A Reply to "Walter" About Preparing For SPIFR (Single Pilot Instrument Flight Rules) Flights

Walter writes: Going to make the leap to an IFR EMS base. after 30 years mostly VFR utility/ EMS. Any tips or resources from an operational point of view for someone in my situation. Thank you in advance. 

Occasionally, in the midst of all the chaff on the JustHelicopters original forum,  a real helicopter-related topic comes up - you know, something other than my boss, job, company, coworkers, nurse, medic, pilot SUCKS... These rare points of light are enjoyable, and if you aren't familiar with the forum I encourage you to check it out and look for the stuff worth looking at.

(disclaimer: these comments should not be construed as substituting for an authorized course of training, these are things to consider post-training)

Feel free to chime in with a comment below if you have anything constructive to add...

Hi Walter,

Think crawl, walk, run...

Start out doing very simple IFR legs in weather that doesn't challenge you too much. Add IFR legs to your can-do file slowly, perhaps after flying them under IFR in VFR conditions so you can get the lay of the land, and see where you actually will be in reference to hard objects before flying "blind." Always have at least two ways out of the clouds ( an emergency screaming descent doesn't count), and enough fuel to to both. Your alternate must have weather allowing you to break out, and if you are flying EMS, your alternate should work for the patient too. You do them no favors taking them away from the care they need. Make sure you are comfortable using every system on the aircraft, and also make sure that you are able to fly IFR with no help from any system. A reference was made to the Careflight crash - if radios and systems start giving you problems, let that stuff go and just fly the aircraft. And as required ask for help...


Remember that every emergency procedure you are responsible for handling while flying VFR can occur while in the clouds; like engine failure, TR failure or loss of control, or hydraulic failure. My BK autopilot used to quit in turbulence and to reset it you had to pull two circuit breakers, wait, and cuss. A friend was shooting an approach in moderate rain and thick cloud, and had turned his wipers on. The wiper motor got hot and started smoking, forcing the single pilot and his crew to identify the source of an electrical fire - talk about distraction. If a generator is going to quit - it will quit in the clouds!

Ask for emergency procedure training to be integrated into your SPIFR training... Most companies don't do this.

I disagree with folks who say that SPIFR and HEMS don't go together. I have done it with Hershey, Geisinger, and Omniflight. It's nice to have another option.  And I think that being IFR current and proficient makes one a better all-around pilot. (I am a VFR Astar pilot these days and miss IFR flying.) You do not need to do 6 approaches in 6 months - you will take an instrument check ride every six months and this will handle currency (if not proficiency...) Procedural trainers are better than nothing, Sim training is great.


Don't jump in over your head. Take your time, get used to the machine and the area first...


Crawl... fly your area under VFR in VMC. Play with all the gadgets on your aircraft. Learn normal, versus degraded, versus inop, and what this will mean to you. Become an expert on the use of your GPS,  The time will come when being able to immediately access any feature will be important. Keep in mind that more than one pilot has begun an ILS with the display showing GPS information. As a technique, prepare lesson plans and instruct your crew members on all your gadgets, radios, and indicators. They will listen - they want to know that you know...

Walk...fly your area under IFR in VFR conditions, shoot the approaches. Talk to ATC. Tune radios. The whole enchilada, but in good weather.


Run... fly legs you are comfortable and proficient on under IFR in IMC (with a second way out).


Years ago a SPIFR guy crashed in PA while getting fuel, solo. He got confused, or behind the aircraft - or maybe had a system failure.. And then there was the Careflight crash...

Click here for a story about that crash from the crew's perspective

Those are the only HEMS SPIFR crashes I remember...Anyone else?


safe flights


PS. If you are flying company owned approaches, remember they only get checked once a year (volunteer to be the guy doing the checking with a fed onboard). Towers can come up between checks... watch out.

Signs Of Icing - from the JH forum

Bigger, rounded items of the aircraft create a flow field that slows down the rate of ice accretion, compared to smaller, thinner items. 

So look for ice to begin accreting first on things like windshield wipers, OAT probes, and wire strike protection blades.

Those kinds of things on the aircraft are what you pick out to look at. 

You will see ice accreting on these sorts of shapes and projections first. 

You should be aware of likely icing conditions during preflight planning, so as to stay out of them.

But there is an old saying, "Ice is where you find it," it's hard to predict, many variables.

