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#1 medic4cqb

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Posted 10 February 2015 - 08:50 PM

"Date: 1/10/2015 2100 MST

Program: Intermountain Life Flight
   250 North 2370 West
   Salt Lake City,UT 84116

Type: A109-K2

Weather: Intermittant snow showers, approx 1500' overcast

Team: Pilot, flight paramedic, flight nurse. No injuries reported. No patient.

Description:
   Aircraft departed a landing zone in mountainous terrain after dark. A
   light snow had been falling prior to departure and windscreens were
   cleared of snow twice during preflight inspection. Some additional
   snow had collected on windscreen prior to lift-off, but instead of
   blowing off during climb-out as was normal, the snow froze to the
   outside of the windscreen and additional snow/ice continued to
   accumulate until the windscreen was essentially obscured about 30
   seconds after take-off.  With the accumulation of snow on the outside
   of the windscreen, the inside also fogged over due to the warmer moist
   air inside the aircraft. The windshield defroster was unable to clear
   away that layer of moisture. Although the ceiling was estimated to be
   approximately 1500 feet above the ground, the condition was treated as
   inadvertent IMC (IIMC) due to the pilot�s inability to see through the
   windscreen. It was also deemed to be unsafe to attempt to abort the
   takeoff and return to the LZ due to the lack of forward visibility
   through the windscreen. As the aircraft was in a valley with rising
   terrain on either side, the pilot transitioned to instrument flight
   and a maximum power climb was initiated in accordance with the IIMC
   protocol. Initial attempts to contact Salt Lake Approach Control were
   unsuccessful due to the high terrain between the aircraft and the
   airport. During the climb to 12,500�, the pilot engaged the autopilot,
   but it functioned erratically in a manner that resulted in an
   un-commanded left turn and a loss of altitude, so the pilot disengaged
   it and hand flew the aircraft for the rest of the flight.
   During this time, the paramedic in the left seat assisted the pilot by
   tuning radio frequencies, communicating the aircraft�s status to the
   Communications Center and by monitoring and reporting the status of
   specific instruments as requested by the pilot. After contacting Salt
   Lake Approach control and receiving initial vector to the ILS approach
   at KSLC, the pilot then checked the AWOS and found that the weather at
   the Ogden airport was reported to be better than at the Salt Lake
   airport. Rain was falling at Ogden and the pilot believed that the
   rain would clear the accumulation of snow and ice from the windscreen.
   The pilot requested a change of destination, and the paramedic again
   assisted by pulling up the approach plate for the ILS at Ogden on the
   iPad. The aircraft completed a successful approach to the Ogden
   airport.
   

Additional Info:
   As a result of this event, this organization is now considering a more
   formal approach to training front-seat medical crew members to assist
   the pilot in the event of specific emergency procedures.

Source: William Winn, Safety Officer"

FW Members,

Reference this incident, are there programs already implementing this sort of training for medical crew members aboard rotor wing programs? Aside from all crew members aboard the aircraft being involved in flight safety, is there additional safety and flight training undergone by crew member?
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Steve A., RN, CCRN, EMT-P

"The usefulness of a cup is in its emptiness..."
- Bruce Lee


#2 Jwade

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Posted 10 February 2015 - 11:04 PM

Steve,

 

This will be aircraft and operator dependent obviously, but, i can say the programs i have been associated with have all had the med crew learn how to handle the radios, etc in case of emergency.....

 

One of my closest friends is a pilot for IHC Lifeflight in SLC, i just spoke to him and he said they were very lucky on this call....Poor decision making and flight never should have happened in the first place.

 

Almost the same exact scenario the University of Utah AIRMED program suffered their Fatal crash in 90's......They essentially took off in a blizzard and CFIT into the side of canyon..........

 

Hopefully there is some serious debriefing going on over this flight......Very Lucky.....I lived in SLC for many years, and know those areas well......


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John Wade MBA, CCEMT-P, FP-C, RN

"Have the courage to follow your heart and intuition, they somehow already know what you truly want to become" Steve Jobs

#3 medic4cqb

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Posted 10 February 2015 - 11:27 PM

Thanks John,

Seems like this should be a standard across the board in this industry. I'm a big supporter of the dual-pilot model, which is non-existent nowadays. Metro Life Flight had dual-pilots when they flew in the S-76s, but I don't believe they use that set-up anymore in the EC-145 airframe. I understand cost of operations being the main factor influencing that decision though.

Also, thank you so much again for the resume help... I'll keep you updated.
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Steve A., RN, CCRN, EMT-P

"The usefulness of a cup is in its emptiness..."
- Bruce Lee


#4 Iainhol

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Posted 16 February 2015 - 10:02 PM

As part of my master's thesis I looked into what aeronautical education medical crew members were provided during new hire orientation. Though for the sake of scientific research the sample size would be considered small, it showed substantial variation in what was taught. Some programs didn't provide any weather education, others put medical crew members in the aircraft while the pilot practice autorotations. It seemed that many programs had an informal process were a pilot would sit down and teach during downtime - some pilots had lesson plans, others didn't. 

 

For the second part of my thesis, I worked with a group of medical crew members and pilots to create a template for a curriculum to be used for your typical VFR program. You can find a copy of this in the VisionZero toolbox: http://aams.org/tool...ew Members.docx This is all based on the private pilot education and referenced in the FAA published instructional material. 

 

I personally feel that aeronautical education is essential to enhance the safety of HEMS. I believe that the reason there are so many HEMS accident is a direct result of bad decisions. I think combining AMRM with aeronautical education is going to be key to reducing our accident rate. It is great to say everyone keep their eyes outside the aircraft, but if you don't know how to scan the sky or report traffic properly how effective are you really being? I am not saying that medical crew members are going to have the same knowledge and experience as professional pilots. The comparison I use is like a medic and EMT-B, if you are the medic and have a couple EMTs who can hold c-spine, do high quality CPR, gather equipment, your job as a medic became considerably easier and you can focus on advance skills. Much like a pilot focusing on single pilot IFR and can be comfortable with their front seat passenger tuning radios, pulling up plates, etc.

