Could you share some information about your background as a helicopter pilot, and how you became involved in helicopter emergency medical services (HEMS)?

It was June 1989 and National Learn How to Fly Month. I was working with a friend of mine who was a private airplane pilot and he took me out for a flight in a small Cessna. It was interesting but not all that exciting. Having watched several TV shows with helicopters, I thought that would be more exciting so I broke open the phone book (no internet in 1989) and found a helicopter flight school at a nearby airport. I booked a demo helicopter flight and was hooked.

It took many years and sacrifices to afford the $150 hourly rate (about $373 an hour today) to acquire the requisite flight hours and experience for the private, commercial, instrument and flight instructor ratings in order to get a job flying helicopters. The dream for me was always HEMS. Watching news footage of a local air ambulance landing on the highway amidst blocked traffic, emergency vehicles and then lifting the crew with a patient to the nearest trauma center seemed so cool to me. The road from low-time flight instructor to Air Medical Pilot had many twists and turns but I was super fortunate, right place, right time kind of scenario, and I’ve been flying HEMS for the last 22 years and still really enjoy the work, the crews and being part of a professional team that helps others.

The massive amount of avionics that are now inside a helicopter cockpit has helped safety, but is there a risk of overload for pilots keeping track of so many different screens?

I was always taught that two-thirds of your time flying (in VMC; visual meteorological conditions) should be spent looking outside the aircraft. Modern cockpits have a breadth of technology that provides so much great information that it can sometimes serve as a distraction if you’re not disciplined. I read somewhere not long ago that ‘too many choices is no choice’. Basically that most people/pilots would rate themselves as master multi-taskers, while evidence-based testing reveals that they are actually wrong. Inherent in aviation is the need to monitor multiple systems and conditions inside and outside the aircraft, so companies dedicate a good amount of time training pilots to develop and maintain a proper scan. It is ultimately up to the pilot to break out the manuals and master the equipment on his or her aircraft and practice prioritizing the information it provides based on the phase of flight and type of operation being conducted.

What’s made the biggest difference to you as a pilot when it comes to a piece of technology you use all the time (either in the cockpit or before you fly)?

By far the greatest safety enhancement I have experienced is having night vision goggles (NVGs). I flew EMS for about 11 years before NVGs made it into the civilian market and I can’t imagine ever going back to conducting night operations without them. NVGs allow you to see almost as much detail as you can during day operations, depending on the amount of ambient and celestial light available to magnify, and they allow you to see areas of clouds that are invisible to the unaided eye. For operational aid during flight evaluations, ForeFlight has been a game changer. It’s an iPad-based weather application that provides real-time weather, flight plan filing, NOTAMs, and so much more. Every time you think they can’t improve on something, they do, and at the same time they exceed your expectations – every time! Long gone are the days of having to contact the Flight Service Station via landline and try to copy and visualize their weather briefing as they rapid-fire read it to you.

HEMS pilots need to occasionally land on unmarked ground; how can pilots make these unscheduled landings as safe as possible?

We put a lot of trust in the ground crews, who brief us in the landing zone (LZ) they’ve selected. About 10 minutes from arrival we will receive a brief regarding the LZ – description, hazards, obstacles, any sloping to the surface and wind direction are typical items. This is another instance for night operations where NVGs are invaluable and have vastly increased the safety of operations during night landings. Many of the counties, particularly in more rural areas, have predetermined landing zones called PELAs, which stands for ‘predetermined emergency landing areas’. These PELAs have been surveyed, many have a windsock near the perimeter of the LZ, some are even paved, and a few even have helipad-type lights to mark the corners. Often these areas have been visited by HEMS operators in the service area, photographed and included in a book of common use landing zones with specific annotation of power lines, unlit towers, surface type (paved, unpaved, dirt prone to result in brownout during dry conditions, etc.) and some here in Texas even mention the probability of cows in the touchdown area. They are a great resource and allow ground and flight crews to become familiar with this known entity versus always landing at some new location.

‘One to say no’ is a now famous saying in the helicopter industry; do you think it’s really true that HEMS flights don’t take off just because one member of the team says it’s too dangerous?

That edict has been modified even further now. HEMS operators with more than 10 aircraft are required to staff an operational control center that reviews each flight request, checks the pilot’s risk assessment for that particular request, and has the ability to cancel the flight if their evaluation determines that the risk factor is too high. So now it would be more accurate to say ‘Four to go and one to say no’. I can confirm that any single member of the team need only indicate that they are uncomfortable with the conditions and the flight is not undertaken. Typically, weather is the most prominent concern for crew and there are a wide range of experience levels working in this field, which plays a big part in each individual’s comfort level. In addition to crew comfort with ambient conditions, another large factor could be the crew’s experience with a particular pilot and that pilot’s level of experience. The flight nurse might be less inclined to be comfortable in marginal weather while flying with a newer or relief pilot, whereas flying with a senior pilot whom they’ve flown with for a long time might not present the same concerns.

Training and keeping current on different helicopter types are key attributes for pilots; how is the training you take part in changing for the better, and what kinds of technology do you use now (e.g. virtual reality)?

