Why did you pick EMS?

[Wally]

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

 

JPDPilot- Personally, I don't ask and I don't want to know, period. Three questions provide all the data I need:

How much does the patient weigh?

Does this patient have altitude considerations?

And, do I need to insist on Lifeguard right of way vs a minute or two around a busy traffic pattern?

 

My job is to fly safely, efficiently, and within the conditions set by my employer. I *could* take more runs and "save more lives" than the company allows me to- I've been flying a very long time: I'm comfortable in, and have flown, in a lot worse conditions than company minimums; and I've "seen the elephant". I *can* do it, I have a proven record- does that make me responsible for NOT doing it?

 

In my mind, it's like the drive to work- if I don't crash, waste time or break down, I've done that job. Does that mean that "I saved the life" of anybody car pooling with me? (NO!) However, I could kill somebody if I mess up... I work very hard to do all I can of the former (transport within agreed professional conditions) without any of the latter (mistakes).

 

Don't mean to steal arotrhd's thunder, but there's such a clear distinction in my mind that I had to speak up.

Edited August 27, 2007 by Wally

[JPDPilot]

JPDPilot- Personally, I don't ask and I don't want to know, period. Three questions provide all the data I need:

How much does the patient weigh?

Does this patient have altitude considerations?

And, do I need to insist on Lifeguard right of way vs a minute or two around a busy traffic pattern?

 

That's all the info you need to know. It's probably going to be the same way I'm going to think; I probably won't ask either, but I'm not afraid to take responsibility for lives I've helped to save. It's reality.

 

My job is to fly safely, efficiently, and within the conditions set by my employer. I *could* take more runs and "save more lives" than the company allows me to- I've been flying a very long time: I'm comfortable in, and have flown, in a lot worse conditions than company minimums; and I've "seen the elephant". I *can* do it, I have a proven record- does that make me responsible for NOT doing it?

 

No, you're not responsible for not doing it. To set the limits is the company's responsibility. Insofar as you do your job safely, efficiently, and within company limits, you are partly responsible for any lives saved. Insofar as the company sets limits and otherwise provides a safe, efficient, and effective emergency transport service, the company is responsible for any lives saved.

 

I think the problem some of you pilots have with responsibility lies in distinguishing between what's in your control and what's not. As long as you do what's in your power (not necessarily in the absolute sense of what you are capable of doing, but in the relative sense of what you are allowed to do), you take responsibility for the positive and not the negative since the negative is the result of what's not within your control. You can only take responsibility for the negative when you have not done what's within your power (in the relative sense).

 

Does that mean that "I saved the life" of anybody car pooling with me?

 

This example doesn't work because the purpose of a carpool isn't to save a life.

 

JPDPilot

[ADRidge]

I think the point being made (and I can see both sides) is that the primary function of HEMS isn't to save lives. It's to transport someone in dire need of help to somewhere that they can receive the help they require. Just like an ambulance's primary function is to transport and stabilize.

[arotrhd]

ADRidge: to your posts, AMEN!

 

JPD:

 

The posts that have been exchanged have been thought provoking, and I thank you for the opportunity. Maybe I'm just too dense to understand the position you support, but your prior post kept me thinking otherwise. If your point is you'd really enjoy working as part of a team that brings comfort to those in great need, great. EMS pilots certainly are part of the team and the system. But a previous post is reason for me to write s'more. Perhaps I'm being redundant at times, but this may benefit others as well.

 

From you initial posts, I still am at a loss as to why the saves are so important to you - please help me understand. Is there a concern that one day you're going to show up at the pearly white gates and the Big Guy is going to say, "Hmmm JPDPilot, looks like you're a few shy in the saves category...sorry, you can't come in"? Or is somebody going to chase you with a hatchet unless you show some saves? What gives? If saving lives is important, one can argue that the same can be accomplished by volunteering on a suicide hotline. Or offering to drive some drunks home from the bar. Heck, maybe the pilots who provide traffic reports save lives by alerting other drivers of problems ahead. There's a thousand ways. Let's go a bit more:

 

"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."