 

We were fortunate enough to present a ground school for medical crew members at AMTC in Nashville. We had slightly under 150 in attendance and received great reviews - it shows medical crew members want to know this stuff. We were also contacted by various programs about hosting this at their program, or helping them create/update an aeronautical curriculum. Deb and I are also now writing for Vertical 911 sharing a topic in each edition. You can see our first one in their latest edition: http://www.verticalm...1/files/70.html

 

It hasn't always been easy; in the beginning we had people tell us if we are going to suggest teaching medical crews about aviation, then we should teach pilots how to titrate drips. If the industry standard was 3 to titrate and 1 to say, then yes pilots would need to learn about drips, but right now only aviation decisions require an unanimous vote. Fortunately since AMTC we have picked up traction; we submitted to present at AMTC this year, this time collaborating with NEMSPA. 

 

I hope over the next 10 years aeronautical education will become as common as wearing helmets - the trend is getting better. In 2013 I believe there was one topic at AMTC where a pilot shared aeronautical knowledge to an audience of medical crew members. Last year I believe there was 4 including us. 

 

Feel free to contact me off the forum if you have specific questions or want to discuss it further. 


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#5 Wally

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Posted 17 February 2015 - 02:21 PM

"lainhol" said:

I personally feel that aeronautical education is essential to enhance the safety of HEMS. I believe that the reason there are so many HEMS accident is a direct result of bad decisions. I think combining AMRM with aeronautical education is going to be key to reducing our accident rate."

 

There's some facts, inference from facts and theoretically untenable conclusions in the quotation, which gets to a fundamental falsehood in AMRM/'3 to go".

"I believe that the reason there are so many HEMS accident is a direct result of bad decisions." is founded on facts. The great majority, somewhere between 80% and 90% of HEMS accidents are the result of poor decisions. The medical crew, or any other non-aviation personnel (a/k/a passengers) on board the aircraft at  can do absolutely nothing to resolve that issue other than refusing to go.Period. Nobody but the pilot(s) can evaluate their individual capability, with aircraft considerations, at the instant of the request. Diffusing and confusing the decision is never a god practice. If you find yourself saying anything but "No!" you're promoting an unsafe practice.

Once the in-flight issue is in progress, non-pilot assistance becomes much more difficult to define. The pilot may be task saturated and any distraction might be fatal. It is most productive to wait for the pilot's request for action. No amount of aeronautical education of a non-pilot will likely be helpful, the issues are immediate.

I'm not anti-AMRM or "3 to go", I use the heck out of it. I would use absolutely any tool to hand that I thought might be effective, including coin flips and PFM. But I use them like I use a wrench as a hammer; I know a wrench is not a hammer, it's not an effective hammer, but it might be all I have to do the job. Confusing the two creates problems, no amount of education makes a wrench a hammer: medical crew are not the answer to HEMS safety, good pilot decisions are. Promote situations and support that improve the probability of that happening and you improve safety.


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#6 medic4cqb

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Posted 17 February 2015 - 04:23 PM

Wally,

I see your point and while I agree that adding confusion into the equation of an eminent incident likely worsens things; I don't see the problem in educating the medical crews. I don't believe medical crews are the answer to safety, but as a "team" involved in the safety of all aboard the aircraft, the more you know and can contribute would be appreciated, don't you think? Clearly no medical crew member, is going to tell you how to do your job, just like no pilot is going to tell the med crew how to do theirs. One would think though, as a consortium of air medical professionals, that decisions made in that aircraft would involve all passengers (minus the patient(s). I see nothing wrong with this sort of education.
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Steve A., RN, CCRN, EMT-P

"The usefulness of a cup is in its emptiness..."
- Bruce Lee


#7 Iainhol

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Posted 17 February 2015 - 05:25 PM

Wally - I agree with your points and concerns. I think this education can provide better teamwork, which can improve safety. You said:

>> If you find yourself saying anything but "No!" you're promoting an unsafe practice.<<

So if my phone's app said there is enroute fog, do you think I would do better saying no rather than asking the pilot if he is saying yes. The answer might be that reporting station is in a valley which is typically easy to fly over, or that it is a trend by the shore and by the time we get there it'll likely be cleared and if it hasn't there is no risk as it is daylight and the weather is clear on the way back.

I think it has to be the appropriate level of education and used in the correct context - it's not going to be like putting two pilots upfront but I do believe that a second set of properly trained eyes looking for and reporting traffic or can ask what the TAF is showing for the rest of the day, etc is better than someone with no training and trying to make decisions based of a general weather app.
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#8 Wally

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Posted 17 February 2015 - 05:50 PM

Wally,

I see your point and while I agree that adding confusion into the equation of an eminent incident likely worsens things; I don't see the problem in educating the medical crews. I don't believe medical crews are the answer to safety, but as a "team" involved in the safety of all aboard the aircraft, the more you know and can contribute would be appreciated, don't you think? Clearly no medical crew member, is going to tell you how to do your job, just like no pilot is going to tell the med crew how to do theirs. One would think though, as a consortium of air medical professionals, that decisions made in that aircraft would involve all passengers (minus the patient(s). I see nothing wrong with this sort of education.

 

The exact problem is stated: "One would think though, as a consortium of air medical professionals, that decisions made in that aircraft would involve all passengers (minus the patient(s)." No. Diffuse responsibility is confused responsibility. Medical crew are passengers, and I will use everything available, but nobody except the pilot will be held ultimately responsible in the law. If your pilot is not competent to do the job without passenger assistance, you should not be flying.

 

lainhol:

 

"So if my phone's app said there is enroute fog, do you think I would do better saying no rather than asking the pilot if he is saying yes. The answer might be that reporting station is in a valley which is typically easy to fly over, or that it is a trend by the shore and by the time we get there it'll likely be cleared and if it hasn't there is no risk as it is daylight and the weather is clear on the way back

I think it has to be the appropriate level of education and used in the correct context - it's not going to be like putting two pilots upfront but I do believe that a second set of properly trained eyes looking for and reporting traffic or can ask what the TAF is showing for the rest of the day, etc is better than someone with no training and trying to make decisions based of a general weather app."

