Healthcare is often compared to the aviation industry, but working in acute care is more like putting out fires than flying commercial planes.

This is the message delivered by geriatrics and acute general medicine Dr David Oliver, who writes in the BMJ that while medicine can learn from commercial aviation’s relentless focus on safety – and its in-built protection of staff of reporting concerns – the comparison ignores important and stark differences between the two sectors.

Where modern aviation is an “inherently safe activity” dealing with a generally well population, acute healthcare deals with the unstable, the sick and the dying.

“And no number of protocols or checklists can eliminate all common harms and incidents,” he writes.

Another crucial difference is that commercial airline companies can ditch unprofitable routes, while acute healthcare settings “must continue to soak up relentless demand…..no matter what key parts of logistics might be broken”.

And while planes simply won’t take off without a full complement of crew members, “in the acute NHS we frequently do the equivalent of taking off with the co-pilot missing and two of the cabin crew absent”.

“I’d say that acute healthcare has a lot more in common with firefighters – including those attending a stricken plane after an emergency landing – than with scheduled flights.”