Why did you pick EMS?

[ADRidge]

First off, as of right now I only have 3.3 hours in helicopters so I'm a long way from even my first job, let alone an EMS type career. That being said, the more I think about what it is you folks do when you DO get to fly, the more I think I'd be really interested in the work.

 

So what was your motivation for choosing EMS over any other kind of helicopter work? Was it the fact that you can spend time with your family? Better aircraft? More challenging flying? Some higher calling to help people in some capacity?

[Wally]

"So what was your motivation for choosing EMS over any other kind of helicopter work?"

 

To be honest, the job was here when I moved the family to my wife's hometown. Being home half of every 24 hour duty day, instead of a company crash rack, is a big factor in staying here. The GoM flies more and pays better, comparable schedule. CFI gets old, ag & utility are unpredictable, on the road a lot.

[arotrhd]

Many reasons to pick EMS as a profession, but one reason not to (even as ironic as it may first seem): "to save lives"...

 

-WATCH FOR THE WIRES-

[apiaguy]

Many reasons to pick EMS as a profession, but one reason not to (even as ironic is it may first seem): "to save lives"...

 

-WATCH FOR THE WIRES-

 

 

care to explain?

 

When asked why somebody does any career you will always get interesting answers that may or may not make sense to another individual. When I applied to grad school I had to write a personal essay about why I wanted to be in this field.... and anytime I would interview with schools they always asked why I wanted to be..... anyway,

It doesn't seem like a bad response for why someone wants to be in EMS. Doesn't sound any different than somebody saying they're not in the helicopter industry for the money.

[ADRidge]

Many reasons to pick EMS as a profession, but one reason not to (even as ironic is it may first seem): "to save lives"...

 

-WATCH FOR THE WIRES-

 

Well that's understandable given that not everyone you pick up is going to survive. I just put it out there, trying to think of all the possible reasons one might get involved in this particular field.

[Gomer Pylot]

People who get into EMS 'to save lives' tend to have lots of accidents, and accidents don't save lives, they kill people.  I try to think of it as just picking up some bolts at one place and taking them to another, just like in the GOM.  If you're trying to save lives, you're pushing the envelope on everything - weather, weights, fuel, everything and that's deadly.  I got into it because that's where a job was available.  Simple as that.  I'm no hero, and I don't want to be.  People had accidents and lived or died long before helicopters came along, and this is just another way to make money, both for me and the company I work for.  I intend to go home at the end of every hitch just like I came, the same as I've always done in any job.  

[delorean]

care to explain?

 

When asked why somebody does any career you will always get interesting answers that may or may not make sense to another individual. When I applied to grad school I had to write a personal essay about why I wanted to be in this field.... and anytime I would interview with schools they always asked why I wanted to be..... anyway,

It doesn't seem like a bad response for why someone wants to be in EMS. Doesn't sound any different than somebody saying they're not in the helicopter industry for the money.

 

Because it will get you killed. It's called the "white knight" syndrome......If you're in EMS to save lives, you're going to push weather minimums, exceed the aircrafts limitations, land in LZs too small, rush through walkarounds & starts, etc. You'll eventually push the limit one too many times and kill yourself, your med crew, and possibly the person you're trying to save. 3 dead to save 1.

 

Also, you're going to see a lot of patients who are already dead, going to die, or will have a life long disability. Can you get over that? How about seeing a little kid who will never walk again? If you can't stomach that, it isn't for you. Then if you start blaming yourself for not flying fast enough or not landing in that first LZ, your going to have some serious head problems or push it on the next flight.

 

You have to be totally heartless toward the patient and their family. It sounds bad, but that's what you have to do to stay alive in this industry. You have to fly the helicopter the same with and without a patient on board. The patient is merely cargo. Start to care, get the "white knight" feeling, and your heading toward disaster.

 

Our training manager has an excellent (actually scary) PowerPoint presentation he shows in new hire training. It's a bunch of really graphic car accidents, natural disasters, etc--basically a lot of blood and guts photos--the kind of stuff you see on rotten.com. Runs through these photos, stops periodically, and immediately asks you things like emergency procedures, your birth date, recite the Pledge, and so on. Most guys a in such shock, they can't do it. This is the kind of stuff you see on scenes. It's not very often, but like with anything else in a helicopter, you only have to go "deer in the headlights" once at the wrong time and that's it.

