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Helicopter EMS Issues in the USA

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Helicopter EMS Issues in the USA

Old 16th Nov 2010, 21:59
  #81 (permalink)  
 
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Only one is really needed.

1) Remove the customer in any possible way from affecting the operational control of the aviation side.

You can only remove that by removing the profit factor.
Hence just like helmet fire said, it shall never happen in the States.

Let's see which program shall be next in creating a smoking hole somewhere in the states.

Let's then listen to the mourning and "they were heroes" bull**** over and over again.
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Old 20th Dec 2010, 19:48
  #82 (permalink)  
 
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Link from Connect MidMissouri

If you make it through the atrociously-written (OK, I'm being a bit unkind - she's just printing verbatim what the witness said) article, you'll find that "one of the engines" blew up. On a 350, what exactly does that leave the pilot by way of spare power-plants, hmm?

From the photos, it would appear that the pilot did a very good job of keeping the aircraft level after touchdown.
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Old 22nd Dec 2012, 18:33
  #83 (permalink)  
 
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Bell 407 training in the US


I have read that there are going to be many more Bell 407's in the US to cover EMS work. I suppose this must be one of the best EMS helicopters?
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Old 22nd Dec 2012, 20:44
  #84 (permalink)  
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Stude,

They are the cheapest....not the best.




As to the FAA comments.....

Truck Drivers have far more strict (read restrictive) Hours of Service than do Pilots.

Last edited by SASless; 22nd Dec 2012 at 20:47.
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Old 18th Jul 2013, 15:15
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Bigger EMS helicopters required in US

To accommodate the nation’s super-sized patients, emergency medical providers are now being forced to purchase larger helicopters. More than two-thirds of American adults are overweight or obese, which has caused a dilemma for air transport providers.

“It’s an issue for sure,” Craig Yale, vice president of corporate development for Air Methods, told NBC. “We can get to a scene and find that the patient is too heavy to be able to go.”

Some emergency helicopters are unable to carry patients weighing more than 250 pounds, and others are able to accommodate patients weighing up to 650 pounds. As a result, emergency medical providers have been forced to expand their fleets and purchase larger air ambulances, which can be costly.
Patients become too heavy for medical emergency helicopters ? RT USA
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Old 5th Apr 2015, 10:02
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With a mega order of 200 B407GXP I don't see Air Methods paying too much attention to passenger size.

Air Methods Buying 200 Bell 407GXP Helicopters | Flying Magazine

I'm surprised to see no comment here on the two fatal HEMS accidents in the US last month.

More US Night HEMS Accidents

But at least the FAA have ensured there will never be another HEMS accident in the US (HAA HAA HAA).
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Old 5th Apr 2015, 12:17
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With a mega order of 200 B407GXP I don't see Air Methods paying too much attention to passenger size.
On the contrary, that's why the 407 was selected. For most operations (other than hot/high) the 407 provided better metrics than the other choices B2/B3 and 130. CG issues affect the latter such that routinely 250-300lbs are the max passenger weights possible for the sectors flown. It's not just patient weights that are increasing, but in many cases it's the crews as well, with the pilots being the most critical CG wise of course. In addition, there is an ever increasing requirement by regulators to carry more equipment - in many states the air ambulance falls under the same regulation as the ground ambulance with little distinction made. 175-250lbs of equipment is the norm.

In my opinion the EC130 is a good aircraft in the EMS configuration and a better fit for medical care, with improved access over the 407. From a business perspective I can sell that over many other choices including twins eg. 135. Unfortunately experience has shown that the cg issues which impact the B2/B3, remain for the 130. Of course the health care industry in the US has a very different economic model which promotes single use. That's just a reality which accepts the cost/risk benefit.

