It’s 0200 and the phone ringing wakes you out of a deep sleep. You’ve got a scene request 10 miles south with one patient. Your final destination will be the trauma center at a hospital 20 miles east of the scene. The weather has been marginal all night. Can you take the flight? The clock is ticking.
This is a commonly encountered scenario for Helicopter Air Ambulance (HAA) Pilots. We have to make a timely decision to accept or turn-down a flight based upon critical information: passenger weight (performance/limitations assessment), route of flight (fuel/navigation/weather assessment), and other crew risks (sleep, stress, experience, equipment, etc…).
Sometimes you’ve got to make this decision right after being woken up.
HAA Preflight Preparation
Many of the factors that impact flight can be evaluated or calculated at the beginning of the shift, leaving us with less to consider once the call comes in.
When we show up to the start of a shift, one of the first things we do is conduct a preflight inspection of the aircraft. We follow the manufacturer’s checklist, and ensure all documents/equipment required by 14 CFR 135 and our operator’s OpSpecs/General Operations Manual (GOM) are on board. We also note critical flight planning information such as the fuel quantity, oxygen quantity, and the time/days remaining until a maintenance task is required. Medical personnel also have their own checks to conduct of their on-board equipment.
Once the helicopter’s weight and balance is calculated with this information and the known weights of the crew, we can go ahead and calculate the maximum patient weight we can carry off the pad. Then, based upon our existing knowledge of the fuel burn rate and fuel weight, we know if we can take a heavier patient at another location after our assumed flight time, or whether we need to hop back up and burn a little extra fuel while the medical crew prepares the patient for transport.
Knowing the fuel quantity is obviously important for time and distance planning. If we only have 1:40 worth of fuel at the cruise burn rate, then we can’t take a flight that involves a total of more than 1:20 worth of flight time without a fuel stop built in—this is due to the regulatory requirement to have a 20min fuel reserve, which, incidentally, the GOM may require a larger reserve if certain weather conditions are present. We could also take a few minutes to add fuel at the start of such a long flight to mitigate this, if it won’t negatively impact the ability to carry the weight of the patient. In general, we keep the fuel load such that we can operate within a pre-determined service area without the need to stop for fuel with a patient in-transit.
When assessing weather, typically we will be frequently checking the weather on days where the forecast is anything other than high-ceilings, high-visibility, and no storms. Different operators may have differing official sources that pilots can choose from. One unofficial tool we commonly use just for general awareness is HEMS Tool, which I discussed in an article a few months ago.
If the weather is great in our entire area and projected to remain that way for the next few hours, our communications center will know we can launch immediately with just the route and patient weight information. However, if we are concerned that at least part of our area will have declining weather in the near future, we will go on a weather-check status that lets the center know to ask us for a weather evaluation of the route before continuing with the rest of the dispatch information. Also, if we absolutely can’t go anywhere due to weather, we can place ourselves in a weather hold status.
Finally, we can evaluate our own static risk and that of the medical crewmembers. Static risk factors include how much sleep we had prior to the shift, how much experience we have with the area/aircraft, nutrition, hydration, and aircraft equipment issues/limitations, to highlight a few. Having figured out our static risk with the operator’s risk matrix, now all we will have to do is add the risk of the factors of the flight request once alerted.
We brief the medical crewmembers on the pertinent details and discuss our plans for emergencies, contingencies, inadvertent encounters with poor weather, and the tasks of each member with regards to launching the aircraft, alerting for traffic/obstacles, and post-flight procedures.
Now we wait for the call.
Accepting Or Declining The Flight
We’ve done everything we can to plan for any flight that comes our way. If we get a flight request, we only need a few additional pieces of information to determine if we can or can’t take it.
Obviously, we need the route. If the flight is just a transfer between hospitals, we’ll look at the flight leg from our base, to the pick-up hospital, to the receiving facility, and then back to base. If the flight is a scene request—landing at either a pre-designated Landing Zone (LZ) or directly at the scene—we’ll evaluate the route in the similar manner, as it is typically already known which hospital the patient will be going to. Essentially, we are checking that we have enough fuel for the flight, that the weather will be at or above the minimums established by 14 CFR 135 or the sometimes-more-restrictive GOM for that flight, and that we can complete the flight within the duty time limits also established by 14 CFR 135. Then, we just need the patient weight to ensure we will be within the helicopter’s limitations throughout that portion of the transport.
Some hiccups can be dealt with. For instance, if the patient’s weight is higher than what we could carry at pick-up, we can still go to the destination, drop the medical crew off to prepare the patient, fly around to burn the fuel off as quick as possible (typically we are only needing a few minutes of burn time in these cases), and then get the patient.
If the weather is an issue, we may be able to delay the flight a short time (depending on the patient’s medical requirements) or adjust our route to avoid the weather. If the weather isn’t going to work, we decline the flight and the patient is then often either transported by ground or by another helicopter—sometimes the weather is such that we may not be able to get to the patient, but a helicopter from another location may have acceptable weather to get there instead and complete the transport.
