Monday, August 24, 2020

A Flight Paramedic Writes...

"Coffee Talk.....or in my case Beer Talk..... Real talk for a moment and this is gonna be long so if you give zero fox or don’t have the attention span then keep scrolling, no judgement. This is just something we all need to remember, especially right now. 

My husband took me out to lunch today to one of our favorite spots for a burger and beer because he felt like doing something sweet for me. Not because he wants something from me but because I have been making an extra effort to be and do sweet things for him like making his favorite soup, getting him a Happy Day gift, and just being all around more affectionate. We talked about things we wanted for the future and plans we wanted to start working towards, which was nice and something we haven’t done in a while. 

For me, it’s hard to be vulnerable and show emotion even to my kids and my spouse. Working in public safety for so long, especially being brought up in older school public safety, you learn early that you have to compartmentalize and show no emotion....especially being a female in a predominately male field. It is drilled into you. You have to be able to turn off emotion to work efficiently in times when you see things no human being should ever have to see. You have to be better, work harder and be stronger. Working like this establishes you as a paramedic and not just a “female”, as well as preserves your mental state enough to be able to continue working. What you don’t realize early on though, is that this will bleed over into your personal life as well. You become closed off, reserved and quiet. It gets harder to show emotion on your days off, and harder not imagine all the ways things could “go wrong” in any given recreational situation. It gets harder to turn off your “public servant” brain and turn on your “human brain”. Being a manager/supervisor/leader makes it that much harder because you have to be the strong one people can come to, trust, and rely on amongst all the other factors this profession already entails. In my work life, I strive to be the mom/big sister figure that my people can come to knowing that it will be without judgement but also that hard truths will be told if need be. I try to always greet my people with a smile, try to make them laugh when appropriate and be strong for them when they need me to be. I am also human, and what most people don’t see is the tears that I shed for them, our patients and sometimes myself. I have had my moments sobbing in the bathtub or screaming at the night air by myself. I suffer from depression, anxiety, self harm and PTSD not just from public safety but from other factors of my life as well. (Whoo that’s not easy to say out loud!) I have to remind myself that it’s ok to be emotional and show emotion at the appropriate time. We have to constantly work on ourselves not to get lost in the “this is just who I am now” mindset and remind ourselves to be outwardly vulnerable, sweet, loving and kind to the people that we love and care about. Luckily I have a partner that not only understands because he’s been there, but reminds me to be Jennifer and not just the paramedic or the supervisor when I get lost in it. It’s so important to be cognizant of yourself and see when you need to remind yourself to be you again. I have overcome a lot in this profession, from being a single mom going though paramedic school on an EMT Basic salary, to being sexually assaulted more than once on duty, to having my reputation trashed for reporting one of those assaults, to having my superiors protect my assailant before me, to being told I couldn’t do it cause I wasn’t a man, to being held back from promotion for standing up for what’s right, to being told I got as far as I did only because I was pretty, to being told I will never make it in this career, to now....a 17 year veteran, a flight paramedic, being promoted to my current level after less than two years at my current job, to now out ranking that same person who tried to hold me back from that previous promotion, while being a mother to my kids and a wife my husband can be proud of. It’s hard, it really is. I work at it everyday. Some days I fail but others I surprise even myself and prevail. It’s up to you to be happy and make your life what you want it to be. It’s up to you to remember who you are and to work everyday at being the person you want to be.

“I hope you remember that if you encounter an obstacle in the road, don’t think of it as an obstacle at all....think of it as a challenge to find a new path on the road less traveled.”

Thanks for coming to my Ted Talk. You may now rejoin your regularly scheduled scrolling. 🤣✌🏼"

Thanks Jennifer for opening up and sharing your thoughts. There might very well  be some young person struggling--right this instant--with the exact issues you discuss, and we hope they derive comfort and strength from this.

Thanks for everything you do, every day. 


Wednesday, June 17, 2020

Guidance From Above...

Dan , I’m 48 years old. I’ve flown in excess of 10,000 hours. His arm still rests behind my back on every flight.

Last week, I had an epiphany. As an Air Medical Resource Management instructor for the last ten years, I have been putting out information about a well-defined hazardous attitude threatening the human-variety of pilot since manned-flight began.


