HEMS - Regulations and saving life [Archive]

zaplead

10th Oct 2002, 18:53

Within the UK EMS is performed principally by Air Ambulance Units.
All taskings must come via a regional Ambulance Service control centre to satisfy the legalities of claiming exemptions under the Air Navigation Order, Rules of the Air and JAR-OPS where operations operate under it.
An emergency helicopter flight which proceeds directly to the scene of the incident/accident is known as a primary mission.
For these taskings, more correctly known as HEMS (Helicopter Emergency Medical Service) taskings, exemptions from the ANO to permit low flying for recon, approach and take off over congested areas, flight in closer proximity to 3rd parties & reduced flight visibility.
Relaxations may also be applied regarding aircraft performance providing deviation from optimum performance is for the shortest possible period.
These dispensations may only be claimed where life is percieved as being lost and "where immediate and rapid transportation" is required.
If immediate and rapid transportation is not neccessary and the injury/illness is not felt to be life threatening an exemption may not be claimed and therefore the helicopter may only alight and depart from areas which do not require the pilot to claim any dispensations, or from pre-surveyed landing sites within the Helicopter and Hospital Helicopter Landing Site guides.
Where this is the case the tasking is more correctly referred to as an Air Ambulance Tasking.
These flights are subject to normal public transport rules and performance criteria.
Because of the definition of a HEMS task as being one in which the helicopter proceeds directly to the scene of an incident, if a casualty has been moved from the accident scene to another location deemed to be more suitable for helicopter alighting, any attempt to land there will not permit the pilot to use dispensations and may be impossible to perform legally.
Similarly, when landing at hospital sites public transport performance must be maintained unless the patients condition is deemed to be life threatening.
Occasionally the only way to do so it to land at larger sites permitting a flight profile which is safer in the event of a forced landing.
As someone remarked above, it is not good practice to bring more casualties to an incident, however there is a disturbing trend amongst Ambulance Services to respond HEMS helicopters to trivial complaints and then place the crews under moral and ethical pressure whether to breach the rules established for their safety and that of the patient and others.
Frequently, this will occur because if not lifted the patient faces a long and distressing wait in a field for a land ambulance.
HEMS crews work hard to keep themselves and others safe but there is inherent risk in flying, which those who inappropriately task these resources do not worry about because they just want to clear up jobs and they are not risking their life and license when it all goes wrong trying to lift a broken ankle of a football pitch....................:(

TeeS

11th Oct 2002, 10:46

Zaplead

Your post brings up a what I perceive to be one of UK HEMS bigger problems. If you ask ten UK EMS pilots how and when they are allowed to apply the available exemptions you will get at least five different views, possibly ten.

One of the confusions is created by the pre-JAR terminology of a Primary Mission. This term, to the best of my knowledge, is not recognised under JAR but as you suggest enabled the following situations-

1. Call to a collapse in a city street, 2 P.M. outside pub - we could apply every exemption under the sun, land in the street cause loads of disruption etc. etc. despite being 80% sure that this was a person who had five too many drinks in the pub. That said, there is 20% chance that this is a life threatening collapse so we could do it. (Yes, I know a wise man will land in the large factory site 800m up the road and get the medics to hitch a lift, but I'm talking about what the rules say I can do!)

2. Call from road ambulance crew to assist them with a patient in a city street who has been hit by falling scaffolding pole. Patient has massive head and chest injuries an airway problem and possible spinal injuries - he needs to be in a trauma unit now! During the ten minutes that we will take to travel to the scene, the road crew will package the patient and transport him to a large factory site 800m up the road suitable for our landing. -"I am very sorry road crew, but by loading your patient onto the vehicle and conveying him up the road you have turned this into a secondary mission - I am now unable to land at an unsurveyed landing site in a congested area to pick him up. Please feel free to turn round and drive four miles through the traffic jam to a pre-surveyed secondary site"

Thankfully, JAR does away with Primary, Secondary and Tertiary (inter-hospital) missions and splits it into HEMS and Air Ambulance where HEMS is a response to a location at which a person is in urgent need of medical treatment etc. (I do not have the full definition in front of me so please don't savage me for not quoting it) and Air Ambulance is a routine movement of a patient, usually pre-planned, carried out to normal AOC criteria. The term "Life Threatening" is not used within the definitions although it does still appear in CAA exemptions.

I feel very strongly that because EMS pilots are, by the very nature of the operations, isolated from each other we are diverging in our understanding and interpretation of the rules (with all of us convinced that we have the correct perception of them).

I would be a very happy man to see a conference organised involving EMS line pilots, Aircrew Paramedics etc from around the U.K. to discuss the future but I suspect we all work too many hours to attend.

Cheers

TeeS

Thomas coupling

11th Oct 2002, 11:02

Tees: nail on the head...excellent posting, if I might say so. The bottom line is that the insurance lawyers have got their teeth into this making it an absolute minefield....

You're damned if you do and you're damned if you don't...

It remains to be said, that the commander gets it squared away in his head, gets his employer on board too and has a quiet word with his flight ops inspector, so that they are singing from the same hymn sheet;)

Q Max: I think you'll find that when I was in the mil, a little word called "attrition rate" and a statement at the front of JSP 318 saying "overide the rules provided you act in the exigencies of the service"...had a lot to do with how I operated within my SAR role.
This culture does not exist in civvy street...thankfully. There are rules, don't break them, because big brother is no longer there to protect you. For once, you have to take on your own responsibilities. Why do you think more and more pilots are taking out third party insurance?

You have to think about yourself standing in that box staring at experts from the CAA / insurance / AAIB / Barristers, and be able to fend off their questions, any one of which could sink you without trace!
Do you HONESTLY know the rules. inside out, or do you really think that by making front page news as a hero, you'll be let off because you're a goodie?:rolleyes:

You mentioned, the Sikorsky crew...I did make it quite clear that SAR crews were exempt from my deliberations.

JeapordiZZZZZZe
StandardiZZZZe
LobotomiZZZZZZZe.

ZZZZZZZZZzzzz

twistgrip

11th Oct 2002, 13:17

Ahh - litigation. The great leveller.

What would you do if it was your son on the roof TC?

Unfair question maybe, but, what..........?

Hoverman

11th Oct 2002, 14:12

TC
"overide the rules provided you act in the exigencies of the service"...had a lot to do with how I operated within my SAR role. This culture does not exist in civvy street...thankfully.
Why "thankfully"?
Wouldn't it be better if the law in civvy street was that 'operational necessity in emergency circs' (or similar words to cover lifesaving or recovering a sick/injured person) be a complete answer to any whinging/prosecution by the CAA?
And a complete answer to the insurance companies?

I agree with you the 'hero if you bend the rules and it works' and 'damned if you bend them and it doesn't' is a problem - but that's the fault of the system.
I admit I admire people who us their own judgment and ignore the rules to try to help others and think I would if the necessity arose. Breaking the rules doesn't mean you're not flying safely because too many of our rules in the UK are far too restrictive anyway.

Thomas coupling

12th Oct 2002, 01:00

Can't you see? That's the problem. In this day and age where litigation is second nature, operators have to protect themselves. Dare I say it, the CAA's primary role is to promote safety on all fronts and this is right down their alley. They will eat you for breakfast, if only to set an example.
The Home Office has reminded all C Constables that their aircraft are not in the rescue role and diversions from the rules will not be tolerated: FACT. If you don't believe me ask any emergency service pilot where it is laid down that they can step outside the limits to carry out a life threatening rescue (authorised by the C Constable/Health authority). It's not, because they can't, it's against the law!

Why do you think police cars no longer chase high speed stolen vehicles. It's because they have a "duty of care" to others (the public) and of course they'll be sued off the face of the earth if they continue to cause collateral damage in so doing. It is no longer the environment where you can bumble into a rescue because you think you're leading the moral cause. There is NO circumstance where you can knowingly place your aircraft in a position where there is a serious risk to third parties.

In response to the emotional blackmail from twist grip:

In such circumstances where I am confronted by something as unique as that of rescuing my family by using the helo I'm flying; God help me if this happened, because I would have to look deep inside myself. I would be prepared to lose my job over it, no question, but could i live with myself if I killed someone else in the process, as well as fail to rescue my family? What an impossible dilemma :( A no win situation.

I'm faced with situations similar to the thrust of this topic, on occasion in my present role. We did 150 HEMS trips last year. We didn't go to some because of the very reasons I'm discussing here. The risk assessment was too high unfortunately for the victim, I'm sad to say. But I'm not in the job of being a hero, I'm trying to do the job to the best of my ability within the confines of the regs. That's legislation for you - dispatched by the authorities - on behalf of the public.

If we don't like it - change it.

Hoverman

12th Oct 2002, 10:56

TC
I'm not missing the point, I was making one.
At the moment, Police/EMS pilots are at risk if they break the regs and something goes wrong. With a petty aviation authority like ours, there's a good chance some small-minded type in Enforcement or Prosecution will want to prosecute. And the UK is fast going the American way of people wanting to sue for everything under the sun.
My point is that the law/legislation should be changed so emergency services pilots are not at risk when they break regs in the course of a rescue/urgent recovery.
(I have always respected and admired guys who ignore the rules in order to carry out a rescue and think/hope I'd have the courage to do the same if the circumstances made it necessary.)

But, in your earlier posts you've repeatedly implied breaking rules = not flying safely. That's what I think is plain daft.
You seem to equate breaking/bending the rules with endangering the a/c or other people. One doesnt' follow from the other. Many, if not most, of our rules are so stupidly restrictive that the only danger involved is the danger of being prosecuted.

You say "The rules aren't there for you to 'bend' and then expect to get away with after a phone call to the CAA. "
Well, they should be, and the phone call would be enough if the law was changed as I'm suggesting.

SASless

12th Oct 2002, 11:46

What a chilling thought....ringing up the CAA....saying oh by the way dear chap....why just yesterday I tossed yer rule book out the windy.....made like that American singer...what was his name...Sinatra....and errrr....yes...these were the circumstances and this is why I did what I did....WHAT? You mean that regulation printed in Version 8954, dated yesterday, but not promulgated yet....denies me dispensation for said act and you must make a voluminous report about my violations and see the appropriate punishments are applied.....HOW MUCH, FOR HOW LONG? Or I can get a barrister?

I like the American way....do said sinful act or acts......and get on bent knee....pray forgiveness and ask for divine intervention (please lord, strike the FAA both blind and deaf for a while ?) and when confronted by the video tape....continue to insist that is not you and that it must be your idiot brother!:rolleyes:

Bertie Thruster

12th Oct 2002, 12:35

TeeS: My HEMS exemption, issued by CAA, applies "when engaged in HEMS" as defined in JAROPS 3.

That JAROPS definition makes no mention of "proceeding directly to the scene of an accident" or" response to a location" as mentioned by you and Zaplead. Your JAROPS purpose is to "facilitate emergency medical assistance, where immediate and rapid transportation is essential" So nothing to stop you landing by that ambulance in the large factory site. The HEMS definition is quite clear.

However, to satisfy the CAA exemption requirement "life is perceived as being lost" still applies if you cannot acheive Group A performance during landing or takeoff.

So how do the air medics apply that rule? Fractured wrist? perhaps not. Tib and fib? maybe. Femur, possibly? 80 yr old hypothermic? Suspected(but not confirmed)broken neck? Not clear at all!!

TC has got it right. Damned anyway!

Q max

12th Oct 2002, 13:47

NOW you are making sense and I (almost) entirely agree with you!

There is a danger in the UK that people cosider themselves safe if they are obeying the rules. This is not necessarily true - and their judgement is diminished by believing they are somehow magically protected.

Common sense and judgement are still required to fly safely !
Obeying the rules alone will not save you.

... and yes of course that means saying NO to things when no one else can see why - especially 'since its legal' !

TeeS

12th Oct 2002, 15:31

Bertie
I think you have misread my posting, the examples I gave referred to the pre-JAR system which split missions into Primary (responding to the scene), Secondary (meeting an ambulance) and Tertiary(inter-hospital) missions and did not take into account the patient condition.

JAR has simplified and clarified the situation, however my point was that confusion still exists because people in the industry continue to use pre-JAR terminology.

TC, thanks for the kind comments.

Cheers

TeeS

wde

13th Oct 2002, 00:08

Well well now, there are some hot heads out and about now aren't there....

Here is some basic math:

4 > 1

Don't risk 4 lives to "maybe" save one life..it's just bad math.

...unless of course you are trained, trained, trained as a rescue pilot flying equipment suitable for a rescue mission with back-end crew members who are rescue specialists with rescue training. If you are an EMS pilot, remember that you are a fast ambulance driver capable of doing many things but first and foremost responsible for conducting flight in a safe manner with the utmost respect for the lives of your crew and within the constraints of your national air regs.

Hoverman

13th Oct 2002, 09:19

I agree - until the last nine words.
Provided all your other factors are satisfied, I wouldn't criticise someone for flying outside the contraints of the national air regs.
I don't buy this idea that flying within the regs = flying safely, and flying outside the regs = endangering.

As I've said, if the regs prevent a job being done which could be done safely then the law is an ass and ought to be changed.

Randy_g

13th Oct 2002, 12:42

The regs should be followed, however if something is unsafe, but legal we should say no. It's interesting how road ambulances, and police do not have to follow the traffic laws, while on a call. As for leaving rescues only to trained people, what makes you trained ?? I've had to do several rescues while on fires, and other operations, yet I've had no specific rescue training. I've had medics in the back who were all briefed and trained on the helicopter, but weren't specific "flight nurses", or rescue techs. These rescues were all done safely, and with the safety of all onboard uppermost in my mind. As it is during all of my flights.

Cheers

The Nr Fairy

13th Oct 2002, 19:42

Randy_g :

That bit about ambulances and police cars being able to break traffic laws in an emergency - not over here at least.

There's a thread on JB, albeit UK specific, about this. Check "I don't really think so . . ." (http://www.pprune.org/forums/showthread.php?s=&threadid=68776&perpage=15&pagenumber=3) It would surprise me if there were not similar constraints on emergency vehicle drivers in other countries.

Thomas coupling

13th Oct 2002, 23:31

Hoverman, you make yourself look more of a prat everytime you re-inforce your views on flying outside the rules.
What on earth makes you think you know better than the national laws of this country? Are you better qualified? Wiser? More experienced? Or do you simply have this thing against authority?

I have never met one person to date, who honestly believes that the rules they fly under when they fly HEMS, are unjust or irrational....except you:confused:

Hasn't it dawned on you yet that (in this instance) rules are made based on: experience gained, SAFETY, and last but not least: your protection :o . By people who have some credibility to say the least.
{Could one imagine someone like you becoming a CAA inspector}

You sound like a very frustrated, angry, anti-establishment and I'll hazard a guess...inexperienced aviator!

I hope your employers don't read this thread, for your sake. I for one wouldn't want you in my team :eek:

TeeS

14th Oct 2002, 09:09

Well, I have thought long and hard over making this posting-Firstly because I would not like to encourage anyone to carry out what would be considered a reckless piece of flying and secondly because I suspect I am not going to enjoy being flamed!!

I have to say I agree with some bits of both sides of what has become a very polarised argument. On the one side, I can see that merely breaking a rule does not equate to being dangerous. eg I consider it dangerous to break a 30mph speed limit in a built up area where children might be playing etc. however I would not consider it dangerous if someone drove at 85mph on a clear motorway in good conditions, but both involve breaking rules. I can also understand that it would be wrong to risk uninvolved passengers or bystanders in a dangerous rescue attempt. That said I could have nothing but admiration for the pilot of the jetranger attempting to haul survivors from the Potomac crash out of the frozen river!

On the subject of rule breaking then I assume the main concern within the UK is the implication of rule 5 on a rescue attempt-

Rule 5(1)b - endangering persons/property if an engine fails.
Rule 5(1)c - flight over congested cities, towns etc.
Rule 5(1)d - flight over open air assembly of more than 1000 people
Rule 5(1)e - flight within 500ft of persons buildings etc.

Rule 5(2) - is fairly boring, does not affect most people and I suspect most of us stop reading about midway through it- however it is worth continuing to -

Rule 5(3) - Nothing in this rule shall prohibit an aircraft from flying in such a manner as is necessary for the purpose of saving life.

So it does appear that the CAA have actually considered the possibility of flying 'outside the Rules' as we normally consider them.

HEMS and Police pilots within the UK are still constrained by their relevant ops manuals and exemptions which limit the extent of alleviation to rule 5.

Hope that all makes sense and adds something to the discussion.

TeeS

Hoverman

14th Oct 2002, 10:59

"{Could one imagine someone like you becoming a CAA inspector}"
TC
I'm happy to take all your other insults on the chin because I'm familiar with your debating style, but suggesting a fellow aviator would even consider becoming a CAA inspector is downright offensive.
This is meant to be friendly discussion. Abuse of that nature is uncalled for, and completely OTT. A withdrawal would be appreciated, and an apology would not be amiss.

Devil 49

14th Oct 2002, 15:33

If you can't do it without creating more casualties, dont.
If you wouldn't do it in spite of the knowledge you'd lose your ticket and job, don't.

In my orientation, my employer explained the company's wishes-
All flights are to be considered as air taxi, illustrated as the "box of rocks' analogy-as in would I do the same for a "box of rocks".
Second, we are generally not engaged in rescue missions. We're not equipped or trained. If I can help, do it safely and within the regs, I'm allowed to use my best professional judgement. I've been around long enough to have a very clear idea of my capabilities, on both sides of the rules. These conditions seem fine and sensible, and I can sleep at night with the rules.

But employer rules and FARs don't define what's safe and in good conscience. I can imagine scenarios where I'd declare an emergency and risk losing my job and ticket. For instance-patient loaded, circumnavigating Class B, when patient status suddenly and precipitously declines. The med crew urgently requests nearest-and I can't get clearance into the B for the most expeditious route to the nearest facility? LIfe and death emergency, in qualified opinion? I'd declare and go, without creating any more casualties, explain and hope that my judgement is supported.

ARIS

14th Oct 2002, 16:07

Widely known "Human Factors" fact:

Example of "Dangerous character type" - for a pilot:
Someone who decides which rules he/she agrees with (& adheres to) and those he/she doesn't.
I.e a person who thinks they know better than the rule makers.

It might interest Hoverman to know that such character types are rare (thank Goodness) amongst pilots.

(If you don't believe me, ask the experts at Farnborough).

Incidentally, I heard once that a certain UK HEMS unit was invited to stop operating on the basis that it was starting to get its Flight Safety priorities "confused". They should have been:
1. Safety of aircraft & crew
2. Safety of the public
3. Dealing with the casualty.
IN THAT ORDER.
In their case No 3 was becoming more important than No 1.

Food for thought. :)

Bronx

14th Oct 2002, 16:38

ARIS/TC
I dunno if you're limiting your comments to HEMS ops, or helo flying generally. If the first, I don't know the UK regs so can't comment. If the second, aren't you being just a bit sweeping? It's not as if there's some universal worldwide agreement on what regs and rules are necessary for safety.
Your UK rule 5 is much stricter than our FAA regs on low flying. Can't see no wrong in a pilot saying in his opinion the rule 5 is too strict. We have to comply with the regs but I can't see what's so terrible bout a pilot saying he disagees with this or that rule. I'm a bit worried about you saying we should just accept laws are made by wiser cleverer people who know more than we do? You must have got better quality government employees and politicians over there than we do!
:confused:

The Nr Fairy

14th Oct 2002, 17:56

Bronx :

The way I read it, Aris isn't saying it's wrong to disagree with the regs.

What he's quoting says to me "Dangerous pilots choose which regs to obey and which to disregard", which is a different thing from just disagreeing.

By implication, this to me means "If you disagree with the rules because you think they're wrong, work from inside the system to get them changed."

ARIS

14th Oct 2002, 18:33

Thanks, Bronx, (oops! - sorry Bronx, I meant thanks Nr Fairy!!) I concur your interpretation. However, I was also being specific about this particular subject which has some pretty heavy rules associated with it.
Where does the "dangerous" pilot with the aforementioned tendencies draw the line? - When he/she decides??!!
Surely this is a very unhealthy character trait?

This (profession) is also about discipline. Rules evolve via experienced & wise inputs but they are there to support our No 1 priority - the safety of our flying from ours, our passengers & the publics point of view.

I'm still quite gobsmacked that a pilot can be "proud" to break the rules per se. The implications are frightening. :eek:

Q max

14th Oct 2002, 18:52

Nr: Aris does say: "...he/she agrees with (& adheres to) ...."

Nr: "By implication, this to me means "If you disagree with the rules because you think they're wrong, work from inside the system to get them changed." "

- you can't question the system if disagreeing makes you dangerous ! Catch 22

Aris: I'd be amazed if anyone was 'proud' to do this..

you say the priorities are:

1. Safety of aircraft & crew
2. Safety of the public
3. Dealing with the casualty.
IN THAT ORDER.

Where in that order would you put 'rule compliance' ?

I'd be pretty happy to put it at 3rd equal - wouldn't you?

ARIS

15th Oct 2002, 10:49

Q max: I hear what you're saying but am trying to look more deeply at pilot culture.

It seems that some of us are of a known dangerous character type. This is the point I'm making. The rest of us will make sensible decisions based on the rules and our professional discipline.

What was that saying? "Rules were made for the guidance of the wise and adherence of fools" - or something like that. I'm not saying that "the wise" do not adhere to the rules, merely that the wise are sensible about the way they go about their flying within the right culture, perhaps created by the rules.

I re-iterate that amongst the 'Human Factors' boffins, the tendency to decide which rules they agree with and which they don't (and disregard) is a known very dangerous character trait for pilots.

Incidentally, be amazed - look at Hoverman's post!

Bronx

15th Oct 2002, 15:00

Thomas/ARIS
Well I've read and reread Hoverman's posts and can't see what's so amazing and I just don't get your beef with him.
Hoverman accpets 'first and foremost you're responsible for conducting flight in a safe manner with the utmost respect for the lives of your crew.'

No problem with that is there? But in exceptional circumstances PROVIDED IT CAN BE DONE SAFELY, he admires guys who are prepared to jeopardize their own tickets by infringing the regs for the sake of saving other and likes to think he'd behave selflessly if he was in the same cirumstances. For saying that you attack him for being a dangerous pilot.
Why is that so bad if they or he have enough experience, use their judgement and decide it can be done safely? Or do you think nobody has that capability to exercise good jdgement except the lawmakers?

Hoverman says he don't buy the idea that flying within the regs = flying safely, and breaking the regs = endangering. I agree with him. Breaking the regs MIGHT be dangerous. depends on the circumstances but in the words of the ol song, it ain't necessarily so.
You seem t be shifting your ground a bit now and being more moderate but, unless I misunderstood, you were saying the lawmakers know best and only some dangerous idiot would think he knows better.
Look at what you wrote. Quote "What on earth makes you think you know better than the national laws of this country? Are you better qualified? Wiser? More experienced? Or do you simply have this thing against authority? Hasn't it dawned on you yet that (in this instance) rules are made based on: experience gained, SAFETY, and last but not least: your protection. By people who have some credibility to say the least. " Unquote.
Strong words. What's so bad about somebody thinking the lawmakers have got it wrong?
AND, According to you someone who's prepared to use his own judgement and break a reg in exceptional circumstances is a dangerous pilot! Wow! That's a new one on me.
You've got a lot of faith in the lawmakers getting it right all the time. But I read lots of posts from British pilots complaining that your CAA is wrong about such and such, out of touch with the real world and too strict. I think the FAA is sometimes, but from what I read on the forum and from talks with my British friends, the FAA seems to be much more realistic and supportive of aviators than the UK CAA. (I sincerely don't mean to start a UK-US war here.)

I'll never forget the footage of that 206 pilot rescuing people from the icy Potomac after the airplane crash a few years ago. He even had his skids in the water at one point so a guy could cling on and be flown to safety. He broke every rule in the book, but saved five people. What a hero. Although the FAA's not perfect, I somehow don't think there's anyone in the FAA who's a big enough a**hole to question that guy. Sounds to me like if that had happened in the UK, the pilot would have to explain himself to your CAA investigators.

And since your so hung up on this personality/character trait thing, what do your psycho boffins say about about pilots who get so angry and start insulting folks because they hold a different point of view. Amaze yourself .... read the thread from the beginning and count up how many people you've insulted. :rolleyes:

SASless

15th Oct 2002, 15:24

Darn Bronx.....all that......spot on and to the very point of the matter....I agree one hundred percent with what you said! The least you could have done is throw in at least one Bronx Cheer to him! I will do it for you what say? :p Psssssst!

ARIS

15th Oct 2002, 17:09

:confused: Sadly, Bronx, we'll have to agree to differ. Thanks for your input though!;)

Heliport

15th Oct 2002, 19:03

Interesting discussion.
Do you realy disagree with all Bronx's points ARIS?

What about you TC?

PPRUNE FAN#1

15th Oct 2002, 19:08

Bronx wrote:
I'll never forget the footage of that 206 pilot rescuing people from the icy Potomac after the airplane crash a few years ago. He even had his skids in the water at one point so a guy could cling on and be flown to safety. He broke every rule in the book, but saved five people.

Umm. What?

Wasn't that a U.S. Park Police helicopter? Arent' they categorized as "public service" or whatever that exemption is to U.S. FAR's?

Bronx, I know you said that they broke "every rule in the book," but could you be a little more specific as to just exactly WHICH rules they "broke"?

Expanding on that, can you specify how many and which rules would have been broken if it was a civilian, commercial operator who hauled those people out of the river? Were any of them sling-loaded?

Seems to me that your FAA recognizes the fact that the number of times civilian helicopters are involved in "life-saving rescues" is extremely small and not deserving of regulations to specifically prohibit or allow them.

Flying Lawyer

15th Oct 2002, 20:35

I think the point being made was the pilot of the Parks Police LongRanger carried out the rescues in circumstances which some contributors (based on what they've said here) might think were dangerous.
Not only did he fly in the middle of a snowstorm, but he was hovering inches above the Potomac which was iced over. At one point, his skids touched or even went slightly into the water- one of those rescued had two broken arms and couldn't put the lifebelt on. As I remember (it was 1982), the pilot put the skids on/slightly under the water, the crewman bent the man over the skids and he was flown to the river bank.
The crew went over the river six times and saved five lives; sadly a true hero who passed the lifebelt to five others instead of taking it himself drowned before he could be rescued.

