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influence the safe conduct of air-medical oper- ations. Even so, it is still important to attempt to understand what may have


between a pilot’s ears as he and all on board approached the point of impact with the terrain.


TOLERANCE OF RISK One issue that has to be addressed is the


individual level of risk tolerance possessed by both pilots and medical crewmembers. In the presence of time pressures, organizational pres- sures, and a high level of personal motivation, how much risk can, or should, a crew accept? There are no risk-free air medical flights.


That is a reality that all accept. A crewmember’s level of risk tolerance is conditioned largely by his individual personality and by his previous expe- riences. The majority of rotor-wing pilots in air- medical transport received their initial training and gained their early experience as pilots in the mil- itary. In that


environment a pilot’s perceived


worth, as well as his next promotion, depended to some degree on his readiness to accomplish the mission, or die trying. We don’t need to argue the appropriateness of that philosophy in the arena of


been going on


national defense, but none would find it accept- able for the air medical transport industry. There are probably very few pilots, if any,


in the industry who would admit to regularly and intentionally ‘pushing the envelope’ to complete a patient transport. Still, 6 or 8 (or 28) years of


accepting high levels of risk will have an effect on a person’s decision making, unless it is active- ly mitigated by more proximate influences. That is why clear policies and strong statements from management, like the one cited above, are so important for every flight program.


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