As for accidents, it remains a challenge for night ops. The new and improved EC130T2 which comes online this year, will see some additional benefits for aviation and medical crews alike with many new airframes and retrofits. This includes G500/G1000 with synthetic vision, and simple auto pilots - more tools and training. One hopes that coupled to NVG's etc this will reduce the inherent risk of single pilot night time ops, but there is always the human element which cannot be removed from the equation. Where many pilots develop their experience in a single pilot VFR environment or enter the industry from a specialized multi crew background, human factors/training/cultural and proficiency considerations weigh heavily. There is also the shear scale of operations in the US to consider, which whilst not mitigating the need for improvement, certainly contribute to the statistical inevitability.

Last edited by crunchingnumbers; 5th Apr 2015 at 13:29.
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Old 5th Apr 2015, 16:04
  #88 (permalink)  
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Never Fretter posted:
(1)... "With a mega order of 200 B407GXP I don't see Air Methods paying too much attention to passenger size.

Air Methods Buying 200 Bell 407GXP Helicopters | Flying Magazine

(2)... I'm surprised to see no comment here on the two fatal HEMS accidents in the US last month.

More US Night HEMS Accidents

(3)... But at least the FAA have ensured there will never be another HEMS accident in the US (HAA HAA HAA)."

(1) The 407 vs the 350 was purely a better deal by airframe offering. Announced in the company as saving hundreds of millions of dollars. From the line, it doesn't really make much difference to the pilots if you're not operating in a hot and high environment. The AS350 CG issue is usually a less serious issue than patient girth, our safety belts have a finite length and no approved extenders. I might be able to keep you in CG at 350 lbs, but if you're bigger around than 52-54 inches, you're going by truck. I don't see that changing with the 407 deployment.

(2) Two more HEMS night accidents are not remarked on here?
Okay, one appears weather related by an operator for whom this was the fourth fatal crash of 5 aircraft based in Oklahoma in the last 3, 4 or 5 years. Pick an accident in that series, and there may be a reason to excuse the operator. On the other hand, it could well be that this operator is the coal mine canary for the industry that believes it has no problems. That's my opinion.
The other accident may have a weather factor, but I lean more towards a human factor.
We'll have a better idea when the accident reports come out.

(3) I agree entirely and completely, "HAA, ha ha ha". Now that I no longer operate an "emergency service" it removes so much pressure to go... Not.
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Old 6th Apr 2015, 08:04
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US HEMS = Profit, profit, profit

This same story has been going for decades. While ever the US HEMS industry continues, (for the most part), to be run by private for-profit operators, a for-profit health care system and companies seeking a way to make a quick buck with less capable helicopters not suited to specific missions and tasking, you will continue the horrific safety record in the US with little or no change. Take out any profit and commercial incentive and your system will become what it can be.
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Old 6th Apr 2015, 12:45
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Question

(1) Forgive my naivety but isn't the cabin size a factor too when selecting a medical helicopter. Surely the cabin of a 407 will still be particularly tight with a large patient needing ventilation etc during flight plus medical crew and equipment? After all isn't that Bell's marketing point for the 429? I could see a 407 being slightly easier to justify for short transits but I see that there are cases of patients being flown past the closest hospital.
State Investigates Medical Helicopter Company | KRGV.com | Rio Grande Valley, TX

(2) Is in commercially advantageous to use two helicopters (after a road accident with multiple casualties say) rather than one larger helicopter?

(3) On the point that "take out any profit and commercial incentive", surely that isn't stopping commercial airlines achieve amazing levels of safety. Does this mean that the medical industry in the US are culturally accepting of a certain level of attrition and happy to continue to use providers with a poor safety record without penalty?

(4) Why so many night accidents? More US Night HEMS Accidents Is it a sign of the number of night flights or their relative risk?
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Old 6th Apr 2015, 14:49
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Cabin size is sufficient. The problem with size is patient girth, as Devil49 pointed out. That's the only thing that really matters.

Using one big helicopter instead of multiple smaller ones isn't viable economically. You can't plan for a situation that happens only a very few times per year, you have to plan for the everyday case.