 

If your weather app leads to your personal decision to decline dispatch, do so.

But- As a basis for a decision, is your weather app a qualified source as far as your operator is concerned?

What's your pilot's particular capability at the time of request?

What is your aircraft situation?

Are you going to be at the controls at the time of the weather encounter?

If you don't bear any responsibility (and you don't, in the eyes of the law) why would you do anything to influence the decision towards accepting dispatch? One professional pilot to another, I would never put myself in that position, on what basis do you?


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#9 Jwade

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Posted 17 February 2015 - 10:31 PM

"lainhol" said:

I personally feel that aeronautical education is essential to enhance the safety of HEMS. I believe that the reason there are so many HEMS accident is a direct result of bad decisions. I think combining AMRM with aeronautical education is going to be key to reducing our accident rate."

 

There's some facts, inference from facts and theoretically untenable conclusions in the quotation, which gets to a fundamental falsehood in AMRM/'3 to go".

"I believe that the reason there are so many HEMS accident is a direct result of bad decisions." is founded on facts. The great majority, somewhere between 80% and 90% of HEMS accidents are the result of poor decisions. The medical crew, or any other non-aviation personnel (a/k/a passengers) on board the aircraft at  can do absolutely nothing to resolve that issue other than refusing to go.Period. Nobody but the pilot(s) can evaluate their individual capability, with aircraft considerations, at the instant of the request. Diffusing and confusing the decision is never a god practice. If you find yourself saying anything but "No!" you're promoting an unsafe practice.

Once the in-flight issue is in progress, non-pilot assistance becomes much more difficult to define. The pilot may be task saturated and any distraction might be fatal. It is most productive to wait for the pilot's request for action. No amount of aeronautical education of a non-pilot will likely be helpful, the issues are immediate.

I'm not anti-AMRM or "3 to go", I use the heck out of it. I would use absolutely any tool to hand that I thought might be effective, including coin flips and PFM. But I use them like I use a wrench as a hammer; I know a wrench is not a hammer, it's not an effective hammer, but it might be all I have to do the job. Confusing the two creates problems, no amount of education makes a wrench a hammer: medical crew are not the answer to HEMS safety, good pilot decisions are. Promote situations and support that improve the probability of that happening and you improve safety.

 

 

Wally,

 

You clearly make some valid points, but, I think you are missing the bigger picture.  As you stated, the facts show pilots are making poor decisions.....The question is why?   Arrogance, Skill degradation, non-proficient in IFR,  Pilot Ego, ??????    Obviously, the "norm" for aviation is the PIC makes all the decisions, this is taught to us pilots from day 1 of flight school.......Now, after thousands of hours, you take a job in an industry where you are dealing with a sky high accident rate and medical crew who all of sudden can affect the decision making of a flight request......I'm sure this probably does not sit too well with most pilots.....

 

In the end, everyone has a vested interest in going home at night. 3 sets of eyes will always be better than just yours. You don't need to go through flight school to learn how to competently operate the radio's or talk to ATC in an emergency......It's well documented most VFR HEMS pilots while IFR current, are not even remotely close to proficient or competent........

 

You stated in the previous thread your willingness to potentially fly an aircraft with medical crew on board without working safety equipment.......This speaks volumes IMO.......and despite your denials on the culture at Air Methods, it's clear this is a systemic problem and not an isolated incident.......I can guarantee that decision was made at the highest levels of the company.............Everything I have ever said about the culture and the administration there was validated beyond reproach. I am so happy they got their ass handed to them by OSHA......

 

Medical Crew members will ALWAYS have input as to whether a flight is accepted or not......Embrace it or go back to oil & gas.........There is nothing wrong with promoting education......Most of the pilots I have ever flown with had no issues teaching the medical crew about radio's, GPS, etc........Those who did, moved on pretty quickly........

 

Most med crew while Type A, know their limitations, and would not even remotely think they are qualified to make aviation decisions.....Granted there will be the outlier or two.....

 

I never met a pilot who didn't think they were competent and had sound decision making skills..................Not really the best argument to get your point across....


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John Wade MBA, CCEMT-P, FP-C, RN

"Have the courage to follow your heart and intuition, they somehow already know what you truly want to become" Steve Jobs

#10 Wally

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Posted 18 February 2015 - 12:50 AM

Point by point:

" As you stated, the facts show pilots are making poor decisions.....The question is why?"

I have my theories, not germane to this discussion of medical crew benefit in the cockpit.

 

"Now, after thousands of hours, you take a job in an industry where you are dealing with a sky high accident rate and medical crew who all of sudden can affect the decision making of a flight request."

Medical crew can decline a request. Any passenger I've ever flown (since the military) could do so. Medical crew are not authorized to accept dispatch. So what's your point exactly?

 

"3 sets of eyes will always be better than just yours"

Obfuscation. My point is AMRM/'3 to go" isn't a solution, it's a problem when unqualified and untrained input becomes a factor. Say no if you wish, I would if I though it warranted. But I would never, ever offer an opinion that suggested departure.

 

"It's well documented most VFR HEMS pilots while IFR current, are not even remotely close to proficient or competent."

Your a check airman now?

 

"You stated in the previous thread your willingness to potentially fly an aircraft with medical crew on board without working safety equipment."

Never happened.

 

"Medical Crew members will ALWAYS have input as to whether a flight is accepted or not."

Name the operator that allows a medical crew member to compel a pilot to accept a request. Please.


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#11 Jwade

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Posted 18 February 2015 - 04:41 AM

1.  Why is it not relevant to the discussion?  Of course it is...

 

2.  My point is, Medical crew still have the option to accept or not accept a flight request even if the PIC accepts........This i believe directly insults most PIC's who are not used to having their decision making skills questioned........

 

3. AMRM, while not perfect, is a step in the right direction.  Based on the amount of trained and qualified input(read: Professional HEMS Pilots"  that went into making such poor decisions and making perfectly good aircraft lawn darts in the last 15 years, one can certainly make the argument it can't get any worse by including AMRM....Be part of the solution, not the problem Wally.

