How to be an air medical pilot
Mike Biasatti details the professional and personal qualities that make air medical pilots unique in their skillset; examining their resilience and ability to perform on-the-spot risk assessments in the face of life-or-death situations
Aviation is one of those wonderful industries that has so many facets to it that whether your aspirations are to fight fires, fly tours, fly in the logging business in support of the timber industry, support the offshore oil industry, participate in air taxi work, or fly air medical helicopters, then you can. Each specific vocation of flying takes the basic aeronautical skillset possessed by all helicopter pilots, and then requires more narrowly defined talents to perform the duties of the position.
Everywhere has different requirements
Air medical companies all have their own specific requirements for would-be candidates. When I was an aspiring HEMS (helicopter EMS) pilot, before the designation was changed to HAA (helicopter air ambulance) the minima for entry, especially for a civilian-trained pilots like myself, were daunting:
- Commercial rotorcraft helicopter license (ATP preferred)
- Bachelor’s degree preferred
- 3,000 total flight hours
- 2,500 hours pilot in command (PIC) category
- 500 hours rotor-wing time
- 250 hours night flying
- 100 hours Instrument Meteorological Conditions (IMC)
Each company set their own minima and requirements beyond the applicant holding a Commercial Helicopter License, and those were from the premier air medical company at that time in my mind, so they were goals, but would take a breadth of exposure to other forms of flying in order to accumulate those requirements.
Fast forward 20 years, and things have loosened up a bit. HAAs experienced an explosion of growth in the last 20 years, and with that growth and a finite supply of helicopter pilots that could meet the stringent minima, those minima were adjusted slightly. More common requirements now look like this:
- 2,000 total flight hours
- 1,000 hours PIC in category
- 500 hours rotor-wing turbine time
- 100 hours unaided night
- 50 hours actual or simulated IMC
In 2014, the Federal Aviation Administration (FAA) added section 600 to part 135 of the FARs (Federal Aviation Regulations), setting forth pilot organizational requirements for businesses operating in this field. Since 2017, all HAA pilots have been required to possess an instrument rating. The vast majority of helicopters operate in a visual flight rule (VFR) configuration, but a large number of the accidents the industry experienced were deemed to have, at least at some point, been the result of VFR flight into instrument meteorological conditions (IMC). Furthermore, FAR 135.00 set forth weather minimums in Class G (uncontrolled) airspace. Aircraft equipment requirements were phased in, as were most of the changes, giving the operators the opportunity to get their fleet and crews into compliance.
In 2016, companies operating 10 or more helicopters were required to create an OCC (Operations Control Center) staffed with persons to verify pilot planning, check their weather assessments, monitor their flight progress, and ensure pilot currency. No pilot could now depart on a flight request until a member of the OCC had reviewed their submitted risk assessment to include fuel planning, route, type of flight and many other particulars applicable to the proposed flight request. Pilots were now required to determine a minimum safe altitude for the proposed flight and ensure that they could clear it by 300’ during daylight hours and by 500’ at night. In 2017, added to the flight planning requirements to aid in reducing CFIT (Controlled Flight into Terrain or Obstacles), aircraft were required to have HTAWS (Helicopter Terrain and Warning System) onboard.
Many of the operators had already implemented most of these minimums in their own operations manual, and to some extent, went beyond what was being required, so the transition – for many – was fairly seamless, but from then on, everyone had to operate under the same rules.
Reality of flying a HAA
So, taking into account the myriad of technical requirements listed above, what does it take to be a HAA pilot? You must have a commercial helicopter certificate with an instrument rating. You will be required to obtain and maintain a second-class flight physical annually, although a few operators require a first-class flight physical. You will need to meet – or be very near – the required flight time experience that each particular company has, though don’t get discouraged, many operators will make some exceptions if one column is lower on time and another is higher – much of your success will come from your interpersonal skills.
Part of the team
To be successful as an HAA pilot, you will need to work as a team with your medical crew. A common configuration for medical helicopters is one pilot, one nurse and one paramedic. All operations are conducted with crew resource management as a cornerstone. While your med crew are not aviators, they afford you two extra sets of eyes, which can really come in handy when you are landing in a residential cul-de-sac with power lines and trees all around. Learning to solicit their input, especially when it comes to deteriorating weather, is essential. Some air medical helicopters are rated for IFR (Instrument Flight Rules) flight. Typically, but not always, those are twin-engine helicopters with redundant systems to include an autopilot (used in lieu of a second in command aka co-pilot) flown by pilots who maintain their instrument currency, but these probably make up only about six per cent of the helicopters assigned to HAA duty.
Shift work isn’t for everyone, but it has its benefits!
A typical schedule for the pilot is seven shifts on, followed by seven shifts off. These are 12-hour shifts, and in some programs – like mine – the seven shifts are split between day and night. As an example, I work Thursday through to Sunday days (07:00hrs to 19:00hrs) and then, after 24 hours off, I work Monday to Wednesday nights (19:00hrs to 07:00hrs). The more common schedule is to work seven straight day shifts, then you’re off for seven days, and when you return, you’ll work seven night shifts. All in all, you get half the year off. Pretty sweet.
A preflight allows you to check everything is in order, lights work, no oil dripping, fuel load.
A typical work day involves arriving to your assigned base, which could be at an airport, hospital helipad or standalone location. The medical crew typically work 24-hour shifts. You meet with the pilot on duty and brief re his or her shift, any aircraft issues or planned maintenance, the current weather and any pending flights. Once that’s done, he or she departs, and your day really begins. Start by taking a look at the aircraft logbook for any work that was done on the aircraft, brief with the mechanic if he is on site, and then proceed to the aircraft. Check the current and forecast weather to see what conditions are like and what they are expected to be like throughout your shift.
