The Helicopter Air Ambulance Identity Crisis: Blending Aviation and Critical Care Part 3 | Ep 67

Welcome back to the Valor Flight Crew Podcast, hosted by ECHO and brought to you by Vertical HeliCASTS and Valor Plus.

In today’s episode, we are joined again by researcher, educator, and seasoned flight paramedic Russell Griffin for a thought-provoking conversation about the powerful connection between identity, culture, and safety, in the air medical world.

Together, we explore what really shapes safety culture inside high-risk organizations—from the policies written on paper to the behaviors crews live out every day. We dive into how personal identity, professional background, and organizational expectations influence decision-making, communication, and crew dynamics in both aviation and healthcare environments.

This episode takes an honest look at the challenges of blending aviation and medical cultures, the critical role of crew resource management, and why humility, vulnerability, and open dialogue, are essential for building strong teams and safer operations. It’s a conversation about leadership, accountability, and understanding how the culture we create directly impacts the care we provide and the risks we accept.

So strap in, check your gauges, and join us as we lift into another conversation focused on safety, culture, and the people behind the mission.

Thank you to our sponsors Thank you to our sponsors Airbus, Metro Aviation and Precision Aviation Group.

Transcript

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In today's episode, we are joined again by researcher, educator, and seasoned flight paramedic Russell Griffin for a thought-provoking conversation about the powerful connection between identity, culture, and safety in the air medical world. Organizational identity really is that shared understanding of who the organization is, right? So I can ask you the question, right? So, like, who are we at work? Like, what's your organizational identity? You would answer that question from your oneness, like how connected you are to your organization, right? So when you have a strong organizational identity in the social sciences world, we would say that you identify with that organization. But for that to be true, you actually have to know what the answer to that question is. Like, what is your organizational identity? Welcome back to the Valor Flight Crew Podcast, hosted by Echo and brought to you by Vertical Holocast and Valor Plus. Together, we explore what really shapes safety culture inside high-risk organizations, from the policies written on paper to the behaviors crews live out every day. We dive into how personal identity, professional background, and organizational expectations influence decision-making, communication, and crew dynamics in both aviation and healthcare environments. This episode takes an honest look at the challenges of blending aviation and medical cultures, the critical role of crew resource management, and why humility, vulnerability, and open dialogue are essential for building strong teams and safer operations. It's a conversation about leadership, accountability, and understanding how the culture we create directly impacts the care we provide and the risks we accept. So strap in, check your gauges, and join us as we lift into another conversation focused on safety, culture, and the people behind the mission. Thank you to our sponsors, Precision Aviation Group, Airbus, and Metro Aviation. Welcome to the Valor Flight Crew Podcast. Brought to you by Vertical Helicast, produced in partnership with Echo, every coast helicopter operation. The Valor Flight Crew Podcast promotes the personnel and life-saving equipment behind helicopter air ambulance services. Join hosts Mike Fidelity and Blake Driver for in-depth interviews and expert insights from air medical personnel, pilots, communication specialists, and maintenance crews who play critical roles in airborne emergency response technique. I think what the challenge is sometimes and where the CRM may make or break that aspect of it is when you're faced with those difficult situations. I can think of certainly a couple of times in my career where the situation has come up of it's an IFR night, uh, we're gonna have to land at an airport. The patient is got X, Y, or Z going on with them, so it's gonna require intermediate transport, which maybe that's anywhere from 10 to 20 minutes to get to or from the hospital, plus the transfers. Right. And so that can that can play out one of two ways. That can play out where you have a pilot that automatically accepts the flight because, hey, we can fly, we can go do this. Yeah. And your med crew sitting back saying, Yeah, but what about is this the right thing for the patient? Right? Or then you have that situation where the three of you make that determination together to figure out what the best option is for that particular patient. And maybe ground critical care is the better option based off of location and and you know, weather concerns or inner, you know, multiple moves for that patient or or what have you. And so I think we've all kind of been faced with some similar situations like that along the way, where it was like we have that identity, we know what we are here to do and want to do, but we have differing opinions on how we're going to accomplish that task, right? And that's where the CRM has maybe made or broken those situations to be able to uh kind of um affect the overall culture of that crew, right? And maybe I'm saying not saying that the right way as far as using all of those terms, but I feel like those are how a lot of those things maybe come together. Yeah, I think you're what's done is you're bridging actually two really important big concepts. And that and that is with many of us, I think, when we think about CRM, it's easy to apply it to the aviation element um components of a of a trip, right? But I don't know about your experience. In my experience, what you just described was an even more complicated scenario, especially when you're getting uh clinical or transport-related elements that you now actually become uncomfortable. But you might be comfortable with the flight, like the actual, like I know we're I have our certified and the pilot's great, but the patient's clinical information that I have, the components that we're gonna have to go through to be able to execute this mission, or maybe even the patient's acuity, right? Their actual you know condition. Um, I might be uncomfortable. I don't know about y'all's experience, but I never really felt I was in a super great position to say I'm uncomfortable with that clinically. Like I can do ECMO, I could do balloon pounds, right? I could do some ECMO. I mean, like that stuff was okay. But when you start mixing all those other things in, you raise the question of like, is this what's in the best patient's interest from a clinical perspective? Um, I don't know about y'all's take on this, but from a medicine side of the house, it can be really easy to like just shut up and go. Like you figure it out at the bedside, you know. And I'm not saying like anybody ever literally told me that, but that is exactly what I experienced. I mean, like, you can make you can have that conversation on when you get to the patient's side. And it's like, okay, whatever. But even if but you know, like the the the term, the the phrase that I have heard and have been told to accept is well, sometimes the work is hard. And and okay, yes, sometimes the work is hard. And I don't think any of us will dispute that, yeah, sometimes the work is hard, but where I think this decision making or this CRM, like you said, it's easy to apply it to the aviation side, you know, and and and we love to blanket the the phrase and we love our words and acronyms of of CRM. But when it comes to the actual clinical side, like I wonder sometimes where, well, sometimes, Blake, the work is hard. Yeah, no shit. Like that that's why I'm here. But is it what's best for the patient? And I think sometimes we get that thrown in our lap and saying, Well, that's why you're here, and that's why you do this job. Okay, but at the same time, what I'm telling you, Mike, you you brought up this great perspective of it's an IFR night, there's gonna be multiple moves of the patient. Well, guess what, Blake? You gotta suck it up. Sometimes the work is hard. Yes, I know the work is hard. Duh, that's why I'm here. But if we look at it from the perspective of what's really best for the patient, now is my organizational culture and identity to be like we can take that patient because we can do all these things. We did all these things, and look how great we are because we did these things. We're amazing. We transferred this ECMO patient, we transferred this patient that had two impellas and they're intubated, and we did all these things. Yeah, but it took us 12 hours to do it, and we moved the patient multiple times, they coded or whatever. You know what I'm saying? So, like, I don't know how many times do I need the phrase sometimes the work is hard thrown in my face? And and do I not have a leg to stand on because I'm just a paramedic, or maybe I'm just a nurse, or maybe I'm both of those. And do the physicians like does that get thrown back and and and deciding the movement of that patient? And did we really do the right thing? And then, furthermore, can we retrospectively look at it and be like, you know what? Maybe sometimes we got to take the L. And maybe that's the wrong word, right? But maybe we weren't the best mode of transport for that patient. But hey, it looks good. It looks good because it meets our culture and it says this is our job. I think where that put comes into play. I mean, sometimes sometimes, yes, it is hard, and sometimes it doesn't matter if it's the easy or hard thing to do, that it's the right thing for that patient, right? And we still have to go and do it anyway, and we have to give it our best shot because this is the only option they have. Sure. But I think that comes when you when you have options. So as a program, if you have, you know, if you're one of those programs that that has the option of ground, rotor, and fixed, right? Like what is what is the best option at that time when you combine those clinical and you combine that aviation aspect of it? And and are do you have the freedom as a crew to be able to make that best case scenario decision, right? And I think that's where that CRM comes into and kind of ties all of those things together because there has to be that happy balance, there has to be that melding between the aviation side and the medical side of the house, and you have to be able to look at this situation from that thousand-foot view or 50,000 foot view if you want to even go further, and be able to make that best case decision for that patient and yourselves at the end of the day, right? Because everybody goes home. Absolutely, absolutely, and and I think you know, having those guiding principles that I'm gonna get put on a placard and hang on on my wall from Russell Griffin. Absolutely, you know, I think it helps to guide where some of that is coming from in the first place. But Russell, I'm curious, have you encountered maybe some real world examples that that maybe didn't go the way that it was supposed to? Um, where we kind of talked about the safety voice side of things, but maybe some of the operational decision making ended up becoming flawed secondary to some of these CRM or identity crisis issues, or you know, maybe there were some other examples that you have from communication along the way, breakdowns that maybe just didn't go according to plan. What have what has been your experience with some of that stuff? Yeah, so it's fascinating because from the research perspective, uh I mean it was uh like 1983. I don't know, I'd look up the actual dates. It was uh 1983 to 2022, 405 uh Hems-related accidents, total of 362 fatalities, and read every single accident report through those, and went through the transcripts where they were available for from the crew, right? Or debriefings and the investigations. And it's it's unbelievable how littered the sort of investigation records are about the breakdowns in these things, and what I've discovered, and this is probably the biggest paradox, and I think it's actually one of the presentations I had accepted for Echo this September coming up this fall, is that it's easy to kind of get our feelings wrapped around the whole pressure to fly and the you know the the burden of response and that element, but when you look at the data, return to base and reposition is more deadly. Yep. Yeah. So okay. Not studying that, I'm not saying we're doing things right in the pressure to fly phase. Unequivocally, there are dramatically preventable future accidents in the pre. So when I say pressure to fly, I'm talking about response and transporting, right? Those are the two phases. When I talk about low pressure or no pressure flights, that's going to be repositioned or return to base. When you look at those and you break them down, and I you know, did everything possible in those cases to be able to separate them. The the actual lethality, like how fatal accidents are, it's it's worse than the return to base and reposition flights. And the total number of fatalities is higher in the transporting and responding phase, because naturally in transporting, you have typically other people or even family members, depending on what you're doing. But it's like that actually goes in the face of everything that we're talking about. And that's where it comes back to this kind of like identity thing. Well, what is it then that that's killing us when we're returning to base? What is it that's getting us when we in it been? I don't know the answer to that question, but what I can tell you is you're gonna find all sorts of evidence throughout the accident investigations of where these breakdown communications have happened, and then you can actually have it from God bless those souls who have survived accidents, and we'll give a retelling. You know, obviously, one of the most difficult, but one of the most candid and best conversations that I've heard you all have in particular was, of course, uh with Rhett Train, right? And actually, and we have with Fortune Fox trial. And you know, his retelling of that story and the crew, like literally speaking up, and you know, Rhett tells his side of that storyline about his life, what are we doing? Like, man, stop. And you now have this collision of like communication barriers, and it and it's the real-time processing is happening so fast that to try to understand those dynamics at any given time, it it's just like the pace of the event is unfolding faster than your ability to process the information. Absolutely. I think it's like 100%, boom, you're in trouble. But if we're not having that conversation, like when have we experienced that gang? Like what like let's talk about what it's gonna mean. Like, what's our safe word? How do we pause operations? Because you know what, it goes back to the everybody goes home, right? I mean, it's like I don't know what it is. I don't know. So it so I I'll be honest. I think, sorry, my I think one of the best things to say is almost every incident that you can look at, you'll find a combination of communication breakdowns. And you'll find these uh this combination of sort of even misinterpreting the actual unfolding scenario. I mean, I don't know about y'all, but when I'm out facing in the back of an aircraft, that's like one of the scariest places in the world to be, especially when I'm with a crew up front. Like if you have a metagrammerse up front and you know you're working in an emergency, it's like I'm putting all my faith in what's happening up there. Um so the ability to assert an opinion is primarily obstructed. Thank you to our sponsor, Precision Aviation Group. Mission critical operators and fleet managers rely on Precision Aviation Group as a worldwide leading rotor and fixed-wing MRO provider. TAG provides tip-to-tail solutions in four MRO segments: avionics, components, engines, and manufacturing DER services. A single point of contact gives you access to over 150 million in inventory globally 24-7. Just call 800-537-2778. Others sell parts, we sell support. But is it now I want to go home versus everyone goes home? Because if it's that if it's that phase of those, but you know, so it's a it's a low risk, right? I don't know. I it's all high risk because my life, your life, the pilot's life, like is it I just want to go home and versus everybody goes home? Because I want to go home, but it's also everybody goes home. So if everybody goes home, then I go home. And then where's that pressure? Is is there one person making that pressure? And and Russell, you talked about this in your research. Is it now that if I speak up, like I want to go home, but I also want everybody to go home? But I don't want to be looked at as the guy that just, well, what, you don't want to go home? You don't want to, you just don't want to fly tonight, you don't want to get back to base. Do we is that self-imposed? Is this top-down, bottom-up? How do we approach that and embrace that part of the CRM versus I want to go home versus everybody goes home? It's all of the above, Pat. And I'm glad that you asked it that way. It's almost like I need to give you a $20 bill or something. Um what you just did was brought full circle the question about identity. The yeah, there's a lot of reasons we can explain the fatality rate on return to base and reposition, right? You can attribute it to fatigue, you can refute refer to it as what we call sort of task residue. Uh task residue cognitively occurs when you switch, switching tasks, right? So if you're in this high pressure scenario and you're doing whatever big trauma, and then you load up an aircraft, you know, you're gonna have a passive loss of attention and you're gonna be cognitively, you know, in a different space. That might be part of it, part of it could be um just simple normalization of deviance, right? You start to have this this like, well, it's a low-risk flag. So why do I need to be eyes out? I can chart, right? Yeah, maybe but I do think probably the biggest in my, and that's why I have no motive in being right. There isn't like evidence that can purport this. I think it's identity. I think it's identity. Nobody wants to be the, especially empathy for the pilots and and for the crew. Nobody wants to be the one that like lands short and puts it in the field at three o'clock in the morning and goes, it just got too bad. And it's better that we land safe and we're here on the ground versus I can get there and I got the get deritis, right? I I think that that is it is a combination of self-imposed and organizational expectations, and we're wearing flight suits, and people think we're heroes. And it's one of the questions with this identity that I would love to be able to find a way for us to rebrand heroism and be able to acknowledge the fact that it might be more courageous for it us to like, you know, take one on the chin and go, we've got to like pick field. I mean, this is not, we're not, it's not worth it. We're gonna be potentially humiliated, we're gonna be potentially embarrassed, we might have to like tow an aircraft, we might be out of service, we might be stuck in a field, but you know what? I'm alive. That sounds really pleasing and like easy to the ears when we say it that way. But you both know when we're in the aircraft at three o'clock in the morning, that rationality isn't present. Yeah, for sure. It's like we're heroes, we're brave, we're trained, we're courageous, we can get there, we're gonna make it, or whatever the scenario is. But it's like that I that identity that we have and that the organization has shipped has shaped us into has led us down that path. And it's a collision of both self-impost as well as external pressures. Yeah, and I think that those external pressures are certainly you know much more prevalent. Uh like it's natural. We get down tones go off, right? We're the three of us are going out on a flight, we have that endorphin dump, we're on a high, you know, but what happens when that energy drink wears off? And that's when we're dropping that patient off at the hospital, right? And now we go into this like depression, if you will, right? And I, you know, I think that those repo legs on the way home are oftentimes that the endorphins are done, we've worn off our energy drink now, we're in that lull phase, we let our guard down. Like I hope it's not an identity thing at that point. I'm sure there's some get their itis, right? But I hope that it's not an intentional thing. I don't that that we're going down that route. But I also don't know how to necessarily combat that lull in our, you know, dopamine circulating, that we're not at that point where we're on high alert until we are physically back on the ground at base. But Mike, there's another flight pending, or there's another call. You just drop that patient off at the hospital and you you have that lull dump and like, oh hey guys, we got another flight request. Yeah. Maybe I just need to keep that in the back of my head the whole time. Like I'm always on alert for another flight, right? But but but but Mike, that's that you bring you bring up like the most that's this industry, right? Because the pre-hospital world, like the patient care world, it doesn't stop. Yeah, and I think as providers and as leaders and as people that do this job, like and and and Russell, I I man, I said this earlier. What's the difference between the ground and air? Who how who am I to say that one is more valuable than the other? Well, but maybe the risk is just high. If I get a flat tire on the ambulance, the the risk is less likely that I'm gonna end up with severe injury, disability, or god forbid death, versus we have an incident in the aircraft. And I think we should acknowledge that that's just the nature of this business. But but Mike, I think, and I think we talked about this before and and the um in one of our other podcasts about you've completed that flight, you just had that insane intense trauma, right? And you and Mike, we nailed it in the back of that aircraft, right? We took care of that patient, Russell. We did amazing things. We got that patient to the trauma center, and now we're like, we're trying to clean up, right? And you just have that that release and now another flight comes in. Uh, it's an inner facility. Uh, it's coming out of the hospital two blocks away, um, and it's going 15 minutes, a 15 minute flight. And now where do we use that that CRM and how do we make those decisions? Well, this is our identity, this is our culture. We treat and transport patients. It's the highest, the sickest of the sick to the routine, but patients still need care. They still have to get there. So, how do those standards come into play? And how do we make sure that we're still doing that root that routine transfer is still equally as important, right? Like, who am I to say that that patient's care is any more or less important than the the severely injured trauma patient versus the person that needs to get to where the special the specialty is? And if you take away that, well, I don't know what that patient condition is when the decision is made to accept that flight. We've we've built that into there's no identifying patient information. So you okay, there's another flight. Can you accept it? Mike, can we do this flight? It seems to be routine. Can we accept that flight? So we do, and then we start getting the patient. Okay, it just seems fair enough. It seems straightforward, it seems easy enough. It's a routine stroke, you know. But then now did we just uh bring in another level of either are we safer, are we unsafe by taking that? We just had this huge, insane flight, and are we now not acknowledging maybe some of the weather, all these other factors? So, Russell, Mike, like how do we how do we make sure we're doing it safe? Because we we still have an identity, we still have a job to do, how are we making sure that we're doing it safely? Thank you to our sponsor, Metro Aviation. Metro Aviation, the world's largest family-owned aeromedical operator, offers comprehensive aircraft services with 160 plus aircraft in over 25 states. The completion center installs medical and law enforcement kits in avionics, serving diverse aviation needs including offshore, utility, VIP, and corporate sectors. Yeah, I love it. I love it. So I think it's a tricky answer, but I do think that there is an answer. And that is we need to recognize the operational realities that we face. And what I mean by that is for those of us that have done this a long time, it does just become task work, right? And obviously the routine flight thing is a killer in and of itself because success reads complacency, right? And that's just as a reality. I I don't know. I think one of the questions might be do we need to create intentionality, right? Do we need to have so if we're if we just drop off a patient, let's say we don't have an uh an impending uh flight, but we're we know we're getting ready to return to base. Maybe we need to discuss is it operationally beneficial for us to meet at the nose of the aircraft before we load in and say, statistically, this is the deadliest phase of flight in air medical transport in the US. What we're gonna do is talk about this proactively and discuss what are our risks going home? What can we do to limit those risks and how are we gonna communicate as a crucial if we face those things? It sounds like that's ridiculous, but I tell you what, the evidence demonstrates it's not. I mean, that like it realistically says that no. I mean, we move into a phase, there's a thousand things, fatigue is undeniably huge. But when I talk about the operational reality, I think that's something we need to grapple with. Are we, as clinicians and as providers in such a psychologically or emotionally or physically exhaustive state at the end of one of these transports that we are literally limited in our capacity to function moving forward? I don't know. I mean, that's like research. I think that would be fascinating. I mean, is that part of it that we actually do need to go? Well, what are the signs and symptoms of needing a timeout? Like what I we we know we have timeouts, and some organizations are more promoting or encouraging. But I never would have thought about that as somebody that was, you know, you're doing this for many, many years, of stopping like on the helipad on the way home and going like, all right, like what are we gonna do on this flight? All of the attention is being delivered on the actual responding transport phase of life of flight. So I think it's a big question about well, if we know that's what the data shows us, and if we know it's so dangerous, then what are we doing to actually inhibit? What are the I don't want to say the barriers, we don't want to put operational barriers, but we want to enable operational behaviors that will break that tendency. Uh and I love what you said there. And I never really thought about it that way. And that we should, you know, should we have that conversation? Should we meet at the nose of the aircraft? And should we have that? Like, I think we all go into this relaxation mode. And then you add fatigue on top of it when that endorphin rush is done and we're already fatigued. Does that put us into a place of deeper fatigue or less arousal in that moment to be able to be alert, to look around, to take in all of our surroundings and not answer that text message or not be making plans for later that night or to, you know, all of a sudden your head is is bobbing in the back of the aircraft, right? Like I all of these all of these factors I think play into it on that that leg home. And I think that you know, we can certainly do more as an industry. I I don't know necessarily know of having to have that conversation of physically saying statistically this is the worst part, but but there needs to be an acknowledgement of it somehow. There needs to be a way to put each of those crew members at a place of understanding that this is statistically the most dangerous part for us. Like maybe there's a code word, maybe there's something else that we, you know, that we do that is acknowledging that. And I I don't think it should just be for that leg, but I think there does need to be an acknowledgement that guys, this is still a possibility. Like we can't let our guard down now. We still have to be on alert. But Mike, I think it starts with us, right? Whether it's pilot, medic, nurse, I think somebody has to at least start the conversation. And and I think the more that we I don't know, is there an art to having difficult conversation to where our conversations not really difficult or are they just conversation? Either the more we have them, do we uncover some of these things? But but uh Mike, you said it, like we gotta start somewhere in this industry because we we we we have to do it and and have that because if we put our heads in the sand or or we just say, oh, it's just a it's a five-minute flight home, we gotta start somewhere. We have to. Yeah, I'll tell you what, um, you came full circle, didn't know it. Uh this is this is the core of identity crisis. This is what I meant by the provocation in that language. If we believe we are above all else a commercial aviation organization whose first accountability is to like operate aircraft or whatever it is that we have safely and effectively, and that transcends everything else, that's where the attention goes. I trained many a flight nurse over the years, God bless them. They probably have all recovered by now. One of the things I always explained was your level of clinical expertise needs to be so proficient that you can focus almost all of your attention on the safe operation of the aircraft. And if that requires you abandoning patient care to ensure that you all arrive alive, that's what you need to do. If a pilot needs you to clear a side and you're the one on the BBM, you might need to drop the BBM and look for lines, right? That's that was the kind of culture I grew up with. As I grew up with really strong, incredibly talented crews, but there wasn't any confusion. And what I mean by that is pick a commercial, you know, operator like scheduled flights, Southwest American Airlines, any of them. If they had a fatality accident rate that was as significant on repositioning ferry flights with no, you know, um you know, paying customers on board that was anything like this, it'd be like, what the hell are we doing? Like it just doesn't make sense, right? So it's like that level of expectation or expertise. I mean, honestly, like crashing out in the back and like taking a nap and like doing these, like, uh, where's my next Snickers bar? That's like the