HEMS crash.

[alouette3]

An EMS EC135 crashed last night in Wisconsin, USA. All three on board were killed.
Thoughts and prayers with the ones left behind.
Alt3.
http://www.nbc15.com/home/headlines/18842074.html

[Aser]

In the last years, HEMS at night in EEUU seems to be one of the most risky bussiness...

R.I.P. :(

[SASless]

The aircraft was owned by Air Methods, INC., the pilot was employed by AMC and the medical crew were employees of the medical facility.

Weather reports about the time of the crash reported to be:

Here are the METARS for around that time frame:

METAR KLSE 110253Z AUTO 00000KT 4SM -RA BR SCT013 OVC035 10/08 A2972 RMK AO2 RAB0154 SLP063 P0004 60008 T01000078 56015

METAR KLSE 110353Z AUTO 00000KT 8SM -RA FEW014 OVC050 10/08 A2970 RMK AO2 SLP056 P0008 T01000078

SPECI KLSE 110430Z AUTO 04004KT 6SM -RA BR BKN014 BKN032 OVC050 09/07 A2968 RMK AO2 P0003

METAR KLSE 110453Z AUTO 00000KT 6SM -RA BR SCT014 BKN032 OVC048 09/07 A2967 RMK AO2 SLP048 P0005 T00940072

SPECI KLSE 110541Z AUTO 35004KT 7SM -RA BKN014 OVC030 09/08 A2966 RMK AO2 P0001

METAR KLSE 110553Z AUTO 01004KT 7SM -RA BKN014 OVC030 09/08 A2966 RMK AO2 SLP044 P0002 60023 T00940078 10117 20094 401720067 56018

The terrain in that area is about 1100 FT AGL

Ground search crews were hampered by dense fog which obscured the elevated terrain.

[Gomer Pylot]

Is there any indication of whether they were IFR or VFR? The EC135 is a very capable SPIFR machine, and if I were flying it at night in marginal weather, returning to base at an airport, I would almost always file IFR, even with good weather, just for the practice. I have no details at all on this accident, though. If I understand the press releases correctly, they were about 4 miles from their home base, but I'm not certain of that.

[alouette]

I think SPIFR puts the pilot under an enormous stress load in inclement weather. However tragic, I look forward for the NTSB report.

[Oogle]

Ground search crews were hampered by dense fog which obscured the elevated terrain.

That may have been a contributing factor. The actual temp and dew point temps were very close together on the METARS that you posted.

A sad day and I wish it didn't happen.
:(

[bb in ca]

Sasless wrote, "The terrain in that area is about 1100 FT AGL."

You've got me stumped on this one. Did you mean 1100' ASL or maybe that terrain around the airport is 1100' AAE.

Regardless, it's sad news but what's really sad is that it's not a surpise and with the current mentality in US medevac helicopter operations and current FAA regulations it won't be a surpise next time either.

bb

[SASless]

Late night post....and did not catch the elevation error!

I believe what was being implied was the higher ground between the takeoff point and the destination rose 1100 feet above the takeoff point.


Tragic as this accident is....as all are....the FAA changes to operational control and weather review by operators has made a difference in the accident rate for EMS operators.

I posted the weather without comment as I felt it would be useful to those who care to examine such tragic events with an eye towards trying to understand how something like this can happen....perhaps to them in the future.

The value of a CVR and data recorder's value to investigators cannot be over stated.

Perhaps what is needed now is a recorded telephone line at the operators dispatch office so investigators can hear the conversation between the pilot and the person exercising operational control over the aircraft.

[Gomer Pylot]

That's already very common. Most dispatch phone lines, at least for larger operators, are recorded 24/7, as are the radio communications. I'm pretty sure Air Methods records theirs. I have no idea whether he called in to dispatch before launching back to base.

I agree with Flungdung - SPIFR is far less stressful, and often less busy, than trying to scudrun in the dark, at least for me.

[imabell]

hi sasless,

not trying to be smart but isn't it the pilot who, in the end, exercises operational control over the aircraft???

i am certainly not speculating on this tragedy but taking history into account i hope there are lots of alarm bells ringing.

another case of the rescuer becoming the victim.

i'm with you oogle, i wish it didn't happen.

[remote hook]

When are the Americans going to figure out that SPIFR in helicopters isn't worth it??? The EMS accident record is appalling.

Condolences to all involved.

RH

[SASless]

Under FAR Part 135 require an Operator to maintain operational control over all aircraft and flights. In the past that was ignored by both the FAA and Operators less Operations Manuals and 135 Ops Specs setting forth the weather minima and related information by which the Pilot-In-Command was to conduct the flight.

After several years of high loss rates of aircraft and personnel the FAA was criticized by the NTSB and industry critics for failing to ensure Part 135 Dispatch requirements were being complied with. That brought about the creation of centralized dispatch centers for the various EMS operators.

Since that occurred, the EMS accident rate has improved greatly.

