Clinicians in an Aviation Environment: Safety, Teamwork, and Professionalism
By Henry Frank
It’s the people who make an organization great, and LifeFlight of Maine is no exception.
There are more than 120 of us on the LifeFlight team. All of us are used to getting A’s, we are unaccustomed to failure, we rarely meet a challenge we can’t surmount, and our personal commitment to high achievement is coded into our DNA. This dedication to excellence is reinforced and encouraged every day when we come to work, not for the sake of individual recognition, but for our colleagues, for our patients, and for Maine.
Our mission is highly specialized and interdisciplinary. We have pilots who used to fly military aircraft now transporting civilians to lifesaving medical care. We have critical care clinicians who now practice medicine thousands of feet in the air. We adapt our skills and develop new ones, so that when someone in Maine is facing a critical injury or illness, we can provide them with the fastest, safest, most advanced medical care and transport available.
“Most of us on the clinical side have no aviation background,” said Veronica Marzonie, one of our flight nurses and also the clinical leader of our internal Safety Committee. The committee is comprised of individuals who represent various roles within the organization. It regularly reviews and reinforces our safety training — especially for the medical crew — and constantly looks for ways to enhance the safety of our operations.
“The Federal Aviation Administration (FAA) does not recognize medical personnel as ‘crew members,’” said Pete Cartmell, a retired US Army helicopter pilot and LifeFlight’s Director of Operations for aviation. “However, internally, we do treat them as a crew member. We want them to be part of the aviation decision making process. We solicit their input. We want to train them up to at least a minimum standard for performance in and around the aircraft that far exceeds what would be required by the FAA for a ‘passenger.’”
Our medical crew members receive extensive safety training during their months-long orientation when they join our team. The purpose is to make them comfortable in and around the aircraft, to educate them on both FAA and LifeFlight safety protocols, and to train them to enhance the safety of our aviation operation.
“This is a single-pilot IFR program,” Pete explained. “As a pilot, you are expected to be able to accomplish all of the aviation tasks by yourself.” When a patient is on board, the medical crew is in the back of the aircraft, fully focused on caring for that person. When the pilot lands and the medical crew enters the hospital to transfer their patient, the pilot may reposition the aircraft to clear the helipad or refuel nearby.
But on the legs of each transport without a patient on board, our clinicians have a role to play in aviation. “The most helpful thing that the medical crew members offer us is another set of eyes. It’s another line of safety,” Pete said. “You leverage the people you have on board to enhance safety for your operation.” Since our helicopters are operated by a single pilot, a clinical crew member will typically sit in the front of the aircraft with the pilot on a flight leg without a patient on board.
Our clinical colleagues go through extensive safety training during orientation, and additionally participate in annual safety days and online instruction. “The general idea is all about bringing folks with medical experience into this environment,” said Veronica. “When I’m prepping a medication, my partner double checks me. The same principle applies here.”
For example, our medical crew members are trained to use night vision goggles to provide that extra set of eyes at night. They are trained for unforeseen circumstances and how to mitigate risk. They are trained to maintain situational awareness. Most importantly, they are trained to speak up.
We have a mantra on our team: “Three to go, one to say ‘no.’” On a typical helicopter transport, our crew consists of three people: a pilot, a nurse, and a paramedic. For a mission to proceed, everyone needs to be on the same page. If someone has concerns, they are expected to speak up, and if we cannot sufficiently address the concern or question, we transport the patient by ground instead.
“We will solicit input from the medical crew,” said Pete. “I have had experienced crew members say, ‘I’m not comfortable with that. I think we should go by ground.’ We also do that in flight. I’ve encountered weather in flight that I was comfortable with, but a crew member said they weren’t. As the pilot, I explained my reasoning and in some cases we all agreed to proceed. In other cases, the medical crew reached the patient by ground.”
“Situational awareness is developed over time,” Pete continued. “We try right from the beginning to stress the importance that they are on board the aircraft and lives are at stake. They have a voice. We encourage them to speak up and be part of the decision-making process.”
“Coming into this industry, knowing that I wanted to do this type of job, I realized that the more knowledge I could gain, the more I brought to the table,” said Veronica. “I’m passionate about the fact that we can design systems that reduce the risks involved in what we do.”
We do everything we can to be there for our patients, when and where they need us. We have invested heavily in technology and training to make LifeFlight as safe and reliable as possible. Our team is deeply committed to these efforts. In the end, our patients are relying on us to get them the care they need, and we are relying on one another to do so safely. We strive to be worthy of the trust placed in us by our patients and their families in their hour of need, and we work tirelessly to be the best at what we do for the sake of our team and for the people of Maine.
Henry Frank is the Director of Communications for LifeFlight of Maine and The LifeFlight Foundation. He joined the organization in February 2023 and is humbled daily by the expertise, professionalism, and dedication of his colleagues to the mission and to the people of Maine.