TC or ARIS or anybody else .....
Was the pilot a brave hero who risked his own life to save others?
Or a dangerous pilot with a character defect?

(I think pilot and crewman were both heros - but I'm only an amateur pilot, not a trained professional.)

PPRUNE FAN#1

15th Oct 2002, 23:00

Flying Lawyer opined:
I think the point being made was the pilot of the Parks Police LongRanger carried out the rescues in circumstances which some contributors (based on what they've said here) might think were dangerous.

The point is that what the Park Police crew did with a helicopter that awful day was the EXACT thing for which it was invented: doing something that, at the time, no other machine on earth could do. "Dangerous" is one thing. Illegal (or against the rules) is something else. But it is curious that Bronx phrased it the way he did.

There is no "rule" against flying in snow, nor is it dangerous; a LongRanger equipped with snow baffles (as that one was) is perfectly capable of doing it.

There is no "rule" against hovering low over water or putting a skid under the surface to allow a passenger to board. Looked like expert flying to me, not luck.

The "single-engines are fine" guys wouldn't even argue that the operation would have been any safer in a TwinSquirrel.

We're not talking semantics here. I personally do not believe that what the Park Police did that day was "dangerous," nor would it be considered breaking "every rule in the book" on either side of the Atlantic. Now, if it had been two guys (a pilot and his traffic-reporter partner, say) out in their commercial LongRanger that day...

Thomas coupling

16th Oct 2002, 09:13

If anything, it's stimulated an interesting bent on aspects of helo flying. Looking over previous entries it would appear I may have been a little 'short' with Hoverman and for that I do apologise without reservation (even if you did slag me off on the twin Vs single thread about this EMS issue!).
I have a vested interest in this subject ever since we as a HEMS/Police unit were advised that some of our 'rescues' were bordering on the illegal for want of a better word. Up until then we had successfully completed innumerable 'rescues' some of which achieved national TV coverage in programmes like Police/camera/action and '999'.
Other units had done similar 'good' work:
The floods where a police helo rescued people from the club house roof / the police helo that dragged a suicidal woman back ashore using the skids to tow her / paramedic leaning off the skids whilst helo hovering inches above the sea, to grab a drowning child.
As a result of all these and others, the Home Office waded in and reminded our bosses that we were operating outside our remit. A massive debate took place resulting in inumerable discussions between the CAA / HO and police/HEMS units.
The end result: the statement 'protecting' the pilot from liability in these cases (written down in our rule book) was retracted in an amendment of the rules to avoid future misinterpretation :eek:

This is the interesting bit: Off the record, they all agree that should these situations occur again, they all know what they would do as individuals but they could NEVER legislate for it:confused: When you sit down and pour over it, you can understand why: If the rules and/or performance limits of the helo are compromised, there will ALWAYS be someone out there threatening to sue. Authorities therefore cannot legislate FOR these rescues even though they expect the pilot to go out and do his moral duty:mad:
The same goes for HEMS work. It is strictly regulated and a pilot can do his/her job 90% of the time. The performance requirements and rules are very flexible, but they do eventually draw the line...step over it and you'll suddenly find you've got no friends:eek:
The Potomac river is a beautiful example:
The helo driver was a true hero, irrespective of his background (mil/civvy). It is a call, hopefully, all of us would answer, honourably. BUT and it's a whopping BUT....
if the helo went into the river because, for instance he clipped some debris, or the engine iced up, or the skids got wedged under some wreckage, there is a chance additional casualties would have ensued. What would the authorities have done then? What would the estates of the airline victims have done? What would bystanders have done if they had been injured by the subsequent crash? A legal nightmare is it not. At the time, emotion masks everything and heroism rules the day. If things did go badly wrong though, I suspect the legal/insurance machine would fire up and months later, in the cold light of the day who's head would role????
You're damned if you do ...and damned if you don't

You know what they say: if you couldn't take a joke...you shouldn't have joined :D

Secretly, we all know what we would do...don't we?

My round.

john du'pruyting

16th Oct 2002, 09:19

Well PPRUNE FAN#1 as much as I admire the pilot of the Parks aircraft and would fully support his actions, I would also say that what he was doing would contravene a number of rules here in the UK. The obvious one is his inability to alight in a safe area (without damage to people or property) in the event of an engine failure. With one person hanging on his skid there is a chance that three people could have died if the rescue aircraft had lost an/ the engine! In that case, the pilot took a risk and it worked out fine (considering the circumstances). In defence of the legislators, they have to look at the worst case scenario. Flying Lawyer is a useful person to ask in this case. His arguments to defend fellow pilots in cases against the CAA are fine. But hypothetically, had that aircraft had a single engine failure whilst attempting the rescue and had the person being rescued died underneath said helicopter, and had that persons next of kin retained flying lawyer as there legal advisor (phew, a lot of ands there), then.
What approach would FL have taken in trying to sue the pants off
A. The Pilot fo attempting to rescue people in such a situation
B. The Pilots employer for not supervising the pilot correctly and thus enabling him to think he should carry out the attempted rescue (remember, we are talking hypothetically here!)
C. The regulator for not ensuring that all pilots are aware of there responsibilities in such cases.
I appreciate that there are a few hypothetical points here that may not have applied to the actual potomac rescue but I hope they illustrate my general thrust!
Or would FL have advised his clients that there was no possible case for the pilot to answer because he was trying to save life?
:confused:
Now at this point I would boringly look through the ANO and ops manual to see what other rules he may have contravened, but I am at home and that is not the point. There may well be occasions when you consider breaking the rules, if it all goes well you may be back home to tea, medals and a hero's welcome, if it goes t*ts up you can bet your bottom dollar/ pound/ euro that your name will be off everybodys christmas card list within seconds.:)

Bronx

16th Oct 2002, 10:27

Prune Fan
Just seen your post and questions. Both John du p and Thomas have already given full explanations, no point in me repeating.

Thomas
You and Hoverman are not far apart when it gets to the gritty. It's damned if you do, damned if you don't at the moment but Hoverman argues the lawmakers should change things so the pilot using his best judgement in an emergency situation/attempting a rescue has a defence to prosecution or being sued. I think that's good sense but until that happens, hero pilots are still putting their heads on the block.
You're right, "secretly ......"! ;)

PPRUNE FAN#1

16th Oct 2002, 15:13

Bronx sidestepped:
Just seen your post and questions. Both John du p and Thomas have already given full explanations, no point in me repeating.

Both TC and Jdp are in the UK. YOU, Bronx, are in the U.S. So I'm just curious about your frame of reference. You stated that the Park Police pilot broke "every rule in the book." So I want to know specifically,

...Which book?

...Which rules?

See, there's a "book" of rules which supercedes every law book: it is our moral code. It's in our DNA. We do what we can to help preserve human life. It is that codebook which tells us, internally, what is "right" and what is "wrong."

We can talk lawsuits from now until kingdom come, but there is an overriding moral obligation that those Park Police pilots had - the requirement to try to do something given the technology and skills at their disposal. Remember, if not for the invention of the helicopter, ALL 79 people aboard that 737 would have perished. The bystanders on the shore would've been able to do nothing but watch everyone freeze to death.

I suppose those Park Police pilots could have sat in their warm, cozy office and refused to fly based on the rationalization that the day was too snowy and/or the operation was too risky, or that they hadn't been trained to drag people out of the water with their skids. But they did not. Indeed, they could not. They responded to a call for help. Hey, they were policemen - that was their job! When they got to the scene, they improvised; there just aren't rulebooks and official manuals to cover every situation humans (especially our policemen) sometimes find themselves in.

Perhaps Bronx was just being facetious or "cute" or careless with his phrasing. But if he really does think that the U.S. Park Police pilot and his paramedic broke "every rule in the book," then perhaps he should take a little trip up to Washington D.C. I'm sure Don Usher and Gene Windsor would have some words of enlightenment for him.

But what if, in the course of trying to SAVE LIVES, they crashed and hurt one of the bystander/gawkers? Would someone be lowlife enough to sue? Who knows. And if they did, who cares? What's really important here? Only the most paranoid girly-men (what you yanks call "wussies") would worry about a lawsuit MORE than trying to save someone's life. God help us if that's the society we've become, chaps.

before landing check list

16th Oct 2002, 15:57

Long ago I was given some priceless advice. At the time I was flying in Central America and "away from the flag pole". I was told "fly whatever your abilities, morals and common sense dictate". To this day I use that as my baseline standard.
Yes, more then likely I would have flown and landed on the towers if I thought that there was a reasonable expectation the mission could have been accomplished and if I had a crew with me I would have asked first. If there were any objection I would have landed and dropped them somewhere first before attempting a pick up. I think that if I saw some survivors on top of the building and I did not at least try for a rescue I would have had a hard time living with myself. Tomas, I really feel sorry for your milquetoast attitude. Maybe if you were there you may have changed your mind. I hope so.
j

SASless

16th Oct 2002, 16:21

Well, for this one old helicopter pilot.....somewhere in the very bottom of my being.....is a notion ....that I shall not stand by and watch innocent people die without doing anything and everything I can do to help them. If I am in a position to assist...I will show up....not stand there with a video camera or cell phone stuck in my ear talking to the live news channel. If it means chucking the rule book out the window then we can just discuss it later....I might be in court but I will be standing there with head up and shoulders back. The rulebook is a guide....not a commandmant.

Sometimes in this life you just have to stick your neck out.....those that do make it a better world to live in. The question is when to do that and how far to go in your efforts. That is a very individual question that only we ourselves can make.

Heliport

16th Oct 2002, 16:30

Pprune Fan
You've got the wrong end of the stick.
Bronx was arguing in support Hoverman's opinion of doing what you can to save lives even if it means breaking rules, against TC and ARIS stricter approach to the rules (since modified/explained in TC's case) and in admiration of the heroism of the pilot in the Potomac rescue.

PPRUNE FAN#1

16th Oct 2002, 20:22

Heliport wrote:
Pprune Fan
You've got the wrong end of the stick.
Bronx was arguing in support Hoverman's opinion of doing what you can to save lives even if it means breaking rules, against TC and ARIS stricter approach to the rules (since modified/explained in TC's case) and in admiration of the heroism of the pilot in the Potomac rescue.

Then why the back-handed swipe at them? Not much of a compliment or endorsement if you ask me. "Broke every rule in the book"? Says who? Flippant statements like that only perpetuate the misguided idea that Usher and Windsor were somehow dangerously or perhaps recklessly negligent in what they did. B*llocks! If I were in their place, I sure wouldn't want somebody coming at me after the fact and saying that about me.

Don Usher was obviously a very capable and competent pilot who kept his cool and, along with Gene Windsor devised an ingenious way of saving some lives that would otherwise have been lost. It is just plain WRONG to characterize what they did that day as flagrantly breaking rules. So I'm just asking: Which "rules?" AFM limitations? FAR's? U.S.P.P. guidelines? Rules of common sense or decency? Rule of thumb? Area rule?

Hoverman

16th Oct 2002, 21:20

Prune Fan
Get back in your pram and read again how the discussion developed. It wasn't a "backhanded swipe" at them.
At the stage of the debate when some contributors were pushing strict adherence to the rules and condemning pilots who use their own judgement in exceptional circumstances if it's safe and necessary, Bronx gave the Potomac rescue as an unforgettable illustration of heroism by a pilot who bravely did what needed to be done to save lives.
Others have pointed out reasons why, if it had gone wrong, he might have been sued. Sadly, in our litigation culture they might have a point, see TC's and Jdp's posts, but as you've probably gathered, I'm in the Bronx, SASless, Flying Lawyer camp on this as you obviously are ...... and I suspect deep down so is my mate TC.;)

GLSNightPilot

17th Oct 2002, 03:09

This really has nothing to do with the gist of the discussion, but in point of fact in the US public use aircraft -i.e., those operated by any government entity, are not & legally cannot be regulated by the FAA. The FAR's simply do not apply. The entity operating the aircraft may, & usually do, choose to follow the regulations. It's the same for military, police, or any other government entity. Pilots of government-operated, public-use aircraft are normally immune from lawsuits & prosecution, & in point of fact aren't even required to have a pilot's license.

Whether any of this is dangerous is debatable, as evidenced by this thread.

PPRUNE FAN#1

17th Oct 2002, 14:29

Stan wrote:
This really has nothing to do with the gist of the discussion, but in point of fact in the US public use aircraft -i.e., those operated by any government entity, are not & legally cannot be regulated by the FAA. The FAR's simply do not apply. The entity operating the aircraft may, & usually do, choose to follow the regulations. It's the same for military, police, or any other government entity. Pilots of government-operated, public-use aircraft are normally immune from lawsuits & prosecution, & in point of fact aren't even required to have a pilot's license.

That was exactly my point, old chap! It's all very well and good to proclaim someone a "hero" and then add (for dramatic effect?) and he broke every rule in the book doing it! But that's not always the case, and I don't think it was with the Air Florida crash/rescue either.

We've become such a paranoid, milquetoast society that we think anything out of the ordinary must necessarily be against the rules. You know, Stan, the old if it's not specifically permitted, then it must be prohibited. Sad.

Thomas coupling

17th Oct 2002, 17:43

What does 'milquetoast' mean?:confused:

Xnr

17th Oct 2002, 20:09

Ok

So if you are a government agency you may be above the rules and regs......that's no surprise.

What if your commercial operator under contract to one of these agencies.....

What if your under contract to a specific hospital.....

Cheers

Steve76

18th Oct 2002, 00:10

Milquetoast .... now thats a cool word.
I guess it must mean something like "pathetic liberal white protectionist" :D :D :D

GLSNightPilot

18th Oct 2002, 00:53

All commercial operations are regulated by the FAA. If you are a commercial firm contracted to a government agency, hospital, or anyone else, it's a commercial operation. The government agency must own & operate the aircraft to be outside the scope of the FAA. There are lots of these, BTW. In addition to the military, most states, & many counties & cities operate aircraft, many of them surplus military aircraft. Note, however, that if the government entity charges another entity for the flight, it becomes a commercial operation, & subject to FAA scrutiny. Most operations do follow the FAR's, but they do it voluntarily.

Xnr

18th Oct 2002, 04:20

Stan

You are absolutely right IMHO.

Part of the reason that government agencies contract out is cost....the other reason is LIABILITY.

If you are breaking the regs and someone dies.....they will wash their hands of it and point the finger...

For that matter the company you are working for will probably do the same.

A sobering thought.

Cheers

Bronx

18th Oct 2002, 10:42

Thomas /Steve

Dunno if 'milquetoast' would make it into your Oxford english dictionary, but it's a way of saying 'timid' or 'unassertive'. It comes from the name of a very timid comic strip character here way back when, called Caspar Milquetoast. It's one of those pompous words (like "opined") which you don't hear too often but is used by pseud journo types ..... and other pretentious people who hope they'll come across as 'intellectual' if they use a word most folks don't know or don't use ..........if you get my drift. ;)

BlenderPilot

18th Oct 2002, 16:51

On a different point of view, over here you can fly ANYWAY you want as long as you don't crash, the rules are sooo poorly written or old, even the own authorities don't know them! So we usually "revert to common sense" when flying.

A couple of years ago I was flying in Honduras doing relief work for hurricane Mitch, as we flew over the Mayan ruins of Copan, one of the passengers suggested we land and quickly visit the ruins since we were already there, so we did, then as we were coming out we were approached by a very stressed out gentleman who asked us to take some ladies who had been severely injured in a minivan crash to nearby San Pedro Sula, by the time we had arrived in San Pedro and found ANY hospital from the air, we had problably broken every ICAO regulation regarding, WX Minima, Suitable landing site, MAX TO WT, Comunications, Passenger capacity, Fuel reserves, Etc. Etc.

I know it all sounds like a stupid thing to do, but now that I think about it, the flight at the time was done with a relative measure of safety, it was all a series of calculated decisions, evaluating every possible "what if" and having a way out of mostly everything. Even if the rules would have NEVER allowed this flight, and this is what I really love about flying helicopters . . . .

sometimes its all up to us, our ability, common sense and experience, there is no one to tell you and there are no ops. manuals you can read to help you decide what to do, it all comes down to the pilot, and the decision you make regarding a flight.

PPRUNE FAN#1

18th Oct 2002, 17:19

Bronx postulated:
It's one of those pompous words (like "opined") which you don't hear too often but is used by pseud journo types ..... and other pretentious people who hope they'll come across as 'intellectual' if they use a word most folks don't know or don't use ..........if you get my drift.

Oh, we get your drift, Bronx. But you know old chap, some people don't have to pretend to be intellectual. Some people are not careless or indiscriminate with language. And some people actually think about what they want to say before pounding the keys.

I won't apologize for being intelligent, but I am sorry if the schools there in the Bronx didn't adequately prepare you for conversation with adults (thank the NYC public school system for that - I'm sure you communicate very well with your homies). But please try to keep up. This is, after all, an international forum. I've found that if you keep a dictionary near the computer, it'll help a lot when people use words you don't know.

Heliport

18th Oct 2002, 19:55

PF#1
Do try to keep up. Bronx didn't suggest you were intelligent, and he knew what the word meant ~ unlike most of the rest of us, I suspect.

PPRUNE FAN#1

18th Oct 2002, 21:33

Mod God: At the risk of being pedantic (of which I've already been accused), I full well know that Bronx did not accuse me of being intelligent. Then again, coming from the Bronx, he might not recognize intelligence if it pistol-whipped him over the noggin on the D Train or whatever they call the Underground over there. But he mentioned pretentious people who hope they'll come across as 'intellectual' and I have no doubt about whom he was referring.

I wonder why you lot always make things personal and turn vicious? I simply and repeatedly asked Bronx to explain what he meant by a particular phrase he used to describe an event, and everybody starts dancing like I'm shooting at their feet! I would say that you helicopter pilots are nothing but neurotic nutjobs, but I won't. For two reasons:
1) I'm not at all sure that Bronx actually is a pilot; and
2) You'd probably all mistake me for that Lu Zuckerman person or somebody held in equal disdain.

G'day!

Cyclic Hotline

18th Oct 2002, 21:57

I wonder why you lot always make things personal and turn vicious? I simply and repeatedly asked Bronx to explain what he meant by a particular phrase he used to describe an event, and everybody starts dancing like I'm shooting at their feet! I would say that you....blah, blah, blah.........

Of course it would be beyond the realm of possibility that you're antagonistic attitude might provoke a similar response to those so challenged?

To some you might appear long on opinion and bluster, but short on knowledge and fact - who knows, I am surely not one to judge?

Anyway, is that G'day a long term proposition, as it is becoming increasingly apparent that no-one on this board is ever going to remotely approach you're intellectual capacity or social grace? ;)

SASless

18th Oct 2002, 22:02

PruneFan.....we rotorheads are neurotic nutjobs! You think riding around in a collection of thousands of rotating bits and pieces, built to the minimum standard, by the lowest bidder, and maintained to the minimum standard.....flying over inhospitable surfaces.....in evil weather is something that would promote mental well being? Dear chap....get a grip....we are hands on pilots....and have never been known for being the quietest, most pacific folks in aviation. Thus when you evoke a somewhat caustic response....why just learn to weave your way through the flak. Cyber bullets create cyber wounds......only the Mod's can bring about cyber death. (note to the mod's....you sterling gentlemen are doing a most commendable job of what is such a daunting task too, I might add!)

Heliport

13th Aug 2003, 13:18

http://www.sikorsky.com/Images/SAC_Sikorsky_Aircraft_Corporation/US-en/R-4LtCowgillfriendsLeytePI-sml.jpg
Lt. Cowgill (center, second row) and friends with R-4 on floating aircraft repair unit (ARU) off the Philippines.

They were known as the "Ivory Soap" pilots and they were among the pioneers of helicopter medevac. And now the last of that group has passed away.

Bob Cowgill, the last of five Army Air Force pilots who flew 70 soldiers to safety during the WW II Ivory Soap rescues in the Philippines was 79.
Ivory Soap was the code name for a project during World War II that took Liberty Ships and outfitted them to conduct aviation repair in the Pacific theater. Among the things they carried were Sikorsky helicopters.

During June of 1945, the five aviators flew Sikorsky R-4 and R-6 helicopters into a combat zone in the Philippines to bring injured soldiers out for medical treatment, often under fire.
Many were the first cases flown with external litters welded in-theater to the side of the R-6 airframe. Details of the missions remained classified for decades.

Cowgill died in Port Townsend, Wash. He graduated from the University of Washington with a degree in aeronautical engineering and became an Army Aviator. After the war, he went with Hiller Helicopters, where he became he chief flight test engineer.

In 1968 he left aerospace engineering and became an authority on Pacific Northwest coastal Native American art and history. He developed a large collection of art, artifacts and books and devoted the last 35 years of his life to carving pieces inspired by that culture. His art was the subject of a major retrospective exhibit this year.

He was modest about his unit's World War II achievements that helped validate Igor Sikorsky's dream of how the helicopter would be used.

In April of 2003 Cowgill finally received recognition for his role in medical evacuations in the Philippines, receiving an Air Medal. He was awarded the Sikorsky Winged-S Rescue Award in 2001 after his unit's exploits came to light.

"I know what we did and I've always been proud of it. That's good enough for me," he told the Port Townsend Leader newspaper last year.
http://www.sikorsky.com/Images/SAC_Sikorsky_Aircraft_Corporation/US-en/R-4CowgillOndeckOkinawa1945-sml2.jpg
Lt. Cowgill in the cockpit of an R-4 on Okinawa in 1945

Rich Lee

13th Aug 2003, 13:29

Heliport. Great post. Amazing story and fantastic photos. Thanks

Barannfin

13th Aug 2003, 13:41

Sad news, does anybody know if this was the first instance of using helicopters to evacuate people?

Bronx

13th Aug 2003, 15:31

Interesting era.
Is that Lu Z. standing in the background, middle right?

B47

13th Aug 2003, 20:31

Barannfin,

That honour goes to Floyd Carlson (just), Bell Helicopter's test pilot, who carried out a rescue on 5 Jan 1945.

Bell's chief test pilot (fixed wing) baled out of a stricken YP-59 jet fighter and parachuted 10,000 ft into a remote area and deep snow. Although injured and having lost his flying boots, he made it to a farmhouse but no vehicle could get to him. Carlson took off in helicopter ship No 2, picked up a doctor, and made it to him in time to treat his injuries and save the loss of his toes. An ambulance made it to him three hours later behind a snow plough.

But, if this rescue was technically not an evacuation by helicopter, that happened a short time later in March 1945.

Carlson rescued two fishermen stranded on breaking ice in the middle of Lake Erie. Before leaving base, Carlson experimented with a mechanic to determine the right fuel load and weight and balance to ensure he could pick up a man from the hover without settling. He then rescued the fishermen one at a time after they'd spent 21 hours on the ice.

So endeth the history lesson!

Capn Notarious

13th Aug 2003, 20:35

The sneering brainless would say in the mocking manner."get a life"

Bob did and saved many.
A real quality man.

Bronx

13th Aug 2003, 23:03

Barranfin / B47

Documented first uses of the helicopter for medical and rescue purposes:

First ‘MEDICAL SUPPORT’ Flights January 3, 1944
USCG flew plasma from the Battery in New York City to a hospital in Sandy Hook. Snow squalls and sleet had grounded all fixed winged aircraft and the plasma was badly needed for sailors injured in an explosion aboard the USS Turner. This initial "flight for mankind" was made by Cdr. Frank Erickson, USCG in the first operational model of the Sikorsky R-4 helicopter.
January 15, 1945, Bell Model 30 (prototype Bell 47) used by Floyd Carlson to fly a doctor to a farm house in Western New York. The doctor treated a Bell’s Chief Pilot Jack Woollams suffering frostbite after baling out of his crippled P-59 Airacomet jet.
(They weren't evacuation flights - and Carlson's evac flight was the second by a few weeks.)
First ‘MEDEVAC’ Flight January 1945
A Sikorsky YR-4 was dismantled at Wright Field (Dayton, Ohio) on January 17, 1945, loaded on a C-54 transport, and flown to the North Burma theater of operations. It was quickly reassembled and only nine days later, on January 26, 1945, Capt. Frank Peterson, AAF flew it to evacuate a wounded weather observer from a 4,700 foot mountain ridge in the Naga hills of Burma.
http://members.cox.net/eholmes333/4burma.jpg
Peterson's YR-4, with escorting L-5, refueling enroute to mountain rescue - Chindwin River, Burma
Source data & 1/26/45 photo from de-classified AAF document, National Air & Space Museum archives.
This WWII combat zone mission is believed to be the first time a helicopter was actually used to rescue AND transport a trauma patient. Possibly Lt. Carter Harman, AAF, made a medevac flight near Mawlu, Burma on April 23, 1944. No official, documented source yet found to confirm.
First ‘RESCUE’ Flights March 14, 1945
Floyd Carlson flew a Bell Model 30 to rescue two commercial fishermen stranded on an ice flow in Lake Erie. The fishermen were ferried, one at a time, to shore.
April, 1945, the first large scale rescue occurred when the US Army and USCG teamed up to rescue nine downed Canadian airmen. Lt. August Kleisch, USCG flew a R-4 that had been airlifted to the area to extricate these men from snow drifts 180 miles south of Goose Bay, Labrador.
First ‘HOIST’ Rescue November 29, 1945
Sikorsky test pilot Jimmy Viner and Capt. Jackson Beighle, AAF (acting as hoist operator) used a R-5 with a new hydraulic hoist to lift two men from a large barge breaking apart in a storm on Penfield Reef off of Bridgeport, Conn.
http://members.cox.net/eholmes333/4barge.jpg
Photo, from the Igor I. Sikorsky Historical Archives, Inc. web site, shows one of the barge's crew being lowered to the beach - the barge can be seen in the distant background.

When Igor Sikorsky's VS-300 experimental rotorcraft made it's first free flight in 1940, he is quoted as saying this new vehicle is for the "benefit of mankind". In just four years, this wish or prophecy became a reality.

Lu Zuckerman

13th Aug 2003, 23:45

To: Bronx

When that happened I was only 14 ½ years old. However 2 ½ years later I was in the Coast Guard and two years after that I was working on helicopters. Coast Guard aviators at Floyd Bennett field not too far from the Bronx trained most of the helicopter pilots of that era. I had the privilege of working with and flying with most of those same aviators.

:cool: :ok:

Barannfin

14th Aug 2003, 09:01

Thanks for all that information Bronx. Its pretty amazing how quickly the helicopters proved themselves to, what I think is thier best mission.

