Stacy Fiscus, Vision Zero Chair, shares her thoughts on HEMS safety
and challengesbroken_chopper_forweb her fellow crewmembers…
Education.  Awareness. Vigilance.


Humans are not perfect.

I heard recently that, by nature, humans make between two and twelve errors every hour. Some aviation studies in Europe have proven this number to be even higher. Considering this information, it doesn’t necessarily surprise me that we have our current air medical accident rate, nor the rate of line of duty deaths across the public service spectrum. However, in our job as flight crew we often work with at least two other crewmembers at any given time. In almost every EMS job, you have at least one partner. In firefighting, you generally have an entire team looking after each other. Is error really so common that we all can be making the same error at the exact same time? Apparently.

Many of us have headstrong “Type A” personalities. We strive for perfection in our careers when it comes to things like certification. We work hard and study until our eyes want to pop out of our heads just to achieve “alphabet soup status” behind our names. I can remember being 19 years old and studying nearly every day of my life for four months and skipping social events just to be able to sign my charts “Stacy Fiscus, FP-C.” Yet, in my opinion, it seems that as an industry we are not striving for our own individual perfection in self-preservation and safety. I certainly realize that everyone does not fall into this stereotype. I have flown with some of the best and brightest, whom hold flight safety in the highest regard. Yet, they’re still human, leaving them open to make mistakes, right?

One of the big “mysteries” in air medicine is how we can prevent further air medical accidents from happening. The question seems to flair up every time an accident happens. Each time, I’ve heard groups debate the answer, several seemingly good ideas surface. Some believe that more technologically advanced equipment is the answer. Aircraft should be equipped with systems that warn you of upcoming obstacles, or with autopilot that will essentially fly your aircraft for you at altitude. Others say that the type of aircraft matters, that only twin-engine helicopters that are IFR (instrument flight rules) capable should be used for EMS operations. Some say that having data recorders on all aircraft should be mandatory. Data recorders would allow us to study what happened post-accident or incident in order to prevent the same thing from happening again. Another simple fix offered up has been the need for more policies and procedures, and modifications to corporate safety management systems. A newspaper in a town that recently experienced a crash even went so far as to suggest that the industry needs to immediately stop night-time helicopter air ambulance operations. Many of these ideas provide food for thought, and could potentially mitigate some of the risk of air medicine. But, none of them are the “silver bullet.”

The truth is that over 80% of air medical accidents are caused by human error. Eighty percent have certainly not been caused by the type of aircraft that a crew is onboard, or how many engines it has. We are doing this to ourselves. Human error encompasses each crewmember flying on the aircraft, not just the pilot. The silver bullet can be found within each person involved in the operation; from administration to the mechanic, communication specialist, pilot, and the medical crew strapping themselves in (yes, wearing your seatbelt properly is a vital piece towards a safe return) and working together to get themselves home at the end of their shift. Air Medical Resource Management or Crew Resource Management classes commonly teach this. These classes teach us how to work together as a team, and watch each other’s back. However, classes don’t do us much service if we aren’t effectively using what we are taught when we are out in the field.

Wear your seatbelt properly on every single flight.

Wear your helmet properly with the chinstrap secured and the visor down on every single flight.

Keep your eyes out and watch for obstacles on every single flight.

Fly with your mind free and clear, and stay back when it isn’t, on every single flight.

Let your partners know when you see them not doing these things, or doing anything unsafe, on every single flight.

Last but not least, for the love of all that is holy, SPEAK UP when you feel ill at ease. Do this on every single flight where you feel uncomfortable. I cannot stress this enough.

Though they are not here to tell us this, I would venture to guess at least one crewmember involved in the majority of fatal accidents caused by human error probably felt uneasy at some point during their last flight. Speaking up to your peers is a hard thing to do. It takes courage for the most seasoned flight crewmembers, let alone when you are the ‘new guy.’ When I was new, I was afraid to be the “talk of the base” if I were to ruffle a few feathers and abort a flight. I was taught all of the appropriate ways to voice my concern in my flight academy, and never felt any pressure to complete a flight. Yet, I put pressure on myself to not be ‘the one’ who said I wanted to turn around. Though I still hear about perceived pressure in the industry, we often bring the pressure upon ourselves. Over time, I learned that there will always be someone or something to talk about at the base the next day; and if I was the subject, everyone would forget about it within 24 hours. No big deal.

Nowadays, anyone I fly with will tell you I’m the first to point at their visor or grab and adjust their belts for them. I’m the first to point out some weather I see and don’t like, giving respect to my pilots and their knowledge of course. Sometimes, I just like and need to hear the reasoning behind a certain decision and why that decision is okay.. Often, this is all it takes to turn my uncomfortable feeling into a comfortable one. Leading by example is one of the easiest and most effective ways to enforce proper flight safety habits. I’ve found that without saying a word and just utilizing my equipment properly, others will follow. If pilots give an effective morning brief and set their expectations for the day, the crew will respect them and follow their lead. These simple habits have saved lives in this industry.  Some would not be alive today had they had skipped even one of these things before they lifted the ground. We have nearly 700 incident and accident survivors in our industry to prove it. Are we listening to them?

Lastly, don’t ever think that the worst can’t happen to you. Everybody is “accident free”…until they aren’t. This job is amazing and wonderful. Most say it is the best job they have ever had and all they can imagine themselves doing. I know that is true for me. We love this job, and sometimes we love it to death. As an industry, we are being complacent and not respecting the fact that this job we love can bite us back. To be frank, complacency is for losers. Complacency can kill you. Treat the helicopter with the same respect you treat your certification tests. Strive to be the best. I get into my aircraft with confidence, knowing that I will do the best I can to ensure we all make it back home safely at the end of the day. Can you say you are doing everything possible to create a positive outcome of your flight? If not, change your behavior…or your profession.

Those that we have lost, as well as their family members, inspire me. Those that have survived and share their stories motivate me to continue to learn. Their lives and their work cannot be in vain. We have a responsibility to our crews, our families, and ourselves to do better. I want to see more positive articles about helicopter air ambulance crews than negative ones. Most of all, I want to see the numbers change. Hold yourself and your peers accountable, and do the right thing.

Like Ghandi says, “Be the change you wish to see in the world.” It starts with you.

stacy_profile1Stacy Fiscus is the Vision Zero Chair for the Association of Air Medical Services, as well as the Chief Flight Paramedic for Haiti Air Ambulance based in Port Au Prince, Haiti. Stacy is also active as a Board Member at Large for the International Association of Flight and Critical Care Paramedics, and is the project manager for Protean LLC’s website, She sits on the AAMS Joint Safety Council and Communications & Public Relations Committee, and contributes to EMS Flight Crew daily on Facebook. Stacy resides in Huntingtown, Maryland on her time off from Haiti Air Ambulance.