This is a slight detraction from the normal ‘Skids Up’, but it is still very pertinent…
For those that do not know, the Central American region just had a Category 4 Tropical Storm followed by a hurricane within one week. Before the hurricane arrived, we already had more than 2.5 million people displaced due to flooding and landslides which buried entire villages alive.
A local aviation enthusiast and TV company, Guatefly TV, did a special as a thanks to the multiple helicopter crews that volunteered to conduct rescue and humanitarian aid during the first critical days. As part of my interview, I was asked, “What emotions did you have whilst saving all those men, women and children who have lost everything?” I responded honestly and from the center of my heart, and the TV crew were aghast…
This leads me to this edition of ‘Skids Up’: Taming the Beast Within.
That inner beast is EMOTION. Emotion is a good thing, do not get me wrong. It is our emotion that drives us to do the work that we do, but it can also be an overpowering force that leads to BAD DECISIONS. If you are a regular follower of ‘Skids Up’, then you know that bad decisions and helicopters do not mix. Remember the Rule of 3’s? ‘3 seconds following a bad decision.’
There are many research papers available on the ‘influence paths of occupational stress and emotion’, linking the stress First Responders and Rescue Teams all face as part of their daily lives. These can be linked to depression, PTSD, and a plethora of negative outcomes. I am not going to refer to any of those, but I will explain from a personal perspective how I can confidently say, “NONE.” There is an equally simple word: TRAINING.
If we train to the point of our own individual and team failure, we learn and improve for the next time. This training cannot be by PowerPoint alone. It needs to be high stress, high fidelity and as realistic as you can make it. Especially with helicopters, we can ensure that the training area is safe, but the simulation needs to be REAL. Contact a disabled veterans group and ask for some volunteer role playing/simulation casualties. They’ll actually know firsthand how to act when losing a limb, for example. Add moulage and make it realistic and horrible.
The purpose of this is what the military have learnt the hard way: If your training program is difficult, anything else is potentially much easier. This has led to phrases such as ‘train hard – fight easy’ and ‘the more blood you lose in training, the less in combat’ which also apply equally to civilian operations. High stress training as air crews also assists us in developing our BOLDFACE, Normal and Emergency checklists. And as we know, checklists are designed to reduce stress during periods of high cognitive overload. If we ‘train hard and fight easy’, our checklists and procedures become second nature, muscle memory develops, and we can prove that we have the right gear, equipment and bags for our specific mission profile.
As our mission develops, we follow procedures, and DO OUR JOB to the best of our ability. Remember many years ago at the start of our training? As a patient advocate, we do all we can based on our experience, training, and equipment available – EVERYTHING we can. That is why we are called, isn’t it? A higher continuum of care? But don’t forget what is known in the Rescue world as the ‘hierarchy of rescue’:
- The helicopter
- The aircrew
- Everyone else
- The casualty
Without the helicopter, we cannot do our job. Without us as aircrew, the helicopter is a lump of metal. Then everyone else is good and well, and we won’t have any other injuries to deal with. And as far as the casualty? They are NOT GOING ANYWHERE! Make ourselves SAFE FIRST. And part of that safety is being trained to a high level, so that we can assist the casualty we are called for.
So how does this relate back to emotion? Simple. Concentrate on being a highly trained air crew, used to training at an extreme level, and then we can follow well established procedures that involve zero emotional requirement.
Take for example this picture. This is a factory surrounded by 12-foot deep floodwater and approximately 2500 people are surviving on the upper levels. They all need saving. Driving rain, high winds, and a rooftop ‘hover step’ (i.e. the helicopter remains in the hover). As a situation we air crew train for, CRM calls are so fast that there is no time to allow the mind to detract from the situation. Who do you save, and in what order? As quoted by Kevin Costner in the ‘Guardian© ‘, “The most important person to keep alive is yourself. They are looking for a miracle – You have to find a way to be that miracle. I swim the hardest and fastest and take the first I come to.”
After we complete our mission, whether a successful outcome or not, we debrief it and actually micro-analyze everyone’s involvement. Start with a Hot debrief (helps if you record it, though rarely the case), then complete a formal debrief that is MANDATORY. But WHY micro-analyze every action and step taken? From my personal experience, it helps stress, burnout and PTSD, because you are not left second-guessing your actions on any given call. If you got it wrong (we are human after all), you got it wrong, but we learn and evolve from it. That useless medic bag you all moan about on social media? Through training records and debriefs, you now have a physical evidence trail to prove you need something different.
Let’s say during a Mass Casualty Incident, you saved 25, but a child was lost… Was that because of a bad triage system (designed to remove human and emotional content)? Does it need revising? Or was it unpreventable? Remember: there are those that will live, those that will die, and those whose outcome will be determined by the actions we take at that specific moment.
Train your inner beast to perform. ‘Even on our worst day, we have to be the best.’