Industry practice has been to consider the EMS flight as Part 135 (Air Taxi rules if you will) but revert to the more liberal Part 91 (Non-commerical rules) for the flight home after dropping off the patient(s). The weather minima for Part 91 regarding night flight and weather minima are much less restrictive than under Part 135.

Picking a stat off the top of my head....if my memory serves me right....80% of fatal accidents occur "after" dropping off the patient and as the aircraft is on its way home or to a refuelling point prior to the flight home.

CFIT accidents resulting from indavertent IMC while operating VFR continue to plaque the industry for a number of reasons. We have a lot of "dark" areas with few or no weather reporting thus unexpected weather can be a direct result of that. Throw in uneven terrain and no NVG's....and the trap is set.

Despite some operator's propaganda...."IFR" programs sometimes really are not as the budget does not provide adequate training or opportunity to stay "current and proficient" although by means of a checkride to minimum standard every six months makes one legally "current".

There is a world of difference between doing a practice approach on the way to the fuel point without screens or foggles and encountering IIMC at night while being only legally current.

Planned SPIFR beats heck out of scud running but as an industry that is what happens more often than not. Being fully equipped....including training and real currency is the cornerstone of SPIFR but that is the hard part to maintain in a working EMS operation.

The price we pay for falling short of the mark is dear.

[Old Skool]

That is the key, as SASLess says, the difference between current and proficient can be huge, the extra stability gadgets of an IFR ship can help but again if they are not regularly practised can be possible hinderence or distraction.

[alouette3]

Old Skool:
Could'nt agree with you more. It should be required for pilots at an IFR program to conduct a full IFR flight by day and night once during every shift ,if not more,irrespective of the weather. This will increase familiarity with the equipment, the air traffic system and the process. A bi annual check ride certainly keeps you legal but not necessarily safe.

[SASless]

The lost aircraft had landed at another HEMS operation to unload the patient they had been dispatched to carry. I wonder if there was any contact between the two crews. If so, I would bet there would have been some discussion about weather if only to invite the visiting pilot to the office for a weather check and cup of coffee.

An interesting question.....what if you landed to drop off a patient and while shut down you discovered the host operation had cancelled flight operations based upon the existing weather? Would you takeoff or beg a bed for the night until weather improved?

Just what-if'ing here....not making any suggestions regarding the accident in question.

[Devil 49]

My understanding is it was an IFR EC135 enroute home at 2230 local (2-3 hours after sunset) from a refueling stop at the KLSE for the leg to Madison WI, after transporting a patient to La Crosse.
The topos of the area show hills rising approx 500-600 feet above the airport of last departure, approx 4-5 miles from the airport, roughly N-S, course roughly SE. Very little cultural lighting indicated on the charts in the area of the hills, 5-10 miles across and wooded hills probably obscuring what little might have been there. City of La Crosse West of hills, small towns/lightly populated farmland East, going from light into dark, with little to see across the hills.
A direct line from KLSE to Madison goes across the area of the crash, with a local roadway in the valley bottom, elevation rises 300' or so either side. The "talking heads" report impact near the top of one, wreckage down the slope.
I'm suspicious of the METAR, as some of the automated obs I see bear little resemblance to the cockpit view. I understand that there's software that averages the trend and reports a calculated number for vis. Viewing public sector loops for clouds shows bands E-W moving North into the area about this time.
Before y'all get all bent around IFR, equipment, proficiency and requirements, and given I've never flown in the upper Midwest:
It's VFR/MVFR 95% of the time where I am. When it's IMC, it would take longer to file and fly than transport by ground, so there'd be little obvious revenue gain/business justification.
IFR capability increase the safety of the leg home, if I stayed current and proficient. I wouldn't be able to stay current in normal ops, I'd have to do training legs w/safety pilot, prohibitive as we have staffing issues now. Requiring IFR would eliminate most programs here for very little real gain. Besdies which, I can recover to base a lot cheaper by ground than training costs alone (one time in the last year, for example).
As to the reported crisis in US EMS, I don't have the numbers, but my guess is that we're safer than air taxi as a whole. Air ambulance accidents make good press, and, largely, are fairly well equipped and staffed. Nights and recovery legs do feature far too heavily in the accidents reported for me to be casual about that. It's interesting that the last two fatals in the company were IFR Twins, late day/early night, attempting the return to base VFR, and perhaps encountering weather. Were they both at the end of a long day shift? I don't know.
I've never been pressured in any way to complete a leg in 7 years with the company, period. Management, at every level, will come down like the proverbial ton of bricks on anybody disputing an abort/decline.
I detest the "talking box" fix. Give me a well equipped airframe; good, timely data; Night vision goggles; and night scheduling with scientific, physiologic considerations.

[WhirlwindIII]

"If one thinks safety is expensive, try the price of an accident" (no idea who coined it).

I've been taught the total average cost of helicopter accidents is 10 times the obvious direct loss/es. Should make decisions easy about IFR ops, currency, etc.

It's in the math.