 

I'm in it for the schedule, the down time, and the money. All three are great. I really like working nights.....I don't like flying at night that much, but I like having all day off. We usually don't get flights after midnight, so it's nice to get a full 8 hrs sleep while getting paid. Day shift is easy flying, but boredom can easily set in on a 12 hr shift when you're not flying.

 

We do a 7on/7off schedule so you get a whole week off every other week. Other jobs like ENG or charter pay about the same, but you usually work 5 days a week. That's 261 days a year versus 182 a year you work. Plus it's usually all during the day versus a mix of days & nights. 14 days of sick/vacation a year takes you down to 168 days a year.

 

An aircraft is an aircraft to me. As long as it's well maintained and has a good history, I really don't care. But some have more goodies than others. ENG helicopters have all kinds of cool electronics, EMS may have cool stuff like radar and searchlights, law enforcement has FLIR and sirens.

 

EMS flying is unpredictable which is fun. You get the call and you have 5 minutes to get in the air. Scene calls are fun during the day, and nerve racking at night. It's cool landing on the interstate, bridges, river banks, and other places you'd never get to normally land on. Hospital transfers are always the same scenery so their boring, but it's safer at night. Rooftop helipads are fun the first few times too.

 

I love it.....Wouldn't trade this job for any other job in the world.

[ADRidge]

Great post, Delorean. That's what appeals to me from what I've read about EMS flying. Challenging landings in odd places, things like that. Reading that post got me all hyped up, gave me the same feeling I get after an hour in the robbie.

[JPDPilot]

I tend to disagree when you guys say that pilots can't go in to HEMS safely with the idea that they're going to save lives. I do agree that you can't fly everyone safely, but I still think you can do HEMS safely with the idea that you're going to do it to save lives. You just have to think that you're only going to save lives if you aren't going to put yourself and your crew at risk.

I'm not an EMS pilot yet, but I want to do it eventually. Pretty much the only reason I'm going to do this is to help save lives. I just won't fly a mission if I'm risking three lives to save one. In other words you can do HEMS to save lives, but only without putting yourself and your crew at risk. Does that make sense?

 

JPDPilot

[delorean]

I tend to disagree when you guys say that pilots can't go in to HEMS safely with the idea that they're going to save lives.

 

I here ya......Yeah, that's what we do--we save lives--but that's not our primary job description. It's more of a byproduct of my job. My primary job function under 135 is to fly a helicopter with two company employees to location A, pick up a passenger, fly to point B to drop them off, then return to base in a timely manner. If we save a life in that process, so be it; if we don't, oh well. We don't get paid any different, we don't get thanked or reprimanded, we just go out and do our job the way our company's 135 Ops Manual and Medical Protocol dictates.

 

Most of the med crews don't see it any different that I do. However there are always the exceptions. I've flown with a few people who are extremely passionate about "saving lives". They'll sit there and talk about all the ones they've saved and really make themselves out to be a real hero with a major god-complex. They'll stand over you're shoulder when you check WX and tell you "it ain't that bad", they'll tell you "hurry up" or "we need to get movin'" on the flights, and have their door open and be half way out of the helicopter before the skid touches the ground. They don't last very long in this company. But how long they last [mentally] after their patient dies is the bigger issue.

[ADRidge]

So it seems to me that you have to look at it just like any other job. You carry freight. It might be priority freight, but it's still just gear in the rear.

 

So tell me about the flying. When you get a call, assuming the weather is good, do police/ground EMS pick out a site to land or is that all on you?

[Wally]

I tend to disagree when you guys say that pilots can't go in to HEMS safely with the idea that they're going to save lives. I do agree that you can't fly everyone safely, but I still think you can do HEMS safely with the idea that you're going to do it to save lives. You just have to think that you're only going to save lives if you aren't going to put yourself and your crew at risk.

I'm not an EMS pilot yet, but I want to do it eventually. Pretty much the only reason I'm going to do this is to help save lives. I just won't fly a mission if I'm risking three lives to save one. In other words you can do HEMS to save lives, but only without putting yourself and your crew at risk. Does that make sense?

