US HEMS Ops

[QTG]

The Americans are giving HEMS operations a bad name. Discuss...............

[cptjim]

Wow, that was a bold statement at rather a sensitive time!!! I hope you have your flak jacket on!

Perhaps you'd care to give us your opinion rather than just start the fire! :ugh:

[WhirlwindIII]

Wouldn't it be interesting if we just looked at how offshore do their avn ops, how corporate do it, how utility do it, etc. and draw the parallels and divergences, and go from there.

Having experienced all the above I can confidently make the assertion that distractions (usually from the medical side) and adrenalin (the rush rush rush syndrome, etc.) are the two MAJOR differences EMS pilots have to deal with. Another is thermal fatigue from all this silly safety crap we have to wear to be in accordance with that generated by standards organization/s that look only at, and mirror, military safety initiatives - nomex, helmets, gloves, high-top leather boots, etc. etc. etc. I support it, when the weather is amenable to its use, but when the weather gets warm we are adding a type of distraction, thermal fatigue aka increase in body core temp, that IS fixable by shedding this stuff, and quickly.

[SASless]

Ah my dear friend.....how can the crew look so smashing without the helmets, gloves, nomex uniforms with all the stripes and stuff. Why without all that they would not be recognized as being "Flight Nurses/Paramedics". Image is everything don't you know?

The interesting study would be on survivability of crew in EMS crashes. When one smacks terra firma at near warp speed....even kevlar undies would not save your arse.:uhoh:

[victor papa]

I am not involved with US HEMS at all but do not believe we can or should call it an embarassment. Yes, there are very important lessons to be learned from the current unfortunate spate off accidents. In my years in aviation, I seem to feel that we (who ever) do ok for 5 years-then 1 accident-then another.............and another and another etc in short time frame. They continue as Murphy plays his part AND THEN SOMEBODY WITH GUTS MAKE THE RIGHT DECISION(not necessarily popular) and the chain off events (with the help of the aviation angel) almost stops as if we should all have noticed what changed-somebody broke the chain and we all learned and live. For 6 monts/1 year /2years we all provess to sticking to what we learned and we will not take the risks again. Then a while later in ANY area(country/continent) somebody starts taking risks-forcing others too take risk in order to be competitive-then the first accident......2nd etc and we all learn the lesson again. Europe seems to be ahead with legislation at the moment but it did not come without it's share of accidents(not that I agree necessarily with the twin at all times only syndrome), but that is now and blaming or insulting the US will not prevent complacency a year/2/5 from now. Why do we not just apply lessons learned to all across FAA/JAR/EASE/CAA ? who ever but address the issues killing us and sharing. CFIT? Non-aviation personnel overriding the commander? Emotions in HEMS?(specialised CRM more often?) Cockpit environment with pilot and medical staff all believing they are in charge? Controllers at hospitals/on scene with no aviation training but playing ATC role? Weather reports? Technolagy? etc.

[[email protected]]

Cheap might be what you get when you allow market competition but it comes at the price of flight safety. Lower experience levels, less training, single pilot ops plus the operational pressures of trying to save lives is a dangerous mix.

[WhirlwindIII]

victor papa

You have your finger on the picture!

Guts would not be required if this business were set up as a fully professional endeavor. The medical types, and others, thinking they have some sort of command over the situation is a HUGE distraction to the pilot I have not experienced to this level of intensity in any other type of helicopter work.

WIII

[Gomer Pylot]

I agree about the nomex, helmets, and other crap. IMO they cause more accidents/injuries than they prevent. There are few, if any, survivable helicopter accidents in which nomex or helmets prevent injury. The heat they hold in increases fatigue and distraction, and these can lead to an accident that would otherwise not happen. It's all image, not safety. Sitting on a hot Texas highway in the summer, with the cockpit temp well over 100, with Nomex and a helmet, you can easily get heat fatigue before the med crew gets back with the patient. Let me wear comfortable cotton clothing, low shoes, and a lightweight headset instead of all the fancy clothes and I'll be a safer pilot. The problem is, CAMTS requires all this stuff, and we must all bow down to the CAMTS gods. They're clueless but powerful.

[Shawn Coyle]

I might agree on the nomex. It only adds a few seconds of additional protection over cotton and lightweight long underwear in a fire.
Helmets are another thing - we need lightweight helmets with some provision for cooling. They have been proven to save lives by stopping people being knocked unconscious in a crash.
But how many survivable helicopter accidents have a fire?

[WhirlwindIII]

When safety bits become a problem, they are a problem - aka if it looks bad, it is bad (usually applied to weather decisions). Make it an ongoing subject at safety meetings, bring it up to your company, deal with it. I am.

When it gets hot my ideas are:

Helmets? Oversized white suspension system SPH4 with cooling gel inserts - does work! Carry extra gels in a small cooler bag with plastic ice inserts.

Nomex? Buy your own flight suits of a different material. I won't go in to the myriad of possible objections and etc.

High top leather boots? Who's kidding whom, and who is going to know under those overlength trousers there resides a good pair of shoes. And who will care!?

Gloves? Last I wore them was in RVN.

[OBX Lifeguard]

There are a number of problems I see with the way HEMS ops in the US are currently done, but I'll take bank robber Willy Sutton's advice and go "where the money is"... and that's CFIT.

Back when I was flying 'freighter' Be58s on night runs and a CE500 135, inadvertant IMC in a UH-60 or a BH-222 would have been no big deal. I would aviate, navigate and communicate. And the reason it was no big deal was I flew on the guages all the time. I was as comfortable IMC as I was on a pretty Spring day.

But instrument competence and comfort are perishable skills. Just because I could run three miles 2 years ago doesn't mean I could do that today. And just because I have a rusty old instrument ticket in my pocket doesn't mean I can fly on the guages today. And a 15 minute flight check with a set of Foggles each year just proves you can 'peek' good enough to smooze the check airman. If I want to stay in shape in both physical and instrument 'fitness' I have to 'exercise'.

I have the good fortune of flying for an operation that allows us to use our helicopter to maintain instrument currency in non-revenue flying. We also use the aircraft to get an IPC every year.

But I realize there are some bean counters that would have apoplexy at the thought of all that boring holes in the sky with no money coming in. But there are answers that I think would be cost effective. They would take the cooperation of the FAA and operators but they are doable.

First, the regs used to credit half your approaches and time in other category aircraft towards minimums. Why was this changed? Up until a couple of years ago I had a BE36 and it kept me sharp on instruments whether I was flying the Bonanza or our BK. Instrument flying is instrument flying. All my pilots are also fixed wing pukes. Half their currency requirements could be met semi-annually in a CE172 for a couple hundred bucks if the regs were changed back.

Second, give some credit for desktop simulators like the ASA On Top PCATD Flight Simulator. Yeah they cost about $3,000, but a group purchase could make them cheaper and they would be available all the time. Mandate that every pilot fly it every month. Allows you keep the procedural part of instrument flying down cold. Yeah, after flying the UH-60 full motion simulator I hate flying anything less too, but it keeps me 'sharp' and I like being sharp.

Third. Be absolutely frank with the hospital why they want to pay for the few extra hours you have to use the aircraft for instrument training. I presented the crash numbers to the bean counters in my organization and they now insist we do training and are happy to have us 'boring holes'. If they don't hear us checking in with dispatch on a 'training flight' for a while I get a polite inquiry about it...

We will never have a zero accident rate... but true instrument competence would go a long way to fixing this problem.

[WhirlwindIII]

OBX - I agree.