A preflight allows you to check everything is in order, lights work, no oil dripping, fuel load. A helicopter is a million parts, all flying in formation, and operates under a massive torque strain, so it’s imperative that you take a good look at all the critical components. Your mechanic will perform an airworthiness check every few days, which is a more detailed examination of the aircraft and any scheduled maintenance (of which there is a lot).
Teamwork makes the dreamwork
The aircraft looks good, you have everything you need for your first flight request, now it’s time to brief the medical crew. They may very well have been out at the aircraft during your inspection checking their equipment and various medicines they carry. You’ll discuss with them the weather, any work done or expected to be done on the aircraft, any safety-related incidents that have occurred, any safety bulletins, and a general passenger briefing that includes reminders to secure any loose equipment and remain vigilant, especially during takeoff and landing, but all the time really. I like to remind my crews that every seat in the aircraft has a vantage point that no other seat has identically. There may be some overlap, but each viewing angle is unique, and they need to take ownership of that area and make sure the pilot doesn’t do anything unexpected. One of my best friends used to say ‘if the flight was anything but boring, I did something wrong’. While the stress of treating patients will be anything but boring, the flight itself should be.
There are various administrative duties shared by the four pilots at the base, so there may very well be some of those to tend to, as well as check in with the Communication Center. Think of the Com Center as the dispatchers of the program. They receive calls from various agencies or hospitals requesting transport of someone. Their responsibilities are many.
And now you wait. In the early days, for me, it wasn’t uncommon to fly two to five patients in a shift. Over the years, the number of medical helicopters has grown so much that one flight per shift is not uncommon, and sometimes you might not receive any requests. During the shift, you keep a watchful eye on the weather, you can study, of course there are televisions to watch, a small kitchen for meal prep, and each crewmember has their own room with various work-related items, and a bed.
When the call comes
When a flight request comes in, the pilot will check the weather. If it is unflyable (thunderstorms in the area, ceiling below VFR or IFR depending on the program, icing conditions etc, then you have to decline those flights. If the weather is acceptable, you advise the medical crew, gather up whatever you need, and head to the aircraft. Always walk completely around the aircraft before getting in. Many a pilot has, through a desire to be expedient, walked right over a power cord attached to the aircraft, or a cowling that was left open. The medical crew should be arriving and perform a walk around as well. Redundancy aids safety.
You’ve been given a distance and heading, which allows you to plot your course, and they will provide you with GPS co-ordinates for the location. About half the requests are from smaller hospitals needing to move patients to larger ones where specialty care is available, and the other half are from EMS agencies responding to motor vehicle accidents, stroke patients, gunshot wounds, you name it.
In these instances, the ground unit on scene will set up a landing zone and brief you on any hazards. Once you have landed, the medical crew will depart the aircraft to the waiting ambulance, or into the hospital, and later will return with the patient. You are responsible for keeping a check on any changing weather patterns, fuel requirements for the next leg of flight, calculating the highest obstacle along this next route. Radio traffic can get a little overwhelming sometimes. You have to maintain a listening watch on ATC (Air Traffic Control) frequencies for any airspace you’ll be operating in or through, the company dispatch radio, and air-to-air channel to keep up with local helicopter traffic in the areas you’ll be operating. Sometimes, it seems like everyone wants to talk at once, so you will need to prioritize. The old adage comes to mind: Aviate, Navigate, Communicate.
The old adage comes to mind: Aviate, Navigate, Communicate.
Don’t get so caught up in radio chatter that you are distracted from your primary role of keeping the aircraft level, traveling in the right direction and away from any conflicting targets. Fly the aircraft first, navigate it in the direction it needs to go, and then respond to radio calls.
Once the patient is loaded and then you have arrived at the trauma center or receiving facility, the medical crew will unload the patient and take them into the hospital, and report to the receiving physician or nurse and transfer care. While this is going on, its not uncommon for the pilot to fly to a nearby location to put fuel on, so that when the crew comes back, there is enough to accept any request that comes in while they are returning to their base.
On the flight back, the medical crew is typically working on their chart, which they will continue to do once they arrive back at base. Upon landing, they will depart, and you’ll follow the shutdown checklist. There are checklists for everything you do: start up, cruise, before landing, landing and shutdown. Checklists keep you out of trouble. Follow them. After shutdown is complete, perform another walk completely around the aircraft looking for anything that isn’t right, oil or hydraulic fluid seeping down the side, latches popped, just a good look over.
Upon returning to the pilot’s office, you’ll log the details of the flight, account for any fuel your purchased, and submit. Perform a post-flight briefing with your crew and communication specialist to see if there were any issues during any part of the flight. A continuous process of improvement takes place to ensure we are delivering on our mission of providing safe, fast and efficient air medical transportation to people experiencing medical issues.
What matters most is a can-do attitude
Any pilot applying for an air medical job will presumably have the requisite ratings and flight time, but what differentiates one candidate from another is attitude. A positive attitude, open to criticism / suggestion without losing their temper is paramount. A person who likes to work in a collaborative environment, who will go above and beyond what is expected, and do so with a good attitude even after 11 hours of your 12-hour shift has elapsed. The days can feel long; make sure you’re okay with sometimes hours of inactivity and then all of a sudden, moments of urgency. Those who are most successful in this line of work can multitask successfully, avoid allowing the presumed urgency of the patient to alter your responsibility to your crew and the safe outcome of every flight, and truthfully, someone who is pleasant to be around and likes being part of a team of people who like helping others. It is a fantastic job and well worth the sacrifices you have to make to get there. Good luck!