 

This was a perfect example of what I was trying to get at; now you've assigned a ticking clock to a patient's status. Now combine it with what appears to be a sef-induced responsibility (or need for all or part of a "save") for the patient's ultimate outcome. If a "save" is important, than you have concern = care = emotion. Not a good combination in my opinion. Here goes: Tick tick tick... it's going to take extra time to liftoff and use the same departure corridor that was used for the approach...there shouldn't be any unknown hazards going direct...tick tick tick...OK, I know I can shave a minute off transport time by not climbing, to hell with the wires...tick tick...damn, I should have burned some fuel off, we're really too heavy for the conditions...it's OK, I'll only make gentle inputs and I won't overtorque or overtemp, it'll be finesse....tick tick TICK...crap, the headwinds will be increasing along our prescribed fly-in route (not quite as straight, but obstruction free)....it's OK, I know a shorcut and so what if the weather and terrain might not be nearly as optimal...TICK TICK TICK...but it's OK, 'cause I've flown this way a hundred times...and curse the low stratus, I'm better cause I'm a great pilot...and the patient has to be saved...

 

(at least, that's what I can derive from the example)

 

Again, my earlier post was trying to associate the self-importance of saving lives with introducing/tying in emotions and the execution of job duties, then what the influences on decision making will be. It's all the little links that start showing up because of the mindset of "if I don't get the patient to the ER in time, they're a goner. And they have to be saved." Another form of 'gettheritis'. At what cost? This is where ADM gets influenced (unnecessarily) by non-relevant, external factors. This is how emotions get introduced (If I don't make thing happen faster...). This is how distractions occur. And with a habitual mindset like this, it will become consistent behavior and the it's only a matter of time before something goes wrong. And no, I don't buy the arguement that you can pick and choose the times that you'll let yourself be influenced. Given your example, what would your reaction be if 5 minutes from the hospital, a tail rotor chip light illuminated? Keep going? Hey, time's important for the patient as you've stated. To make things even muddier, you know it will take at least an additional 20 minutes more than the patient's "clock" has before adequate backup transportation arrives. What to do?

 

OK, now for the saving lives part...

 

Rarely does a patient have such a convenient item as a timepiece for the med crews to determine transport time. It is the job of the medcrew to initiate/continue trauma care and stabilize a patient, not the pilot's. The pilot merely controls and expedites a safe and efficient transport mode, as Wally, Gomer and Delorean have stated. Yes, actions of the pilot do have some impact on the patients ability to recieve advanced care, but if there is a scene transport, the patient may have exceeded the golden hour by some time. The med crews just do their best with what is presented, and usually, the entire crew can only deliver a "stable" human package (sometimes the patient gets better in route, but it's usually keeping them stable and doing the best to prevent the patient from crashing). Continuing on, once the patient hits the trauma bay, the ER staff goes to work and more tools come out. There's the magic. Sometimes the patient goes to surgery, sometimes the attending trauma physician calls TOD. My point here is you usually will not know of the patients final outcome; it is not a TV show where things come to a convenient conclusion and everything works out (or not) in an hour. Often, the patients that make it through optimal transport and advanced care protocols still develop severe complications and end up worse off than the condition you would have seen...sometimes they die in a few days or suffer for awhile and then die a few weeks later. Sometimes months. Then what, is it still a save to you? Are you a better person because of it?

 

Now, let's discuss an aspect of the job that hasn't ben discussed much: for most rotary EMS programs (I'll qualify with community based programs), there's about 50/50 flight time between on-scene calls and inter-facility transports. With the IFTs, the mission is to transport a stable patient, or organs, from facility "A" to "B". Sometimes a doctor will go, sometimes not. Does this type of transport meet your criteria for a save? Or is it just executing one's job safely and responsibly? Again, I have found this (actually moved it) to be a safety topic because it strikes a nerve.

 

I gotta lighten up. OK...some hospital humor:

 

So what's really the #1 cause of death?

 

LIFE.

