title: Role of pilot instrument proficiency in the safety of helicopter emergency medical services.
abstract: OBJECTIVE
  To determine whether instrument-proficient pilots would more safely manage a flight into unplanned instrument meteorologic conditions (IMC) than would nonproficient pilots.
  
  
  METHODS
  A controlled experimental study was performed using a full-motion helicopter simulator. Participants were emergency medical services (EMS) pilots with commercial licenses and previous simulator experience who were blinded to the study design and hypothesis. During a simulated EMS mission, cloud ceiling and visibility were decreased until IMC prevailed, and pilot actions were recorded. Data included the altitude at which the aircraft entered IMC, and whether the pilots maintained control of the aircraft, flew within aviation standards (i.e., bank angle, airspeed), and safely landed.
  
  
  RESULTS
  Twenty-eight pilots (13 instrument-proficient, 15 nonproficient) participated; they had a median of 6,300 hours of helicopter experience. Two pilots crashed, both from the nonproficient group. The instrument-proficient pilots lost control less often (15% vs 67%, p < 0.05), maintained instrument standards more often (77% vs 40%, p < 0.05), and entered IMC at a higher altitude (689 feet vs 517 feet, p < 0.05) compared with the nonproficient pilots. Instructor comments indicated that the nonproficient pilots made more errors than did the instrument-proficient pilots.
  
  
  CONCLUSIONS
  Instrument-proficient pilots more safely manage an unexpected encounter with IMC. Helicopter EMS programs should strongly consider maintaining instrument proficiency to enhance safety.
authors.affiliation: Pennsylvania State University College of Medicine, Milton S. Hershey Medical Center, Center for Emergency Medical Services, Hershey 17033-0850, USA. rwuerz@nursing.hmc.psu.edu
authors.forename: R C
authors.initials: RC
authors.lastname: Wuerz
authors.forename: R
authors.initials: R
authors.lastname: O'Neal
mesh_terms: D000060:Accidents, Aviation / Q000517:prevention & control*; D017732:Air Ambulances / Q000592:standards*; D000401:Aircraft / Q000295:instrumentation*; D003198:Computer Simulation; D016001:Confidence Intervals; D006801:Humans; D007318:Inservice Training; D011361:Professional Competence; D017751:Safety Management; D018561:Space Simulation / Q000295:instrumentation; D014187:Transportation of Patients / Q000379:methods / Q000592:standards*; D014481:United States