Date: 201205
Local time of day: 1801-2400
Location: ZZZ.Airport, US
Flight conditions: Marginal
Weather elements / visibility: Thunderstorm
Light: Night
Aircraft: Eurocopter AS 350/355/EC130 - Astar/Twinstar/Ecureuil
Operator: Air Taxi
Operating under: Part 135
Mission: Ambulance
Flight phase: Parked
Reporter organization: Contracted Service
Reporter function: Captain; Pilot Flying
Human factors: Workload; Time Pressure; Communication Breakdown
Anomaly: Deviation / Discrepancy - Procedural Published Material / Policy
Detector: Person Flight Crew
When detected: Other Before flight
Result: General None Reported / Taken
Contributing factors: Procedure; Weather; Manuals; Human Factors; Company Policy; Aircraft
Primary problem: Procedure

Narrative: We met in the hangar and prepared to launch. Mission parameters; including possible destination hospitals; were discussed. [X] County protocol dictates that trauma patients with burns are flown to the nearest trauma center. Patients with burns only; are flown to Hospital [X]. At the time the initial call came in; the patient's actual condition was yet to be determined. The first responders had not yet arrived. When I checked the weather; the radar showed a huge thunderstorm [near] the potential LZ. This storm was part of a large system; moving from the southwest. At the time the call came in; [the area] was covered in a large level 3 to 4 thunderstorm. Hospital [Y] was open. It was also the alternate hospital if [Hospital X] was weathered out. Medics indicated that they wanted to adhere to the protocol and preferred [Hospital X]. At this point; and up until launch; the PIC had neither rejected nor accepted the flight. I had only outlined options and solicited medic preferences. None of the medical crew indicated that I should 'just launch and Go to [Hospital Y].' More information was required. It is important to note that the PIC is not directly involved in communications with the [X] County Dispatcher. This is handled exclusively by the medics. The PIC can simply advise the medics; on Go; No-GO; or GO with conditional options. The PIC does not accept a flight. He can only reject a flight if; in his judgement; [Operating Manual] & FAR parameters are not met. Based on the facts available; I decided that we would need 30 gallons of additional fuel to proceed. Contingency fuel would be prudent in case we encountered airspace clearance problems; had to circumnavigate weather; or hold near the hospital; waiting for the weather to clear. Additionally; I wanted extra fuel to go back to the alternate hospital or hold nearby if the storm near the scene LZ delayed initial landing. Fuel = options. Since the patient report lacked detail and; statistically; we only fly about 30% of the Alert-1 calls received; I decided to wait for more facts before pumping an additional 30 gallons. If the call canceled; or the patient had trauma; the additional fuel would not be necessary and would seriously reduce the useful load we could fly from the base on a subsequent call. De-fueling would require nearly an hour's flight to burn off at significant cost. Just in case; I readied the fuel truck and laid the hose next to the helicopter to expedite the fueling process. As I asked the medics to request a first responder ETA; someone on the net requested that we pre-launch. I repeated the request for their ETA and was told about four minutes. Since the fuel decision was important; if not critical; I elected to wait for first responder arrival before launching. My priorities are crew safety; patient welfare; customer support and cost in that order. Transporting the patient to the preferred hospital outweighed the negatives of a short delay. I felt that proceeding to the intended destination without contingency fuel was imprudent; unwise; compromised safety and was possibly in violation of 135.69; and the [Operating Manual]. Based on my considered experience; I thought my decision was the best balance of safety concerns; regulatory requirements; patient outcome; and costs. When the word came in that the passenger was a burn only; I quickly fueled the helicopter and launched within a few minutes. After the passenger was loaded; we proceeded south and watched the thunderstorms dissipate on the radar allowing us to get into Hospital [X]. The mission was completed without further incident. AFTERMATH: The Base Coordinator asked that [I] respond to an inquiry from the EMS Chief who was concerned about the fact that I had delayed a launch after being told to do so. I responded that the customer merely makes transportation requests; they do not have the ultimate authority to order a launch. That authority rests solely with the PIC under FAR 135.67 and the [Operating Manual]. I explained my decision; informed him that I stood by my decision and told him that the Chief was welcome to discuss it with me if he had any further concerns or questions. I was later told that the Chief disagreed with my assessment. I expressed my displeasure; informing the coordinator that neither the Chief; [X] County Dispatch or anyone other than the Certificate Holder; may exercise operational control over the [flight] program. (See FAR 119.9; 119.43; 135.79 and Operating Manual) To wit: 'Only a PIC who is a direct employee of [Corporation] may exercise this second tier Operational Control over any [Corporation] flight.' 'At no time shall any non-certified entity attempt to exercise Operational Control nor hinder in any way; [Corporation] oversight and/or exercising of Operational Control...' 'The...call center (County Dispatch or Command) has no authority to override the authority of [Corporation]; or the pilot's authority to refuse any mission; or other flight safety issues. At no time during a response to a medical flight will speed into action criteria be allowed to compromise safety. Failure to adhere to the certificate holder's directions and instructions may be subject to legal enforcement action by the FAA.' My actions also complied with FAR 135.23; 135.25; 135.65; 135.71; 135.209. [Corporation] Risk Assessment Program was also utilized. Operating Manual Condition for patient leg was indicated to be 'C.' [Operating Manual Requests for Service states: 'No attempts should be made by the Communications Specialist (in this case County Command) to question the pilot's judgment in denying a flight request.'Suggestions: Since I am now being 'questioned' about my decision(s) by the customer and my supervisors contrary to the [Operating Manual]; the issue of operational control needs to be addressed. If this isn't an operational control issue; then I don't know what is. Being questioned and second-guessed about conservative; pro-safety PIC decisions constitutes pressure to fly. Therefore it is a serious (indeed major) safety of flight issue which needs to be addressed at the highest level of management.




Synopsis: Contracted EMS helicopter pilot was questioned by the customer regarding a delayed takeoff for trauma patient pickup and delivery to a hospital. Pilot maintains that he acted in accordance with FAR's and the company Operating Manual in making his decision based upon safety of flight considerations affected by weather and fuel requirements.