# New to HEMS, looking for advice



## Sublime (Jan 17, 2019)

Hello all, been a long while since I posted on these forums. I'm looking for some advice. my goal ever since starting my career has been to become a flight nurse. I finally achieved that goal recently and will start orientation in a couple weeks for a local non-profit HEMS service. I've found that I have been so focused on meeting  the requirements, nailing the interviews, studying for the tests ect. that I really neglected really thinking about the inherent dangers associated with this line of work and I don't know that I really have prepared myself for it. I've found myself getting more nervous about flying everyday the closer orientation starts. I have done flight ride outs before and enjoyed it, but the thought of doing it everyday has kept me up a few nights lately. I know this sounds stupid because this is what signed up for and worked towards for years now, but I don't know, now that it's here I have a nervous feeling I can't seem to shake. Prior to this all I would think about is what I needed to know to get the job, now that I have it, I have been thinking about things like how my daughters would grow up if I were in a crash and died in the next year. Is this normal for anyone one else? Any encouraging words?


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## akflightmedic (Jan 17, 2019)

Very normal thoughts and you should take very normal plans of action.

Secure a life insurance policy on yourself, a policy outside of the one your employer will offer. Take that one too, but definitely carry your own personal one which stays with you no matter where you are. Talk to a financial planner to help you determine how much coverage you should get. You have kids, are you the breadwinner? Is there a spouse in the picture...think Nanny/Childcare, think school needs as they grow, think college, think healthcare needs, braces, whatever.

Also consider AFLAC. Great policies to have including STD and LTD. I recommend carrying these in addition to, or in lieu of what your employer offers.

Have all your final wishes prepared and make them known to whoever you need to. Also have a POA stating what limitations or rights they have. 

Do NOT ever make a minor child a beneficiary. You need to have someone you know who will use the funds appropriately on their behalf named. Or have a trust named as beneficiary and then make someone in charge of the trust which is monitored by lawyers. If you name a minor as a beneficiary, the state gets to control the proceeds and determine what and how best to spend on your child. It also could be tied up and not as readily available when truly needed. 

Once you have things like this taken care of, you will find that you can relax, focus on the job and enjoy the heck out of it.


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## Sublime (Jan 17, 2019)

Haha, thanks. Already have a life insurance policy and all those types of things taken care of. I guess what I am wanting to know is things like, how do I know when it is safe to fly? They have a 3 to go 1 to say no policy, but I have no aviation background, and I don't know when it would be safe aside from days when its obviously terrible outside. I assume I'll get most of the aviation things in training, but maybe it would help my nerves to study up on that part a bit.


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## VFlutter (Jan 17, 2019)

Sublime said:


> how do I know when it is safe to fly? They have a 3 to go 1 to say no policy, but I have no aviation background, and I don't know when it would be safe aside from days when its obviously terrible outside. I assume I'll get most of the aviation things in training, but maybe it would help my nerves to study up on that part a bit.



That is a difficult topic. Be present when the pilot checks weather, have a discussion, and speak up if you have concerns. Personally, I trust my pilots and give them the benefit of the doubt as well as knowing that operational control is also a second set of eyes. I still have my own opinion and will voice concerns if I have them but that rarely even happens. When you first start out you really don't know what you don't know. Lightening under NVG can be intimidating even if it is a hundreds of miles away, visibility and ceiling can be difficult to put into perspective, etc. I am completely comfortable flying at minimums and we do so frequently, other people may not be. You have to figure that out for yourself.


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## GMCmedic (Jan 17, 2019)

My 2 big issues were nausea and having to rely on others till I got a feel for the weather, nausea lasted 3 flights and only with patients on board. 

I still have to lean on my partner and pilots for some weather calls, you'll essentially force yourself to be comfortable with their judgement till you get comfortable in the job. If you trust your partner and pilots this won't be an issue. 

Remember, you play an active roll in your own safety.