 

-WATCH FOR THE WIRES-

[JPDPilot]

I think the point being made (and I can see both sides) is that the primary function of HEMS isn't to save lives. It's to transport someone in dire need of help to somewhere that they can receive the help they require. Just like an ambulance's primary function is to transport and stabilize.

 

You almost hit the nail on the head, but not quite. You were only several words off. Maybe you meant to write this:

 

I think the point being made (and I can see both sides) is that the primary function of HEMS is to help save lives by transporting someone in dire need of help to somewhere that they can receive the help they require. Just like an ambulance's primary function is to transport and stabilize.

 

Sorry ADRidge, I just couldn't help it.

 

JPDPilot

[delorean]

I think the point being made (and I can see both sides) is that the primary function of HEMS is to help save lives by transporting someone in dire need of help to somewhere that they can receive the help they require. Just like an ambulance's primary function is to transport and stabilize.

 

No.....Like any other business under capitalism, the primary function of a HEMS operation is to make money and bring profits back to its owner or shareholders. Saving lives can be a very profitable way of doing this.

 

It's nice to say "the mission is #1" or "safety is our top priority", but it's not. If saving lives was #1 we'd have helicopter every single city in the US; likewise if safety was really #1, we wouldn't be in the aviation business in the first place!

 

This opens a whole new set of discussion about the price of a human life and how safety & money have to balance each other out. No reason to get into it.......just wanted to make a brief point.

[ADRidge]

You almost hit the nail on the head, but not quite. You were only several words off. Maybe you meant to write this:

 

I think the point being made (and I can see both sides) is that the primary function of HEMS is to help save lives by transporting someone in dire need of help to somewhere that they can receive the help they require. Just like an ambulance's primary function is to transport and stabilize.

 

Sorry ADRidge, I just couldn't help it.

 

JPDPilot

 

No... and I'll tell you why. That is a goal that, while it may be obtainable in some situations on some days, generally just sets a pilot, a crew, a program up for failure. I watched a good friend of mine die on the side of the road four years ago. I did what I could to help him, I tried incredibly hard and so did the first responders. My goal was to save the guy's life, and I failed. Another way to look at it (and one I have since adopted) was that my goal should have been to do the best I could to try, which in retrospect, I did.

 

In HEMS, the strategy that seems most efficient for everyone involved is to do the best you can, as safely as possible and as detached as possible. That way, when you DO lose a patient, it doesn't set you back as far, mentally. That way when you go out the next time, you don't risk the lives of three or four people for one very unfortunate soul.

 

I don't know jack about flying yet, but I'd like to think I know about the mindset necessary. This is why ER docs have a very dry sense of humor, and why EMTs are some of the funniest but most detached people I've run across.

 

But then again, I could be completely wrong.

[Gomer Pylot]

Yep, Delorean hit the nail on the head. The purpose, the one and only purpose, of EMS helicopters is to make money. Period. There is no other purpose at all. If some lives are saved, that's just a side effect, and has nothing to do with the business. And it is just another business. My job is to make money for the company by flying safely and efficiently from one place to another, carrying cargo. It may be breathing, but it's just cargo. If I crash, I cost the company money. If I don't fly, the company may not make money, but it doesn't lose any either. Anyone who truly believes otherwise is most likely going to die, and take others with him.

[JPDPilot]

Yep, Delorean hit the nail on the head. The purpose, the one and only purpose, of EMS helicopters is to make money. Period. There is no other purpose at all. If some lives are saved, that's just a side effect, and has nothing to do with the business. And it is just another business. My job is to make money for the company by flying safely and efficiently from one place to another, carrying cargo. It may be breathing, but it's just cargo. If I crash, I cost the company money. If I don't fly, the company may not make money, but it doesn't lose any either. Anyone who truly believes otherwise is most likely going to die, and take others with him.

 

Gomer,

 

Is that the same for hospitals (nurses, doctors)?

