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EMSWORLD.com | NOVEMBER 2017 43 the same error: Let's develop the same sterile crew concept for EMS, firefighters and aero- medical personnel. Keep Your Head in the Game There are four sections to 14 CFR 121.542. First: (a) No certificate holder shall require, nor may any flight crewmember perform, any duties dur- ing a critical phase of flight except those duties required for the safe operation of the aircraft. What does this mean for EMS or fire depart- ments? Let's change the wording to fit what we do. EMTs and firefighters shall not perform any duties during a critical phase (e.g., lights and siren) of a call except those duties required for the safe operation of their vehicle. Dispatchers or management shall not engage in activities or make requests or directives after a crew has been dispatched that are not directly related to their call. Here's what this means: Once the tones drop for a call, the EMTs and firefighters in the vehicle will only engage in the duties needed for the safe conduct of the call. Personal phones are put away. No personal text mes- sages by either person. No eating. No conver- sation not directly related to the call. Chit-chat is shut down—you keep your head in the game. Dispatch shall not, for example, ask, "What is your off time?" This type of question is not directly related to the safe operation of the call, and you would simply answer "sterile crew" and discuss it with dispatch after the call is complete. Can you talk while lights-and-siren? Yes! However, the discussion must directly relate to the call. For example, it would be appropri- ate to mention, while traveling to an MVC, to remember to don reflective vests, take addi- tional equipment you might need, directions or anything else you know about the scene. What happens if you get a personal or a company text message or phone or radio call while running lights-and-siren? This is common and will continue even in a perfect system. Frequently systems will send addi- tional dispatch information via text or CAD, or perhaps a pager. These messages often clarify what was initially given verbally and can include additional information that's impor- tant to the call. How do you look at these mes- sages while running lights-and-siren? Pilots have the same problem. Airlines initially made a mistake in how they handled this. The pilot flying was called just that, the "pilot flying," while the other pilot was the "pilot not flying." These were the official terms! But it generally implied that while one person was working (flying), the other one was not engaged. Sometimes this was the case! Now we use the terms "pilot flying" and "pilot monitoring." This terminology suggests both pilots are active. Similarly, there have been occasions when the person driving the ambulance or fire truck has been doing everything: conducting radio calls, reading text messages, looking at the map, all while the person next to them is dis- engaged. Let's be honest, four firefighters in a truck going lights-and-siren to a scene can get crazy. Are they reducing their driver's workload, or are they a distraction—telling stories, the latest joke, complaining about somebody? How about EMS ride-alongs? Those days of others in the vehicle distracting the driver need to stop. Now ask yourself, where is the radio handset located in your unit—next to the driver or the right seat of the cab? When we get a radio call from dispatch, there's a powerful urge to answer it. Some really important information might be available. But here's where you work together: Let the driver drive with both hands available while the other person answers the radio. You work as a crew. How does a pilot handle a text message while taxiing a plane? The pilot monitoring would simply say, "I'm heads-down." This tells the pilot flying that he will evaluate the message and be briefly unable to look out the right side for traffic. When he's done, he'll brief the pilot on the message. It is common to hear in the cockpit "heads-down" and "I'm back with you." These are clear communi- cations between two people. What about looking down at the map? Same thing: just announce it. Everyone is engaged, and no one is distracting. Permission Denied The next part of the aviation regulation is important. (b) No flight crewmember may engage in, nor may any pilot in command permit, any activity during a critical phase of flight which could distract any flight crewmember from the performance of his or her duties or which could interfere in any way with the proper conduct of those duties. What does this mean? The rule applies to everyone, including, for us, the firefighters in the back of the fire truck, the ride-along in the ambulance and even the dispatcher. But in any ambulance, fire or aeromedical call, there is someone in charge. In an airplane it's the PIC (pilot-in-command). The person who is in charge shall not permit others to distract. How do you handle this in the real world? If we were flying and about to begin our approach and a third pilot said, "I just realized we might be able to make the game tonight!" as the PIC (likely with a touch of irritation in my voice), I'd say, "Sterile cockpit reminder." If it happened again, I would say "Sterile cock- pit," followed by a meeting after the flight to decide what level of corrective action or train- ing needed to be applied. What should you do in this situation in EMS? In the beginning you will do well just A TOOL ANYONE CAN USE When else are we sterile crew? Here's the beautiful thing: Anybody can call it, any time. If you see a situation developing in which you want everyone to pay attention and perhaps listen to some radio traffic from other units that need help, just call "sterile crew." You've been working a tense cardiac arrest for 20 minutes and someone expresses some dark humor? Snap the focus back to the task with "sterile crew." Sort out the problem later. Maybe the conversation has suddenly gone in the wrong direction with family members present. It's a quick and easy way to call a halt to it. Sterile crew can be very short duration. For example, your partner is outside helping you back up the unit at the hospital, and you are literally the only one in the truck. Don't make calls to dispatch as you back up. Or perhaps you're going to unload the patient from the back—stay in the game; sterile crew applies. —Dick Blanchet