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## Peak (Jan 17, 2019)

Sublime said:


> ...Is this normal for anyone one else? Any encouraging words?



Its extremely normal and a huge reason why a lot of medics and nurses don't get into flight. I have a persistent fear that my bird is going to hit a powerline in poor visibility or some bubba's unpermitted hack job. I can count the times I've had to fly rotor wing on one hand, and I have no intention of doing any more. 

I had a  pediatric stroke and we called FFL to fly him into the hospital. Conditions were good but there was a cell about 30 miles out, they should have had time to land, package, and take off. When they landed there was a gust of wind that pushed the helo towards one of the buildings, It seemed that their blades were within 10 feet of the building. That easily could have been the death of 3 flight crew and probably several injuries to bystanders. They didn't do anything wrong, were picking up a legitimately high risk time sensitive patient, and it still could have cost them their lives.

Companies will preach that whole 3 to say no stuff, but it isn't always true. In the above case weather was good, but it would have grounded them in Denver for hours while the storm passed. They only took the call when they realized that it was a kid who really needed transport. I've known quite a few crews who push the limits a little bit for pediatric cases, and while they might view the risk as worth it the reality is that they are putting their lives on the line for a call. 

You really have to think about if the job is worth it. It is dangerous but also comes with a lot of rewards. We put ourselves in all kinds of risk, whether it be from disease exposure in hospital or car accidents on the streets and every thing in between. There have also been a number of hospital workers in the US recently murdered from someone's ex, so there is a risk of death in pulling shift in hospital too. 

It's a hard decision to make, and I wish you the best of luck with it.


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## Tigger (Jan 17, 2019)

I was under the impression that most programs only accepted flights based on weather vs. location calculations and not anything regarding patient status? Putting that information in the dispatch seems like a horrid safety issue.


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## DesertMedic66 (Jan 17, 2019)

Tigger said:


> I was under the impression that most programs only accepted flights based on weather vs. location calculations and not anything regarding patient status? Putting that information in the dispatch seems like a horrid safety issue.


Depends on the company. My base is a unique one for our company in regards to the local EMS system dispatches us. We do auto launch and stand bys on initial 911 calls so we hear the calls as they come out.


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## Tigger (Jan 17, 2019)

DesertMedic66 said:


> Depends on the company. My base is a unique one for our company in regards to the local EMS system dispatches us. We do auto launch and stand bys on initial 911 calls so we hear the calls as they come out.


Do you think that plays a role in flying decisions?

Now that I think about it, one of the local crews also monitors the primary county channel while working in the hospital but I am not sure how that affects their decision making.


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## DesertMedic66 (Jan 18, 2019)

Tigger said:


> Do you think that plays a role in flying decisions?
> 
> Now that I think about it, one of the local crews also monitors the primary county channel while working in the hospital but I am not sure how that affects their decision making.


I haven’t seen it change anyone’s minds. When we get dispatched our radio sends out a tone and we hear the dispatch information. We all make a decision on yes we can take it or no we can not take it. If we can take it then we keep monitoring the radio traffic. If we can’t then the radio goes back on mute so we have no idea what is going on.


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## VFlutter (Jan 18, 2019)

Most companies do not allow patient information prior to the pilot accepting the flight. I think that is the way it should be. There are many cases, i.e. pediatrics, that people likely do push to take a flight when they otherwise would not have. Only caveat are specialty flights in which extended bedside times may play into weather decisions but pilots will usually accept and then recheck once we know it may be a while on scene to make sure a front will not be moving in. 

Some bases are more aggressive than others. Some will not accept a flight unless they are confident they can complete the flight in its entirety. Others will still accept if there is a chance weather might move in resulting in the medical crew going by ground or being left at the hospital for a while. We occasionally will be dropped off at the receiving as our pilot goes to the airport to refuel and wait for a storm to pass through. We hangout in the cafeteria for a bit then get back to base after it passes. 

