Helicopter shopping is a dirty little secret in Emergency Medical Services (EMS).
A taboo event everybody knows happens, but nobody ever talks about.
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?
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.
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.
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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