[Gomer Pylot]

Having an IFR machine for EMS is an advantage for a few programs, not so much for others. It depends on how the program is run. If the program does almost all transfers, between large cities, then it can work. If the program is doing mostly scene flights, it makes no sense at all, because you simply cannot file IFR and do a 10 minute, or shorter, flight to a scene, and then to a hospital, under the present setup. Having an IFR aircraft just for the return home simply makes no economic sense. I think the pressure to fly any time for EMS has gone away, and the only pressure on the pilot is what he places on himself. Gethomeitis is as strong in EMS as in any other sector, I believe. I don't know how to eliminate that, or to insure good decision making all the time. Good judgment comes from learning from bad decisions, and if we're lucky we survive the bad decisions we make and learn from them. If we're not, the bad decisions kill us. Night flight requires more concentration and care, but people get sick and injured at night, and if we want to provide the care, we have to fly at night, or else just shut down all night operations and ignore the sick and maimed, as they seem to do across the pond. Helicopters are not raining from the night sky here. There are far more EMS helicopters flying in the US than there are helicopters in Europe, and an accident a year, or fewer, isn't that surprising. The US has decided, for better or for worse, that the benefits outweigh the costs, and night flights will continue. We just have to be very careful about conducting those flights. I don't think company policies or hospital pressure has much to do with it any longer, it's just a matter of making the pilots realize that they aren't lifesavers, they're just moneymakers for the companies. That's the hard part.

[Swart Baard]

We are a SPIFR HEMS program and have been for the last 14+ years. Personally I have flown for 6+ years DPIFR on the NSea and the last 10+ yrs SPIFR HEMS USA.
SPIFR at night is far more comfortable than SPVFR at night. We recently went from a SPIFR EC145 to a SPVFR BK117, and not having the ability to go IFR if neccesary was a little nerve racking. However if one adjusts ones personal minima and behaves more conservatively then it can be done safely.
R H I am curious about your background. Do you have any SPIFR experience?

[WhirlwindIII]

FAA have advocated for years that pilots get their instrument rating and keep it current, both fixed and rotary wing. Why operators are not interested in this, across the board, is obviously economic, but also somewhat naive.

Considering night EMS is certainly a bit hectic at times being IFR current provides a much safer option for those night flights that wind up involving unanticipated weather.

The big deal about taking an operation IFR is not how many IFR flights one makes for an EMS operator, it's the number of VFR flights that go on the basis of having the ability to bail out IFR if necessary. The straight forward IFR flights emerge as a matter of course.

Properly managed (i.e. dispatched, followed, supported in real time etc.) HEMS SPIFR should enable return on investment, greater safety, and greater completions for the sake of patients and business.

I think it's all a matter of time before SPIFR becomes a night requirement.

[Old Skool]

I think i would rather NVG became a night requirement, that may change though if ADS-B and WAAS delivers as promised. The infrastructure right now only really suits the airlines. The aircraft in question i think was an IFR ship, should we be more focused on NVG, it doesn't help in inadvertant IMC but wouldn't it make a bigger safety improvement for the buck.
I read that AM said NVG are in short supply because of the war and would have used them if they were readily available.

[WhirlwindIII]

I heard NVGs were in short supply as well. ADS-B and WAAS (with LNAV/VNAV and LPV DA, etc.) are excellent as well (I'm very familiar with both), plus, airborne satellite communication to a reliable dispatch center.

The IFR option should be standard. Gives pilots a real chance excepting lines of T-storms and icing. As to airlines dominating the ATC system, that is true, but it is changing slowly with the advent of GPS low level routes; some in metropolitan areas, others in more remote regions.

When one uses the callsign LifeGuard here in the states the airlines get NO priority. Decades ago I came from the end of Long Island under LifeGuard status straight to 34th St. heliport in Manhattan (patient destined for the hospital across the street). ATC made holes all the way to include arrivals at JFK and departures from LaGuardia - needless to say this was a very serious patient. ATC made no bones about doing it.

[Gomer Pylot]

I would also like NVGs, but they are in short supply. I doubt I'll see them before I retire. I also don't believe SPIFR will be required in the US in the foreseeable future. Too many politicians have been paid off, and will be in the future, although I doubt it's even necessary. This isn't a priority of any influential politician, there are too many other things biting them in the butt, and it would take Congressional action to bring it on. Ain't gonna happen any time soon.

[500e]

"Cynic" :(

[eurocopter beans]

To maintain safe currency in the SPIFR environment in a machine like the ec135 what are the requirements imposed by HEMS companies. Im thinking about how many approaches (precisison/non precision, & transits etc)??

