Hello from Albuquerque:
Mr. Lappos, while I agree with your presentation about technology solving a number of our problems offshore, I do not think it will work in the EMS game. This is mainly due to most oil platforms don’t move. As an EMS pilot, I have never been to the same road intersection twice when responding to a wreck.
The very first thing is what the aircraft and crew is asked to do. Generally, we give a patient a fast ride to a hospital. Very little real medicine is practiced while in flight. A medical crew doesn’t want to do a number of procedures in flight. They try to stabilize the patient prior to transport unless there’s nothing left to do at their skill level but go.
So if the crew isn’t doing much beyond administering drugs, providing oxygen, monitoring vital signs and so forth, why do we need a large, twin engined helicopter? Three days ago, I flew to a multi casualty scene in our Astar. Another flight program responded as well in their Agusta 109E. Both aircraft and crew did the same thing – fast ride to the hospital. Both programs are VFR along with most EMS programs in the U.S. I have seen the cockpit of this aircraft - fully equipped for single pilot IFR. I’m guessing, but the Agusta probably cost a couple million more than the Astar – to do the same flight. This is why there are a lot of single engined EMS aircraft in the market.
What I see as the downside to single engined machines is the reduced potential for adding things like a simple auto-pilot. I’d like to think that everything that goes into a smaller machine is scaled down, but that’s not the case. To my knowledge, the Eurocopter auto-pilot for an Astar weighs maybe 70-80 pounds. Sure it could be installed, but then we’d be down to an hours worth of fuel and have the ability to carry a 180 lb patient. That won’t work here in New Mexico.
So what we need on the aircraft end is a cheap to buy and operate, single engined machine, with enough useful load for us to be able to do a reasonable distance, large patient, cabin with a little elbow room and still have the ability to add those things which are near and dear to us – auto-pilot, EGPW, enhanced vision equipment, etc.
This brings me to your IFR low level routes and point in space approaches. If I leave ABQ (5230’) headed east, before I get 10 miles, I need about a 12-14K MSA to clear the mountains. Presently, when we get over there, there’s no approach to shoot. So we take the time and money to have our own built and in the process buy the big twin with all the equipment needed to shoot a point in space approach to auto-hover. Say we have a certified (how much does this cost?) approach to every 10 mile square box over there, well, that’s a lot of approaches and a lot of money. We do it anyway. So far so good.
Here’s the bottom line, the part that kills the most of us. Sooner or later a crew will go IFR over there, shoot the approach, break out at 200’ and when they do, they get a radio call that goes something like this: “Heroflight 1, what’s your ETE. The patient is still being extricated.”(And a bunch of medical stuff which prompts you and the med crew to believe you need to be there instead of where you are) So there you are at the end of your point in space approach and the wreck is 7 miles up some gravel road surrounded by forest. Are you going to wait at your breakout point, which in all probability will alienate the local EMS provider (because you do fly a helicopter which can land anywhere, right?), or you going to go up the road VFR?
You don’t know what the obstacles are along this road because you only half way trust the database installed with all the other fancy equipment, so you have to do this part visually, unlike the surveyed approach you just shot. If you re-enter the clouds, you’re not doing the patient much good because now you have to climb up and re-shoot the original approach. You do this a few times with some of these local EMS providers and they’ll soon realize it’s just as quick to go by ground than to delay the transport waiting for you.
So what do you do? If you go up the road like the A109 crew did in northern California a few years ago after an IFR approach to the nearest airport, you drive it into the side of a hill and die. No, they didn’t have all the additional equipment you refer to, but they went over there IFR and decided to continue VFR into IMC conditions. This is the decision whereby we kill ourselves.
The point here is if a helicopter goes to an airport for anything other than fuel, you might as well send an airplane. Same goes for sending a helicopter to someplace far away from where it needs to be. Unless you can make up these approaches to literally any point in space, on the fly, with guaranteed obstacle clearance and aircraft performance margins, it won’t work doing EMS scene responses. Would the FAA sign off on this even if it were possible? I don’t think so considering how long it took them to let us use NVGs. EMS flight programs are already doing point in space approaches to hospitals and the like with technology present today. What would be the incentive for an operator to buy into all this new stuff?
As an aside, the regulations are also far behind even today’s technology. I can MEL our radar altimeter and launch out on the darkest night, WITHOUT NVGs, but I have to have it if I fly aided, even though I can now see the terrain. Make any sense to you?
I’m all for embracing technology that will make my job safer and easier, but until there’s a piece of equipment I can strap on my head or a turreted ball under the nose that allows me to see at night and in clouds like I was flying VFR in some semblance of VMC, we need to raise our weather minimums, get the medical crews more involved in the decision to go or stay home and just say no more often to requests for service.
Ron Powell
PHI Air Medical Services
Albuquerque NM