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.
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.
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.
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.
