Flight Nurses

[TimW68]

In time I hope to fly HEMS and I just have simple question with regard to Flight Nurses. I have seen blurbs that they can be a real problem for pilots. If the pilot is in command of the ship in what ways can the nurse become problematic, and what is the pecking order in HEMS Ops?

[Gomer Pylot]

To quote a former member of management of an EMS company: "It's not unusual for a nurse to get a pilot fired. But there has never been a recorded case of a pilot getting a nurse fired". Nurses can't legally affect the conduct of a flight, but if they start complaining to management about a pilot, the pilot is in trouble. EMS companies want to be medical companies, and pilots are just ambulance drivers, unimportant in the grand scheme of things. If a pilot can't get along with the med crews, the pilot is the one who will go, not the med crews, regardless of who is right or wrong.

[67november]

To quote a former member of management of an EMS company: "It's not unusual for a nurse to get a pilot fired. But there has never been a recorded case of a pilot getting a nurse fired". Nurses can't legally affect the conduct of a flight, but if they start complaining to management about a pilot, the pilot is in trouble. EMS companies want to be medical companies, and pilots are just ambulance drivers, unimportant in the grand scheme of things. If a pilot can't get along with the med crews, the pilot is the one who will go, not the med crews, regardless of who is right or wrong.

 

 

now isn't that just a giant crock of BS, since it is the PIC who is in control.

[JDHelicopterPilot]

now isn't that just a giant crock of BS, since it is the PIC who is in control.

 

 

It's sad but there is some truth to what Gomer said. The pilot is the PIC and that isn't the issue really. I think what really happens is sometimes the crew doesn't get along and for some reason it's the pilot that ends up being transfered or let go.

 

Having said that, there are steps to take if you are having an issue with someone at the base. Don't wait for it to get out of hand because then it's to late. As soon as there is a problem go to your lead pilot, then work your way up the chain of comand if need be.

 

I wouldn't worry to much about it. From what I have seen they trust me to the flying and I let them handle the medical stuff. However, we help each other out when we can. Instead of being individualists it should be a team effort. We are all there for the same reason. To get someone from point A to B so they can get the care they need. It's so much easier when we all work together. If you are someone who likes to be alone or work alone then flying EMS will be hard.

 

JD

[SkidKid]

Gomer and JD are right.

 

I would add: Go to the individual first. If it is something that you are concerned about, enough to take it up the chain, first go to the individual you have a problem with. He/she may not even know that, whatever the issue is, is bothering you. The pilot can explain weather decisions, flying techniques, etc., if it is within the normal flight issues.

 

If it is personality issues, look in the mirror. In a conflict there must be at least 2 differing points of view. The odds are 50/50 that YOU are the problem.

 

Also understand these 2 principles:

 

1. No one comes to work intending to do a poor job. (very rare exceptions exist)

 

2. Everyone is allowed to have a bad day.

 

If you cannot accept these principals, you will never be happy anywhere you work. People are the ingredient that make for problems in a workplace. Anywhere there are people you have a less than perfect work environment. As a person, you, and I, make the workplace less perfect for someone else.

 

Grow a pair and take it to the person. Don't be a crybaby and tell his boss, it might end up making you look foolish.

[Gomer Pylot]

@67N: no, the PIC is not in control. The PIC is in charge of the aircraft during flight, but that's all. EMS isn't all flying; in fact, that's a very small part of the day or night. Most of the time is spent at the base doing other things, and there the pilot is definitely not in charge. If you can't get along well with others, you won't do well in this job. Play nice, or don't play, because if there is a fight, the pilot will lose. I've never had any problems personally, but I know of several pilots who either were moved to other bases or moved to unemployment because the med crews couldn't work with them for one reason or another.

[67november]

@67N: no, the PIC is not in control. The PIC is in charge of the aircraft during flight, but that's all. EMS isn't all flying; in fact, that's a very small part of the day or night. Most of the time is spent at the base doing other things, and there the pilot is definitely not in charge. If you can't get along well with others, you won't do well in this job. Play nice, or don't play, because if there is a fight, the pilot will lose. I've never had any problems personally, but I know of several pilots who either were moved to other bases or moved to unemployment because the med crews couldn't work with them for one reason or another.

 

GP your point is well taken, not being of that industry it does seem to be such a bit of a one sided biased opinion of who is in charge of a life flight.

