Confusion indicates that the presence of this text is not general known:
ACJ to Appendix 1 to JAR-OPS 3.005(d)
The JAA HEMS philosophy
See Appendix 1 to JAR-OPS 3.005(d)
1 Introduction
This ACJ outlines the JAA HEMS philosophy. Starting with a description of acceptable risk and introducing a taxonomy used in other industries, it describes how risk has been addressed in the HEMS appendix to provide a system of safety to the appropriate standard. It discusses the difference between HEMS, Air Ambulance and SAR - in regulatory terms. It also discusses the application of Operations to Public Interest Sites in the HEMS context.
2 Acceptable risk
The broad aim of any aviation legislation is to permit the widest spectrum of operations with the minimum risk. In fact it may be worth considering who/what is at risk and who/what is being protected. In the view of the JAA Helicopter Sub-Committee (HSC) three groups are being protected:
- Third parties (including property) - highest protection.
- Passengers (including patients)
- Crew members (including task specialists) - lowest
It is for the Authority to facilitate a method for the assessment of risk - or as it is more commonly known, safety management.
3 Risk management
Safety management textbooks[1] describe four different approaches to the management of risk. All but the first have been used in the production of the HEMS appendix and, if we consider that the engine failure accountability of Class I performance equates to zero risk, then all four are used (this of course is not strictly true as there are a number of helicopter parts - such as the tail rotor which, due to a lack of redundancy, cannot satisfy the criteria):
Applying the taxonomy to HEMS gives:
- Zero Risk; no risk of accident with a harmful consequence - Class 1 performance (within the qualification stated above) - the HEMS Operating Base.
- De Minimis; minimised to an acceptable safety target - for example the exposure time concept where the target is less than 5 x 10-8 (in the case of elevated landing sites at hospitals in a congested hostile environment the risk is contained to the deck edge strike case - and so in effect minimised to an exposure of seconds).
- Comparative Risk; comparison to other exposure - the carriage of a patient with a spinal injury in an ambulance that is subject to ground effect compared to the risk of a HEMS flight (consequential and comparative risk).
- As Low as Reasonably Practical; where additional controls are not economically or reasonably practical - operations at the HEMS operational site (the accident site).
It is stated in JAR-OPS 3.005(d) that “...HEMS operations shall be conducted in accordance with the requirement contained in JAR-OPS 3 except for the variations contained in Appendix 1 to JAR-OPS 3.005(d) for which a special approval is required.”
In simple terms there are three areas in HEMS operations where risk, beyond that allowed in the main body of JAR-OPS 3, is defined and accepted:
- in the en-route phase; where alleviation is given from height and visibility rules;
- at the accident site; where alleviation is given from the performance and size requirement; and
- at an elevated hospital site in a congested hostile environment; where alleviation is given from the deck edge strike - providing elements of the Appendix 1 to JAR-OPS 3.517(a) are satisfied.
In mitigation against these additional and considered risks, experience levels are set, specialist training is required (such as instrument training to compensate for the increased risk of inadvertent entry into cloud); and operation with two crew (two pilots, or one pilot and a HEMS crew member) is mandated. (HEMS crews - including medical passengers - are also expected to operate in accordance with good CRM principles.)
4 Air ambulance
In regulatory terms, air ambulance is considered to be a normal transport task where the risk is no higher than for operations to the full JAR-OPS 3 compliance. This is not intended to contradict/complement medical terminology but is simply a statement of policy; none of the risk elements of HEMS should be extant and therefore none of the additional requirements of HEMS need be applied.
If we can provide a road ambulance analogy:
- If called to an emergency; an ambulance would proceed at great speed, sounding its siren and proceeding against traffic lights - thus matching the risk of operation to the risk of a potential death (= HEMS operations).
- For a transfer of a patient (or equipment) where life and death (or consequential injury of ground transport) is not an issue; the journey would be conducted without sirens and within normal rules of motoring - once again matching the risk to the task (= air ambulance operations).
The underlying principle is; the aviation risk should be proportional to the task.
It is for the medical professional to decide between HEMS or air ambulance - not the pilot! For that reason, medical staff who undertake to task medical sorties should be fully aware of the additional risks that are (potentially) present under HEMS operations (and the pre-requisite for the operator to hold a HEMS approval). (For example in some countries, hospitals have principle and alternative sites. The patient may be landed at the safer alternative site (usually in the grounds of the hospital) thus eliminating risk - against the small inconvenience of a short ambulance transfer from the site to the hospital.)
Once the decision between HEMS or air ambulance has been taken by the medical professional, the commander makes an operational judgement over the conduct of the flight.
