Thoughts on EMS training

March 4, 2010 by Tim McAdams

The helicopter EMS industry is struggling with a high accident rate. Several months ago the NTSB published recommendations ranging from equipment requirements to increased training. There seems to be no doubt in the helicopter industry that the FAA will mandate one or more of the NTSB recommendations this year. In the past the FAA has been reluctant to act; however, the feeling now is if the FAA does not come out with something strong to stop the accidents, Congress will.

In my opinion, increasing the amount and type of training will do the most good. Using technologies such as HTAWS and NVGs are helpful as well, but I think the most benefit will come from better training.

EMS is a tough business with lots of cost pressures, and spending more money on training can be hard to justify sometimes. I was told by one EMS vendor that watching costs was paramount to survival, if he couldn’t bid a competitive price and lost contracts they’d be out of business.

An interesting dichotomy was when I flew a corporate helicopter. I was trained at FlightSafety every six months and could take the helicopter (a Bell 430) out once a month to practice. The corporate mission was nowhere near as demanding as EMS flying, yet there was considerably more emphasis placed on training. Sometimes I wonder if the difference was because the person who ultimately approved the training budget also rode in the back of the helicopter. Those passengers certainly had a vested interest in the proficiency of the pilots.

It will be interesting to see what the FAA does. If operators can afford the technology and the increased training then that’s the best scenario. However, if it’s one or the other I believe the best improvement in the accident rate will come from enhanced training.


  • CR

    You said it, the person who ultimately approved the training budget also rode in the back of the helicopter. I don’t even think it’s more training that’s needed although some companies are a joke in this regard. I think if management was to fly in the back of one of our EMS helicopters at night in bad weather, they would have a different approach. Accidents happen because we are forced, yes I said it FORCED to fly in bad weather with marginal or less than desirable equipment.

    You’re the PIC and you can’t be forced, you might say but in the real world that’s BS. Every so often we’re told that if we don’t have enough flights the base will close and we’ll lose our jobs. That forces you to fly. Then there’s the new barely qualified pilot who takes every flight no matter what and then comes back to brag how bad the weather was and how he made it. Just an accident waiting to happen but since he’s likable to the medical crews then they follow him blindly, some right into the ground.

    It’s not a secret but when you complain you get fired and the FAA or anyone else can;t do a thing about it. I know it’s a business to make money and insurance keeps paying for the crashed helicopters so management just hires a new crew and after a few tears and sorrow the next week everything is back to normal pushing pilots to fly more so the base doesn’t close.

    Everybody knows this but nobody in power wants to do anything about it.

  • Avi Weiss

    CR / Tim;

    As you both mention, economic “desperation” belies poor judgment “exacerbation”.

    While almost every facet of life is caught in this reality, due to aviation’s inherent intolerance of poor judgment, actions based on such judgment often come to grief. Since the EMS community has done little to change the operational mentality of operators, the powers that be will be left with little choice but to implement new rules as a “blunt instrument” to slow the rate of poor judgment. These rules likely wont stop all the accidents based on poor judgment completely, but it will likely have some effect at lowering the casualty rate.

    As I’ve mentioned numerous times in the comment section on posts made to this blog regarding EMS, I believe that the accident rate can be greatly reduced without the introduction of new rules by moving to a industry-sanctioned operation certification program such as the TOPS program implemented by the tour industry. Having different certification levels (VFR Day, VFR Day/Night, IFR Day, IFR Day/Night), as well as minimum aircraft and support equipment (twin engine, NVG, etc) would at once remove the marginal operators, raise the level of safety, and lower the accident rate.

    Yes, some operators might be forced to close, but that will likely happen to those who close anyway after they have an accident / incident due to poor operating practices, only it will likely happen only after lives have been lost.

  • CR

    That might help but once everything is in place the operators will continue to pressure the pilots. So you’ll have a pilot authorized to fly VFR night. That’s what we have right now and we still have pilots crashing. As long as you have pilots from all levels of experience having to please the operator (because they need the salary so they don’t want the base to close and lose their jobs) by taking flights in bad weather we’ll keep having accidents.

  • Avi Weiss

    Hey CR;

    My apologies. I had left off some details of the certification program in my comment above as I had included them in other posts, but will include here to address your good observations.

    Though I have no hard data to back the following statement, from being active in the FAAST community and the WINGS safety program, casual empirical observation DOES show a CAUSAL relationship between the amount of SAFETY-oriented training a pilot receives on a regular basis, and the level of safety he operates on a daily basis. Its not a far stretch to say that pilots who are part of a training program that increases both their proficiency in the type of flying they perform, and their safety awareness during those operations, will be more likely to exhibit a more proficient and safety-oriented approach to “normal” flight operations.

    Much like the TOPS program, the primary purpose of the EMS certification program would be to create pilot knowledge and proficiency in EMS operations that are not the focus of any of the FAA rotorcraft certifications. For example, the “VFR – night” certification would focus on night operations to off-airport locations, confined areas, and perhaps even pinnacles. This would also require the pilot being NVG equipped, trained, and proficient in their use. Currently, there is no such requirement for pilots to receive such training. The certification program would also require a certain number of contiguous accident/fatality-free hours to keep the certification, because as you say, what good is certification if poor judgment-based accidents still occur.