It is understandable that ppl do not always get along but a situation that can cause a pilot to lose favor with a company because of the crew member(s) that is not friendly with the pilot seems to me a bit over the top.

This is a small community and what comes around goes around, so actions of a person who is part of a crew for patient recover and transport to a place of a medical facility would show a bit more restraint, but being that they are merely hospital personnel (and I use that term loosely) they should have a higher respect for those that are transporting them to the scene of the accident and back.

[Wally]

Gomer Pylot is spot on in his appraisal of the situation.

The misapprehension is that EMS is an aviation job- WRONG! This is an EMS job that flies, Emergency Medical Service is: First; Last; and Always the purpose and potential profit source. Use of the helicopter provides a way of reducing time in transport, and having the provider (vendor) "in house" provides quality control.

"The customer is always right"- no one ever wins an argument with a customer, and EMS is the customer. If an issue arises in the crew, you have to use it as an educational opportunity, and keep it on a professional basis and impersonal.

The good news/bad news is that medical staff tend to cycle through the job, and while they're there, it's because they want to fly. Use that enthusiasm, be entirely professional while flying, and keep the personality conflicts mature, respectful, and in the station, and generally, it's a good job.

[delorean]

You are entering the world of a "Medical company utilizing aviation". The FAA freaks out everytime they hear that, but that's what it is.

 

You are no more than a bus driver. You may be PIC, but that gives you control of the aircraft and nothing more. The nurse & paramedic in the back are NOT flight/required "Crewmembers" as defined by the FARs, they are company employees. You are NOT the "captain" or the "senior ranking officer" on the helicopter either.

 

Pilots that get in trouble with this are the big ego type that come in thinking they run the show since they are "PILOT IN COMMAND". They try to boss the medcrew around and it just doesn't work since most of them had a big enough ego BEFORE they put a flight suit on.

 

As long as you are a nice guy and get along with people, you're not going to have a problem. Bases are like big families--disfunctional as all hell--but in the end, still a family. If you don't get along with one person, but everyone else, chances are they don't get along with other people too. The non-conformers and jackasses will get voted off the show in good time--just wait it out. Over the years, one way I've been able to gauge the stability of a base's crew is to look how many people are still married to their first spouse. For a while, the 15 people assigned to our base had all been there 5-10 yrs.....all with their first wives. Not scientific, but it shows you can works things out.

 

The aforementioned applies to programs where you and the mewcrew work for the same company. VENDOR (hospital) programs are a different story. You & the mechanic work for a company that provides the 135; the med crew works for the hospital and therefore, also, a CUSTOMER. You upset that medcrew (the customer) and now you're gone--maybe not out of the company, but out of that base.

 

Like I said, just be a nice guy and don't ever flaunt the PIC status. Make the decisions as a group and only pull the PIC card if you have to--then document want happened and send it to your lead.

 

I've never really had a problem. Our base works great together and anyone that ever got hired and disturbed that dynamic was voted off in 6 months (BTW, they were both 2x divorcee's if that supports my hypothosis.)

[67november]

Well I for one am now enlightened on the EMS world.

 

thanks for the replys, makes sense now.

[RockyMountainPilot]

Most pilots think that they are a dictator and have full control over what happens with the aircraft. Although, this might be true in a physical sense of control, it won't get you far in the world of crews. Think of the PIC as the President of the aircraft and you have two Senators in back. They make the decisions as to the best course of action for the patient, and if you have no objections, that is what will occur. However, if you do have an objection, you can veto their decision. You are not the only authority on the operation of the aircraft, but the final authority. If you act like you are the only authority, you will be booted.

[Sparker]

So far these are very good examples of conflict to expect on base, but I have heard a lot of issues can come up in the air as well.

 

For example, a pilot on steep approach to a confined to pick up a patient; trees on one side, wires on the other, on final a flight nurse nurse yells "WIRES!!!" the pilot is required to go around and set up on approach again, the same nurse yells out "TREE!", the pilot has no choice but to go around again. The pilot saw the wires and the trees, was clear of them had the experience to know the landing would have been safe, but the flight nurse is making PICish decisions with zero PIC experience.

 

This anecdote is third or fourth hand by the time I am typing it here, but is there any validity to these scenarios? This story was supposedly from a former Calstar pilot.