 

JPDPilot

Edited August 29, 2007 by JPDPilot

[Gomer Pylot]

Of course it is. In the USA, there is only one reason for any business, and especially for hospitals. They are for-profit corporations, and have no other reason for existence. No profit, no hospital. There is no altruism in capitalism, just profit motive. Individuals are more difficult to pigeonhole, but the doctors and nurses I know are mostly in it for the money. There is always the adrenaline junky, and some who just want to help others, but the profit motive is always there.

[delorean]

My wife is an ER nurse at a busy Level I trauma center.....She works only Saturday & Sunday from 3pm-3am and is usually on her feet for the whole 12 hrs (which usually turns into 14-16 hrs).

 

Is she in it for the "mission"......hell no! She's in it for the $46/hr and only having to work 2 days a week.

[Wally]

JPDPilot- I'm an EMS pilot. My wife's a physician. My first wife was a nurse. Trust me, it's a job, first, last, and always. Yes, the intent is to apply skills to help somebody, but it's impersonal. It's kinda like statistics- any bit of data, by itself, tells you very little about the whole. If the statistics show patient outcome is improved, then lives might be- but money most definitely will be- saved. Emotional involvement is minimized because it interferes with the intellectual judgments the job requires- proven fact.

[JPDPilot]

Of course it is. In the USA, there is only one reason for any business, and especially for hospitals. They are for-profit corporations, and have no other reason for existence. No profit, no hospital.

Sorry, that's not true. If no hospital was allowed to make a profit, there would still be hospitals. There always have been, and there always will be--for the simple reason that they're needed. If seculars couldn't find it in themselves to help others not-for-profit, religious would be doing it. Remember that society and the world are run by a higher Providence...

 

There is always the adrenaline junky, and some who just want to help others, but the profit motive is always there.

Of course it's always there. But that doesn't mean it has to be the primary motive. It's most unfortunate that so many in the medical industry, pilots included, have their primary motive as profit. I suppose that's to be expected in a godless society.

 

Emotional involvement is minimized because it interferes with the intellectual judgments the job requires- proven fact.

Wanting to save another's life only interferes with intellectual judgments if one lets it. In the case of medical professionals, the motive of saving another's life is an overall pervading motive supporting the whole career, but it's not necessarily consciously in the MP's mind as he makes professional decisions. The more immediate motive of sustaining the person's heartbeat, oxygen, etc. is present. I think differentiating between these motives and balancing them within the career is only impossible for those who make it so... Human reason and the will to make it work are powerful tools at our disposal; we just need to use them!

 

The root of the problem which this "motives behind EMS" debate is dealing with is religion. No-religion looks at human beings selfishly--as objects of profit--because the world only revolves around each one's self. Religion, or Christianity specifically, looks at them as creatures of God, made in His image and likeness, and thus objects of love for His sake; the world no longer revolves around oneself but exists because of and for God.

 

Anyway, it's obvious I'm Christian, and my religion influences my look at the industry. I see I'm not going to get anywhere with you guys in this discussion because apparently you don't come from this same perspective at all. It's sad how people only think in terms of me, myself, and I.

 

Thanks everyone for sharing your opinions. Have a good Labor Day weekend!

 

Fly safe,

JPDPilot

[zemogman]

I understand both points of view...however I agree with JPDPilot in that...if you are trying to convince me or anyone else that helping others in a way that may lead to saving their life should not to be a motive in the medical profession ---- I believe you are mistaken. We would not have any EMT's, EMS, FireFighters, Police, etc...if that motive were eliminated. Helping others is a noble cause...in my opinion. That it is...

 

Not the primary motive --- maybe not

Not the primary focus in the middle of an emergency --- definitely not

Not to be confused with a "God complex" --- obviously

Understanding that sometimes your best effort won't be enough --- critically important

 

I believe emotions can get in the way in every area of life, especially when operating a helicopter in the transport of a patient in bad condition. Putting them on the "back-burner" during the task is crucial...but flying to help save lives is an honorable intention, even if you end-up saving a scum-bag...that decision is left for the judicial system and that discussion will make this post too long...

 

So I think it's something like..."help save lives...but keep your emotions in check" --- we've all been let down before, severely or not, and that too is a part of life that must be dealt with...it builds character.