[zalt]

From ASRS (first two with 206s, next 3 with BK117s, then 3 S76s)

1 Synopsis ACN: 635667 Oct 2004 nighttime

AN EMS BELL 206 INADVERTENTLY ENTERED IMC FOR SEVERAL SECONDS ENRTE WITH A PATIENT ON BOARD.
Flight Conditions : Marginal
Weather Elements : Rain
Light : Night

Narrative

WHILE ON AN EMS FLT, I ENCOUNTERED LIMITED VISIBILITY WITH GND REF. THE FLT WAS FLYING FROM A HOSPITAL WITH A PATIENT ON BOARD. THE RAIN HAD PICKED UP AND THE VISIBILITY WAS LESS THAN RPTED. AT 1000 FT MSL, WE STARTED TO LOSE GND REF. I WAS ABLE TO MAINTAIN A COUPLE OF LIGHTS TO THE SIDE BUT FORWARD LIGHTS ALL DISAPPEARED. I MAINTAINED STRAIGHT AND LEVEL WITH THE USE OF INSTS AND THE 2 LIGHTS OUT THE SIDE. THE TIME LINE WAS SHORT AND THEN WE HAD FORWARD LIGHTS AGAIN, NO ALT WAS LOST. OUR HDG WAS ON TRACK AND WE CONTINUED OUR FLT WITHOUT INCIDENT. THE PROB IS HAVING A PATIENT ONBOARD AND FEELING THE PRESSURE TO TRY TO CONTINUE THE FLT IN LESS THAN RPTED CONDITIONS. THE SHIP WAS IFR CAPABLE, BUT THEY HAD DISCONNECTED THE AUTOPLT SO IT WAS INOP. I AM ATP RATED BUT NOT CURRENT IFR. WE DO HAVE ANOTHER IFR SHIP WHICH SHOULD HAVE BEEN SENT ON THE FLT BUT WE ARE CLOSER BY 18 MI AND OUR SHIP IS MUCH CHEAPER TO FLY. BECAUSE OF THIS FLT THEY WILL FROM NOW ON SEND THE OTHER SHIP IF IT IS AVAILABLE. IT IS TOO BAD THAT WE SOMETIMES HAVE TO HAVE LESS THAN FAVORABLE FLTS TO GET NON AVIATION PEOPLE TO REALIZE CLOSER AND CHEAPER ARE NOT ALWAYS THE RIGHT THING TO DO.

2 Synopsis ACN: 642919 Jan 2005 afternoon
A MEDICAL TRANSPORT HELI BECAME IMC ON A VFR FLT PLAN AND CONTINUED TO HIS DEST.
Flight Conditions : Marginal
Weather Elements : Rain
Weather Elements : Fog
Light : Daylight

Narrative
ON JAN/FRI/05, I ENTERED IMC DURING A PATIENT TRANSPORT FROM ZZZ1 TO ZZZ2. WEATHER AT ALL RPTING POINTS ALONG THE RTE WAS ABOVE COMPANY DAY, CROSS-COUNTRY MINIMUMS. IN FACT, THE LOWEST CONDITIONS RPTED WERE CEILINGS OF 2600 FT OVERCAST AND 5 MI VISIBILITY IN LIGHT RAIN AT ZZZ3. THE FLT WAS RELATIVELY UNEVENTFUL FROM INITIAL LAUNCH FROM BASE THROUGH PICKUP AT ZZZ1 AND MOST OF THE FLT WITH THE PATIENT ABOARD. THE PLT OF ANOTHER COMPANY ACFT WHO HAD HEARD OUR LAST VOICE RPT TO OUR COMPANY DISPATCHER, CONTACTED US ON THE COMPANY FREQUENCY AND INFORMED US THAT THE FARTHER N WE GOT THE BETTER THE WX CONDITIONS WOULD BE. ABOUT 2/3 OF THE WAY THROUGH OUR LEG FROM ZZZ1 TO ZZZ3 WE ENCOUNTERED CEILINGS LOWER THAN RPTED AND WISPY MIST AT 500 FT AGL AND BELOW. THE MIST INTENSIFIED TO THE POINT WHERE I WAS BECOMING CONCERNED, SO WE TURNED SW, PLANNING TO LAND BACK AT ZZZ1 AND CONTINUE THE PATIENT TRANSPORT BY GND FROM THERE. AS WE PROGRESSED TOWARD ZZZ3, CONDITIONS GRADUALLY IMPROVED THE FURTHER W WE GOT. THE IMPROVED CONDITIONS WE FOUND NEAR ZZZ3 LASTED ONLY ABOUT 7 TO 8 MI AND AGAIN BEGAN TO DETERIORATE SIMILAR TO THE WISPY MIST WE HAD ENCOUNTERED EARLIER TO THE E, HOWEVER, AT 500 FT AGL, WE COULD STILL SEE SEVERAL MI UP THE INTERSTATE. GIVEN THOSE CONDITIONS, I BELIEVED CEILINGS AND VISIBILITY WOULD BE IMPROVING VERY SOON, HOWEVER, I STILL HAD NOT MENTALLY DISCARDED THE IDEA OF TURNING BACK IF CONDITIONS WORSENED. ABOUT THE SAME TIME, I PASSED A TOWER ON MY R AND SAW ANOTHER, PERHAPS A MI AHEAD, AT THE 10 O'CLOCK POS AND CONSULTED MY SECTIONAL CHART IN AN ATTEMPT TO PRECISELY FIX MY POS IN RELATION TO ANY OTHER OBSTACLES I MIGHT NEED TO AVOID IF I DID INDEED CHOOSE TO TURN AROUND. WHILE CONSULTING MY CHART, I HEARD THE RADAR ALTIMETER TONE, I HAD SET THE WARNING FLAG AT 400 FT AGL BECAUSE THE TALLEST TOWER I NOTED NEAR MY INTENDED RTE WAS 361 FT AGL. I GLANCED UP FROM THE CHART, NOTED THE NEEDLE GENTLY OSCILLATING AT THE 400 FT MARK, CONFIRMED MY ALT AND HDG WITH A BRIEF GLANCE OUTSIDE AND APPLIED GENTLE AFT PRESSURE TO THE CYCLIC TO INITIATE A GRADUAL CLB BACK TO 500 FT AGL. I THEN CONTACTED CTR, HE TOLD ME I WAS IN 'RADAR CONTACT,' AND ALMOST IMMEDIATELY TOLD ME TO RE-CONTACT APCH. I SWITCHED BACK TO APCH, WHO GAVE ME AN ASSIGNED HDG AND ALT. THE CTLR ASKED IF THE ACFT AND PLT WERE INSTRUMENT RATED. I REPLIED 'THE PLT IS, THE ACFT IS NOT' AND TOLD HIM THAT I WAS TRAPPED BETWEEN LAYERS. HE WENT ON TO TELL ME THE WX CONDITIONS SHOULD BE IMPROVING AS WE PROGRESSED TOWARD ZZZ3. GIVEN THESE FACTORS, I WAS CONVINCED THAT THE SAFER AND BETTER CHOICE WAS TO CONTINUE TOWARD ZZZ3. I WILL ADMIT THAT I ALSO REALIZED THAT CONTINUING TOWARD ZZZ3 WOULD PUT THE PATIENT FAR CLOSER TO -- PERHAPS AT -- HIS DEST, HOWEVER, I CONSIDERED THAT 'ICING ON THE CAKE,' AND IT WAS NEVER A FACTOR IN MY DECISION TO CONTINUE. AS THE CTLR WAS COOPERATING WITH ME AND DID NO SOUND ANNOYED OR FLUSTERED, CONTRARY TO COMPANY POLICY, I CHOSE NOT TO SQUAWK 7700 AND CONTINUED ON INSTRUMENTS TOWARD ZZZ3 INTENDING TO BREAK OFF TO ZZZ2 AFTER I BECAME VMC AGAIN. ABOUT 2 MI S OF THE ABC VORTAC, I REACQUIRED CONTINUOUS VISUAL CONTACT WITH THE GND, NOTIFIED APCH AND REQUESTED VFR DIRECT TO ZZZ2. THE CTLR APPROVED MY REQUEST, WE DELIVERED THE PATIENT, AND DEPARTED TO ZZZ3 FOR FUEL. LOOKING BACK, I DON'T SEE MUCH THAT I COULD DO DIFFERENTLY. WHILE, ADMITTEDLY, MY BASIC AIRWORK COULD HAVE BEEN BETTER, I BELIEVE I MADE PRUDENT DECISIONS AT ALL POINTS ALONG THE TIMELINE, AND WE DELIVERED THE PATIENT SAFELY. DURING THIS FLT, AS I HAVE IN NUMEROUS OTHERS, I WAS DEALING WITH MY FLT ENVIRONMENT IN THE BEST WAY I KNEW HOW. UNFORTUNATELY, DEALING WITH THIS SIT REQUIRED MORE HEADS DOWN TIME WITH THE CHART THAN ON AN AVERAGE FLT, BOTH IN ORDER TO ACCURATELY FIX MY POS IF THINGS 'WENT SOUTH' AND TO DETERMINE FREQUENCIES REQUIRED AT POSSIBLE ALTERNATES. IN THE FUTURE, I WILL APPLY EVEN MORE CONSERVATIVE DECISION-MAKING CRITERIA DURING FLTS IN WX CLOSE TO COMPANY MINIMUMS, AND I WILL WORK TO REDUCE HEADS DOWN TIME IN MY FLYING.


