Wagging the Dog

By Staff Writer | April 1, 2016
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You might be familiar with “the tail wagging the dog” situations. But the new century has seemed to usher in an emergency medical service (EMS) helicopter era in which an amazing array of miscellaneous business and ancillary elements is assigned strikingly counterproductive priority over legitimately safe flight operations.

My own history with EMS helicopters includes many years of having operated as a small, independently owned set of programs. We owned ourselves and initially staffed a single operational base. We organized the way we did things based largely on my U.S. Coast Guard experience, modified as needed by advice from close friends operating Hermann Life Flight in Houston.

At the time, Hermann also was a small, independent activity. We recognized that two aircraft were required to provide continuous service to a single base. Therefore, we quickly assembled a high-quality maintenance team. Our top priority was to acquire and retain the best possible pilots, who could deliver superior judgment on top of their demonstrated superior skills.


We paid our quality operations and maintenance teams well, so that they could work as comfortably stable employees. We funded their elevated welfare by minimizing our roster of nonproductive personnel. We had no human resources department to support, for instance—and we didn’t need one. Each pilot, as an example of our administrative simplicity, agreed to assume 25% of all operational workload, which was understood as accommodating one-fourth of the regular flight schedule plus all miscellaneous additional duty time for training, maintenance support, etc.

Vacation-pay accounting, as a specific example of our straightforward administration, was nothing more than an annually written secondary bonus check, based on seniority and merit. Any pilot could use these funds to negotiate with his colleagues to cover any time desired above regular, rotational time off.

Everyone was happy, and we generated no “dead” bureaucratic expenses. We served our community for more than 15 years configured this way, transported nearly 10,000 patients and never put a scratch on a person or an aircraft.

Contemporary large organizations present a dramatic contrast. They operate large fleets of staffed aircraft across diverse geographic settings and broadly varied demographic and medical environments. These have developed into true bureaucratic monsters.

Entire departments of “parasite personnel”—tasked with all manner of secondary functions not directly engaged in actual flight/medical operations—have grown inexorably. Many have taken on self-preservation characteristics imitating behavioral phenomena usually found only in branches of federal government.

Even some safety programs have become bureaucratic, more concerned with their own propagation and with perceptions of safety from outside perspectives (exacerbated by too many layers of counterproductive and often distracting computer infrastructure) than with the actual realization of safety itself.

I know of one particular case.

A network of EMS helicopter bases owned and operated by a large company had one of its regular line pilots inadvertently switch off the hydraulic flight control boost in his AStar during a period when the whole network was expediting implementation of standardized night-vision goggle use. The pilot experienced unaccustomed “goggle environment” distraction and consequently made an abnormally provoked mistake in the cockpit, which upset the aircraft calamitously and nearly resulted in a catastrophic accident.

Knowing what happened to this particular pilot would have been extremely valuable to other bases and other crews in the network. But fast, practical lateral channels of communication within the bloated safety programs of the company did not exist. So unfortunately the mishap and what could have been learned from it, were never shared.

The nature of human organizations is such that improvement and growth are inevitably sought. But these are not always synonymous. Organizational growth for its own sake is not necessarily a worthy goal in EMS helicopters, especially when size and complexity do not advance operational safety, allowing the tail to find a particularly unfortunate new way of wagging the dog.


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