    To your point, what good is a pilot training program if they are under financial pressure from management to fly. To mitigate those pressures, the certification program will also have a mandatory training syllabus for management and dispatchers. Among other items, this training will include awareness of “pressure-induced operations”, and all the ramifications therein. After all, what good is pushing a pilot to take a flight that has a high likelihood of killing the patient and crew?

    In addition to all the proficiency and awareness training, the certification program will also serve as a “public awareness and measurement” tool. At the moment, there is no easy way for an EMS “customer” (hospital, private transport operator, ski resort, etc) to make a “first-order” evaluation of an operators qualification and safety record quickly. By having a known, easily identifiable safety-oriented certification, customers will be able to “self-select” the operator based on their compliance to a higher standard of performance. Operators who don’t participate in the program will hopefully find themselves with dwindling business, and thus either be forced to close shop, or put forth the requisite time and money to operate at the higher level of performance. As the saying goes “a rising tide lifts all ships”. If your boat has holes, better get them fixed.

    Like anything else in life, an operators participation in the certification program is not a guarantee that flights they operate won’t come to grief. In the final analysis, it is up to ALL the people involved to act responsibly, professionally, and safely. It will be alot easier to do that if ALL the people involved are properly educated, trained, proficient, and MOTIVATED to do so.

  • CR

    It all sounds nice, sort of what CAAMTS says it does for the industry but as anyone flying EMS for any significant amount of time will tell you CAAMTS is a joke.

    When you say that the certification program will also have a mandatory training syllabus for management, do you really think that management doesn’t know that they are putting pressure on pilots to fly? They know exactly what they’re doing but the money issue makes them continue to do it. Even if you try to keep them honest with inspections, CAAMTS comes around every few years and does an inspection. Of course they advertise the inspection months ahead of time so you can change everything you’re doing wrong before they get there and the day that they leave your boss tells you to put it all back the way it was before the inspection. I have lived that many times.

    Not trying to burst anyone’s bubble and I’m not a grouchy pilot either but I too was once an aviation safety counselor and gave many WINGS trainings at my airport. I’m just saying that I wish it were as easy as what you’re proposing. The only way to fix this is for the FAA to stop bowing to the pressures of the big companies and mandate by Regulation some real sets of Op Specs where the company can’t find a loop hole, mandate NVGs and ME helicopters for all night operations and IFR helicopters for areas where it’s known that VFR is not the norm.

    The second thing they can do is to have a real whistle blower program with real protection where a pilot can call and tell them when an operator is doing something illegal or unsafe. Until then management will continue to put pressure on pilots to take flights because even if the pilot crashes they’ll still get their helicopter paid for by insurance and just hire a new pilot and it’ll be business as usual. That’s how it’s been at all the bases where they’ve had accidents, go look that up and see.

  • Kevin Carbone

    ED/IT Aviation Products Div released a new version of our eSectionals software on April 8th to assist all pilots who FLY LOW to comply with a new FAA regulation for air-medical pilots (HEMS A021). eSectionals lets the pilot draw their flight route on an a Sectional or TAC. The software then displays all the obstacles along their flight path, shows an elevation profile, and marks the highest terrain for each flight leg, and prints a table of the data. HEMS A021 requires pilots to fly at certain minimums above the highest terrain and highest obstacle for each leg of their flight. In addtion, when the flight path is not know, eSectionals permits the pilot to draw a box around the flight area. eSectionals then creates a report to document all the obstacles and finds the highest obstalce and terrain within that flight area. Currently, over 50% of all HEMS operators are using our eSectionals US Edition to assist them in complying with A021. eSectionals, for that purpose, is excellent for anyone who flys low, pipline surveillance, spraying operations, and so on. You can get more info by visiting In our Press Release topic, you can find a link to download our HEMS USER GUIIDE(pdf).

  • Brendan Fitzpatrick

    I’m always amazed when I learn about EMS operations that are non-profit and funded by donations. I imagaine budgeting can take a major role in operations where your success depends on the generosity of individuals and businesses – especially in a down economy.

  • Old Pilot

    What a joke! As long as the medical side of the industry sets the tone of operations there will be no change. Kevin says use that cool computer planning tool to comply with HEMS A021, you’re not serious are you? First that costs $$$ the hospitals are NOT going to spend, second we are already under pressure to check WX and NOTAMS, plan the route IAW HEMS A021 pull the A/C out of the hanger, do a walk around, start & runup “using the checklist of course” and depart in 7 yes I said SEVEN minutes. Now do you really believe this all happens? Cause if you do I have some beachfront property in Inchon I would like to sell you. Then of coures there is the WX shopping you know three other programs have said no so they call you and most of the time don’t tell you anyone else has said no. I could go on but my blood presssure is going to spike if I do.