 

JPDPilot

 

I'll allow myself to think that what WE do is try to help people. The "WE" in that sentence is not just me, it's everybody involved: the guy who takes the time to make the report; the 911 operator who sends the help; the fire, EMS and peace officers who respond and summon more help; the dispatch center who offer me the flight; the medical crew who do all they can; and the trauma center who'll ultimately take what we bring'em; and there's lot's more folks who slip my mind. That's the "We" who try to make a difference, and I'm a very small part of that. All I do is what helicopter pilots do every day- fly good and not crash. I've been to improvised LZs on other jobs. I've flown nights, too. I've dispatched with only a general idea of the exact run to be made, same-same in the GoM, and other jobs.

The biggest differences between EMs and any other helo jobs: I've got crew members; "Look-see's" are not appropriate; and, I have to maintain a situational awareness that allows me to accept dispatch and be off in 5-10 minutes with a better than reasonable assurance that I'll be able to get to many different destinations in 3-4 hours. A good working knowledge of the area and asset management is a plus.

As to the patient/passengers, I don't want to know, and I actively resist getting any information. I tell the story that when I first started, I flew EMS for 3 months before I realized the medic- who sits behind and beside my left elbow- was ventilating most of our passengers.

The oldest EMS pilot I know told me once "All bleeding eventually stops. All patients eventually die. And, if you drop a baby, you should pick it up." My job is to fly the aircraft as safely as possible, and after that, fly as efficiently as I can, and finally make as few mistakes as possible, and make those I do make minor and repairable. If I let someone else's emergency become my emergency, I've added stress to what can already be a demanding situation, and that creates mistakes.

[arotrhd]

JPD: I understand you as well. But, no disrespect intended, I believe you are thinking a little too locally and not seeing the global picture. More to my point: if someone's life is saved, it is the entire system which worked on that occasion - from initial responders to flight crew (Med staff AND pilot) to ER staff, including the patient. Everyone involved did their part or had some devine intervention or stroke of luck while caring/transporting the patient(s). Remember that the only reasons airmed programs exist are (in theory...and hopefully) is to get a critically ill patient the most advanced level of care inside the golden hour or to minimize a patients transit time to a facility that offers a specialized/higher care. Oh, and to earn shareholders some dividends too. And when a helo is called out (in some areas), the patient is probably in a pretty bad condition that won't get a whole lot better. One could argue that you could drive an ambulance and do (many) of the same things you described a desire to do. And for that matter, the med crew working on the patient (and reports afterwards) would really have a greater claim. If you haven't done so, visit some local programs and find out just how glamorous the job is. Don't just talk to the pilots, but flight nurses and PMs as well. What you might find is the EMS has less to do with patients and more to do with politics.

 

Here's a good one from an older flight nurse I knew: "if one claims that they 'saved' someones's life while in their care, one is equally responsible for the victims they didn't save while in their care" (kinda makes a nice grab for the cohones and gives a gentle squeeze with a nice shake, wouldn't you agree?). I think Gomer, Delorean and Wally have answered the basics in the best ways relating to purely a pilots viewpoint.

 

Perhaps of more value of "saving lives" to get in is to have a great sense (and morbid) sense of hume to stay in. If you get a chance, pick up and read "Trauma Junkie" by Janice Hudson. Aside from some great recollections, she gets into a little medical philosophy towards the end that raises some challenging questions about patient care protocols and death.

 

-WATCH FOR THE WIRES-

[delorean]

So it seems to me that you have to look at it just like any other job. You carry freight. It might be priority freight, but it's still just gear in the rear.

 

So tell me about the flying. When you get a call, assuming the weather is good, do police/ground EMS pick out a site to land or is that all on you?

 

You hit the nail on the head.

 

Typically when 911 receives a call there has been any kind of bad car accident, ATV accident, long fall, burn, gun shot, or other call that could may require a helicopter, they'll call us direct or our dispatch and place us on ground standby. Then give the nearest city or predetermined LZ, the nature of the call, and request an ETA. When the EMS ground crew makes it to the scene, they'll decide whether or not the helicopter is needed. At that point we either requested for the flight or disregarded.

 

If we go, the 911 dispatchers will give us a ground contact and a frequency to get a hold of fire & EMS that will be landing us. Typically the fire dept handles the extrication and landing of the helicopter, EMS handles the patient of course, and the police handle traffic control and demographic/patient info.

