By Shannon Eliot
EMS1 Editor
SAN JOSE, Calif. — Significant gains can be made in HEMS safety operations by focusing efforts on four main areas, according to a presentation made at an EMS conference on Monday.
William Winn, a veteran pilot who oversees the safety program for Intermountain Life Flight in Salt Lake City, said that culture, training, psychology, and technology and are key factors in preventing aircraft accidents.
He made the comments during his presentation, “The Patient First, Safety Always,” at the 2009 Air Medical Transport Conference in San Jose, Calif.
“Very rarely do accidents occur from a single isolated event,” Winn said. “More often than not, they are the result of a chain of events that lead to unsafe outcomes. By understanding how and where these links exist, we can implement policies and practices to prevent them.”
Winn emphasized the necessity for the agency to promote a safety culture focusing on responsibility and consistency.
“While formal policies such as SOPs provide a good start, it’s important to make sure that they are universally enforced and don’t take a backseat to the sometimes contradictory informal cultural elements, such as a flight program’s emphasis on volume, liftoff response times, or competition,” he said. “It’s easy to talk the talk, but accidents are going to be prevented only by walking the walk. Managers should not only recognize and reward not only exceptional acts, but also consistent compliance.”
Further, it is essential for pilots and crew members to possess the highest possible degree of both individual and team competency, according to Winn.
“The logic is that pilots and medical crew members who are expert at the technical tasks will enjoy a greater measure of ‘cognitive reserve’ while performing their duties,” Winn said. “This allows them to have greater situational awareness and minimize mistakes born from human error.”
Perhaps the most difficult variable to control, Winn said, is the individual, or psychology. Winn noted that most accident investigations focus primarily on the ‘sharp end’ — those individuals whose actions or inaction most directly resulted in the accident — of the causal chain. The majority of ‘sharp-enders’ include pilots, air traffic controllers, and maintenance technicians.
“Risk assessment and risk tolerance are two real and important factors that vary from pilot to pilot,” Winn said. “Factors affecting risk tolerance include the ‘four P’s,’ or perception, pressures, personality, and payoff. An action considered risky by one pilot may not be given a second thought by another, especially if that pilot is more experienced or established.”
Winn also said that even if two pilots do agree on a level of perceived risk, they may handle it very differently depending on what’s at stake.
“Sometimes a pilot’s perceived worth depends to some degree on his willingness to accomplish the mission, or die trying,” Winn said. “They may ask themselves what the potential consequences are if they complete a risky mission, but then they follow that by asking what will happen if they don’t. Thus it’s important for leadership to stress the importance of erring on the side of safety whenever there is serious doubt as to the proper course of action.”
The final variable that can influence HEMS safety operations is technology, according to Winn.
“Any pilot — no matter how experienced — will make human errors,” Winn said. “A significant number of such errors are the result of inadequate situation awareness. Technology such as night vision goggles, terrain alert and awareness warning systems, and traffic alert and collision avoidance systems can prevent some of those errors.”
Winn also stressed the importance of having technology for an agency to learn how to prevent future accidents.
“When an accident does occur, some kind of flight data monitoring and cockpit voice recording system may provide information to help prevent future occurrences,” Winn said. “While the industry may resist because of cost and perceived effectiveness, it’s important to view this undertaking in the proper perspective.”
Focus on safety
The Air Medical Transport Conference (AMTC) has so far attracted 2,100 attendees and will host more than 150 educational sessions over three days covering safety, core clinical, specialty clinical, management, aviation, research, and communications. In addition, more than 160 companies will be displaying products and services directly applicable to air and critical care ground medicine.
“The focus of this year has really been quality of patient care, safe transport, and general aviation safety, given the number of medical helicopter crashes in recent memory,” said Dr. Dan Haskins, Secretary of the Association of Air Medical Services. “The conference is proving to be an effective way to network, learn how others are doing things, and achieve consensus on where the industry should go from here.”
While the conference is focused on air medical operations, Haskins said there are lessons for the broader EMS community coming out of the event as well.
“This week isn’t just about what’s going on in the air, but also for issues in critical care ground transport,” Haskins said. “It’s about looking to the future, where — I hope — we have true integration between ground and air operations into a statewide system.”