[alouette3]

Beans:
Most companies play it by the book:i.e. the FARs. This typically involves a full IFR check ride every six months and to maintain currency, the pilots are required to do at least six approaches every six months ,track a VOR, etc.
All this keeps them current but does it keep them proficient? IMHO, helicopter pilots are very comfortable at 1000 agl. And since the use of the IFR system(aircraft equipment and ATC) is sporadic, there is a tendency to avoid IFR as far as possible.It is all about the comfort level of the pilot flying IFR.Our airline counterparts get into that mode right from day one. That is a cultural difference that will take time to eliminate. Meanwhile, a quick easy fix would be to mandate NVGs and TAWS for all VFR operations and if the helicopter is IFR capable then it should be mandated to fly IFR all the time. Which means, that if an IFR program is requested for a patient transfer, they should file and fly IFR irrespective of the weather.This will not eliminate crashes(after all ,the scene work is still going to be mainly VFR for the forseeable future) but it will go a long way in reducing the number of accidents which have that "continued VFR into IMC" sting in the tail.
Alt3.

[WhirlwindIII]

alouette3

Good stuff.

I agree with you in respect to TAWS, and perhaps NVG. I also agree in principle reference full time IFR but in practice mandating HEMS IFR everywhere will not be taken lightly by the medical industry, or relatives of patients, considering the delay to patient care that provides.

As to SPIFR HEMS I look more to monthly mandatory simulated or actual IMC/IFR time with a training captain, desktop simulators or greater, etc. etc.

No doubt being a SPIFR EMS helicopter pilot is very serious business and more difficult than lining up with another fixed wing airline crewmember on 27L for yet again, another IFR sector.

There are macro issues concerning the interplay between management and pilots, medical crewmembers and pilots, etc. etc. but the bottom line is that if the pilot does not have the training and equipment to deal with what weather he/she gets dealt out in the flying environment the results can be dire.

IMHO the recent decrease in HEMS accidents has less to do with operational control and perceived dispatch interplay than it does to the vast increase in VFR minimums operators have adopted/been forced to adopt.

WIII

[SASless]

Alouette sums up the situation very well. If VFR night weather minimums were set to a safe level and NVG's were introduced into the system then we would see far fewer accidents at night. Perhaps WIII's statement confirms part of that when he talks of operators having to adopt higher weather minimums since the FAA changes have been implemented.

[WhirlwindIII]

SASless

I agree.

Seems things are pointing towards the full package of SPIFR, TAWS, NVG, etc. as the answer; eventually.

Only fly in the ointment is the statistical fact single engine helicopters are seen to be no more dangerous than twins (although it appears that is a very general and broad crunch) therefore major operators are reequipping that way (particulary with Long Rangers and B2 A-Stars) - point being, who wants to fly a HEMS Single Engine SPIFR? I know early D-Model A-Stars had SAS and autopilot available but not sure what the possibilities are for that machine these days, or the extent to which it would impact available load.

Time will tell!

WIII

[SASless]

The one vice more engine debate re IFR/IMC does get confusing. Is it the redundancy the second engine (or more) brings by having a second generator or the ability to continue flight following a single engine failure which by definition single engine aircraft cannot do?

I am of the mindset the twin engine, fully IFR kitted aircraft, combined with training and experience both accumulated and recent to effectively continue flight in IMC conditions (whether intentional or inadvertent) is the answer.

Without the training and experience all of the fancy gadgets in the world will not prevent bad things from happening. The flip side of that coin is without sufficient equipment on the aircraft....no amount of experience and training will overcome that and then too bad things happen.

Add in the collateral issues of weather reporting, landing aids, communications, operation safety culture and all the rest have to be in place as well.

Therein lies the challenge to the HEMS industry....how to accomplish all that and do so in such a fashion as to remain economically viable.

Perhaps there is a compromise between the UK/EU models and the US models that ought to be considered. The US view of providing 24/7 service of equal capability might need modifying.

At least under the US FAA system there is the flexibility to be able to accomplish that as compared to the very highly restrictive UK/EU/JAR/EASA system.

I for one would much rather be in the USA when I have my life threatening experience and need emergency transport to a Trauma Center. If that need is at night......there is no comparison between the US system and the UK system that gives one comfort about the availibility of HEMS service at night if you are not in the USA.

[WhirlwindIII]

Certainly the devil is in the collateral details which historically operators have been reluctant to delve in to.

I want nothing to do with SE SPIFR.

If one doesn't know how to use all the gadgets, and when to use them, etc. the best of equipment becomes a liability rather than an enhancement. Kinda like flying with a really dim copilot - negative synergy.

I'm not familiar with the UK HEMS system/s but worked eight years over there so know the lingo. From what I see US adoption of the JARS is a painfully slow thing, but we're getting there. I am reasonably fond of the UK way of doing things.

[hostile]

Hello folks,

If you really looking for safety in HEMS operation, all should have both of them. NVG without IFR knowledge and skills might cause problems also. Think, if you are in the middle of somewhere and you are loose your NVG expectedly. That's happen in real life occasionally. You might have inadvertment phenomenom and to fix this situation, you need to have some way out.

For my opinion; ME SP(or MP)IFR with NVG. No money, no funny.

