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EMS Helicopter Shopping: Dead Wrong

EMS Helicopter Shopping: Dead Wrong

Helicopter shopping is a dirty little secret in Emergency Medical Services (EMS).

A taboo event everybody knows happens, but nobody ever talks about.

Why?

Because like most things (good and bad) in EMS and air medical, nothing happens on its own.

Helicopter shopping happens because flight programs let it happen. The fix to helicopter shopping is the same as the fix for helicopter crashes awareness, accountability and focused effort toward prevention.

Pretending bad things don’t happen is not a solution.

What is helicopter shopping?

Helicopter shopping is the practice of asking as many helicopter companies as necessary to fly a patient.

The most insidious form of helicopter shopping is asking competing air medical services to fly the same patient, and then applying pressure for pilots to fly.

Why would anyone “shop” for an (EMS) helicopter?

Easy answer.

Helicopter shoppers know the weather is crappy and most pilots are staying on the ground.

Or, they know a flight request was already turned down for weather and now it’s time to “shop” for results.

Ironically, hospitals view helicopter shopping as a way to hedge against risk.  The risk of no flight programs accepting their transport requests. The risk of losing revenue or future referrals by failing to transfer patients as quickly as possible.

The Real Danger of Helicopter Shopping

The most reprehensible way to shop helicopters is by pitting two competing air medical services against each other. Unfortunately, this is really easy to do.

Why?

Because it’s as simple as inserting an extra comment into a routine flight request. The dispatcher or flight communications specialist simply mentions a pilot from a competing program is also checking weather as she passes her flight request to the next pilot in her coverage area.

And just like that…the “rules of the game” change.

Sadly, this is often just the beginning of a dangerous cycle.

If one or two or ten pilots turn down the flight request…no worries, aggressive hospitals just keep shopping until they get the “right” answer.

The theory is if you shop long enough and hard enough, a flight program somewhere will eventually take your request.

Why Is Helicopter Shopping A Big Deal?

The big deal is the first, second and third helicopter programs that declined the flight did so for good reason.  In almost all cases, the reason is weather.

The even bigger deal is the pilot who eventually accepts the flight, may or may not have all the weather turn-down information. He may have no idea the flight was already declined by four different pilots who were all closer to the accident scene.

See the problem?

Because it’s a clear and obvious problem to flight programs that pay attention and care.

The biggest deal of all regarding helicopter shopping is the very real potential for catastrophe. From a safety perspective, the “chain of events” that leads to every accident is already two or three links strong.

Why Break The Silence About Helicopter Shopping?

Air medical crews do great work.

Air medical crews deserve better.

The first step to playing a safer game is putting all the cards on the table. No hidden agendas. No putting profits ahead of crew safety. This seems an easy thing to do, but it’s not. It’s actually very difficult.

Why is it difficult?

Because at the highest levels of air medical management, nobody admits mistakes or takes responsibility for broken systems that allow helicopter shopping to manifest. No health system or hospital publicly admits to helicopter shopping. Yet, it still happens. If you’re an active flight nurse, flight medic or EMS pilot, you know it happens routinely.

A Real World Example of Helicopter Shopping

To understand how helicopter shopping starts, put yourself in this situation:

Your job is to coordinate moving patients from hospital A to hospital B.  You have a job to do, and you know a helicopter program just turned down a flight for weather.

For this example, you’re the same smart person you are in real life.

You already know it’s not in your best interest to tell the whole story to the next pilot you ask.

Of course you condemn lying and refuse to do it.  But, you also have no requirement to do anything more than ask another pilot to do a weather check for a patient flight. You remind yourself it’s the pilot’s responsibility to do the weather check, and if the pilot doesn’t want to fly in the current weather conditions, they can always turn it down.

Remember, it’s human nature to phrase questions in a way that leads to answers we want to hear.

Everyone does this. It’s just how we’re wired as humans.

So you rationalize a little: so what if the next pilot doesn’t have every detail of every weather turn-down?  It’s his job to check weather before every flight anyway, right?

Now, throw in a couple not so hypothetical factors like: your employer has no policy on how to handle weather turn downs for patient transfer requests.  You know the expectation is for you to “make it happen” when it comes to patient transfers.  You also know you get compliments when you get patients flying, and the “I’m disappointed in you look” when you don’t.

Can you see how helicopter shopping starts?  Subtle, innocent, even deceptively pretty?

But it’s not pretty. It’s deadly.

The Big Question: How Do We Fix It?

First, enough with denial.