behaviors of being a medic. It's not the part of being like, I'm part of a flight crew, and that expectation is a higher calling when it comes to this level of risk. It's just different. Because to your point earlier, Blake, the consequences of action or inaction are so profoundly different than what happens on the ground. And I think it's that level of acknowledgement that it's like we don't want to elevate our bravado, we want to elevate our accountability and our attention to detail and those things, and and recognizing that we have to be all in on this. And if we're not, then we need to have both the courage and the enablement to say we need a timeout, we need to rethink this, like what we call me, whatever it is. I think that also all these things that we're talking about, especially in in the blending aviation and patient care or health care. I I think this goes one step further into like initial training for people in healthcare, whether you're at the the the pre-hospital basic level or or maybe into the the the initial introductory levels of nursing or or you know healthcare, like maybe we start this from the beginning. I've I'd never heard in EMT school that there may be a time you have to put the BVM down, you know, to to you know, because they BSI seen safety, right? That's that's paramount. Yeah, that's that's the whole structure of introductory to to pre-hospital. But I mean, maybe if that expectation or that ideation of there may be a moment you have to stop what you're doing in patient care to make sure everything is safe. Maybe in the in the in the fire world, you know, as you go through introductory and through fire school and as you come through, even in the physician world, you know, or whatever that role may be, maybe if we introduce that earlier on in the onset, then that maybe that's does that grow as our identity as we come up through and further our education and further things through the world of delivering patient care? I love that, and this is part of the reason why I love these conversations with you, Russell, because yeah, you challenge me to think in a different way. And and I think that you know, never have I thought about like I've always thought you need to be a strong clinician to be a flight nurse or a flight paramedic. I've never looked at it from the perspective and I've always I've always been very what I would consider safe within the industry. I've I've tried to put that safety first mentality, but I've never looked at it from the perspective of you need to be so sound in your clinical or so skilled in your school in your clinical scope that if you have to not do something, if you can't look away from your patient for a second, then you probably haven't set yourself up for success because the the paramount, the thing that matters most in that moment is the safety of the entire crew. And and I I think it just, you know, there are those there are those patients where you are working your tail off the entire transport. And there are those patients you can't take your your eyes off of them because it requires both of you to care for that patient. I'm I'm not suggesting that people need to stop caring for patients, but you also need to know that if you have to look away for a couple seconds, that you're setting yourself up in a good spot or that you're having that communication between you and your partner in the back so that somebody's focusing on one thing while doing I can think of patient situations where I maybe have not been able to do that because of whatever was happening at that moment in time with that patient. Um, and we have all had those where you know Murphy is alive and well and uh things are just not going right and it's not just one thing, right? But but I've never really thought about it in that perspective. It's kind of always been the okay, well, on the way to the flight, it's all of our responsibility. When I have the patient in the back, my primary responsibility is the patient. Um, but still, in reality, my primary responsibility is is the safety still at this point, right? Um, but we get it's easy to get like caught in that in that little world, right? And that that that what's in front of us right now and the thing that we need to do and why we were in this aircraft in the first place is to take care of that patient, right? Um But we still at the end of the day can't keep doing that until we keep that safety focus. And and so I appreciate having these conversations because I feel as though there is a the the identity, my my identity as a flight clinician I think very much complements the identity of the aviation side of the house. But there are those times where they do butt heads, and I think that that's the challenge sometimes is being able to work through those situations because they are very similar, but there is certainly those times where you have to prioritize one over the other. And I guess, you know, at the end of the day, like with the research that you've done, do you feel like as a global industry looking at this, do you feel as though we have a pretty happy balance across the industry, or are you seeing it lean in one direction or the other more and why? Thanks to our sponsor, Airbus. Airbus provides the most efficient helicopter solutions to its customers who serve, protect, save lives, and safely carry passengers in demanding environments. Its civil and military helicopters are flying all over the world, making missions possible. Visit Airbus.com for more information. And there's our enemies here. Uh maybe a little bit of both. Maybe you were hoping I we wouldn't get to that question. No, no, you're you're good. So I'm gonna so I'm gonna give a I'm gonna give a hopefully a helpful answer. I'm gonna answer because you asked at the industry level. Um tie my tie story and get very specific. So if we go back to the late 1800s, early 19th century, um, the United States fire service was evolving in the U.S. and it's really well portrayed in Leonardo DiCaprio Gangson, New York. In that movie, there's depictions of fire companies, that's right, where some of the early terminology came from, who are competing against each other to suppress fires because there were