Yes HEMS is potentially dangerous job but so is life in general. You can also die in a car accident going to work, in an ambulance running code, or any number of crazy random ways that people get killed on a daily basis. Some people focus on that aspect too much. It is a job of calculated risks, mitigate risk the best you can. Personally I don't think it is a bad way to go out.


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## Peak (Jan 18, 2019)

Tigger said:


> I was under the impression that most programs only accepted flights based on weather vs. location calculations and not anything regarding patient status? Putting that information in the dispatch seems like a horrid safety issue.



I can't speak to what most 911 HEMS gets for dispatch but we do get call information for our specialty teams. Depending on what the patient situation is will reflect what teams we send and what specialty equipment and supplies (especially if there will be prolonged stabilization prior to coming back) go with them.

In that particular situation I don't know if they actually got call information prior, but the fire captain from the department helping us set up a landing zone had been making some phone calls when we heard they turned down the flight. All I know is somehow he got them to fly. I'm sure it's a huge safety issue and violated all kinds of department/company policies, but the reality is that they took the call in less than ideal conditions. They also aren't the first crew to fly in less than ideal conditions.

I won't go into too much detail because there aren't many peds strokes so its difficult to maintain confidentiality. That kid did end up having multiple thrombus on imaging, was treated appropriately, and now has returned to baseline status and you never would have known he had a stroke. That flight was critical in his outcome and the fact that they did end up taking the call is a key reason that he doesn't have any disability from it.

I didn't tell that story because I want to shame the crew or that they did anything wrong, and I couldn't be more appreciative of them. All of our jobs come with risk, but those that fly rotor have more average risk than most of us.

When you think about flights outside of HEMS, you think about submitting flight plans, staying in established air space, landing on regulated runways or pads, and in highly populated areas you will often have ATC available, even if it's just a regional center that is helping you in small airports that don't have towers. Landing in inclimate weather isn't as difficult at regulated pads/runways, there are a variety of landing aids and most of the fixed wing planes can land IFR anyway.

Most if not all of that goes away with HEMS. They land in areas that you wouldn't be allowed to otherwise, they fly with no or very abbreviated flight plans, there is little or no ATC in their response areas, and preflight checks are abbreviated compared to non HEMS checklists. There is more risk in this, but it is balanced with the hope that it will save lives.


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## Tigger (Jan 20, 2019)

Peak said:


> I can't speak to what most 911 HEMS gets for dispatch but we do get call information for our specialty teams. Depending on what the patient situation is will reflect what teams we send and what specialty equipment and supplies (especially if there will be prolonged stabilization prior to coming back) go with them.


I guess I don't understand how that affects the _pilot's_ choice when accepting the flight. Speciality things notwithstanding, he/she still needs to fly the aircraft to the "scene." If there is a reason to not fly there, it doesn't matter what the patient is.



> When you think about flights outside of HEMS, you think about submitting flight plans, staying in established air space, landing on regulated runways or pads, and in highly populated areas you will often have ATC available, even if it's just a regional center that is helping you in small airports that don't have towers. Landing in inclimate weather isn't as difficult at regulated pads/runways, there are a variety of landing aids and most of the fixed wing planes can land IFR anyway.
> 
> Most if not all of that goes away with HEMS. They land in areas that you wouldn't be allowed to otherwise, they fly with no or very abbreviated flight plans, there is little or no ATC in their response areas, and preflight checks are abbreviated compared to non HEMS checklists. There is more risk in this, but it is balanced with the hope that it will save lives.


Perhaps American HEMS should consider operating like its brethren in many other countries where the rate of accidents is significantly less? To my knowledge, Canada requires air medical to be completed in dual pilot, IFR rated aircraft. They have established LZs with instrument approaches to accomplish this. Commercial air travel is exceptionally safe, and HEMS is still commercial air travel. Why eliminate all the things that make it that safe? I pushed my previous/PRN employer to make a serious push to only land helicopters at designated and secured landing zones with GPS approaches. The few extra minutes that it takes us to go by ground to LZs make a middling patient care difference and allow for a safer patient handoff. We also pushed hard to ensure that responders knew what no-fly weather looked like (with FFL's help) and instructed them to not even request a helicopter in these situations as too many times someone accepted a flight into a blizzard in our area. Sure, flight has final authority, but I am not going to be party to sending folks in a small, VFR rated, single engine aircraft into those conditions at elevation. They have access to weather and radar, I have access to my own eyes. 