 

I mentioned predetermined LZs......we have about 500 in our 120 mile diameter service area. These are football fields, big parking lots, large intersections, park ground, and even some community helipads. We'll meet the ambulance there if they decide to use them. Sometimes they'll just send us to the nearest LZ, but then give us coordinates to the scene itself if we're going to beat them to the LZ. The predetermined LZ are much nicer--we know the area, we already have the coordinates, we can give an exact ETA, we don't have to circle it 2-3 times looking for wires and obstacles, etc. With the scene itself, sometimes we get bad coordinates, sometimes the area is too small or too dangerous to land in, too much of a slope, and so on. At that point, we find a place to land and they'll meet us there.

[BillyBob]

How much help do you pilots get from the med crew on the LZ recon? Does the obstacle identification help continue throughout the landing?

 

 

I'm sure the answer changes with the individual crew members but I was just looking for a general answer.

 

Thanks

[Gomer Pylot]

The med crew is responsible for looking for obstacles all the way to the ground, and on the way out. After all, it's their butts on the line, too, and if the patient dies because they took a minute or so to look outside during a takeoff, then that patient was going to die anyway. We're a crew, and everyone has to work together. I can't see everything, especially at night, so I depend on them to help. I don't trust them to see everything, because I have the ultimate responsibility, but they do actively watch for stuff. It's part of their job, and essential to keep them from getting hurt. I have to say that I couldn't do what they do - sit in the back and trust someone else up front to do everything safely, especially knowing what I know.

[ADRidge]

You know.... I kinda feel like a jerk for saying this, but only kinda.... that sounds like some really cool flying. I know people are getting hurt/dying for you guys to fly, but it sounds like y'all run into some challenges not seen by other types of pilots.

[JPDPilot]

"if one claims that they 'saved' someones's life while in their care, one is equally responsible for the victims they didn't save while in their care"

 

That doesn't make sense to me. I think that someone can claim to have helped save the life of a victim in they're care if the victim lives and not feel responsible for the victim if he/she died. If a victim lives because of help from another person, that person can claim to have helped save the victim. If on the other hand the victim died while under the care of someone, that person isn't equally responsible for not saving the life because as long as they've done they're best they haven't done anything to cause the person to die.

 

JPDPilot

Edited August 24, 2007 by JPDPilot

[zemogman]

That doesn't make sense to me. I think that someone can claim to have helped save the life of a victim in they're care if the victim lives and not feel responsible for the victim if he/she died. If a victim lives because of help from another person, that person can claim to have helped save the victim. If on the other hand the victim died while under the care of someone, that person isn't equally responsible for not saving the life because as long as they've done they're best they haven't done anything to cause the person to die.

 

JPDPilot

 

 

I agree...well said...accidents "just" happen and people make choices that "create" accidents too...either way you're on the tail end trying to make things better. That in itself assumes that things were bad in the first place.

 

I can see, however, someone with a God-complex having problems in the industry

 

All this is my opinion of course...I'm not in the medical field but I've been on the good side of two heimlich manuevers (both people I helped get out of a critical choking situation, one of which was already blue) and able to help a three year old girl choking on a small hair clip. I usually jump at the chance to help anyone... not for a hero points...it just comes out of me...I'm glad things worked out three different times...However, in all fairness, I don't know how I would have felt if those I tried to help didn't make it. I didn't stop to think "what if they don't make it" --- I was only trying to help.

 

The reason I agree with JPDPilot is that I will probably use this exact thinking if something doesn't work-out the way I hoped...

[arotrhd]

JPD-

 

Let me begin by qualifying my position regarding your posts: I sincerely hope you become involved in an airmed program if it is your goal, and you do it safely and retire to live a long healthy life. And sorry if I threadjacked this topic.

 

I actually had to read the topic and posts a few times and take some time to formulate a quality response...if this has turned into some dissertation, again, sorry. That being said, my responses to the original topic and your posts have attempted to relate the position of "saving lives" directly to safety. A huge part of being safe is thinking and making critical decisions with safety being paramount, as others have generously shared. Get emotions involved in normal situations then black and white turn to shades of grey; then throw in some distractions. Now add this into the EMS equation where a pilot's mental state (emotional) may have the greatest potential to be influenced/impaired by some missions. This is true perhaps moreso than in any other industry sector (corporate operation pressures may come close).

