In response to the rash of helicopter accidents experienced over the past few years by the medical transport industry, the National Emergency Medical Services Pilots Association (Nemspa) has rolled out a new safety/risk assessment plan known as the “No Pressure Initiative.”

The program is intended to bring a set of more formalized best practices to members who may face internal and external pressures to fly in marginal conditions. It is a collaborative effort among Nemspa and other allied organizations including the Association of Air Medical Services, the Air and Surface Transport Nurses Association, the Air Medical Physicians Association, the International Association of Flight Paramedics and the National Association of Air Medical Communications Specialists. The initiative consists of three protocol levels aimed at streamlining the decision-making process.

Based on the results of a membership survey conducted by Nemspa, the association found that about 30 percent of pilots felt pressure to fly when they felt they shouldn’t. “I wouldn’t say it’s a major issue, but it was certainly significant,” said Nemspa president Kent Johnson. “They feel that this is an issue, that for whatever reason flight crews sometimes feel pressure to accept a flight request and sometimes that’s in marginal weather conditions.”

Developing a Safety Culture

The first level of the initiative calls for an organization to assess its culture and to support and reward safe decision-making practices, while deemphasizing statistics such as individual flight volumes. The initiative also advises flight teams not to let patient type or condition influence flight-related decisions. “The pressure part feeds into this,” said Johnson, who is also the chief pilot for Salt Lake City-based Intermountain Life Flight. “A lot of this will probably be internal pressure, what you do to yourself–‘If I don’t do this, this little kid is going to die, I’m his only hope’–and you have to separate yourself from that. Some of that goes back to education and working with the groups to learn you just can’t look at it this way. You’re a transporter, you’re not in the business of saving lives, you’re in the business of transporting people.”

The second part of the initiative deals with risk assessment and recommends that all EMS programs adopt a risk assessment tool or outside consultation as part of their preflight decision-making process. Based on variables such as weather, pilot experience, fatigue and the specific operational situation, the flight should be cancelled when the flight team is not comfortable with accepting it.

The final level of protocols is an en route decision point (EDP) based on the actual weather conditions encountered during the flight. “The FAA is very specific on what those minimums are, and most pilots know those fairly well,” Johnson told AIN. “The problem that you run into is that when you are actually out flying and weather might be deteriorating somewhat. It becomes very subjective, and a pilot has to make that call. What the en route decision protocol does is it sets hard and fast limits where there is no fudge factor. What we are setting is airspeed and altitude limits and for our particular program, if you go less than 500 feet or less than 90 knots you have to either turn around, land or transition to IFR.” Johnson’s organization has been using the EDP procedure for several years and reports positive results. “What we’ve learned from our pilot group was that this took pressure away from them and that they liked the concept,” he explained. “When I have a hard limit and I know that’s as far as I can go, then the pressure goes away.”

Last month, Nemspa hosted a retreat with representatives from the other organizations to hammer out the criteria for the next phase of the industry-wide safety initiative. “We’re calling it the cultural health assessment program or Chap,” said Johnson, who added it will consist of an in-depth survey of the nation’s EMS programs to create a database. “It will give you a picture of whether you have weak areas in your corporate culture. If you do then you can make improvement there because a lot of times you have these issues and you aren’t aware of them.” This next phase is expected to launch around the middle of the year.