But why do we need to do that? Why did the county EMS council have to pass a resolution stating that single rejection by any air medical provider meant no subsequent requests? Why won't the operators do that?


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## Peak (Jan 21, 2019)

So incidentally we just recently had a very stable floor kid flown in rotor who would have been bls ground appropriate but was flown due to the distance.

I was talking with the crew afterwards and we were all talking about how ridiculous it was to fly that kid, how he should have gone ground, and a bit of why was the kid being transferred to us anyway (there is a small but pretty capable children's hospital in the state they came from). I apparently made the misstep of pointing out how fixed wing or ground would have been safer and there wasn't really a reason to put a crew at risk. The room fell silent at the mention of rotor being dangerous.

I'm not sure if there is a culture of silence around the dangers involved, but their was palpable tension after I crossed that apparent faux pas. I'm not sure if it was a crew thing, a company thing, or if it was more widespread but it seemed like the risks were something not to be talked about.

The weird thing is that when I was on fire this was something we talked about quite a bit. What would we go interior for on a questionable structure. When is it okay to go in before SO state shows up on a BOLO. When would you rescue on a hazmat that we didn't really understand. We also recognized that there was a real chance that we wouldn't be going home at the end of the day.

I don't have any way to really understand the culture in HEMS in the US, but I suspect that it plays into this in a huge way.


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## Tigger (Jan 21, 2019)

Peak said:


> I don't have any way to really understand the culture in HEMS in the US, but I suspect that it plays into this in a huge way.


I don't either. I think a lot of it comes down to the whole "risk a lot to save a lot" mantra that many in the emergency services have adopted. But I don't really think it applies to routinely doing inherently risky things. When cops talk about active shooters and fire talks about going interior in structure fires, these are relatively rare events. They are not frequently operating on a razor's edge. Air medical frequently flies small, VFR aircraft into unimproved landing zones in poor weather at night. This essentially normalizes the risk, so when someone says "we can save a life if we accept" the starting point for risk calculation is already inherently flawed.

This is not meant to trash on HEMS. There is a definite need here regionally, and it is a career path that I could see myself drawn towards. I just wonder if sometimes a bit more regulation is needed for the industry.


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## DesertMedic66 (Jan 22, 2019)

For HEMS we understand that we take risks and anytime we are up in the air is a risk. Depending on your company how you view risk and what you do about it can vary greatly. There are companies that will take great risks and there are others that won’t fly if there is a single cloud in the sky. 

The company that I am employed by has a risk assessment tool that allows us to get an objective look at the risk of each and ever mission (patient flight, relocation flight, search and assist flight, etc). We have a simple stop light system. Green is minimal/low risk and we are good to accept a mission from that aspect. Yellow means there are some issues and that we must contact our control center to get more info and go from there. Red is an automatic no go. It takes many factors into consideration which we normally do not think about.

Each base has to justify a reason to stay open and since the majority of HEMS are private that justification is in the form of profit. One of the ways to save money is buy using smaller VFR only aircraft. They are cheaper in initial cost, cheaper in maintenance, and cheaper in fuel usage. At my current base if we were using a dual engine IFR airship, I doubt we would by able to operate for more than a couple of months in profit.


