Preparing for the unexpected - train, train, train

Chief Pilot at Air Methods Raj Helweg discusses the advances in, and importance of, air medical training
Every day, air medical providers help save lives. Like any type of emergency medical transportation, the work they undertake carries inherent safety risks. However, the benefits to patients, families and communities far outweigh these risks – that is why safety and reducing the risk for air medical crews and patients is a constant focus and continual priority. 
Risk mitigation at Air Methods in 2018 took numerous forms, including enhancements to aircraft, developing new emergency clinical procedures and improving training for pilots and clinicians. One training enhancement in particular gained steam last year and it will continue to improve the safety and success of air medical missions in 2019 and the near future: full flight simulators.
Flight simulators offer pilots training experiences that would be otherwise impossible outside of real-life emergency situations, seeing as they would rarely occur outside of these. Instead, simulators deliver the experience without the risk and help pilots develop the decision-making skills and muscle memory to automatically and correctly respond should these situations ever happen during patient transportation.
Preparing for the unexpected
Air Methods devotes considerable training resources to implementing flight simulators in our training. We believe simulators have many benefits over traditional lecture and live, in-flight training alone. Hence, more than 85 per cent of our 1,300 pilots – both rotor-wing and fixed-wing – now receive initial and recurrent simulator training in Level D simulators, in partnership with FlightSafety International, an aviation services training provider. This gives our pilots the most realistic – yet safest – in-flight experience available. Our check pilots provide the training for the AS350, EC130, EC145, EC135 and the Bell 407. We contract our fixed-wing training for the Pilatus PC-12 and King Air 200 to FlightSafety, with our instructors having the final look during the route check portion of the required training.
All our pilots in command (PICs) join our organisation with a minimum documented 2,000 total flight hours for visual flight rules (VFR) and 2,500 total flight hours for instrument flight rules (IFR). Retraining them for the unique high-risk scenarios is essential for their safety and success on missions – that is why a key aspect of our simulator training involves avoidance of controlled flight into terrain and inadvertent instrument meteorological conditions (IIMC) scenarios. 
Prior to their annual evaluation, each pilot completes at least two simulator training sessions lasting up to two hours. During these sessions, pilots encounter numerous scenarios that require them to apply their knowledge of day, night and night vision goggle-aided night flight in VFR and IFR weather conditions.
Simulated emergency experiences could include an engine or transmission problem, a rotor system caution light or another malfunction that the pilot must react to while protecting the safety of the crew and patient. Like any major mechanical error, pilots are not warned what will happen, nor when it will happen. Unlike in real life, pilots have the luxury of repeating malfunctions until the correct reaction becomes automatic.
Hands-on without harm
All air medical pilots must know their aircraft and be capable of flying in varied weather conditions across numerous urban, rural and mountainous environments. We strive to set our pilots up for success by exposing them to potential problems within the simulator – so if something happens during a transportation operation, they will react appropriately. Seeing a malfunction or dealing with an emergency for the first time whilst on a mission is not the ideal way of learning.
The ability to realistically repeat the experience of serious mechanical malfunctions or other unexpected situations builds confidence and ingrains muscle memory. This all occurs in a safe environment that eliminates the possibility of harm to personnel or damage to the aircraft. Pilots can also review recordings of how they reacted in the simulator, this allows them to visualise how they performed and identify any improvements they may need to make. 
Research has highlighted that this type of learning is highly effective, particularly in training for unexpected events. A recent study compared how two groups of airplane pilots reacted to unpredictable and variable mechanical failures in simulators. The group that had practised in unpredictable and variable environments had higher situational awareness and thus performed better during simulated mechanical failures than the control group who were trained in a predictable and invariable manner.
Another significant benefit of simulator training is cost. When we use a simulator, we are not occupying a helicopter that may be needed for an air medical emergency, and so can avoid spending money on fuel and other valuable resources during training exercises.
Annual training dovetails with safety
In 2019 and beyond, simulator training should be implemented throughout the year as part of air medical providers’ safety culture. At Air Methods, the team continues to train every year following all Federal Aviation Administration (FAA) guidelines and Commission on Accreditation of Medical Transport Systems (CAMTS) standards. 
Dedication to training in this way ensures that pilots’ skills are aligned with the latest standards and best practices. It also simultaneously helps our crew and patients avoid unnecessary risk – guiding them toward safer missions and clinical pathways with better preparation, decision making and consistent execution.

About the author

Raj Helweg is the chief pilot for Air Methods. Nine months after his introductory flight in Seattle in 1997, Raj worked as a flight instructor in Atlanta. He then moved to Prescott, Arizona, where he continued to work as a flight instructor. After flying tours in the Grand Canyon, Raj began his EMS flying career. He worked as a line pilot and a lead pilot for then Omniflight's Native Air program and PHI Air Medical. After Omniflight was acquired by Air Methods, he served in the regional aviation manager and regional aviation director roles. Today, Raj oversees the training and compliance of approximately 1,300 pilots in his role as chief pilot for Air Methods.