So no matter what the forecasts or rather lack of icing forecasts, I always tell people, when you punch into cloud, take a look right away at your OAT gauge and scan it regularly. 

If the temps are right in cloud for icing, basically +2C to -15C or thereabouts, take some action to get out of that environment. 

Know the temperatures aloft from preflight planning, climbing won't always get you into the colder air and descending won't always get you into the warmer.

On that note, a temperature inversion mixed with cloud is a likely recipe for freezing rain type conditions, DON'T GO THERE.

Air Ambulances Lack Oversight on Medical Care... The Bend Bulletin

Courtesy Marklan Hawryluk/The Bend Bulletin...

Want to know how we got to where we are in HEMS?

Click here for the full and informative story...

Rapid Growth in Air Ambulance Industry Raises Safety Concerns

Fueled by high reimbursement rates and scant regulation, the rapid growth of the helicopter EMS industry over the past 15 years has transformed what many consider a life-saving service into an industry fraught with safety concerns but little oversight.

Click here for for full story...

Feedback on Sleeping on Duty...from our friend Josh

Dan, i couldn't agree with this post more. I say this having worked in both arenas. 7 years in a busy level I trauma center ED and in the flight arena. And I can say this, working a long 3+ hour flight at night with a sick pt. is just as tiring as a 12 ED shift. However, there are a few things to consider when comparing the two. First, i 
think that the "powers that be" fail to recognize what i call "insensible flight stressors." These include low humidity, low O2 environment, high stress, high noise and relatively high pt. acuity. these things combined create an increased metabolic state in the flight crew. (pilot included). Stated plainly, we chew up all our natural glucose and we're damn tired with our bodies having been in overdrive to maintain homeostasis for the duration of the flight. Now, in the hospital, the effects of being tired can range from fairly simple, like walking into the wrong pt. room to moderately bad, such as a med error. In the flight arena, the consequences can be much more dire. Walking into a tail rotor, in my opinion is a FAR greater consequence. (i know we've all been habitualized to maintaining our situational awareness, but people still get punchy, or they're new, or they're just plain tired and not paying attention) The tired flight nurse/medic is also prone to making pt. care mistakes. Often the pt's we fly are of the higher acuity and thus, much more medically fragile. Medical mistakes in this pt. population have far greater consequences that giving 60 Keterolac IV instead of IM in the hospital. Furthermore, when and IF a pt. goes south in the hospital, multitudes of people rush in and the medical menagerie begins. In the aircraft, its just you and your equally tired partner. No help. No pulling over. No flying faster. Just you and your partner.
I guess what I'm saying is this; Nurses get tired on duty, but comparatively, flight nurses face greater fatigue factors than hospital based RN's. The consequences however are far greater for the flight team. Not only for the safety of the crew, but for the quality of care provided, the utilization of limited care providers and the reputation and quality of the flight program.
12 hr shift or 24 hr shift? it doesn't matter. I've also worked both types of schedules flying, and there is little difference given the topic of fatigue. (I much prefer 24 hr shifts however.)
Flight crews should be required to rest while on duty. Their duties, responsibilities and the sheer gravity of the job they volunteer for demands their full attention, not standardization of flight RN vs. Hospital RN rest requirements.

To Sleep on Duty, or Not to Sleep on Duty...That is the Question...

Flying at 3 am  is different than working in a hospital at 3 am.

Long ago, I showed up at a HEMS base in the early morning to teach an AMRM class. I went around back, found an open door, and walked in quietly finding on-duty clinicians napping in recliners. There were no beds for them at that base. It brought back memories of "the rule" for many hospital-based programs with clinicians working 12 hour shifts.

No Sleeping On Duty...

One can imagine how this rule got started. When helicopters were all hospital-based, the medical staff worked for the hospital, and were peers of the clinicians working in-house. As no ED, ICU or floor nurses are permitted to sleep on duty, why would a flight-crew be permitted to sleep? Even the appearance of being treated preferentially could cause problems for the flight program. If word got out that leadership was letting aircrew members sleep, other staff on night shift might demand the same treatment.

This is a case of safety taking a back-seat to politics, perceptions, and appearances. The nature of flight duty on night shift is completely different than that of working in-house. Sitting around and waiting is different than walking around and talking to people in a busy health-care environment.