B]3 Synopsis ACN: 619323 May 2004[/B]

BK117 PLT LAUNCHES HELI TO A HOVER BEFORE EMS CREW IS ABLE TO BOARD.

B]Narrative[/B]

THE FLT CREW AND MYSELF HAD JUST COMPLETED DELIVERING A PATIENT. I COMPLETED THE SHUTDOWN AND EXITED THE ACFT. WE (ACFT #1) WERE THEN DISPATCHED TO ZZZ1. I CLBED BACK INTO THE ACFT AND BEGAN THE START PROCS GETTING #1 ENG ON LINE AT IDLE. I RECEIVED A PAGE CANCELING OUR RESPONSE TO ZZZ1. SHUTTING DOWN THE ENG JUST STARTED, I NOTICED MY CREW APCHING THE ACFT. ONCE AGAIN I BEGAN AND COMPLETED THE START PROC GETTING BOTH ENGS ON LINE AND COMPLETING THE CHKS. I ADVANCED THE THROTTLES TO 100%, DID A PREFLT CHK ENG INSTS IN THE GREEN, MASTER CAUTION DOOR LIGHT ON, THROTTLES FULL FORWARD. I BEGAN AND CONTINUED TO PULL PITCH. ABOUT 10 FT IN THE AIR, I SAW THE PARAMEDIC OUT MY R DOOR. OUT THE L FRONT, I SAW THE FLT NURSE. I HAD STARTED A R YAW TO GET THE NOSE INTO THE WIND. I IMMEDIATELY STOPPED AND LANDED THE ACFT. THE CREW SECURED THE EQUIP AND CLOSED THE REAR DOORS. THEY THEN BOARDED AND WE WENT OVER WHAT HAD JUST OCCURRED. I CHKED WITH THE CREW TO SEE IF THERE HAD BEEN ANY INJURIES OR DAMAGE CAUSED BY THIS EVENT. THE CREW ASSURED ME NO INJURIES OR ACFT DAMAGE HAD OCCURRED AND WERE PREPARED TO CONTINUE. WE THEN DID A NORMAL TKOF CHK WITH ME CHALLENGING THE CREW ABOUT BELTS AND DOORS AND THEM ANSWERING SECURE AND REFERRING TO OBSTACLES AROUND THE ACFT. WE THEN WENT TO FAST FUEL AND I DOUBLECHKED THE ACFT FOR DAMAGE. NO DAMAGE WAS FOUND ON THE ACFT.

4 Synopsis ACN: 603799 Dec 2003

SINGLE PLT OF BK117C HELO ON A LIFEGUARD FLT PENETRATES THE DCADIZ WHEN HE FAILS TO PROGRAM HIS NAV EQUIP FOR THE APPROPRIATE DEST.

Narrative

I WAS THE DUTY PLT FOR AN EMS HELICOPTER SERVICE. I WAS DISPATCHED FOR A PATIENT PICK UP AT AN AREA HOSPITAL AROUND XA00. A QUICK MAP RECON SHOWED A VFR ROUTE IN AND OUT AND THE FLT WAS ACCEPTED AND LAUNCHED. THE FIRST LEG WAS UNEVENTFUL TO ZZZ, THE SECOND LEG TO ZZZ1 IS WHERE THINGS WENT WRONG. WHEN I DIALED IN ZZZ1, WE HAD JUST TURNED INTO THE SETTING SUN AND I MIS-DIALED ZZZ2 INSTEAD. I KNEW THE HDG AND DISTANCE WERE INCORRECT SO I PICKED UP A 250-260 DEG HDG TO STAY CLEAR OF THE WASHINGTON AREA AND BEGAN TO TROUBLESHOOT MY ERROR. THINGS BECAME ADDITIONALLY COMPLICATED BY A LOSS OF COMMUNICATION WITH MY DISPATCH. BETWEEN THOSE PROBS, I THOUGHT I HAD A GOOD GROUND TRACK AND HAD IDENTIFIED A LANDMARK THAT SHOWED ME ON COURSE AND CLEAR. WHEN I GOT THE PROPER ID ENTERED, IT SHOWED ME JUST N OF NDY. I KNEW THAT I WAS INSIDE THE 30 MILE ARC AND AT THAT POINT, I COULD SEE MY DESTINATION WHICH I KNEW WAS CLEAR SO I CONTINUED IN AND LANDED. AS I TOUCHED DOWN, A BLACK HAWK CIRCLED OVERHEAD. I CAME UP ON 121.5 AND TALKED WITH THE AIR MARSHALL AND TOLD HIM WHO I WAS AND WHAT I WAS DOING. I ASKED IF I COULD REPOSITION TO ZZZ3 TO REFUEL AND HE SAID YES. HE THEN CAME BACK AND ASKED FOR MY TAIL NUMBER, SAID HE KNEW WHO WE WERE AND WHAT WE WERE DOING, SAID GOODBYE AND LEFT THE AREA. I RETURNED TO THE HOSPITAL AND PICKED UP MY CREW AND PATIENT. THERE WAS A MESSAGE TO CALL ATC ON A LAND LINE SO I DID AND GAVE THEM MY NAME, TAIL #, ETC, AND RETURNED VIA ZZZ1. I DID TRY WASHINGTON APCH ON THE WAY OUT BUT GOT NO RESPONSE. IN MY HASTE TO PROVIDE A QUICK RESPONSE AND TRANSPORT A SICK PATIENT EXPEDITIOUSLY, I DID NOT PLAN PREFLT AS WELL AS I SHOULD HAVE AND I DIDN'T USE ALL OF THE RESOURCES THAT WERE AVAILABLE TO ME WHEN I HAD PROBS. WITH HINDSIGHT, I REALIZE THAT APCH CTL COULD HAVE HELPED ME IMMENSELY, AND IF I HAD THE SAME FLT TOMORROW I WOULD HANDLE IT VERY DIFFERENTLY AND USE OF ALL THOSE RESOURCES.