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## Carlos Danger (Jan 22, 2019)

VFlutter said:


> That is a difficult topic. Be present when the pilot checks weather, have a discussion, and speak up if you have concerns. *Personally, I trust my pilots and give them the benefit of the doubt* as well as knowing that operational control is also a second set of eyes. I still have my own opinion and will voice concerns if I have them but that rarely even happens. When you first start out you really don't know what you don't know. Lightening under NVG can be intimidating even if it is a hundreds of miles away, visibility and ceiling can be difficult to put into perspective, etc. I am completely comfortable flying at minimums and we do so frequently, other people may not be. You have to figure that out for yourself.



For a long time the industry thought that the key to safety was CRM and a robust "three to go, one to say no" policy. While CRM certainly has it's place, it gets a LOT more lip service than actual utilization, and I don't think there are many places that train it effectively. "Three to go, one to say no" is inherently flawed for the simple fact that med crew members - even ones with lots of HEMS experience - are never as adept at assessing weather safety as the pilot is, and everyone knows it. Pretending otherwise is like saying the pilot should have a say in which interventions to perform on a sick patient. A green crew member is never going to say no, for obvious reasons. One with a little more experience might, but if your pilot doesn't agree, you look bad and you risk creating friction with that pilot, no matter what anyone says. For a few times everyone will act like it's cool. Make a habit of it, and you will be reminded that you don't know how to read weather, and the whole culture at that base or program just became toxic. The corporate safety folks can tell you otherwise until they are blue in the face, but they are wrong. I think everyone gets this in the back of their mind, which is why these policies don't work as intended. Bottom line is, if you really feel unsafe doing something, then don't do it. But…you have no choice but to trust your pilot. You are literally putting your life in their hands every day, but that's what you signed up for when you got into HEMS.



Tigger said:


> Do you think that <the pilot hearing dispatch info> plays a role in flying decisions?



It definitely can. After a CFIT in poor visibility, people always say "man, he was such a good pilot, what was he thinking taking off in that weather?" and the answer is that there are many things that can influence the quality of a decision like that. The ability to make objective decisions may itself be impaired, from stress or fatigue, for example, or subtle pressure to make a given decision may exist. The classic example is the pilot who flies out of a small, rural base for a for-profit operator. The last few months have been slow and maybe he's had to turn down a handful of flights due to weather. The med crew is getting antsy, and everyone has in the back of their mind that if their base doesn't produce, eventually they will be looked at by corporate, meaning their jobs are at risk. Maybe a competing operator has even been taking calls in their area, which everyone in HEMS knows is a very big deal. After a week or so of this weighing in the back of everyone's minds, a call comes in. Weather is not ideal, normally the pilot would turn this one down. But he's flown in worse before, many times. What decision is he likely to make? Dispatch info can similarly have subtle effects on a pilot's decision. It might not be obvious what they are thinking, and of course when asked about it they'll all give some generic answer about how their first priority will ALWAYS be getting themselves home to mama at the end of their shift, so they would never let their decision be affected by listening to audio of a 911 response to a 4 year old girl struck by a car a two-hour drive from the closest trauma center - usually in the humorous, macho, tough-guy style that former military helicopter pilots are known for. But there is simply no way that kind of thing doesn't at least potentially have an effect.




Tigger said:


> I don't either. I think a lot of it comes down to the whole "risk a lot to save a lot" mantra that many in the emergency services have adopted. But I don't really think it applies to routine doing inherently risky things. When cops talk about active shooters and fire talks about going interior in structure fires, these are relatively rare events. They are not frequently operating on a razor's edge. Air medical frequently flies small, VFR aircraft into unimproved landing zones in poor weather at night.


Yes.



Tigger said:


> Perhaps American HEMS should consider operating like its brethren in many other countries where the rate of accidents is significantly less? To my knowledge, Canada requires air medical to be completed in dual pilot, IFR rated aircraft. They have established LZs with instrument approaches to accomplish this. Commercial air travel is exceptionally safe, and HEMS is still commercial air travel. Why eliminate all the things that make it that safe?