As Mr. Sikorsky once said, If you need help anywhere in the world, a plane can fly over and drop flowers. But a helicopter can land and rescue you.
(alright maybe not anywhere)

Thats what I am looking forward to doing in the USCG.

Lu, you wouldn't happen to still be in touch with any current CG aviators would you?

Heliport

8th Jun 2004, 21:42

This thread starts with a discussion about CAA regulations threatening the future of a hospital helipad but goes on to discuss wider HEMS and SAR issues.
Heliport

Birmingham Evening Mail reportBIRMINGHAM Children's Hospital will lose its helicopter landing pad unless it can find pounds 1.2 million by the end of the year.

Critically-injured children might have to be flown to other hospitals around the city for initial treatment before being transferred by land ambulance to the city centre hospital to receive the specialist paediatric treatment they need.
Hospital managers and air ambulance operators have called for action to save the helipad.

Up to 40 patients a year, many with lifethreatening injuries, are flown to the hospital from all over the country.

The current helipad will be decommissioned in December because of new regulations introduced by the Civil Aviation Authority.

The CAA rules state that helicopters using hospital landing sites must have three clear routes in and out of the area.

But its current location surrounded by the hospital, Central Hall, and Aston University halls of residence, means it does not meet the guidelines.
The only alternative would be to build a landing site on top of the new £13 million burns unit which has just been given the goahead by city planners.

The hospital's A&E manager, Mandy Sankey, said any delay to a child receiving life- saving specialist treatment during the 'golden hour' - the first 60 minutes after an accident - could reduce the chances of survival. 'We have to find the money,' she added.

autosync

8th Jun 2004, 23:42

Typical Stupidity.

Does any problems in the past that would give them good grounds to make this stupid new Regulation?
Or is it just another pointless act at our expense to give them justification of having a job?

SilsoeSid

9th Jun 2004, 02:29

The CAA rules state that helicopters using hospital landing sites must have three clear routes in and out of the area.
If this is taken as read, flicking through the HLS Directory (UK Hospitals), I get the feeling that there will be further problems like this nationwide.

3 clear routes in and out seems a bit restrictive around any hospital area.

Be nice to get a HEMS pilots eye view on this.

imabell

9th Jun 2004, 03:32

i thought some of the regulations we had in australia were sometimes a backward step but your morons take the prize.

it took us fifteen years of argument with our casa to be able to do curved approaches and departures to avoid flying over congested areas and the like. in other words utilising the machine properly.

three tracks in and out is a joke and apparently endangers life. they should be held accountable for their actions.

maybe we could make a trophy, a jar of prunes perhaps, for the person or group within the the civil aviation authority of each country that comes up with the most ludicrous regulation each year.

it may make all of the crap they have in their systems come out the right end for a change.:yuk: :yuk: :yuk:

Bravo 99 (AJB)

9th Jun 2004, 06:49

Would you not think that these idiots would allow some discresion based on the life saving potential of this unit. I wonder what the bright spark from fualty towers that dreamed up this idea would feel like if his child had severe injuries then had to be transported by land ambulance from some where else into the middle of Birmingham on a hot busy traffic conjested day.

Silsoesid is also right this has far reaching conciquences for the rest of the hospitals in the uk.

God help us bureaucracy gone senceless again

Sincerely

Bravo 99 (AJB)

MaxNg

9th Jun 2004, 07:44

Heliport

Can you post a link to the relevant rule or proposed rule.

:(

jellycopter

9th Jun 2004, 07:53

Rule 5.

If said helipad fails to meet new requirements it still should not effect life-saving flights. Rule 5 will be the 'critical' rule here and crews are absolved from adherance of Rule 5 for the purposes of saving life.

Routine (planned) medical transfer flights, will however, still continue to be effected.

J

Helinut

9th Jun 2004, 10:33

You need to be a bit careful about believing technical detail from newspapers, but the theme sounds terribly familiar.

Bear in mind that any air ambo (and police hele) in the UK will be two engine anyway!

The CAA have also just tightened up their regulation of "rescue work" carried out by police helicopters. In the UK none are SAR equipped (no winches etc). Nevertheless, from time to time police helicopters end up in situations where people are drowning, and there are no rescue boats etc. An almost instinctive reaction from the crew is to use the helicopter to save the people - low hover over the water, grab the person and lift them to safety. Notwithstanding any rational view of the risk, (risk exposure to the helicopter and crew is very low v. almost certain drowning of the casualty) the CAA have now more or less promised to prosecute the next pilot and police force who use their helicopter like this.

It is clear that they won't be happy until we are only able to use heicopters like aeroplanes.

:mad:

I ought to ask FL if he will defend the first of us who gets clobbered by this one.

Robbo Jock

9th Jun 2004, 11:33

Does the Childrens Hospital actually need this helipad ? There's talk about the 'golden hour' after an accident; how does this differ from children to adults ? If there are other casualty units "around the city" (presumably therefore only within a few minutes flying time of each other) each of which can stabilise accident victims (adult or child) within the golden hour, does having this additional one actually help ? If there are not 'three clear routes in and out' of the current helipad, how far away is the proposed new one, that presumably does have them ? And hence, how long must the critically injured patient spend on a trolley being rushed from the new pad to the casualty department ?

They say that "Up to 40 patients a year, many with life threatening injuries, are flown to the hospital from all over the country." unless that's a mis-spelling of county, most of these sound like transfers rather than children requiring "life-saving specialist treatment during the 'golden hour'".

Or is this a disgruntled manager about to lose part of their empire deciding to blame the CAA and pull the 'children may be affected' ploy ? After all, that's sure to provoke an outcry and secure their budget for next year.

Flying Lawyer

9th Jun 2004, 12:59

Robbo Jock
I've always understood that children aren't taken to a specialist children's hospital unless there's a good reason, but I may be wrong about that. What I do know is that Birmimgham Children's Hospital is nationally (and internationally) renowned so the reference to 'country' in the report may not be a typo.

"Or is this a disgruntled manager about to lose part of their empire empire deciding to blame the CAA and pull the 'children may be affected' ploy "
:confused:
Apart from genuine concern for the children, why would hospital managers be concerned about whether they are brought in as quickly as possible rather than via another hospital by road transfer?
empire?
Do you think 'empire' might be over-stating it just a little? It's a helipad.
deciding to blame the CAA
Deciding? Was the helipad was going to be closed anyway?
the 'children may be affected' ploy
There's a clue in the name of the hospital. ;)

budget for next year?
How will it affect their budget? Ah! I think I've just worked out where you're coming from. If some of the 40 children die in Accident & Emergency at the first non-specialist hospital, or during the road transfer, Birmingham Children's Hospital treats fewer patients, therefore proportionately lower budget next year. Is that it?

I see Air Ambulance operators have also called for action to save the helipad. Why would it matter to them which hospital helipad they use - unless of course they have an informed and genuine concern for the patients?

Like you, I'm not a professional pilot and not qualified to judge whether the regulations are reasonable or OTT cautious. I always attach a lot of weight to the opinions of the professionals out there doing the job because they're in a better position to judge than anyone else.

pilotwolf

9th Jun 2004, 13:16

Unfortunately the subject of aermedical transport - both routine and emergency response - is a VERY political/money based decision here in the UK.

Its difficult for me to say what I really want to because of my position! But the bottom line is £££ come before patients - hence no formal NHS funding - be it for air ambulances or hospital helipads.

Another example of this penny pinching is the (reported) review of the long standing arrangement between Sussex Ambulance and Sussex Police where a paramedic flys on a full time basis with the police asu. Sussex ambulance bosses are now 'auditing' to see if the paramedic should be moved elsewhere during busy periods and leaving Sussex without paramedic air support, (except SAR of course).

:mad: :mad: :mad:

PW

TeeS

9th Jun 2004, 14:44

Jellycopter

“Rule 5.

If said helipad fails to meet new requirements it still should not affect life-saving flights. Rule 5 will be the 'critical' rule here and crews are absolved from adherance of Rule 5 for the purposes of saving life.”

Unfortunately, we do not just have to comply with the ANO. Each hospital landing site that we wish to utilise, whether for HEMS or Air Ambulance is listed in a company landing site guide. We are then granted an exemption from various aspects of rule 5 when operating to that site. If a HEMS pilot wishes to utilise the “for the purposes of saving life” clause in rule 5, then I believe he should do it in the knowledge that he might require the services of flying lawyer!

Robbo Jock

“Does the Childrens Hospital actually need this helipad? There's talk about the 'golden hour' after an accident; how does this differ from children to adults ? If there are other casualty units "around the city" (presumably therefore only within a few minutes flying time of each other) each of which can stabilise accident victims (adult or child) within the golden hour, does having this additional one actually help?”

Yes, frankly the treatment of paediatric trauma is hugely different from that of adults, hence the trauma unit at Selly Oak in Birmingham does not take patients under 16 years of age. The majority of children taken to this unit by air, have been involved in pedestrian RTA’s and have either multiple injuries or isolated head injuries.

The Golden Hour actually refers to the time from initial trauma to reaching ‘definitive care.’ What defines ‘definitive care’ depends on the injury; in one case it might be an orthopaedic surgeon at a general hospital, in an other, it might require the intervention of a neurosurgeon. In my opinion, the term ‘golden hour’ is overused, if a patient is going to die without appropriate treatment in 23 minutes then it surely becomes a ‘golden 23 minutes.’

(Please note: the opinions expressed are those of the author, not necessarily those of his employers or the NHS!)

What Limits

9th Jun 2004, 16:18

At last, some good may have come out of the Belgrano (For our overseas viewers, this is the CAA building at London, Gatwick).

For years our HEMS pilots have been forced to make dangerous approaches to many landing sites in this country. I believe that Birmingham Children's is one of these in that you have to land in the street outside, it first having been closed by the Police.

I have never landed there but I have landed at Selly Oak, which must rate in the Top Ten Worst. Having flown most of the HEMS aircraft in this country, I have my own hit list, do you?

Its about time the CAA forced the hand of the Bliar Government. Ultimately the only way forward is a helipad with DIRECT ACCESS to A & E / ER. Too many times have I had to wait with a VSI patient while an Ambulance turns up to take my patient from the helipad to the A & E Department. Why are we still doing this?

Unfortunately most Governments (especially this one) have a tombstone mentality. So children will have to die before something gets done. Lets hope its not mine or yours.

Remember that lifesaving advice "Never let emotion get in the way of good judgement."

Bravo 99 (AJB)

9th Jun 2004, 16:51

Hi Helinut

having spoken to the guys at pas about where an air ambu can land on shouts (this discusion followed an RTA in shrops. during my training at pas) is what you say about rule 5, that although HEMS pilots can deviate from group A to i think its group B) please excuse if i am off the plot a little, even if the patiant due for recovery is a life threatening case. that he ( the Pilot) could still be prosecuted by the CAA if they so wished.

the guys did advise that if the a/c when on the ground ( the Crew) found that the patiant was not of such nature ie life threatening the a/c must be put back into its correct profile . i e under or on weight take off profile as the book etc before it can lift from the incident.. Rule five seemed reading first that it was a cover for the pilots but it seems this may not be the case.
Considering that the Pilot is only doing his job this threat of prosicution hanging over his head seems a little unfair consdiering that he is only doing his job.

With regard to robbo jock as an ex fire officer example RTA Multiple casualties multi injuries

CAS evac to copthorne Hospital say 7 mins
Land ambulance takes 40 to 50 mins dependant on traffic that day, casualty air lifted lived one of the ones by land died, I think that answers you quistion. and this was about six years ago so the traffic has increased by know.

Keep up the good work guys

Sincerely

Bravo 99 (AJB)

(Slightly modified as advised by Bronx)

Bronx

9th Jun 2004, 17:24

Hey Bravo 99

Don't take it the wrong way but if you read what you've written before you hit the button it could make it easier to read, and easier to work out what you're saying.

Bravo 99 (AJB)

9th Jun 2004, 17:55

Sorry Bronx I have altered it slightly I hope that it is more legable

Sincerely

Bravo 99 (AJB)

S76Heavy

9th Jun 2004, 22:09

I have to agree with What Limits on this. After all, HEMS and Casevac to Hospitals are a form of public transport, and helicopter landings at certain hospital sites, especially those which are able to provide special care to patients, are rather predictable in the sense that everybody knows they will take place.
So why not demand the same level of safety (for crews, patients and passers-by) as for instance in offshore flying, where flights take place to remote helidecks?

I do agree that funding for this should be provided, and I am aware of the problems there. But to accept unnecessary risks and put the burden on the crews by putting them in a "damned if you do, damned if you don't" scenario, should be out of the question.
Remember the Aussie SAR accident discussion about providing the profesionals at the sharp end with the right tools for the job?

Helinut

9th Jun 2004, 23:12

The problem is that the money probably won't be found, so the flying will have to stop............

Bravo 99 (AJB)

10th Jun 2004, 06:42

I think that we all agree that safety is the primary factor in all enviroments and especialy in this role.

having seen first hand both police and air ambulance operations its seemed clear that funding for the police operations seemed unlimited and there units where fantastically equipped but when you arrive at an air ambulance unit it was ussually a portacabin or something similar.

Why when this role/service is a key factor in saving life, is there no funding available. it seems so strange and unjust almost.

Sincerely

Bravo 99 (AJB)

Head Turner

10th Jun 2004, 16:18

Under the Health and Safety Act 1974 it is the empolyers duty of care and obliges the employer to take 'reasonable care of those that might foreseeably be affected by his act or omissions'.
A Risk Assessment is required for , in this instance, the Heli Pad, and 'so far as reasonable practical' safety measures must be put in place.
Therefore I understand from the law that the hospital has a duty to provide a safe operating area for the helicopters, their crews and hospital and ancillary staff that are required to attend a helicopter activity.
The HSE could attend the helipad. There are sanction that can be taken against those found to be in breach of the law. They could serve a Enforcxement Notice, either in the form of an Improvment Notice or an Prohibition Notice. It would appear from my knowledge that a Prohibition Notice be served as the workplace (helipad) activly involves, or will involve, the risk of serious personal injury.
If the helipad at this hospital or one elsewhere provided for the use of helicopters delivering or collecting patients then that helipad has to be safe to use by suitable helicopter flown by suitably trained crews. Limitations in use could be due to weather, time of day, type of helicopter, proficiency of crews or a combination of these items.
So where the CAA comes into this is not clearly understood.
Are they seeking a fundamental change in the law?

£££ do play a major role in this situation and it will be a balancing act of cost of safety enhancements versus the risk of serious injury occurring.

So coming up with a 'off the shelf' requirement aint solving the problem. So a jar of prunes to the CAA. They must suffer alot from the runs!

TeeS

10th Jun 2004, 18:23

Head Turner

Please don't suggest HSE involvement in anything to do with helicopters - what are we going to do for jobs when helo's are re-defined as mobile buzz saws. Each one will be required to be surrounded by steel mesh safety screens. Opening the mesh will automatically activate the rotor brake which will be required to stop the blades in 0.2 seconds.

Cheers

TeeS

Bravo 99 (AJB)

10th Jun 2004, 19:15

Without trying to get myself shot down in flames. but the HSE although has an interest in safety for services such as HEMS or in my old case fire service HSE has guide lines but as the nature of the job is specific risk associated in the case of the fire service it was usual for the fire service to have and impliment specific SIPS/SOPS etc.
the service would look to the HSE for guidance but only when an incident/accident ocured did they become involved.

In the case such as this (HEMS) Instead of this being the fire service to be the specific govening body it would be the CAA .

it therefore would indicate that the CAA are at the for front of this decision i would find it strange if the HSE had any further interest other than the normal duty of care.

I may be completely wrong but i would be extremaly suppriced if this was HSE.

Sincerely

Bravo 99 (AJB)

Heliport

10th Jun 2004, 19:22

The HSE is totally irrelevant to the issues here.

Let's not spoil the thread by following this red herring.

Heliport

semirigid rotor

10th Jun 2004, 20:24

A question for Flying Lawyer:

Have you heard any rumours (as suggested earlier in this thread) that the CAA will prosecute should a Police / Hems helicopter be used to drag someone out of a life threatening situation?:*

It will be interesting to see the public reaction to the video of someone losing their life, with a helicopter nearby not attempting to rescue the poor :mad:

I don't know of many crews who will standby and do nothing if they feel they can effect a rescue even if it involves a slight risk. I'm not talking about reckless flying here, just experienced crews making a considered decision :ok:

pilotwolf

10th Jun 2004, 21:11

Probably unlikely to happen in the near future but having spent 15 years in the ambulance service I would risk my licence to save a life...

I also doubt that there are many pilots here who wouldn't do the same...

Act first and argue (with CAA) later? I would... anyone here who wouldn't?

PW

cyclic_fondler

10th Jun 2004, 22:31

I'm sure that the CAA would love the publicity in the daily tabloids if they tried to prosecute a pilot ;)

"Hero Pilot saves life but loses License"

[email protected]

11th Jun 2004, 05:34

I think that treating HEMS/air ambulance as public transport ops is fraught with danger; if exceptions cannot be made for the immediate saving of life then what next. When SAR ends up in civilian hands will we not be allowed to rescue people because we cannot guarantee to be safe single engine while we winch them in? It is a question of balancing risk against benefit and unfortunately there are many for whom the risk of litigation greatly outweighs the benefit of saving lives. The HSE started out as a good idea to improve safety in the workplace but has become just another very complicated layer of bureaucracy to make getting difficult jobs done almost impossible.

Heliport

11th Jun 2004, 05:39

As far as I know, the HSE has nothing to do with this specific issue at Birmingham.
The problem seems to be that the new CAA Regs will prevent the helipad at that hospital being used, even though it's been used without incident for many years.

Bravo 99 (AJB)

11th Jun 2004, 06:42

I agree with Pilot wolf

if i was in that position i would risk my licence to save a life any time of the day with out quistion the safety obviously is primary for crew and A/C but the CAA I would not think twice about upseting them.

Sincerely

Andy

Bravo 99 (AJB)

old heliman

11th Jun 2004, 09:45

Sorry to spoil a rumour but there are NO new Rules from CAA relating to helipads at hospitals etc. JAR Ops has introduced some changes for public interest sites but that is all.

Any hospital site used has always required compliance with Rule 5(1)(b), (i.e. no 3rd party risk) and that goes back to the year dot, nothing new there, and really why should innocent people be put at risk in a congested area? Is risking multiple lives acceptable to save 1, even a child?

Regarding SAR, I would respectfully point out that civil SAR helos are allowed to pick up in the same way as the military, including accepting 3rd party risk where necessary and this is I suggest a red herring for this particular topic of Birmingham hospital.

There was a meeting many moons ago between the Police ACPO (including a well know Lawyer (not FL on this occasion and no offence to him intended) where the issue of saving life was discussed in full and the situation regarding police pilots using the 'saving life' bit discussed. It is no different to an ambulance or fire engine driver going through red lights and then hitting and killing someone. They could be done for it but it would depend on the degree of judgement and common sense applied in the particular situation that would help decide whether a prosecution would take place. The police lawyer agreed that this was correct.

In other words the aircraft commander does what he is paid to do, looks at the situation, makes a decision and chooses whether or not it would be reasonable on that occasion to break the law and gets on with it.

I know that the CAA have not issued any sort of decree regarding this site or changed any rule. Maybe the operators have re-assessed it and decided it was not acceptable, maybe the hospital decided this themselves, maybe someone who knows the FACTS of what has happened might post something.

Sorry to spoil a good rumour

old heliman

11th Jun 2004, 11:06

Just to add to my last, the 'saving life' Rule was designed to address the need to low fly if the a/c had a problem that needed that 'out', NOT to address the SAR/HEMS/Police use of an aircraft. This has been misunderstood for years. Before I get howled down about being wrong, the Rules of the Air changes sent out by the GA department of the CAA many months ago, addressed this and make it clear. If you look at the proposed change it removes that alleviation completely and relies instead on Article 84 of the ANO, as explained in the covering text.

Please excuse me while I duck from an incoming Hellfire from an Apache!!!:D

Thomas coupling

11th Jun 2004, 12:44

Two issues here:
(a) Landings at hospitals, and,
(b) Saving life in helos.

(a) The CAA are beginning to show an interest in this because of the ever increasing demands from Europe under JAR. Annex 14 to one of their regs shows that the operator must be able to fly a safe profile to the hospital helipad, should an engine fail (similarly on take off too).
Alternatively, the hospital should take on the burden and build a suitable site to cater for most if not all helos. Guess where the burden will end up - helo operators, because hospitals are not going to spend millions transforming/building landing sites.

Only the older a/c will suffer (105's, 355's etc.) New gen a/c can cope with the regs.
The deadline for this is forever slipping because most of the German helos are 105's! Current deadline: 2009 and counting.

This ruling is quite complicated and I have tried to simplify it somewhat.

Hospital landing sites has nothing whatsoever to do with the HSE!

(b) Saving life in a public transport helo.

A very VERY emotive subject.

It is very easy to take the moral high ground here and become the local hero while saving that little girl who is struggling in the icy cold river beneath the hovering chopper. Of course, anyone who has any conscience would think first and foremost about dangling the skid in the water and saving her.

BUT,
one has to consider the implications:

if the chopper went in, the girl would die and so to, the crew of the chopper. What is the advantage to that?????

One hopes that the helo/pilot will do its job and save the day, but if either fails, then you are looking at a manslaughter charge.

The CAA will always officially declare that they will prosecute if you operate beyond your clearance. They have to say that. What they do at the end of the day, is another matter.

We have discussed this until the cows have come home:
We would do everything to assist third parties to save the victim[Comms/illuminate scene/throw liferaft etc]. But if we ALL ONBOARD honestly thought the victim was about to die, we would do what we had to do :uhoh:
What that entails is between me, my maker and a very good lawyer:oh:

semirigid rotor

11th Jun 2004, 13:02

Old heliman; You have confused the hell out of me! Are you saying that given the circumstances we have the right to break the law? :uhoh:

Thomas Coupling; Is it not a sad situation that in this day and age; to save someones life, part of the decision making process is - between me, my maker and a very good lawyer?

Like most of us in this corner of the industry, I have already discussed this with those that I fly with, and we have all agreed what we would do as a crew. But one day one of us is going to be put in an awful position and fear of prosecution, with all that implies should not be part of the equation.

Bravo 99 (AJB)

11th Jun 2004, 19:42

Thomas coupling
has a point and i would agree that this is a very emotic subject. But i would have thought that one must way up the gain with the potential for loss. it is like saying that you could not send a B.A Team into a burning building on a persons reported shout (B.A = breathing Apratus Persons reported = People trapped ) becouse there is a possablilty of the pump failing and the crew lossing water. It is a pluasable argument but the risk must be looked at to the gain. as previously stated safety first but by the nature of the work there is risk.

the discision regarding putting the A/C in a compromised position i would have thought that most Pilots would have had these sort of dicusions in the crew room on many occasions before the situation that is currently being dicussed happens and I would have thought that he would know what limits he will go to and to what limits his crew would and way up the options from there.

Sincerely

Bravo 99 (AJB)

Just to add though I think we all know what discision all pilots would take but as we all are saying. having the potential for prosecution hanging over the final decision seems heavy unfair and almost unjust. unfortunatly this probably will not change things and the threat will always be there. I just hope that on the day it happens all the cards are stacked in the pilot and crews favour.

B99

whoateallthepies

14th Jun 2004, 16:55

Yes, an emotive subject.

I found myself in the position of having to dunk an Explorer's skids in the sea so the paramedic could lift out a drowning three year old girl.

Long before this we had discussed this possible scenario as a crew, following a similar incident in South Wales. The consensus was that we would help other agencies as much as possible but that risking the helicopter was a no-no.
When it came to the crunch, with a lifeboat or winch-equipped helicopter more than 15 minutes away, the decision was easy to make and I believe most pilots would have made the same decision. Do you watch a child drown or do you lift her out? The possibility of litigation never entered my head but the risk to the helicopter was certainly uppermost in my mind. As Bravo 99 (AJB) says, the cards were certainly stacked in our favour with an offshore breeze and gentle swell.
Of course the CAA took a great interest following the event but they were as pleased at the successful outcome as anyone. That's not to say that they wouldn't have jumped all over me if I had C***ed up, I was in no doubt that they would have!

I hope none of you have to make a similar decision, I certainly don't want to do it again. Our unit now carries a self-inflating device to chuck to survivors but that wouldn't have been of much use on the day.

Sorry this thread has gone off the Hospital Landing Site topic a bit, but I felt I should add my thoughts after reading it.

WestWind1950

14th Jun 2004, 19:43

just discover this thread...

it's not only a UK or CAA problem... as mentioned above, it reverts to regulations set down by JAR-OPS 3 and the requiremtents a pilot has to fullfill to be able to fly to or from a landing spot.... the requirements are quite restrictive and if put into full force would not allow any landings at most hospital sites anywhere because they do not fullfill the necessary standards. For example, it is not allowed for a single engined heli to fly over difficult environment or to an elevated landing site. So all heli operations must have twin-engine heli's for most HEMS flying. The police and SAR are exempt from JAR-OPS but do, at least here in Germany, try to comply.

In the end it looks like helipads must meet the ICAO requirements. This means an elevated landing site having at least 1,5 times the length of the largest heli flying there (though how are we to know how big future heli's may be?) . ...plus many more difficulties. Actually, because of obstacles found on most hospitals, only elevated sites may in the future be possible.
The various German operators have been discussing this problem for 3 years now but still no proper solution.

In a desperate emergency, it is in the end the pilots decission whether he lands or not. And, if something goes wrong, it'll be the insurance companies that hang him or the company he flies for.

Yes, it's sensible to have the landing sites regulated to a certain degree, but what the new EU regulations are asking for will make flying direct to hospitals nearly impossible.

These regs, as mentioned before, have been floating around for about 3 years now... the outcries are coming a bit late. The German CAA is trying to have the ICAO regulations applying only to sites with more then 400 takeoffs and landings a year... but my opinion is, either the site is safe or not.... you can't go according to a number!!

It's nice to know, that not only over here we are getting upset about all this.... I just wonder, who in the EU came up with these regs in the first place :confused:

Westy

PS. sorry for the length.....

Thomas coupling

15th Jun 2004, 14:28

I'm not particularly concerned about the litigation aspect per se. However, I have to remind myself occassionally that:

(a) I (as a police helicopter pilot), am flying 'punters' around. Fee paying passengers. Would I divert offshore to save someone if I had a cab full of punters from a race course on the way home? (excessive example accepted) but that's how the CAA/JAA perceive the carriage of police observers.