 

4. Absolutely NOT.......But after reading through EVERY single NTSB crash docket for the last 20 years and throwing the data into SAS, it becomes painfully obvious the lack of actual IFR time = lack of proficiency which then equated to dead after going IIMC and CFIT........

 

5. Here is your exact statement from the previous AirMethods thread: "I can't say that I would or would not accept dispatch with an inop ELT. Every call is a unique scenario, often weighted with unquantifiable factors."

Again, the fact you would / could even consider a potential flight without a working ELT with medical crew / patient on board tells me everything i need to know......Part of the problem, not the solution......Organizational Culture......People don't give it nearly the credit it deserves....

 

6. I never said any medical crew could compel a pilot to accept a flight.......I stated the medical crew can always override your decision to accept a flight if they feel your decision making skills are lacking.........

 

7.  Bottom line here is the extended pattern of poor PIC decision making skills year after year resulting in the needless deaths of so many people have brought us to where we are today.........When so many of them could have been avoided by simply checking your ego at the door and stop trying to " beat the weather back to base"..........


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John Wade MBA, CCEMT-P, FP-C, RN

"Have the courage to follow your heart and intuition, they somehow already know what you truly want to become" Steve Jobs

#12 medic4cqb

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Posted 18 February 2015 - 05:26 AM

Ironically, I found this while doing some leisure reading...

http://www.youtube.c...be_gdata_player
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Steve A., RN, CCRN, EMT-P

"The usefulness of a cup is in its emptiness..."
- Bruce Lee


#13 justapilot

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Posted 18 February 2015 - 11:23 AM

"lainhol" said:

I personally feel that aeronautical education is essential to enhance the safety of HEMS. I believe that the reason there are so many HEMS accident is a direct result of bad decisions. I think combining AMRM with aeronautical education is going to be key to reducing our accident rate."

 

There's some facts, inference from facts and theoretically untenable conclusions in the quotation, which gets to a fundamental falsehood in AMRM/'3 to go".

 

"I believe that the reason there are so many HEMS accident is a direct result of bad decisions." is founded on facts. The great majority, somewhere between 80% and 90% of HEMS accidents are the result of poor decisions. The medical crew, or any other non-aviation personnel (a/k/a passengers) on board the aircraft at  can do absolutely nothing to resolve that issue other than refusing to go.Period. Nobody but the pilot(s) can evaluate their individual capability, with aircraft considerations, at the instant of the request. Diffusing and confusing the decision is never a god practice. If you find yourself saying anything but "No!" you're promoting an unsafe practice.

 

Once the in-flight issue is in progress, non-pilot assistance becomes much more difficult to define. The pilot may be task saturated and any distraction might be fatal. It is most productive to wait for the pilot's request for action. No amount of aeronautical education of a non-pilot will likely be helpful, the issues are immediate.

 

I'm not anti-AMRM or "3 to go", I use the heck out of it. I would use absolutely any tool to hand that I thought might be effective, including coin flips and PFM. But I use them like I use a wrench as a hammer; I know a wrench is not a hammer, it's not an effective hammer, but it might be all I have to do the job. Confusing the two creates problems, no amount of education makes a wrench a hammer: medical crew are not the answer to HEMS safety, good pilot decisions are. Promote situations and support that improve the probability of that happening and you improve safety.

 

 

You're a glutton for punishment, Wally! I, however, am not....so I am just temporarily popping in to the lion's den to offer a little moral support from the non-participating aviation lurkers and to encourage you to continue fighting the good fight. You are not alone, brother.

 

It would be foolish to discount pilot distraction during critical phases of preflight planning and flight as a contributing factor to poor decision making. The inane administrative and "political" workload is already substantial and ever increasing, while the demands to "be off the ground" remain unabated. The last thing we need is more distraction from the actual job at hand.

 

The other professionals onboard are certainly an available resource, but inflicting that resource on a pilot is highly counterproductive. I find it instructive that some would assume that any wisdom they might choose to offer would, inherently, be timely and useful to the process. That their unsolicited participation could never distract or contribute to a "bad outcome". Instead, it's surely a poorly trained and stupid pilot. Ego, indeed.

 

The medical personnel aboard HEMS helicopters already hold the ultimate trump card. If you are confident in your aviation expertise and experience (or even if you aren't), if you feel the need to overrule the pilot's course of action, by all means, DO IT. You've been granted that authority by the pilot's boss (but notably, not by the FAA). Decline or discontinue the flight. It could save our lives. But stop wasting time and muddying the waters by passively hinting or attempting to bully the pilot into doing what you want. Sign your name to it. When a pilot accepts or declines a flight request, their professional competence and reputation hang in the balance. If you want a place at that aviation table, yours should too.


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#14 Wally

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Posted 19 February 2015 - 05:07 PM

1.  Why is it not relevant to the discussion?  Of course it is...

 

2.  My point is, Medical crew still have the option to accept or not accept a flight request even if the PIC accepts........This i believe directly insults most PIC's who are not used to having their decision making skills questioned........

 

3. AMRM, while not perfect, is a step in the right direction.  Based on the amount of trained and qualified input(read: Professional HEMS Pilots"  that went into making such poor decisions and making perfectly good aircraft lawn darts in the last 15 years, one can certainly make the argument it can't get any worse by including AMRM....Be part of the solution, not the problem Wally.

 

4. Absolutely NOT.......But after reading through EVERY single NTSB crash docket for the last 20 years and throwing the data into SAS, it becomes painfully obvious the lack of actual IFR time = lack of proficiency which then equated to dead after going IIMC and CFIT........

 

5. Here is your exact statement from the previous AirMethods thread: "I can't say that I would or would not accept dispatch with an inop ELT. Every call is a unique scenario, often weighted with unquantifiable factors."

Again, the fact you would / could even consider a potential flight without a working ELT with medical crew / patient on board tells me everything i need to know......Part of the problem, not the solution......Organizational Culture......People don't give it nearly the credit it deserves....

 

6. I never said any medical crew could compel a pilot to accept a flight.......I stated the medical crew can always override your decision to accept a flight if they feel your decision making skills are lacking.........

 

7.  Bottom line here is the extended pattern of poor PIC decision making skills year after year resulting in the needless deaths of so many people have brought us to where we are today.........When so many of them could have been avoided by simply checking your ego at the door and stop trying to " beat the weather back to base"..........

 

Mr Wade

You wrongly interpret my statement I can't say that I would or would not accept dispatch with an inop ELT. Every call is a unique scenario, often weighted with unquantifiable factors."

 

Some equipment may legally and safely have maintenance deferred under an approved MEL (Minimum Equipment List) procedures for continued operations. That does not remove the requirement for the PIC to exercise discretion in accepting a flight. Hence my statement “I can't say that I would or would not accept dispatch with an inop ELT. Every call is a unique scenario, often weighted with unquantifiable factors.”. That does not imply I would accept dispatch with inoperative equipment that creates an unsafe condition. It means that I would consider the implications in each case. An inoperative ELT may or may not be a safety consideration. This is supported by the fact that the FAA will allow operation with an inop ELT within MEL considerations. That is also my position, again, with adequate consideration of the specific proposed flight conditions.

The aircraft condition and MEL status is part of the crew briefing process. Were we on the same crew with an inop ELT, you would be fully aware of it and within policy if you considered it a safety issue and refused dispatch.


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#15 Wally

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Posted 19 February 2015 - 06:34 PM

1.  Why is it not relevant to the discussion?  Of course it is...

...

7.  Bottom line here is the extended pattern of poor PIC decision making skills year after year resulting in the needless deaths of so many people have brought us to where we are today.........When so many of them could have been avoided by simply checking your ego at the door and stop trying to " beat the weather back to base"..........

 

This thread started with the narration of an event where a medical crew member provided assistance to a pilot during an inflight issue. Good on that crewmember! But, it doesn’t follow  that that pilot would not have concluded that flight as successfully without the crewmember’s assistance. So, how did this thread move on to justifying an absolute requirement of aviation education of medical crew to save lives?

To start with, I am a pilot. I can do the basic flying job of HEMS without medical crew. Period. The FAA, my employer, and I insist on that minimum capability, as should you. If you don’t insist, you’re a fool to get in the pilot you doubt’s aircraft. The PIC may not know of inability, evidently some medical crew are convinced of the proposition- but continue to fly. Hellooooo! Russian roulette anybody? Your input and advice to that pilot does not, repeat- does not make the flight safer! It might make you feel better, but no matter how much lipstick you put on a pig…

 

My flying does not make it an HEMS aircraft, you (the medical crew) make that so. In my experience, you’re an unusually dedicated, skilled and capable part of the population, and generally do well and good work. That should be enough, it would be for me. The issue comes with professional separation (I will repeat a fundamental professional pilot principle: I would never attempt to influence another PIC’s decision to accept a flight. Why would you?)

Which gets to the issue this thread is at: Some posters here don’t respect the separation of professional domains and duties. If a pilot spends a decade or two polishing their craft, they suffer from instant  “Arrogance, Skill degradation, non-proficient in IFR,  Pilot Ego…” as soon as they start flying HEMS. Some posters think a quick course in a few aviation subjects and a smart phone app provde a medical crew member with a wealth of useful knowledge that is somehow critical.

 

I know a few pilots with some of the first issues (arrogance, etc.) but they are exceptions. To assume that those faults and those few generally exhibiting them accounts for any safety issues in the industry ignores the real issues.

However, the second expressed view (that a little aviation training of medical crew is critical) is definitely part of the safety issue. It dilutes the PIC responsibility by presenting the appearance that it’s shared, which it is not- The PIC is absolutely responsible if the flight occurs. It confuses the PIC decision process by introducing a committee aspect which requires skills not necessarily common. And, frankly, I find unsolicited input distracting, and occasionally argumentative, whether the medical crew intends that or not. In one case, that was the crew member’s intention, but that’s another story.

 

Do I use AMRM and the “3 to go”? Absolutely, always have and always will. But I will tune you out and ignore you when I have to. Want to bet your life on your PIC always being successful at that? Me either.

 

Jwade asked regarding poor HEMS pilot decisions:

1.  Why is it not relevant to the discussion?  Of course it is...

 

You asked for it, you get it, Toyota!

Why do I think poor decisions occur in this industry? My experience is there are many reasons::

  • Poor training. Training is seen as a cost not an investment.

  • Adversarial relationship between training departments and line pilots. Our goal is common- be the best and safest pilots. Biggest mistake my employer ever made was deciding that the training department pilots had to be “managers” enforcing management dictates.

  • Management remote and ignorant of job demands. Fly the line occasionally!.

  • Too much training time in the industry is limited to commercial pilot level skills. Those skills are too limited to be useful in the industry. Example- airport traffic patterns are for airplanes at airports. The most useful approach in my bag of tricks is what the Army calls a “high overhead”, a circling to land using constant turning and descent. Flying that pattern in reverse is the safest departure in valleys or in the presence of obstructions.I am prohibited from using that and have never had it even demonstrated by a company instructor. Teach and insist that the helicopter be flown like a helicopter! But I digress…

  • Isolation minimizes peer influence. Bad habits become deeply ingrained.

 

And now to the major specific hazard- night operations:

  • Scheduling, scheduling, scheduling! You can scientifically expect human beings to flip their wake/sleep schedules like you turn on a machine.

  • Poor training (none) in managing that process. Yes, my particular fixation…

  • I wish I could avoid this last opinion- many of my colleagues are far too casual about night duty and consider the day before a night shift to be a day off.

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#16 USDalum97

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Posted 19 February 2015 - 10:40 PM

Wally, I've been around here for a while and have always appreciated your input from the pilot perspective. This place is mostly dominated by the medical side. Usually, I agree with almost everything you have to say. However, on this topic, I have some opinions that are a bit different than yours.

 

First, I don't believe most accidents happen because of 1 bad decision made during a critical phase of flight. Sure, if we have a sudden tail rotor failure, I'm going to do my best to keep my screaming to a minimum and not distract you while you land the helicopter. However, an educated crew member may be able to better detect a situation that is forming due to previously undetected questionable decisions. Think about it. As the PIC, why would you intentionally make a bad decision? I don't think you would. Then why all the accidents? A properly trained medical crew member may be able to spot things that are starting to look bad before the pilot notices. Who is the person least able to recognize fatigue? (spoiler...it's the person who is fatigued). Who has the hardest time finding grammatical mistakes on an essay paper? (spoiler...it's the author). Who is the least likely to recognize bad decisions that are being made? Yep....I would definitely say the person making the mistakes.

 

Unfortunately, this situation is hard to quantify. How many flights would have been accepted by the PIC, had it not been for the educated medical crew member, into adverse weather which would have caused an accident? Impossible to quantify. However, we all know it has happened where a PIC has been "overruled" on accepting a flight and the weather wound up turning to crap. Ultimately, this scenario MAY have put the flight in jeopardy. 

 

Second, if you had to go on a ferry flight with another pilot, but only the other pilot had controls, you wouldn't ask about weather or the helicopter status? After all, you wouldn't want to influence another pilot's decision making, would you?

 

Third, in a hospital based program, it is my belief that the medical side is the one making the flight request, not the fire department or ambulance company on scene. If the hospital employee (medical crew member) decides to NOT request a flight based on their knowledge/intuition/gut feeling/etc, that's on them. They have the right to NOT request a flight. They should also own that decision and be able to articulate it.

 

I've been pressured by a pilot to take a flight. He wanted to skirt around weather between two different storms, with a patient on board, for a 2 hour flight. I said no thank you. He was upset and wanted me to call in another nurse. I explained that he was welcomed to show up and take the patient himself, but that myself and my partner were not going with him. The flight went the next day when the weather cleared.

 

Fourth, and here is a big one for me...you don't have to be a pilot to understand weather. I know, shocker, right? Last I checked, flight schools do not give anyone a degree in meteorology. I am able to learn and understand weather concepts without having to be able to physically manipulate a set of controls or read an MGT gauge.

 

Another pilot got very upset with me once for not waking him up to check weather in the middle of the night. When I went to bed it was foggy and it was forecasted to be foggy all night. I've been at this for a while and have a pretty good understanding of the weather. When I answered the phone at 3am, I turned down the IFT request. In the morning I got all sorts of grief because I didn't give him the chance to even look at weather. Once again, if one of us isn't willing to go, none of us are going. I would never accept the flight without first checking with the pilot, but I darn sure have the right to refuse to go.

 

Fifth, here is a quote from you "This thread started with the narration of an event where a medical crew member provided assistance to a pilot during an inflight issue. Good on that crewmember! But, it doesn’t follow  that that pilot would not have concluded that flight as successfully without the crewmember’s assistance." Based on the information from the program, it says "During this time, the paramedic in the left seat assisted the pilot by tuning radio frequencies, communicating the aircraft status to the Communications Center and by monitoring and reporting the status of specific instruments as requested by the pilot." It seems like in this case, the information provided by the medical crew member was not unsolicited advice. Had prior training not been conducted, the pilot would have had to explain, while IIMC, how to read certain gauges, tune frequencies, and use the ipad. Seems like in the original scenario, prior training was key to a successful resolution to the flight.


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#17 Wally

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Posted 20 February 2015 - 01:49 PM

Wally, I've been around here for a while and have always appreciated your input from the pilot perspective. This place is mostly dominated by the medical side. Usually, I agree with almost everything you have to say. However, on this topic, I have some opinions that are a bit different than yours.

 

First, I don't believe most accidents happen because of 1 bad decision made during a critical phase of flight. Sure, if we have a sudden tail rotor failure, I'm going to do my best to keep my screaming to a minimum and not distract you while you land the helicopter. However, an educated crew member may be able to better detect a situation that is forming due to previously undetected questionable decisions. Think about it. As the PIC, why would you intentionally make a bad decision? I don't think you would. Then why all the accidents? A properly trained medical crew member may be able to spot things that are starting to look bad before the pilot notices. Who is the person least able to recognize fatigue? (spoiler...it's the person who is fatigued). Who has the hardest time finding grammatical mistakes on an essay paper? (spoiler...it's the author). Who is the least likely to recognize bad decisions that are being made? Yep....I would definitely say the person making the mistakes.

 

Unfortunately, this situation is hard to quantify. How many flights would have been accepted by the PIC, had it not been for the educated medical crew member, into adverse weather which would have caused an accident? Impossible to quantify. However, we all know it has happened where a PIC has been "overruled" on accepting a flight and the weather wound up turning to crap. Ultimately, this scenario MAY have put the flight in jeopardy. 

 

Second, if you had to go on a ferry flight with another pilot, but only the other pilot had controls, you wouldn't ask about weather or the helicopter status? After all, you wouldn't want to influence another pilot's decision making, would you?

 

Third, in a hospital based program, it is my belief that the medical side is the one making the flight request, not the fire department or ambulance company on scene. If the hospital employee (medical crew member) decides to NOT request a flight based on their knowledge/intuition/gut feeling/etc, that's on them. They have the right to NOT request a flight. They should also own that decision and be able to articulate it.

 

I've been pressured by a pilot to take a flight. He wanted to skirt around weather between two different storms, with a patient on board, for a 2 hour flight. I said no thank you. He was upset and wanted me to call in another nurse. I explained that he was welcomed to show up and take the patient himself, but that myself and my partner were not going with him. The flight went the next day when the weather cleared.

 

Fourth, and here is a big one for me...you don't have to be a pilot to understand weather. I know, shocker, right? Last I checked, flight schools do not give anyone a degree in meteorology. I am able to learn and understand weather concepts without having to be able to physically manipulate a set of controls or read an MGT gauge.