5 Synopsis ACN: 319288 Oct 1995 nighttime
AN EMS HELI WAS FORCED TO FLY SINGLE PLT IN IMC TO COMPLETE HIS MISSION.
Flight Conditions : Mixed
Light : Night

Narrative

OPERATING A BK117 AS A HOSPITAL BASED 135 NON SCHEDULED CARRIER, CERTIFIED AS SINGLE PLT VFR OR DUAL PLT IFR. DURING SHIFT CHANGE, RECEIVED TELEPHONIC WX BRIEF AS WELL AS COMPUTER GENERATED DUAT BRIEF FROM NWS AT APPROX XA00 LCL. WX BRIEF WAS FOR A 75 MI RADIUS OF ARPT XYZ AND INCLUDED SYNOPSIS, AREA FORECASTS, SIGMETS, SA, FT, WINDS ALOFT, NOTAMS. FORECASTS INDICATED VFR CONDITIONS FOR ENTIRE SHIFT OF 12 HRS. AT APPROX XH10 LCL, WE WERE DISPATCHED TO TRANSPORT A PATIENT FROM XYZ TO ZZZ APPROX 160 NM. WE DEPARTED ARPT XYZ WITH SKY CONDITIONS CLR, VISIBILITY UNRESTR. NO CURRENT OBSERVATIONS AVAILABLE WITHIN 60 NM OF ZZZ AT THAT TIME OF NIGHT. FLT PROCEEDED S WHERE UNFORECASTED WX WAS ENCOUNTERED. ALT WAS INCREASED FROM 2500 FT MSL TO 3500 FT MSL IN ORDER TO REMAIN VFR. AT APPROX XI30 LCL AND 35 MI N OF ZZZ, I ASKED FOR AND RECEIVED AN IFR CLRNC INTO THE CLASS B AIRSPACE. THIS DECISION WAS BASED ON FUEL REMAINING AND NOT BEING ABLE TO TURN BACK. CLRNC WAS GIVEN FOR THE VOR/DME 17 APCH AT ZZZ. THE APCH WAS EXECUTED AND ACTUAL IMC CONDITIONS WERE ENCOUNTERED FOR APPROX 2 MINS. WE BROKE OUT AT APPROX 700 FT MSL AND THE ACFT WAS LANDED SAFELY AT ZZZ. MEDICAL CREW RETURNED TO XYZ AFTER COMPLETION OF TRANSFER AT APPROX XK40 LCL. SA INDICATED 5 MI VISIBILITY, 16 MI BROKEN AND 4 MI IN FOG. I FILED ANOTHER IFR FLT PLAN DIRECT. WE DEPARTED ZZZ AT XL15 LCL WITH A SVFR CLRNC. APPROX 12 MI N OF ZZZ, I ACTIVATED THE IFR FLT PLAN IN ORDER TO GO VFR ON TOP. THE ENTIRE FLT BACK WAS CONDUCTED VFR ON TOP. UPON ARR AT XYZ, CLRNC WAS GIVEN BY CTR TO EXPECT ILS RWY 13 APCH. RADAR CONTACT WAS LOST AND WE WERE TOLD TO CONTACT XYZ APCH. CONTACT WAS MADE BY XYZ AND WE WERE CLRED FOR VOR/DME 4 APCH AT XYZ. AGAIN, IMC CONDITIONS WERE ENCOUNTERED DURING FINAL APCH LEG. WE BROKE OUT 200 FT ABOVE MDA AND LANDED AGAIN SAFELY AT XYZ. THIS MISSION WAS OPERATED SINGLE PLT. I SHOULD HAVE RECONFIRMED MY WX PRIOR TO DEP FROM XYZ. SAFETY WAS PRIMARY CONSIDERATION IN ASKING FOR IFR CLRNCS. VIOLATIONS OF FARS CONCERNING SINGLE PLT IFR FLT WAS NOT INTENTIONAL, BUT AT THE TIME IT WAS THE REALITY I WAS FACED WITH.

6 Synopsis ACN: 671298 Sept 2005

EMS HELI PLT FORCED TO ENTER STADIUM TFR WITHOUT CONTACTING APPROPRIATE ATC CTL.
Flight Conditions : VMC
Light : Night

Narrative

WHILE FLYING AN EMS HELI, I CONTACTED APCH CTL AND WAS GRANTED PERMISSION TO ENTER THE ACTIVE STADIUM TFR TO LAND TO PICK UP A PATIENT AT THE HOSPITAL ROOFTOP HELIPAD. THE HOSPITAL HELIPAD IS ABOUT 3 NM FROM THE STADIUM AND THE TFR MUST BE ENTERED IN ORDER TO CONDUCT A SAFE APCH INTO THE WIND AND LAND. UPON MY DEP I WAS UNABLE TO CONTACT APCH CTL FROM THE HOSPITAL ROOFTOP (WHICH IS QUITE NORMAL), SO I LIFTED OFF THE HELIPAD IN LIFEGUARD STATUS AND ATTEMPTED TO CONTACT THEM IN THE AIR TO INFORM THEM THAT I WAS DEPARTING THE TFR. AFTER SEVERAL ATTEMPTS, I WAS FINALLY ABLE TO MAKE POSITIVE COM WITH APCH WHEN I REACHED AN ALT OF APPROX 1500 FT MSL. THE ATC CTLR WAS VERY NICE AND APOLOGIZED FOR THE DELAYED COMS AND EXPLAINED THAT RADIO COMS ARE MANY TIMES UNREADABLE AT THOSE LOWER ALTS. LATER THAT EVENING I WAS RETURNING TO THE HOSPITAL WITH ANOTHER PATIENT ON BOARD AND ONCE AGAIN IN LIFEGUARD STATUS. MY FLT WAS EXTREMELY SHORT, ONLY 8 MINS OF ENRTE FLT TIME AND I REMAINED AT ALTS OF 800-1000 FT MSL FOR THE ENTIRE RTE IN REGARD TO THE SAFETY OF THE PATIENT ON BOARD, WHO WAS SENSITIVE TO PRESSURE AND OXYGEN CHANGES. AFTER ABOUT 3 ATTEMPTS, I WAS UNABLE TO CONTACT APCH TO ENTER AND LAND WITHIN THE STADIUM TFR. CLBING TO ALT WOULD DELAY MY FLT AND ALSO ADD PRESSURE TO MY PATIENT'S LUNGS, MAKING THE FLT NOT ONLY LONGER, BUT ALSO MAKING IT MORE DIFFICULT FOR THE PATIENT TO BREATHE. I CONTINUED ON MY FLT PATH FOR THE SAFETY OF MY PATIENT, MADE A BLIND RADIO CALL OF MY INTENTIONS TO ENTER THE TFR AND LAND AT THE HOSPITAL WITHIN THE TFR, THEN DSNDED FOR MY APCH TO THE HELIPAD. I ENTERED AND LANDED WITHIN THE STADIUM TFR WITHOUT MAKING POSITIVE COMS WITH APCH. I WAS IN LIFEGUARD STATUS. THE SAFETY AND SURVIVAL OF MY PATIENT DEPENDED ON A QUICK ARR. I DO KNOW OF MANY OTHER OCCASIONS THAT OTHER LIFEGUARD FLTS HAVE HAD DIFFICULTY MAKING RADIO COMS AT THOSE LOW ALTS ESPECIALLY WHEN WX IS INVOLVED AND THE HELIS ARE VFR AND REMAINING BENEATH THE CLOUD CEILING. THIS IS DEFINITELY AN ISSUE BEING THAT THERE ARE SEVERAL HOSPITALS WITHIN THE STADIUM TFR. THE ONLY FIX TO THIS DILEMMA MIGHT BE TO GIVE LIFEGUARD STATUS ACFT AN AUTOMATIC CLRNC THROUGH THIS PARTICULAR STADIUM TFR WHILE TALKING ON THE COMMON AIR-TO-AIR FREQ. OR, TO ALLOW EMS OR EMER HELIS AT THESE LOW ALTS TO CALL APCH FROM CELL OR SATELLITE PHONES WHILE INFLT TO GAIN PERMISSION TO ENTER THE TFR (IF THIS WERE A LEGAL OPTION WHILE IN LOW FLT, MANY WOULD UTILIZE IT). CELL PHONES HAVE GOOD RECEPTION IN AREAS WHERE RADIOS DO NOT.


