One of the most interesting questions I got during my command upgrade interview:
You’re flying a dying patient to the main hospital helipad in London.
During the flight, you get a technical issue.
You run the emergency checklist.
The result?
“Land as soon as practicable.”
So far, so good, right? ✅
But… there’s another piece of information:
Once you land, the Minimum Equipment List (MEL) states the aircraft is grounded the moment you touch the ground…
And you’re currently heading towards one of the most important hospital helipads in the capital.
Land there and you could potentially block that pad for days (or even more than a week) while engineers, parts and logistics are arranged.
That could affect multiple critically ill patients who need it.
So what do you do?
Continue to the hospital because that’s where your patient needs to go?
Return to base?
Divert somewhere more suitable for the aircraft, accepting the consequences for the patient currently on board?
➡️What if the patient doesn’t make it?
➡️ Is there another option?
I loved this question because there isn’t a page in any manual that gives you the answer.
🔸 The checklist tells you what the aircraft can do.
🔸 The MEL tells you what happens after you land.
🔸 The doctors in the back have made their preference VERY clear…
But none if these tells you as the commander what you “should” do.
That requires taking a much wider view of the situation: the patient, the aircraft, the landing site, the emergency services, the operational consequences and the risks created by each available option.
Your impact on the system.
You’ll have to be creative sometimes, as long as you don’t violate safety protocols.
“Just knowing all the rules” isn’t always good enough.
It’s making a decision when several perfectly valid considerations are pulling you in different directions.
I have asked many captains this question, all had different answers.
And to be honest, my own decisions have changed massively over the years too.
What would you do?
Let’s take a look at how to deal with ambiguity.
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🔍 Finding the middle ground in 5 steps
Pilots just follow checklists and SOP’s right?
Well… ehm – yea, they do. But…
The longer I’ve spent learning from my own and other pilots’ mistakes, the more “dealing with ambiguity” becomes one of the most important skillsets you can have.
So, where do you start with this?
Throw the textbook out of the window the moment you complete your line training?
We talked about decision making under pressure recently:
But, let’s take it a step further when there just isn’t any single “right” decision.
Turns out there is a middle ground between being a complete cowboy and being “one of those SOP guys”, took me a while to get there though!
But we can simplify the framework in 5 easy steps ⤵️
1️⃣ Separate facts from what you ‘think’ you know
Every great decision always starts with accurate data.
How to get it?
Consciously take time to diagnose the situation as accurately as you possibly can 👀
The more time you have available, the more time you can take here.
What exactly is going on. Is that stuff you “think” or can actually observe?
What about the pilot next to you, do you agree on what’s going on, have the facts all laid out in a nice and straight lane?
If not, start laying them out!
2️⃣ Work out where you DO have agency (and respect where you don’t)
There are things that we have agency over, and things we simply don’t!
Of course in severe emergencies we have agency over more things than usual, but where do we draw the line before that point?
The exact same circumstances of a flight can be seen as something we can and can’t have agency over – depending on your perspective.
It’s this mindset shift that can seriously help you out when things get tough.
Examples?
Sure!
| No Agency ❌ | Agency ✅ |
| Aircraft Limitations | How close we get to them |
| Technical failures | How we deal with it |
| SOP’s | Choices SOP’s deliberately leave to us |
| Weather | Whether we depart, divert, hold, return to base etc |
| Fuel already burnt | How we manage the fuel remaining |
| Presence of Commercial pressure | How much influence we allow it to have on us |
| Information we can’t get | How we use the information we do have |
| A deteriorating environment | How soon we choose to intervene |
| The consequences already created | How we stop them from compounding |
Well – quite the list (and we’re not even close to listing all of them) 😅
The problem starts when we think that we can change anything in the left column.
Ignoring aircraft limits, pretending “we’re fine” at 400’ cruise altitude, or thinking that the piece of information we need is not “that important”.
That’s when we enter cowboy territory!
Finding the line might be trickier for some than others, depending on the company culture, your personality, and the circumstances you’re in.
3️⃣ Optimise for your highest priority
What is most important to you in this situation?
When you get sucked into grey areas, it’s easy to lose sight on what’s actually important.
What is priority 1, then 2, and then 3?