We all know it happens. Stop pretending your flight program is the exception, or because you addressed this very issue at a staff meeting three years ago, it no longer applies to your Helicopter Emergency Medical Services (HEMS) program.

Please…

Helicopter shopping is real…ignoring the problem does nothing to fix the problem.

As operators, lets do more than bury our heads in the sand and attend more memorial services.

“Poor aircrew (insert name here), if only they knew about the first three weather turn downs….” 

Together, lets make a concerted effort to never hear those words.

Second, remember that trying to improve a process is impersonal. You’re not attacking a dispatcher or flight communications specialist by trying to improve a process. You may need to remind yourself (and others) of this fact. My opinion of dispatchers and flight communication specialists is included in a recent article, The 20-60-20 Rule of Helicopter EMS.

Third, realize you can’t do it all on our own, but you can get started now.

Here’s Where To Start:

1. Tell the whole truth

Tell the whole truth and encourage others to do the same.

If you know a pilot turned down a flight for weather, man (or woman) up and say it.  Or, if you know the turn-down is a maintenance issue, don’t hide behind the weather. Consider a mnemonic the U.S. Coast Guard teaches regarding public relations:

“Bad news doesn’t get better with age.”

It’s true. And the same rule easily applies to flight requests that cannot be completed.

Just say it.

Be a pro and pass all the information you have to any person who requests it.

2. Ask the tough questions

If something sounds fishy in a flight request, ask for clarification.

Is there a reason three flight programs 50 miles closer aren’t doing this flight?

Can you please find out if they turned this request down for weather?

Simple, but important.

3.  Share Information Freely

For all the right reasons, share information with competing programs.

Help strengthen the collective consciousness of the entire industry. There is no benefit to passing incomplete information to competing flight programs. None.

If your pilots (presumably, ones you hired and trust) decline a flight for weather or maintenance, share this information.

Imagine if your flight program developed a reputation for always passing all relevant information to all concerned parties? How could that reputation possibly hurt you or your company?

I phrase it this way because there is real resistance between competing flight programs. Think of all the times your company states safety is “non-proprietary” or something similar.  In essence, you’re following policy; and more importantly, you’re doing the right thing.

4.  Fly Like You’re Going To Court

It saddens me to include this. But it is necessary.

Out of necessity, medical professionals factor legality into all their operations.  It’s time for aviation professionals to do the same.

If you’re a professional helicopter pilot who believes your company or the Federal Aviation Administration (FAA) will protect you from legal or civil penalties because you followed their rules …the really good news is you probably have enough stored optimism to find a better career.

The not so good news is you have zero chance of this actually happening.

The point is to remember that just because something is legal, it doesn’t mean it’s smart or safe. Look at the big picture, and include in your thought process how you would explain your decision to fly in court – after three other professional pilots declined.

See what I mean?

5.  Practice Professionalism

Treat other professionals as professionals.

Remember, you don’t need to agree with a specific decision to support the person who made the decision.

I remind my coaching clients to constantly assess and re-assess what really matters to them.

Every now and then, remind yourself that no job is worth a career, and no career is worth your life.

Helicopter shopping is subtle. It doesn’t get the time or attention it deserves from most air medical flight programs and crews. The reason is the secondary role helicopter shopping contributes to HEMS accidents.

Helicopter shopping is never “front and center” as the primary reason for a helicopter crash. It’s usually buried somewhere in the middle or near the beginning of the “chain of events” that leads to an accident.

But make no mistake, it’s every bit as important to flight crew safety as any other contributing factor.

Make an effort today to keep helicopter shopping in check. Follow the recommendations in this article. Your flight crews are worth it.

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About the Author: Troy is an Air Medical Career Expert passionate about a team approach to improving air medical safety from the ground up. Troy is a former Army medic, Army pilot, Coast Guard pilot and EMS pilot. Troy has taught hundreds of wannabe flight medics, flight nurses and EMS pilots the exact steps needed to launch air medical careers.

Comments

  1. well they ask you to call no what ever. and the EMT-P who ask for them all the time need to quit. there is a lot of sorry emt-p out there that only want to watch tv not work.

    • And there are a lot of idiot pilots who think they can fly through hell in a cracker box 206 or 135. It’s a team effort, it’s should be a team decision. If anyone is uncomfortable with the parameters. It should be a no go. I’d rather be wrong 100 times and not go when we could’ve then be right once and end up on fire on the side of a mountain.

    • Jim,

      Remember that you’ll never be able to control other people’s actions. The best you can do is give each flight request its proper attention and perspective.

