What does it take to make it as a fixed-wing air ambulance pilot?

I was recently asked to give a presentation at the Royal Aeronautical Society Critical Care in the Air conference regarding what makes a good air ambulance pilot.

It struck me that this is a subject that rarely surfaces in our industry. We tend to concentrate on the aircraft, medical equipment and the medical staff. No one pays much attention to the crew flying the machine. It is assumed that the pilots have been trained to get the aircraft from A to B, but what else do they do?

I have been involved in this section of the aero industry for over 40 years, having never been interested in joining the airlines. I flew my first solo in a wooden glider on my 16th birthday, gained my gliding ‘Silver C’ badge and obtained my private pilot’s licence by the time I was 17. Soon after, I was a full-time glider tug pilot and flying instructor, before studying for the commercial ground school subjects at the suitably named London School of Navigation.

Once I had gained my commercial licence, the only job available at the time involved flying a small aeroplane for six hours per day with one hand, while at the same time taking aerial photographs of farms and houses with the other hand. The route to my commercial licence was protracted and the pay was poor, but the most important thing I learned was to be able to fly an aeroplane with my eyes closed.

One of the most important skills an ambulance pilot needs to learn is to be able to get ahead of the aeroplane that they are flying. By this I mean the ability to fly and operate the aircraft while also being able to devote important thinking time to other matters relating to the flight. Many pilots can manage this, but others really struggle and some will never be able to do it. Without this important skill, pilots can’t devote precious time to other considerations, something the air ambulance pilot must do more than most.

My career took me from cargo to VIP and finally air ambulance, but these days, budding pilots have a much more structured approach to the industry, either through scholarships, sponsorship or parental funding. Many kids dream of being a pilot, but what does being a pilot mean to them? It normally involves a Boeing or Airbus and a large airline. It’s only once a pilot starts their training that the various paths within aviation become clear. Some pilots will take the VIP route instead of an airline and still be able to fly a big shiny private jet, however it soon becomes clear that this kind of life is not all it’s cracked up to be, living life at the behest of the aircraft owner.

I get CVs from pilots who are currently in the airline or VIP industry, fed up with what they do and looking for a change; maybe they are heading towards the end of their career and want a slower pace of life. Once they understand what our pilots put into their job, most will decide to stay where they are. I have no doubt that they may be extremely proficient pilots, but they have been used to sitting in the cockpit and closing the door behind them, allowing the airline’s dispatch to take care of everything.

Some may make the transition from the airlines to our world, but I have found that good ambulance pilots are best home grown, enthusiastic and empathetic.

Much of my flying was single crew. Invariably, the patient would be on a stretcher and the medical crew would ask if the accompanying relative could sit up the front with me. Once the usual flying aspects had been covered, the conversation would move on to what had occurred to these people and more importantly what was going to happen to them on returning to the UK. For many transfers, it’s the beginning of a life changing experience for the whole family, and the fact is that the medical crew and also the flight crew are a big part of this process. The standard of care that the returning patient and family receives on the flight home will have a big impact and the flight crew must play a big part in this care, not with just the loading and unloading but with their general demeanour and understanding.

Flight medical crew deal with serious injury and illness almost daily, and I am in awe at their ability to get the job done with a certain degree of detachment. In contrast, pilots are expected to take charge of the delicate loading process and then climb into the cockpit to fly the aircraft. That’s a big ask, especially when the patient may be an infant.

Inevitably, some flight crew will decide to move on into the airline world, but the ones who stay within the ambulance field will become extremely dedicated people that have that extra capability which enables them to fly the aircraft – but also do so much more.

I have always believed that you can teach almost anyone to fly a plane, but that’s not enough.