We also will evaluate other dynamic factors into our risk assessment, such as the length of time we have already been on duty, medical crewmembers’ issues, the forecasted weather trends, performance limitations in high density altitude/temperature environments, and the impact of deferred inoperable equipment. These can be assessed quickly at the time of receiving the flight request, and some can turn into static risk factors and be accounted for when they occur during the duty period even in the absence of a flight request.
If we decline a flight, it is imperative that we somehow communicate that to other pilots in the area. Why? Because sometimes customers will “shop” for helicopters to transport their patient, creating a pressure potentially for someone to take a flight in marginal or straight-up bad conditions. It’s important to know if someone else was called for this flight and why it was declined, as that information could also contain something critical—such as non-forecast weather—that we missed in our own evaluation of risk. One method of passing this information is a website called the WeatherTurndown.com provided by AirMed International, which has over 600 participating programs at the time of this writing.
One additional key point: any crewmember can decline the flight or terminate the flight. If I’m not comfortable, we aren’t going. If the flight nurse isn’t comfortable, we aren’t going. If the flight medic isn’t comfortable, we aren’t going. It’s an important part of a safety culture to operate this way, not to mention that job satisfaction would be low if you felt compelled to fly in conditions that worry you, and that would also impact your performance.
If we take a flight, operationally we encounter a few common issues:
On hot days and/or high altitudes, the performance of the aircraft can be close to operating limits with a patient onboard, particularly if the patient weighs such that we are at or near gross weight. You can’t go screaming into or out of an LZ/helipad, and need to fly the aircraft carefully and conservatively.
Wires, trees, buildings, vehicles, and debris are common at LZs. An effective high and low reconnaissance of the site must be conducted, and care in deciding the best approach path is needed. Many hospital helipads are poorly planned and situated in confined areas also requiring great care in their use.
At night, these obstructions are even more difficult to spot. Fortunately you should have Night Vision Goggles (NVGs) for the conduct of all night flights, and the aircraft typically has one or more pilot-adjustable spotlights to assist in assessing the scene.
Patient status is not something that is to impact your decision to accept a flight or decline it. But, once you’re in the air it is possible that the patient’s condition could change mid-flight and necessitate a change in destination. In case of such an occurrence, we must always be situationally aware of our aircraft’s capabilities, fuel quantity, location, weather, and surrounding airspace in order to address a change safely and effectively. This isn’t a job for a casual helicopter pilot—you’ve got to be on-top of your game and an effective, safe, and quick decision-maker.
Typical Shift Schedule
What’s a typical work schedule like? Many operators use a 7/7 schedule, meaning that a pilot will work seven days (12-14hr shifts) and then be off for seven days. This is a great schedule, as you basically have half the year off for personal time! Occasionally you may take overtime shifts to help with pilot shortages or covering for vacations/sickness, giving you a chance to earn some extra money. I personally value time over money, so working a 7/7 is my preferred long-term arrangement.
On duty you take care of the aircraft, keep a check of the weather/notices to airmen (NOTAMS), study for yourself to maintain awareness, and participate in any company/regulatory training that comes around. You can enjoy watching movies, playing video games, and working out in the gym—hopefully your base has a nice gym like the one I work at. There is a lot of down-time between flights, and you can do mostly whatever you want as long as you are attentive to the job.
Earn money sleeping!
What Requirements Exist To Become An HAA Pilot?
Here is a common break-down of the hours, certificates, and experience requirements sought by HAA operators in the United States. Some of these are minimums designated by insurance and accreditation organizations, and others by regulations or employer/customer requirements.
Total Time: 2000hrs
Total Pilot-In-Command (PIC): 1000hrs
Cross Country Time: 500hrs
Night Time: 100hrs (at least 50hrs unaided-no NVGs)
Instrument: 75hrs (50hrs in flight)
Commercial Pilot Rotorcraft Certificate
Instrument Helicopter Rating
Second Class Medical
They will typically have a maximum weight limit for the pilot in the low-200lbs range, and require you to live within a certain distance of the base you will be working at. Experience-wise they are looking for pilots who can act competently and safely in single-pilot operations, and ideally have frequent experience with off-airport operations—not to mention prior experience with HAA, NVG operations, Part 135 operations, instrument flight, and such being an added bonus.
The Helicopter Air Ambulance Pilot career is great if you want a lot of time off, don’t care about flying more than a hundred or so hours each year, and enjoy the process and challenge of having to make safe and effective decisions about a flight quickly. You have to be a self-starter and motivated to maintain your knowledge proficiently, and the successful completion of a medical flight is a great reward. If you only like to fly pre-determined routes and have everything figured out for you, stick with tours or traffic watch.
Lifting with four souls,
My Other Career Articles: