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Under pressure: the self-induced stress of a HEMS pilot

by Captain Owen McTeggart BALPA Member and HEMS Pilot

I’ve been a HEMS pilot based in Cumbria for the past seven years, and each day comes with its own set of challenges. Contrary to what you might think, we experience a quieter time during the winter, as most of the 15 million annual visitors to the Lake District come during the summer months. Throughout this period, we’re dealing with novice walkers, climbers, paragliders and others who sometimes find themselves in remote locations needing urgent medical help.

While our general work is slightly different to that of a commercial airline pilot, our training is equally as intensive and diverse. For example, all our pilots are trained/tested IFR, as per commercial pilots, but most HEMS pilots will have previous mountain flying experience of how to navigate and land in such terrain. But, being charity funded, we don’t get as much training in this environment as we would like.

We also experience some issues in common with those in commercial aviation, such as fatigue. However, one specific issue that crops up is the self-induced pressure we can put ourselves under. Knowing that the choices we make can be the difference between life and death brings with it an enormous weight of responsibility. The general awareness of this pressure within our community is very good. There is no point rushing to the aircraft without taking into account our own safety, the weather, the best route, how close we can get and how serious the injury is.

We discuss this as a crew and make a plan. If there is a serious injury in a difficult location, we may accept increased risk while maintaining the safety of the crew, aircraft and other users of the fells. However, if the injury is not an immediate threat to life, we will offload some risk by landing further away, with the doctor and paramedic walking to the patient.

Risk factors

We are also aware of how certain factors can play a part in our involvement in the job. We have a good CRM programme in place that means should any crew member believe that the task doesn’t justify the risk, the task will be discontinued. For example, the doctor has a greater understanding of the medical reasons for the task and is best placed to advise whether or not the sortie is worth the increased risk of a low-flying HEMS mission in strong winds.

Self-induced pressure can come from all the crew, but for different reasons. For example, if a crew member has a young family and the task is to a child, the perception of risk versus need can be skewed by the thought of “what if it was my child?”. This is where CAA/EASA regulations come in, to protect us from ourselves.

Commercial aviation comes with commercial pressures to complete the sortie, HEMS comes with emotional pressures to get the job done. Good CRM training and self/crew discipline stops us taking undue risk for those heart-string pulling tasks. There are countless anecdotal tails of HEMS crews busting a gut to get to that life or death task, only for the patient to walk to the aircraft with an overnight bag packed. Being part of a HEMS operation brings other stresses as well, such as the fact that we’re charity-based and, therefore, there isn’t always operational joined up thinking between neighbouring charities, or NHS trusts and the local Air Ambulance charity. But this is constantly being worked on, so the most appropriate aircraft is sent to the task, even if it is in the neighbouring charity’s or NHS trust’s area.

We share some other dangers with the commercial aviation sector, too – drones and lasers have become an increasing risk. The last thing we need is a laser attack on the way to the hospital. Add this to the long-standing mid-air collision risks with general aviation aircraft, and some days can bring with them a lot of different stressful factors. I have a growing concern over the lengthy and difficult process of reporting, and wonder if AIRPROX figures and such are lower than we see in reality, as a result.

However, being a HEMS pilot can be incredibly rewarding. The self-induced stress does reduce with time and experience, but it’s important we maintain good CRM and continue to evaluate each situation as it arises.