I couldn't agree more. IFR capability is a nice thing to have. In some environments it is essential to flying safely, in others it really isn't as long as conservative rules towards the weather are used. Two pilots though, really is a game changer. You can add together all the other safety practices done in American HEMS, multiply their effectiveness by 10, and they still won't even come close to touching the increase in safety that comes by doubling the number of pilot brains and eyes you have in the cockpit.

The downside, of course, is cost. You need bigger aircraft, and you need twice the number of pilots. Increased cost = decreased corporate profits.


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## CANMAN (Feb 3, 2019)

Lots of good info in this thread already for stuff to look out for. I can't stress enough, and do so with all my orientee's, that once you get through orientation don't stop learning and asking questions. Make it a point each day to take some time out with the pilots to learn about an A/C system, or learn more about weather. Learn how to work the autopilot in your A/C (if applicable), learn more about weather mins, IIMC recovery, temp/dew point spreads, etc. If the weather is questionable and your partner and pilot feel comfortable accepting a flight ask why, and what is the pilot's game-plan if conditions aren't as stated. They should absolutely be able to articulate to you why they feel comfortable accepting the flight, and what their plan is if things aren't as reported. 

If you abort a flight, or complete one but have weather questions come back and discuss it. When out flying around you're local area ask questions about height of tower's, how much cloud clearance you currently have, how far away is that tower/airplane etc. This will increase your ability to estimate distances of things, which is helpful when out and flying about in marginal weather in making the call to turn around and go home. 

I very much agree with the "you don't know what you don't know" when you're first starting out. So make it a point to learn as much as you can about the stuff you don't know much about....


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## CANMAN (Feb 3, 2019)

Peak said:


> So incidentally we just recently had a very stable floor kid flown in rotor who would have been bls ground appropriate but was flown due to the distance.
> 
> I was talking with the crew afterwards and we were all talking about how ridiculous it was to fly that kid, how he should have gone ground, and a bit of why was the kid being transferred to us anyway (there is a small but pretty capable children's hospital in the state they came from). I apparently made the misstep of pointing out how fixed wing or ground would have been safer and there wasn't really a reason to put a crew at risk. The room fell silent at the mention of rotor being dangerous.
> 
> ...



IDK your background, where you work, or anything additional about the situation, but it may have been they felt like their judgement was being questionable by a non-flight hospital provider. Now before the flaming starts, we all know how many factors are considered by pilots and flight crew members prior to taking a flight. That being said if a nurse at the receiving facility questioned the safety of the flight we just flew, I might be a little standoff-ish because how am I supposed to know if you have knowledge of all that goes into flight acceptance etc. I think it could be looked at as you just inferred that we took an unsafe flight, when in reality it may have been a medically un-necessary flight but not unsafe. I think when you look at ambulance vs. HEMS crashes the numbers would also reflect that ambulance transport isn't "safer" than a HEMS flight. Statistically there are more ambulance crashes vs. HEMS, the HEMS flights just often carry more fatalities obviously. So I don't know that's really a sound argument to a flight crew. Also, MOST flight provider's aren't able to question medical necessity of their own flights their program takes. While I don't agree with it, this is often decided from a MD to MD conversation under EMTALA laws or at a much higher level in the program then the flight crew level. That being said they most likely don't have much course of action in determining what they fly as far as medical necessity and while they're likely agree the kid could have easily gone by ground the safety of the transport really shouldn't be questioned my opinion just because it wasn't the most appropriate mode, likely decided at the MD level. 

As an industry I think one area where we could really excel is MD outreach as to what should qualify as a HEMS flight to decrease over-utilization for the patient who doesn't meet medical necessity or there is a more appropriate mode. I don't know/think they get much training on that however, under law are often the one's making the decision, which seems like an area of process improvement that would help drastically. That being said there's still going to be the MD's who call just because they want the patient gone and there will always be programs to accept those transfers, so it's not a completely fixable problem.


