By Jay Fitch, PhD
Pilots want to avoid a mid-air collision at all costs. There are a number of useful tactics pilots use that can be adapted for EMS leaders who want to avoid a mid-career catastrophe. Here are seven rules used by great pilots and great EMS leaders alike.
1. Increase situational awareness
Pilots develop strong situational awareness skills and keep their eyes outside the aircraft, constantly searching the sky for other planes. My instructor used to say, “keep your head on a swivel and stay alert.”
Likewise, EMS leaders need to stay alert to stakeholder concerns by dedicating specific hours in their schedule each week to be outside their office, visiting stations, observing, and speaking directly to caregivers to be sure they have good situational operational awareness. If you keep your eyes inside the plane or hide in your office, the outcome is not likely to be positive.
2. Follow altitude rules
The FAA designates certain altitudes for easterly and westerly flights to keep aircraft separated by at least 1,000 feet. It’s always embarrassing for a pilot to request a certain altitude and have the controller respond, “That’s a bad altitude for your direction of travel.”
Similarly, having a bad altitude (read attitude) is one way leaders often go down the wrong path, and become perceived as moody, uncaring or downright mean spirited. Keeping the right attitude as you go about your tasks helps avoid conflicts and unnecessary collisions with others.
3. Use all of your resources and technology
There are always lots of distractions for EMS leaders. And, like pilots, we must learn to manage distractions, use the technology available to our advantage, and interpret the data that the technology delivers promptly and correctly.
If an EMS leader is not routinely tracking key clinical, operational and financial indicators, it’s as dangerous as a pilot not monitoring engine instruments while flying over the ocean. Leaders and pilots both have to know how to interpret the subtle indicators that are telling us to take an appropriate action.
I recently had a particular instrument fail while flying. Had I used the full technology available and cross checked several other data points, I wouldn’t have made an emergency landing. EMS leaders shouldn’t rely upon a single data point either when making important decisions. Spotting trends is an important skill to be developed for pilots and EMS leaders.
4. Maintain vigilance during high-risk operations
Pilots use extra caution during take-offs and landings, when flying in crowded airspace or in other hostile environments. EMS leaders are also often engaged in high-risk political operations. Presenting budgets, accomplishing labor negotiations, terminating a subordinate, or dealing with a difficult city/county council member could all be considered a high-risk operation.
So what’s a leader to do? Like pilots, leaders should use a checklist to make sure that key steps are not overlooked.
Another strategy used by pilots during taxi, takeoff or landing maneuvers is called the “sterile cockpit.” This procedure eliminates all unnecessary conversation to help the pilot focus on critical tasks. EMS leaders also need to reduce distractions by closing their doors and putting phones on silent mode to focus mightily while trying to solve a thorny problem or deal with a high-risk situation. Each interruption or distraction can result in missed steps and lead to an unfortunate incident.
5. Increase your visibility
Most pilots like to use all available aircraft lights to be easily seen by other planes traversing the sky. Likewise, EMS leaders need to significantly increase their visibility within the community.
Leaders need to be engaged across a wide variety of civic organizations to make sure their agencies’ story gets told and are positively perceived in the community. Ensure leaders at all levels of the organization consistently participate at neighborhood and other grass-roots meetings. If you’ve been visible and active with community groups, it’s much easier to obtain support when you need spend political capital for the patients’ benefit.
6. Listen well
Pilots communicate with air traffic controllers to get needed information and to share PIREPS, (pilot reports) helpful to others following along the same route. For a pilot, air traffic controllers are an essential resource. Pilots have to listen intently because controllers speak rapidly, and the information can be confusing if you are not paying attention. Controllers expect that you will listen well, fully understand and are able to read back the instructions provided.
There is an art to using the right words when you communicate. Effective aviation phraseology combines brevity with the transfer of complete and correct information. Pilots who listen well can glean a great deal of helpful information from controllers and others on the frequency.
In the same manner, EMS leaders should consider caregivers and field supervisors a valuable resource and part of their air traffic control system. Leaders must listen carefully, read back or paraphrase the information received to positively demonstrate they really heard it. Paraphrasing ensures that both parties have a common understanding.
Leadership phraseology must also be brief and support the complete transfer of correct information.
7. Expect the unexpected
EMS leaders and pilots have to anticipate the unexpected. Pilots have clear rules about how to approach a non-towered airport for landing. They include announcing your intentions on a common radio frequency, entering a standard traffic pattern at the correct speed and altitude, and not getting “behind the airplane” (becoming task saturated). Every pilot is taught these basic rules.
A few months ago, on a clear day, while approaching my home airport, another aircraft suddenly appeared. The pilot entered the pattern at the wrong place and had not made any radio calls to alert others. He cut off my approach to the field, requiring immediate action to avoid a collision. Had I been complacent or otherwise not paying attention, someone else might be writing this article.
EMS leaders must also be vigilant in anticipating an unplanned event. Council slashes your budget ... a beloved off-duty employee dies suddenly ... the media is investigating your service for sexual abuse of a patient. Each of these are examples of how leaders can be caught off guard and suffer a career crash as a result.
One of the most common phrases in pilot training is “aviate, navigate and communicate.” It means when the unexpected happens, keep flying the plane and don’t give up. Navigate to know where you are going and communicate to let others know what’s going on.
These concepts work for EMS leaders as well. Don’t give up when something goes wrong. If you find yourself off course, know where you were originally headed and communicate with those above, below and around you about what’s going on.
In many respects, pilots and EMS leaders understand that your career will be filled with hours of blue sky punctuated by moments of sheer terror.
Use these seven simple strategies to avoid crashing your EMS leadership career. Have a great flight.
This article, originally published in October 2019, has been updated.