My standard spiel revolves around the threat of an impulsive response to a suddenly-developing problem. Say one of your two engines catches on fire, and you see a fire-light in the cockpit. You exclaim, "crap, we gotta fire on two!" and you reach forward and smartly pull the number one engine's fire-control handle and shut that engine's fuel valve. Now you have two problems instead of one. It's happened more than once.

Acting on impulse in an emergency situation often makes a bad situation much much worse. Better to announce what you think is happening, take a deep breath, and devise (and announce) a response. "I'm looking at a fire light on the number two engine. Crew, prepare for an emergency landing and tell me if you see any other indications of us being on fire. I am going to slow down to single engine speed and put my hand on the number two fire control handle. I've confirmed the light and the handle. You see smoke. I'm pulling it."

So that's one type of threat from acting on impulse, and an example of how to fight that urge. But there's another threat of acting on impulse. Consider a beautiful day and a perfectly operating helicopter and a pilot who has an impulse to "have a little fun." This type of impulse has killed a crowd of crews too. In our industry, the most recent event took place in the Superstition Mountains. The Air Force suffered a famous and now iconic tragedy involving a B-52. And then they lost a C-17. It happens. We have to be on the lookout for it. Within ourselves and each other. Impulsivity, in any form, is bad.

So I sat down and wrote the next "Focus on Safety" column for Vertical Valor Magazine. I titled it "Neither Willful Nor Thrillful Be." And as I sometimes do with a draft, I sent it to a friend to review. This one went to Miles Dunagan, HEMS pilot and president of the National EMS Pilots Association. He's a good sounding board.

He wrote back.

"Hi Dan,

It’s always Great to hear from you!

I like it. I believe it is prevalent. I’m afraid it will always be in our business. While reading, my thoughts went directly to my pals I’ve lost. None were seeking a thrill, but their desire to achieve an outcome took them farther into the danger zone where we allow our judgment to--not necessarily be absent--but perhaps just slow to surface when we face hazards that were unexpected.

My dad and I talked about it. Of course this was before the dementia took so much from him. (Hard to believe he’s been gone a year)I simply asked him.”Dad how did y’all do it back in 1970-71?”. What were your minimums? His response, “we really didn’t have any son”. Then how did you do it I asked? He shrugged his shoulders and talked about that feeling when your hair on the back of your head starts to stick up, it’s time to turn around. I said Dad, that’s too late! He admitted that I was correct, and that he was lucky. We’ve came a long way, but that desire to produce good outcomes was powerful in 1970, and still is 50 years later.

The desire for the thrill can be overwhelming. I remember being a young pilot. I remember flying with my dad during those mid teens in an Astar. When I got my private, my dad let me swap to the right seat and he went in the left. We had the high back seats. My dad would put his right arm on the back of my chair. Kind like an arm rest. During these informative years, my dad watched me like a hawk. As these were often empty legs, I remember many times setting up for a departure. I would climb out and get set up for cruise and now we’re getting somewhere. Then , it seemed like my weakest suit was setting up for our approach for landing. I would make my turn around the LZ, assess winds, look for wires, and here we go. Dad had been instructing since the 60s. He was pretty good. He would let me make mistakes. He would allow me to get set up and start my approach. I would be lined up for what I judged as the perfect approach path and then it would happen. That right arm that was resting on the back of my chair would come to life and he would pop me on the back of my head. I would execute a go around and he would ask me 'what was wrong with that approach son?' I would look and see a pole (wire) that I had missed because I got in a hurry and was careless. Or I would re-assess the wind and realize I had lined up down wind. Believe it or not, these are great memories. I can’t help but tear up remember them.

Dan , I’m 48 years old. I’ve flown in excess of 10,000 hours. My dad's arm still rests behind my back on every flight. It makes me take an extra look. It makes me review a chart one more time. It motivates me to ask questions as we are circling a scene or a pad I’ve landed at countless times.

I can relate to your story of being thrillful my friend. Something tells me that the  Blackhawk pilot who thought enough of you to expose your shortcoming in judgement before that Black Cat departure all those years ago was riding with you from that day forward.  (added: yep!)

All this doesn’t mean we’ve never made mistakes flying. It just means we've had a little different perspective than those who let bravado and macho attitudes creep into the cockpit with them...

Sorry to ramble my friend.

Thanks for sharing.

Very Respectfully,


About Miles Dunagan's dad...