 

Another pilot got very upset with me once for not waking him up to check weather in the middle of the night. When I went to bed it was foggy and it was forecasted to be foggy all night. I've been at this for a while and have a pretty good understanding of the weather. When I answered the phone at 3am, I turned down the IFT request. In the morning I got all sorts of grief because I didn't give him the chance to even look at weather. Once again, if one of us isn't willing to go, none of us are going. I would never accept the flight without first checking with the pilot, but I darn sure have the right to refuse to go.

 

Fifth, here is a quote from you "This thread started with the narration of an event where a medical crew member provided assistance to a pilot during an inflight issue. Good on that crewmember! But, it doesn’t follow  that that pilot would not have concluded that flight as successfully without the crewmember’s assistance." Based on the information from the program, it says "During this time, the paramedic in the left seat assisted the pilot by tuning radio frequencies, communicating the aircraft status to the Communications Center and by monitoring and reporting the status of specific instruments as requested by the pilot." It seems like in this case, the information provided by the medical crew member was not unsolicited advice. Had prior training not been conducted, the pilot would have had to explain, while IIMC, how to read certain gauges, tune frequencies, and use the ipad. Seems like in the original scenario, prior training was key to a successful resolution to the flight.

 

"Second, if you had to go on a ferry flight with another pilot, but only the other pilot had controls, you wouldn't ask about weather or the helicopter status? After all, you wouldn't want to influence another pilot's decision making, would you?"

 

Ask about weather and helicopter status? Certainly. Offer an opinion during the decsison process? Absolutely not.

 

Third, in a hospital based program...

 

Depends on the contract specifics.

 

I've been pressured by a pilot to take a flight. He wanted to skirt around weather between two different storms, with a patient on board, for a 2 hour flight. I said no thank you. He was upset and wanted me to call in another nurse. I explained that he was welcomed to show up and take the patient himself, but that myself and my partner were not going with him. The flight went the next day when the weather cleared.

 

If I anticipate any issue with weather, I offer the duty crew specifics and my plan to resolve the issue. This might be as simple as a deviation, but the crew has the option to decline. The weather is what you see from the cockpit and it probably well not always be clear blue and 22, I don't intend any pressure when I offer a plan. I see that as part of my duty.

 

Fourth, and here is a big one for me...you don't have to be a pilot to understand weather.

 

You do have to be the one who will fly the aircraft and is responsible, period. You don't want to go along on that flight, decline.

 

"Another pilot got very upset with me once for not waking him up to check weather in the middle of the night. When I went to bed it was foggy and it was forecasted to be foggy all night. I've been at this for a while and have a pretty good understanding of the weather. When I answered the phone at 3am, I turned down the IFT request. In the morning I got all sorts of grief because I didn't give him the chance to even look at weather. Once again, if one of us isn't willing to go, none of us are going. I would never accept the flight without first checking with the pilot, but I darn sure have the right to refuse to go."

 

The PIC should make the decision to accept or decline before any medical crew input. If the pilot had some idea that this request had been seen favorably by anybody else, an impression that influences the decision is created. I understand what you're saying that you would have refused dispatch, I support that part of the process, but all requests should be referred to the pilot first.


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#18 USDalum97

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Posted 21 February 2015 - 11:00 PM

 

 

Ask about weather and helicopter status? Certainly. Offer an opinion during the decsison process? Absolutely not.

 

 

If I anticipate any issue with weather, I offer the duty crew specifics and my plan to resolve the issue. This might be as simple as a deviation, but the crew has the option to decline. The weather is what you see from the cockpit and it probably well not always be clear blue and 22, I don't intend any pressure when I offer a plan. I see that as part of my duty.

 

You do have to be the one who will fly the aircraft and is responsible, period. You don't want to go along on that flight, decline.

 

The PIC should make the decision to accept or decline before any medical crew input. If the pilot had some idea that this request had been seen favorably by anybody else, an impression that influences the decision is created. I understand what you're saying that you would have refused dispatch, I support that part of the process, but all requests should be referred to the pilot first.

Ask about weather and helicopter status? Certainly. Offer an opinion during the decsison process? Absolutely not.

 

So you mean to tell me that if you ask about the weather and it is obviously marginal at best, but the PIC says it is safe, you would just go? At what point would you suggest interjecting an opinion? At some point we all need to take responsibility for ourselves and our fellow co-workers (and patients). I think it is absolutely the professional and correct thing to suggest that the flight be delayed until the weather clears more. 

 

If I anticipate any issue with weather, I offer the duty crew specifics and my plan to resolve the issue. This might be as simple as a deviation, but the crew has the option to decline. The weather is what you see from the cockpit and it probably well not always be clear blue and 22, I don't intend any pressure when I offer a plan. I see that as part of my duty.

 

While it is great that YOU would off the crew specifics and communicate your plan, not all of your colleagues do the same. Case in point. New pilot shows up to the base. He's never flown EMS. His only knowledge of the local was obtained during his orientation flight and check ride. On his first shift he makes it clear that he is the PIC and that he will handle all communications (even to the 2 EMS dispatch centers we have to talk with). He also expects us to not speak until spoken to and any offers of suggestions will be met with the IC being isolated. About 2 minutes into his very first flight he reminded us of his rules when we tried to politely tell him he was going the wrong way. It wasn't until about 10 minutes later that he finally relented and listened to us and turned around. He was unapologetic during post-flight debrief. That is the type of dangerous, "I'm in charge" attitude that I believe will kill people.

 

You do have to be the one who will fly the aircraft and is responsible, period. You don't want to go along on that flight, decline.

 

I don't fly the aircraft. I have responsibilities though. If WE go out in bad weather and have an incident, there will be some heat coming my way. I would expect my boss to be upset with me for doing something that I knew was wrong. I also have a responsibility to come home to my wife and kids. It doesn't take a meteorologist (or a pilot), to understand weather. I am capable of understanding the concepts. I can also apply that knowledge to the concept of safety and risk management. No stick wiggling required.

 

The PIC should make the decision to accept or decline before any medical crew input. If the pilot had some idea that this request had been seen favorably by anybody else, an impression that influences the decision is created. I understand what you're saying that you would have refused dispatch, I support that part of the process, but all requests should be referred to the pilot first.

