A Post From Blog-Contributor and Flight Nurse Josh Henke : You Can Say No!

This is an open letter to my peers, my cohort.
Open letters seem to the the soup of the day lately, so thats what I'm calling it,

Dear flight crews. You do not have to fly. Just because the badge on your chest denotes a Flight
nurse or Flight paramedic, this does not mean that you are tied to your aircraft. You are, at the end
of the day, a nurse and a paramedic. you can go by air, you can go by ground. You can go by
horse and buggy if that is the safest option (dear lord I want to do that just once), but you are not
tied to your aircraft.

Editors note - as depicted in Airbus Helicopter's excellent video, "That Others May Live," pilots, being humans, can get caught up in "driving forward, getting the job done, finishing the mission." We are susceptible to a sort of "mission intoxication," You may be the last line of defense against this. And it may mean you have to accept spending hours in a bus. That acceptance may save your life.

Back to Josh...

It reminds me of a saying from my wildfire days; “never fly unless you have to”. But the converse
also exists and should be held just as dearly; “you don’t have to fly.”

I read the NTSB preliminary report for the most recent fatal HEMS crash today. I took a few hours
to cool down, but I’m still many things about that accident. I'm sad. I’m appalled. I'm a little hot
under the collar, but mostly, I feel kind of guilty. I feel  that we may have let a group of our peers down. You might think I’m taking this a little personally, but let me explain.

I feel guilty because I get the impression that the flight crew didn't know, or didn't feel
comfortable saying no. How is this not a daily conversation between every flight crew member
on shift? How is this not a mantra; the very cornerstone of what we do? You can say no.

It seems hard, I get it. Especially you new people. You want to be a team player or maybe you
don't feel like you have the authority to say no. But i promise you, you can say no. And if you don’t think “no” is appropriate, try asking a question. If your pilot or partner can't give you a good answer, the next step is “no."

Lets try a scenario...

Nurse: "Hey pilot, that weather seems pretty low. I know I’m new here, but that just doesn't look
right.”

Pilot: “Its ok. i’ve done this a thousand times before. We’ll just climb up through the clouds, get
on top and be on our way.”

Nurse: “Don’t we need two engines and a lot more equipment to be able to do that safely?”

Pilot: “Seriously, it’s OK. were only 20 miles away. it'll be quick. Now hurry up, the weather is still
dropping and we need to go.”

Does this scenario make you comfortable?
The correct answer is this scenario should scare the hell out of you and make you double time it
to the ambulance to go by ground. You can say no.

If you think your company will fire you for saying no on scene or saying no to accepting a flight
then you need to find a new program. Anyone that is willing to sacrifice your life for a patients - or a paycheck) - and maybe both, does not deserve your time, your education, your skills or your loyalty.

You can say no.

But what about the pilot? I admit, its easy to look up to these guys. they've been zipping around
the skies for 5000+ hours. Probably longer than a lot of us have been alive and lots of them in
much more unforgiving arenas. That does not mean that you cannot question them if something
looks out of the norm. (Don’t yak their ear off for an entire flight questioning every decision, thats
a good way to get a grumpy pilot. Keep the big picture in mind.)

Pilots are people too, with a myriad of backgrounds. Some are comfortable flying at 300 ft all
night. Some come from a background with an entirely different mission focus. some are newer
than others. But at the end of the day, you are climbing in their aircraft, with them at the controls
and possibly a patient on board. If something doesn't look right, ask the question. If they can't
give you an educated, descriptive answer with a plan, its time to start thinking about no.

Lets try another example.

Nurse: “Hey pilot, were hovering kinda close to those mountains looking for this guy. i'm not
super comfortable with this.”

Pilot: “Nurse, i hear ya. I've got 5 disks away from the obstacle, the winds are calm. if
anything goes wrong i have a good escape route forward and left.  If you're still concerned, we
can abort, but i feel very comfortable in out present position.”

Nurse: “Ok, now that you explain it, I feel a lot better about it and our place for an emergency
should it arise. thanks”

That scenario? I feel pretty good about that, don’t you? If you're nervous, ask questions. If the answer isn't a good one, say no, or seek a better answer.

If the plan for for the flight goes against things you've been taught, say no.

You can say no.

Fly safely friends...

Josh...

Josh with a former patient, now a lifetime friend. We can and do accomplish this job safely,
but it takes all of us, working together. HelicopterEMS.com