7 Synopsis ACN: 482860 Aug 2000 morning

AIR AMBULANCE HELI FLT ENRTE BTWN 2 HOSPITALS CLIPS A PROHIBITED AREA DUE TO INSUFFICIENT PREFLT PLANNING.
Flight Conditions : VMC
Light : Daylight

Narrative

I FLY A PART 135 S76 HELI, SINGLE PLT MEDICAL TRANSPORT MISSION. ON AUG/XA/00, I RECEIVED AN URGENT REQUEST FOR MEDICAL TRANSPORT OF A NEWBORN FROM A HOSPITAL IN ZZZ TO A HOSPITAL IN XXX. WE WERE TO PICK UP A MEDICAL TEAM FIRST, THEN FLY TO ZZZ FOR A PICKUP. I HAD NOT FLOWN INTO THE ZZZ AREA FOR SEVERAL YRS AND HAD NEVER BEEN TO ZZZ. A HASTY MAP RECONNAISSANCE DID NOT SHOW ME THE HOSPITAL, BUT THE COORDINATES PLACED IT OUTSIDE OF PROHIBITED AIRSPACE, SO I LANDED AND PLANNED TO USE RADAR TO ASSIST. UPON ARR AT THE RPTING POINT, WITH THE ZZZ HELI RTE CHART OUT, I WAS GIVEN CLRNC DIRECT TO ZZZ. AFTER SEEING I WAS WELL CLR OF THE PROHIBITED SPACE, I SET MY MAP DOWN ON THE CTR CONSOLE TO WATCH FOR TFC AND SEARCH FOR THE HELIPORT USING OUR GPS TO NAV. ZZZ TWR TOLD ME TO TURN 20 DEGS R TO AVOID A PROHIBITED AREA. I ANSWERED 'ROGER' AND STATED THAT 'I DID HAVE MY MAP OUT.' TWR REPLIED 'YOU ARE FLYING IN HERE WITHOUT A MAP?' TO WHICH I ANSWERED THAT 'I HAD A MAP, BUT HAD SET IT DOWN TO FIND THE HELIPAD.' I DID NOT AT THIS TIME KNOW WHERE THE PROHIBITED AREA WAS. TWR GAVE ME A FREQ CHANGE WHICH I ROGERED. REALIZING I WAS STILL 3-4 MI FROM ZZZ, I CALLED BACK TO TWR TO RE-ESTABLISH CONTACT. AS I MANEUVERED THE HELI S TO THE ZZZ PAD, THE TWR ROGERED ME AND TOLD ME TO CALL LNDG ASSURED AT THE HOSPITAL. ON A 1/2 MI FINAL TO THE HOSPITAL PAD, I CALLED LNDG ASSURED AND WAS GIVEN A FREQ CHANGE FROM YYY TWR. I DID NOT KNOW THE LOCATION OF THE PROHIBITED AREA, BUT TWR SAID NOTHING ABOUT IT. I AM NOT CERTAIN, BUT I COULD HAVE FLOWN OVER PART OF THE PROHIBITED AREA ON FINAL TO ZZZ. ON THE GND, I DID A THOROUGH RECONNAISSANCE OF THE MAP, NOTICING A 'BLOW UP' OF THE AREA ON THE BACK OF THE MAP. ON DEP, I TOOK OFF W FOLLOWING THE RTE N TO KEEP WELL CLR OF THE PROHIBITED AREA. IN RETROSPECT, I REALIZE THAT I SHOULD NOT HAVE LAUNCHED WITHOUT KNOWING THE EXACT POS OF ZZZ ON THE MAP. I ALLOWED THE URGENCY OF THE TRANSPORT OF A SICK INFANT TO RUSH ME. A MORE THOROUGH MAP RECONNAISSANCE WOULD HAVE REVEALED THE PROHIBITED AREA PROX (1 MI) TO ZZZ AND PROMPTED MORE CAUTION ON MY PART. FURTHER, BEING UNFAMILIAR WITH THE AREA, I SHOULD HAVE REQUESTED RADAR VECTORS FROM YYY TWR AROUND THE PROHIBITED AREAS AND TO ZZZ. MY TRIMBLE GPS HAS RESTR AIRSPACE WARNINGS, BUT DID NOT WARN ME OF THIS ONE. TO PREVENT A RECURRENCE OF THIS EVENT, I BRIEFED OUR PLTS ON THIS EVENT AND INFORMED MY CHIEF PLT. WE NOW HAVE A SECTION IN OUR READING FILE ON THE ZZZ AREA AIRSPACE.

8 Synopsis ACN: 392709 Jan 1998 night

AN SK76 FLIES VFR INTO IMC IN ZZZ, US, AIRSPACE. DURING THE SHORT FLT, ICING BECOMES MODERATE SO THE HELI RETURNS TO DEP STATION WITH ICE ON ITS ROTARY BLADES AND AIRFRAME.
Flight Conditions : IMC
Light : Night

Narrative

ENRTE TO HOSPITAL TO PICK UP PAX, WX AT ARPT WAS 800 FT AND 5 MI. NEAREST WX TO THE E WAS 1500 FT, 7 MI. HOSPITAL IS DIRECTLY IN THE MIDDLE. OVER HALFWAY TO HOSPITAL WE ENTERED IMC CONDITIONS AND REQUESTED RADAR VECTORS FOR THE ILS RWY 32 APCH BACK INTO ARPT THEN WE PICKED UP MODERATE RIME ICING. ACFT DOES NOT HAVE DEICING CAPABILITIES, HOWEVER SINCE WE WERE IMC AND JUST 20 MI FROM THE ARPT, I ELECTED TO STAY AT 2500 FT MSL FOR THE APCH. THE ACFT WOULD ONLY FLY AT ABOUT 100 KTS COMPARED TO 150 KTS, SO I FIGURED THE ICING HAD TO BE MODERATE OR SO. ON FINAL WE BROKE OUT (VMC) AND LANDED THE ACFT. THE ACFT HAD SIGNIFICANT ICE ON BLADES AND FUSELAGE. LOOKING BACK I SHOULD HAVE BEEN MORE PRUDENT ABOUT THE WX SINCE ARPT HAD LOW CEILINGS ABOUT 1-2 HRS EARLIER THAN THE FLT, ALSO SINCE IT WAS EXTREMELY DARK, I SHOULD HAVE BEEN FLYING AT A LOWER SPD, SO THAT I WOULD HAVE HAD MORE REACTION TIME AND NEVER WOULD HAVE GONE IMC. I CONSIDER MYSELF LUCKY THAT ALL WENT WELL, AND I WILL CERTAINLY NEVER FORGET THAT GUT WRENCHING FEELING OF PICKING UP THE ICE ON THE ACFT.