  • CR

    I agree. the new A021 is a joke. The idea behind it was fine but then they left the loophole I was talking about. If there’s an obstacle you just have to be able to go around it. What did A021 change? NOTHING. You fly the same routes but now have to waste time documenting the highest obstacle. More wasted time. Do you think the pilots who ran into things didn’t know they were there when they departed? Of course they did but for some reason or another, usually bad weather and high workload, they missed something. Tell me how writing that highest obstacle number before taking off is going to help you.

    Like I said before, until the FAA gets serious about wanting to fix the problem and not just putting out useless Op Specs to please some people that don’t really do anything to help, we’ll all continue to be in danger of becoming statistics too.

    PS : I just thought about something. As soon as Congress or whoever can do it makes it criminally negligent for managers to put pressure on pilots and we see a few of these yahoos go to jail then we’ll start seeing some changes. Every company says safety is their #1 concern, until you remind them of the money issue, then safety goes to #2 (pun intended).

  • Avi Weiss


    I concur that rules will have an immediate effect on reducing the amount of “bad behavior” both on the management side and the flight crew side, and I too have been around long enough to not be “Pollyanna” about the immediacy and totality of effect that certification programs and even new FAA RULES would have on the overall accident rate, but as you know changing mindset is neither simple nor quick, especially in the aviation community.

    Even if rule changes WERE implemented, continually operating safely requires a continuous safety mindset, something that really can’t be legislated. Sure… management knows they are putting pressure on pilots, but to your point, if they are aren’t forced to constantly think about, or live with the consequences of that pressure (even outside of criminal negligence, which by the way, such charges can always be brought by prosecutors NOW, if they felt there was criminal intent, and they had PROOF of such action), then it is easier for them to maintain the status-quo. Will forcing them through safety awareness training once a quarter make a difference? If the course has strong content and good presentation, and generates organization-wide awareness, my bet is it will reach some of them, which is better than none of them. Hopefully over time, that number would grow.

    Again, it would be the “completeness” of the program that would work to simultaneously improve pilot tools, skills and proficiency in the specific areas of operation, imbue the WHOLE operation with a safety mindset, and educate the consumers of EMS services that they have a CHOICE in selecting operators who work to a higher standard of performance. That covers all the “risk-generation” elements, but again, in the end its the judgment and value system of the people involved that will make or break it.

  • Jack of Hearts

    Money is the issue in a lot of things. If the FAA wants safety, they need to come up with a lot of money. Next time an EMS helicopter gets called and the weather is too bad to fly, don’t fly and send the bill for lost revenue to the FAA.

  • Tony

    Just a note,
    Not all EMS companies skimp on training. Not every EMS company let the medical side pressure pilots.
    I’ve been doing this for a while and I’ve seen the “good, bad and ugly”.
    I’m just a pilot whose been working for several years.
    At my current employment my is training is quite good. I have great and well maintained equipment to use. Luckily I have well trained and motivated crews to work with. And I have never ever been questioned for turning down a flight due to questionable weather or maintenance issues.
    Usually when people respond on these sites there is a lot of negativity.
    The bad is out there but its not all bad.
    For the young pilots remember that during your interview that you are also interviewing your new company.
    The FAA standards are minimums. If your employer is straining just to achieve the minimums you may wan’t to look elsewhere.

  • CR

    Tony, I’m extremely happy you have found a great company to work for. Please tell us what company you work for. I’d be proud to tell the world which company I work for if it was as good as you are telling us yours is.

  • CR

    When you hear someone speaking so well about their company without mentioning the name of that great EMS company it’s usually 1- they’re new at that company so they’re in the honeymoon stage and can’t see the bad side 2- They’re low timers and just glad to have a job flying a turbine 3- they’re really in management trying to downplay the bad press and not a line pilot….just saying.

  • M

    I am a pilot new to HEMS, and I am trying to soak up as much as I can. My questions are genuine, I’m not trying to be flippant.

    -Multi-Engine Helicopters: First, I have no time in twin helicopters. That being said, my understanding is that most HEMS accidents are due to helicopters running into things: from towers/obstacles, to LZ mishaps, to other helicopters. How does a twin helicopter help? Or are the twins meant to address a power problem for ingress/egress?

    -IFR: I do hold IFR and CFII ratings in helis and airplanes. I definitely do understand the benefit of being able to fly IFR, if only to react to inadvertent IMC. Moreover, I recently heard Matt Zucarro explain that one of HAIs top lobbying issues is to establish a low-altitude airspace system. How would this IFR capability and airspace structure aid in off-site operations? I would think the most dangerous situation would be descending IFR into an area you hope is VMC, with no approach or wx observations.

    -Training: In the article above, Mr. McAdams mentioned increased training. Specifically in what area? As I mentioned, how do you increase training for CFIT/O? (I have dubbed CFIO as Controlled Flight into Obstacles) I imagine that it is largely due to low weather, visibility, and single pilot workload which causes the pilot to “miss” what is going on outside. Short of two-pilot crews (which I support) how can this be mitigated by training?

    I am hear to learn, any insight is greatly appreciated.


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