For years training was conducted in the aircraft, which was great for real-world, seat-of-the-pants flying, but in the aircraft the number of emergency procedures is very limited. In addition, the weather you encounter on the day and time of training is what it is and doesn’t lend itself to exposing the pilot to any number of variable wind speeds, cloud heights and reduced visibility. In the modern full-motion flight simulator the instructor can simulate pretty much anything: snow, ice, wind shear, thunderstorms, instrument meteorological conditions (IMC), and every possible emergency procedure imaginable. Furthermore, when a training phase has an unsatisfactory outcome – say, for instance, the pilot is performing an instrument approach in IMC and drifts too far from the localizer – in the aircraft you would have to perform the missed approach procedure, which would take several minutes to get vectored and re-sequenced for the approach, all while consuming fuel and getting integrated into existing instrument flight rules (IFR) traffic. In the simulator, under that same scenario, the instructor could freeze the flight, move the aircraft back a few miles and continue from that point. Simulator training is a huge advantage for HEMS operators.

How challenging is it for you – and other pilots – to switch between different airframes that are part of a HEMS fleet, and what are the main obstacles that a pilot has to overcome in these situations?

I flew the Bell 430 for 13 years before we switched into the EC145 and one thing I noticed was the degree of muscle memory that had to be overcome. For almost a year, every time I got the checklist item to start the first engine I would reach up to the upper glare shield where the Bell had its start buttons to realize quickly that the Eurocopter had its start switches on the forward lower left console. Discipline on the part of the pilot is crucial. Spend your downtime referring to training material, checklists and sitting in the aircraft ‘dry flying’. Dry flying is where you run your checklists while in the cockpit; everything up

to starting the aircraft. Challenge yourself on what starter limits you’re looking for, when to abort a start, what voltage is acceptable, how soon do you need to see the blades start turning. If your operator has you assigned to multiple airframes or just different versions of the same aircraft, it is your obligation to be the master of every aircraft you’re currently qualified in. It never seems to fail: that first night shift you’ll show up and the spare helicopter is waiting for you. Gauge placement, aircraft lighting, limitations and weight and balance variations are just a few of the subtle differences you might be presented with, and just know that one time you show up and haven’t been diligent in your professional duties, a flight will be pending as you arrive at the base. Demand of yourself that which you expect of others in their professional capacity.

Flights into inadvertent instrument meteorological conditions (IIMC) continue to cause accidents; if there was an easy solution to stop this happening, it would have been implemented already. But what, to you, are the ways in which HEMS pilots avoid putting themselves and their crews in danger?

A fair amount of the flight requests we receive occur during visual flight rules (VFR) and are very easy to accept. Depending on the time of year, time of day and geographic location, a portion of the flight requests we receive arrive at a time that we just can’t accept them; current low IFR, IFR, thunderstorms, icing, etc. The instances of IIMC encounters typically occur when the current or forecasted weather is in the marginal category. Flight requests vary in distance, direction and time. In these cases this is where active crew engagement [is essential], not just during the acceptance phase of the request, but en route as well. If the weather at the destination point (your base typically) is within company or Federal Aviation Administration (FAA) standards, how is the weather in the direction you are going to pick up the patient, how long will that take, how long will the medical crew need to assess and load that patient, how long and in what direction is the flight leg from the pickup point to the destination hospital, and, while not a factor in the acceptance of the flight, can I reasonably expect to get the crew and aircraft from the receiving hospital back to the base of operations? Weather is fluid and can change rapidly. It doesn’t do the patient any good if you are able to pick them up from the referring hospital or EMS agency to then have to land in a field somewhere because of the weather along that route.

There are many weather resources available today that were not available 21 years ago when I started in this business, and that has certainly enhanced safety. My first 20 years in HEMS I was in a twin-engine IFR helicopter, so encounters with IIMC were less of an issue since an IFR clearance was easily obtained when ceilings and visibility degraded. However, a substantial majority of the HEMS operations in the USA are conducted in single-engine VFR aircraft requiring even more caution as weather systems move in and conditions change. Human factors play a role in the decision-making process. Human traits like ego, arrogance and [a feeling of] invincibility can have a big impact on the pilot’s (and crew’s to some extent) willingness to accept lower weather conditions, especially once the patient is onboard or when they are done with the patient leg of the flight and are trying to get back to the base (‘get home-itis’).

During annual or semi-annual training a good deal of time is spent on inadvertent encounters with IMCs. Avoidance is the best practice, of course, but with the use of full-motion simulators, which is pretty standard across the US HEMS market, pilots can be subjected to flying the aircraft after losing visual references and practice positive aircraft control so if despite their very best efforts they enter IIMC they’ll have the tools and training to safely return to VMC or conduct an instrument approach.

Crew engagement is essential and their concerns are absolutely honored. I have heard stories of younger pilots, early in their HEMS careers, who were let go because they didn’t honor the flight nurse or flight paramedic’s expression of being uncomfortable with continuing a flight based on current or forecast conditions. It’s a huge responsibility to be called to transport a patient in need of higher-level or trauma care, but it is an even greater responsibility to make sure your crew goes home at the end of the shift. Soliciting your crew’s thought, checking in with them with updates, creates and strengthens the team aspect of the work you’re doing.

What do you love most about your job, and what is the most challenging aspect of it?

Flying with a purpose, even after 22 years with the same company, it still has the cool factor for me.

The HEMS industry faces many challenges in the USA as it operates under the umbrella of two of the most highly regulated industries there are: aviation and healthcare. Changes that are out of your control but impact the work you do can be challenging.