 

For the next part, I am going to have to correalate "saving lives" with having some heightened concern about a patient's outcome, especially prior to and during transport = emotional involvement/attachment. Please don't take this to mean that you have to be a cold-hearted, uncaring SOB.

 

As most of us know, EMS deals intimately with unfortunate conditions that fellow humans experience. I'm right with you in desiring to assist someone who is in pain/discomfort or needs medical attention; that is a normal human reaction and response. But what I question is your motive to "save lives" as an EMS pilot: again, no disrespect, I have to wonder what recognition you need, or expect, and from whom. What do you expect to gain or what does it fulfill? The psychological term for this is countertransference. The point that I'm trying to make is there are many circumstances and situations that you will be exposed to and how do you honestly check your emotions prior to and during an EMS mission so you can provide the best service/work output (for the patient's benefit, in this case)? After all, you wrote that a save has a high level of importance.

 

In regards to my earlier borrowed quote "if one claims that they 'saved' someones's life while in their care, one is equally responsible for the victims they didn't save while in their care", it was the flight nurse's gentle way of ackowledging that she is not God (actually she does A LOT of praying), and even with her umpteen years of honing and teaching her acute medical skills, she doesn't have to go to sleep and later have to wake up with ghosts asking her why she didn't do things differently to keep a perfect score. It's her emotional barrier, coping mechanism and method of staying focused and not being distracted all rolled into one (Hint hint). She is able to do this by removing the "human" from the patient and therefore removing her emotions during evaluation/treatment. Sometimes the mess she gets to work on could barely be called human, but even for a screaming child with some bad burns, she keeps a very clinical response. Of course she is ultimately concerned for their best outcom, but she is most worried about the here and now, not a year from now (so to speak). And outside of caring for a patient, she really is nice. If emotional barriers are not present (airmed, for this discussion) people either burn-out early, quit because of pressure, drink, or do some other stoopid things like balling up an aircraft and calling some funerals early retirement partys.

 

What does bother her is not being able to learn something new and being able to apply it (clinically speaking).

 

Maybe I'm taking your position a little too seriously, but you might be in for a rude awakening if the question of why you want to be an EMS pilot comes up during an interview. And there really hasn't been discussion about the other really undesireable collaterals of the job...Wally? Gomer? Delorean, thoughts & input?

 

Now for some minature theatre (role playing):

A call comes in and you and the medcrew get kicked out of bed for an on-scene pickup. Early morning, bad weather - flyable, but near minimums and you know the flight back to recieving trauma facility is not going to be any easier. Everyone says GO, but you're all still tired because this is the 4th flight and you feel like you haven't gotten out of the helo since you clocked in for shift. You crank up and arrive on scene a half hour later and you see lots of lights and responders working on a few piles (actually, you saw them a few miles back). Anyways, it appears as a really bad MVA and anything with lights and sirens within the nearest 10 miles has come to pay a visit. On recon orbits, you fly over wreckage that looks like it could have been 1/8th of a mile of trash scattered on the roadside by a open trashtruck. Everyone identifies you hazards and you have a clear LZ on the highway; flightcrew calls out and confirms wires and other obstructions. Skids down, aircraft secured, medcrew deploy and go to work. PM radios you a minute later to say 1 for transport, unrestrained male approx 200 lbs, ALC & obvious blunt force and penetrating trauma; extrication finished, starting packaging and should be skids up in few moments. Somewhere between seeing several yellow tarps and what "feels" like a short and incomplete patient evaluation given the situation, you just KNOW the guy's in trouble. Run through checklist, review frequencies. Ok, patient's onboard, medcrew is strapped in and announce patient and they are secure, LZ clear. Off you go into the wild black yonder. Yep, Wx is geting worse and you only have to do this for 45 minutes. By now, you don't have to worry about staying awake because every few minutes the patient lets out a really bad primal-type of scream that you can hear even through the helmet ANR. About halfway to go, you inquire and the nurse says very serious injuries, but stable. OK good, almost there. She confirms it was a high speed MVA - no details, but also confirmed 5 expired on scene, understood some were young kids. Ok, on final approach to the hospital, med staff is waiting just off the deck. You land, secure aircraft and do a hot offload. You spool down and secure the aircraft - just you outside for a few minutes. You wander inside and stay just outside the trauma bay for a few moments...hey this looks good, people are working, but not in a rush - dude's going to come through. ALLRIGHT!! You slide over to the medsnack to meet the medcrew doing reports. Nurse says good save...got more info on the crash: young parents and 3 kids on way back home from a family wedding and bam, they're gone. Read below for her final statement; and then consider what your likely response would be if you had known some/all of the facts before getting paged, or on-scene, or midway to hospital...

