I differ a little there spinwing: the accidents in Australia did not change much - it steered one state government away from single engine VFR helos, there were only three of those in use in that state, and it did not even mandate NVG! There was nothing ground breaking or monumental in the changes. That is a very different proposition from what the USA is going through - for a start, each helicopter in QLD had only one client and none were competing on a cost basis with any other. There was no loss of work, nor redundencies for machines and operators. Similar changes (mandate IFR Twins) would have a massive impact and are therefore unfortunately unlikely in a for-profit system such as the USA.
I think a whole lot of this thread has been written with passion and intelligence, and it has made a lot of sense from both sides of each discussion point raised. One thing really stands out though - our responses are always shaped by our experiences and our operating cultures; that is why we have such different view points. I will throw a few into the mix from my limited experiences.
Perspective. Australia achieves as much EMS SAR flying per year as they are doing each day and a bit in the USA!!! The USA has over 1000 machines (according to an earlier post - though that seems extreme) and Australia has less than 35. I cannot do the maths, but it seems that we Australia have to look at accident rates over a 40 odd year period to see if it is close to the annual rate for the US. Therefore it an Apples V Oranges arguement to compare anyone else with the US, particularly give the unusual commercial and job competitve nature of a majority of the US industry.
The Golden Hour. There is no evidence indicating a sudden increase in mortality or morbidity in the 61st minute of a reponse. Whilst many response organisations use it as a mantra and marketing tool to easily convey the need for speed to the layman, the reality is so clouded by regional settings as to be almost irrelevant to some. For example, in one part of our area we deliver medical care and capability in the helicopter that exceeds the Emergency Department. So, is the golden hour until we arrive, or until we deliver the patient to lower care levels in the medical facility?? All I am trying to convey is that there are no "absolutes". What "must" be done in one region "should not" be done in another.
The only discussion point that has so far concerned me was inferring that "we never save lives". The use of the royal "we" here is what is incorrect IMHO. I have flown for many organisations that can lay claim to survivors purely because a helicopter was able to bring rescue and/or sufficiently high level of medical care within a time frame that would have otherwise resulted in death. That is not a reason to grab a cowboy hat and show everyone how long your willy is, but at the same time it is inconsistent with the notion that it is like flying logs or rigpigs. I recognise that some organisations do not have high level medical care on board and may only do inter hospital transfers, but that is not a reason to cast an "absolute" that no-one else saves lives. It must be self evident that moving someone to a medical facility "saves lives" - so the question is: what bit of the ED saved the lives? Why was it not bought on the helicopter? Can the helicopter bring SOME of the bits on offer at the ED and thus be in a position to "save lives" ??? Is rescue from an iminent building fire, flooded river, sinking boat, or soccer match "saving lives"???
We have talked in depth about reponse times and how "dangerous" short ones are, but I stick to my previous points on this: time of response does not equal safety of response. Response process ensures safety.
Another absolute that drew my attention was that we pilots should "never" know the condition of the casualty. That has not been an important factor in my experience in influencing a PROFFESSIONAL. I note with some danger of a faded memory that the majority of the US HEMS accidents are on the return leg after patient delivery. In other words - patient condition was NOT a factor in the majority of press on itis accidents in the US. In the organisation I currently work for, patient condition is as openly discussed amongst the crew(aviation and medical) as is the weather and the aircraft performance, how tired we are and how inexperienced we might be at the proposed type of flight. CRM. So I see it would be appropriate in some cultures, but please dont force it on ours by saying "never".
Two other things about this notion to consider are:
1. Why do we never give crew of the year to the guys who had to say "no" in often extremely trying circumstances? I can employ heaps of pilots who will say yes, but where do I find the one big enough to say no?
2. If it was your child dying, would you try harder? Do other peoples children then deserve less effort? Ethically a really tough one I think (and I really struggle with it at times). Absolutes are a big call. What if you say no to a take off because by the time you get back to base you will have exceeded you duty time by 1 hour - and then you find out it was to a severe road accident involving your family to which the the ambulance is more than an hour away. Is that one hour a sound risk V gain decision in light of your family trapped and bleeding? Or is it absolutely innapropriate? Is it really "never" appropriate for aviation and medical professionals to weigh up the risks and make a crew decision on what "is" appropriate??
Lastly, the calls that HEMS must be done "this" way (which nearly always resembles the way the proponent is doing it now!). Here are my calls for moving to the ideal HEMS culture in FULL recognition that I dont know the benefits of other ways NOR will anything I say make the slightest change to other ways of doing it!
Twin engine PC2 preferred. IFR with SPIFR autopilot. SP plus "HEMS crewmember" or co-pilot for operating (not medical) crew, in accordance with EASA's smart and latest requirements (Australian front seat crewies do not comply in nearly all cases). No unaided HEMS/SAR. Primary response at night only by NVG HEMS/SAR, only where trauma rates after dark can be shown to be inadequately covered by road response, and only where helo brings significantly higher levels of medical care than that available on the road. Inter hosptials by night must have NVG. HEMS pilots to be instrument rated and current (yes, even where their area of ops precludes IFR). HEMS crews given extensive CRM training (not the one day giggle over the Air Florida and Tennerife accidents), HEMS organisations run not-for-profit BUT with strict governance regulations in terms of management and board members (no "old boys" clubs), HEMS organisations not to make money from flying - the money is made from standing charges (yes we run a model in Australia where providers lose money each time they fly!).
I know these "are no absolutes" and there will be many other suggestions, but this is my drivel...write your own
