Approaching the scene from the air offers considerable advantages over a road response. The entire Helicopter Emergency Medical Service (HEMS) crew (of which the pre-hospital and retrieval team (PHR) are an integral component) should utilise this opportunity to both study the incident scene from above and ensure all potential aviation hazards are communicated clearly and briefly. This should be done by referencing a clock face (where the nose of the aircraft is at 12 o’clock) and using the terms ‘high’ or ‘low’ to point out hazards. Landing site selection is at the discretion of the pilot, who is ultimately responsible for aircraft safety. A landing site may be pre-arranged with on-scene emergency services to facilitate landing but the final decision always rests with the pilot.

Key points (note many of these in the above scene) to look out for from the air in the HEMS environment are detailed in the box below.