 

I humbly submit for your consideration: unchecked emotions will get you distracted and distractions may get the patient, medcrew and you killed. And you (usually) are the only driver. Also, I'm not saying you shouldn't hope for the best pain-free full mobility outcome for people who got jacked up, but once it starts effecting decisions and judgement, watch out.

 

-WATCH FOR THE WIRES-

 

Turns out the surviving victim has a BAC of .220 with 4 priors and crossed into opposing lane. Good save, right? For some operators, there's as many situations that have this type of conclusion as there are the "innocent" wrong place-wrong time, bad luck types. How will you balance all of these out?

[delorean]

Good scenario.....that sounds familiar. I don't know how many times I've had to haul that same drunk idiot that almost (or did) wipe out a whole family.

 

Our dispatch isn't supposed to tell the pilot who or what the patient is--just location (and a destination hospital if it's a transfer). It doesn't really work now that we all use radios, before it was a big pain in the butt passing the phone back and forth. It wasn't like we weren't going to find out, it just wasn't supposed to influence our weather check.

 

Things I hear.........On the way to the scene or transfer hospital, the med crew sometimes talks back and forth about what they need to get ready or their past experiences with this type of call. We'll get a patient report from the ground unit or hospital. Once on scene I don't really see or hear anything from the crew until they come back with the patient. They tell me where they want to go and that's about it. On the way they're always talking about the patient and then I hear the patient report they give to the receiving hospital.

 

You know what? All of it goes in one ear and out another. They use big words and acronyms that I don't know--just like if we talk airspace or aerodynamics to them (except they pretend to know that stuff). I purposely try not to learn anything about what they do. It's hard when you hang out with two medical people all day, then go home to my wife (an ER nurse). That stuff sound interesting, but I have to keep they're medical talk like a foreign language. That way my brain doesn't even begin to process what they're saying while we're flying. Like I said--in one ear and out the other.

 

My company still or used to have a policy that they wouldn't hire any pilots who had any kind of formal medical training or that had paramedic, EMT, nursing licenses. They didn't want pilots trying to help or interfere. Some of the guys who have been here a while said they used to fly with a pilot whom was a part time chiropractor. They said he was always jumping in on back injuries talking about what nerves were pinched, etc. Drove them nuts.....like they could do anything about it when the guy's on a backboard with a neck brace.

 

----------------

 

So here's a question to hijack this topic again: How about law enforcement pilots? Anybody that wants to be a police, DEA, or other government LEO pilot usually has to be an officer for at least two years before they can apply for flight program. Then they get trained from scratch and can be out flying night missions with 40 hrs and Private Pilot certificate. Some agencies may require 200 hrs or a commercial certificate, but since it's public service, there really aren't any minimums. Is that safe? Turn a really good LEO into a low-time helicopter pilot in a turbine helicopter. Chasing the bad guys, where's his head--safe operation of the aircraft or "nailing the perp!"

 

I know I'll get flamed by some of the LEO guys here, but I disagree with that system on a whole about only hiring from within. On your replies, please let us know your dept/agencies' minimums on hrs and how you separate yourselves from your initial training as LEO. I just don't understand how EMS pilots have to meet all kinds of STATE (not FAA) minimums in the thousands of hours, yet LEO is good to go in under a hundred. Your job is just as hard as ours most of the time, I think.

 

Thanks for reading......

[Wally]

As to the LZs we use at scenes (forgive me if somebody's already answered- I'm on nights, 2nd night tonite), the requesting agency generally picks them. Many use preselected, preevaluated locations. Most use what's nearest. We provide training and coaching as to our requirements and how to make helicopter EMS operations work. 99% of the time the scene LZs are better than some of our hospital pads. If there's an issue, those of us with an aerial view can usually provide a convenient alternate.

Illustration- head on MVA, with entrapment and fatalities, on a state route in rolling, forested hills. The scene boss wants us to use the highway, but it's too narrow, wires. I tell'em that there's a field through the trees just North of his LZ, with a driveway and gate, if he can get keys.