Some leaders will read this and consider forcing flight crews to work in-house while not on a flight, but the truth is - that option degrades the quality of the program and the morale of the staff. Flight crew members are special; they volunteer for hazardous duty, they take on much more responsibility than a typical in-house clinician. They are expected to be "better." They should be treated that way or they will end up leaving.

When your experienced staff leaves, it costs money for training, orientation, and mistakes. How much better and simpler things will be if we look at every policy and rule from an operational standpoint - and remember that often, what's best for your staff is what's best for your company. You don't want just any clown taking care of sick people in your helicopter.

Morale and training costs are not the main reason that flight crews working a night shift should be permitted to take naps. The real reason is that you - Mr. or Ms. Manager - don't want to be the person explaining to the media why you are hosting a memorial service.

In 2009 I was the pilot of the last aircraft in this memorial-flight line-up. My second. We can go a day, We can go a month. Can we go a full year without a HEMS helicopter crash? It's not up to me... It's up to you!

The NTSB and the FAA have done research on aircrews and fatigue. So has Dr. Mark Rosekind, currently leading the NHTSA and an expert on fatigue. Fatigue is a hidden factor in many of our mishaps. Fatigue affects mood, performance and judgement.

The nature of flight operations at night are completely different than taking care of patients in a hospital setting. Especially the empty-leg back to base after dropping a patient at a distant facility - the leg in which bad things happen most often. Crews get "up" for the patient-care portion of the flight, then they struggle to stay alert on the way home. If this return trip occurs at the nightly physiologic low-point - typically between 2:00 am and 4:00 am - then your crew will be as sharp as a bowling ball.

Fatigued crews lose the mental-edge that prevents loose latches, cowl-strikes, tail-rotor strikes, open fuel-caps, objects dropped from aircraft in flight, still-connected cords and cables, and -  God-forbid - mid-air collisions. Surely you remember a time when you were wide awake at work, and almost fell asleep on the drive home. Well now imagine that it's your pilot falling asleep, and the crew is sleeping with him.

Flying at 3 am  is different than working in a hospital at 3 am.

As Dr. Mark noted in his research, when you are tired, "any sleep is better than no sleep." Maybe you don't want to provide beds in bedrooms, comfortable recliners in a quiet dark room will suffice...

In the interest of safety, it should be the policy of your flight program that crews are permitted to nap on night shift. Even crews working 12 hour shifts. They are probably doing it anyway, and forcing them to break a rule to do what comes so naturally creates cognitive dissonance and emotional discord.

safe flights...

Is Mechanism of Injury a Valid Reason to Fly a Patient?

“It’s sort of the perfect storm,” said Dr. Michael Abernethy, chief flight surgeon for University of Wisconsin Health’s Med Flight. “It’s great money, it’s unregulated and there’s really no utilization criteria.” (quoted in The Bulletin, Bend Oregon)

If your system does not support viewing this video clip, access it by clicking here...

When we fly a patient who walks out of the hospital hours after arrival, some question the appropriateness of the flight. Then again, there are injuries which cannot be detected in the field, which might prove serious or fatal after some time has elapsed.

In some cases, staff at receiving facilities give helicopter crews a hard time.  "Why did you fly this patient?" asks the overworked and fatigued resident. Few if any cases allow a crew to decide that a patient does not need to be flown after arriving on scene. If first responders call, the patient will fly...


What do you think? Do you have any stories about flights that ended up being appropriate after all?

Here is one anecdote...

Some years ago I flew a mechanism of injury patient who was alert, oriented, and telling us not to make such a fuss over her, she was "fine".

We were only minutes into the flight when she decompensated, she became unresponsive and her belly began to show evidence of internal bleeding.

We were on our way to the "closest trauma center" in Camden, NJ, and upon arrival were unable to land as the pad was occupied by the State Police helicopter, shut down and unmanned delivering a patient the facility.

My crew made the decision to "cross state lines" (if you operate in the Philly area, you will understand that statement) to take her to our trauma center in West Philly (all of a 2-3 minute furthther flight).

We landed at our facility before the helicopter at the original destination had cleared the pad, in fact as I recall, the patient was in the OR, exanguination protocols in effect, by the time the other pad was clear.

Moral of this true story, unless you have a CT scanner available in your A/C or ground unit, perhaps mechanism of injury is not such a bad thing.

For all the naysayers, if this one life was saved for certain by that criteria, how many others have been as well?