[PO dust devil]

Having the fortitude to say "sorry all we just can't go" is an essential way to reduce the risk of a disaster. I have been an inexperienced boggy as well and think this is a paradigm which needs to be part of the EMS culture in training and practice. Maybe this is something which can be taught and learned, maybe not.

Managers and clients with the fortitude to say "Thanks Skipper, we understand and support that decision" would be the other half of that equation.

Interhospital transfers in the middle of the night where the helo is used so the ground crews don't get woken or taken out of their response areas are a couple of examples of a bad mind set exhibited by many dispatchers.

Things which "could" stop a flight for me would be:

A/C unserviceabilities
Wx/genrally
Wx/Lack of alternates
Wx/icing
lighting
destination hls
navaids
lighting
notams
Whole crew skills/competence

Any of those can be evidenced debriefed and discussed later in the cold light of day.

FWIW

DD

[SASless]

Whirlwind,

Having played the wiener roast scene as a weenie....WEAR GLOVES!

The sticks get pretty darn hot quick when flames are filling your cockpit.

My gloves burned off but they saved my hands from truly serious injury....seven weeks and I was good as new almost. Without them I would have claws instead of fingers I think. I hate the nomex/leather style our DOD thinks so highly of....whereas the RAF leather gloves are a treat.

The nomex did as advertised....charred and did not stick to my legs. Where the trousers pullled tight and had but a single layer of cloth....I got my worse burn. Where the pockets were I got by with superficial burns.

Nomex does not stop bullets however so skip that idea.

I would suggest all leather above the ankle boots....again...it is nice to have feet vice stumps as clogging to Bluegrass is a bummer without toes.

I hate to wear a helmet but even as hard as my noggin is....Gentex hats are a whole lot stronger and don't bleed when hit firmly with a sharp instrument like speed selects, door posts, cyclic sticks, and fence posts.

Safety gear is only useful if worn correctly when exposed to some hazard.

[WhirlwindIII]

Not one to shun advice I'll be looking in to your reccomendations. Never worn a Gentex. When it gets hot and sweaty and distracting the safety bits start to come off in deference to maintaining a reasonably sharp state of mind.

Am familiar with the RAF white leather gloves. Definitely a treat. Lot of folks at Bristows had them, though I didn't.

[sox6]

Zalt - are those for real?

[Shell Management]

Sadly yes. There is a very gung-ho attitude:
Arizona Medical Helicopter Crash Brings Awareness To Local Airmed Safety Protocol - News - Augusta, GA (http://www.wjbf.com/midatlantic/jbf/news_index.apx.-content-articles-JBF-2008-07-01-0007.html)
Hatfield: "If you could imagine...you have a trama patient in the back of the aircraft that could possibly be dying, and your crew is working franticaly to save their life, as well as, you may be flying through airspace. At the same time, you need to be talking to air traffic control plus be vigilant of other aircraft in the area. So, it's a very demanding enviroment that you have to continually strive to do your best."

It is stange that having said that, procedures and hazard management are weaker when there is NO patient (or an organ unconnected to the crew and medics!) on board.
Medical alert-21/02/2006-Flight International (http://www.flightglobal.com/articles/2006/02/21/204855/medical-alert.html)

As part of the International Helicopter safety Team effort, from the U.S. Joint Helicopter Safety Analysis Team: Year 2000 Report, after reviewing 12 EMS accidents from 2000 the following recommendations were made for US EMS:

1. Develop and use a formalized systems safety approach (i.e., SMS) to risk management and assessment to improve decision-making in flight operations and on a personal basis. Provide comprehensive risk management training to include mission-based risk assessment, weather assessment training and risk-based flight operations decision-making. The training should demonstrate that the safety culture of the organization encourages aborting or canceling the flight when the risk factors don’t justify conducting or continuing the mission.
2. Establish an operator safety culture that includes clearly communicated flight operations standards and procedures, a formalized flight operations quality oversight program, a clearly defined safety program that provides for non-punitive safety event reporting, the use of risk assessment and management practices and policy to reduce the risk of VFR flights being continued into adverse weather, and company management oversight to ensure compliance with regulations and procedures and to eliminate Procedural Intentional Non-Compliance (PINC).
3. Provide comprehensive training for all managers on their safety role in the organization and the organization’s role in providing a Safety Management System, to include safety standards and management accountability.
4. Provide training that would address: transition to a new make and model helicopter; helicopter preflight inspections; autorotation procedures and technique; recognition and response to aircraft system failures; and emergency procedures.
5. Encourage the use of new technology that would assist in raising pilots’ and crews’ situational awareness, e.g., night vision goggles (NVGs), synthetic vision systems (SVSs), terrain / proximity awareness, weather in the cockpit, GPS moving map displays, etc.
6. Develop a set of standards and a mentoring program for pilots and mechanics that places emphasis on managing / mitigating the increased risk during the following: less then one year’s service with the operator, less then one year’s experience with HEMS operations, less than one year at a particular geographical location, less then one year’s experience in a primary aircraft model.
7. Increase the frequency of and provide comprehensive ground, flight and / or simulator / flight training device (FTD) training to reduce the risk of inadvertent flight into instrument meteorological conditions (IIMC).
8. Provide comprehensive scenario-based ground and flight simulator training for Aeronautical Decision Making and risk identification and mitigation.
9. Promote the installation of cockpit data recorders (CDR) and cockpit voice recorders (CVRs), and establish a helicopter operations monitoring program (HOMP) or helicopter flight operations quality assurance program (HFOQA) to verify and improve employee flight performance. Provide feedback for scenario-based / line oriented flight training (LOFT).
10. Install cockpit recording devices to allow accident / incident investigators to understand system anomalies and pilot / crew performance that preceded an aircraft mishap.
11. Establish systems to ensure adherence to maintenance policy and procedures, and compliance with Quality Assurance requirements, with the emphasis on oversight and guidance for remote locations.
12. For OEMs: Develop a minimum equipment standard for HEMS aircraft. Emphasis should be placed on night vision-compatible cockpits, terrain / proximity awareness, weather in the cockpit, stability augmentation systems, etc.
13. For industry and operator associations: Develop an EMS community infrastructure for standardization of radios and training for those responsible for establishment and security of helicopter landing areas.

[SASless]

I am not suggesting one brand of helmet over another....just that they are proven to be worthwhile in some circumstances. If one smacks good ol' Earth at near warp speed....nothing is going to matter. It in those less than absolutely fatal circumstances they may prevent or reduce cranial injuries. When worn with visor down...eye and facial injuries are less prone to occur.

Plus...for the EMS God's and Goddesses out there they are so totally awesome in appearance....particularly if the competition wear them.

[WhirlwindIII]

Ah, ok. I think the SPH4 is made by Gentex. The light dawns! Don't mind me.

