Pilots by their nature are largely optimistic and dedicated to completing the mission, a trait that seems to be stronger in those who fly helicopter EMS. The reluctance to turn down a flight when a patient's life is potentially at stake, even when low clouds are moving in, and/or the temperature/dew point spread is narrowing, is understandable, even emotionally laudable. Life-savers are heroes after all. It is their job to fly into uncertain, dark skies.


By doing so they needlessly put their lives, the lives of their crew — and patients — at risk. So far this year we've seen more than a half-dozen of these scenarios end in tears. Numerous studies have shown that helicopter pilots, even those with instrument ratings, tend to lose aircraft control within less than a minute of encountering inadvertent instrument meteorological conditions (IMC).

Like many aviation accidents, most of these have failure chains. It all begins with the pilot's decision to launch into marginal visual flight rule (MVFR) conditions — forward visibility of only 3-5 miles and ceilings of 1,000 to 3,000 feet. Most always, MVFR leads to IMC just as certain as day fades into darkness. Add night skies, near-freezing temperatures and a rapidly shrinking temperature-dew point spread (when the numbers match you get fog), and you have the perfect storm — conditions that challenge the skills of even the most experienced pilot.

It occurs astonishingly fast, even in seemingly good weather. As a newly-minted pilot, I remember taking off from Chicago Meigs field on what appeared to be a bright sunny day and banking off toward the Michigan shore into what I thought was straight and level flight. In the haze, Lake Michigan's emerald water faded into blue skies destroying the natural horizon and imposing inner-ear trickery. Within minutes I came perilously close to rolling inverted and losing control of the airplane. It can happen to anyone.

The solution is not to launch into MVFR unless you are filed IFR, have the proper equipment and are current. If you are flying for a VFR-only operation, and many helicopter EMS programs are, this means you do not go. Period. Even if that means the patient dies.

More and more helicopter EMS operations require the concurrence of the pilot(s) and flight paramedics to make go/no-go decisions. Some also require approval of their dispatch or ops centers. The policy needs to be consistent across all individuals and organizations. And the behavior needs to be reinforced with frequent pilot simulator training that includes IMC avoidance in addition to recovery procedures for inadvertent IMC encounters. The larger helicopter EMS providers are doing this now and the rest of the industry should follow suit.