Resource Hub HAI/D.J. Sonsteng Photography Assuming a “mission” mentality in HAA operations doesn’t equate to recklessness. It promotes safety. Much has been made in pilot talk and recent writing about what seems to be the new dirty word in the helicopter air ambulance (HAA) industry: “mission.” Some safety commentators tell us that a “mission mentality” can lead to dangerous attitudes in the cockpit. Even using the word “mission” to characterize an operation marks the speaker as a risk-taker. Several senior pilots in my company have said that former military pilots, especially, make the mistake of considering what HAA crews do a “mission” when what we execute is merely a “flight request.” We operate “medical taxis,” another pilot has told me. Well, for those of you who prefer the BLUF (bottom line up front), I offer that our safety record in HAA, and in public-service aviation in general, would be better if we embraced more of a mission mentality, not less. What’s Within Our Control Various statistics show that human error is the primary or a contributing factor in 60% to 80% of helicopter accidents. Among the long list of FAA-identified human errors that can be attributed specifically to the flight crew (as opposed to organizational failures) are: Failing to properly plan a flight path Failing to adequately maintain the helicopter Failing to operate the aircraft properly Operating the helicopter in unsafe conditions Failing to operate the aircraft in accordance with its operational limitations. A May 2021 FAA study, “Medical Helicopter Accident Review: Causes and Contributing Factors,” organizes these factors under the broad brushstroke of “planning and training deficiencies.” Training is a topic for another discussion, but planning is something we can directly address as a flight crew. First, let’s take emotion out of the word “mission.” The definition of the word isn’t just running out to the helicopter with our hair on fire but, according to Merriam-Webster, simply “a specific task with which a person or group is charged.” This is exactly what we do in HAA, and while we have little say over issues prior to the sound of “the tones” or the dispatcher’s phone call, the next step is completely within our control. That’s exactly the step I struggled with as a new HAA pilot. I felt my specific aircraft training was comprehensive and my instructors outstanding, yet there was very little discussion of mission planning for HAA, even though most of us are familiar with the axiom “planning mitigates risk.” What was apparent was that our company hired very experienced pilots who already knew how to plan a mission. But HAA missions differ from what most of us military helicopter pilots have experienced. Most military helicopter pilots fly in a dual-pilot cockpit and have never flown single-pilot. Nor have they been the sole decision maker in planning and operations as they find themselves in HAA. They are also inexperienced in providing their own weather briefings and terrain analysis. And civil HAA lacks the homogeneity and background in training that military crews are accustomed to, which can muddy the judgment and crew resource management acumen of former military pilots. These are huge cultural shifts. In deciding what would work for me in HAA given my military experience, I determined HAA flight planning had to have a framework, be continuous, and be flexible enough to encompass both scene and interfacility flights as well as VFR, IFR, and NVG (night-vision goggles). Adapting Military Planning to Civilian Operations Let the eye-rolling commence when I say that what eventually worked for me was the military mnemonic “METT-TC,” which stands for the following six factors of planning and execution: Mission Enemy Troops Terrain (and weather) Time (and time available) Civilian considerations. METT-TC is used primarily by the US Army as “a framework to aid … in analyzing a situation, prioritizing key aspects, and then planning accordingly to achieve success.” That approach sounded reasonable to me, and I easily adapted it to my newfound air ambulance career. METT-TC facilitates an organized process that makes the complex clearer and fits with another axiom: if one is well prepared, planning is minimal. Whole weeks are devoted in professional military education to understanding and utilizing METT-TC, but without getting too far in the weeds, I’ll condense it for HAA purposes. Mission The mission usually includes a mission statement and commander’s intent for an operation. My HAA director of operations doesn’t want to hear from me for every call, so I boil down this “M” into making sure I have a good command of our GOM (general operations manual), MEL (minimum equipment list), checklists and procedures, and of course, 14 CFR Parts 91 and 135: the basic knowledge my boss expects me to have as a professional aviator before turning the blades on company aircraft. I found that once I had a comprehensive understanding of this step, I was better able to make informed decisions as an HAA