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'Too drunk to fly': When would you speak up?
Let's look at several at-risk behaviors that may put you and other innocent people including patients at risk
By Jim Love
On February 16, a Frontier Airline pilot was escorted off his plane by four police officers moments before the scheduled takeoff. The pilot was allegedly inebriated and called "too drunk to fly."
He was reported to the airline by the hotel shuttle bus driver. As someone who flies a lot, I appreciate the commitment this driver made to protect us all, for speaking up.
We have all been on hotel airport shuttle busses. Ask yourself, what would you have done if you had been on this shuttle? Would you have reported the pilot? Would you assume someone else would spot it and report it?
I don't want to be flown by a pilot who is legally drunk, exhibiting a known at-risk behavior, possibly endangering my life. I have the right to expect to be flown by a sober, competent pilot.
Let's put this in EMS terms and look at several at-risk behaviors that may put you and other innocent people including patients at risk. These behaviors include:
• Lifting incorrectly, risking low back injury, injury to partner and possibly dropping the patient.
• Proceeding through a red light at a busy intersection without stopping and clearing each lane.
• DWE: driving while exhausted for whatever reason.
• Not taking proper precautions such as wearing gloves, goggles and other protection.
• Not confirming tube placement.
• A partner clearly under the influence as the pilot described above.
If you were the partner in any of these situations, and the odds are very real you have, what would you do? Would you say something? Who would you talk to?
Would you talk to your partner or a supervisor/manager? Would you perhaps call the medical director? Is there ever a time when it would be OK to refuse to run a call?
Years ago I had the opportunity to take a driver instructor class unlike any I had every taken before. The instructors were former FAA investigators. They approached driver training and safety from a completely different direction.
The focus of their program was all about such questions as posed above, your decisions to those questions and communication skills.
During class, they told of an investigation they conducted after a passenger plane taxied off the end of a runway into the water beyond. When asked, the copilot acknowledged that in fact he saw the water, that he did not say anything to the pilot.
When asked why he remained silent, the copilot stated he assumed the pilot had to see the ocean directly in front of him — how could he not? It's easy to assume someone else will address the issue that it need not fall on you.
Why else might someone not say something? Other reasons identified included being afraid of confrontation and a fear of retribution. What if the person who runs the red light gets suspended or in some other way disciplined? Are you ready to take the heat?
In its simplest explanation, it's just easier to look the other way — less paperwork, less anxiety. No confrontation.
But what about those times when there is a crash, a patient drop, a back injury or a case of TB. How will you feel if you knew and failed to say something? How will you feel if there is a fatal collision and you did not do the right thing? What if this hotel shuttle driver did not say anything — remember, the pilot made it all the way to the plane.
Dan White Monday, March 05, 2012 1:18:53 PM Flying is easier than EMS too. They basically just take off and land, the computer does the rest. We don't have the advantage of computers plotting our way points to the hospital. This is also another great reason to always tip shuttle drivers. 
Greg Friese Tuesday, March 13, 2012 7:15:16 PM The easy part is seeing the behavior. The hard part is what do you do about it. Stopping a behavior, especially an ingrained habit, is never easy. Jim, what are some techniques for calling a time-out, especially for the mundane things like poor lifting technique or PPE compliance? 
Skip Kirkwood Tuesday, March 13, 2012 10:26:29 PM We call those "Stop the us!" moments. It's easy enough to say, and to get people to know what it means. You can freeze a whole team with it, then identify and address the immediate issue (like, the safety of the team, the patient, the airplane, etc.).
Jim Love Wednesday, March 14, 2012 11:04:31 AM Thanks for the question Greg. I recall many, many years ago starting to lift a little old lady off of a bathroom floor. I set myself up to do it wrong- to use poor body mechanics because she was so small I did not see the risk. Just as I started to lift - an on scene FF put his hand on my back to keep me from lifting and said, "You need to do it right." This simple act make a world of difference to me and some 20 plus years later, I still remember this small act. Its really about having that open line of dialogue, the climate and culture that makes it OK to speak up. There is certainly the authority/seniority card. Those who are less in rank or lower in seniority will often follow the example of the more senior- so half the battle is setting the right example.
We always had a policy that any employee who felt his or her life in danger could refuse to run with an individual. I never had it happen to me- it did happen, only a few times and it is impactful across an entire organization. Its interesting in that years ago I had an opportunity to interview the safety and risk manager for one of the biggest airlines. He advised that every employee there from a pilot to a baggage handler to a ticket agent had the ability to stop a flight in order to avert a potential disaster. Again this goes to the openness, the commitment to and the culture of safety. I think what Skip describes below is his departments method of averting disaster. Thanks again for the comments and question, Jim. 
Ed Roble Wednesday, March 14, 2012 10:11:33 PM We always had one rule. If your drinking stay away the station and the scene. 
Robert Gift Friday, March 16, 2012 4:58:55 PM If I had reasonable suspicion, I would have confronted the pilot directly, not claiming that he is drunk but questioning his condition to fly. I would have called police and the airline. I would asked THEM to check the pilot. 
