If you are at Heli-Expo Feb. 25-27 in Anaheim, Calif., check out Paul Ratté's safety presentation Feb. 26. Ratté is the resident safety guru — aka "director of aviation safety programs" — for aircraft insurer USAIG. He is also a helicopter pilot and the former commanding officer at U.S. Coast Guard Air Station Atlantic City.

During his 26-year USCG career, Ratté flew missions in Alaska, the Atlantic, Gulf Coast and Great Lakes, won two Distinguished Flying Crosses for extraordinary rescues, served as an aviation training center standardization pilot and led National Capital Region air-intercept operations.

In the presentation Responders Are Different: Managing Responder Risks, Ratté plans to discuss the special risks inherent with flying for an on-call operation such as HEMS, risk mapping and management, and balancing the needs for crew autonomy.

I won't spoil the fun with all the specifics here, but I did catch up with Ratté last week between blizzards for a lively discussion about striking a balance between risk and reward on HEMS missions. He made a central point for establishing and maintaining a good risk management system: You need to balance crew autonomy with decision support from the organization.

"You don't want to create a culture where people are risk-avoiders, you want measured risk-takers. You don't just have the operational challenge of flying the mission, you have the secondary requirement to manage information quickly and knowing the capabilities of your personnel," Ratté said.

And that means creating "layers of defense that expand or contract as needed, that can expand quickly and involve other people as the situation becomes more complex."

Ratté gave two examples: Procedure calls for only landing in a predefined zone or when a ground unit is already present.

"What happens when you beat the ground unit to the scene or when a patient can’t be extricated to the predefined LZ?" he said. "Now you have to land in an unexpected area and without a ground unit. Is this strictly a pilot decision, or do you get a review from a dispatcher or the director of operations? Do you decide to step back?

"Take another example — an Alzheimer's patient wanders away from a care facility, and the local police ask for your help. But your flight crew is not trained for search and rescue and unfamiliar with the local terrain."

Ratté says the key to getting the right people in on these decisions is moving the information to them fast enough to classify the category of risk — low, medium or high. When it's high risk, "sometimes you have to say no or even stop an operation in progress. In these situations, pilots need to understand that they are not being second-guessed; rather, there is a process standing behind them designed to keep them and their crews safe."