Carping about the economic model in the US does no good. I would also like to see the entire medical industry model change, but it's not going to happen. Capitalism will continue to rule, so we need to find the best way to deal with that and its effects. The FAA is required by law to consider economics in its regulations, and can't impose any that would cause severe economic penalties, regardless of whether they would save lives. It's wrong, but it's the reality.

I think the number of night accidents reflect both the numbers, and the relative risk. I almost always had about as many night as day flights, and I suspect the numbers are at least on the same order of magnitude with most programs. But night EMS has its dangers. It's dark. That makes it hard to see. Duh. But it's true. Googles help a lot, but they have their limitations. Everything is one color, and the field of vision is very narrow. It's really easy to miss seeing something that's just a few degrees to one side. The biggest danger, IMO, is the physiological difference. If you're asleep, and wake up from deep sleep for a flight, sleep inertia is difficult to overcome, and can take a long time to pass. Pilots who live locally, and stay on the same diurnal schedule regardless of the work schedule are more likely to be affected, and are also more numerous. Companies want to save money by having crews live locally so they don't have to provide quarters, and pilots don't like being away from home for a week at a time. IMO, this causes accidents, and lives. But it won't change. Money talks.

Night HEMS accidents could be completely eliminated, of course. Just eliminate all night HEMS flying. Lots of people across the pond advocate that, and some don't allow night flights there. But one has to take a broader view, I believe. Of course people die in night HEMS crashes. But the real question is whether those deaths outnumber the lives saved overall. That's a difficult number to quantify. But one still needs to consider the tens of thousands of night HEMS flights annually in the US, and the relatively small number of accidents. I'm certain that night HEMS flights will continue, and continue growing. How to properly regulate them, and minimize the risks, is the question. We will never eliminate risk, we can only minimize it.
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Old 6th Apr 2015, 15:21
  #92 (permalink)  
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There is ALWAYS a profit consideration

whether it's public service/government, "not for profit", charity, or a conventional for-profit business model. The profitability is determined in different ways that makes it harder for people to see the decision points.

Public service/government will use a limited budget (hopefully) to provide the best value, another name for profitable application of resources. If the budget "Super Bug Smasher" law enforcement/air ambulance is not justified by providing "x" number of transports to the public at large, that budget will be redirected to something else. There aren't limitless funds, even in enlightened Europe- do you see many air ambulances with flight into known icing capability over yonder? No? I would think it would be very useful...

Not for profit... same-same, only cash flow can be directed to various entities as equipment, salaries and bonuses, whatever makes the bottom line all 'zero-ey". I can't count the number of not-for profits gone belly-up because of what is termed poor profitability in a conventional business scenario.

And finally, the much maligned "for profit enterprise"- Efficient application of resources required or you fail. HEMS/HAA or whatever the PC term is this week can be done safely by a for profit, witness the current airline industry compared to earlier for an idea of possible room for improvement. As in any operation, HEMS/HAA management for safety requires proper prioritizing and management of resources. THAT is not routinely done in the US, Gomer Pylot brings up some of the issues. It's not that management intends to compromise operational safety for profit, it's that they don't SEE the factors acting to increase risk. Another example of that issue as I see it- None (zero, zilch, nada) of my company's management fly the job, ever. All of my company's instructional staff are management. Even my chief pilot, for whom I have great respect, has a historic and dated view of the job and challenges faced.

Another example from night problems in the US HEMS/HAA industry- pilots plan on sleeping on the job (for various reasons, not germaine) and do so. Now at Oh-dark thirty, the request comes in, awakens the pilot, the pilot checks weather and compares METARs to forecast while awakening the crew (response time isn't the criteria except that it IS tracked and used to critique). What was missed that is really, really important? trends. You have to monitor trends to have any real idea of weather. Forecasts are guesses, observations are history, trends show where the weather will probably be going in spite of forecasts...
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Old 6th Apr 2015, 17:47
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Devil49, I agree with part of your post, the last part mainly.
The part with which I don't agree is where you refer to the airline industry:

1. Following the Buffalo accidents of a few years back and the uproar that followed it, even the Regionals had to bite the bullet and accept a minimum of an ATP license for their SICs and the flight time experience that comes with it, the HEMS industry is going into the opposite direction with no end in sight.