 

Hope this makes sense...

[Wally]

Sorry, that's not true. If no hospital was allowed to make a profit, there would still be hospitals. There always have been, and there always will be--for the simple reason that they're needed. If seculars couldn't find it in themselves to help others not-for-profit, religious would be doing it. Remember that society and the world are run by a higher Providence...

Of course it's always there. But that doesn't mean it has to be the primary motive. It's most unfortunate that so many in the medical industry, pilots included, have their primary motive as profit. I suppose that's to be expected in a godless society.

Wanting to save another's life only interferes with intellectual judgments if one lets it. In the case of medical professionals, the motive of saving another's life is an overall pervading motive supporting the whole career, but it's not necessarily consciously in the MP's mind as he makes professional decisions. The more immediate motive of sustaining the person's heartbeat, oxygen, etc. is present. I think differentiating between these motives and balancing them within the career is only impossible for those who make it so... Human reason and the will to make it work are powerful tools at our disposal; we just need to use them!

 

The root of the problem which this "motives behind EMS" debate is dealing with is religion. No-religion looks at human beings selfishly--as objects of profit--because the world only revolves around each one's self. Religion, or Christianity specifically, looks at them as creatures of God, made in His image and likeness, and thus objects of love for His sake; the world no longer revolves around oneself but exists because of and for God.

 

Anyway, it's obvious I'm Christian, and my religion influences my look at the industry. I see I'm not going to get anywhere with you guys in this discussion because apparently you don't come from this same perspective at all. It's sad how people only think in terms of me, myself, and I.

 

Thanks everyone for sharing your opinions. Have a good Labor Day weekend!

 

Fly safe,

JPDPilot

 

 

Aa, so-ka, so-ka... brother, you could not be more wrong in your character and value judgment.

You're correct in one thing, however- Your ideas are not going to change a behavior learned at great cost, over decades of experience- mine, and those who taught me. After you've walked the walk and not just talked the talk...

Edited August 29, 2007 by Wally

[arotrhd]

At least we have a much better understanding of our positions, however defended (I'm an advocate for clarity over agreement in discussions). I would be interested in reading the comments generated by airmed flightcrews (medcrews + pilots) in response to a parallel topic in a core airmed forum like flightweb.

 

ADR: Good original question & topic.

 

-WATCH FOR THE WIRES-

[Wally]

At least we have a much better understanding of our positions, however defended (I'm an advocate for clarity over agreement in discussions). I would be interested in reading the comments generated by airmed flightcrews (medcrews + pilots) in response to a parallel topic in a core airmed forum like flightweb.

 

ADR: Good original question & topic.

 

-WATCH FOR THE WIRES-

 

Flightweb is far too cerebral to actually argue. If you can't demonstrate something mathematically or cite a peer reviewed source, they won't play with you.

[arotrhd]

I'm not sure this wouldn't register because it's not a bolus of this or 50cc's of that, no offense; the forum routinely demonstrates they have some great arguments, even outside of the purely clinical related topics. Anyways, it still might be a fun post to see what buttons get pressed. Not gonna volunteer now, but I might later if someone doesn't beat me there.

 

-WATCH FOR THE WIRES-

[Gomer Pylot]

Well, there is always the mildly entertaining Just Helicopters. You'll have to count me out, though - I can't even stand to type that into my browser's address window.

[arotrhd]

I'm not going to touch that one even with your 10' stick. J-What??? Gomer, come on, don't make me think you're not one of the sages 'round here.

 

-WATCH FOR THE WIRES-

[ADRidge]

Wow... this thing really took off. Great points on both sides of the coin. I want to thank all of you for taking the time to answer my question and start a thought-provoking debate.

[kodoz]

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.

Nobody's mentioned it, but is the founding principle of EMS part of the HEMS orientation?

