Getting the Message Safely

Dispatch: “79-11, respond Code 3 to 100 Nothing-Could-Go-Wrong Drive for a cardiac problem. Further information and cross street will be sent to your pager.”

79-11: “Responding to the address and standing by for further information.”

We’ve all been there: way too little information. How many patients? What age? What gender? What the heck are they calling a “cardiac problem”? Chest pain or a full arrest? Maybe a knife in the chest causing chest pain?

Fortunately we are familiar with the neighborhood and know that street on the west side of town. Of course we are on the other side. It’s 4 p.m., so the after-work traffic is beginning to swell. After only about three blocks, we get the tone signaling we have a message.

How we manage the next few moments is huge!

How is this situation handled in the aviation industry? It’s a critical phase, responding Code 3, and we have an interruption. In this situation you would be surprised how little difference there is between two people in the front of an ambulance responding and two people in the front of an airplane flying.

If you both look at the message you’ve received, nobody is driving. In an airliner, regardless of size, it’s the same.

One person is to fly the plane, called the pilot flying (PF), and the other is the pilot monitoring (PM). It’s black and white. There is no gray. One person is flying the plane at all times. Every moment. Let’s say we are taxiing out from the gate, headed to the runway. A tone goes off in the cockpit, and there’s a message. What do we do?

If we are in the middle of a checklist, such as the before-takeoff checklist (a really important checklist), we ignore the interruption until we’ve completed the checklist. Likewise in an ambulance, there are times when you should ignore the interruption! Interruptions in the middle of a checklist are known killers in aviation. If it’s an interruption by a radio call from the tower, we likely will answer the tower and then start the before-takeoff checklist all over again. We do not just pick up where we think we left off. That also has proven not to work—proven the hard way. There are times we tell the tower to stand by, as what we are doing is even more critical.

Heads Down

When the situation permits, the PM will say, “I’m heads down.” This could be while taxiing, during takeoff or on final approach. It could even be at cruise altitude, where the workload is much lighter. “I’m heads down” is a standard phrase to communicate that mean “I’m not monitoring the PF, and I’m not looking out the window for traffic; I’m going to retrieve the message or update the flight management computer (FMC).” Just like the communication gear in the ambulance, the FMC can really help you or cause you real headaches.

It’s easy to make a wrong turn at an airport while taxiing in or out from the gate. I’d suspect that at any large airport, it’s a daily occurrence for a plane to stop and ask for confirmation of its taxi route. Have you ever made a wrong turn in an ambulance? I certainly have.

When we taxi or fly and there is a message, it is common practice when conditions permit for only one person to read and evaluate the message. When the person flying (or driving the ambulance) is ready to listen, I can brief them on the message.

As we respond Code 3, how do we handle a computer message? If conditions permit, you would announce, “I’m heads down” and review the message, brief your driving partner and issue any required responses (e.g., “page received”) by text or radio. You would then say, “I’m back with you.”

The “back with you” tells your partner you’re done with the message and fully back into the call. It’s just as important as the first call.

Eyes Up

Here’s a case where I would ignore the dispatcher’s message and not call “I’m heads down”: We are approaching an intersection, and traffic is heavy. We are using lights and siren. The traffic light is red. Everyone needs to have their eyes outside—no extraneous conversation, focused on following the rules of traffic to the letter. Intersections are hot spots for collisions. We are all aware of that.

Your driving partner has the right to counter your “heads down” statement by just saying, “No, I need you with me,” or perhaps, “I need you looking outside for a minute.”

Ask any airline pilot if they use the phrase “I’m heads down,” and they will likely respond with “all the time!” Talk to your partner before the start of your next shift and discuss this topic. It’s a Crew Resource Management thing, but just a tiny part of it.

Captain Dick Blanchet (ret.), BS, MBA, has worked as a paramedic for Abbott EMS in St. Louis, MO, and Illinois for more than 20 years. He is also an airline captain on a Boeing 747 with more than 17,000 flight hours. As a USAF pilot, he flew the C-9 Nightingale Aeromedical aircraft for 5 years.