Simplistically, the above type of air ambulance operations could be conducted by any operator holding an AOC (HEMS operators hold an AOC) - and usually are when the carriage of medical supplies (equipment, blood, organs, drugs etc.) is undertaken and when urgency is not an issue.
5 Search and rescue (SAR)
SAR operations, because they are conducted with substantial alleviations from operational and performance standards; are strictly controlled; the crews are trained to the appropriate standard; and they are held at a high state of readiness. Control and tasking is usually exercised by the Police (or the Military or Coastguard in a maritime State) and mandated under State Regulations.
It was not intended when JAR-OPS 3 was introduced, that HEMS operations would be conducted by operators not holding an AOC or operating to other than HEMS standards. It was also not expected that the SAR label would be used to circumvent the intent of JAR-OPS 3 or permit HEMS operations to a lesser standard.
6 Operating under a HEMS approval
The HEMS appendix originally contained the definitions for Air Ambulance and SAR - introduced to clarify the differences between the three activities. In consideration that, in some States, confusion has been the result, all references to activities other than HEMS have now been removed from the appendix and placed into ACJ material.
There are only two possibilities; transportation as passengers or cargo under the full auspices of JAR-OPS 3 (this does not permit any of the alleviations of the HEMS appendix - landing and take-off performance must be in compliance with the performance subparts of JAR-OPS 3); or operations under a HEMS approval.
7 HEMS operational sites
The HEMS philosophy attributes the appropriate levels of risk for each operational site; this is derived from practical considerations and in consideration of the probability of use. The risk is expected to be inversely proportional to the amount of use of the site. The types of site are:
HEMS operating base; from which all operations will start and finish. There is a high probability of a large number of take-offs and landings at this heliport and for that reason no alleviation from operating procedures or performance rules are contained in the HEMS appendix.
HEMS operating site; because this is the primary pick up site related to an incident or accident, its use can never be pre-planned and therefore attracts alleviations from operating procedures and performance rules - when appropriate.
The hospital site; is usually at ground level in hospital grounds or, if elevated, on a hospital building. It may have been established during a period when performance criteria was not a consideration. The amount of use of such sites depends on their location and their facilities; normally, it will be greater than that of the HEMS operating site but less than for a HEMS operating base. Such sites attract some alleviations under the HEMS rules.
8 Problems with hospital sites
During implementation of JAR-OPS 3, it was established that a number of States had encountered problems with the impact of performance rules where helicopters were operated for HEMS. Although States accept that progress should be made towards operations where risks associated with a critical power unit failure are eliminated, or limited by the exposure time concept, a number of landing sites exist which do not (or never can) allow operations to Performance Class 1 or 2 requirements.
These sites are generally found in a congested hostile environment:
- in the grounds of hospitals; or
- on hospital buildings;
The problem of hospital sites is mainly historical and, whilst the Authority could insist that such sites not be used - or used at such a low weight that critical power unit failure performance is assured, it would seriously curtail a number of existing operations.
Even though the rule for the use of such sites in hospital grounds for HEMS operations (Appendix 1 to JAR-OPS 3.005(d) sub-paragraph (c)(2)(i)(A)) attracts alleviation until 2005, it is only partial and will still impact upon present operations.
Because such operations are performed in the public interest, it was felt that the Authority should be able to exercise its discretion so as to allow continued use of such sites provided that it is satisfied that an adequate level of safety can be maintained - notwithstanding that the site does not allow operations to Performance Class 1 or 2 standards. However, it is in the interest of continuing improvements in safety that the alleviation of such operations be constrained to existing sites, and for a limited period.
It is felt that the use of public interest sites should be controlled. This will require that a State directory of sites be kept and approval given only when the operator has an entry in the Route Manual Section of the Operations Manual.
The directory (and the entry in the Operations Manual) should contain for each approved site; the dimensions; any non-conformance with Annex 14; the main risks; and, the contingency plan should an incident occur. Each entry should also contain a diagram (or annotated photograph) showing the main aspects of the site.
9 Summary
In summary, the following points are considered to be germane to the JAA philosophy and HEMS regulations:
- Absolute levels of safety are conditioned by society.
- Potential risk must only be to a level appropriate to the task.
- Protection is afforded at levels appropriate to the occupants.
- The HEMS appendix addresses a number of risk areas and mitigation is built in.
- Only HEMS operations are dealt with by the appendix.
- There are three main categories of HEMS sites and each is addressed appropriately.
- State alleviation from the requirement at a hospital site is available but such alleviations should be strictly controlled by a system of registration.
- SAR is a State controlled activity and the label should not be used by operators to circumvent HEMS regulations.
10 References
a. Managing the Risks of Organizational Accidents - Professor James Reason.