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## Peak (Feb 3, 2019)

CANMAN said:


> IDK your background, where you work, or anything additional about the situation, but it may have been they felt like their judgement was being questionable by a non-flight hospital provider. Now before the flaming starts, we all know how many factors are considered by pilots and flight crew members prior to taking a flight. That being said if a nurse at the receiving facility questioned the safety of the flight we just flew, I might be a little standoff-ish because how am I supposed to know if you have knowledge of all that goes into flight acceptance etc. I think it could be looked at as you just inferred that we took an unsafe flight, when in reality it may have been a medically un-necessary flight but not unsafe. I think when you look at ambulance vs. HEMS crashes the numbers would also reflect that ambulance transport isn't "safer" than a HEMS flight. Statistically there are more ambulance crashes vs. HEMS, the HEMS flights just often carry more fatalities obviously. So I don't know that's really a sound argument to a flight crew. Also, MOST flight provider's aren't able to question medical necessity of their own flights their program takes. While I don't agree with it, this is often decided from a MD to MD conversation under EMTALA laws or at a much higher level in the program then the flight crew level. That being said they most likely don't have much course of action in determining what they fly as far as medical necessity and while they're likely agree the kid could have easily gone by ground the safety of the transport really shouldn't be questioned my opinion just because it wasn't the most appropriate mode, likely decided at the MD level.
> 
> As an industry I think one area where we could really excel is MD outreach as to what should qualify as a HEMS flight to decrease over-utilization for the patient who doesn't meet medical necessity or there is a more appropriate mode. I don't know/think they get much training on that however, under law are often the one's making the decision, which seems like an area of process improvement that would help drastically. That being said there's still going to be the MD's who call just because they want the patient gone and there will always be programs to accept those transfers, so it's not a completely fixable problem.



A brief highlight of my background is that I want zero to hero and was lucky enough to get on a small but very progressive department, and for a while tried to get on big department. After quite a bit of effort I realized that wasn't going to work out so I went to nursing school. I worked for a while at a large peds level one program, got burned out of the politics and left. 

I now work at a quaternary referral center and what I do really depends on the needs of the programs. I have been doing more inpatient critical care although I still work in our ED quite a bit; I work the vast majority of my time on the peds side of the house but I still do adults if they absolutely need it. I also do work with our EMS outreach and education although that is a smaller portion of what I do currsntly. I still do some EMS stuff, but mostly with our high risk peds programs and we mostly do everything we can to stay out in the field and not transport in.

I can appreciate your perspective, but I don't think that it was the case with this crew. They know my background and we were all in agreement about how the kid could have been a bls ground transfer, the kid didn't really need transfer and so on. We were all in agreement and everything was copacetic until I mentioned that flying is dangerous.

I guess I should have been more specific that when I say HEMS is dangerous I specifically mean that there  are proportionally more fatalities in HEMS, not recoverable injuries.

Unfortunately as the recieving facility there is little we can do to affect how patients are delivered to us. We certainly try to give our advice but that is ultimately up to the spending facility. I think that there is so much competition to get HEMS flights that the medical director for our program, and likely most programs, isnt going to risk offending anyone else and just have them use a competing service.


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## CANMAN (Feb 3, 2019)

Peak said:


> A brief highlight of my background is that I want zero to hero and was lucky enough to get on a small but very progressive department, and for a while tried to get on big department. After quite a bit of effort I realized that wasn't going to work out so I went to nursing school. I worked for a while at a large peds level one program, got burned out of the politics and left.
> 
> I now work at a quaternary referral center and what I do really depends on the needs of the programs. I have been doing more inpatient critical care although I still work in our ED quite a bit; I work the vast majority of my time on the peds side of the house but I still do adults if they absolutely need it. I also do work with our EMS outreach and education although that is a smaller portion of what I do currsntly. I still do some EMS stuff, but mostly with our high risk peds programs and we mostly do everything we can to stay out in the field and not transport in.
> 
> ...