pilot. Enemy I haven’t heard of anyone being shot down in HAA, but we still face an enemy. And it’s one of the most dangerous. As the Walt Kelly cartoon character Pogo famously said, “We have met the enemy and he is us.” Remember, a large percentage of helicopter accidents can be attributed to human error. If we view ourselves as the “enemy” and understand that our planning and actions may be the primary cause of our demise or success, we can more adequately address some of the personal and professional challenges we face as aircrew members—and avoid the civilian version of fratricide. Troops Most of us in HAA still wear a uniform, and as pilots, we are responsible for the safe conduct of the flight, including the actions of our flight crews. In essence, our crew is our troop. And as a crew, we must be a well-coordinated, communicative, and participatory team, as our crew resource management training encourages. I’m a huge proponent of incorporating the IMSAFE (illness, medication, stress, alcohol, fatigue, emotion) model into every flight-shift briefing and encouraging crew members to honestly and objectively do the same throughout their time on duty. Our success depends on our well-being, truly having our “head in the game,” and integrating the individual into the team concept. Terrain (and Weather) Among other positions I held in my 33-year military career was that of an aviation mission survivability officer (AMSO). As AMSOs, we held the maxim that every weapon system had a PH (probability of hit) versus a PK (probability of kill), but that terrain and weather most always had a PH and PK of 100% each. IIMC (inadvertent entry into instrument meteorological conditions) and CFIT (controlled flight into terrain) have always been, and continue to be, nemeses of aviation and HAA in particular. We have a plethora of tools at our disposal to combat these threats, and most of us understand that knowledge and continuous monitoring of the topography of our area and changing weather conditions make for a safer flight. The US National Weather Service Helicopter Emergency Medical Services Tool is a great resource, but it’s only a tool and must be combined with a deeper understanding of current observations and specific forecast products to be effective. Map study, planned HOE (highest obstacles en route) between known facilities, use of electronic flight bag resources, a detailed IIMC plan, and forward-looking terrain- and obstacle-avoidance systems can complete our detailed threat-avoidance / threat-mitigation tool kit. These, with many other available inputs, constitute our intelligence. Time (and Time Available) Performance expert Michael Altshuler wrote, “The bad news is time flies. The good news is you’re the pilot.” That couldn’t be truer in our industry. Time is of the essence in what we do, but not taking the time to plan, decide, and act in a safe and legal manner is consistently our undoing. And that’s where lies the central part of the argument to embrace the mission concept. If we allow ourselves the time and effort to plan before the tones ever sound, and have a template for our plan and actions, we increase the chances of making a good decision and conducting a safe flight—or declining a mission request when prudent. It’s up to us. Civilian Considerations Instead of noncombatants on the battlefield, the word “civilians” now refers to the professionals, volunteers, and facilities both integral and peripheral to our decision-making and flights as nonmilitary, HAA professionals. Assessing the emergency services available in our geographic area, their capabilities and limitations, and the level of training we can lend them facilitates a better, safer integration of people and assets in HAA operations. Similarly, maintaining a knowledgeable flight operations or dispatch department and an extensively researched and documented record that details facility information adds more to our planning and execution tool kit. All of this serves to better prepare and support HAA crews in the variety of situations and locations in which we may find ourselves operating. And all these topics can be addressed before we ever put on a flight suit. Preparation over Planning The logistics of the Lewis and Clark Expedition have long stuck with me: preparation is more important to the effort than specific planning. So it is with HAA: continual attention to and improvement of our mission preparations are critical to planning when time is fleeting. That said, there will never be a one-size-fits-all process for, or method of, conducting a flight safely, and mine surely isn’t the only way that can get us to the lofty goal of zero accidents. But a process and a method are necessary in reaching for that goal. By applying a structured approach to planning, staying informed of critical flight issues, and incorporating a template to determine our actions, we significantly increase our opportunities for success—and survival. As Benjamin Franklin cautioned, “If you fail to plan, you are planning to fail.”
