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✍ “[This is] another exercise in getting involved in
the medical situation at the scene and how it can
affect a pilot’s judgment. We can never let the medical
necessity override our good judgment and prevent
us from being safe.” (ACN 141232)
✍ “I was involved in patient care when I should
have been totally involved in flying.” (ACN 146594)
✍ “…High risk delivery, mother in distress. I allowed
patient’s condition to influence my decisions.
Got above layer, had to descend IFR in a noncertified
but well-equipped aircraft.” (ACN 58837)
Issue Number 6 15
In crystal-clear 20/20 hindsight, many pilots seem to
have come to similar conclusions:
✍ “Pilots, especially those in my line of work, should
never let the circumstances around them dictate the
way they would normally fly. If a flight has to be
delayed in order to safely fly that mission, then so be
it. No flight is so important that the lives of the flight
crew should be jeopardized due to incomplete or
inaccurate pre-flight planning.” (ACN 100727)
✍ “…Quick EMS helicopter responses, numerous
interruptions during start-up, added pressure of a
dying person, causing pilot to make emotional decisions
instead of safe ones and the pilot allowing this
to happen. Most likely a pilot would not fly unless
under excessive pressure to do so— not by anyone
(else), but self-imposed.” (ACN 118240)
Distraction
Distraction from the primary task of flying the aircraft
was reported in many incidents. Distraction was often
cited in terms of external influences—noise interference
from medical equipment, aircraft equipment problems
or malfunctions, traffic avoidance in high-density
traffic areas, interruptions, monitoring of multiple radio
frequencies, radio frequency congestion, poor visibility,
marginal weather, and impending low-fuel situation.
There were also a number of internal sources of
distraction, including personal and family concerns,
lack of familiarity with the area, involvement in patient
condition, confusion about procedure, and misunderstandings
about duty delegation.
Up to Your Empennage in Alligators
Workload as such was not cited as a major contributor
to EMS incidents. However, workload is a complex
concept and is subject to a variety of influences that can
lead to activity overload, shedding of tasks, fatigue, and
ultimately to incidents such as those reported. An
unexpected finding was that cruise flight, when cockpit
activity might be expected to be low, appeared to be a
magnet for EMS safety incidents. Both airspace violations
and NMACs were reported as most frequently
occurring in cruise flight and in VFR weather. In-flight
weather encounters were also reported as occurring
most often in cruise flight. Although cruise is not usually
a time of intense aircraft-handling activity (as
might be during takeoff or approach), it is a time when
the EMS pilot might be attending to tasks inside the
cockpit—providing position reports to dispatch, coordinating
with the medical center, programming navaids,
or communicating with other EMS personnel—rather
than specifically watching for conflicting traffic, a cloud
layer, or airspace boundaries.
Aircraft equipment can also play a vital role in pilot
workload. Although many EMS helicopters are not IFRcertified,
most come very well-equipped. This is a doubleedged
sword for many pilots. The abundance and quality
of equipment provides a level of confidence about the
pilot’s ability to handle inadvertent IMC. However, the
complexity of some modern IFR-equipped aircraft can
require more than one set of hands and eyes to be used
to maximum advantage. A few EMS helicopters are
equipped with autopilots. Even 2-pilot crews who might
comfortably handle such a well-equipped aircraft may
find themselves defeated in legally completing their
missions because their aircraft is not IFR-certified.
✍ “It is frustrating to have an aircraft that is so
well equipped with twin engine reliability and can’t
even legally depart to VFR on top or to make a simple
ILS or LOC/DME approach to conservative minimums.”
(ACN 58837)
Several accounts indicated that having an IFR rating
with currency and following pre-arranged procedures
can be literal lifesavers when encountering inadvertent
IMC. One fortunate reporter had everything in his favor
when he encountered unforeseen weather conditions.
✍ “On climbout, I lost all ground references at 400
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