"Dad was one of the original 6 pilots to start the Memphis Police Aviation unit in 1969. He flew full time, then later as a reserve. He held an ATP and was a DPE for 14 years."

In the Army, we call a guy like that "the long pole in the tent." Today, he has been gone a year. May God continue to bless Mr. Dunagan's soul and comfort his son Miles Dunagan


When Noobs Fly

Image courtesy Roger Buck
This image brings to mind a topic of discussion that has come up twice in the last week during phone conversations with pilots associated with two of the largest HEMS companies in America. In both of those discussions, the difficulties of transitioning to a pilot job in HEMS from either the civilian track (student, CFI, CFII, time-building job, HEMS job) or the military track (member of a dual-pilot team flying military missions in an aviation unit) were covered in detail. "Fire hose" is used to describe the method of imparting the new information that must be assimilated by a new HEMS pilot. Because training costs money, and those getting the training sometimes quit right after receiving it, companies are loathe to devote one more dollar or one more minute than they have to. Too often, this proves to be a false economy.
Being a HEMS pilot IS DIFFERENT. The civilian-trained new hire has a steep learning curve. She is basically thrust out there into a whole new world, on her own, left to her own devices. She'll either sink or swim. But if she sinks she's taking other people and a helicopter down with her. A new guy right out of the military has to drastically change his mindset. And then there's the whole "we are here to save lives" thing. (The lives any HEMS pilot should focus on saving are the lives of the nurse and medic in the helicopter with him--or her).
A sad end for some wonderful aircraft.
Now back in the good old days, when we all flew helicopters with two front seats like the 145 in the picture above, a new pilot flew with an experienced pilot at a base. This allowed the new guy or gal time to acclimate. Time to see how things get done, learn about the pitfalls, and how to avoid getting dead. Then HCFA happened and our numbers exploded. And single front seats became the norm, with a patient laying beside the pilot. This has caused problems.
A new pilot went through training and quit halfway through his first day on duty. He realized (thank GOD) that he was over his head and listened to that small still voice within it.
Another pilot landed a helicopter too far back on a pinnacle-like pad and after shut-down the aircraft pitched back to a large nose-up angle. (That is a pants-crapping story right there.)
Another pilot responded to pressure by hurrying. He failed to open a hangar door all the way and backed a tail-boom into it.
These events are not exclusive to any one company. As a wise pilot once said, "the only difference between these companies is the paint job." As Yogi Berra might have said if asked, "we do things the way we do things."
The offshore industry had (and may still have) a habit of assigning a new guy, with a low hire-number as a "float" or relief pilot. Don't do this in HEMS.
Learning the ins and outs of a new base takes time. It's stressful, both on the new pilot and on the crew at the base. Let a new pilot get her feet under her at one location before knocking them out from under her by sending her somewhere else.
Understand this. Smart pilots rely on guidance from medical team members, just like smart offshore pilots rely on guidance from oilfield workers. Sometimes it's a hint or a suggestion and sometimes it's like a drowning man getting tossed a life-ring. It doesn't matter what the FAA says about crew versus passenger--someone who has been climbing into that airframe at that base for several years is a PRICELESS resource. Only an idiot would waste it.
The medical team in question must KNOW that the noob can fly. Never violate that trust. Never presume to "fly him and watch him." Don't let him or her out of the hangar if there is any question about that. Beyond that, the teams are almost always willing to offer assistance, advice, and institutional knowledge. Ask for it and listen to it. It's not a sign of weakness to say, "I'm new at this type of flying and I would appreciate any help you might offer."
If you are a pilot new to a base, make darned sure that the first time you lift off with your team mates in the back it is slow, smooth, and comforting. I was orienting a new pilot once, to work at my base as a relief. He was a good guy. His background was civilian medic and military pilot. He was upfront alone in a 206 and I was in back with the nurse and medic. On his first takeoff the aircraft rolled about twenty degrees right. They later said my eyes got wide, and they refused to fly with him. First impressions and all.
Ask your medical team for input on your progress. Ask them for tips "on how the other guys do things here." Being single pilot doesn't mean that you are totally on your own. Experience is sitting right next to you. Use it.

(Clinical managers; work with aviation managers and pair fresh new pilots with your oldest and wisest nurses and medics for the first few shifts .There was a time when they would have had another pilot to lean on. That time has passed.)