Totally agree with the last paragraph, and it's frustrating. When I flew at a tertiary Children's Hospital they had a great triage and intake program setup where the Medical Control Officer who accepted the patient for transfer also kinda help guide some care with suggestions and also suggested mode of transport often times. This was often a suggestion to send kids via their dedicated aircraft for critical and time sensitive patients, and then either via ground for non-critical, and sub some stuff to the contract vendor that was lower level ALS or BLS transfer. I think that worked well in the Peds world because there are far more MD's who are less comfortable with Peds than Adults. If you're transferred to a larger/tertiary hospital I think the MD getting the patient should have a say in mode of transfer, but unfortunately that's in the hands of the referring MD, and often times these MD's at the sending facilities just want the patient gone and aren't concerned about mode, appropriateness, etc.


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## E tank (Feb 3, 2019)

I've known a lot more nurses killed on the way home/to work (2) than LOD  flight nurses (0).


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## Carlos Danger (Feb 8, 2019)

Civil air crew member (55.5 fatality rate) is the third most deadly job in America, with the subset of HEMS probably being more hazardous than than the larger industry. Only commercial fishers (86.0) and loggers (135.0) are more likely to be killed at work.

For comparison, police don't even make the top 10, and firefighters aren't even in the top 25.


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## CANMAN (Feb 8, 2019)

Remi said:


> Civil air crew member (55.5 fatality rate) is the third most deadly job in America, with the subset of HEMS probably being more hazardous than than the larger industry. Only commercial fishers (86.0) and loggers (135.0) are more likely to be killed at work.
> 
> For comparison, police don't even make the top 10, and firefighters aren't even in the top 25.



You have a link to reference? Interesting numbers.


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## DrParasite (Feb 8, 2019)

CANMAN said:


> You have a link to reference? Interesting numbers.


Ask and you shall receive:









						The 34 deadliest jobs in America
					

Some jobs have a higher risk of fatal injuries than others, such as fishing and logging workers, according to the Bureau of Labor Statistics.




					www.businessinsider.com
				




But it's not entirely accurate, because all of the injuries and fatalities are based on *per 100,000 workers* so when you take a look at HEMS (or civilian air crew), it's a relatively small worker pool, so every crash raises the number higher than one with a larger employment pool.


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## CANMAN (Feb 8, 2019)

DrParasite said:


> Ask and you shall receive:
> 
> 
> 
> ...



Exactly my point, I don’t know if we really know how many people actually work HEMS. So to compare it to law enforcement where  we have about 850k LEO’s in the nation and already 15 killed in line of duty I think is difficult. If we knew a ballpark of how many HEMS providers there are then we could look back but I don’t know if anyone has done something like that. I don’t know that grouping us in with every single pilot and type of air carrier is going to give us numbers that are anywhere near accurate. With that being said if I was a betting man I would say the fatality rate in oil and gas, as well as power line rotor wing is much higher than HEMS, and I think mission profile has a lot to do with the risk.


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## MackTheKnife (Feb 13, 2019)

Sublime said:


> Hello all, been a long while since I posted on these forums. I'm looking for some advice. my goal ever since starting my career has been to become a flight nurse. I finally achieved that goal recently and will start orientation in a couple weeks for a local non-profit HEMS service. I've found that I have been so focused on meeting  the requirements, nailing the interviews, studying for the tests ect. that I really neglected really thinking about the inherent dangers associated with this line of work and I don't know that I really have prepared myself for it. I've found myself getting more nervous about flying everyday the closer orientation starts. I have done flight ride outs before and enjoyed it, but the thought of doing it everyday has kept me up a few nights lately. I know this sounds stupid because this is what signed up for and worked towards for years now, but I don't know, now that it's here I have a nervous feeling I can't seem to shake. Prior to this all I would think about is what I needed to know to get the job, now that I have it, I have been thinking about things like how my daughters would grow up if I were in a crash and died in the next year. Is this normal for anyone one else? Any encouraging words?


This is  something you wanted and achieved. Get excited about that and think of the adrenaline!


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