The Smartest Person in the Helicopter...

This statement is going to make some people angry, but the guy or gal flying the aircraft you are riding in may not have the best "handle" on what is going on with the aircraft, the environment, and the situation at any instant.

Don't believe me? I have four little answers to that.  N.  T. S .B.

How could this be?

As we sit and contemplate crashes, mishaps both large and small, it is easy to fall into "armchair" mode and smugly ask ourselves "how the heck - or why the heck -  did they do that?" Monday-morning quarterbacking ignores the fact that the people who participated in the adverse event were "in the arena."

As safety-expert, AMRM wizard, and former EMS pilot William Winn pointed out in his work on AMRM and situational awareness; we who fly operate in a naturalistic environment. So, what does that mean, "naturalistic environment?"

Well, it means that flying an aircraft in uncertain weather conditions at 3:00 AM with the possibility of unlit towers in our path, birds everywhere, a patient whose condition is deteriorating, a headwind that wasn't forecast, and a fuel gauge that seems to be racing to empty is much different than sitting on one's sun-porch and pontificating on who did what where when and why.

Here is a note on a famous "naturalistic environment."

On January 22nd 1991, during the Gulf War, an eight-man S.A.S. (Special Air Service - Britain's version of -  and the precursor of -  our Delta Force) team known as Bravo-Two-Zero were sent on a mission behind enemy lines. Their mission was to remain concealed near the main supply route in Western Iraq for 14 days. During this time they would be expected to sever Iraqi fibre-optic cables, and report on the movement of scud missile launchers. However, due to source limitations, they were given suboptimal equipment. They also received vague intelligence reports. This was apparent when they arrived at their drop off point to find it only about 200 meters from an Iraqi anti-aircraft stronghold. This had not been reported by Intelligence. Because this information was crucial to the success of the mission, the group attempted to contact their base via radio and inform them of the new situation. It was at this time that they realised that they had no contact with base. It was later discovered they had been given the wrong radio frequencies. The group then made the decision to sit out until a liaison arrived in 24 hours. Unfortunately, that was too long a wait. They were spotted by an Iraqi goat herder, and from then a malady of errors began its course. The team were separated. They were confronted with intermittent enemy contact, and were completely unsupported by the larger organisation. Over the next three days, three of the eight died, and four were captured. Only one man made his way back across the Syrian border. This planning error resulted in one of the most costly patrols in SAS history. 
(David, 1997) 

This event was described in a riveting book and movie, and points out how the best-laid plans can go to hell in a handbasket.

This happens to us too, in our helicopters, as we fly sick people from one place to another...

If you want to become more informed about how naturalistic environments affect decision-making, click here (paper by Dr. Taryn Elliot)

In a nutshell, what we have to do at 3:00 AM (or at anytime we are flying) is react to ever-changing conditions by an ongoing process of situation-assessment, pattern-recognition, situational-awareness, and decision-making. Each choice we make affects our future, and typically leads to other choices having to be made, to react to future changes in our situation. All this occurs in a rapidly-changing dynamic environment with various stressors, distractions, and a lack of resources - like time!

"It would be expected that the more experience a person had, the more successful they would be at decision-making. However this has been found to be incorrect. It seems that decision error can be attributed to any of: individual, organisational, or social factors." (Dr. Elliot)

It's no wonder that things go wrong. Indeed, it's a wonder that things don't go wrong more often. The standard operating model in HEMS is a single-pilot, single-engine aircraft with modest capabilities, and "crew-members" who are not really recognized as such by the FAA or - frequently - the pilots flying the aircraft. Vernacular statements like, "self-loading baggage," "climb-in, strap-in, and shut-up," and "you take care of the sick people and I will fly the aircraft," reveal the state of things in our industry. We don't have a copilot there to monitor our performance.

And this contributes to fatal crashes.

Although we don't usually have a copilot in our helicopters, we do have at least two smart people on board who can be developed into resources able to help us make choices that don't kill us. Sometimes the dumbest guy in the room comes up with the answer that saves the day. We can't shut anyone out, or alienate anyone to the point that they "sit back and shut up" and watch us make a mistake. Although my medical crew members are - perhaps - busy taking care of a patient, they are certainly NOT mired down with flying the aircraft. They may see something I don't, or become aware of something I am not, like a new ticking sound or a new vibration, or a new smell...

Note: It's very hard to only crash a part of a helicopter. Never sit back and give up on the situation...

I sat in the jump-seat of a C-5 Galaxy once, on a flight from Japan to Korea. As we got ready to take-off, the PIC stopped the aircraft (all 380,000 pounds of it), turned around, and stated to the entire body present, "okay, so what we are going to do is..." After describing his understanding of the future, he made sure that's what we all had in mind too - even me, an army warrant officer helicopter pilot. He wanted to develop a "shared-mental-model," and offer a chance for anyone to detect a plot-flaw.

BRILLIANT!

safe-flights...