Monday, April 8, 2019

Learn How To Fail Brilliantly!

By: Josh Henke, RN, BSN, CEN, CFRN, CCRN, Georgetown University.

Image result for Intubation in a helicopter
Image courtesy Sydney HEMS. 

Aviation and medicine have long-complimented each other. Checklists are the first thing that comes to mind when thinking of this. The airline industry helped to revolutionize the medical industry with the system-wide adoption of checklists, and the acceptance of resource-management. I challenge you to find an O.R. that does not follow a checklist prior to making the first cut. (Hint: you won’t)

I was reminded of the similarities between aviation and medicine the other day while talking to a non-flying, never-intubated-anyone peer. He was asking me about RSI and all of the stuff that goes along with it. I could hear the tension in his voice as  he was thinking of himself in the hot-seat with a patient. Just the thought of dropping a difficult tube can get a medical provider in a tizzy, with or without a checklist. I found myself articulating something I have long held dear;

 Learn how to fail brilliantly. Be the best at failing.

This might sound odd, but hear me out. We are all going to miss tubes. Anyone that tells you they never missed a tube is lying. We all have or will miss that airway, and its how we fail that determines the patient's outcome. The planning for failure; being brilliant with your back-up plan assures that WHEN stuff DOES go south, you are the best at re-acclimating and implementing a solution. I also like the phrase “you can BLS someone all the way to Texas if you’re good at it!”

In the air medical world, failure carries a higher price. But, failures do happen. Engines quit, wheels don’t deploy, blades can go rapidly south. My advice is - even in this case - know how to fail brilliantly. You can have the best pilot in the world, but even he can’t make a helicopter NOT FAIL despite his many years of flying-experience.

I challenge you to think about this; how might your operation fail? And how can you be brilliant when it does?
Who is designated to make radio call outs in the event of an emergency?
Are you allowed to put the gear down?
Do you, in the left seat, spend time looking for appropriate LZs in case sh!t happens in a hurry?

Take some time and think about how you plan for failed-airways and apply that to your air operations. Checklists have pervaded the medical industry and made it a better place. Can we use the lessons learned in critical-care medicine to do the same for aviation?

Are you willing to be part of that success-story? As my pilot-friend Dan Foulds says, “You are not a passenger!  Learn as much as you can about aviation as fast as you can and be a contributing- member of your flight-team!"

Wednesday, January 30, 2019

It Can Happen to You Too...

It was bound to happen. As women entered the ranks of HEMS pilots, it was only a matter of time until misfortune struck one of them as it has so many men sitting at the controls.

It seems no one gets a pass. Take note, this could happen to you too. Are you doing everything possible to mitigate risk as you fly sick people?

For now, let's keep the families of these victims in our thoughts. As hard as it is, let's not speculate or say things that might make terrible pain even worse. Let's let the NTSB and the FAA do their jobs.

For now, let's consider these souls, and search our own.

Fly safely, friends...


Monday, January 28, 2019

From our Facebook page: You! Incorporated!

Image courtesy Gary Christian

As we begin the annual misery known as tax preparation, we are again grateful to the friend who several years ago said,

"You do have an LLC, right?"

Maybe you are way ahead of us on this and have been enjoying the benefits of incorporating for awhile. If so, feel free to add to the discussion with a comment. Tax wizards we aren't - but we do like to save tax dollars.

Let's say you are a nurse or paramedic who occasionally teaches a class for an outside agency. Do you get a check made out to you as a contractor? If so you should incorporate.

Are you a pilot who does a bit of flying for a friend. Do you speak at AMTC or a regional conference? If you get paid in any regard for occasional work that you do and are not an employee of the payor - you should incorporate.

If you do two simple things you can enjoy many of the tax-saving benefits that large corporate entities do.

1. Go online and visit your secretary of state and create your corporation. Several years ago, we created a "sole-proprietor" limited liability company named AMRM Training Solutions. In Georgia it's cheap - and you do not need a lawyer or legal service. You can do it yourself. We pay $50.00 per year as a for-profit. That cost is tax deductible.

For Georgia visit


If you happen to live in Michigan, you might start here


2. File for a federal employer identification number. It's easy.

If you do a gig that pays more than a few hundred dollars, the payor wants to deduct what they have paid you, so they will ask you to fill out a W-9 (it's online too). You will enter your EIN also known as your taxpayer ID number. At tax-filing time, your preparer will need the number for your return.

