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Sunday, March 1, 2009

EMS

Terry Terrell

Don’t Wag the Dog

High levels of stress are inherent in EMS helicopter operations, generating pressures that tend to cause the backward circumstance of the dog being wagged instead of the tail. Looking back, it can be seen that early civilian EMS programs in the U.S. were sometimes hastily arranged. As contracts were signed, and as crews organized, the message from management was too often very clear, "Accomplish all requested missions as the super heroes we advertise and promise; whatever it takes."

Obviously, as can be seen through even a cursory look at EMS helicopter operations during the late 1970s and early 1980s, safety performance became horrible; a function of pilots flying into unacceptable weather, attempting to stretch finite aviation capabilities to fit any mission demands. This course was allowed instead of properly starting by educating medical consumers about the helicopter’s capabilities and limitations. The tail was being allowed to wag the dog in a dangerous way for the first time.

Eventually, safety performance improved as pilots and aviation providers became better at imposing reasonable limits on themselves, and as medical transportation customers became educated with regard to what their available aviation resources could realistically deliver safely. It was learned that emotional responses to medical emergencies could not be allowed to dictate aviation decision-making. Knowledge, experience and programs properly refining weather acceptance and mission strategy standards, eventually brought EMS helicopter activities into accident rate ranges with more familiar aviation norms.

Today, quite a lot is known about how to restrain excessively enthusiastic responses by EMS helicopter programs, but smooth operations often provoke the challenge of preventing complacency.

My own programs have traditionally started orientation classes, for both crews and pilots, by asking for a volunteer to describe a proper mission goal. Usually someone will end up offering, "It’s to use our human and equipment resources to assist the medically needy in our community to the best of our ability." This provides a perfect opportunity to present that such lofty notions are actually the "B" part of the mission, impossible unless an extremely critical part "A" is thoroughly accomplished first. Part A is assuring that a safe mission return is always positively arranged and confirmed!

Helicopters can contribute nothing in attempting any mission until Part A is achieved. I always emphasize that we are dedicated not to being recklessly dashing heroes on a single day, but to arranging "to be reliable, enduring heroes for many decades." Pilots must function as effective leaders of people and missions. EMS operators must enable pilots accordingly, avoiding weak "going through the motions" training programs that fall short of establishing this critically essential standard. Our local programs always finish instilling this strategic philosophy by conceding that delivering medical assistance to the needy is indeed our payload, but that the payload can only be delivered if the delivery system is fully perfected first. In this way, it is confirmed that the helicopter component of the EMS partnership - the "dog" - is made to stand rock steady, allowing the medical mission to "wag" effectively.

In developing this pet lover’s way of looking at things, I imagined emergency medical helicopter operations to be a uniquely fitted setting, but a closer look at rotary-wing operations across the spectrum of helicopter uses reveals that the tail relentlessly pressures toward becoming the wagger instead of the wagee.

These days, night vision equipment, terrain warning systems, etc. are being examined as possible remedies for poor helicopter safety performance, but those of us who have been around know that no tool kit can ever replace quality human judgment and safety leadership. The offshore pilot is constantly pushed by the dog’s tail, as is the police pilot facing a fellow officer’s distressed voice on the radio pleading for assistance. The dog’s tail can be almost irresistibly powerful.

Ultimately, though, the gear can be carried, the officer assisted, and the patient transported, only when sound human decisions are made, and when the dog remains firmly and unwaveringly in control of the tail.

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