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feet….Landed in farm field about 1/2 mile from
airport. Although fully equipped, aircraft was not
IFR certified. This situation had been previously
addressed and rehearsed. An instrument rating,
planning for inadvertent IFR, and current approach
plates kept a bad situation from ending in disaster.”
(ACN 169746)
16 Issue Number 6
Emergency 911
Summary and Recommendations
Many of the human factors considerations cited in the
EMS incident reports are known to have a significant
impact in other aviation environments, and are ongoing
topics of human factors research. The pilots themselves
recognized some of these considerations and often had
suggestions for resolving the problems they encountered.
 There appears to be a need for more concise, less
frequent communication between EMS pilots and
ATC. Some pilots have recommended that EMS
aircraft be assigned discrete transponder codes while
operating in airspace requiring ATC communication.
In theory, this would allow a pilot to make the
initial ATC contact and state his or her intentions,
then be tracked on radar with minimal additional
radio calls. Other pilots seem to feel that standardization
of the “Lifeguard” callsign (see sidebar on
“Priority Handling” and “Lifeguard”) would go a long
way in facilitating EMS flights through some types
of airspace. One approach might be for EMS pilots to
arrange a friendly discussion with the Tower supervisors
in the areas where Lifeguard flights frequently
occur. This might provide a mutual understanding of
the responsibilities and expectations of both pilots
and controllers in Lifeguard radio communications.
Another recommendation is to obtain Letters of
Agreement (LOAs) with the local ATC facilities most
frequently contacted. Many pilots find that an LOA
can define routes, altitudes, reporting points, and
other operational information that helps to streamline
the communication process for both pilots and
controllers. This can be especially helpful when a
hospital helipad in located within controlled airspace.
Associated with improvements in ATC communication
are improvements in crew communication. Crew
Resource Management (CRM) is not just for major
airlines or big companies. Clear, assertive communications
among all EMS team members—pilots, flight
nurses, paramedics, doctors, administrators, dispatchers,
and on-scene personnel—are vital if the
EMS flight team is to perform its duties efficiently
and successfully.
 Another aspect of CRM and Aeronautical Decision
Making (ADM) is the concept of task management
and delegation. Many incidents were reported as
occurring when and where they were least expected—
in day VFR, during cruise flight. In two-pilot operations,
tasks need to be delegated such that one pilot
is always “outside” the aircraft, looking for that
potential NMAC or IMC encounter. In single-pilot
operations, on-board personnel may need to take an
active role in all phases of the EMS operation.
 A recommendation that is often repeated by both
EMS pilots and human factors researchers is the
need for the pilot to be isolated as much as possible
from the patient’s condition. There have been many
attempts to do this, and the situation continues to
improve. Pilots are rarely greeted anymore with a
heart-wrenching request to “save a dying child.”
Typically, the question is simply put to the pilot:
“Can we get there and back?” with no mention made
as to the nature of the emergency or the patient’s
condition. This helps remove some of the emotional
pressure, and encourage the pilot to make an objective
decision about whether the flight can reasonably
be completed safely.
 Finally, many of the pilot reporters indicated that an
instrument rating and currency were very helpful, if
not invaluable, in encounters with unforecast
weather. Since most EMS helicopters are IFRequipped
even if they are not IFR-certified, an
instrument rating and currency at least provide a
pilot with options in case of an in-flight weather
encounter.
All efforts need to proceed towards developing solutions
and preventive mechanisms within the National Airspace
System and the EMS team. Each individual
involved in these important emergency operations needs
to become a part of the larger effort to improve communication,
decrease distraction, decrease time pressure
to realistic levels, and assist in workload management.
Issue Number 6 17
　
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