2. An airline FLIGHT CREW decision to not depart is not usually followed by subliminal or overt pressure by the passengers (read customers) to launch, penalty removal from the position as it often happens with HEMS pilots.

You are right HEMS pilots do not want to travel, but that would remove most cases of get-home-itis (you ARE away for a week or so).
Sleeping quarters need not be anything fancier than a double wide, which is the industry standard anyway.
GomerPylot is correct, have you ever seen your med crew trying to do compressions on a 400 pounder in flight? There just isn't enough space above the poor person and the cabin ceiling.
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Old 6th Apr 2015, 18:24
  #94 (permalink)  
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Tottigol:
Devil49, I agree with part of your post, the last part mainly.
The part with which I don't agree is where you refer to the airline industry:

1. Following the Buffalo accidents of a few years back and the uproar that followed it, even the Regionals had to bite the bullet and accept a minimum of an ATP license for their SICs and the flight time experience that comes with it, the HEMS industry is going into the opposite direction with no end in sight.


Look even further back in airline history and the industry's safety wasn't stellar.
The Buffalo accident has much to teach the industry, especially regarding crew rest, yet I haven't heard discussion one from management or my peers. It's like that never happens...

2. An airline FLIGHT CREW decision to not depart is not usually followed by subliminal or overt pressure by the passengers (read customers) to launch, penalty removal from the position as it often happens with HEMS pilots.


I have never had an abort or decline brought up, much less critiqued by AVIATION management. Medical crew is another kettle of fish entirely but I'll chew my lip for a bit on that.

You are right HEMS pilots do not want to travel, but that would remove most cases of get-home-itis (you ARE away for a week or so).
Sleeping quarters need not be anything fancier than a double wide, which is the industry standard anyway.


My base has a pilot suite separate from the operations area.
You're halfway to a point with "get-home-itis" in that the issue of company providing poor support for weather aborts. That can be an issue, whether it's admitted or not.

GomerPylot is correct, have you ever seen your med crew trying to do compressions on a 400 pounder in flight? There just isn't enough space above the poor person and the cabin ceiling.

Yep, I have. The ceiling isn't the issue, it's lateral patient access seems a bigger problem in my unqualified estimation. The 407 won't be an improvement in that regard, but perhaps we'll have "thumpers" and other automation by then.
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Old 6th Apr 2015, 20:33
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It is worth watching this the pilot's integrity though his comments after this flight was the flight nurse and paramedic refused to fly with him ever again..

https://www.youtube.com/watch?v=EMxuO77mdQo

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Old 7th Apr 2015, 01:39
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I have never had a member of management question, or even comment on, a decision of mine to fly or not fly. I can't say the same for the 25+ years I spent flying in the GOM. The attitude from management is entirely different. I've also never had a complaint from the med crews. They have sometimes commented on other pilots' decisions, but if they ever said anything about mine, it was never related to me by anyone. The med crews knew I would fly if I thought it was safe and legal, and would refuse if not. Med crews, like everyone else, tend to value competence and level-headedness. Being unsure and changing your mind often scares them. If they trust you to know your job, and your commitment to doing it right, they won't question your decisions nearly as much. They can usually tell if you're turning down a flight just because you prefer to sleep, and if you do that a few times, your trust is gone. None of this is unique to flying, it's standard in every industry, every job.

I will say that 3800 hours at retirement isn't much. That says that it was a long time between flights, and it's impossible to stay proficient while not flying. HEMS is not a job for low-time pilots. You don't get a chance to fly that often, and when you do you have to be perfect every time. It's difficult even with tens of thousands of hours.

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Old 10th Apr 2015, 12:12
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What roster do US HEMS pilots normally work? I'm struggling to understand the comment above that they are woken up for night flights. Surely they don't work 24 on?