Hostile:ok:

[Shawn Coyle]

If we look at the majority of HEMS accidents, we see most of them happen at night in less than ideal weather conditions, and when returning from dropping off a patient.
People run into things they can't see in time to avoid.
Fitting a TAWS system with accuracy suitable for helicopter operations would help prevent that (it's been done in tour helicopters in Hawaii, and they're definitely VFR)
Making people fly dedicated routes with specific altitudes at night would also go a long way to reducing accidents.
And didn't the FAA just change the rules about what visibility requirements are at night??? What happened in this accident vis-a-vis those new rules?

[Gomer Pylot]

The FAA changed the rules? When? What rules exactly? I haven't seen anything about it. Our ops specs haven't changed, and I've seen no changes to Part 135. What do you know that I don't?

[SASless]

Gom,

The "rules and regs" have not changed per se....but attention to them has. Also an OpSpec change has the effect of a rule change in that it sets forth specifications the operator must adhere to in its conduct of air operations.

The rule change being referred to is actually the increased oversight the FAA has mandated be done to ensure operators fully comply with existing FAR's and Op Spec's.

[WhirlwindIII]

SASless et al

Essentially correct. It seems many operators are now using 800/2 & 1000/3 for day local and cross country, and higher than that at night for VFR HEMS.

The minimums pretty much beg IFR with airborne approach funtion to point in space and ADS-B to ATC, etc. It'll come in due time. The problem I see is this influx of single engine helicopters to HEMS here in the US. I can't see the industry going IFR with them.

To my mind there is not a lot of good macro thinking going on - mostly competitive thinking betwixt operators to see who can be cheaper than the other.

WIII

[Devil 49]

The stuff that kills people at night hasn't changed since I started flying and I suspect, since people started flying: Stupid decisions, the consequences of which are amplified by not being able to see to avoid and adapt as the flight progresses. The same accidents at the same comparison rate, were occurring when I flew in Vietnam.
The military has made huge progress in overcoming the issues, some of their proven solutions are adaptable to the civilian world. There are considerable differences to be considered in adopting those to the civilian world.
First, NVGs. The major difference between day and night operations is the ability to "see and avoid", weather, mountains, wires, antennae, whatever- Day ops can see "it", night ops can't, and "it" kills.
I would love to have a second engine, half my flying life has been in multis. They're not the answer, safety-wise, without huge SOP changes, training and pay cost increases. Maintaining and managing the systems also introduces issues, and those issues, if not successfully dealt with make multis more dangerous than singles.
I would love to have SPIFR capability. That's just me, because there's NO business rationale to make it cost effective in my area. And, NO!, we don't launch with an IFR recovery as a potential resolution to IMC. In my area it makes no patient care/business sense whatsoever. We land when the WX goes below comfortable VFR. Consider- I understand that this accident was an SPIFR aircraft, Air Method's last fatal was an SPIFR, and most of the CJ crashes just before their sale were SPIFR...
Some of the other military solutions that aren't really adaptable-
Two pilot crews. This is the single most effective safety enhancement possible. Almost none of the US fleet would support it, especially with the "health-care crisis" (read as: somebody else should pay for it) and the resulting plunge to the bottom as costs are cut, so-called "equality of care" is ensured, and responsibility is broadly distributed to everyone else, which means, of course- nobody is actually responsible. But, I digress...
"Go pills" and "no go pills". The military can use them, we can't. That's fine, there is a huge difference in our mission parameters.
Which leads, finally, my one-note song: scheduling for nights. Pretend that lack of sleep, circadian disruption, and general fatigue are adequately addressed by the "10 hour of uninterrupted rest" regulation and you get what we have- pilots operating at the minimum state of alertness making the most challenging decisions of the job- Night ops.

[alouette3]

Devil49:
Great post.
The mystery of SPIFR capable helicopters crashing in IFR conditions would have to be solved by the human factors folks.There is an obvious gap that needs to be plugged there and needs involvement of the regulators ,operators and the pilots.
As to the night scheduling issue:could'nt agree with you more. The Part 121 ands 135 regs of the FAA are probably the most liberal in the world. Consider this: in a 90 day period a part 135 opearator can schedule me for 77 days of work with 8 hours of flying everyday and still be legal. Nobody does it ,but, they can. Most other countries have duty time regulations that are a lot more pilot friendly. Some have clauses about extra rest periods for flights originating or terminating after midnight.We need to look at that closely.
There are EMS bases around the US where it is not unusual for pilots to work 7 straight nights in a row and fly every night of the shift. I don't buy the fact that on the last night, at O dark thirty ,the pilot is not tired.While most companies talk the talk about take -yourself-off-the-shift-if-you-are-tired stuff, try doing that a couple of times and see what happens.The first guys to give you grief will be your fellow pilots.
The "tombstone imperative " forced the FAA to regulate duty time for HEMS operators. Maybe they need to look at the issue once again. Especially since, as Shawn rightly pointed out, most accidents happen at night.
Thoughts?
Alt3.