 

I'm confused by this. What do you mean by "seen favorably"? If who saw the request? If it is truly a 3 to go, 1 to say no, environment, what does it matter who sees the request first? If I look outside and can't see the helicopter, we aren't going. The scenario I gave was a no-brainer. Even when the weather is totally clear I will ask the pilot if we are good to go prior to accepting an IFT or out of area scene request. However, if the weather is 0/0, why wake everyone up? 

 

I will agree that I can't make an official "accept or decline" decision for the operator per FAA regulation. However, I can say that I am not going. Think about it. There are pilots who will say "only the PIC can accept or decline a flight." while puffing out their chest. So if the pilot says the weather is good and he accepts the flight, I am now compelled to go? After all, I can't decline a flight, right? 


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#19 Wally

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Posted 22 February 2015 - 12:03 AM

Ask about weather and helicopter status? Certainly. Offer an opinion during the decsison process? Absolutely not.

 

So you mean to tell me that if you ask about the weather and it is obviously marginal at best, but the PIC says it is safe, you would just go? At what point would you suggest interjecting an opinion? At some point we all need to take responsibility for ourselves and our fellow co-workers (and patients). I think it is absolutely the professional and correct thing to suggest that the flight be delayed until the weather clears more. 

 

If I anticipate any issue with weather, I offer the duty crew specifics and my plan to resolve the issue. This might be as simple as a deviation, but the crew has the option to decline. The weather is what you see from the cockpit and it probably well not always be clear blue and 22, I don't intend any pressure when I offer a plan. I see that as part of my duty.

 

While it is great that YOU would off the crew specifics and communicate your plan, not all of your colleagues do the same. Case in point. New pilot shows up to the base. He's never flown EMS. His only knowledge of the local was obtained during his orientation flight and check ride. On his first shift he makes it clear that he is the PIC and that he will handle all communications (even to the 2 EMS dispatch centers we have to talk with). He also expects us to not speak until spoken to and any offers of suggestions will be met with the IC being isolated. About 2 minutes into his very first flight he reminded us of his rules when we tried to politely tell him he was going the wrong way. It wasn't until about 10 minutes later that he finally relented and listened to us and turned around. He was unapologetic during post-flight debrief. That is the type of dangerous, "I'm in charge" attitude that I believe will kill people.

 

You do have to be the one who will fly the aircraft and is responsible, period. You don't want to go along on that flight, decline.

 

I don't fly the aircraft. I have responsibilities though. If WE go out in bad weather and have an incident, there will be some heat coming my way. I would expect my boss to be upset with me for doing something that I knew was wrong. I also have a responsibility to come home to my wife and kids. It doesn't take a meteorologist (or a pilot), to understand weather. I am capable of understanding the concepts. I can also apply that knowledge to the concept of safety and risk management. No stick wiggling required.

 

The PIC should make the decision to accept or decline before any medical crew input. If the pilot had some idea that this request had been seen favorably by anybody else, an impression that influences the decision is created. I understand what you're saying that you would have refused dispatch, I support that part of the process, but all requests should be referred to the pilot first.

 

I'm confused by this. What do you mean by "seen favorably"? If who saw the request? If it is truly a 3 to go, 1 to say no, environment, what does it matter who sees the request first? If I look outside and can't see the helicopter, we aren't going. The scenario I gave was a no-brainer. Even when the weather is totally clear I will ask the pilot if we are good to go prior to accepting an IFT or out of area scene request. However, if the weather is 0/0, why wake everyone up? 

 

I will agree that I can't make an official "accept or decline" decision for the operator per FAA regulation. However, I can say that I am not going. Think about it. There are pilots who will say "only the PIC can accept or decline a flight." while puffing out their chest. So if the pilot says the weather is good and he accepts the flight, I am now compelled to go? After all, I can't decline a flight, right? 

 

So you mean to tell me that if you ask about the weather and it is obviously marginal at best, but the PIC says it is safe, you would just go? At what point would you suggest interjecting an opinion? At some point we all need to take responsibility for ourselves and our fellow co-workers (and patients). I think it is absolutely the professional and correct thing to suggest that the flight be delayed until the weather clears more. 

 

The point I am trying to make is that I allow the pilot to absolutely make the pilot decision without interference- do not skew the process. If the decision is against departure, that is the end. If the decision is to depart, then I have to decide if I'm getting in.

 

I don't fly the aircraft. I have responsibilities though. If WE go out in bad weather and have an incident, there will be some heat coming my way. I would expect my boss to be upset with me for doing something that I knew was wrong. I also have a responsibility to come home to my wife and kids. It doesn't take a meteorologist (or a pilot), to understand weather. I am capable of understanding the concepts. I can also apply that knowledge to the concept of safety and risk management. No stick wiggling required.

 

That's correct- YOU don't fly the aircraft, you're not trained for that and you're not responsible for that decision and execution. Whether you get in or not, is a separate issue. Further, most operators allow/require that anybody can abort a flight in progress. You're opinion and input has a place and sequence, and it's after the PIC's decision to accept.

The concept that the crew could be held at fault for a pilot's decision is new to me...


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#20 USDalum97

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Posted 22 February 2015 - 06:34 AM

 

The concept that the crew could be held at fault for a pilot's decision is new to me...

 

And we have boiled it down to the main point that seemed to have started the thread. I absolutely agree that medical crew would not be held at fault for a pilot's aviation decision. I have maintained all along that I would be held liable for my own decisions. If I choose not to get on board...I own that decision and am fully prepared to stand behind it with facts and solid reasoning. Luckily, I've never been second-guessed in over 12 years. 

 

Again, I understand that only a pilot can accept a flight. It is a fine line about who is declining a flight though. If you accept the flight and I refuse to go with you, who declined the flight? You were asked to go, you said yes, then you didn't go. Why not?

 

In the original scenario, the (assumed) trained medical crew member ASSISTED the pilot and the outcome was a safe landing. Who would argue AGAINST having them trained, especially for emergencies? Part of the training should be to give information as requested, not just randomly shout out random frequencies and gauge readings. Training the medical crew to assist AS REQUESTED by the PIC has no downside that I can see.


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