[Wally]

So far these are very good examples of conflict to expect on base, but I have heard a lot of issues can come up in the air as well.

 

For example, a pilot on steep approach to a confined to pick up a patient; trees on one side, wires on the other, on final a flight nurse nurse yells "WIRES!!!" the pilot is required to go around and set up on approach again, the same nurse yells out "TREE!", the pilot has no choice but to go around again. The pilot saw the wires and the trees, was clear of them had the experience to know the landing would have been safe, but the flight nurse is making PICish decisions with zero PIC experience.

 

This anecdote is third or fourth hand by the time I am typing it here, but is there any validity to these scenarios? This story was supposedly from a former Calstar pilot.

 

That's not how I/we handle that high recon, I orbit pilot side and discuss potential issues- wires, signs, trees, vehicles, anything that affects where I'm going and how I'm going to get there. Do this as though you're teaching a student confined area work. I ask the off-side crew if I need to orbit the other direction, that side nearest, usually not required. Then I give the route in and transition to it, and specify 'sterile cockpit'.

As I fly the approach, I get updates from crew and call obstruction status, "Coming over the wires (trees, etc) into the LZ... Do you have the trees on your side?" to the medic, who's on the the far side, and await a response. If it's tight or there's something I want the nurse/crew seated behind me to monitor, I'll ask for specifics, "Do you have the sign (stump, bush) " and it's location. If anything briefed is mentioned, I'll identify and confirm, "The black wire to the service entrance from the pole on the right of way?" and then call it clear or stop and determine the obstruction called and clearance or issue.

Unless there's something unanticipated moving in the LZ, we stop the approach briefly, clear the issue and don't go around. Yes, there are people who'd let you land in anything, and some who'll call obstacles in the next state, and one works with what one has...

 

My experience is that cool, calm and collected communication works with just about everybody. NEVER ignore any input, stress is natural, but fear comes from lack of control. It's better to fly to another LZ than destroy the confidence of crew in their ability to avoid trouble by communicating an issue.

Edited October 7, 2009 by Wally

[Sparker]

Easily one of the best discussions on this site for a long time, thanks.

[TimW68]

I do appreciate the advise as far as the ground relationships and feel I will have no problem fitting in (still married 1st wife 16yrs). The last few posts is where I was most concerned, with regard to in flight backseat pilots, ie. someone without formal training telling me how to operate the aircraft (assuming I am flying professionally). I have heard of Flight Nurses referring to the helicopter as "My Helicopter", and oozing with authority. From the responses I'm guessing that is certainly not the norm. I do like the CRM approach regarding obstructions to the LZ.

[Gomer Pylot]

If you get along with the crew, and they are comfortable with your piloting skills, that sort of thing won't happen. We discuss things on the high recon and the approach, but they don't screw with me, because they know it's not right. I respect their medical skills and their help in identifying hazards, and they respect my ability and determination to keep them alive. We don't do horseplay or gotcha on a flight. Not ever. As long as everyone respects each other, it's just a job and nothing dramatic happens.

 

It may (or may not) help that I've been flying longer than any of our med crew has been alive. But we also have one pilot who is probably the youngest person at the base, and she doesn't have any problems with the med crews, so I think it's mostly a matter of being professional and playing nicely with others.

[Wally]

I do appreciate the advise as far as the ground relationships and feel I will have no problem fitting in (still married 1st wife 16yrs). The last few posts is where I was most concerned, with regard to in flight backseat pilots, ie. someone without formal training telling me how to operate the aircraft (assuming I am flying professionally). I have heard of Flight Nurses referring to the helicopter as "My Helicopter", and oozing with authority. From the responses I'm guessing that is certainly not the norm. I do like the CRM approach regarding obstructions to the LZ.

 

I don't have any problem with the attitude expressed with "Flight Nurses referring to the helicopter as "My Helicopter", and oozing with authority.", it is their helicopter, too- we're a crew, a team. It's also my mechanic's helicopter, and anybody else's in the program. With that in mind, I listen to and consider what everybody has to say. I'll explain what, and why I'm doing what I'm doing, and then I do my job. I've never had consequences from that approach on this job, and only once in 41 years of flying.

That said, pilots do come to professional grief from conflict with crew members in this job. It's very, very seldom the result of sound professional decisions in flight.