[hostile]

Good posts devil49, alouette3 and sasless,

I went through all these problems as a post holder in Europe past 5 years. It wasn't easy time for the company's, post holders, pilot's , CAA (JAA) or even financiers. Some times it went too far, but it will found its gold happy medium with a good result. How to interpret the new meaning of regulations was the main problem.

We all wanted to fly as safe as possible. CFIT caused by bad weather is the case I don't want to see anytime or any reason. The most difficult maneuver with HEMS helicopter is 180 degrees turn back! This is the case what all must accept without any accusation. Companies should have policy to give all support for pilot(s) in this situation.

If you think this is gonna be expensive, try accident.

Hostile:ok:

[Gomer Pylot]

IMO flying 7 straight nights and flying every night is safer than flying 3 days and then 3 nights, or vice versa. I find it far easier to fly nights if I stay on nights, and let my body adjust to that. I spent a number of years flying nights full time, and I far prefer that to rotating between days and nights. Constantly changing one's circadian rhythm is tiring and in the long run, dangerous in several ways.

[Old Skool]

I think a problem is lots of EMS pilots like the split shift because they are hoping for a quiet night and plenty of sleep, then they can enjoy the next day with the hope of a good nights sleep again. The problem arises when we have a couple of busy nights and we aren't fully adjusted still, not sleeping well during the day but still hoping for a quiet night.
I never sleep well on hitch and find i'm better off staying up and sleeping during the day, i'm not sure if i would like 7 nights straight.

[Shawn Coyle]

Just to add some fuel to this discussion - has there been any change to the unofficial statistic that 25% of helicopter pilots with autopilots don't use them?

[helmet fire]

This thread has some great discussions that are part of the debate we need to continue: SPIFR v DPIFR v NVFR v TAWS v EGPWS v NVG etc.

I believe that the industry has generally conquered most of the issues we are discussing here by using the appropriate method of removing and hazard or danger from a system:
1. Engineer it out.
2. If you can't: train to work around / cope with it, create SOPs, etc.
3. If you still can't remove the danger: analyse risk V gain to determine if you should be doing it.

I think we have ticked the engineering it out box to the best of our ability as an industry, though there are more improvements to come. I am a strong advocate of IFR and NVG but think we should be adding EVS (IR) systems too. We have engineered EGPWS and TAWS systems, point in space GPS procedures (though coupled helicopter ones should be introduced ASAP: see Nick L's repeated calls for this), we have fantastically reliable twins like the EC135, great 3 axis autopilot systems, and advanced planning tools.

It is the next area that seems to have let us down, and the training in particular. It is no good having a fantastic 3 axis autopilot equipped twin and then crashing it because your type rating is so poor that you cannot cope with malfunctions. Each person who claims that twins are more dangerous than singles is testament to this issue being one of our most pressing. Do we look at a version of the European model of type ratings requiring continual currencies? How many hours should a type rating be? etc, etc.

I think one simple step can immediately be introduced into world wide HEMS to make it better. The step originated in the EASA system and was implemented through a review of some Norwegian night HEMS accidents.

It is that there must be two pilots IN THE FRONT of all HEMS operations (day, night, ifr, etc). You may fill the second pilot's position with a "HEMS Crewmember" that must be trained to assist the pilot. In practice, that would be a crewmember with all the pilot theory completed, some basic flight training, and significant training on CRM and instrument interpretation.

This requirement has not burdened the Euro HEMS systems into oblivion. In my view it has made it world's best practice (no I am not European!). They often use a three man crew with the paramedic trained up to HEMS crewmember level and the doctor in the back. This system ensures two on board crew are trained to interpret the flight environment and naturally then a second person will have input into the mission decisions. Combine this with SPIFR machines and autopilots, EVS, NVG and TRAINING and I think we are getting there!

Let the debate continue..............

[FairWeatherFlyer]

SASless writes:

I for one would much rather be in the USA when I have my life threatening experience and need emergency transport to a Trauma Center. If that need is at night......there is no comparison between the US system and the UK system that gives one comfort about the availibility of HEMS service at night if you are not in the USA.

Isn't the irony here that as a knowledgeable PAX you'd welcome the (presumably prompter) medical attention and then if it was dark and the weather was **** might decline the ride back to the Center in favour of road based transport?

I'm puzzled as to the economics here. The insurance feedback loop normally fixes stuff like this (eventually). Who takes the financial cost of killing the hospital staff?

Devil 49 writes:

The stuff that kills people at night hasn't changed since I started flying

Not sure how old you are... today on the radio (link will change over time):

Steve Punt turns private investigator, examining little mysteries that perplex, amuse and beguile.

He explores the area around Dark Peak in the Peak District, which can claim to be Britain's own Bermuda Triangle. Over 50 aircraft crashed there in a space of 30 years.

http://www.bbc.co.uk/radio/aod/radio4_aod.shtml?radio4/puntpi

[SASless]

Complex twins????