[WhirlwindIII]

Shell Management

The IHST has brought up a lot of nice ideas. Some or most of them might be implemented if we could just get the adrenalin out, and the professionalism in, which is of course the thrust of what they are addressing, professionalism. Perhaps there should be formal licensing to be a medical crewmember, from the aviation authorities. It really puts them on the hook with respect to their performance and levels the aviation playing field whilst aloft.

For a pilot to help a medical person, to the extent we can, I have never seen a problem. However, for a medical person to help a pilot, it seems they are all about control, which is indeed what they are taught - control the situation, whether it is in the hospital, or on the street. Obvious reasons for this, and sets up an obvious subtle conflict in the pilot's mind.

However, what the pilot needs is for the medical person to think like a pilot, appreciate the pilot's perspective, and help fill in the gaps in his or her progressive thinking, as the flight unfolds.

The other thing is complication! EMS pilots make so bloody many radio calls it is distracting, then the safety gear in summer, etc. etc.

My general hit list: Get the adrenalin out, and the professionalism in
Get the medical people thinking like pilots to the extent they can provide help to him or her.
Right now where the rubber meets the road, the pilot, there is nothing but drastically mounting initiatives involving the amount of illumination of the moon, a risk matrix, doing all of every bit of admin before taking off, make a LOT of radio calls, etc. To me this is NOT very helpful - the ideas are good, but it just amounts to a load of distraction to performing a safe flight.

Simplify!

Thank you.

[Gomer Pylot]

The attitude of the med crew can usually be adjusted by talking and by the attitude of the pilot. It's not unusual for one of the med crew to get the fuel hose and start refueling the aircraft before I get it shut down, without my even asking. We all do pretty much whatever is required to get the job done, within reason. I don't touch patients, and they don't touch the controls, but other than that, we share duties and attitudes. I assume they know their jobs, they assume I know mine, and we're all willing to help out with whatever needs to be done at the time. I know there are other bases in the company where this isn't the case, and I think those bases suffer as a result. If you walk in thinking you're an aviation god, you're going to meet medical gods and goddesses. If you go in as a human being, you'll likely meet other human beings. At least that's been my experience.

I agree about the radio calls and the "safety" equipment. They're all distractions, usually when you really don't need distractions. IMO, one of my primary duties is task prioritization, and radio calls are never near the top of my list. I call when I get around to it in most cases, except when I'm trying to get into or out of Class B airspace, and then the other radios can wait. My dispatch is at the bottom of the radio list, and near the bottom of all my lists.

[Shawn Coyle]

Slightly off topic perhaps, but how is it that airline dispatchers and corporate flight department dispatchers are trained and tested and qualified, and EMS dispatchers are not?

[alouette3]

Shawn :
I maybe wrong here and I hope somebody will jump in and set me straight.
Technically, EMS 'dispatchers' are not really FAA certified dipatchers.That is, they have not taken the FAA exam and received the dispatcher ticket from the FAA.All Part 121 operators and some Part 135 carriers do use qualified dispatchers,who are FAA certified.
In the HEMS world , they are, in reality, Communication Specialists:ComSpecs. for short. The term 'dispatcher' is a throw over from the ambulance /police system, on the ground.
The ComSpecs. field calls and send the aircraft on their way, but do not share operational responsibility with the pilot, as they do in Part 121 ops.
Anybody else care to elaborate? Gomer Pylot, WWIII,SASLess???
Alt3

[SASless]

A3,

You hit the nail on the head.

Until very recently, "dispatchers" were basically "ambulance"/"fire"/"public safety" comm center workers. Things might vary a bit from operation to operation but as far as being "FAA Licensed" aviation dispatchers they are not.

The FAA did recently require 135 Operators (HEMS) to comply with aircraft dispatch and flight following requirements as set forth by FAR 135. Some operators now have a central "dispatch" office manned by FAA licensed pilots who "track" flights and monitor pre-flight weather decisions.

I flew at one operation where some of the dispatchers were very switched on and would monitor weather for us and several times made a real difference. But again, they were not "FAA Licensed, trained, or rated pilots" but were just very sharp folks.

Perhaps some of the active EMS pilots can describe how their system works.

[tottigol]

Shawn asked:
"Slightly off topic perhaps, but how is it that airline dispatchers and corporate flight department dispatchers are trained and tested and qualified, and EMS dispatchers are not?"

My answer:
10 $ and change per hour. At least in this South TX location.

[SASless]

Tott,

That is for pilots....and less for the "dispatchers" right?:E

[Shawn Coyle]

So why doesn't the FAA mandate dispatchers for EMS have some EMS relevant training / certification??

[Lutefisk989]

Shawn asks a great question. But at the pace it takes the FAA to make rule making happen...ugh.

HEMS operators would be well served to make this happen themselves. And to stop the "out Part 91, in Part 135" nonsense.

[havoc]

YouTube - Pilot Psychology Lecture: Emergency Procedures & Complacency (http://www.youtube.com/watch?v=2zY8tIDSIV8)

[Gomer Pylot]

The FAA doesn't even mandate dispatchers for EMS, (or any other Part 135 operation, for that matter) much less any certification or training standards. Only Part 121 requires dispatchers. The last Part 135 revision took several years, and involved a lot of wrangling. I was involved in the helicopter rewrite to some extent, and it was done by the big operators, with not a lot of EMS input or thought. I don't expect another major revision soon, and requiring dispatchers would be a very major change.

[helmet fire]

I am always amazed that fingers get pointed at dispatchers in these discussions. I recognise that a growing trend in US flight safety is to take the decisions out of the hands of pilots. This trend extends into risk management protocols that require pilots to fill out a form before dispatch, or juggle some numbers into a go/no summation.

This trend is not confined to the US. In some parts of Australia, it is now prohibited to do a night primary landing scene without it first being identified and established by ground ambulance. There are no training qualifications given to the ambulance personnel (other than another SOP).

Why don't/can't we admit that we don't know everything and identify training and education shortfalls that would equip us to make better decisions? Why do we react by moving all our decision processes to "tasking agents" or risk management formulae? The outcome of this trend is to reduce the decisions pilots are making and thus leave them singularly inexperienced and under prepared for the difficult in flight decisions that are really what makes HEMS a profession. Very few dispatchers and risk spreadsheets are available to you in the air.

Lastly, can I observe from outside the US HEMS industry that they are by far the busiest HEMS sector in the world, and will thus often be represented in HEMS accidents - that does not necessarily translate into an extreme of danger - it is a twist on statistics. Like the amount of R22 accidents not translating into evidence that the R22 is dangerous.

Despite MANY examples of fixed wing transport mid airs (even whilst in controlled airspace) and the attendant huge cost in lives lost, there is no knee jerk call to ban passengers from aircraft! Why do we always face a call to ban HEMS with each accident?

[tottigol]

To answer Shawn, most HEMS dispatch centres in the US are staffed by the "customer".
Except for those large 135 operators with a wide fleet of "community based" helicopters (as in PHI, AMC and AEL) where they have their own dispatch centres staffed by specialist and where there are pilots in a "flight supervisor" capacity.

Here's the normal process:
1) A 911 call is received requesting medical EMS
2) depending on the severity or mechanisms at least one (usually the best PRd) EMS program is extended a phone call and a helicopter is put on STBY or launched.
3) Some programs scan the airwaves with their radios and launch on their initiative (jump the call).
4) The race against time... and competitors is on...