actual reimbursements affiliated with that in the early fire service. In the US, that became a very regulated industry. And then, you know, that was basically eliminated and hence the traditions. And of course, the fire service is 220 years of tradition unimpeded by progress. Uh, we all know that's true, but the refrigerator's industry is self-regulated. It's and like that doesn't exist, right? So we have mutual aid agreements, but you're you're quite literally not seeing compete that it's just as illogical when it comes to that that type of um emergency suppression. I I think in the US, in particular, the air minimal transport industry, we're still stuck in that paradox. And and I don't mean not to say that competition is a problem, and I think it's it's commercial aviation, it's just a reality. Right. How do we get the industry to go forward with that? I I would like to write, maybe it will, I don't know, find somebody else to do this with me. In 1999, the Institute of Medicine published a report called EMS at the crossroads, and it was basically a reflection on um the history of EMS and its sort of evolution. I feel like we're at this sort of air medical transport at the crossroads and you know, starting to address some of these questions and ask really tough things. Like, what are we willing to give up to get what we want? I don't know. But I think that's something that we need to spend some time and reflection on. Uh, I I think it is to your point, there are like there are very, very uh very easy ways to have very difficult conversations, there's structured ways to do that. Um, and that's maybe that's a conversation for another day that we could have. But there are ways we can bring up difficult topics in a way that always doesn't incite violence in the people we want to talk to. But that is back to the, I mean, that's part of the identity, right? If we uh frame ourselves as an organization who will have tough conversations, yeah, candid can mean conflict, but we value that over right making poor decisions and them getting people hurt. I I don't I don't know the answer. I can st I can definitely see from speaking with clinicians that work for all types and varieties of programs that it is very much all over the place. There's a lot of good programs, a lot of good programs trying to do a lot of good things. And we conduct you know thousands of flights every year very safely. That should all be applauded. But I I can't look at the trend. And you know, even mutual friends of ours like Michael Benton and other champions in this industry, we can't look at the trend and go, this is acceptable. And one of the earliest lessons I learned in medicine, and I and I think we have to have like a healthy state of paranoia in this business. And one of the earliest lessons I learned was you know what the difference is between today and the worst call of your career? It's the next call. You don't have the livery in this industry to like gain speed and be like, I'm gonna be okay today, and I'm gonna like earn tenure and knowledge and stuff. Yeah, and so what that meant to me is I learned as a corner from very young, especially in flight medicine. We have to control the controllables. You need to know how to operate that ventilator, like your life depends on it, right? Because one day it might. Like whatever, like because that's what I mean. If you're if you're head down in a ventilator because you can't remember how they got a SIMB, whatever with a P5, and you know, and if you're struggling with that and you got a pilot in class B who's isolated you, and they're trying to navigate, you know, uh a crossing aircraft, if they don't want to take you off isolation because you're back there freaking out because you don't remember how to do the functional basic stuff for the that's where it's like that's what I mean. So I don't have an abstract answer, but I definitely think the industry and God bless the you know operators association, and there's really good groups of people trying to continue to come together. And I'm just one person that hopefully isn't pissing too many people off, but is are willing to have a conversation with there. I do think we need to ask this principle like what are we willing to give up to get what we want? Because it there's not any other way to approach that conversation uh that I can think of. And I'm damn man, I um man, that hits and I and and Russell, this is why I love having these conversations with you because you you bring up the things that I think either you know the you know the people that you're friends with, they're like, ah, you know why I'm friends with that guy? Because he'll always say the things that I'm either afraid to say out loud, right? You know, you're like, that's why we keep Mike around, he'll say it. You know, that's why we love that's why we love Russell. But I love so much the fact that you challenge it just me personally to continually strive to be better because uh like we are perfectionists, and I think if we know that we will never achieve perfection, but along that way, we will achieve excellence and greatness along the way. That's why I love having these conversations, Russell, because I feel like there's probably people out there that want to, but you're the guy that puts in the work and time to have these conversations because you truly have this drive for this industry to be better, to be safer. And that really comes again to really full circle, I think, in the patient care delivery. And that is why I love having these conversations. You challenge me as a on a personal level to just one be a better person, but I think two to also be a better clinician and be a better provider out there because that's truly why we do this. And and I want to throw out this this last question. I know the things that I take away from these conversations, and I don't think it's one thing. I have like a I have a list here uh of of things, but if there's one major takeaway that you could put out there for our listeners to take back to their base, to take back to their home, to take back to themselves, what's one thing given today's conversation, what's one thing you think you would put out there for them to take