Of special note, when you start searching for these resources, lots of sites will present themselves as your go-to resource. They cost money. You don't need to pay money to a service to do these things. Make sure you are at the state or federal website and you can do it yourself. Those guys are trying to run a scam. They have official-looking websites and send official-looking letters designed to scam you.

So, what's the benefit of incorporation? Well, if you have a business and are out there generating revenue, lots of "household" costs are tax deductible. Do you have smartphones? Check. Internet service? Check. Do you drive your vehicle to a gig? Keep track of the miles because they are deductible. If you present at AMTC or ECHO, all the expenses are deductible because you are furthering the aims of your business. You are an industry expert sharing knowledge and looking for gigs. Right?
Notwithstanding the audit-scare from a few years back, the room in which you bang on your computer is deductible as a home-office. But don't take our word for it - ask your tax preparer.

From our perspective, this is purely for the purposes of reducing our tax burden. We write off the costs mentioned and others, and then "lose" another few thousand dollars each year. Do we "intend" to make a profit? Absolutely! And that means our corporation can continue to lose money (and allow us to pay fewer taxes) indefinitely.

Here's to You, Incorporated!

Wednesday, December 12, 2018

Event Review - Case Study: Loss of Control Due to Retreating Blade Stall

Image courtesy Australian Transport Safety Board

About 10 years ago, I corresponded with my chief pilot at Omniflight Helicopters, Mr. Eric Pangburn, about the aircraft at my base "surging" nose-up in cruise flight. It was not a violent pitch up, rather it was a smooth and steady pitch up that was overcome with a reduction of collective and forward cyclic. It was disconcerting and I wanted to know why it was happening.

The phenomenon was also experienced by another pilot at my base, Mr. Tim Lilley. Our experiences were similar and in the same aircraft, N171MU a BK-117A4. These events were not "high and hot" but occurred near sea level and moderate temps.

Eric included his friend Shawn Coyle, a well-known helicopter expert, and writer, in our discussion, and Mr. Coyle added his thoughts - to wit that erosion of the leading edge of blades might reduce the margin to RBS. The answer: ease up and slow down.

A pilot-friend at another base, Mr. Mike Sharp (now deceased) had experienced an RBS loss of control event prior to our events. Mike was operating a BK-117A4 N117LS and in his case, he was high, it was hot, and the aircraft was heavy. He mentioned noticing that he was near the "haze line" in the atmosphere, with clear cooler air above the level of the haze and warmer "muggier" air below.  As he descended the aircraft snapped up violently - similar to the event described in the linked report from the Australian Transport Safety Board. First a pitch up to near vertical, then a flopping over to a dive straight down. The medical crew became weightless in flight and came out of their seats. (Mr. Don Lamb and Mrs. Robbin Perry)

I recommend you imagine yourselves in this crews seats as you read this report. Imagine the dismay they must have felt and consider their responses, determine if you would respond in the same way or would do something differently.  I also respectfully recommend that pilots avoid pitching over on the nose by way of accelerating in the dive. Since the recommended recovery for RBS is to lower the collective, lowering collective to descend should help prevent the occurrence. Mentally rehearse, prepare, and if possible prevent - this crew missed dying by a relatively small margin.

I have no data to back up the following assumption, but I imagine that a BK117, EC-135, or EC-145 might be similarly susceptible to this problem because of their rotor systems. If you have experience with RBS, please share what you have learned in a comment.

May you have safe flights and may you avoid a "soil-the-pants" situation.

Dan Foulds

"Shortly after 1400 Central Daylight-saving Time, a ‘violent’, uncommanded nose-up pitching of the helicopter occurred. The pilot instinctively applied full forward cyclic control, but using both hands given the severity of the pitch-up, in an attempt to regain control but was unable to arrest the continuing nose-up pitch. At about 70° nose-up the helicopter rolled left through approximately 120° and commenced a steep descent. On seeing the ground through the windscreen, the pilot applied full rearward cyclic, which resulted in the helicopter pulling out of its now near vertical nose-down attitude and levelling off at about 1,000 ft (about 800 ft above ground level)."

Click here to access the Australian Transport Safety Board report.