"I have my boltcutters, go ahead and land. We'll have transport there before you're shut down." Talking to him afterward, he said he knew the field was there, but it was sloped and brushy, he cleared the highway, in case that was better.

We work very hard to be of assistance to the emergency agencies (They DO save lives) and maintain communication. Those are the folks who make my job a positive experience, many of them are volunteers, there just to help. All of our medical staff have years of experience with the agencies, and still work wit them when they can. It must get in the blood....

Edited August 25, 2007 by Wally

[BillyBob]

As to the LZs we use at scenes (forgive me if somebody's already answered- I'm on nights, 2nd night tonite), the requesting agency generally picks them. Many use preselected, preevaluated locations. Most use what's nearest. We provide training and coaching as to our requirements and how to make helicopter EMS operations work. 99% of the time the scene LZs are better than some of our hospital pads. If there's an issue, those of us with an aerial view can usually provide a convenient alternate.

Illustration- head on MVA, with entrapment and fatalities, on a state route in rolling, forested hills. The scene boss wants us to use the highway, but it's too narrow, wires. I tell'em that there's a field through the trees just North of his LZ, with a driveway and gate, if he can get keys.

"I have my boltcutters, go ahead and land. We'll have transport there before you're shut down." Talking to him afterward, he said he knew the field was there, but it was sloped and brushy, he cleared the highway, in case that was better.

We work very hard to be of assistance to the emergency agencies (They DO save lives) and maintain communication. Those are the folks who make my job a positive experience, many of them are volunteers, there just to help. All of our medical staff have years of experience with the agencies, and still work wit them when they can. It must get in the blood....

 

 

Thanks to all the responses. Please keep the info coming.

[ADRidge]

I was hesitant to ask this question on the EMS forum and not the general forum, given that people rarely post here. I'm glad this thing has gotten the detailed and well thought out responses it has so far.

[JPDPilot]

JPD-

 

Let me begin by qualifying my position regarding your posts: I sincerely hope you become involved in an airmed program if it is your goal, and you do it safely and retire to live a long healthy life. And sorry if I threadjacked this topic.

 

I actually had to read the topic and posts a few times and take some time to formulate a quality response...if this has turned into some dissertation, again, sorry. That being said, my responses to the original topic and your posts have attempted to relate the position of "saving lives" directly to safety. A huge part of being safe is thinking and making critical decisions with safety being paramount, as others have generously shared. Get emotions involved in normal situations then black and white turn to shades of grey; then throw in some distractions. Now add this into the EMS equation where a pilot's mental state (emotional) may have the greatest potential to be influenced/impaired by some missions. This is true perhaps moreso than in any other industry sector (corporate operation pressures may come close).

 

For the next part, I am going to have to correalate "saving lives" with having some heightened concern about a patient's outcome, especially prior to and during transport = emotional involvement/attachment. Please don't take this to mean that you have to be a cold-hearted, uncaring SOB.

 

As most of us know, EMS deals intimately with unfortunate conditions that fellow humans experience. I'm right with you in desiring to assist someone who is in pain/discomfort or needs medical attention; that is a normal human reaction and response. But what I question is your motive to "save lives" as an EMS pilot: again, no disrespect, I have to wonder what recognition you need, or expect, and from whom. What do you expect to gain or what does it fulfill? The psychological term for this is countertransference. The point that I'm trying to make is there are many circumstances and situations that you will be exposed to and how do you honestly check your emotions prior to and during an EMS mission so you can provide the best service/work output (for the patient's benefit, in this case)? After all, you wrote that a save has a high level of importance.

 

In regards to my earlier borrowed quote "if one claims that they 'saved' someones's life while in their care, one is equally responsible for the victims they didn't save while in their care", it was the flight nurse's gentle way of ackowledging that she is not God (actually she does A LOT of praying), and even with her umpteen years of honing and teaching her acute medical skills, she doesn't have to go to sleep and later have to wake up with ghosts asking her why she didn't do things differently to keep a perfect score. It's her emotional barrier, coping mechanism and method of staying focused and not being distracted all rolled into one (Hint hint). She is able to do this by removing the "human" from the patient and therefore removing her emotions during evaluation/treatment. Sometimes the mess she gets to work on could barely be called human, but even for a screaming child with some bad burns, she keeps a very clinical response. Of course she is ultimately concerned for their best outcom, but she is most worried about the here and now, not a year from now (so to speak). And outside of caring for a patient, she really is nice. If emotional barriers are not present (airmed, for this discussion) people either burn-out early, quit because of pressure, drink, or do some other stoopid things like balling up an aircraft and calling some funerals early retirement partys.