 

First, do no harm

 

I was shocked to hear that in my first EMT class--I went in with the "savin' lives" mentality. The saying initially had it's roots in ambulance drivers' just chucking patients in the back of a station wagon, going pedal to the metal to get them to the hospital, and in the process usually worsening their injuries through improper handling or accidents. So when EMS was formally developed, their first goal was simply to get the patient to the hospital in no-worse condition than when they left a scene. Now it's applied to all EMS (and, ideally, SAR) operations: in every EMS class I've been in or taught, you hear over and over again that you can't help your patient by becoming another patient (or fatality), and that if you get hurt trying to help, you've taken resources from your patient and therefore ended up doing harm.

 

To make this point, one of my wilderness EMS instructors liked to tell the story of a hiker who slipped off the edge of a waterfall. One-by-one the others in his group ran over to help, each one of them too slipping in the same spot and falling. Instead of having one patient to evac, they ended up with 3. And during our EMT course, we went over cases where EMTs or paramedics hadn't followed procedure en route to a call or the hospital and ended up having an accident. One of them was an infamous accident in the Boston area where an ambulance went through an intersection and hit a truck broadside; the truck's driver was trapped and died in the post-crash fire. The EMT driving the ambulance wasn't at fault (the other driver was said to have clearly ran through a red light), but we discussed the case in the context that, even though your ambulance has the right-of-way and you may very well be on the way to a call where the patient desperately needs help, your safety is always in the patient's best interest.

 

This is how EMT and first responder students who have that single-minded "save lives" drive are grounded, and even if you do every procedure book-perfect, you get no credit with your instructor if you don't verbalize clearing the scene first. "Primum non nocere--to do otherwise is in direct conflict with the mission of EMS."

[JPDPilot]

Posted at the forum at www.helitorque.com by an EMS pilot whose been flying for over nine years at Stanford Hospital in CA:

 

 

In almost nine years of EMS flying at the Stanford University Hospital in California, there are so many flights that have made me proud!

 

Professional pride comes from every flight when I feel like I've done my best. Sometimes the outcome for the patients is not good, but I still feel good about knowing that I've done my part to safely complete the mission!

 

But it's the kids that have made me weep, both in sadness and in relief!! Every once in a while, we'll get a recovered kid in a wheel chair come up to the helipad and want to see the helicopter that brought them to the hospital.

(they often don't remember the ride)

 

The best job on Earth.

 

I often tell people that the single greatest contribution that I'll ever make to this world is my wonderful son. But some of the flights I've done with Stanford are a close second place!

 

james

[Sparker]

Posted at the forum at www.helitorque.com by an EMS pilot whose been flying for over nine years at Stanford Hospital in CA:

In almost nine years of EMS flying at the Stanford University Hospital in California, there are so many flights that have made me proud!

 

Professional pride comes from every flight when I feel like I've done my best. Sometimes the outcome for the patients is not good, but I still feel good about knowing that I've done my part to safely complete the mission!

 

But it's the kids that have made me weep, both in sadness and in relief!! Every once in a while, we'll get a recovered kid in a wheel chair come up to the helipad and want to see the helicopter that brought them to the hospital.

(they often don't remember the ride)

 

The best job on Earth.

 

I often tell people that the single greatest contribution that I'll ever make to this world is my wonderful son. But some of the flights I've done with Stanford are a close second place!

 

james

 

I find interesting that you would be so insistent that you are right about this, especially with the EMS pilots saying you are not.

 

 

The whole point is that it is a slippery slope, yes you may help save lives, but acknowledging it leads to indulging in it which leads to yearning to do it more and trying harder and harder until something bad happens. I know you said you would stay within the companies' requirements, but eventually your desire may overrule the reqs.

 

Maybe when you take the flight suit off you can maybe think about saving a life or two, but the instant that flight suit goes on you need to drop the emotion immediately.

[flyingseapig]

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?

 

It may sound honorable to get into EMS to save lives but as people have already said it can also get you into trouble. I just recently got back from an interview with a company and it is their policy to not inform the pilots or have the medics let the pilots know the status of their patients on board just for that reason, they don't want people pushing the limits or taking unnecessary risks of the flight crew just to save one life. Get into the industry for the work schedule or stability not for the lifesaving part, so you won't try and be a hero!