anything educated about it; it would have been pure ignorant stupidity and foolishness to try and continue. Another time at the hospital co-located with our corporate headquarters where we were to pickup our patient, I stepped into dispatch to look at the radar. Thunderstorms were popping up all along the route to the receiving hospital. The company president just happened to be in dispatch also. This man was pointing out all the ways I could pick my way through the storms. I personally knew with the changing weather that it would not be prudent to attempt to complete the flight, so I had to call it off in spite of the company president's encouragement to accept and make the flight. I told this gentleman the words of wisdom my buddy had passed on to me years before and also told him that we'd be going back to our base and not making this flight regardless of what he thought I could do. This man prior to becoming our company's president had been a hospital administrator and was a non-pilot, but even if he was a pilot if I felt not to go he would be more than welcome to try it himself as long as none of my loved ones were in the back. And, more power to him if he could have successfully made it. C'est la vie, and some of my friends consider what I did for a job was not real work. That may be debatable, but when they actually do the job we can then have a better debate.

HEMS has been a good job though that I thoroughly enjoyed. Its accident rate has gone through the ceiling recently and has gotten a lot of national attention. I have my own theory on the best means to improve their current lousy safety record that differs from current well meaning attempts. Time will tell whether or not the current attempts will produce viable results.

Till then, if you fly: fly safe. If you drive, don't drink. If you drink, don't drive. Cherish each day you have because life is a precious gift. No one is promised tomorrow. Value the time you have with those you love. Later...



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