back and ponder or discuss to work on and change? What would it be? Um I think. Given the essence of this conversation relative to this topic, it is to have the vulnerability and also the courage to spend some time in reflection and writing down, or however you want to say it, like what your identity is, both as a person, like from a human perspective, and then also from like a professional lens. And then if that transcends over to those who you know are leaders in the organization, you know, can you begin to articulate those as an organization? Not what you want your culture to be, all that kind of stuff, but really writing down like this, this is this is as I want people to have, I think there's a joy that can come with the connection of having a sense of oneself. And I always, I mean, like I appreciate your kind comments. It means the world to me. And that comes through like a 51 years of making really bad decisions and doing a lot of stupid stuff. And like, you know, I hope the enduring trait is the humility to recognize that I've done a lot of like dumb things and I've treated people poorly in life, and I made you know decisions that I regret and I want to make right. And hopefully this is like part of that making it right over time, you know. But I think that that's the one thing is to really make sure that you're connected with what you do and don't let what you do drive who you are, because one day you're gonna take this uniform off, right? One day you're just gonna be a guy or a gal or you're gonna be whatever. And you wanna you want that now to help drive what you do, but you also want that in the future because this is a phase and that final part of what you do and who you are, but it's not who you are. I love that. Oh man. I think Mike, what do you think? Russell, what do you think? I think uh another podcast. How do we how do we prepare for when we hang up the flight suit? Yeah. Yeah. Well, I feel like today has been informative, provocative, and also a therapy session for me. All in one. All in one, dude. Oh, all in one. Oh man, that self-reflection certainly hits home a little bit. And and you know, it I think we all struggle to some extent with not uh with with separating who we are and what we do. And I think that's a natural thing in this in this industry. And I think that um, you know, I certainly have taken a lot of things away. I think you know what I thought I knew my identity was before, I'm not so sure walking out of this conversation now. Oh, I don't even I don't even know now. I I need to go back and find it. I got I gotta go find it. Yeah. But uh I've truly appreciated having this discussion, Russell. Always a pleasure having you on, and thank you for for making us think about the difficult questions and being provocative in those terms to make us look at it a different way. Like I I so appreciate the ability to have those open and honest conversations, and I can't wait to have more of them. So thank you so much for joining us today. Yeah, thank you guys. I'll leave you with this. Uh I hope you're as proud of yourselves as I am of you. You're doing the Lord's work and making the world a better place. So thank you for having me. And I can't wait to chat in that in the future. So fly safe. Absolutely. Thank you so much. For all you guys out there, thank you again for your continued support of the Valor Flight Crew Podcast and the Vertical Hellcast platform. If you're all caught up on your Valor Flight Crew, uh make sure you head on over to verticalhelicast.com where you can check out the Hanger Z podcast, helicopter podcast, vertical MRO podcast. Be safe, everyone. We'll see you next time. Thanks for joining us for this episode of the Valor Flight Crew Podcast. Don't forget to like and subscribe to hear more stories that promote the personnel and equipment behind the missions in public safety aviation. Lastly, stand by for a message from our sponsors. Thank you to our sponsor, Metro Aviation. Metro Aviation, the world's largest family-owned air medical operator, offers comprehensive aircraft services with 160 plus aircraft in over 25 states. The completion center installs medical and law enforcement kits in avionics, serving diverse aviation needs including offshore, utility, VIP, and corporate sectors. Thanks to our sponsor, Airbus. Airbus provides the most efficient helicopter solutions to its customers who serve, protect, save lives, and safely carry passengers in demanding environments. Its civil and military helicopters are flying all over the world, making missions possible. Visit Airbus.com for more information. Thank you to our sponsor, Presticision Aviation Group. Mission critical operators and fleet managers rely on Presticision Aviation Group as a worldwide leading rotor and fixed-wing MRO provider. TAG provides tip-to-tail solutions in four MRO segments: avionics, components, engines, and manufacturing DER services. A single point of contact gives you access to over 150 million in inventory globally 24-7. Just call 800-537-2778, Precision Aviation Group. Others sell parts. We sell support. Thanks for joining us on this episode of the Vower Flight Crew Podcast. A huge thank you to Russell Griffin for sharing his insight, experience, and honest perspective on the human side of safety culture and identity. Conversations like this remind us that safety is never just about policies, checklists, or procedures. It's about people. It's about the culture we create, the way we communicate under pressure, and the willingness to stay humble, speak up, and keep learning from one another every day. Whether you work in the cockpit, the cabin, or behind the scenes supporting the mission, we hope this discussion encourages you to reflect on the role identity, leadership, and teamwork play in the environments we operate and in the patients we serve. As always, thank you for being a part of this community and for everything you do to keep your crews, your patients, and yourselves safe. Until next time, take these conversations back to your bases and keep challenging each other to define your identity, refine your culture, and elevate your safety margins. We'll see you next time on the Valor Flight Crew podcast.