10 Lessons I Learnt the Hard Way From 7 Years as a HEMS Pilot

After 7 years of being a HEMS pilot, I can safely say I’ve made more mistakes and errors than I can count.

Some were small and forgettable. Others? They really stuck with me 🚨

They taught me lessons the hard way – through stress, hindsight, debriefings, and moments where I realised just how much I didn’t know (and still don’t!).

Over the years, I’ve kept a pilot decision journal, where I reflect on the good AND the bad 💭

I’ve noticed that most of the ‘bad’ can be summarised in 10 main lessons that I’ve learnt the hard way.

Not from textbooks, not from line training courses, not from flight school, but from doing the job and making mistakes along the way.

So here they are: my 10 biggest lessons from my most notable mistakes throughout 7 years as a HEMS pilot ✅

I’d love to know: which of these lessons resonate with you? What would you add to the list?

We don’t publish all our Notes from the Cockpit (like this one) publicly, some are shared only by email. Get the next one sent straight to your inbox ⤵️

1) Your Worst Flight Could Come Out of Nowhere

Pilots are very used to routine. Routines are good, SOP’s are there for a reason, but what if routines or SOP’s don’t quite fit or get broken up? Well, that’s where I’ve learnt a lot…

I’ve had flights that are going exactly as planned, and then something happens that you simply could not plan for.

From drones during the approach, to a group of children running into the reject area, or weather that wasn’t forecast and that fuel site you planned for happens to just be broken without a NOTAM.

Normally you can just deal with these threats by isolating them, and managing them. When things are getting stacked against you and your crew though, it can quickly ramp up to be a more complicated picture and potentially create one of your worst days as a pilot.

It probably won’t be one specific thing that’ll catch you out, it’ll be a combination of factors that all merge together into an ugly monster trying to ruin your career (or life).

The problem is of course: you never know when that day will come! It could be today, tomorrow, or in five years. For me personally, I just remind myself every day that today could be that day, and force myself to be as vigilant as possible.

The moment I stop this mindset is the moment my next flight will make me regret it.

We discussed how to stay vigilant throughout your career here:

Defensive Flying 101: Are you Vigilant or Complacent?

2) Weather can be Your Biggest Enemy, if You Let it

Bad weather does not crash helicopters – bad decisions in bad weather do. All pretty basic stuff, and not an issue if we can predict what the weather will be at time X and place Y.

The problem is, we’re not flying to airports, and even if we were, a weather forecast is nothing more than just that, a forecast – not a crystal ball.

Weather can be so unpredictable, especially if you fly in areas that aren’t covered by TAFs or METARs.

Unfortunately you’re often dealing with guesswork and gut feelings!

Local effects, wind patterns, sudden valley fog, downdrafts, local temperature drops. Each of these can seriously bite you in the ass if you don’t detect them in time and properly understand what is going on.

Even more of an issue if the data you use is incorrect!

“The FMS says we’re into wind”

“Yes, but that flag below us shows we’re definitely not!”

Things like downwind approaches are often caused by a mismatch between your mental model and reality, as we discussed here:

The Downwind Approach: A Silent Killer

Annoyingly, some of these weather effects come down to local knowledge and have nothing to do with how well you interpret a TAF . I’ve had flights where we said to each-other ‘there is no way we can make that’ and it turned out we could’ve, and vice versa.

If there’s any doubt – there’s no doubt. Experience makes this easier (the doubt part), but never fool proof!

3) Fatigue Creeps up on You

From dreaming about butterflies and rainbows, to taking off on Night Vision Goggles (NVG), flying an NVG take-off, crossing active Gatwick ILS traffic, while getting ready for the approach checks for your landing site, all in about 20 minutes.

It’s a recipe for fatigue-related threats. Yet, that is a pretty standard HEMS night!

We’ve gone into this and how to manage it in this article:

How to Manage Fatigue and Survive Nightshifts

I’ve lost count of the amount of times my First Officer and I had to correct each other’s actions after a long night.

It’s those moments that make me so happy to be involved in a multi-pilot environment: you have each other’s backs when you both need it.

Us humans are pretty bad at assessing how fatigued we are. It’s like asking a drunk person to accurately state their blood alcohol level 🤷🏽

Fatigue can be masked by adrenaline flowing through your system while you transitioning between different phases of flight, but once that wears off it becomes a lot more noticeable.

This doesn’t just apply to flying at night, long flights during the day also require awareness on fatigue levels of both yourself and your crew members, not to mention timezones for the long haul pilots here.

4) The Landing Site Has More Threats than the Rest of the Flight Combined

Taking off from an airport and cruising along to the overhead combined, have less risk than the approach phase. Don’t just take my word for it, have a look at the EASA data on this, which consistently shows the approach phase and HEMS to have the most risk:

Highlights of the 2024 Helicopter Accident Data | The Why Spotlight #1

Think about all the types of threats that already present risk in general, that either become way more relevant, or have more serious consequences during an approach:

🔸 Drones

🔸 Being downwind

🔸 Wires

🔸 Unlit obstacles

🔸 People (especially the crazy ones)

🔸 Animals

🔸 Kites / Cranes / Masts

The list goes on…

Here are 8 that we’ve covered in more detail:

Don’t Let These 8 Helicopter Landing Site Threats Surprise You

This is where normalisation of risk comes in. We’ve all seen videos of pilots trying to land in fields that look absolutely ridiculous. Too small or just unsuitable.

This is often not just an “oopsie”: it’s normalisation of risk. We’re all susceptible to this, as the job becomes more “routine” and “normal”.

In HEMS (especially night HEMS), you’re operating in one of the highest risk profiles in the entire aviation industry. The moment you stop respecting that, is the moment you invite risk to turn into trouble.

Fly another orbit, mention that threat that wasn’t picked up by your captain or first officer. Don’t let the fact you did the exact same thing yesterday get in the way of your vigilance levels.

5) Emotional Intelligence Matters Way More than You Think

Both pilots and management have a tendency to think that being a good pilot means:

🔸 Flying a great ILS approach

🔸 Flying on the numbers

🔸 Knowing everything there is the know about the aircraft

🔸 Any other technical skill imaginable

But the longer I am in this job, the more I realise that me and the rest of the crew would rather fly with someone with great emotional intelligence that’s a little rusty on the controls, than a complete *#=[#] who sucks the life out of everyone “but hey he can fly the best ILS you’ve ever seen 😃”

We’ve covered this here:

What is Emotional Intelligence, and Why is it Crucial for Pilots?

Emotional intelligence, being a great team member, interpersonal skills, non-technical skills, it all comes down to being great to work with.

Being able to work with all sorts of individuals is a skill that is so underestimated. There is not a single hour in flight school that’s spent on this.

This has created many situations that I’ve seen first hand where otherwise “great” pilots are just not successful, because they don’t understand how other people work and think.

The cheapest and most effective investment you can go for is to improve your emotional intelligence, it will pay you back massively throughout your career!

6) Life is Nuanced, and So is Aviation

Safe vs unsafe, good vs bad, acceptable vs unacceptable: my personal / natural way of looking at things can be quite black and white.

Not as effective or helpful as I thought when I entered the industry!

People, life, and aviation are nuanced and usually complex, trying to fit it all into two brackets didn’t get me very far – because it doesn’t work.

Here’s an example: most HEMS operation manuals state “weigh off the medical risk of the patient against the aviation risk you’re willing to accept”

That essentially means that getting close to your own personal (and legal) limits should only really be acceptable for a patient that desperately needs medical help.

This is in contrast to many (one of which used to be me) who say: no, it’s either safe or it’s not safe – end of story.

The thing is, this doesn’t mean I’m going to break the rules or my personal limits for any mission. It just means I am willing to get closer to them (and accept additional risk) if the situation can benefit from it.

I used to look at this with a bit of a judgmental attitude, but over time I’ve started to see how accepting additional risk, if there is enough benefit is actually just a professional way to deal with risk tolerance.

7) Your Aircraft Will Eventually let you Down

After weeks, months, and years of no engine failure, you might take that TDP or LDP (or V1 for our fixed wing friends) less seriously than someone who has had to deal with it in the heat of the moment.

I’ve had a few moments where I’ve been reminded that no matter how great your engineering department is, the aircraft will eventually let you down when you desperately need it not to.

Loading in a code red patient, starting up, with hundreds of people watching in the middle of London, and then having to shutdown to call engineering, is probably one of my least favourite moments as a HEMS pilot.

Sure, we’re all safe and on the ground, but the mission has a pretty big red cross in my head now, great! ❌

You sometimes run the risk of running on autopilot if you’re at the end of a busy day. When things go wrong when you least expect them to, it sets you up for a game of catch-up.

It took me a few times of getting burned like this to now have it in the back of my mind it all times.

I remember having an attitude heading reference system (AHRS) failure while on approach to a hospital helipad in London, with a patient that was not doing well at all. Do you continue knowing that you will block a helipad for days (because the MEL limits you from taking off) and save the patient, or not?

Having the “what if X happens here” in the back of your head at all times might sound a little neurotic to some, but I think it ‘s just a byproduct of a healthy dose of vigilance that I’ve had to train myself to get to over time.

Not just about engine failures: any system, process, or assumption can be broken down this way and has saved me many times from a whole lot of trouble.

8) You Can’t Please Everyone, and you Shouldn’t Try

In HEMS, there’s pressure from pretty much every angle: dispatch, medics, hospital staff, even your own flight crew. Everyone wants the mission to go, and when you’re the captain, it’s easy to fall into the trap of trying to make everyone happy.

We’ve discussed this here:

Let’s Talk About Commercial Pressure in Aviation

I’ve definitely stepped into this trap in the past, and overthought decisions not because they weren’t safe, but because I didn’t want to let people down.

The turning point came when I realised this: every time you say “yes” to please someone, you’re gambling with the one thing you’re responsible for: safety.

You’re not hired to be agreeable. You’re hired to make the right call, even when it disappoints someone, whether that’s your boss or your crew members.

It took time for me to accept that a respected pilot won’t always be popular. Sometimes you’ll be the bad guy who cancels the flight, diverts, or delays the mission – and that’s okay.

In fact, it’s essential.

My job isn’t to please everyone – it’s to protect everyone from my own monkey brain – and theirs. Even if they don’t thank me for it in the moment.

9) Trust – but Verify

You can’t have an aviation industry without trust. You trust your crew, your maintenance team, your dispatchers, your medics.

Most of the time, that trust is completely reasonable and earned. But over the years, I’ve learnt a critical addition: trust – but verify.

I once launched on a time-critical flight based on a verbal weather update, that turned out to be… optimistic. I trusted the source – a great person, a great pilot, experienced, with no reason to doubt them.

But I didn’t double-check. Halfway into the flight, the weather turned ugly. We made it back safely after I decided to abort, but it was a wake-up call after checking the amended TAF back at base.

I’ve also had a situation where my first officer had already told our medical crew we could accept the tasking, when I hadn’t looked at the situation yet upon waking up. I ended up putting my foot down and told everyone I wasn’t comfortable with how things were looking.

If I had blindly trusted my crew member, it would not have been a safe flight.

I can remember many other occasions where the verification of the trust I already had in someone would’ve been hugely beneficial.

It’s not about mistrusting people. It’s about protecting your crew, by double-checking the things that matter.

Fuel figures, weather, patient weights, NOTAMs, grid references, you name it. A second look often takes a few seconds and can save you hours of trouble or worse.

This goes both ways of course. I fully expect any professional pilot to verify my position on things as well.

When something goes wrong, saying “but they told me it was fine” won’t mean much in a court of law.

So yes – build trust, and then verify.

10) The Job Changes You

I used to fly with an exceptionally experienced (and now retired) HEMS pilot. Anytime he saw people panicking or getting worked up, he’d walk in and jokingly ask:

“Is anyone dying, is anyone pregnant? If not – let’s all calm down.”

You start this job thinking it’s all about skill; airmanship, decision-making, precision. In some ways it is. What they don’t tell you beforehand though, is that HEMS changes you – slowly and quietly.

You see people on the worst day of their lives. You land in places no one else would go. You see things you can’t un-see. Some of it stays with you, but also a lot of stuff bothers you less and less as you grow more experienced.

Sometimes members of the public ask us how we stay clearheaded when you constantly see people during the worst times of their lives. But for me, it’s almost scary how easy that is now.

You do what you can, and what you can’t – you can’t.

At first, you think you’re just doing your job. But after a while, you notice how differently you think. How quickly you assess risk. You start filtering out noise at work, but also in life.

I’ve described some of this (and a lot more) here:

My Journey from Student Pilot to HEMS Commander

Conclusion

These 10 lessons weren’t handed to me in a classroom or during line training. They are all based on many mistakes, errors, and being surprised about something I didn’t see coming.

Some came from minor mistakes I could laugh off. Others hit harder, and stayed with me.

The longer I do this job, the more I realise just how complex flying in HEMS is – not just technically, but mentally, emotionally, and operationally.

You don’t just grow as a pilot – you also change as a person. If you’re open to learning, the job will teach you more than any syllabus ever could.

None of this is a checklist you can tick off. I still make many mistakes. I still get surprised a lot. I still write things down in my decision journal, because I want to keep learning for the rest of my career.

If you’re a fellow pilot, and any of this has resonated with you – or if you’ve learnt a lesson I haven’t mentioned: I’d love to hear it. Maybe we can keep each other from learning every lesson the hard way!

We don’t publish all our Notes from the Cockpit (like this one) publicly, some are shared only by email. Get the next one sent straight to your inbox ⤵️