Just how complex is a BK-117/EC-135/EC-145/Bell 230/430/S76/A365?

Some training empires make the procedures very complicated whereas in reality they do not have to be that way at all.

As large and "complex" as a Chinook is....it is still flyable with just one Bod sat in the left hand seat.

[victor papa]

Sasless, isn't the difference between the machines you listed and say a 350B3/407 maybe the workload in the cockpit for the single pilot in difficult circumstances or maybe even more importantly the expectation created? Is modern technolegy maybe hiding individual shortcomings during training which technolegy can not cope or compensate for in a real situation? The only way I see past this is objective sim training testing us under the circumstances that killed most of our fellow HEMS aviators and having the right to say somebody is restricted without being pressurized. Training teaches a lot, but there are certain life skills(decision making, situational awareness, responsibility, gut feel, etc) required when all turns pear shaped that can not be teached but must be identified before me as a individual can work and improove those skills lacking.

[hostile]

AS365, EC135's are not complex. S-76 a little bit more complex, but you have to think what is most useful in either program. EC135 is good for SPIFR with good MCC training with flight attendants.

Hostile

[WhirlwindIII]

Complexity is relative to task saturation, which is relative to a whole load of preceding variables. Any flying machine can be considered complex when it gets ahead of the pilot/operator.

The answers to all that's been brought up here starts at the top of each operator, the industry and respective governments involved.

Without reasonable leadership closely tied to making decisions relative to real field operational requirements progress in HEMS is going to be slow indeed. Needless to say from my point of view we have a leadership problem in the HEMS industry.

[alouette3]

Quote:

Needless to say from my point of view we have a leadership problem in the HEMS industry.

WWIII:
I think you have touched upon another very significant factor in this discussion. Much as I hate to make this about "Us vs. Them" ,one has to note that almost the entire top echelon of the HEMS industry is manned by non-aviators. Good people in their own right, but ,driven by different motivations:money and patient care. The latter being part of what I call the " Ambulance" culture: Get in(quickly!!) ,get out(quickly!!) and save lives(cue hallelujah chorus!!).I wonder how many pilots buy into that.

[Gomer Pylot]

If the top echelon of the US HEMS industry had their druthers, at the very top of the list would be getting rid of pilots altogether. They believe, truly, that if they just didn't have to deal with the #&%^#&$ pilots everything would be rosy, and they would make tons more money. They really hate having to deal with people they can't completely control.

[WhirlwindIII]

I agree with most.

IMHO (I like that one!)

The problem in HEMS flight ops comes in its complication; and substandard support the top folks render. They get very frustrated by what happens, or doesn't happen, on the line, and lash out in not-so funny ways like disciplining pilots, calling pilots lazy, etc. There's no excuse for it. Management are responsible to take care of the folks in the field doing the job. They are the ones who take the ultimate risk and generate the revenue, and no one is more important in a HEMS operator than them albeit each link of the safety chain does rest with everyone involved. When pilots screw up, it is the responsibility of those at the top, and I mean the top.

The myth of us and them is just that, a myth. Top management being completely responsible for what happens in the field unfortunately has morphed in to they feeling they can delegate not only authority to their operations sections, but responsibility as well, simply because they feel they are the corporate or business side of things. Couldn't be more wrong. That's where it breaks down in to one operator competing against another with respect to such as not putting in to the field what is required to do the job (machinery, training, support, mentorship, sanity, etc.), but putting in to the field what is competitive - i.e. single engine this and that; and what the FAA drive down their throats.

HEMS is full of adrenalin (most self induced) and rush practices that are not tolerated in other areas of helicopter ops. Human requirements and the laws of physics are no different in HEMS as Offshore, or executive operations. Our biggest advantage to the medical community is decreasing morbidity, not mortality. The good thing is the former decreases life-long cost to us all thus supports we being available to save lives as well, but that does not happen as often as most would like to think, but it does, and is nice to know.

HEMS operators need to study and emulate the best elements of other helicopter operations with the best safety records - it's at least a start! They also need to DECOMPLICATE the distraction of every pilot's admin, etc. load so he/she can concentrate on the job at hand - flying from A to B to C, etc.

Some operators have unionized pilot shops - if the operator had done their homework before such became a fact a lot of what is being discussed here wouldn't be in print!

Time will tell!

[Shawn Coyle]

EC-135 isn't complicated???
It (and all other light twins that are capable of Category A) has redundancy and complexity to rival a Boeing 737.
When you compare it to a Cessna Mustang (their latest small bizjet), it's more complex in systems. And to get insurance on a Cessna Mustang, you'll do 25 hours of simulator training, plus a whole lot more in-flight training before they sign you off.
And that's before you consider the complexity of the mission - all Cessna Mustangs will takeoff and land on long stretches of paved, lit runway, with good navaids and well-established procedures. Most EMS missions don't know where they going to land when they take off, let alone have to worry about navigation, talking to a different type of ground agency on every mission, not know about wind and weather in detail when they arrive on scene. I could go on...
We delude ourselves if we don't think the helicopters flown are complex. And we need to recognize that the missions are equally complex.

