I bring you a weekly bite-sized chunk of the science behind helicopter human factors and CRM in practice, simplifying the complex and distilling a helicopter related study into a summary of less than 500 words.
TITLE:
Mental health & resilience in crews of Emergency Medical Service helicopters: Load analysis of stressful missions.
WHAT?
Study examining how often HEMS crews are exposed to potentially traumatic or highly stressful missions and whether they subsequently use formal psychological support services. It also explored whether existing organisational resilience measures, such as CRM, peer support and debriefing, may help crews cope with operational stress.
WHERE?
The research was conducted within DRF Luftrettung, one of Europe’s largest HEMS organisations, operating across Germany, Austria, Switzerland and Liechtenstein.
WHEN?
Published in 2026 in Frontiers in Psychiatry. Data covered a two-year period from August 2022 to September 2024.
WHY?
HEMS personnel routinely encounter traumatic events and operate under intense operational pressure, increasing the potential risk of burnout, PTSD and reduced performance. Although many organisations provide peer support and psychological services, little is known about how often these resources are actually used or what factors help crews remain resilient.
HOW?
Retrospectively analysed operational and safety records from 52,266 primary rescue missions, identifing 1,383 potentially stressful events using emergency physician records, safety reports, a logbooks and peer-support records. Stressors included life-threatening paediatric emergencies, suicides, violent crimes, serious operational incidents and human errors with significant consequences. The study then measured how frequently crews accessed available psychosocial support services following these events.
FINDINGS:
During the study period, crews encountered 1,048 serious paediatric emergencies, 216 suicides or suicide attempts, 73 violent crimes, 38 critical or near-miss operational events, and 6 serious human-error events.
Despite high exposure, only four crew members sought formal psychological support (less than 1% of identified stressful events). The authors suggest this may reflect high levels of resilience, effective informal coping within crews, or reluctance to seek help.
They identify regular CRM training, crew debriefing, teamwork, Just Culture and a supportive organisational climate as likely protective factors but acknowledge that under-reporting cannot be excluded.
SO WHAT?
This study reinforces the growing view that resilience is built as much through organisational culture as individual coping skills.
The findings highlight the value of CRM beyond operational coordination. Regular debriefing, psychological safety, trust and supportive leadership may help crews process highly stressful missions before formal intervention becomes necessary.
However, the very low uptake of support services should not automatically be interpreted as evidence of good mental health. It may equally indicate stigma or under-reporting. The authors therefore recommend more qualitative research into how HEMS crews experience stress and which organisational practices genuinely strengthen resilience. The study supports an increasingly proactive approach to mental wellbeing as a core component of human performance and flight safety.
REFERENCE:
Ziehr, S., Kramer, F., & Pracz, K. (2026). Mental health & resilience in crews of emergency medical service helicopters: Load analysis of stressful missions. Frontiers in Psychiatry, 17, 1768489. https://doi.org/10.3389/fpsyt.2026.1768489
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