 

What does bother her is not being able to learn something new and being able to apply it (clinically speaking).

 

Maybe I'm taking your position a little too seriously, but you might be in for a rude awakening if the question of why you want to be an EMS pilot comes up during an interview. And there really hasn't been discussion about the other really undesireable collaterals of the job...Wally? Gomer? Delorean, thoughts & input?

 

Now for some minature theatre (role playing):

A call comes in and you and the medcrew get kicked out of bed for an on-scene pickup. Early morning, bad weather - flyable, but near minimums and you know the flight back to recieving trauma facility is not going to be any easier. Everyone says GO, but you're all still tired because this is the 4th flight and you feel like you haven't gotten out of the helo since you clocked in for shift. You crank up and arrive on scene a half hour later and you see lots of lights and responders working on a few piles (actually, you saw them a few miles back). Anyways, it appears as a really bad MVA and anything with lights and sirens within the nearest 10 miles has come to pay a visit. On recon orbits, you fly over wreckage that looks like it could have been 1/8th of a mile of trash scattered on the roadside by a open trashtruck. Everyone identifies you hazards and you have a clear LZ on the highway; flightcrew calls out and confirms wires and other obstructions. Skids down, aircraft secured, medcrew deploy and go to work. PM radios you a minute later to say 1 for transport, unrestrained male approx 200 lbs, ALC & obvious blunt force and penetrating trauma; extrication finished, starting packaging and should be skids up in few moments. Somewhere between seeing several yellow tarps and what "feels" like a short and incomplete patient evaluation given the situation, you just KNOW the guy's in trouble. Run through checklist, review frequencies. Ok, patient's onboard, medcrew is strapped in and announce patient and they are secure, LZ clear. Off you go into the wild black yonder. Yep, Wx is geting worse and you only have to do this for 45 minutes. By now, you don't have to worry about staying awake because every few minutes the patient lets out a really bad primal-type of scream that you can hear even through the helmet ANR. About halfway to go, you inquire and the nurse says very serious injuries, but stable. OK good, almost there. She confirms it was a high speed MVA - no details, but also confirmed 5 expired on scene, understood some were young kids. Ok, on final approach to the hospital, med staff is waiting just off the deck. You land, secure aircraft and do a hot offload. You spool down and secure the aircraft - just you outside for a few minutes. You wander inside and stay just outside the trauma bay for a few moments...hey this looks good, people are working, but not in a rush - dude's going to come through. ALLRIGHT!! You slide over to the medsnack to meet the medcrew doing reports. Nurse says good save...got more info on the crash: young parents and 3 kids on way back home from a family wedding and bam, they're gone. Read below for her final statement; and then consider what your likely response would be if you had known some/all of the facts before getting paged, or on-scene, or midway to hospital...

 

I humbly submit for your consideration: unchecked emotions will get you distracted and distractions may get the patient, medcrew and you killed. And you (usually) are the only driver. Also, I'm not saying you shouldn't hope for the best pain-free full mobility outcome for people who got jacked up, but once it starts effecting decisions and judgement, watch out.

 

-WATCH FOR THE WIRES-

 

Turns out the surviving victim has a BAC of .220 with 4 priors and crossed into opposing lane. Good save, right? For some operators, there's as many situations that have this type of conclusion as there are the "innocent" wrong place-wrong time, bad luck types. How will you balance all of these out?

 

arotrhd-

 

I don't know why you're talking to me about letting your emotions interfere with flying. That's not my point. I agree with a lot of things you say about not letting your emotions interfere with your flying. What I don't agree with is that you're saying that you're not responsible for saving any lives.

 

Consider this: Someone is critically injured at an accident scene. The victim will only live if they are transported to a trauma center in 30 min or less. The nearest trauma center can only be reached in 30 min or less by helicopter. You go out and pick up the victim and fly the victim to the trauma center and are able to get them there in 30 min or less. That victim, who would have otherwise died, lived because of the air transport. You are partly responsible for saving their life. That's a fact brother.

 

JPDPilot