[WhirlwindIII]

Well said!

The bottom line is that whatever machine we talk about it has limits and when utilized up to them, particularly under multiple variables, the simplest of machines can become very complex in handling requirements given a small amount of time to do so. HEMS is indeed not a joke in the amount of decision making required given the mission time frames involved.

I can take a GIV from the east coast to Europe and make far fewer decisions than doing one EMS mission 20 miles out with RTB hospital.

I wish those empowered to make decisions in this industry would realize these sorts of things! Trying to convey that is impossible at present, irrespective of how much the top folks would like to believe to the contrary.

[DOUBLE BOGEY]

Many years ago, at the very start of a new UK HEMs operation, I was standing in the hangar besides our shiny new (actually second hand) AS355 on our very first day of the Operation.

The Ambulance Service (Client) Director of Operations walked up to me and said;

"Remember Son, when whizzing about trying to save lives, you already have three live bodies on the helicopter, and they must always stay that way"

I marvelled at this insightful remark given that he had never operated a helicopter before and to my surpirse he replied, "whats it got to do with the helicopter? Its exactly the same advice I give to my ambulance drivers day one after they have qualified to drive with blues & twos".

I never forgot his remarks and always in the back of my mind, if its that serious, they will probably croak anyway, so why take too much risk in trying to help.

This, in simplex terms, is the paradox of HEMS. You can spount all you like about machniery, wx minima and management, but in my view, the selection, training and discipline of the pilots involved is the most fundemental building block in the safety of HEMs.

Matrurity, experience, both in flying and life, and a determination to go back to the wife and gets at the end of the working day are the benchmarks of safety.

In my view ther are only really 2 types of pilots:

1. Those who will try things out for themselves.

2. And those who only do what they have been shown and taught.

I know which type I want taking me to Hospital in a Heli!!!

To all you current HEMS boys out there - stay safe and remember the most precious life you will save today - is your own!!!

[alouette3]

All good stuff.
Ultimately it boils down to the three T's:
Temperament: Hire and retain pilots with the right temperament for the job.A shrink to evaluate risk- tolerant versus risk- averse personalities during the hiring process and higher salaries might help.
Training: Realistic and repetitive.Check rides every year and only during the day----really?
Technology: Put the right tools for the job in the right place and in a timely fashion.Don't wait for the horse to bolt before slamming the barn door shut.

You can put it in any order of preference,but it all falls into the purview of people at a higher pay grade than mine.
Alt3.

[hostile]

When I mentioned the EC 135 with SPIFR is not complicated, I also suppose they have at least GPS with moving maps, NVG's AND very well trained crew. Without good training, all aircrafts are complicated.

Hostile:ok:

[Shawn Coyle]

GPS with moving map isn't complicated???
It's a whole world of complexity, with a load of mental baggage that hardly qualifies as carry-on.
If GPS with moving map isn't complicated, why does the latest Sporty's catalog have at least one page of nothing but how to use your Garmin 430/530 / Avidyne / Whatever???
If it's not complicated, why do you need training to use it?
Sorry, but it is complicated. Very complicated. It needs training and recurrent training.
Maybe we need to make it less complicated, but that's not the issue right now.

[hostile]

That's my main issue on it. If and when pilots (and crew) have possibility for training, it is not that complicated anymore. If you only try to read manuals, it is not enough. Using example MS flight simulator games gives you main idea how to use GARMIN GPS's with approaches. It is not that difficult. I didn't say it is like flying VFR with CAVOK, but that is the why this thread is. How to prepare for bad weather and get out of it or cancel whole flight.

Hostile:O

[helmet fire]

It seems we agree there is a training deficit in HEMS (though I would contend that it is a wider problem than just HEMS). I agree thoroughly with Shawn re the complexity issues, and I would note that almost every operator has their cockpit configuration completely different (unlike most airline cockpits) with very unstandardised equipment fits. It is likely even within a single operator to find three different GPS systems in three different aircraft on the line.

Given that there are very poor technical standards governing ergonomic attributes of avionics (many systems have no spec at all) then you can see the "mental baggage" that Shawn refers to having a large cost in terms of free cognitive space available for situational awareness and control manipulation. The only short term answer here remains training!

I mentioned the EASA HEMS crewing requirement above, and would love to hear some open discussion on it's attributes. The standards require Two Pilot or One Pilot Plus HEMS Crewmember in the FRONT during ALL HEMS missions (day, night, ifr). I personally reckon it is the world's best practice and should be mandated across world wide HEMS ops. You?

[hostile]

Agree. I was in Europe when those EASA rules were launch. In that time many things changed in many countries and companies. Like I told earlier it wasn't easy time, but finally it will be good result. It is not ready yet. I hope that same will happened here in US some kind of way. It is not easy way, but hopefully all have equal possibility to follow the road.

Hostile:ok: