Skids Up No. 17: Show Me the Money

“This med bag is a piece of junk… We need new flight helmets… Dispatch never told us…”

We all, at some stage in our professional careers, identify faults in a system, procedures that can be updated, and super new shiny kit that we want, no NEED! But we get refused, laughed at, or the ‘put in a request for the next year’s budget’. Not ideal. So, in this edition of ‘Skids Up’, we will look at the most efficient way of getting the gear you need.

Before we start though, a question: What makes Special Forces so special?

Their rigorous standards, top line equipment, or the individuals and team as a whole? Yes, it is all of those and more, but the most important aspect is one that Special Forces Units take extremely seriously. The reason that all the aforementioned happened in the first place. In one simple word:


HdG Chief Pilot, E Barrera: Debriefing external load cargo.

A simple noun that means, according to the dictionary, “a series of questions about a completed mission or undertaking.” This is where Special Forces become special. Routinely, a debrief lasts longer than the briefing and mission/task combined. Why? Because it is a structured process, like everything we do. Not just a ‘high five, job well done’! Why is it structured? So we do not miss anything, and because we are professionals in all aspects of our work. Also, remember for this process to work, we absolutely must practice Just Culture.

“A culture in which front-line operators or other persons are not punished for actions, omissions or decisions taken by them that are commensurate with their experience and training, but in which gross negligence, willful violations and destructive acts are.”

Throughout this blog, I am going to use the term ‘mission’ – I know personally that many organizations are trying to move away from this term due to its connections with military phraseology. But it is my blog, and it’s a noun in the dictionary (“an important assignment carried out for political, religious, or commercial purposes, typically involving travel’). That means, I am using it!

Hot Debrief

These are done whilst you and the helicopter are still ‘hot’. Turbines run down, power is off, rotors stopped = hot debrief.

Me getting a hot debrief from my chief pilot. (And yes, I am hot!)

They are kept quite simple with open questions. For example:

  • “How did that go?”
  • “Any major problems?”
  • If unlucky, “Are you THAT stupid?”

If able, take notes of questions/issues during your flight/mission. These are the main problems encountered with hot debriefs, though: 

  1. Despite good intentions, they are NEVER (or very rarely) recorded.
  2. They are not structured and rely on an individual ‘noticing something’.
  3. They are valuable, but with no auditable recompense, usually lessons learnt are not ‘taken forward’.

Crew Debrief

This leads us to the absolutely crucial debrief process. Yes, I am aware that some countries have various labor laws that make this difficult, but hopefully by the end of this blog, you will understand the value of all of my ramblings! This debrief needs to be:

  • Mandatory
  • Ensure crew have time! (If they’re not interested and want to go home, it’s less likely they’re going to be honest.)
  • Outline mission aim
  • Systematic approach

The most important aspects are to micro-analyze performance. To avoid arguments, take all relevant policies and procedures manuals, so that there are no grey areas. This is what the book says – Period. If the book is wrong, then you are now starting to collate evidence to support the fact that the book is wrong, outdated, etc. It also needs to be recorded (e.g., GoPro, notetaker, voice recorder). The key problem with ‘notetakers’ is:

  • They do not want to do it in the first place.
  • They do not record EVERYTHING.

For example, if I said, “Today I wore a brown jumper, so sorry it was brown.”, the transcriber will naturally write (unintentionally): “Razor wore a brown jumper.” This is incorrect, because it deviates from an individual’s train-of-thought, and it is the process that we as aircrew need to concentrate on: Are we following a procedure and simply making a mistake? Or are we blatantly disregarding our organization’s procedures and ultimately not of the correct mindset to be actually in this job? So how can we use a simple process micro-analyze? There is a process used by Police during interviews for this exact scenario:

Its official name is ‘SE3R’, or ‘Survey, Extract, Read, Review and Respond.’ This is an ‘amended by Razor version’, so it works for you! They can be used for debriefs, briefs, career progression, whatever you need! Pretty much anything when you get the hang of it! Old school, as always, I do these handwritten and then stick them on the wall or white board (Photograph when finished. It is easier to see than being on a computer, plus it’s easier and cheaper to amend with a pen than constantly printing.) On a piece of paper (landscape), draw a line the length of the paper (an ‘event line’), and at the bottom create boxes or ‘bins’ for additional information to be added:

Now on the event line, write each step of whatever you are debriefing. For example and clarity, let’s take for example a simple scenario and a routine landing at your home heliport:

So, on the ‘event line’ we have the pilot (PIC) and medical crew members’ actions. “What did you do?” – This is the cumulative answer you will normally get. As professional aircrew, this is simply not good enough. We train to fail, not just succeed. So even on our worst day, we can be the best patient advocate on our patients worst day.

So, from this simple event line (which as we progress through the debrief process, we can add to easily, because we are ‘old school’ and doing it manually), we move to the ‘information bins.’ For ease, I will concentrate solely on ‘Medic 1’ and what they have said…

From our initial debrief, we know this is what they did:

  1. Call to dispatch.
  2. Go to the bathroom.
  3. Resupply medical equipment.

Now lets ‘micro analyze’:

From each ‘topic’ on our event line, we put these headings down in the information bins and ask EVERYTHING!

So, from 3 simple statements, we identify, or can instantly see, then micro analyze a wealth of information. This is repeated for EVERY PERSON and EVERY STAGE. The following picture is of a whiteboard; 4 feet high and 6 feet long. This is one of 9 boards used for a 9-minute airshow display!

If you grasp the concept, it can be used for career development or anything else! Put your end goal on the right-hand side. Then break down what qualifications and experience you need to achieve that goal. Maybe acquiring your FP-C or CFRN is your end goal. Everything you need is on the event line. The information bins simple detail the courses, etc. you need to do (e.g., when, where, cost, revision, start date, exam dates, addresses – everything that is pertinent to that ‘bin’).

NOW is the secret!! We need the ‘boss/accountant’ to see it! So, our debriefs need to be reviewed. This particular system of mission review was implemented by GSA HEMS and gives both operational and clinical oversight. I didn’t invent this – I just use it because it works!

2 key aims:

  1. Ensure that missions have been undertaken according to relevant procedures and best practice.  
  2. Identify trends in mission conduct that can be used to guide current and future operational practice.

Stage 1 – Post Mission Review

Following a post-mission debrief undertaken by the crew, an initial review of all paperwork is undertaken by operational management – What we have just done by the process of micro-analysis and Just Culture.

Stage 2 – Operational Review Meeting

Conducted once a month, representing both aviation and clinical personnel, review the most recent missions. 

Important note: This meeting is a no-blame, non-judgmental peer review process with the sole aim of improving, self-governance, learning and operational safety.

Stage 3 – Information Dissemination (Lessons Learnt)

Information from operational reviews will be shared with staff through a range of means including:

  • Duty crews being invited to attend and actively participate in review meetings.
  • Minutes of meetings sent to all staff and key personnel. 

So now we have a FULL and COMPLETE debriefing process. It is recorded and auditable. I honestly believe it helps with work-related stress, also. This isn’t proven, but if you micro-analyze your actions, whether you were right or wrong, you don’t go home second-guessing your actions. That aside, we debrief EVERYTHING! If you are of the modern age and conduct high fidelity training utilizing high stress, moulage, wounded warrior programs for realism, then the debrief process is exactly the same!  BUT only if you use exactly the same equipment and gear for training as you do for live operations. ALL first responders need to develop muscle memory – It’s what allows us to find the surgical cric kit at 0300 hours whilst upside down in a snow-filled ditch or find your IO kit whilst in a bumpy helicopter wearing NVG’s. ‘Train hard – Fight Easy’ is a military mantra – It applies to YOU!

HLTH’s ‘Boone Brothers’ conducting high fidelity simulation training.

Ultimately, it allows us as the OPERATOR to justify that super awesome piece of gear we desperately want (sorry, NEED)! When you can justify it, one day they will let you have it!

Debriefing allows us to go shopping and get shiny things we actually need! Or, if you unfortunately do not get it, and you fail your mission, and are not a patient advocate… When the inevitable ‘witch hunt’ starts, we as a team have a fully documented and auditable trail to say, “We told you.”

Debriefs. Start now.

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