E = External Pressures Helicopter Emergency Medical Service (HEMS) operations,  unique due to the emergency nature of the mission, are  an example of how external pressures influence pilots.  Emergency medical services (EMS) pilots often ferry  critically ill patients, and the pilot is driven by goal  completion. In order to reduce the effect of this pressure,  many EMS operators do not to notify the EMS pilot of  the prospective patient’s condition, but merely confine the  location of the patient pickup and restrict the pilot’s decision- making role to the response to the question “Can the pickup  and transportation to the medical care center be made safely?”  Risking three or four lives in an attempt to save one life is  not a safe practice. The use of personal standard operating procedures (SOPs) is  one way to manage external pressures. The goal is to supply a  release for the external pressures of a flight. These procedures  include, but are not limited to: External pressures are influences external to the flight that  create a sense of pressure to complete a flight—often at the  expense of safety. Factors that can be external pressures  include the following: The following accident offers an example of how external  pressures influence a pilot. Two pilots were giving helicopter  demonstrations at an air show. The first pilot demonstrated a  barrel roll in front of the stands. Not to be outdone, the second  pilot (with passengers) decided to execute a hammerhead type  maneuver. Flying past the stands at 90 knots, the pilot pulled  the helicopter into a steep climb that ended at about 200  feet. When the speed dissipated to near zero, he rolled back  to the ground in a nose-low attitude to regain airspeed with  the obvious intention of pulling the aircraft out of the dive  near the ground. An error in judgment led to the pilot being  unable to pull the helicopter out of the dive. The helicopter  struck the ground, killing all onboard.  The desire to impress someone can be a powerful external  pressure, especially when coupled with the internal pressure  of pride. Perhaps the pilot decided to perform a maneuver  not in his training profile, or one in which he had not  demonstrated proficiency. It appears there was nothing in this  pilot’s experiences to help him effectively assess the high risk  of this maneuver in an aircraft loaded with passengers. It is  not uncommon to see people motivated by external pressures  who are also driven internally by their own attitude.  The key to managing external pressure is to be ready for  and accept delays. Remember that people get delayed when  traveling on airlines, driving a car, or taking a bus. The pilot’s  goal is to manage risk, not increase it. Risk can be identified and mitigated by using checklists such  as PAVE and IMSAFE. Accident data offers the opportunity  to explain how pilots can use risk management to increase  the safety of a flight. Management of external pressure is the single most important  key to risk management because it is the one risk factor  category that can cause a pilot to ignore all other risk factors.  External pressures place time-related pressure on the pilot  and figure into a majority of accidents.  Chapter Summary Change 1 (January 2016) 3-9 • Eliminate pressure to return home, even on a casual  day flight, by carrying a small overnight kit containing  prescriptions, contact lens solutions, toiletries, or other  necessities on every flight. •  Manage passenger expectations. Ensure passengers  know that they might not arrive on a firm schedule,  and if they must arrive by a certain time, they should  make alternative plans. •  Advise those who are waiting at the destination that  the arrival may be delayed. Know how to notify them  when delays are encountered.  • For really important trips, plan to leave early enough  so that there would still be time to drive to the  destination. •  Have alternate plans for a late arrival or make backup  airline reservations for must-be-there trips. •  Allow time on a trip for an extra fuel stop or to make  an unexpected landing because of weather. • Someone waiting at the airport for the flight’s arrival • A passenger the pilot does not want to disappoint • The desire to demonstrate pilot qualifications • The desire to impress someone (Probably the two most  dangerous words in aviation are “Watch this!”) • Desire to satisfy a specific personal goal (“get-home- itis,” “get-there-itis,” and “let’s-go-itis”) •  A pilot’s general goal-completion orientation •  The emotional pressure associated with acknowledging  that skill and experience levels may be lower than a  pilot would like them to be. (Pride can be a powerful  external factor.)