Can any one clarify what percentage of HEMS flights are flown at night in the US?
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Old 10th Apr 2015, 14:50
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Never Fretter, an verage of 30% of EMS flights is flown at night in the USA.
The pilots are required to show up rested for night duty.
Normal EMS rotations are 12 hours day shifts and 12 hours night shifts (ie: 07:00-19:00 and 19:00-07:00).
Under part 135.267 unscheduled one pilot operations, minimum rest undisturbed has to be 10 hours in the last 24 hours, with a maximum duty of 14 consecutive hours.

That rest includes driving back and forth from the pilot's domicile.
The pilots are responsible to get their rest once they get home or to their "luxury trailer"
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Old 10th Apr 2015, 16:27
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Thoughts on the video "That Others May Live"

"not much had happened that week, there wasn't a single flight... eager to take the flight."
(Pressure to accept dispatch, self-imposed, also called 'motivated pilot')

"The weather was no good because of the clouds. They asked if..."
(A motivated pilot properly exercises judgement, ultimately proven absolutely correct. The correct decision taken by the pilot is inappropriately influenced.)

"We too off... and there's no way... cancelled, turned around..."
(And again, the pilot's decision is that conditions are not acceptable by the PIC on the scene.)

"Can you maybe go the alternate landing spot? It was clear there, because we had flown over it..."
(The safe conservative decision to not attempt this flight is again inappropriately interfered by the company.)

The pilot's narrative indicates that he is nervous about the situation at the alternate landing site "I'd been looking at that light, it's so dark behind it..." "After several minutes... low level fog developing.."
(I'm not there, so I don't know, but at this point I'm telling the crew they have a choice, they can leave with me or ride the ambulance to the hospital. But this is a 'motivated pilot', not me. The trap is apparent if you will only see it.)

"Yep, there's 'glows around the lights'. Okay, let's go. Get on board. We're leaving and we're leaving now!" "Without the patient on board, Denver had already lifted the helicopter... when they noticed that the ambulance had finally arrived. Well shoot what are we going to do [the decisive error, the decision has been made by the PIC. Now the med crew is flying.]... seven minutes later...
(From this point on, with dispatch and the med crew having put the PIC in the scenario he attempted to avoid, he has to deal with it as it exists.)

Comments:
This pilot made all the right decisions until his foot was in the bear trap. Further, he proved all the capabilities required when tested after the fact. Which proves that nobody in the management chain KNOWS what's wrong. The answer is apparently changing the name of this phase of the industry from HEMS to HAA...

Hire, train and support good people, especially pilots. This pilot had integrity, knowledge, motivation and capability but was betrayed by those he worked with. No means no, shut up or fire somebody if you have the wrong people in the job.

The FAA, Airbus and the industry should be ashamed of the false representations made regarding cockpit videos. The camera was absolutely no help with this pilot's predicament. Airbus's talking heads postulate that management, which positively created this incident should hold more effective tools to blame pilots is wrong as this incident demonstrated multiple times. The answer isn't more outside the cockpit influence on pilot action, it's better training, support and information for the PIC to do the job. Which is expensive and inconvenient and largely a mystery to the industry.


To those discussing HAA/HEMS pilot schedules, the rule cited deals with crew scheduling and assumes rest. This rule works pretty well with daytime operations. My opinion is that the rule fails to deal with night operations generally and HAA/HEMS in particular, perhaps being a primary contributor to the fact the nights are 4 times more dangerous compared to day flights in my work. The rule spectacularly ignores proven physiological issues and presents an illusion of adequacy by doing so.
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Old 10th Apr 2015, 17:54
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Devil,
I agree 110% with you on all matters in your post, however this pilot proved he had all the training/experience/information needed and proved again that experience without external pressure leads to correct decision making.

As you say "The answer isn't more outside the cockpit influence on pilot action, it's better training, support and information for the PIC to do the job."

The answer is LESS out of the cockpit influence, by both the flying customer and remote decision making dispatch.
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