[havoc]

Here is a link to the National EMS Pilots Association. They completed a survey on NVG use in EMS. NVGs are not a silver bullet by no means, but interesting demographics IMHO and of course surveys have limits to what you can really find out.

http://www.nemspa.org/Shared%20Documents/NEMSPA_NVG_Survey_0508.pdf


Chris Eastlee of AAMS Addresses Medevac Safety Concerns (http://www.avweb.com/podcast/podcast/AudioPodcast_ChrisEastlee_MedevacSafety_198250-1.html?kw=self)

[havoc]

I think a version of this has already been introduced but if not:


Maria Cantwell - U.S. Senator from Washington State (http://cantwell.senate.gov/news/record.cfm?id=300239)

[WhirlwindIII]

Gomer

Quote: ""If you walk in thinking you're an aviation god, you're going to meet medical gods and goddesses. If you go in as a human being, you'll likely meet other human beings. At least that's been my experience.""

Absolutely, one gets what one gives. Its about we doing our thing, and they doing theirs, and working as a cooperative team to enjoy work and get the job done, ideally. After more than ten years at our operation it simply just hasn't quite worked that way. Still looking for that silver bullet, or olive branch!

C'est la vive.

WIII

[Devil 49]

First, I have to object to the inflammatory position of the OP.

Poor aviation decision making, obviously. No amount of engines, avionics, gauges, dispatchers, or other 'stuff' fixes the issue. All the gear variations make diddly squat difference in the industry- they crash at about the same rate, Except NVGs...

If the very real possibility of killing oneself by accepting dispatch doesn't stop the flight's launch, what can you expect from regulation? Okay, some new laws could quash a lot of flight activity... I'm assuming that that is a different issue entirely, this is about SAFETY, yes?

Better data, more data, more easily accessible and available to the pilot, in cockpit and in the office- weather data uplinks; "fish finders"; even most cockpit ergonomics are challenges instead of assets...
The companies need to accept that Part 135 is inadequate, especially if the legal minimums are an acceptable objective. Example- the minimum training specified by that Part is patently inadequate.
The industry as a whole works against the model of safe HEMS- but that too, is a separate issue...

[WhirlwindIII]

Devil 49

I think another way of saying what you express is that you feel the industry tries (no shocker there) to do too much, with too little, too quickly.

WIII

[havoc]

IMHO interesting opinion:

Background and recent thread on EMS website:
Air Medical Professionals - FlightWeb Forums (http://www.flightweb.com/forums/index.php?showtopic=1646&st=0&start=0)



Dr. Bryan Bledsoe is an emergency physician and EMS author from Midlothian, Texas. He entered EMS in 1974 as an EMT and attended one of the first paramedic programs in north Texas. Dr. Bledsoe worked for several years in Fort Worth as a paramedic and went on to become an EMS Instructor and Coordinator. Dr. Bledsoe has a B.S. from the University of Texas and a D.O. from the University of North Texas. He completed a residency at Texas Tech University Health Sciences Center and at Scott and White Memorial Hospital/Texas A&M College of Medicine. He is board-certified in emergency medicine.

Dr. Bledsoe has served as the Medical Director for two hospital emergency departments as well as for numerous EMS agencies in north Texas. He is the author of numerous EMS textbooks including: Paramedic Care: Principles & Practice, Paramedic Emergency Care, Prehospital Emergency Pharmacology, Anatomy and Physiology for Emergency Care, and many others. He is a frequent contributor to EMS magazines and presenter at national and international EMS conferences. He is married and lives in Midlothian, Texas. He enjoys salt-water fishing.

Dr. Bledsoe is affiliated with the University of Nevada, Las Vegas in Las Vegas, Nevada. He is co-chair of the Curriculum and Education Board for the United States Special Operations Command (USSOCOM) at MacDill AFB, FL.



My hat is off to all who toil in medical helicopters and fixed-wing aircraft. The last 2 weeks have been an uncomfortable time to be a pilot, flight medic, or flight nurse. I have been interviewed a great deal and I have hammered the helicopter EMS industry. I have been very careful to point out that I highly respect the crews and pilots. But, those words always get ediited out. Kind words do not bring television viewers or newspaper readers. Only harsh criticism does. I received over 200 emails and calls from around the world after the series of interviews following the Flagstaff crashes. Many were from flight paramedics and nurses. EVERY EMAIL AND CALL I RECEIVED FROM MEMBERS OF THE AIR MEDICAL COMMUNITY WAS RESPECTFUL, KIND, SUPPORTIVE, AND INFORMATIVE. Many apologized about how the HEMS had treated me in the past on Flightweb. One nurse personally apologized for an email she sent a year ago acusing me of being a "helicopter hater". Now, a year later, she sees where I was coming from. This speaks well of you. The collective of you--medical providers who fly--have risen above the industry mantra. The risks are real. The patients are less sick. Money is the master. Things are horrible. The media is on you. Yet, your mouthpieces talk about lives saved, the need for more helicopters, and that the safety record is not so bad when you consider the lives saved. I have had 5 phone calls from trauma surgeons (2 I knew) each echoing the same story--they could count on one hand the number of patients they felt benefitted from HEMS transport.

Safety changes have to go beyond NTSA.

We must consider:
1. Dual pilots
2. Full IFR capabilities
3. Larger aircraft with twin engine and system redundancy,
4. NVGs (the AMPA paper is very compelling).
5. Adherence to Part 135 at all times.
6. TAWS
7. Employer supplied helmets and suits.
8. Mandatory rest periods for flight crews along the same lines as for pilots
9. Centralized EMS (non-proprietary) dispatch.
10. Subscriptions must stop.

What does this mean?
1. More than half the fleet must go away. Those that remain must make a committment to safety by adding the needed equipment and rules. All should be operated as a part of a regional EMS system--not like the wrecker industry.
2. Half the current number of flight personnel will lose jobs. Sorry.
3. The more qualified members of the HEMS crew (medics, nurses, pilots) will rise to the top and take the jobs that are open in the new industry. The quality of care will return to what it used to be.

I do believe there is a subset of patients who can benefit from HEMS. We need to figure this out and revise criteria. There is no move to revise current criteria becaue doing so migh cut a few flights. Losing a few flights might hurt the stock value. But, cutting nonessential flights might also save lives.

Be verbal. Speak up. Don't walk away unless the safety issues are dangerous. One of three things will happen: 1) The FAA will step in. 2) Congress will step in. 3) Insurance companies will stop paying--no bucks--no Buck Rogers. The latter is most likely.

We Americans think we are the center of the universe. Does any other first world country boast 750-1,000 medical helicopters? I have met with HEMS officials in New Zealand and Australia where the strategy was to "avoid the Yanks problems" by setting up protocols and barriers to minimize helicopter usage. If we are the only first world country doing anything in medicine, it should give us pause and make us reevaluate the system.

Thanks for the emails and kind thoughts. We are on the same team. My resepct for you guys (and women) continues to climb.

Bryan

[WhirlwindIII]

A question please. The popular validity of HEMS seems to rest on the idea of "saving lives". Where does "decreasing morbidity" through rapid transport (if this is a major reality) come to play?

My guess is doctors get nervous about patient outcome and pull the helicopter trigger in accordance with criteria that caters not only to life-saving but to decreasing morbity to assure quality of life; and such that medical liability is decreased and insurance companies possibly lose less in ongoing rehab and care. Another way of saying the dollar rules. But is that all bad? Where does the HEMS transport criteria line get redefined? Is this line medically driven or mostly a liability/insurance problem, or all three?

Completing transports obviously must not come at the expense of an accident record that can otherwise be dealt with; if all involved decide to do so.

Thanks.

WIII