In the helicopter example in the intro (depending on who you ask), you will get various answers.
Subjectivity is so much stronger than I realised when I started my pilot career.
A is a, and b is b right?
Well, tell me then what the priority is here?
Aircraft safety, patient survival, not blocking the largest london hospital helipad, keeping the doctors in the back happy, staying legal, not breaking FTL schemes, have a pick! 😃
4️⃣ Accept that you may never get certainty
When you’ve laid out your options, and none of them are “THE” answer to your problem, it might still be time to decide.
No one likes that, but it’s part of this career sometimes.
We are trained to get all the info we can, diagnose, cross-check and reduce uncertainty.
That’s good. But sometimes, just getting more information will not lead to a single “easy” answer.
At some point you have to recognise:
“I have enough information to make a defensible decision, even though I don’t know with certainty if it’s the perfect one.”
Otherwise ambiguity creates paralysis: one more call, one more discussion, one more orbit, one more piece of information…
And ironically, waiting for certainty can itself become a decision (sometimes an unsafe one).
5️⃣ Keep asking: Has anything changed? If so: adapt
Sometimes it’s easy to become emotionally invested in the decision you make, a trap I’ve fallen into myself a few times.
I once decided a motorway landing was required to reach a patient. We asked the police to close the motorway so we had space to land as soon as the after take-off checks were completed.
But once arriving overhead, the road wasn’t closed yet. Police said “we are about to finish the closure”.
Ok, while we waited, we spotted a few more options with different threats and a longer journey for the medical crew to reach the patient.
But… surely the police are about to finish the closure, right?
Another orbit….
Another orbit….
Still no road closure.
What do you do?
Just endlessly wait for more information, or go with plan B?
The risk is that as soon as you’re on final for the other landing site, the police calls it and you’ve wasted a road closure and an opportunity to reach the patient.
But endlessly orbiting overhead isn’t helpful either.
There are countless moments like this in aviation.
If things change, or don’t go according to the plan you’ve made, you eventually need to adapt. Being a step ahead here and having a “cutoff point” for plan A is a huge help with this.
💭 Conclusion
Sometimes there just isn’t a “perfect” decision.
The checklist might give you boundaries. The SOP might tell you what you must and must not do. The regulations might define the limits.
But inside those limits, there can still be an enormous grey area.
And that’s where your judgement starts.
➡️ Separate what you know from what you think you know.
➡️ Understand where you have discretion (and where you absolutely don’t).
➡️ Work out what matters most.
➡️ Accept that sometimes you’ll have to act without certainty.
➡️ And when the situation changes, be willing to change your mind with it.
The goal is to not be a cowboy, but also not just blindly following a rulebook either.
Being comfortable enough with uncertainty to make the best defensible decision you can with the information you have.
Easier said than done!
Maybe that’s why, years later, I still don’t have one definitive answer to that command interview question.
And maybe, that was the whole point 😅
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3 Comments
helibrabant · August 30, 2026 at 11:00 AM
I think there is a difference in Landing and shutting down (MEL applies) or landing, keep engine running and take off again (MEL doesn’t apply).
Not sure if you always have to shut down to offload a patient.
MEL I think 50% of the pilots say it’s applicable regardless if you shutdown or not, so when you land, it becomes effective, the other 50% see it as if you don’t shut down, the planned flight is still ongoing so no MEL….
Anonymous · August 30, 2026 at 7:08 AM
Having flown for HEMS in UK and Europe, yes there are quite often cases you have to decide based on your judgement.
It is far to complicated to regulate everything and you cannot count on that.
My way of thinking is
1. I cannot occupy a Hospital Deck with my Helicopter. What about the next patient ? Is he / she less important that the one you have ?
2. Land ( and so leave grounded the helicopter ) in a reasonably accessible area close to the Hospital. Notify the Medics to inform the Hospital where to sent the Ambulance. It is much better than having the patient transferred by road (or boat and road).
3. You do not have to make everybody happy. If things get to complicated try for the less harmful way of action.
My worst , complicating everything, is a Chief Pilot afraid of the Doctors’ complaints….
Jop Dingemans · August 30, 2026 at 8:04 AM
Great points, thanks for sharing!