      Clear Skies & Tailwinds

  2. I agree, very useful message. Everyone in EMS should read this!

  3. It should be an FAA rule that if they (the flight team) are not advised of turn downs and mechanical issues during the time of the request then the person requesting is held liable. Then they might start thinking of legality issues when they shop.

    • Renee,

      Thanks for sharing your thoughts. It’s really difficult to pinpoint exactly where the breakdown in communications occurs. That’s what I meant in the article about the subtlety of helicopter shopping.

      But it’s really encouraging to see people like yourself wanting to improve the process.

      Clear Skies & Tailwinds

    • That’s ridiculous. How can you hold a fireman or dispatcher who has never flown a helicopter liable for requesting if the person trained and licensed to fly makes a poor decision. I’m a volunteer firefighter but my full time job is as a ship capt. And I can tell you that if I don’t feel it’s safe we aren’t doing it. If I choose to do something unsafe the out come is on me. I’m the trained and licensed professional who should know better.

      • Brandon,

        I agree with you. But I think Renee is referring to air medical programs that intentionally withhold information from competing programs for their own benefit. Case in point: it’s pretty typical for a program who receives a call that needs to fly sometime today, to sit on it until one of their own aircraft is available vice transferring the flight to the competing service. It happens all the time.

        Thanks for sharing your perspective.

        Clear Skies & Tailwinds

  4. I must admit I’ve done this on a couple occasions. But mainly due to the fact that the med evac providers in my area are spread out enough that usually one has a clear path to my incident. And if not we have relied on the Coast Guard and National guard before. Rather not because their EMS components arnt as good as the civilian sector. I have done time in dispatch and don’t think we pressure evac. We do let them know we have contacted other evac and why they declined and where they are located. But we don’t call multiple evacs. If denied we move down the list to the next.

  5. Excellent and true perspective. Been there done that, got the t-shirt. Remember 3 to say go and 1 to say no. Never be forced into making a decision based on competition. We all want ro see our families at rhe end of the shift. Thank you for your insight.

  6. Gregory Freeman

    I have been out of the airmed realm for some time. However, there used to be a website / program that Rollie Parrish created called weatherturndown.com or something similar. This was used to keep all agencies informed of calls turned down for safety concerns. Is this not done anymore? If not, it should be revived.

    • Gregory,

      The Weather Turndown Website, http://www.weathertunrdown.com, is still around. It’s actually administered by AirMed International. As an Air Medical Communications Specialist, I have it ready on my desktop every shift I work, and have to log any weather declines from my aircraft there. It’s a great website, but it’s only as accurate the information entered there, and how quickly it’s entered.

      Rollie Parrish had the old FlightWeb website, http://www.flightweb.com. And like you, I wish it would come back. It was a good website, with more than a few good discussions on the chat pages. There was often information about job openings. There were also very good, respectful memorials when needed.

  7. Helicopter shopping isn’t the problem.

    There are a variety of reasons closer helicopter bases might not be able to take a flight that have nothing to do with weather. Even when “weather” is given as a reason for a turndown, it may be for a reason that would not affect you.

    While I like to know if someone else has turned down a flight, I know that information alone may not tell the whole story. We, as pilots, need to be able to make our own weather decisions, both before taking a flight as well as during a flight.

    • Eric,

      I definitely agree pilots need to make their own weather decisions through all phases of flight and ground operations.

      I also agree there are a myriad of reasons closer helicopter bases may not be able (or be the best choice) to complete certain flights.

      Having said all that, this article is about the practice of helicopter shopping and how it relates to weather information –and most importantly the need for pilots to get ALL information pertaining to weather-turn downs.

      If you’re interested in writing an article that addresses all the issues not addressed in this article, we’d be happy to consider it for one of our guest posts. Thanks for commenting.

      Clear Skies & Tailwinds

      • Still, helicopter shopping isn’t the issue. What you are describing is the need for better communication between the pilots of different HEMS bases.

        Even with people at their best, relying on multiple communication links still opens the possibility for information to be lost or incorrect as it’s passed along.

        If a pilot feels like they need a PIREP from another base, ideally they should just pick up the phone and call the other pilot. Unfortunately, with competing programs, I can see how this might be frowned upon by the people running the show at either or both programs. If you need a PIREP from another pilot at your own program, then it should be as simple as a phone call.

  8. There is a system in place called weather turn down that sends a text to anyone signed up for it in your general service area. We use it in Colorado and I think it works pretty well.

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