(b) I am no longer SAR current, and observers are most certainly not rescue trained.

Therefore my major concern would be:
whilst in the process of exercising my (self perceived, blown up) excellent piloting skills and expertise, I blow the rescue, I inadvertently kill 2 passengers and land on top of the drowning victim....Risk management or what?????
My family pay for it emotionally and financially for the rest of their lives.

I've just read a report about a neighbouring police force to ours who went thru just this experience for real recently. They witnessed the falling into a fast flowing freezing river of a scrote(!) followed by the dog who chased after him , followed by the dog handler who went in to save his dog!
The chopper stayed with them and did a very professional job acting (no doubt)as a comms link, threw stuff into the water to help, but in the report I read, didnt actually fly down and effect a physical rescue. That decision must have plumbed the emotional depths of that crew!

Alternative rescue vehicles eventually saved the day due to a co-ordinated effort..........

Gotta get your head round these decisions before the day of the race. Too much adrenaline at the time to think straight...methinks

:ooh:

Westwind 1950: thanks for the input from Germany. Is there ever light at the end of the tunnel, will there be a solution or can you persuade the authorities to delay the regulations for ever!!!!

Mars

15th Jun 2004, 15:11

Westy:

Your post is confused and confusing.

What you have not mentioned is that German Regulations do not contain the latest text of JAR-OPS 3 which deals with most of the issues you have raised. The JAA does not have competence on Heliports/Helidecks or Aerodromes - they are still the responsibility of the State.

The latest version of JAR-OPS 3 (Amendment 3 - 1st April 2004) - in the cases you have mentioned - is notquite restrictive and if put into full force would not allow any landings at most hospital sites anywhere because they do not fullfill the necessary standards.Whilst it is correct that a helicopter operating in Performance Class 3 is not permitted to fly over a hostile environment (except under a specific approval), that provides compliance with ICAO Annex 6 Part III. It is not true that such helicopters cannot operate to an elevated heliport under JAR-OPS 3.

As mentioned before, compliance with the heliport Standards contained in ICAO Annex 14 is an issue for the State and is not regulated under JAR-OPS 3. Whilst the 1.5D that you quote comes directly from Annex 14, most Flight Manuals require a larger FATO than that (2D being a average size).Yes, it's sensible to have the landing sites regulated to a certain degree, but what the new EU regulations are asking for will make flying direct to hospitals nearly impossible.It is not clear to me (and probably others) what particular EU regulations you are quoting here - it is certainly not JAR-OPS 3.

I would suggest that as soon as the German Regulations are brought into harmonisation with the latest version of JAR-OPS 3, the problems that you are describing (for HEMS in Germany) will disappear.

Once the latest proposal for amendment of JAR-OPS 3 are published, you will also see that the link between the Category A procedure (which drives the permitted size of the heliport) and Performance Class 1 has been broken; this will allow the size of the heliport to be directly related to the performance of the helicopter and legitimise operations to most of the elevated heliports at German hospitals (without alleviation).

WestWind1950

15th Jun 2004, 16:20

hi Mars,

When I say EU I'm referring to JAR-OPS. Unfortunately we have a BIG problem in Germany... we must first TRANSLATE the ammendments into German before they can be put into effect...and put into law.... and that takes forever (besides being sometimes quite wrong!). At the moment we are working only with change 1 !!! I don't even possess a draft of 2 or 3! and I hear there is a change 4 out there somewhere. You in the UK don't have this problem :p So, our problem is trying to advise the heliport owners as to how to build or rebuild their sites... only to have lots of money invested which later turns out to have been possibly unnecessary.

It would be very sensible if the EASA can finally take over this... but in a sensible way. Then we no longer would have to wait for the "official" translations..... on the other hand, most of the Germans at the various authority offices don't speak or understand English... another VERY BIG problem!! :uhoh:

Westy

Bravo 99 (AJB)

15th Jun 2004, 17:03

THomas coupling

I have to say that you have a very valid point.

out of curiosity, and not knowing what is written in the POM is it possable that there is something written regarding this type of situation, which could assit in the correct line of thinking ( ie something to sway the dicision) rather than a dicision as you say based on the day/adrenilin etc.

It would be interesting to see if there is.

Sincerely

Andy

Bravo 99 (AJB)

whoateallthepies

15th Jun 2004, 17:18

Thomas

I have to agree that risk management is important and that the role of a police unit is not to have the "derring do" mentality. However, the POM cannot legislate for every situation. Are you saying that a police crew should never exercise their judgement? In particular, do you think it was wrong to rescue the drowning girl? What would you have done?

:confused:

Mars

15th Jun 2004, 18:17

Westy:

It appears to me that the solution is quite clear - keep the versions in synchrony - the German hospital problem has been dealt with by the Authors of JAR-OPS 3; if you as a Nation wish to ignore the solution - so be it.

If the translation of (the amendments to) JAR-OPS 3 into German costs more than the building of a single Annex 14 heliport, I would be astonished.

How you can advise the heliport owners on the building, or re-building, of their sites when you do not even know what the current regulation contains beats me. You (Germany) might wish to conduct a discussion with the Authors of JAR-OPS 3 - it would appear that they have a comprehensive understanding of the hospital problem and have already provided appropriate solutions.

Maybe a temporary solution is for the MOT/LBA/Lande to permit (pro tem.) operators to use the latest version of JAR-OPS 3 whilst the regulations are being updated. Any other State would have already permitted this by using JAR-OPS 3.010 - Exemptions as the basis for amendment of the Operations Specification for each HEMS Operator.

This discussion was first conducted at AIRMED 2000 in Stavanger and led to substantial guidance being put into JAR-OPS 3 at the next amendment cycle. You might wish to obtain the latest copy of JAR-OPS 3 and read Section 1 and, in particular, Section 2 of Subpart B - you will find them revealing.

EASA is not the answer to this, you will merely pay for the translation in another way.

Presstransdown

15th Jun 2004, 18:58

This thread has prompted my first post.

Regarding SAR I have never once had the CAA question the judgement of the crew in carrying out any tasking.
These are non-normal usually one off events that must call on the judgement of the rescue services at that time.

What the regulators are concerned about is the regular and planned use of landing sites, which do not offer a certain level of safety to third parties, casualties and crew (in that order).

I fully support this concern.

Hospital landing site usage has or will increase for the following reasons:
1) The are more helicopters
2) Medical staff are covering themselves
3) Shortage of Ambulances so Helos used instead
4) NHS stretched so patients being moved long distances to where there is a free cot/bed etc

Very recently our SAR unit has had various secondary tasks which involved patient transfer many hundreds of miles.

None of our team mind going out on a limb to recover a person or many persons in distress.
To then have to regularly “wing it” in and out of very small-unlit hospital landing site I consider questionable.

I fully agree with the regulators trying to improve margins of safety for hospital landing sites even if its only for the sake of the children sleeping in the house I’m having to narrowly avoid.

Can I respectfully point out to a previous poster that Civilian /Coastguard SAR is not constrained by any limits on operations other than the self imposed trade off between seriousness of situation/risk to third parties/aircrew/aircraft.

This applies to weather, performance or otherwise.

SASless

15th Jun 2004, 20:11

Praises to IMABELL.....the jar of Prunes idea is perfect....a sure way to get them moving...but I bet the recipients would really S--T!
:ok:

Heliport

15th Jun 2004, 20:43

Presstransdown
You sayCivilian /Coastguard SAR is not constrained by any limits on operations other than the self imposed trade off between seriousness of situation/risk to third parties/aircrew/aircraft.
This applies to weather, performance or otherwise.
Are you saying that:

In practice the CAA don't question what civilian SAR pilots do when carrying out SAR ops,
or
Civvy SAR pilots are legally exempt from Rule 5 and legally exempt from being prosecuted for endangering an aircraft, people or property when carrying out SAR ops?

If you mean the second, it sounds reasonable but where is that written?

WestWind1950

15th Jun 2004, 21:16

@Mars

thanks for your reply.... I wish it was that simple. We had fairly "usable" regulations for heliports dating 1969... they required an area of 15 m X 15 m plus a 10 m safety margin on each side. Unfortunately, not even this "basic" regulation was used for hospital sites.... the arguement being that pilots trying to save a life can ignore all rules :uhoh: .....sure, and there have luckily been hardly any accidents... but the ones that did happen received from the heliport owner (hospital CEO) only the reply, that since the port wasn't certified, it was souly the pilots problem :{

When the JAR-OPS first came out, people suddenly started waking up to the problem... special groups were formed to talk things through... make suggestions. Unfortunately, the results are not very satisfying.... and there is no way that the further amendments can be applied until they are OFFICIALLY translated and OFFICIALLY put into German law! Sad but true.....

I could go on and on, but it wouldn't help much. For me it is very interesting to read how things are done elsewhere. Thanks again.

Westy

Bertie Thruster

15th Jun 2004, 21:48

Just to clarify two points made earlier in this thread;

1. SiloeSid mentioned the hospital HLS directory (I am assuming he means the RAF one)

Inclusion of a site in this directory does not clear it for legal use by a commercial air ambulance operator.

2. Jellycopter talked about Rule 5 and "saving life"

Nowhere in the current ANO exemptions available to UK HEMS units is there any direct reference to saving life.

Heliport

15th Jun 2004, 22:02

Bertie

"Saving life" comes from Rule 5 itself.
Rule 5 (3) of the Rules of the Air says that (3) nothing in Rule 5 prohibits an aircraft from flying in such a manner as is necessary for the purpose of saving life.

Old Heliman says the CAA interprets that law to mean saving life only if there's an emergency involving the aircraft, but that's not what the Rule says.

SilsoeSid

15th Jun 2004, 23:06

Yes it was the 'RAF one' I was flicking through and I am aware that "Inclusion of a site in this directory does not clear it for legal use by a commercial air ambulance operator." :rolleyes:

As the thread was starting at the time, I was looking at the 3 clear route options of the various sites, purely out of interest as I'm sure that some must be used by 'commercial air ambulance operators'! :8

There doesn't appear to be many sites with that many options!! :uhoh:

Commercial air ambulance operators? in England? Bertie must be Scottish! :=

JimL

16th Jun 2004, 07:21

Heliport,

Is it possible to post (or point to) the change in regulations that prompted this thread!!

boomerangben

16th Jun 2004, 09:13

I find this whole issue of increasing regulation/restrictions in aviation very frustrating.

Professional pilots (in whatever role) are paid to make decisions relating to the operation of their aircraft. Those decisions are based on a risk assessment (nothing formal, but just done in the head) and are influenced by many factors (aircraft type, performance, weather, the "need" etc). Police/EMS and in particular SAR are operations which present an infinite variety of scenarios. You cannot regulate them without compromising capability. Why can't the regulators respect these professional pilots and trust them to make decisions. More regulation will turn pilots into robots (or airline pilots!!! :E )

JimL

16th Jun 2004, 10:04

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.

Heliport

16th Jun 2004, 11:08

JimL
I can't!!
I post news items from all over the world which relate to helicopters and helicopter pilots. I can't and don't vouch for the accuracy of the stories quoted.
The thread's now moved on from that particuar story to an interesting discussion of the general issues.

boomerangben
Good post.
I can see it's arguable that the person in the best position to make a decision, taking into account all factors/guidelines is the pilot.
If he has sufficient experience and qualifications to be doing the job, then it's arguable his judgment should be respected.

But, that's never been the approach of the UK regulators and it's never likely to be.

Heliport

old heliman

16th Jun 2004, 14:36

Heliport,, you are right in pointing out that it was the CAA's (legal) interpretation and thus their view and open to challenge, however I also said that under the Rule 5 changes planned that this had been clarified as that reference has been removed from the revised Rule 5 (not yet in) and left to Article 84 of the ANO to provide the requirement. ANO Article 84 says (today) that the Rules of the Air can be departed from "for avoiding immediate danger". This is all mentioned in the text introducing the Rule 5 change.

TC when I said before about the Commander considering his actions before 'breaking ' the law, I also said it was similar to the position of an ambulance or fire engine driver going through red lights. Think about it and if you believe you should do it then so be it ...."at your risk". I didn't say 'do it' (and couldn't anyway) but I think that it is highly unlikely that anyone doing it in a sensible way after proper consideration would be at risk of prosecution later. Other correspondents seem to have indicated that this was their experience in reality.

In other words, "yes I broke the law guv but there were strong mitigating factors".

Heliport, the Regulators in UK do try hard to be pragmatic but I'm afraid that HEMS is public transport pure and simple BUT with alleviations for the emergency site where they may well be needed. The police authority (in the form of the Home Secretary) themselves REQUIRED that police should operate to FULL public transport standards unless operationally essential to have exemptions. It ain't just the regulator being a pain.

But why spoil a good rumour and bitch session with facts?
Hope this clarifies and helps.
:D

Bertie Thruster

16th Jun 2004, 15:30

SiloeSid. When I fly a non-HEMS transfer between two hospital sites approved by our Company, it is a normal commercial air ambulance flight.

Heliport

16th Jun 2004, 16:27

Old Heliman

Thanks for explaining the CAA's position.
So, following on from what you've said, whatever the position under the law at the moment, when the new Rule 5 comes in 'saving life' of anyone outside the aircraft won't be a defence to breaking Rule 5. eg To rescue someone whose life is in immediate danger.
What's the thinking behind that?

You imply the CAA might decide not to prosecute in circumstances like that, but there's no guarantee they won't so the pilot is still at risk. I realise drivers are in the same position if for example they speed to take someone to hospital urgently, but pilots have proved themselves to a far higher standard to get their licences than drivers.

You say "the Regulators in UK do try hard to be pragmatic".
If you'd said the personnel out in the field (Ops Inspectors etc) try to be pragmatic, I think people would agree that most of them are - with some exceptions. But if you mean the people who write the Regulations which are put into the law, what do you say to the very common complaint from pilots that we're regulated too much and aren't allowed enough discretion to use our training and judgement? (Compared with our American colleagues for example.)
Do you think that's a fair criticism of UK Regulators?

eg The FAA allows helicopter pilots to depart from the low flying rules as long as it can be done safely. If something goes wrong, they have to justify what they did and if they can't, they are prosecuted. Here, pilots are prosecuted for breaking the rules even if nothing goes wrong and even if there was no danger to anyone.

Mars

16th Jun 2004, 17:28

Heliport:eg The FAA allows helicopter pilots to depart from the low flying rules as long as it can be done safely.We have been round this buoy before but, as was previously stated, there are no low flying rules for helicopters in FAR 91.119; i.e. they are not required to apply the ICAO Annex 2 Rules of the Air (except in International Airspace).

You also do an injustice to the Flight Operations Inspectorate in stating that they do not influence what is produced as Regulations - they do.

Heliport

16th Jun 2004, 18:35

Mars

I remember someone claiming there are no low flying rules for helicopters in FAR 91.119. :rolleyes: :D

The UK isn't bound to apply the precise terms of ICAO Annex 2 Rules of the Air. The present Rule 5 doesn't adopt the ICAO low flying rule, nor does the new Rule 5 to the best of my recollection.

You've deliberately misquoted what I said about Flight Ops Inspectors.

Amusing diversion. Now .......... back to the topic please.

Heliport

Mars

16th Jun 2004, 18:51

Sorry - I forgot that this was a hobby horse.

SilsoeSid

16th Jun 2004, 21:14

Bertie,

And there's me thinking that the title of this thread was 'HEMS and Regulations'. :ok:

SS.

Bronx

16th Jun 2004, 21:15

Mars

"There are no low flying rules for helicopters in FAR 91.119".
Sounds to good to be true?
It is.

You have Rule 5 "Low Flying". We have FAR 91.119 "Minimum Safe Altitudes".
What was it Fred Astaire sang?
"You like potato and I like potayto,
You like tomato and I like tomayto;
Potato, potayto, tomato, tomayto!
Let's call the whole thing off!

BTW, the Mods do a swell job getting discussions going and they do it in their free time when they're not flying. Quit the sarcasm.

old heliman

17th Jun 2004, 11:05

Heliport,

I cannot speak on behalf of the CAA, just give my personal view.

You asked:
____________________________________________________

when the new Rule 5 comes in 'saving life' of anyone outside the aircraft won't be a defence to breaking Rule 5. eg To rescue someone whose life is in immediate danger.
What's the thinking behind that?

____________________________________________________

If an aircraft crew are dedicated to a particular task, such as SAR or HEMS, then within the UK they are granted exemptions from the "3rd Party Risk" Rule, (5 (1)(b)) to attend the incident and do what is necessary. This can be contained to appropriate numbers of a/c and pilots etc with full knowledge of the trainng given and a/c types used.

To extend that in law to ALL pilots would be unrealistic and unreasonable to innocent 3rd parties whose helo's might not have the performance margins appropriate at the time or whose pilots were not trained and tested to the same level. Who decides if it appropriate to land with risk to 3rd parties? Should it be a pilot who THINKS someone is in trouble? What happens if he gets it all wrong and it turns out that the person wasn't in trouble anyway? Difficult to decide, if not impossible.

Better I suggest to have a basic Rule that protects 3rd parties from unnecessary risk, exempt those from it who need to be exempted (SAR and HEMS on scene) and, in the (very rare) event that a pilot finds himself having to decide whether or not he puts innocent people at risk by attempting to save someone else's life, that he considers theat risk, uses considered judgement and then argues that as a mitgigating factor; than one that allows a total 'free for all' to allow absolutely any pilot at all to use that as justification for his actions in landing, regardless of his a/c type, his training, his licence qualification, experience, conditions of day/night, the nature of the (congested) landing area, and the numbers of people at risk if he gets it wrong....

I know not all will agree but what would this forum be like if they did?

You asked for a reason and that would be mine. That is NOT a CAA view.

Thanks for responding, and sorry about the clumsy way I asked the question.
It's understood that all views posted in these forums are personal views not the views of the companies/organisations we work for.
Heliport

old heliman

17th Jun 2004, 11:11

Sorry, just re-read my last, 2nd para is in wrong order and should have read

"To extend that in law to ALL pilots whose helo's might not have the performance margins appropriate at the time or whose pilots were not trained and tested to the same level would be unrealistic and unreasonable to innocent 3rd parties . Who decides if it appropriate to land with risk to 3rd parties? Should it be a pilot who THINKS someone is in trouble? What happens if he gets it all wrong and it turns out that the person wasn't in trouble anyway? Difficult to decide, if not impossible".

Senility or dick lexica? Not sure.

TeeS

17th Jun 2004, 12:39

JimL

I think you answered your own question i.e.

"Is it possible to post (or point to) the change in regulations that prompted this thread!!"

From your next post:

"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. "

Cheers

TeeS

Mars

17th Jun 2004, 17:26

Thanks Tees,

It is encouraging to see that such a longish post is read. That text was in fact written for a keynote speech at Airmed 2000 and has been incorporated into JAR-OPS 3 since January 1st 2002; it cannot be the trigger for this thread.

It is however a little dated as the restriction on HEMS Public Interest Sites, which was to last until 2005, has (due mostly to the German situation) now been replaced by a continuous alleviation (Amendment 3 as at 01/04/04).

(The text from which the extract was taken, was posted into another thread and was in answer to a question whether transplant organs can be carried by any AOC holder (they can of course) but, due to the sharp eyes of Heliport, has been transferred to this one.)

JimL's post is still in place. I copied it here. ;)
Heliport

TeeS

17th Jun 2004, 17:49

Mars, I am not in a position to get too involved in this topic, however, discussions about this site have been ongoing for a considerable period of time. The information in the ACJ was relevant during the majority of discussion and the continued use of the site is subject to ongoing discussion.

TeeS

Foz2

22nd Jun 2004, 18:19

Hi,

I was just having my lunch in Cavendish Square today and I was told we had to clear out as the Air Ambulance was landing. I was told this happens quite regularly but I am baffled about something. Why risk such a dangerous landing in one of the windiest parts of London with trees and buildings metres away from the rotors? Why not go to Hyde park, Green park etc which are only a stones throw away and would be much easier and safer to land in?

Anyway, I take my hat off to the pilot - pretty impressive flying!!

Cheers

Foz

TeeS

22nd Jun 2004, 19:00

Not knowing the area, I looked it up on Multimap and it looks like Cavendish square is almost a mile from the parks you mention. While that is not far for a gentle walk, it leaves your average paramedic, doctor (and pilot) gasping a bit when they have to run with kit. Life becomes even more interesting if you have to carry the patient back!

From what you say, it sounds like resources on the ground asked for the aircraft to land at Cavendish Square and cleared the area for it's arrival. I suspect that the square was assessed as the most appropriate landing site for the incident location and the Pilot then has the ultimate decision as to whether it is safe.

There really would not be a logical reason to turn down the landing site on the basis of it being "one of the windiest parts of London" and "trees and buildings metres away from the rotors" is generally speaking, par for the course.

Cheers

TeeS

Flying Lawyer

22nd Jun 2004, 19:24

"such a dangerous landing"
It's not dangerous to land Cavendish Square.
I've never noticed it's "one of the windiest parts of London" but, even if it was windy, I can't imagine the wind being outside safe operating limits. In the unlikely event that it was, the pilot wouldn't have landed.

"trees and buildings metres away from the rotors?
There are some trees in the Square (not many) but buildings metres away?? :confused:

"Hyde park, Green park etc which are only a stones throw away and would be much easier and safer to land in?"
A stone's throw away? Are we talking about the same Cavendish Square? Behind John Lewis department store? A suitable landing site in Hyde Park would be about a mile away. If there is a suitable landing site in Green Park, that's the best part of a mile away. I assume the air ambulance was used because it was an emergency - not much point in landing further away than necessary.

One of the great things about helicopters is that they can land virtually anywhere, and in a very small space. From your description, it seems things on the ground were handled efficiently to ensure the helicopter could land safely.
I'm not surprised you were impressed by the flying. Pilots who fly for the emergency services are skilled and experienced.

If it happens regularly, Cavendish Square sounds like a good place to have lunch. :D
I've never been lucky enough to see it, but I understand the London air ambulance lands at Picadilly Circus when circumstances demand. ;)

airborne_artist

22nd Jun 2004, 20:04

Perhaps the medics and/or the aircrew wanted to pop into John Lewis afterwards?

The site will have probably been used before - they have a very comprehensive database of viable landing sites in central London.

Foz2

22nd Jun 2004, 22:42

It would take no more than 5 minutes in an ambulance or police car to get to Hyde Park (Marble Arch end). It didnt seem to be a massive hurry either as the aircraft was on the ground for at least 30 mins before the patient arrived by ambulance.

Just a question, thats all!!

Foz:ok:

Heliport

22nd Jun 2004, 23:54

Nobody's getting at you Foz, they're just answering your question.

There's simply no need to land further away when there's a perfectly suitable landing site nearer the patient. The Square is assessed as suitable landing site by the experts (or it wouldn't be used) so there's no need to land further away at one of the parks.

I don't think you should read too much into the delay between the helicopter landing and the patient arriving. There could be many reasons for that.

Heliport

Shawn Coyle

23rd Jun 2004, 13:58

I don't know the details of the incident you were witness to, but some background on the HEMS operation might help.
They are called only after some pretty tight screening at the 999 center in London, and dispatch with a doctor on board.
They are able to land within 100 yards of the site of the site in order to make the transfer to the helicopter as quickly as possible. The doctor makes the decision whether to transport the patient by helicopter or ambulance and to which hospital - the ambulance folks don't have nearly as much training or experience as the doctor, which is why the helicopter is so valuable.
And they land in a lot of places where the clearances are tight, probably tighter than Cavendish Square...

treadigraph

23rd Jun 2004, 15:21

They landed in an area next to my office a few months ago which seems unbelievably tight: trees, street furniture, buildings, etc ...

Originally landed on top of a carpark (from which the patient had fallen), then manoeuvered down some time after doc had jumped out

Fantastic airmanship - and probably marshalling from the ground too! Would that be by a second crew member?

Pat Malone

23rd Jun 2004, 15:35

I once saw the HEMS Dauphin in the street outside Charing Cross Hospital, and if he had six feet of clearance from three lamp posts I'd be surprised.
An acquaintance in Richmond has had his garden scouted out by the Air Ambulance people as an emergency landing site. Personally I'd be hard put to park my bike in it, and it makes Cavendish Square look like the Gobi.
Good to know these chaps will fly through the eye of a needle when we need them.

SASless

14th Jan 2005, 17:18

WASHINGTON — A sharp increase in fatal accidents on medical helicopters and planes over the past year has prompted two federal aviation agencies to launch safety reviews and to consider broad improvements, the agencies said this week.
The issue has been under examination for months, but three crashes that killed six people in the past nine days have made the issue more urgent.

• A pilot and a paramedic died Monday night when their helicopter plunged into the Potomac River near Washington, D.C.

• Three people died Tuesday when a twin-turboprop used to carry patients crashed in Rawlings, Wyo.

• The pilot of a medical helicopter died in a Jan. 5 crash in Falkner, Miss.

At least 37 people have died in 12 medical helicopter and plane crashes over the past 12 months, according to the National Transportation Safety Board. Seven died in 2003.

The FAA has never taken a hard look at the EMS business....changes usually come within the industry and are generally driven by insurance costs.

The Rotordog

15th Jan 2005, 03:10

As we all know, the trouble is that two of the three examples cited were not strictly "EMS" accidents. The two helicopter crashes were at night: one in bad weather; the other at very low altitude. Neither ship had patients onboard. Either accident could have happened to any operator that flies at night. It would be wrong to single out EMS for these two. But they will. Perhaps the NTSB ought to widen their focus a bit and do a safety check of the entire helicopter industry.

SASless

15th Jan 2005, 03:30

Dog,

One had gone to a scene to pickup a patient....had a minor mechanical problem....and was enroute back to an alternate landing site....and crashed. It was an EMS aircraft and had been on an EMS mission until the maintenance problem occurred.

The second aircraft in the DC area was an EMS aircraft returning to its base in Fredricksburg after completing an EMS flight. One of the people killed was a medical crew member.

The KingAir was on an EMS mission when it crashed.

Sorry....all three were EMS aircraft and crews involved....no matter how you want to argue it. Just because no patient was onboard does not make it something other than what it is.

There is a crisis coming in the EMS business.....however you want to colour the statistics....we are killing a lot of people in the process of conducting EMS operations. The numbers were way up last year....and if the current trend continues, this year will set new records and surpass the grim years when we really slayed a bunch. That situation led to a lot of changes in the EMS industry....maybe it time for another evolutionary change.

I would love to see a real "Blue Ribbon Panel" address safety issues in both the EMS industry and the Gulf of Mexico offshore operations. The cat would certainly be in the pigeons then!

imabell

15th Jan 2005, 03:48

SASless, you're absolutely right.

ditto for australia.

The Rotordog

15th Jan 2005, 13:43

I'm still not sure I see how these helicopter accidents constitute an indictment of the EMS industry. In both cases, there was no patient onboard. Thus, the "pressure to perform" on the pilot was no greater than on any other commercial pilot. It could easily have been me taking off in horrible weather at night from a site landing in my R-44, or scooting low-level up the Potomac River at night. To my mind, there is nothing about these accidents that points to any peculiar aspect or hazard of the EMS mission.

And maybe the NTSB will realize that right off the bat. And maybe they'll go, "Gee, you know, flying helicopters commercially at night really sucks! They fly in bad weather and they fly routes that mandate ridiculously low altitudes...no wonder they crash a lot!"

SASless

15th Jan 2005, 14:20

Ok Dog....

Lets try another way....what markings were on the side of the aircraft? Lifeflight, Lifeguard, Air Life....did the aircraft have EMS interiors, were the aircraft licensed as ambulances? Did the crews have something besides a Red Cross CPR certification? The mere fact they were EMS aircraft and were returning from an EMS mission makes it an EMS related event...elsewise they would have been home snug in their beds and not been up flying.

Are you suggesting helicopters should not fly after dark?

If I can send a student off on a solo night cross country...why should professional pilots not be able to fly in the dark? (....and do so safely?)

Do we crash more aircraft after dark?

What is intrinsically different between day and night flying that makes Night EMS ops so dangerous?

We know flying single engine over open water is hazardous....particularly if the sea state exceeds the capability of the emergency float system on the aircraft...but that does not slow down the offshore industry in the Gulf of Mexico.

What is your point Dog? Assert yourself here....make your case?

The Rotordog

15th Jan 2005, 16:00

SASless:Lets try another way....what markings were on the side of the aircraft? Lifeflight, Lifeguard, Air Life....did the aircraft have EMS interiors, were the aircraft licensed as ambulances?Aircraft get "licensed" as ambulances? Man, I need to learn more about the EMS industry.

Look, all's I'm saying is that just because these helicopters were painted up to look like ambulances, it had nothing to do with the crashes....UNLESS someone can point out to my feeble brain how these accidents were fundamentally different because of their mission. They could have been private, corporate or air-taxi ships in the same scenarios with the same outcomes. And I believe that the NTSB will see that relatively quickly.

Neither aircraft were on a strictly EMS mission at the time, which makes that factor incidental. So why point the accusing finger at EMS? I don't see the relevance. Was there some EMS necessity for flying that low up the Potomac River? (One story I read said radar returns indicated that the helicopter was at 100' +/- 50'.)

For the Mississippi crash, was there some peculiar EMS necessity for taking off and flying in very poor weather at night? The pilot was merely repositioning it to Faulkner University or a nearby hospital pad to park it for the night, no? In other words, just exactly what were the EMS issues that factored into these crashes? They were helicopter crashes, plain and simple. To say that they occurred because they were on an "EMS mission" is a red herring.

If these two helicopters had been painted with corporate colors, or television station logos, would we be championing the NTSB to investigate those market segments? Of course not.Do we crash more aircraft after dark?I cannot answer this, as it is not a valid question. As you know, the actual hard number of aircraft crashed after dark is irrelevant. We must compare the number of hours flown in daylight to the number of hours flown after sunset. The rate of aircraft accidents at night is probably higher, yes. But that is just my gut talking (although that rumbling might be that I have not had breakfast yet).

SASless, your posts are usually intelligent and sane. And I understand your passion about safety, especially with regard to the GOM and EMS segments. But I think it is wrong to lump these particular two accidents into the EMS category. We need to look deeper at why helicopters crash in general.

SASless

15th Jan 2005, 16:35

Dog,

Saying these were not EMS related still escapes me....I received Concern notices about them....an EMS industry accident/incident notification group. To say "EMS" does not apply here would be like saying a crash of a longline helicopter lifting fire gear while on a USFS firefighting contract was not a utility helicopter crash because it was really "leased" to a public agency.

Your point that we would not be saying what we are if it had been an ENG aircraft or a corporate aircraft is probably true....however....it was an EMS aircraft....and EMS operators are losing aircraft and crews at an increasing rate over the past two years.

I can assure you the job advertisements for the replacement pilots shall say...."EMS pilot....blah...blah..blah".

How do you explain the increasing accident rate in the EMS market? Just a fluke in the stats....real increase....nothing to worry about....cost of doing business?

Maybe we need to start posting the photographs of the dead....to put faces with the numbers. I begin to think the EMS industry is in a state of denial....kinda like the Wildebeasts when they do the migration....don't look back, just keep running!

w_ocker

15th Jan 2005, 23:42

G'day fellas.
Just some thoughts from an outsider (ie non-USA, but EMS none-the-less).
Dog, it seems that you are trying to highlight the fact that all helicopter night/poor weather operations carry increased risk that ought to be studied rather than just giving one part of the industry that attention. In this I agree.
However, I also agree with the assertion that these were EMS aircraft employed in the EMS role. The fact that an Air Ambulance is not actually carrying a patient does not mean that it is not doing an EMS job. The EMS role encompasses the whole day - from pre-flight briefings, through training, stand-by periods, crew rest, earlier jobs (and their potential carry-over stresses), maintenance, admin etc etc. So, if a bunch of EMS aircraft begin to show an increased occurence of crashes, especially in a certain flight regimen, surely you agree that a study including all possible causative factors should be made as to why.
Now I know nothing of the circumstances of these recent accidents, but do we know if the crews' decisions may have been influenced by EMS-specific factors? Perhaps they had just performed a particularly harrowing job, or were under pressure to return to base to perform another job. What were the cultures of the opperations in question with regards to turning jobs down due to poor conditions, or allowing aircrew to be possibly pressured by medical factors which, whilst important, do not change the fact that some flights are better left until flight conditions improve.
My point is simply that EMS is differant from other ops in that the life and death pressures can impinge on the decision-making process of the aircrew. I think perhaps a study of training and equipment suitability and CRM knowledge levels of flight, management AND medical/tasking personel would be a good place to start considering the fact that there is a perceived increase in accidents of aircraft engaged in EMS tasking of some kind.
Just my two bits from a down under EMS/fire operator.

Cheers

Steve76

16th Jan 2005, 01:28

Yet another non-US opinion.
On another thread Nick and SAS made some comments in reply to my comments regarding this issue.

To qualify myself:
I did Ambo work in Canada for the better part of 3yrs. It was 24hr shifts IFR and NVFR. We responded to scene calls using S76A models and did patient transfers. 12 machines, 8 bases. To date no machines lost during a call.

Perhaps due to great piloting?
But I know that isn't so, because I think AA work tends to attract SOME (note: NOT ALL) of the lowest skilled aviators in our industry.
...and I worked there :) No doubt I will be arguing this comment for days to come.

Perhaps it was due to great machinery?
Nope..all were A models and most were without autopilots, all were underpowered and the most sophisticated gear was the green screen RADAR (which didn't work that well in my ride).

The reason in my opinion was two fold.

A) The Canadian Rules were adhered to explicitly and the company rules were even tougher.

The NVFR/IFR rules are very specific and you have to follow them to the letter. Unlike the BK117 accident in NZ that we discussed years ago. The company SOP's were designed to make the decision to go flying a no brainer due to the fact that the lowest common denominator might be captain.

They completely factored out the pilots abilities in the decision and stated that if you don't have this + that + and some of that; you just do not go.

Constantly the "management" would email and provide examples of accidents from the states. And they were always from the states. I don't mean to be rude to Nick but the comment from the other thread went something like,

"well what about the person who needs the service?"

Sometimes you just have to say SORRY, no can do.
It ain't worth hurting yourself or getting the "I'd rather be on the ground" feeling for someone you don't know. We are not hero's just pilots. The hero's are the paramedics and nurses and they will gladly tell you that :hmm:

On average I think we would turn down 30% or more of requests.

B) The contract was a government tender.

Being prepaid and government sponsored, it made not going flying profitable.

Prior to the contract being issued, another company flew a 222 on the same operation but for a contracted rate. They got paid when they flew. Some of the stories about those days sent shivers up your spine. I think the most watched video at that base was Nick Lappos in "exposing the myths of ICING conditions"

Remove the motivator of profit and competition and you will have your accident rate cut in half.

[email protected]

16th Jan 2005, 06:18

Rotordog - the reason that these accidents didn't happen to you in your R44 is that you probably wouldn't have been under the pressure to fly that these guys were. As SASless points out they were both returning from missions which meant they had got airborne very quickly - I'm not saying they weren't properly prepared, but it's very different spending an hour doing pre-flight planning and met checking from launching in 5 minutes on a rescue job. With all the adrenaline pumping, crews are usually very sharp and aware but once the job is finished or cancelled there is a natural slump in arousal levels as all that is left is the return to base. This is the time when people get caught out and crews and management need to be aware of it.

Steve76 and w_ocker make very good points - EMS is a business and therefore commercial pressures apply, on top of all the professional ones. Unless the pilots are confident that management will back them up when they decide not to fly, they will keep on pushing the limits and some will get hurt.

Decks

16th Jan 2005, 08:48

Folks,
This is a very interesting topic and please keep the replies coming. I flew in the US for years and was always interested in the night element of EMS flying. I now fly 24hr SAR on the west coast of Ireland and feel much safer on that than the thought of night RTA type scene work.
The point about profit and government contracts is certainly valid. The only pressure here is that which we put on ourselves. The decisions of the crews (conservative or follhardy) are rarely questioned except by each other and money is not a consideration. The direct pressure on corporate or charter pilots is routinely much more, in my experiences.
The equipment is a factor. Once you have good freezing levels and an IFR machine you have a very good safety net.....particularly if you can couple an ILS. Punch in the autopilot and have the HP monitor it, removes a huge amount of workload.
Two crew is certainly a help(4 even better) provided you are working with and not against each other.
Local knowledge is a huge factor. Having it frees up so much mental capacity.When I think of guys doing relief work for the large EMS companies in the States and moving from site to site I shudder.
So what makes night so dangerous. Obviously fatigue is one. Youre tired. You dont give a **** and you just want your bed. Can be difficult to be disciplined.
Not flying very often doesnt help either. And after hours of sitting around talking ****e, the momentum to go and do something productive can be strong.
We routinely fly into prepared off airport helipads and fueling sites. They are fine because you know them and the terrain.

CFIT accidents rarely happen during the day except in cases of inadvertent IMC. If the wx drops you can safely land anywhere. SAR EMS etc during the day is not an overtly difficult job. BUT!!!!!!When I fly over the countryside at night happily up at MSA ( or below MSA on a known GPS route) I look down and think.... landing on the side of the road down there unaided is simply very dangerous. Flying night visual contact single pilot in a VFR only machine....and then having to land.... Lots of odds aginst you.

This industry learned years ago that you cant fly (safely) low level offshore at night without 2 IFR pilots or a coupler or both. It learned that you cant get down to and hover (safely) over the back of anything small (at night) without a hover height hold.
Ban night scene work, allowing all night flights to be done from known sites would be first on my wish list.... Any comments.....???

rotorspeed

16th Jan 2005, 11:03

Most comments on this thread have been generalisations, and there's nothing wrong with that. But with regard to what, if anything, should change in the US EMS industry to reduce the clearly unacceptable accident rate, it would be interesting to look at the specific error that caused each of the accidents over say the last three years.

Was the fundamental error breaching existing operating regulations and procedures? Was it bad pilot judgement operating within the regulations? Mechanical failure? Etc.

If anyone's got the time and interest to go through the records and come up with the detail of the accident causing error I think it would make interesting reading and point to the changes that would have the greatest effect.

For example, the fact presumably is that hundreds of EMS missions take place in bad weather at night each year, many to unprepared sites, and not only do they not crash, presumably the pilots do not think they are taking unreasonable risks either?

So what makes the difference? Surely, luck rarely comes into it, unless its your turn for the statistical chance of mechanical failure?

SASless

16th Jan 2005, 12:43

As to the hundreds of night missions in bad weather and the guys do not think they are taking a great risk.....think about what you just said?

Having done just that...maybe not in the hundreds....but certainly more than a few....and did so as a roving relief pilot.

A few of the trips stand out....

Full Harvest moon....about midnight....heading for State College, PA....getting to the point where the valley narrowed down and had but a couple of ridges to cross...expected to see the lights of town up ahead...but no lights...and vis was getting all shimmery...turned on a landing light to discover I was in one heck of a snowstorm. 180 turn and rtb.

Scene call southwest of San Antonio....noticed the air under the street lights looked kinda "smokey"...on the way back....encountered some real fog....maintained visual contact with the surface but really wished I wasn't there. Popping up was not a good choice...might not have been able to get back down.

Night flight to St. Mary's, PA....cross grain to the mountains....no lights on the ground.....thus no horizion on a cold overcast winter night. Violated the rules....but hard to say you cannot go when the sky is clear....and vis unlimited. Sweated gallons on the way back when the moon had set.....but a beautiful flight up.

The common threads to all of these...night, very dark areas, no weather radar, single pilot, VMC/VFR flight to remote locations, very short time to spare for alternates fuel wise.

The use of known and inspected landing zones greatly reduces risk.

Patients die if you do not go....but they have been dying long before the helicopter EMS business started up.

Two pilots and fully IFR equipped aircraft for night flying would be much safer.

People can argue about a lot of things...but until you have trotted around some parts of this country at night with limited visibility.....one cannot begin to understand how "dark" it gets.

The current argument within EMS circles has to do with the use and value of NVG's for night work.

I accept all the arguments for the NVG's....I absolutely love flying with them....to fly at night unaided...frankly terrifies me. The one argument I have against them...is what do you do when you find yourself in the middle of no-where....either have a real complete goggle failure (rare) or fly yourself into weather as when using the MK I eyeball? When you lose vis on goggles....you are in a very real pickle! You now have to conduct an inadvertent IMC drill and do so single pilot in an aircraft without an autopilot to assist you. That is not a healthy situation to be in.

Any thoughts?

rotorspeed

16th Jan 2005, 15:08

SASless

Interesting reply; and if what you say is representative, a real concern. Surely pilots should not really be doing anything they think is a significant risk at the time? I assume that pilots when operating within limitations of equipment, training and skills do not generally think they are taking significant risks flying helos? Even if the perception of the risk is exaggerated, decision making will usually be impaired because of the consequent stress.

Taking your examples.

The snow storm; presumably the concern was the fact that you were unaware for some time that you had entered and were flying in it. Did the temperature/forecast suggest this was a risk? Could more frequent switching on of the landing light have provided earlier warning for you to turn back? Was it a drama when you did turn back? You obviously acted early enough to avoid a potential accident, but would alternative pilot action have reduced the risk to a level that it was acceptable?

Fog building up. Nasty one, that, as it tends to get worse. Was it forecast? Was it even possible for you to have got a good forecast? Was base far away? Was that clear? What were your outs? Presumably trying to find somewhere to put it down safely that was not yet significantly foggy. How could that risk have been avoided/minimised to acceptable levels?

Night flight to St Mary's. If you violated the rules and you then felt the mission risky, who pressured you into the flight?

I'm not trying to be clever here, just trying to identify why these flights were perceived as risky and what could have been done to avoid that.

I must say I not too keen flying VFR singles at night. IFR capability at least gives you the kit not to be stressed flying without visual reference, particularly assuming you have an autopilot. And the second engine largely eliminates that nagging background thought of "where am I going to go if stops". It also makes it a lot safer taking your time carefully checking out the site from 100ft with no airspeed with the landing lights. So I'd vote for IFR twins; agreed.

Not enough experience with NVGs to have a valid view on use, I'm afraid.

SASless

16th Jan 2005, 15:19

Each one of the three flights I felt comfortable taking...Snow showers were around but the big ol's orange moon was shining...so vis was great....except for that one big cell hanging along my flightpath at the worst point. Radar looked good before we went....

The moon was up on the way to St. Marys but had set prior to the return trip...but stark clear all around....just a very dark area with mountains. Just no lights on the ground around there for quite some way....and with no moon....and a bit of haze....made for an interesting flight. Just reverted to offshore night flying....glance outside every now and then but fly instruments till some lights showed up.

The fog....well that was a an educated guess....short scene flight...all over a populated area mostly....out and back...20 minutes maybe.....just guessed wrong on that one. Did not guess wrong on any more like that...."smoke" under the street lights and it is red for the night! Movie and popcorn event.

I even carry it to the old wind light...temp/dew point within 2-3 degrees....red night....movie and popcorn.

Low cloud....precip is one thing...fog is in a catagory all by itself....if fog is around...or a good possibility....movie and popcorn time.

rotorboy

16th Jan 2005, 15:28

Steve 76 had an intersting observation.

I would be real interested to see accident stats : Stand alone vs hospital based (funded) programs. I would venture a guess that Stand alone programs have a exponentialy higher accident rates...

Surprised you guys havent brought up CAMMTS yet

RB

NickLappos

16th Jan 2005, 15:49

SASless,
You started off arguing that nobody was paying attenton ("The FAA has never taken a hard look at the EMS business....changes usually come within the industry and are generally driven by insurance costs.")

I know that is not true. A major task force worked about 10 years ago, and the results saved the EMS system. Rather than place blame, why not let your excellent points stand for themselves?

The FAA does not sit by when these things happen. I work with 76 oerators who sweat profusely when the FAA examiner comes by after a minor mishap, let alone a pilot error accident. Don't you recall that?

Let me ask, because I think you are expert in this field (at least by surviving all these years!) What should we do?

SASless

16th Jan 2005, 17:29

Nick,

When the FAA shows up...they go through paperwork...they check forms...they check to see if the rules and regulations are being complied with. They do not look to see if the rules are adequate...appropriate....or effective. They look to see if the minimum standards are met....whether the flight took place in accordance with the opspecs and FAR's.....

They do not look to see if the FAA requirements contributed to the accident or if changes are needed in the rules or regulations. If that is so...the NTSB would have a lot less to say about the FAA and its lack of prevention of accidents.

The reason we all sweat a visit from the FAA is there are so many ways of getting caught shorthanded....even if you are dedicated to compliance. It is the paperwork they thrive on. It is the real world things that are killing people.

In this latest crash in Maryland....do you think the FAA is going to criticize themselves for the low level route restrictions? The NTSB might but the FAA darn sure isn't.

The FAA will say something along the lines of "Pilot Error...failed to maintain terrain clearance." As usual...they will be correct...but not necessarily right.

If the FAA is so safety conscious....why is it...my recollection of the old crisis in the EMS industry....the bulk of the changes were intitiated by the industry and not the FAA. If you read the equipment standards for night flight....you can get by with a very marginal amount of equipment. Now put yourself out there in marginal conditions....with no instrument proficency in unfamilar territory...and you have a recipe for disaster. The FAA under part 91 says nothing about having surface lights for control of the aircraft....part 135 does...but we all know that rule is ignored constantly. The FAA knows it....why do they do nothing? They will come in after a crash and some more dead folks and then take an operator to task.....when was the last time they suspended an air carrier's certificate? Ever?

You recall the FAA decision to allow the liferafts to be removed from 727's on the New York...Miami run....due to statisically insignificant probability of a three engine aircraft ever ditching in such a short offshore flight? What was it...three weeks later....a FE flamed out all three engines on one on that very route. The crew got the engines restarted.....but then the FAA changed its mind.

Similar mindset here....just like offshore...allowing Jetrangers for example to run around the Gulf of Mexico over sea states that are beyond the capability of the emergency floats. Is that wise? Do the operators care?

We too often smile at safety....and ignore the realities.

A few things on my wish list...

At least a basic three axis autopilot on every machine with HSI, Standby attitude indicator, and radalt. GPS slaved to the HSI.
GPS coordinates listed for all obstructions in a handy format....and updated.

No single pilot IFR.

Training sufficient to maintain actual....not legal instrument currency...and proficiency not just legal currency.

SX-16 Nitesuns or equivalent on all night aircraft. IR filter if crew has NVG's.

Moveable landing lights on all night aircraft. Lots of them!

Scene lights on all night aircraft.

Sliding doors that can be opened on all aircraft.....to allow the med crew in back to really be able to see wires on approach.

More use of preplanned LZ's at night.

More use of preplanned routes designed to avoid known obstacles. It is a miracle hour....use a minute or two to ehance safety.

Notification of weather turndowns to all EMS units in the area.

Requesters should be required to notify operators when they have been turned down for weather.

No single engine aircraft at night.

More Awos...Asos's at critical points....moutain passess...for example.

NVG's for all night flights.

Organized counseling to defeat the "Hero" image that creeps into EMS crews.....it is a transport mission...not a life saving mission.

Better rest accomodation for crews....particularly for night crews.

I am on record now as to what I think would help...your turn.

What do you think can be done to enhance safety for EMS flights?

rotorspeed

16th Jan 2005, 17:56

Seems a pretty good, sensible list to me SASless, apart from not wanting single pilot IFR.

With the A/P you rightly want anyway, I would much prefer 90kgs more fuel to a second pilot for IFR ops!

Nuada

16th Jan 2005, 19:01

SAS,
Very well said, (throughout the post) and a quite complete listing as well. I have been laboring in the US EMS market for 10+ years now and can testify heartily about the slippery slopes which exist in this section of our indusrtry, and which apparently are not obivious to those, (RotorDog) who have yet to experience the environment. I would add to the miasma before us the contributing factors of cumulative sleep depravation and the ongoing influx of primarily dual pilot seasoned crews.
Asnyone in the business will tell you, most if not all of the major EMS operators are pilot starved, and as such the majority of bases function with short staffing. This results in extended tours, often flip-flopping randomly from day shifting to night shifts.
There is no opportunity to smoothly transition the body and mind (decision-making capacity, remember?) from one extreme to the other. Period. As you grow older, the impact increases. This all has absolutely everything to do with managing a totally 'ad hoc' tactical style of helicopter operation.

It is largely an industry without strong leadership from either the vendor companies or the industry lobby groups, to say nothing of the FAA/NTSB.
If you are seeking guidance, this is absolutely the worst place in the helicopter industry to search.
There is no opportunity to learn and watch your peers manage the 'up-time' and the 'down-time'. The two pilot operations are as rare as pay increases these days. Truthfully, how did we all learn back in those halycon days of yore?
It is NOT good enough to accept a standard of 'Darwin-esque' crew development. It isn't only the good or wise pilot who survive...sometimes the wrong lessons are learned and allowed to seed instead.

Imagine that you have only a dual pilot basis of experience to draw upon? Now put yourself into the darkest hole you might imagine with some random white noise in both ears offering you either inaccurate, disinterested, or distracting information. Now, that I have your head on a swivel...you are in complete control of managing the entire process from choices made to execution of a plan....which may include calling the whole thing off as a poor idea to begin with. It is a large dosage of responsibility, most especially for those who until recently had the benefit of another mind, body and spirit in the cockpit with who to interact.

I am sure there is no single easy answer. I am not sure if any inter-governmental action will effectively incorporate all the divergent elements at play.
I try to treat each call as a separate entity. I try to learn from everyaction I take. I try not to hold too fast to my own ego and imortality. I try to do better tomorrow than I did today. I try very hard to live another day.

It's a quixotic tightrope, not to everyone's liking. I have been in this business for over 36 years. With apologies to all other opinions...this EMS format consistently asks more of all of my judgement and skillset than any other element of our industry in which I have worked.
Make good decisions.
It's still true after all these years.

w_ocker

16th Jan 2005, 21:49

Glad to see this discussion going the way it is.
It seems you guys have some serious challenges ahead. Here is how my mob in Australia do it - note there are several different methods in Aus, but I am one of those poor buggers who works several bases in geographically diverse locations, and this is how we manage.
We operate ME(412)SPIFR, 3 ax AP. 24 hour shifts with strict fatique disciplines. Some of the aircraft are new, some old, some carry just one paramedic, some a cast of thousands. This leads to one problem - the ever-present lack of power margin/range on some ops. Next is the problem of night flight. Yes, we are IFR, but that doesnt alleviate problems of icing, arrival and landing to black-hole roadsides, fog, non-surveyed flight routes and landing areas etc. It seems to me that many of these difficulties would be reduced (not elliminated though) by simply being able to see! I have an NVG background and I still cant believe that we get away with what we do unaided relatively without incident. Frankly SAS, it scares me too! NVG in my ops would allow me an increased ability (not failsafe of course) to see and avoid fog and cloud (ice), avoid terrain (mountain flying at night) and perform far more effective search ops. As for the arguement of inadvert. IMC, I do agree, but it is my belief that this is an IFR job, and thus ought to be conducted by IFR multis with proficient crews.
A healthy company culture of "pilot's decision is final" is vital also.
I often lament some of the short-comings of our system (basically the lack of NVG), but I see that you Yanks have it tougher than me in many ways. I hope you can improve things the way you see fit.
It is worth mentioning that all this gear is obviously expensive and the sad truth is that companies and clients most likely see what we do as an "aint broken dont need fixin' " situation.
That said, fly safe guys and remember that your patient is already in a bad way. Its not your fault and the simple maths of his/her life verses the 3, 4 or 5 of your crew just doesnt add up.
Keep up the discussion guys. Any other examples of how others do it out there?

W

Devil 49

17th Jan 2005, 11:13

Night vision goggles would do more for the night accident issue in U.S. helo EMS than the rest of the list, SASless. I'd have to put rational, scientific pilot scheduling next. Both have universal implications- no matter what, where and how you're flying, safety is enhanced when pilots can see and think clearly.

Decks

17th Jan 2005, 12:11

Am untrained and have never used NVG but am seriously curious as I sense that they would be a major help. We routinely fly coastal missions at night up inlets and into islands and are fairly heavily dependant on the radar. It could fail and also is it telling the truth? Certainly the issue of NVG failure is a big one... whats the thoughts or procedures on this...??? Any EMS pilot willing to talk us through a night scene job with the use of NVG would be really appreciated...

I completely disagree on the notion of " I would rather have the fuel than a copilot". Weak thinking. Managing a crew well takes effort and diplomacy but on the sh*tiest of nights can be a huge plus.

I agree with SASLESS on the point of the FAA or other regulating authorities. The client sees $$$$, the operator sees $$$$ and the key to this business is effectively managing profit against safety. The regulators are in the strongest position to put more sensible regs in place. Are you even required to have a rad alt to fly Part 135 at night...??? Doing that kind of work without a radalt is a complete joke... good, safe, well known regs can help reduce the pressure directly on the pilot. You point at the book and say sorry but no.

Luck cannot be accounted for and shouldnt be routinely the factor which governs a life or death outcome. I am certainly a member of the "There but for the Grace of God go I club". I can think of numerous occassions when it was the factor which kept me out of trouble... And there have probably been other times I dont even know of....

SASless

17th Jan 2005, 12:39

Someone asked what the equipment requirements are for night flight in the USA for EMS aircraft. This is for VFR aircraft.....such as the Jetranger, 407, AS-350, BO-105's, and some K-117's. This is what the FAA thinks is needed. If you check the dates on this regulation...you will see the FAA gave the industry two years to fly without anything before this reg became law. Wonder if anyone died in that two year period because of the lack of instrumentation.

§ 135.159 Equipment requirements: Carrying passengers under VFR at night or under VFR over-the-top conditions.
No person may operate an aircraft carrying passengers under VFR at night or under VFR over-the-top, unless it is equipped with—

(a) A gyroscopic rate-of-turn indicator except on the following aircraft:

(1) Airplanes with a third attitude instrument system usable through flight attitudes of 360 degrees of pitch-and-roll and installed in accordance with the instrument requirements prescribed in §121.305(j) of this chapter.

(2) Helicopters with a third attitude instrument system usable through flight attitudes of ±80 degrees of pitch and ±120 degrees of roll and installed in accordance with §29.1303(g) of this chapter.

(3) Helicopters with a maximum certificated takeoff weight of 6,000 pounds or less.

(b) A slip skid indicator.

(c) A gyroscopic bank-and-pitch indicator.

(d) A gyroscopic direction indicator.

(e) A generator or generators able to supply all probable combinations of continuous in-flight electrical loads for required equipment and for recharging the battery.

(f) For night flights—

(1) An anticollision light system;

(2) Instrument lights to make all instruments, switches, and gauges easily readable, the direct rays of which are shielded from the pilots' eyes; and

(3) A flashlight having at least two size “D” cells or equivalent.

(g) For the purpose of paragraph (e) of this section, a continuous in-flight electrical load includes one that draws current continuously during flight, such as radio equipment and electrically driven instruments and lights, but does not include occasional intermittent loads.

(h) Notwithstanding provisions of paragraphs (b), (c), and (d), helicopters having a maximum certificated takeoff weight of 6,000 pounds or less may be operated until January 6, 1988, under visual flight rules at night without a slip skid indicator, a gyroscopic bank-and-pitch indicator, or a gyroscopic direction indicator.

Now...I ask you....is this the cockpit you want to be sitting in on a marginal night. The boys and girls are out there nightly in just such aircraft. Just the inclusion of a RadAlt makes a world of difference...throw in an HSI...it gets better yet....add a simple three axis autopilot and gee....life is good....now add TCAS...EGPWS....even a fixed tube low light vision device...and life is great. NVG's....and super....a second engine and another pilot....life is grand! What we are talking about is a fully kitted and crewed IFR twin operation I reckon.

rotorspeed

17th Jan 2005, 19:40

Decks

Whether or not you prefer the fuel or the co-pilot for IFR ops must be influenced by the type of aircraft and how it is being operated. On an S76 90 kgs clearly doesn't buy you much extra time and maybe you're operating well below max wt for IFR ops anyway, so it's irrelevant. But if you're not, and operating say an IFR EC135, AS355F1, A109A/C, for example, that extra 30 mins of fuel can be a more valuable safety net. Furthermore it's going to allow you to go further, be at the scene longer, and have a greater choice of alternates if you have to go IMC. If the terrain is more demanding and weather bad, co-pilot benefit increases, agree.

And then in the real world there is the extra cost of a co-pilot to consider. Safety comes at a price, and that price has a limit, but that is another whole new subject!

SASless

17th Jan 2005, 20:00

Once had a Chief Pilot for one of the major EMS operators that prided itself on its four year college degree requirment and all IFR program sales pitch, tell me that he would rather have an autopilot than a co-pilot any time.

I did not understand that logic nor agree with his thinking. Seemed odd...I have a degree so should be able to understand his logic but it did escape me.

Does the addition of another set of eyes....a random thinking brain....and a butt at risk that can sense mortality, beat a blind, deaf, mute electronic robot that has preset thought processes and absolutely no fear of death?:(

The Rotordog

17th Jan 2005, 21:37

SASless asketh:Does the addition of another set of eyes....a random thinking brain....and a butt at risk that can sense mortality, beat a blind, deaf, mute electronic robot that has preset thought processes and absolutely no fear of death?Well...you *know* someone had to chime in with the smartass answer <sigh>...it might as well be me. And that answer is:

...Ask the two pilots who crashed the S-76 on that foggy night in Kentucky awhile back. Oh wait, you can't. They both died.

Does a copilot trump an autopilot? Perhaps. But not always. And it sure would be nice to be able to punch up heading-hold and dial in an altitude (preferably something higher) and be able to look at a map or puke out the vertigo or hear the dreaded answer-back of "No, YOU got the controls."

Your former C.P. obviously felt more confident with the auto-George. You'd prefer a live human one. What's that silly expression the brits are always using..."horses for courses" or something like that? Maybe we should have both?

SASless

17th Jan 2005, 21:46

Dog,

Did you ever read the CVR transcript of that crash? If you did...ask yourself the question...what would I have done as the non-flying pilot in that case?

I formed a very hard opinion of what went wrong there.....at some point....one guy has to be flying the machine...either poles in hands or mashing buttons and twiddling knobs.

Especially, when you see things are not right.....

My vote is two mortals and one robot....technology is great stuff....and two heads ought to be better than one.

Steve76

17th Jan 2005, 22:22

Guys,

The big question of Auto VS "George", is what does G bring to the problem.
Personally, I will take Auto over G anytime as it suits my personality and I know that I can really on Auto to hold a heading and track an ILS accurately.

I think if your two pilots are very experienced and comfortable in the IFR game then you have a great combo. Should one be a 500hr joyride pilot with a fresh IFR; then he is almost useless. Give him more time and he comes good but at the start it is single pilot without an autopilot and a bucket full of stress.

How to get experience then? Take guys from the Oil industry into EMS ops. Almost everything is two pilot and guys will learn from someone definately more experienced.

The other situation in IFR and NVFR op's is to have a great situational awareness of the aircrafts position and what is going on around you as well. Being able to "step" outside the situation and transition to fundamentals at times of distress is critical. To be able to look down at the HSI and immediately know exactly where you are and what the highest obstacles are around you and where the safe exits are, is critical.

Always have a backdoor or a plan to find one.

Like SAS I have been caught by fog. Not at all fun and it is my worst fear in NVFR work. TS, +RA and Hail can be dealt with. When you are looking for the ground that isn't there, then that is terrifying.
How to get out....:) That is a story for another thread.

It is a real shame that so many accidents occur in the US. It is a function of having the most helicopters in the world, but they are the newest and best equipped.
The US weather radar system is superb and when was the last time you guys did an NDB?

SASless

18th Jan 2005, 01:46

Life goes on....get another couple of helicopters....hire another couple of pilots.

Rescuers continued to search Tuesday for the last victim of a helicopter crash which killed at least one person when it went down in the Potomac River late Monday night south of Washington, D.C.

It was the second crash in less than a week for LifeNet/Air Methods Corp. of Englewood, Colo., which owns and operates medical choppers to transport patients, said Ellen Engleman Conners,
chairwoman of the National Transportation Safety Board, which is investigating the crash. Another LifeNet helicopter crashed Jan. 5 in Faulkner, Miss., after apparently hitting some trees, she said.

That pilot was killed. Conners said this is the 11th crash of a medical flight in the past year, and 34 people have died.

"There is a significant spike (in these accidents) over this past year, and it is a significant concern," Conners said. "These
flights try to save lives; when you have a double risk, it's a concern."

For all you EMS pilots out there.....here is a really good analysis of EMS accident rates by Susan Baker of John Hopkins Center...titled "Angels of Mercy or Angels of Death". I strongly reccommend viewing her presentation....very well done.

The link is www.dsls.usra.edu/20041026.pdf

Some startling numbers....

82% of fatal EMS crashes occur at night...

38% of EMS flights are at night....

50% of EMS crashes at night are fatal crashes...

34% of EMS fatal crashes are after dropping off the patient...and heading home

1 public use EMS aircraft crashed compared to 45 commercial aircraft (commercial pressure here you think?)

Gomer Pylot

18th Jan 2005, 02:48

1 public use EMS aircraft crashed compared to 45 commercial aircraft (commercial pressure here you think?)
Maybe, but it's hard to tell without more data. Perhaps it's more of a reflection of the relative numbers of aircraft involved. There are far more commercial operations than there are public use.

Shawn Coyle

19th Jan 2005, 08:59

As a very newbie EMS pilot (passed the checkride today), and one who is going to be operating in a very dark area (at least at night), it is obvious that some things would be very useful - NVGs being one of them. We're scheduled for next year...

But what about some of the enhanced vision stuff we're seeing on business jets? Why not see if some of that can't be included at a reasonable cost?

Next would be WAAS enabled GPS with a good terrain database and obstacle database. Surely someone can come up with something that's reasonble in this area, specfically for helicopters. After all, they operate in a relative small area and the extra memory for the detailed information we need should fit (if they can do the whole country for a bizjet, Southern California should be a breeze..)
And more weather stations please!

SASless

19th Jan 2005, 12:01

Shawn,

Erlanger in Chattanooga has fitted a fixed tube synthetic night vision system and has terrain warning kit as well. You might check with them and see how they get along with what they have.

What type aircraft are you herding around in the desert there doing EMS?

Buitenzorg

21st Jan 2005, 00:25

Reading this thread made me think… and count… and then get one of these sick feelings that are sometimes referred to as an epiphany.

I’ve been in the helicopter industry less than ten years, never flew EMS myself.

Of the dozens of pilots I’ve worked with (between 50 and 100) I can only recall 6 who worked EMS for at least some time.

Of those six, two (33%) were killed in night CFIT accidents while on EMS flights. One in bad weather (fog), the other on a clear but dark night over featureless terrain.

Of the other four, two told me stories of losing (and regaining) control of their basic night VFR equipped aircraft on dark nights over uninhabited terrain that made me want to puke.

The other two only flew IFR and autopilot equipped multis.

SASless

21st Jan 2005, 01:06

Too true....and the FAA and NTSB want to form a partership with operators, NEMPSA, et al....to form a stuy panel to figure out ways to mitigate the death toll?

Yeah Right!

The same partnership that got where we are today.....making like Wildebeests at migration time....keep running and don't look back!

Never had a scare in the daylight doing EMS....but night time provided plenty....and I have danglers the size of BB's!

I love the advertisements for pilots...body weight equipped for flight not to exceed 215 pounds.....underpowered aircraft or CG problems here?

Sierra Vista ...206/407 pilot needed....ever been to Sierra Vista? Dark does not describe it adequately.

Seen West Texas when the fog rolls in.....

Been to West Virginia or around the Applachin Mountains when you fly cross grain over the valleys...DARK!

The Southeast...with the summer haze at night...over the forested areas....waiting for the fog to form?

Night VFR in marginal weather in a basic 206/407/350....with your annual checkride that might include one approach under the hood...and usually a surveillence radar approach at that. Pass the annual checkride and you are still good to go eleven months later.

Gee.....what could we do to improve things?

SASless

22nd Jan 2005, 03:34

NTSB Accident Report on the Washington, DC EMS Crash

NTSB Identification: NYC05MA039
14 CFR Part 91: General Aviation
Accident occurred Monday, January 10, 2005 in Oxon Hill, MD
Aircraft: Eurocopter Deutschland EC 135 P2, registration: N136LN
Injuries: 2 Fatal, 1 Serious.

This is preliminary information, subject to change, and may contain errors. Any errors in this report will be corrected when the final report has been completed.

On January 10, 2005, at 2311 eastern standard time, N136LN, a Eurocopter EC135 P2, operated by Air Methods Corporation, d.b.a. LifeNet, was destroyed during an impact with the Potomac River near Oxon Hill, Maryland. The certificated commercial pilot and flight medic were fatally injured, and the flight nurse received serious injuries. Visual meteorological conditions prevailed, and a company flight plan had been filed for the flight. The flight originated at Washington Hospital Center (DC08), Washington, D.C., at 2304, and was destined for the Stafford Regional Airport (RMN), Stafford, Virginia. The air ambulance positioning flight was conducted under 14 CFR Part 91.

The operator of the helicopter reported that the helicopter crew picked up a patient at the Frederick Hospital, Fredrick, Maryland, and transported the patient to Washington Hospital Center, arriving at 2219.

According to flight-following Global Positioning System (GPS) data recorded by the operator, the helicopter lifted from Washington Hospital Center at 2304, and proceeded southeast and then southwest, along a route consistent with Route 1, on a National Oceanic and Atmospheric Administration (NOAA), Washington, D.C. Helicopter Route Chart. The helicopter turned to a southerly heading in the vicinity of Washington National Airport, and continued along a route consistent with Route 4, on the Washington, D.C. Helicopter Route Chart, towards the Woodrow Wilson Bridge.

A review of the NOAA Chart revealed that it depicted a maximum altitude restriction of 200 feet north of the Woodrow Wilson Bridge, and a maximum altitude restriction of 300 feet, south of the Woodrow Wilson Bridge.

Preliminary radar data provided by the Federal Aviation Administration (FAA) revealed the helicopter flew southbound (180-degree flightpath) along the Potomac River, at an altitude of 200 feet. At 2311, the helicopter was observed just south of the Woodrow Wilson Bridge, maintaining its southbound heading and 200-foot altitude. Four seconds later, the helicopter was observed on an approximate 190-degree heading, and an altitude of 100 feet. The next and last recorded radar hit, was 5 seconds later, on an approximate 200-degree heading, at an altitude of zero feet.

A Safety Board investigator interviewed the flight nurse in the hospital. According to the flight nurse, he was seated in the left front (copilot) seat, the pilot was in the right front (pilot) seat, and the flight medic was seated immediately behind the flight nurse, in the left-side, aft-facing seat.

As the helicopter approached the Woodrow Wilson Bridge from the north, it passed abeam Washington National Airport at a "lower than normal altitude," but climbed 200 to 300 feet before reaching the Wilson Bridge. About 1 mile prior to the bridge, the helicopter appeared to be at the same, or higher altitude, than the marking lights on the cranes, which were positioned near the bridge. The flight nurse "called the lights," on both sides of the river, and the pilot acknowledged him.

As the helicopter climbed, the flight nurse noticed an airplane descending towards Washington National Airport, and wondered if there would be a conflict, or a wake turbulence hazard. Additionally, he stated he was not sure what the relationship was between the helicopter and the airplane, as the airplane passed overhead.

The flight continued along the river close to the Maryland shoreline; however, as the helicopter approached the bridge, the pilot maneuvered the helicopter to cross over the mid-span of the inner loop (westbound) bridge.

The flight nurse remembered being over the outer loop (eastbound) span of the bridge, and then being submerged in the water with his seatbelt on, and his helmet off. He stated, "I don't remember striking something, but my initial reaction was that we must have hit something."

The flight nurse also stated that at no time did the Master Caution lights, or the panel segment lights illuminate. He also did not hear any audio alarms sound. The helicopter was neither high nor low, but "on altitude," relative to other flights which he had been on in the past.

The pilot did not perform any evasive maneuvers, and did not communicate any difficulties either verbally or nonverbally in the vicinity of the bridge. The flight nurse did recall observing a large white bird fly up from the lower left towards the helicopter, but made no mention of striking it. When asked what he thought might have caused the accident to occur, the flight nurse stated, "We must have hit an unlit crane."

The helicopter came to rest in the Potomac River about 0.5 miles south of the Woodrow Wilson Bridge.

The pilot held a commercial pilot certificate with ratings for airplane single and multiengine land, rotorcraft-helicopter, and instrument helicopter. His most recent second-class FAA medical certificate was issued on May 28, 2004.

According to records maintained by the operator, the pilot was hired in June 2004, at which time he reported 2,750 hours of total flight experience, 2,450 of which were in helicopters.

Examination of maintenance records revealed that the helicopter was being maintained in accordance with an FAA Approved Aircraft Inspection Program (AAIP). The last AAIP 50-hour inspection was performed on the helicopter on December 17, 2004. The last 100-hour inspection was performed on November 23, 2004, at an aircraft time of 94.5 total flight hours. The maintenance log indicated that the radar altimeter was inoperative and included a listing of the malfunction in the Approved Minimum Equipment List (MEL) record. As of January 10, 2005, the helicopter had accumulated 166.6 total flight hours.

Weather reported at Washington National Airport, at 2251, included calm winds, 10 miles visibility, broken clouds at 13,000 feet, broken clouds at 20,000 feet, temperature 45 degrees Fahrenheit, dew point 35 degrees Fahrenheit, and altimeter setting 30.25 inches of Hg.

The helicopter was recovered from approximately 5 feet of water in the Potomac River. Debris from the helicopter was recovered along a wreckage path oriented on a southbound heading, consistent with the helicopter's flight path prior to the Wilson Bridge.

The main fuselage section was separated into the lower cockpit area and upper cockpit area. The lower cockpit area contained the flightcrew floorboard section, anti-torque pedals, forward skid frame, and fragments of the ruptured fuel tank. The upper cockpit area contained the flight control tubes, the center electrical and flight control structure (broom closet), the upper flight control deck, the main rotor gearbox, rotor head, and engines.

The mechanical flight control system was assisted by hydraulic actuators and an automatic flight control system (AFCS). The system was controlled by two dual controllable pilot cyclics and collectives. For the EMS mission, the co-pilot controls had been removed. The anti-torque pedals were routed to the tail rotor servo via a Teleflex cable. The cyclic and collective controls were routed through mechanical linkages to an upper deck dual hydraulic servo control system, which controlled lateral, longitudinal, and collective control.

The cyclic, collective, and yaw controls were examined for evidence of malfunctions or pre-impact failures. Continuity could not be established due to breaks in the system and missing portions of the push-pull tubes; however, the breaks were matched and examined for evidence of pre-impact malfunction or failure. Examination of the breaks revealed no pre-impact mechanical malfunctions, and the fractures were consistent with overload fractures and water impact.

The main rotor mast was in place and intact in the main transmission. All four main rotor blades remained attached to their respective mounting areas, which bolted directly to the mast. Three out of four of the pitch change links were integral to their two attach points, the fourth (red) pitch change link was fractured in the middle. The fracture was consistent with compression bending overload.

The root ends of all four main rotor blades remained attached to the main rotor hub. Portions of all four main rotor blade tips were accounted for, and matched to their respective blades. All four main rotor blades contained overload fractures between 6-12 inches from the blade hub, and chordwise scoring on the lower blade skin in the same area. The main rotor blades contained fractures along the span of the blade, consistent with impact damage. No indications of an object or bird strike were noted along the blades.

The main gearbox remained attached to the center section of the upper airframe structure. All four mounting points were intact. The main transmission turned freely, no chips were found on the detectors, and the transmission appeared intact and functional.

Both engines remained attached to the upper fuselage section. Both engines sustained relatively minor damage, and their N1 and N2 sections rotated freely.

The main fuselage was separated from the tail boom section at the aft fuselage frame. The tail section included the tail gearbox, the tail rotor assembly and the complete fenestron assembly.

The tail rotor driveshaft was shifted about 1.5 inches forward. The aft portion of the driveshaft (carbon composite) was found fractured and torsionally cracked and deformed. The tail rotor blades remained complete and attached to the fenestron structure. A rotational scrape was noted on the fenestron shroud structure at the 5 o'clock position corresponding with the blade width.

Several of the helicopter components were retained for further examination.

Safety Board investigators examined sites along the Potomac River that matched the coordinates recorded by ATC radar data and the operator's flight-following GPS. The projected track along these locations toward the accident site was about 300 feet from the nearest crane, and no additional obstructions were observed along the track.

Five of the closest cranes along the Potomac River, near the Wilson Bridge construction project (Maryland side) were examined, and no structural damage or aircraft strike indications were observed.

A Maryland Department of Transportation traffic surveillance video was secured and sent to the Safety Board's Video Laboratory for examination. Preliminary examination revealed an aircraft flying, and then descending, over the bridge about the time of the accident. According to the video, the aircraft passed above and beyond the cranes prior to beginning its descent.

Examination of additional ATC radar data revealed that a 70-passenger Canadair Regional Jet 700 (CRJ-7), passed over the Woodrow Wilson Bridge about 1 minute and 45 seconds before the accident helicopter passed over the bridge. The radar data indicated that the helicopter passed 900 feet directly beneath the flight path of the CRJ-7, while heading in the opposite direction.

Begins to raise the question of whether wake turbulence might have played a part in this crash.....cannot wait to hear the final report.

:(

[email protected]

22nd Jan 2005, 05:55

You certainly could be right Sasless, wake vortices persist for a long time in calm, stable conditions and there seems to be little evidence for any other cause - poor sods.

rotorspeed

22nd Jan 2005, 08:24

This one has looked a bit of a mystery, with nothing at all been found to support the expectation that it hit an obstacle/crane at very low level at night.

I too saw the report on the NTSB site, and agree that wake turbulence perhaps looks the least unlikely at this point, as the investigation progresses.

Having said that, although winds were calm, 900ft below an RJ, which is not exactly huge, 1 min 45 sec after it, which I guess would approximate to say 5 miles spacing, doesn't seem too concerning I wouldn't have thought. Any other views on this?

Of course the other thing is that if that does end up being the most likely cause, the fact that it was a night EMS accident is irrelevant. Could have happened to anyone permitted on the route. More potential for statistics to mislead.

SASless

22nd Jan 2005, 12:18

Rotorspeed,

It could have happened to any helicopter that was there at the time (assuming it was Wake Turbulence...or any other cause in reality) but it was not any other kind of flight.

It was an EMS flight, it was an EMS helicopter, It was an EMS crew, It was assigned to an EMS operation, and it was operated by an EMS operator, and had just dropped off a patient at the hosptial and was heading home to its base with the EMS crew onboard.

Just why is this not an accident attributable to "EMS"?

Yesterday, I read a post by some wizard that said this year's EMS accident rate is actually lower than last years. That is an interesting observation....This year alone...and if we take the first two weeks rate as a base...we are looking at a total of about 48 fatal crashes for this year. Last years rate was more like one per month average.

We cannot use two weeks to judge the rate for the year.

We cannot judge this year to last so early in the year.

And for my two cents worth....we cannot accept a fatal crash per month as being "acceptable losses".

I am a realist....we will never have a "zero" rate of EMS crashes....but we can set a goal that tries to acheive that can we not.

rotorspeed

22nd Jan 2005, 12:51

SASless

I fear you are getting too agitated here in your understandable and valid zeal to see the EMS safety record improve. I have made no comment on this year's rate or what might be acceptable losses.

What I have said is that if this 135 accident turns out to be wake turbulence, the fact that the type of operation was EMS will probably not have been a contributary factor. Yes it was EMS, I know that perfectly well. But the accident could equally well have occurred to any corporate or private helo assuming they were entitled to use that route. This is quite unlike the extra risk of EMS operations landing at unimproved sites at night, for example, which is part of the territory for EMS ops. An accident involving that phase of flight, which many seem to be, clearly is related to the extra risk of EMS ops.

Understand my point now? It is important to try and differentiate which accidents occurring to EMS flights occur because of the specific type of operation, rather than despite it. And in my book, wake turbulence would be despite.

SASless

22nd Jan 2005, 13:16

Agitated....no.....did you say anything about this year's rate...no. Are you correct it could have happened to any aircraft that was there....yes. Was "EMS" a contributing factor to the accident...in my view ....yes. The reasons I say that is as stated in my previous post. I agree there was nothing special about the phase of flight but we do have to remember the front seat is reversed and faces aft instead of the normal configuration. That is also EMS specific here....could that have been a contributing factor? Maybe...maybe not.

If it were a corporate aircraft and crashed for exactly the same reason (whatever it turns out to be) under exactly the same circumstances.....it would still show up under the corporate helicopter crash column....and that is my point. If that same aircraft had just dropped off an executive at National Airport and then headed back to the office...and crashed.....we would clearly call it a corporate accident would we not?

No matter the actual cause...no matter how you slice it. This crash lands firmly and squarely in the EMS catagory. We have to chalk this one up to the EMS industry whether EMS operators want to or not.

How are we being mislead if we chalk this one up to the EMS industry?

rotorspeed

22nd Jan 2005, 13:48

SASless

Have to say you've got me on this one. Just explain how the reversal of the front seat might have contributed to the effects of the wake turbulence we were talking about? Conversely, I can however see that it might have contributed to the fact that he survived the impact. Just clarify how the EMS type of operation might have contributed to a WT cause?

How are we being mislead if we chalk this one up to the EMS industry? Because it is the accidents that get chalked up to the EMS industry that will drive the extent, impact and cost of any changes to EMS operations. Inevitably emotion will overlay objectivity and simple statistics will be used to justify the changes. The more specific and relevant those statistics are, the more appropriate any changes will be.

This applies to any area of helo ops, whether private, corporate, offshore or EMS. There is a fine commercial line that needs to be - and is - trod not to burden any type of operation with more cost and legislation than optimal. The more the accident statistics are relevant to the added risks of a given type of operation the more optimal the conclusions should be.

Presuming (and it may well not turn out to be) this is wake turbulence, this is not an EMS accident; it's a helo accident that just happened to occur to an EMS acft. But of course the stats will say EMS.

SASless, you may well know the following data. What % of total helo hours flown in the US are for EMS? What % of landings are EMS? What % of accidents are EMS? Be interested to see that and any other relevant data you have/can find!

SASless

22nd Jan 2005, 14:36

What catagory do you chalk this accident up to? Which sector of the industry?

I did not say the seat reversal had any thing to do with the accident...read my post. The seat reversal is just another EMS connection is all.

If we assume it was a part 91 operation due to the fact no patient was aboard....and having therefore to assume the nurse and paramedic were employees of Air Methods, Inc......and the aircraft was owned and operated by Air Methods, Inc.....and Air Methods,Inc. is one of the nation's largest EMS operators....

If the nurse and paramedic were not employees of Air Methods...the flight was Part 135 and was conducted under the Air Methods 135 Certificate and OPSPECS.....and the accident would fall under their insurance policy....which covers EMS operations.

My view is simply this....this crash is just another part of an EMS operational flight. One cannot seperate this crash from the EMS accident statistics no matter how you want to. This is just another unfortunate event that befell a crew out doing their jobs.

It has to be counted right along with all the other ways EMS crews get killed. That is what drives the insurance costs and flight rates being charged. It should also have some effect upon wages and other compensation for the crews. It should also have some effect upon FAA surviellence of EMS operations....and scrutiny by insurance carriers.

Right now the only folks that stand to lose by improving the accident rate are the insurance companies and morticians.

I

rotorspeed

22nd Jan 2005, 15:27

SASless

You'd better read your own posts a bit more accurately! You first said:

"we do have to remember the front seat is reversed and faces aft instead of the normal configuration. That is also EMS specific here....could that have been a contributing factor? Maybe."

But you now say:

"I did not say the seat reversal had any thing to do with the accident"

Sounds rather contradictory to me. And you also said:

"Was "EMS" a contributing factor to the accident...in my view ....yes"

But you still haven't answered my question as to how it might have been, given a wake turbulence cause?

SASless

22nd Jan 2005, 15:33

Some more stats taken from the link I posted earlier in this thread....

The EMS accident rate was lowest in 1996 and has climbed since...without a decrease in the trend and shows a marked spike in last year and this years numbers.

There are approximately 130,000 patients moved each year....16 are killed in crashes on average each year.

Death rates by occupation:
All US workers 5 per 100,000
Farmers 26 per 100,000
Miners 27 per 100,000
EMS Crew 74 per 100,000

Non-EMS Helicopters 18% are fatal crashes
EMS Helicopters 37% are fatal crashes
Non-EMS helicopter crashes....12 per 100,000 flight hours
EMS helicopter crashes............19 per 100,000 flight hours

38% of EMS flights are night flights.
82% of fatal EMS crashes occur at night
50% of EMS night crashes are fatal crashes.

Weather plays a role in 76% of fatal EMS crashes

GLSNightPilot

22nd Jan 2005, 20:20

I've been flying at night for some time, and from what I've seen the Washington D.C. accident isn't that hard to figure out. After flying over a presumably well-lit bridge, over a presumably dark river, the pilot could well have just flown into the water. I've been flying offshore, and after flying by a well-lit rig, setting up for a return, at 500 feet, looked up and we were at 200 feet in a descent at >800 ft/min, diving at the water. The other pilot was trying to fly visually, and just lost orientation. If I hadn't taken the controls, the helicopter would have impacted the water at cruise speed in a few more seconds.

Flying VFR-equipped helicopters, using VFR pilots, at night, will always result in accidents. It's simply stupid to do it, but companies are greedy, and the insurance companies can deal with the expense. Of course this gets passed on, but it's spread out, so companies just keep on keeping on. IMO the only way the current levels of deaths will decrease is if the insurance companies stop insuring night VFR flights. The FAA isn't going to do anything about it, that's certain.

SASless

22nd Feb 2005, 17:13

Patient was killed.

DATE
February 21, 2005 13:39 CST

PROGRAM
Air Evac Lifeteam

VENDOR
Own Part 135

ADDRESS
P.O. Box 768
West Plains, MO 65775

WEATHER
Clear. Not a factor

AIRCRAFT_TYPE
BH 206L

TAIL#
N107AE

TEAM
Pilot, Flight Nurse, Flight Paramedic. Fatal injuries. Patient on
board.

DESCRIPTION
The aircraft had just taken off from the scene of an MVA with severely
traumatized patient, south of Maysville, Ark., with a patient on board
and landed hard in a field.

Phoenix Rising

22nd Feb 2005, 18:46

And unfortunately SASLess it wont be the last :(

PR

rotorspeed

23rd Feb 2005, 07:34

Considering no reported injuries from the other 3 healthy people on board, be interesting to know just how close to death the "severely traumatised" patient was anyway, and how much/little of an impact it took to be a fatal. Dare say we'll hear soon.

SASless

23rd Feb 2005, 12:26

Rotorspeed,

Patients die enroute (never admitted to anyway.....due to legal issues with place of death and legal jurisdicitional issues) but no matter how you slice it....the patient was alive when loaded and dead when unloaded at the scene. Ergo....a fatal accident.

When we take people aboard our aircraft as passengers they expect to make it to their destination. If for some reason, we crash a helicopter and they die.....that is a lick on us and goes under the EMS Helicopter Fatal Crash column in the statistical data base.

:(

rotorspeed

24th Feb 2005, 08:09

SASless

No doubt you're right, though this will make some, albeit small, contribution to the EMS fatal stats looking worse than other industries. Probably like road ambulances.

Any news on what accident was/cause etc?

Helipolarbear

24th Feb 2005, 18:36

Hey SASless....great arguement for the pro's and con's of multi-engine CAT A ' Performance One power and crew requirements as indicated in the JAR's. FAA could possibly regulate a little more stringently, and mandate basic Heli Ops requirements similar to the European and others when it comes to Air Ambulance or HEMS.........consider the makeup and profile of the cargo carried....entitled to the best levels of care.......which includes twin engined helicopters with two crew!!:ok: :cool:

SASless

24th Feb 2005, 19:50

I have flown BO-105's, BK-117's, and the Bell 412 on EMS work....you will never....you shall never (imperative tense) catch me in a JetRanger or 350 at night doing EMS work....ever. Promise....take your money to the bank on it. I did not like doing night work in an un-Sas'ed (non-Stab) BK-117 either.

The free enterprise system can be a bit too expensive in lives.

The second engine is no bar from power related accidents but if we operated with CAT A performance (which is a problem if you are doing scene work) at least enroute/cruise engine failures become fairly benign events.

The crux of what EMS operatons should be doing is "to do what is best for the patient" and not money driven alone. So many times, the patient is in a medical facility and stablized....thus delays of a few hours doesn't jeopardize the patients well being and oft times a delay till daylight or better weather would be the best course.

To throw Grandma into a JetRanger or 350 at night or bad weather (or both....worse case scenario) in such a situation borders upon criminal negligence in my view. I would love to be an attorney and specialize in suing EMS operators. It would be a lucrative business nowadays.

To make all the night operations two pilot IFR and Twin IFR machines is expensive but in my view the right thing to do at night outside the built up urban areas. I would accept single pilot IFR equipped twins at night over well light and defined urban areas.

All one man's opinion here....and I am sure there are lots of guys that would argue with my position.

tecpilot

25th Feb 2005, 05:16

Hi Sassie, unbelievable! How could it be that we have the same opinions... :ok:

rotorboy

25th Feb 2005, 05:48

Sasless
OK, you wont get in a 350 or a 206l/407 at night and fly ems , but you'll get in a 30 year old surplus restricted H model huey and snatch logs off the hill for 8 hours a day!..... ;) I am confused

Ps. headed to beautiful Beaumont TX Tuesday for the new gig we discussed the other day... I must return to practiing me espanol.

RB:ok:

SASless

25th Feb 2005, 10:33

rotorboy....

You will not see me snatching logs in a 30 year old Huey either....ever!

I will admit to taking the 30 year old Huey and a 150 foot longline and going way up in the mountains in summer to fling water at a raging forest fire. I never said I was a scaredycat.....just never thought myself completely stupid.:E

Devil 49

25th Feb 2005, 14:10

Some thoughts, tangentally related to the unfortunate event that originated this thread-
Engine failures aren't necessarily killers; howve, pilot failure is routinely fatal. The number of engines doesn't change the accident rate.
Years ago I saw some numbers from the US Army regarding "Class A" accidents. 90% of engine failures, at night and/ or IMC were successful.
IF, and that's big "if," this event was a power failure, it seems it was hardly in the worst circumstance for it- the surrounding area looked large, clear and flat. I'm not speculating on cause by any means- engine failures are never like the chop in training....
But, there's a problem in the industry. We train new EMS pilots to do vertical ascents, and seldom teach how to survive a power failure in that regime. It can be done, in a 206 at least. The images I've seen don't seem to show evidence of that technique having been applied.

The 206 is as safe as any aircraft in non-sched service- twin, single, fixed or rotary. It has one significant vulnerability- LTE. Some eyewitnesses relate descriptions that could be LTE.

I'm going to play my harp a bit more on the pilot failure theme- This helo was newly refurbished and placed into service. The pilot had something like a month in the employ of AEL. Compared to the average experience level at my program, this pilot was a relatively low-time.

Anecdotally, it seems there are points unusually common in proportion, in the last year or so of US EMS accidents:
"Unaided" night flight;
New type, or recently refurbed aircraft;
Relatively inexperienced pilots;
Challenging situations, well out of the norm for run of the mill helicopter pilot training.

Yes, I know- old timers have crashed with years of experience in that very aircraft and LZ- But we are the majority of the fleet, in my observation. Pilot failure kills across all demographics.

SASless

25th Feb 2005, 14:48

Devil 49,

I agree with your statements. We usually do agree on these matters. My point is not that "engines" in any multiple are the cure-all. It would follow I think, that any operator (think combination here of hospital/vendor/insurance company/FAA/government agency) of a 24/7 EMS helicopter would strive to achieve the safest method of operation possible.

That would include sophisticated IFR equipped multi-engine aircraft, well trained IFR current and proficient crews, two pilot crews, medical crews trained in all aspects of the aviation task, a firm set of minimum standards, a very healthy safety culture that demands complete teamwork and encourages bonding of the aviation and medical teams into one cohesive and close knit group. Installation of additional equipment like Night suns, scene lights, IR filters for the nightsun, NVG's.....all would be standard equipment. Ground units would be trained in preparing LZ's....pre-planned LZ's would be set up all over the operating area and surveyed for changes over time.

All that sounds good....but we know the truth.

Training is only to minimum standards required. Those standards are not very demanding in reality. Shortage of Money and manpower resources prevent most of the other sought after improvements.

I question the data from the Army study, did night also include NVG flight where you can see something....that makes a heck of a change in safety? All these safe engine failures, etc at night...in single engine aircraft in the cruise or setting at a hover unmasking over a cleared area...again using NVG's?

The Army kills pilots and writes off Aircraft with great regularity as well....recall the crash in South Carolina along the interstate....killed three people in a BlackHawk. They recently lost one at Fort Hood, killing eleven troops.

The whole trend upwards in safety when one transitions from a single engine 206 or 350 to a twin engined IFR machine is undisputeable. But, as you clearly point out.....the vast number of fatal accidents are caused by the Human being and not the machine. We can never teach judgement....until we do....we will continue to have those kinds of accidents and deaths.

The key to drastically reducing the fatal crash rate is to improve the control measures to prevent bad judgement decisions. For example, a Risk Matrix system if used would help the pilot find a reason to say NO and have a defensible reason. Operators being held accountable in court for their actions (both civil and criminal...as well as certificate action by the FAA) for violations of the FAR's and other laws would go a long way towards reducing the pressure on pilots to fly in questionable weather.

We have to operate at a profit or the operations will fail for financial reasons....but the marginal operators that are only surviving by pushing the pilots would find themselves in other work.

It basically all comes down to the individual pilot....the old addage I learned in a different field of work...but so true here.

"Tea too hot to hold...Tea too hot to drink!" Know when to say NO and then stick to your guns....no waffling or going out to do a weather check. Weather checks are done in front of a computer or by telephone, not in the air. We are too fallible for that method.

One man's opinion here.

Mars

25th Feb 2005, 16:00

SASSless/Devil 49:

I have resisted entering this debate up to now because it appears to have uniquely American flavour but we do have to question the statement that “engine failures are not killers” and the number of engines “do not change the accident rate”. Whether a fatal accident results from a power failure in a single engine helicopter is a matter of: conditions of light and surface; the flight envelope in which the failure occurs; and the skill and training of the pilot (and the potential for survival should this occur over inhospitable terrain).

If an engine failure occurs in a twin it is unlikely to lead to an accident - unless it occurs in a regime where ‘exposure’ is being taken; in which case it should have been the result of a risk assessment (by the pilot - sometimes known as aeronautical decision making). Putting aside the issue of the probability of an engine failure; wouldn’t we all rather be in a twin if an engine failure occurs - under almost any circumstances?

One point it is difficult to find quarrel with is the cultural change that occurs when twin engine IFR operations are being conducted. The skill set that is required to deal with emergencies is more related to management of situations and less to handling - that is not to say that handling is less important but can be more considered. My experience is also that pilots flying twins are more likely to fly in accordance with the regulations - I’m not sure why that is.

If as Devil 49 implies, the spate of accidents appears to be due to a reduction of the experience levels, and if that reduction of experience is likely to continue, it might be appropriate to think about a minimum level of experience for HEMS or the raising of the operational limits as well as improved training and checking - really a must.

There is also a duty of care argument, not just for HEMS but for all operations where an engine failure has the potential for death or injury; when contracting for a flight in a single engine helicopter (especially at night or over inhospitable terrain such as the sea) how many passengers are made aware of the increase in the potential for an accident - with its concomitant risk of death or injury?

Devil 49

25th Feb 2005, 16:50

SASless, I saw the US Army numbers I mentioned so long ago (1983) that I doubt that the current tactical philosophy is pertinent- or goggles- for that matter. What stuck in my mind is how safe helicopter operations can be, with a well trained crew in a real safety culture.

The 206 safety record reflects that as well, it is- or was- the machine of choice for fleet 135 operators that wanted to make money. Hence a very high share of hours flown were by professionals, often with a real safety culture, and sometimes- world class training. Some of the instructors I had the privilege of flying with at PHI were among the best I ever saw, anywhere, since 1968. And, at that time they swung a big stick at the company, safety, equipment and "rules and procedures"-wise. I'm painting with a very broad brush here, but many 135 training departments are almost invisible in their respctive companies, no matter the quality of staff- they don't influence much beyond the government required paperwork. My impresion is they're expected to generate that paper at minimal cost and be good and be quiet the rest of the time. The connection and influence that the training department had at the corporate level made PHI one of the safest operators in the world- when it worked well. When they were pushed down the influence ladder, it was less successful.

Any connection between more sophisticated equipment and safety is the product of reverse selection of data. Pilots selected for upgrades to IFR and multis, are generally more senior and thus have a higher experience level, are generally more skilled, and more dedicated and knowledgeable professionals. My experience is that the weak among that group are soon known by their reputation, and weeded out after selection, by their peers.

No thank you(emphatically!), to the European solution. I shudder when I read the threads discussing aviation rules over there. Besides, and I don't have any data to support this opinon, but I've been told that there's no significant difference in accident rates between our system and theirs, generally speaking- perhaps EMS gets better support, I don't know.
Any connection to improved safety in Europe, or anywhere, is not regulations or equipment- it's the professional pilots, company support and respect for their professional pilots.

MARS, you make a couple very good points-
I would indeed rather be in a twin. Right now I'm more afraid of the dark and the stuff in it, than I am of engine failures. I'm more likely to survive an engine failure at night over the Smokies than I am an encounter with a dark tower, or wires. I do not go in questionable weather, so that's moot.
Also your level of care issue has always been a puzzle to me. If I go to the airport and buy a ticket for air transport, I am entitled to the highest level of care- what we call 121. But, if my broken and usually unconscious body is stuffed into a helo EMS, it's an "charter," and falls under 135????

SASless

25th Feb 2005, 17:04

Mars,

The point about educating your passenger and the "duty of care" issue is an interesting one. I suggest my idea of holding management and owners responsible as well as pilots and mechanics/engineers might go a long way of improving the situation.

Consider this concept in the Gulf of Mexico offshore oil businesss....No jigsaw down there....no effective SAR at all...particularly at night. The primary SAR response will be non-SAR capable commerical helicopters and surface vessels again primarily non SAR capable private vessels. The USCG is busy doing the Homeland Security bit and that has adversely impacted the SAR mission they are so famous for in the past.

Every single day....thousands of passengers are flying in the GOM without survival suits or any viable SAR helicopter service to assist in an emergency. If you go down at night.....you are in big, big trouble.

This is the mindset over here.....bottomline numbers first....everything else second.

Mars

25th Feb 2005, 18:25

Devil 49:

I think it is a part of the mindset that all helicopter operations are conducted under Part 135; this implies that they can be more exposed to risk. There is no question in my mind that helicopters should be operated under Part 135 I merely question whether that should mean a lower safety level - rather than a more flexible regulation. I'm not quite sure what "weeding out by their peers means" - but you are quite correct that there is a selection for twin engine command that is absent from 'single engine single pilot' operations. It is rather like the threads on training with the Robinson which reminds me of the Irish saying - if you want to go to there you shouldn't start from here.

SASSless:

The duty of care in the GOM should be more clearly focussed upon the Oil Industry as they have the means to alter the balance. You would be correct that flying at night in a single outside the survival time without some mitigating safety equipment should be frowned upon if that were the case - my understanding is that singles at night in the GOM is the exception rather than the rule (and, as oil company policy changes, becoming more so). We might also wish to bring to their attention that flying in adverse weather in singles also increases substantially the risk as some accidents in the last two years have shown.

tecpilot

25th Feb 2005, 20:56

Sadly to me to write here, that one of the last single engine EMS helicopters in Germany chrashed tonight. The pilot died in the wreckage. A/c was backtracking to the base without patient. The AS 350 was operated under the note to Appendix 1 to JAR-OPS 3.005(d) " The Authority is empowered to decide which operation is a HEMS operation in the sense of this Appendix." In this federal country it's possible to operate the last single engine helicopters in this business in Germany.
The local CAA approved day operations as interhospital flights.

Of course i've no further informations at the moment available. The a/c is totally destroyed, debris is found on an area more than 300m away. The weather was difficult 400-600ft cloudbase, snow, limited visibility. Other operators canceled missions in this area before the crash. Must be in the last twilight time or it was already dark.
:\ :\ :\

GLSNightPilot

26th Feb 2005, 05:02

I've been flying at night in the GOM for a few years now, and I have a few observations.

Deaths from exposure are non-existant. If you do go in the water, it's not that hard to survive if you have a life vest, and exposure suits are simply excess baggage. You don't die quickly from 80 degree water.

Night flights aren't all that common, but there are a significant number of single-engine flights at night compared to the overall number. There are a few operators flying single-engine at night over water.

Given the choice between single-engine or single-pilot ops, I'll take single-engine every time. A second pilot is far more important than a second engine. Engines don't quit that often, especially turbines, and if they do, a reasonably competent pilot can get the helicopter down safely enough to get everyone out. What kills people is flying into the water inverted, hitting obstacles on landing, flying into thunderstorms, etc. A second pilot is, IMO, far more important than a second engine, and should be required for night flight whether over water or over land. Night EMS single-pilot flights will continue to kill people, as long as they are permitted. Night flight single-pilot flight anywhere will kill people. If I flew single-pilot all the time, I wouldn't be writing this, I would be feeding the fishes. I don't care if you have one engine or three, if it's dark or IMC you need two pilots active in the cockpit, and night flight will eventually become IMC, guaranteed.

JimL

26th Feb 2005, 07:55

Tecpilot,The Authority is empowered to decide which operation is a HEMS operation in the sense of this Appendix.I've no wish to hijack this thread but I think that the intent of the quoted remark needs to be clarified.

The first published version of JAR-OPS 3 had definitions of HEMS and SAR inside the Appendix; as SAR is not regulated under JAR-OPS 3 and as the clause was being used to subvert the intent of the Appendix, it was removed and replaced with the referenced text.

However, in view of an apparent misunderstanding of the scope of HEMS in some States (including Germany) a comprehensive ACJ was written and put into Section 2 of the JAR; this ACJ explained in fine detail the distinction between air ambulance operations, HEMS operations and SAR - principally that air ambulance could be conducted to the main body of JAR-OPS 3 (without the requirement for a HEMS approval), HEMS was to be conducted to the main body as varied by the Appendix and that SAR was under control of the State (whatever their rules may be - somewhat similar to public aircraft in the US). Inter-hospital flights can in no way be regarded as SAR and therefore fall within the scope of JAR-OPS 3 and, depending on the urgency, might take advantage of the alleviation of HEMS (for performance or in-flight conditions).

Contrary to the common (mis)understanding, HEMS operations can be conducted by helicopters operating in Performance Class 3 (single engine operations) - as specified in Appendix 1 to JAR-OPS 3.005(d) paragraph (c)(1); providing they are conducted over a non-hostile environment. However, CAT/HEMS flight at night is prohibited for helicopters operating in PC3 in accordance with JAR-OPS 3.540(a)(6). States manoeuvre their way round this by permitting PC3 at night when there is no carriage of passengers (for example when repositioning) - providing it is permitted in accordance with non-CAT regulations.

Because we do not know the circumstances of the flight, we should not presume that it was conducted outside the regulation (although it does appear that the Lände have discretion to exempt from regulations). I suppose that we can assume that these HEMS operations in PC3 are conducted in the former Eastern part of Germany.

Jim

Mars

26th Feb 2005, 08:07

GLSNightPilot:

As always you present a logical argument but the likelihood of two pilot operations in a single engine helicopter is quite small and, because it would not be within the normal scope would likely suffer from CRM problems (which have been seen even in two crew helicopter operations).

However, I have to take issue with your contention that “deaths from exposure are non existent”; almost within the last two years (On February 16, 2003) there was a ditching in the GOM that resulted in the death of two of the occupants - which occured following a successful escape from the helicopter.

tecpilot

26th Feb 2005, 09:09

JimL

Germany is unfortunately still operating under the first version of JAR-OPS 3.
I've not affirmed the flight was outside the regulations and approvals.
In germany an operator needs an approval to do interhospital-flights independent from JAR-OPS, because it's a public operation, paid by public health insurancies and regulated by a public headquarter. Nearly all federal countries in germany have on this way limited the job to twins. But i don't also affirm the accident was caused by the single engine.

All i wrote is, that one of the last single EMS helicopters chrashed tonight. I'm shure the pilot wasn't aiming to a night flight. May be only one of the not abnormal delays in the EMS business.

SASless

26th Feb 2005, 11:20

Water temperature at the location of the last 407 crash was approximatley 65 degrees F. The closer to shore you get in the Gulf of Mexico, the colder the water gets during the winter.

We wore Mustang Floater Jackets in the summer in Alaska and I have worn the same jacket while flying over the North Sea in the summer.

I found this excerpt in a discussion about the US Coast Guard Policy for their own crewmembers.

The United States Search and Rescue Task Force published data, which shows survival time in 73º water to be almost indefinite, but in 37º water, it ranges betweenº, 30 – 90 minutes. With such a small window of time, why would anyone venture out into the ocean without proper emergency equipment and be thoroughly familiar with how to wear it?

Such equipment consists of cold water immersion protective clothing. As with all emergency and survival equipment, improper storage, handling and failure to use it correctly or in time, diminishes the chances of survival.

The Coast Guard currently requires the use of anti-exposure coveralls when the water temperature or air temperature pose health threats, should a member get wet. According to one manufacturer’s published research, by wearing the anti-exposure suit, the survival time increases approximately 60 minutes, but only if the suit is properly maintained and donned. Dry suits, which prevent water from touching your body, increase your survival even longer.
Preparation
Coast Guard regulations (in the First Coast Guard District, Southern Region) require all of their crew members to don anti-exposure suits when the water temperature is between 50º and 60º. Should the water temperature drop lower than 50º, then dry-suits are mandated. This means, even if the air temperature is 80º, and the water temperature is less than 60º, members must still wear an anti-exposure suit, except if the local station commander applies an exception. Other Coast Guard Districts have procedures that are similar.

Mars

26th Feb 2005, 14:07

Water temperature is not the only element that needs to be considered where survival is concerned - adequate clothing (whether or not survival suits are worn), survival suits and splash-hoods on the lifevest (or on the survival suit if it is integrated) also improve the chances of survival.

The 407 accident that led to the death of two of the occupants in February 2003 occured in seas of 5ft - 9ft and with winds of 25 - 40 mph. Existing guidance indicates that the survival time can be reduced by two thirds with winds above 25 mph. This would put the survival time at less than 30 minutes in sea temperatures of 13C.

Sea states with breaking waves can also reduce the survival time unless spray hoods are deployed (spray hoods, on lifevests or suvival suits, are mandatary for offshore flying in Europe).

You already know that there have been deaths due to exposure in the GOM. If the causal chain contains night flying, high seas, strong winds and single engine operations; one link that is preventing a hazardous event is the reliability of the engine (or any other cause of ditching). With the assumed engine reliability of 1:100,000 (if in fact that is achieved) and usage rates of 400,000 flying hours per year in the GOM, there is the potential for four fatal accidents a year due to engine failure (in addition to those which are not engine related).

The causal chain can be broken in a number of ways but the elimination of single engine night flying and the introduction of an adverse weather policy would be two which could have most effect.

SASless

26th Feb 2005, 14:16

Too true Mars,

Also contained in an article I read while researching this topic is a statement to the effect that drowning deaths are often a result of hypothermia since the victim is unable to turn his back to on-coming waves and spray as he becomes weakened from exposure to cold.

Compound the exposure to cold water and cold air....with the lack of effective airborne SAR capability that now exists in the Gulf Of Mexico and you have a potential for disaster.

Middle of the summer, hot , clear sunny day, flat water, calm winds....immersion in the sea does not present nearly the hazard.

GLSNightPilot

26th Feb 2005, 14:22

I don't see anything that says they died from exposure. Apparently the helicopter capsized immediately upon landing, which is pretty much expected in 9-ft seas. From the NTSB report, it's impossible to attribute the deaths to anything. I don't have access to a coroner's report.

Flying single-engine helicopters when the seas are high isn't the brightest idea anyone ever came up with, but it is unfortunately perfectly legal. Some judgement is required.

Mars

26th Feb 2005, 14:41

GLS:

We are in total agreement but who is to exercise the judgement: the FAA; the customer; the operator; or the pilot.

In some States (and in fact in the current ICAO text), the regulation requires a safe-forced-landing to be carried out in the event of an engine failure. European regulations amplifies that by prohibiting (except in some risk assessed circumstances) flight over a hostile environment in singles (a hostile environment includes the surface conditions, protection of the occupants and survival beyond the search and rescue response/capability) - thus the State takes responsibility.

In the absence of action from the FAA (which is unlikely to change) only the last three are options - I would suggest that in the current climate, the pilot should not bear such a burden and it is therefore left to the operator or the customer - both of whom have corporate responsibility for duty of care.

SASless

26th Feb 2005, 14:44

GLS,

Has any single-engine helicopter flight ever been cancelled due to "sea-state issues"....ever....in the Gulf of Mexico? I am not talking about wind or turbulence or rain but sea state alone?

Can a pilot look at the customer, tell them "NO" and get backing from his company safety, operations, and management?

Do you have first hand information that it ever happened? Do you have any second or third hand knowledge of that ever happening?

You are correct when you say it is legal....I decline to accept the statement that it is a matter of judgement. I would suggest the pursuit of money has put safety well down in priorities in this situation.

GLSNightPilot

27th Feb 2005, 20:57

SASless: Yes, yes, yes, and yes. Actually, it's written into our Ops Manual.

SASless

27th Feb 2005, 21:32

How about the other outfits GLS....

What limits does your outfit publish? Does it enforce those policies or is there a blind eye turned towards those who fly beyond that particular set of rules?

Do you agree with my view of the Coast Guard and their general unpreparedness for deep water SAR on a timely basis? If you fly out towards the very southern reaches of the the American side of the GOM....do you have USCG SAR available to you for the entire route or do you have to rely upon commerical non-SAR aircraft to come find you and maybe drop a raft to you? Any hoist equipped civilian SAR aircraft in the GOM that you know of?

GLSNightPilot

28th Feb 2005, 00:55

The limits are somewhat flexible, but realistic, and enforced. As for USCG SAR, it is somewhat depressing. They will eventually get there, I think, but they are slow. They do have hoists in their cute little Dolphin helicopters. ;-) They don't have a lot of range, but they can refuel on any of the fuel platforms, and often do. My only real complaint is that it seems to take them a rather long time to get started.

3B3

28th Feb 2005, 22:37

Fatal Crashes Provoke Debate on Safety of Sky Ambulances
By BARRY MEIER

On a mild afternoon last week, emergency workers raced up to Jana Austin's
rural Arkansas home to ask if a medical helicopter could land on her
property to transport a victim of a car crash to a nearby hospital. Ms.
Austin, a nursing student, said she readily agreed, and along with her
4-year-old daughter, she watched spellbound as the chopper landed.

But soon after it took off, the helicopter began to spin, slowly at first,
then faster, until it twirled out of control into a nearby pasture. The
patient died, and the three crew members were seriously hurt.

The accident, whose cause is under investigation, was hardly isolated. In
January, a medical helicopter plunged into the Potomac River in Washington,
killing the pilot and a paramedic. In less than two months this year, four
people have died in four accidents. Last year was a particularly deadly one
for flight crews and patients, with 18 people killed in 11 accidents, the
highest number of deaths in a year in more than a decade, according to
federal regulators and an industry group.

The spike is putting a spotlight on a little-regulated and fast-growing
sector of health care: the medical helicopter industry. There are an
estimated 700 medical helicopters operating nationally, about twice the
number flying a decade ago.

Medical helicopters were once nearly all affiliated with hospitals. But more
generous federal reimbursements and changes in payment methods have
attracted more operators, including publicly traded corporations and smaller
concerns that in some cases set up outposts and market their services to
rural emergency units and even homeowners.

Emergency medical helicopters do save lives, by speeding some patients to
hospitals far faster than a ground ambulance could and by reaching remote
areas. But the industry's rapid, competitive growth may also be exacting a
toll. Federal regulators and some doctors worry that the pool of skilled
helicopter pilots has become drained and that some of those flying are
making poor decisions. In addition, some companies are flying older
helicopters that lack the instruments needed to help pilots navigate safely.
Of the 27 fatal medical helicopter accidents that occurred between 1998 and
2004, 21 were at night and often in bad weather, according to federal
statistics.

"You need to raise the bar and say this is where the bar is," said Dr. Scott
Zietlow, the medical director for the helicopter program at the Mayo Clinic.
"If you can't get over it, you can't fly."

Last month, the Federal Aviation Administration, after a meeting with
helicopter operators, proposed steps to improve flight safety. They included
helping pilots assess risks and providing them with up-to-date electronic
equipment.

Separately, the National Transportation Safety Board has been examining
medical helicopter safety and plans to issue recommendations to the Federal
Aviation Administration, a safety board official said.

Initial reviews by the aviation agency and the safety board indicate that
pilot error was to blame in many of the recent accidents. A report in 1988
by the board, which came after a string of accidents in the preceding years,
found that medical helicopters were crashing at a rate three times higher
than that of other helicopters. At that time, the safety board made a number
of recommendations adopted by the aviation agency, including better pilot
training, particularly for flying in bad weather.

Executives of medical helicopter companies and trade groups said they were
greatly concerned by the rising accident numbers but added that the figures
might simply reflect the fact that more helicopters were flying, rather than
an increase in the accident rate.

The executives said they could not be sure a trend existed because the
industry had been operating without a system to track its total flight
hours, a standard measure for assessing air deaths.

Under pressure from regulators, company officials say they hope to have such
a database in place by late spring, and several asserted that they were not
pressuring pilots to take on dangerous missions.

"We are seeing the number of accidents creeping up, and we need to be able
to understand what the factors are," said Tom Judge, executive director of
Lifeflight of Maine, owned by two health care systems there.

The growing concerns about medical helicopter safety are unfolding alongside
a long-running debate over whether many such flights are medically
necessary. The cost of a medical airlift typically ranges from $5,000 to
$8,000, five times or more than that of a traditional ambulance. Private
health plans and some public ones, like Medicare, cover air services, at
least in part.

There are about 350,000 medical helicopter flights annually, with about 30
percent involving calls to accidents or other emergencies, according to the
Association of Air Medical Services, a trade group in Alexandria, Va. Most
other flights involve the transfer of patients between hospitals.

As recently as a decade ago, medical helicopters were generally operated
directly by hospitals and emergency service units or run under arrangements
with aviation companies, including publicly traded ones like the Air Methods
Corporation and Petroleum Helicopters Inc., which provided the helicopters
and pilots.

But industry officials said the business began to change in the late 1990's
when the federal government required hospitals to charge separately for
ambulance services, including airborne ones, rather than bundling such costs
in bills paid by all patients. In addition, Medicare, in adopting a national
fee schedule, increased reimbursement rates for air ambulance flights in
some regions.

As a result, many hospitals decided to abandon their helicopter operations,
and for-profit companies saw an opportunity.

Mr. Judge, the Maine official, said studies showed that 20 percent of
patients transported by air might have died from injuries or illnesses had
they not been flown.

But Dr. Bryan E. Bledsoe, a former emergency room doctor who lives in
Midlothian, Tex., a suburb of Dallas, said 14 medical helicopters operated
within a 75-mile radius of his home.

"The problem is that there is not that much of a need," said Dr. Bledsoe, a
critic of the air-ambulance industry.

Another significant area of industry growth involves companies that are not
connected to hospitals but instead set up helicopter bases in rural areas
and then market their services to local hospitals, emergency officials and,
at times, homeowners.

For example, Air Evac Lifeteam, which started 20 years ago with a single
base in West Plains, Mo., now has 43 sites in 10 central states. For $50 a
household, homeowners receive a company membership guaranteeing that Air
Evac Lifeteam will not seek additional payment from them beyond what an
insurer will pay. Over 150,000 households are signed up, Air Evac executives
said.

The splintering in the way the industry operates has led to a hodgepodge of
standards. For example, the Mayo Clinic, which gets its craft and crews from
an aviation company, requires pilots to have 5,000 hours of experience and
uses only twin-engine helicopters. Air Evac requires pilots to have 1,500
hours of flight time before hiring them and uses older single-engine craft.

"There is a wide variation in self-imposed standards," said Mr. Judge, who
is also president of the industry's trade group.

The Arkansas accident a week ago involved an Air Evac Lifeteam helicopter
that had just been refurbished after spending 20 years ferrying workers and
supplies to oil rigs. Colin Collins, the company's president, says that it
uses only Bell model 206 helicopters like the one that crashed in Arkansas
because they have an excellent safety record and are relatively simple to
maintain.

Local emergency officials said that the Arkansas car-crash victim, Robert
Arneson, 71 of Harlingen, Tex., had a gash on his forehead but was stable
and alert when brought by ambulance to a field for helicopter transfer.

It was about 20 air miles, or a seven-minute flight, from the crash site, a
trip that would have taken about 45 minutes by ground. But because emergency
workers had to locate a landing area and get Ms. Austin's permission to let
the helicopter land on her property, nearly an hour elapsed, officials said,
after the first emergency call and before the helicopter took off.

Mr. Collins said he expected the National Transportation Safety Board to
release its preliminary findings as early as tomorrow.

In recent months, Air Evac Lifeteam has had two fatal crashes. Other
companies have also had troubles. In January, Air Methods, the industry's
biggest operator, had two fatal crashes within one week, including the one
in Washington. Both operators said those incidents involved their first
deaths in many years.

Even company executives acknowledge that the industry's rapid growth may be
outpacing the pool of experienced pilots.

Mr. Collins said most of his pilots a decade ago were Vietnam veterans, but
the majority have retired, and fliers coming out of the military now are not
interested in helicopters.

While company executives said pilots were not being pushed to fly, industry
critics and federal regulators are concerned about whether pilots are making
the right judgments or have the right information and equipment to base them
on.

Last summer, emergency officials in South Carolina summoned a helicopter to
transport a woman found seriously injured beside a highway. But the first
helicopter, which was based in Columbia, S.C., about 50 miles southeast of
the accident, aborted its mission four minutes after takeoff with the pilot
citing fog and deteriorating weather conditions.

The next two helicopter crews contacted also refused to fly, citing the
weather. Officials called a fourth helicopter, in Spartanburg, S.C., which
agreed to fly, arriving about an hour after the accident. The helicopter,
which was owned by the Med-Trans Corporation, picked up the victim and
crashed shortly after takeoff in a nearby national forest. All four people
aboard were killed.

The South Carolina crash remains under investigation by the National Safety
Transportation Board, and Jeffrey B. Guzzetti, its deputy director for
flight safety operations, said the agency was reviewing the pilot's decision
to fly.

Reid Vogel, a spokesman for MedTrans, based in Bismarck, N.D., said the
company could not comment on the accident because of the federal
investigation. But Mr. Vogel said the company's flight team had thoroughly
checked the weather that day.

In last month's notice, the Federal Aviation Administration, citing the
industry's rapid growth and an "unacceptable" number of accidents, suggested
that operators increase the use of technical aids like radar altimeters,
night-vision goggles and terrain awareness warning systems, among other
things.

In addition, it recommended that companies emphasize a "safety culture" and
also improve systems that will give pilots better information about changing
weather conditions while they are in flight.

"In essence, this is a first step in looking at ways to improve operations
and reduce the number of accidents in helicopter emergency services," said
James Ballough, director of flight standards service at the Federal Aviation
Administration.

Stephanie Saul contributed reporting for this article.

SASless

1st Mar 2005, 00:39

Excellent video of crashed EMS helicopters....

http://www.cbsnews.com/sections/i_video/main500251.shtml?channel=i_video&clip=/media/2005/02/28/video677109&sec=3420&vidId=3420&title=Air$@$Ambulance$@$Risks&hitboxMLC=eveningnews

SASless

3rd Mar 2005, 21:26

NTSB Identification: DFW05FA073
Nonscheduled 14 CFR Part 135: Air Taxi & Commuter
Accident occurred Monday, February 21, 2005 in Gentry, AR
Aircraft: Bell 206-L1, registration: N5734M
Injuries: 1 Fatal, 3 Serious.

This is preliminary information, subject to change, and may contain errors. Any errors in this report will be corrected when the final report has been completed.

On February 21, 2005, at 1339 central standard time, a Bell 206-L1 single-engine helicopter, N5734M, operated by Air Evac Lifeteam was substantially damaged shortly after takeoff when it made a hard landing in a field near Gentry, Arkansas. The commercial pilot, the flight nurse, and the paramedic were seriously injured and the patient was fatally injured. The helicopter was registered to Air Evac Leasing Corporation, West Plains, Missouri. A company visual flight rules (VFR) flight plan was filed for the flight that departed about 1337, and was destined for Springdale, Arkansas. Visual meteorological conditions prevailed for the medevac flight conducted under 14 Code of Federal Regulations Part 135.

According to Arkansas State Police reports, the patient was involved in a single vehicle, rollover traffic accident. The patient was bleeding from the ear and was combative. An Air Evac Lifeteam helicopter was dispatched to the scene to pick-up the patient and transport him to a hospital in Springdale, Arkansas. The patient was transported via ambulance approximately one-half mile south of where the vehicle accident occurred to a designated landing zone, where he was loaded on to the helicopter. The landing zone was the front lawn of a private residence.

An Arkansas State Trooper escorted the ambulance and reported that he observed the helicopter circle over the accident site, then make an approach to the north and land. The patient was then transferred over to the flight crew and loaded on to the helicopter. The Trooper observed the helicopter as it departed. He said he heard the helicopter's engine achieve full power and then it began a vertical climb to approximately 100 feet, when it began to spin. The helicopter continued to spin, before it got "silent' and dropped to the ground in a field adjacent to the landing zone.

Several emergency medical service (EMS) personnel also observed the helicopter as it departed. Each reported similar accounts of how the helicopter started to spin shortly after it departed, and subsequently land in the field.

A witness, who owned the property where the helicopter had landed, was in her backyard when she observed the helicopter depart. She said the helicopter was initially parked in her front yard facing the north. As it departed, the helicopter ascended and then began to slowly spin to the right as it maneuvered over her house and toward an open field adjacent to her home. She said the helicopter began to spin faster, and after it made several rotations it "dropped" and landed upright in the field. The witness could not recall how high the helicopter was above the ground when it started to spin, but she felt that it was too low. She also stated that she did not hear any unusual noises from the helicopter during its short flight.

The pilot was interviewed in the hospital the day after the accident. He stated that during his recon of the landing zone, he could not find any indicators that would assist him with determining wind direction; however, when he had reviewed the weather that morning the winds were reported out of the north between 330 and 030 degrees and were "brisk", about 10-15 knots. The pilot was also able to identify and verify all obstacles reported by his crew in the vicinity of the designated landing zone.

After the patient was boarded, the pilot said that he brought the helicopter to a hover and noted that his engine torque was near 100 percent. While still in a hover, the pilot maneuvered the helicopter to the right and stopped when he was within 20-25 feet of the property owner's home. He did this so he could avoid the approximately 60-foot-high power lines that ran diagonally in front of the helicopter from southwest to northeast. There was also a set of power lines that ran north/south behind the property owner's home. Both sets of power lines converged at the same wooden utility pole, which was located north of the home.

The pilot stated that when he departed, he began a vertical ascent but was trying not to increase the collective above the available torque. He said that he was concerned about clearing the power lines and losing effectiveness of the tail rotor. When the helicopter reached an altitude that was slightly below the power lines, it began an uninitiated turn to the right. The pilot had full left torque pedal applied at the time, and said that he attempted to gain forward airspeed, and also used the cyclic to follow the nose of the aircraft in an attempt to fly out of the turn. The pilot was unable to gain airspeed, and the helicopter began to spin to the right and descend. The pilot stated that his only option was to initiate an autoration, so he lowered the collective and placed the throttle in the idle position, which slowed the spinning. When the helicopter was approximately 10-20 feet above the ground, the pilot placed the collective to the full-up position to cushion the landing; however, there was not sufficient main rotor rpm to stop the high rate of descent. After the impact, the pilot said the engine was still running so he secured the helicopter, which included turning off the fuel valve and battery switch.

The helicopter came to rest upright in a grass field approximately 100 yards southeast from where it had departed on a heading of 172 degrees at an elevation of approximately 1,000 feet mean sea level (msl). Both skids were spread their maximum distance, and the belly of the helicopter was laying flat on the ground. The aft skid cross-tube had pushed up into the belly of the aircraft and ruptured the fuel tanks. According to the Arkansas State Trooper, approximately two inches of jet fuel surrounded the helicopter shortly after the accident.

The pilot held a commercial certificate for rotorcraft-helicopter, instrument helicopter, and airplane single-engine land. He was also a certified airframe power plant mechanic. The pilot reported a total of 3,500 hours of total flight time, of which approximately 3,438 hours were in helicopters and 15 hours were in make and model.

His last second class FAA medical was issued on December 13, 2004.

Weather reported at Smith Airport (SLG), Siloam Springs, Arkansas, approximately 10 miles southeast of the accident site, at 1335, included wind from 050 degrees at 7 knots, visibility 10 statute miles, clear skies, temperature 61 degrees Fahrenheit, dewpoint 46 degrees Fahrenheit, and a barometric pressure setting of 30.01 inches of Mercury.

tottigol

3rd Mar 2005, 22:32

Let me guess, 3,423 hrs in piston types and this was the first job after leaving the teaching environment........
Let's see if we can connect this thread with the other one where a shortage of specifically experienced pilots is reported?

It would be nice to be able to check the amount of fuel carried and to weight all people aboard so as to get a total a/c weight.
Luckily for him the rear (main) tank ruptured, and double luckily it did not ignite the fuel.
Oh! There I go again, playing Monday Night football coach:*

At least he recognized LTE and used the correct technique:ok:

SASless

4th Mar 2005, 11:14

Taken from the Wall Street Journal....

Air Ambulances Are Under Fire
Critics Say Emergency Medical Helicopters
Are Overused and Offer Few Benefits to Patients

By KEVIN HELLIKER and VANESSA FUHRMANS
Staff Reporters of THE WALL STREET JOURNAL
March 3, 2005; Page D1

For weeks now, federal regulators have been investigating the safety record of the air-ambulance industry, which has experienced four deadly crashes this year.

But an increasing body of evidence suggests there is a larger question to be asked about emergency-medical air transports: Do they benefit most patients?

The conventional wisdom is that air ambulances save the lives of patients who are too critically ill to withstand a slower ride in a ground ambulance. Yet some observers of the industry say medical air transports actually save very few lives -- while costing as much as 10 times more than ground ambulances. A number of published studies including research at Stanford University and the University of Texas, show that the flights often transport minimally injured patients when ground transport frequently could get them to a hospital faster, and with less risk to others.

"In 20 years of experience in urban critical-care helicopter transport, I can count on the fingers of one hand the number of times I thought flying a patient to the hospital made a significant difference in outcome compared to lights and siren," says David Crippen, an associate professor of critical care and emergency medicine at University of Pittsburgh Medical Center.

Some research on medical air transports:

• A 2002 paper showed a 24% reduction in mortality for seriously injured patients, but nearly 60% of patients actually had lesser injuries.

• A 1995 study of potential organ donors flown by transport found that an estimated 27 out of 28 would have arrived faster by ground ambulance.

Inspired by images of helicopters evacuating wounded soldiers in Vietnam, the air-ambulance industry took root in the 1970s and has grown steadily ever since. The industry fleet has nearly doubled since 1997, and patient transports are rising an estimated 5% a year, according to Tom Judge, president of the Association of Air Medical Services, a trade group.

The current probe of this year's fatal crashes, begun in January, comes as the industry has drawn increasing scrutiny over not just safety, but also efficacy and possible overuse. Also in January, the journal Prehospital Emergency Care published an abstract reporting that a study of 37,500 helicopter-transported patients determined that two of three had only minor injuries. One of four had injuries too minor to require hospital admission. "The evidence says too many patients are being flown, and yet they keep flying more," says Bryan Bledsoe, a physician who co-authored the Prehospital Emergency Care abstract.

Among other recent research critical of air-transport use, Stanford University trauma surgeon Clayton Shatney conducted a study of 947 patients flown to Santa Clara Valley Medical Center and concluded that helicopter service potentially saved the lives of only nine of them -- while potentially serving as detriment to five who could have arrived faster by ground. Travel by helicopter often is slower in urban situations, in part because of a lack of places to land. "In multicasualty situations, it has not been uncommon that ground ambulances arrive before an airship with patients from the same event," says the Stanford study, published in 2002 in the Journal of Trauma, Injury, Infection and Critical Care.

Critics say air ambulances are overused and offer few benefits to patients

To be sure, there are situations where there is little debate that medical air transport has clear benefits, such as in rural areas where patients must travel long distances quickly. Some smaller hospitals that fly patients to bigger facilities say they must err on the side of caution with a patient they aren't equipped to handle themselves. And there is research that shows a value for patients. A 2002 study, conducted by an air medical service in Boston compared patients flown with patients driven and showed a 24% survival benefit among the most seriously injured who were flown. "That's an enormous benefit," says Mr. Judge of the Association of Air Medical Services.

The cost of air ambulances varies -- generally from $5,000 to $10,000 a trip, and sometimes as much as $25,000, according to industry experts. That is typically five to 10 times as much as ground ambulance. But ground transportation also can be not just less expensive, but faster: A 1995 study of air transport of potential organ donors in Houston, conducted by trauma surgeon Christine Cocanour, found that 27 of 28 would have arrived faster by ground ambulance.

Air-transport industry leaders, including Stephen Thomas, a physician and associate medical director of Boston MedFlight, an emergency medical air-transport service, attribute the high rate of minimally injured patients to the difficulty of conducting accurate injury assessments at the scene of accidents -- especially considering that such calls often are made not by physicians but by paramedics and even police.

But the majority of air transports occur not from accident scenes but from hospitals, according to the Association of Air Medical Services and others. Frequently, doctors at a smaller hospital assess and stabilize patients before dispatching them to larger medical centers.

Insurance companies -- which often must pay for the costly transport -- say they are reluctant to second-guess the decisions of these doctors, who may view air transport as the least-risky choice for both the patient's health and the hospital's liability.

Consider the decision on Jan. 11 to fly Ryan Memering out of Memorial Hospital of Carbon County in Rawlins, Wyo. Mr. Memering had two fractured vertebrae and a deep gash inside his mouth from a car accident. Doctors at Carbon County made the decision to fly him to a larger trauma center in Casper, 120 miles away.

Hospital officials in Rawlins say that ordering the air transport was a clear-cut decision: Though the 45-bed rural hospital has a small intensive-care unit, it lacks full-time specialists for higher-level acute or trauma care. "Any time you have something out of their scope of practice, that's a liability for anyone. Do you want to take that risk?" asks Candace Hofmann, the hospital's ambulance director.

The plane dispatched to retrieve Mr. Memering attempted to land in the dark at Rawlins Municipal Airport. It crashed three miles away, killing three of four crew members on board. Not until the next day did Mr. Memering get flown to the Casper hospital, where doctors performed no surgery and released him in four days. "The staff there said Rawlins had panicked basically," says Serena Memering, the patient's wife. Her husband, she says, "feels guilty that three people died because of this. In my opinion, it was a waste of lives."

The Rawlins crash represented the third fatal accident of an air ambulance during the first two weeks of 2005, prompting federal regulators to open a probe.

Safety experts say the industry's crash record is less a threat to patients than to crew members, who if they worked 20 hours a week for 20 years would face a 40% chance of being involved in a fatal crash, according to Johns Hopkins University epidemiologist Susan Baker, a professor in the Johns Hopkins Bloomberg School of Public Health who has studied the industry. Possible outcomes of the federal probe include a requirement that pilots wear night-vision goggles. The four fatal crashes so far this year of air ambulances have killed six crew members and one patient.

Patients can end up paying for helicopter transport that wasn't medically necessary. After 9-year-old Tyler Herman fell and broke his jaw in the wilds of Arizona, doctors at a community hospital decided the boy should fly to Phoenix to undergo plastic surgery for a gash on his face. During the flight he was well enough to sit up and remark on the scenery. Upon arriving in Phoenix, he waited nearly 20 hours to undergo surgery. "We could have driven him there in four hours," says Sharon Herman, the boy's mother. Her insurance didn't cover air transport, leaving the Hermans with a bill for $25,000.

On its own, the air ambulance doesn't appear to be a huge money maker. Earnings at the industry's largest player, Air Methods Corp., climbed to $5.1 million from $3.4 million during the five years ended in 2003. But a 2003 Journal of Trauma study conducted by the University of Michigan Health System, which runs a flight service, found that flown-in patients had better insurance and generated significant "downstream revenue" because the patients developed a relationship with the hospital and often returned years later.

rotorboy

19th Mar 2005, 01:39

BehindTheMedspeak: Medical Helicopters Crash Too Often

Kevin Helliker and Vanessa Fuhrmans wrote a great investigative piece for the March 3 Wall Street Journal on the recent spate of emergency medical helicopter crashes.

Long story short: more often than not an old-fashioned ambulance, with its sirens and flashers and all, makes the trip faster than a helicopter would.

In fact, a Stanford University study published in 2002 noted, "In multicasualty situations, it has not been uncommon that ground ambulances arrive before an airship with patients from the same event."

Not only do helicopters crash far too often (so far this year, there have been four fatal crashes, killing six crew members and one patient), they cost a fortune.

A helicopter ambulance evacuation generally costs from $5,000 to $10,000 a trip, and sometimes up to $25,000, according to industry experts quoted in the Wall Street Journal story.

That is typically five to ten times as much as a ground ambulance.

A 1995 study of air transport of potential organ donors in Houston, conducted by trauma surgeon Christine Cocanour, found that 27 out of 28 would have arrived faster by ground ambulance.

I remember back when I was working at the University of Virginia Medical Center and the powers-that-be decided that they needed a helicopter to be "big-time."

Everyone got all excited about how great it would be, having the ability to fly to Tennessee and West Virginia and bring patients to UVA Hospital.

All I saw was major money out the window and even less sleep than I was already getting when I was on night call, taking care of people who could be just as well and probably better treated in Tennessee and West Virginia.

I mean, they have big-time tertiary care hospitals too.

Nice to know I had the right idea, even back then.

As Bob Dylan wrote, "You don't need a weatherman to know which way the wind blows."

Here's the story.

Air Ambulances Are Under Fire
Critics Say Emergency Medical Helicopters Are Overused and Offer Few Benefits to Patients

For weeks now, federal regulators have been investigating the safety record of the air-ambulance industry, which has experienced four deadly crashes this year.

But an increasing body of evidence suggests there is a larger question to be asked about emergency-medical air transports: Do they benefit most patients?

The conventional wisdom is that air ambulances save the lives of patients who are too critically ill to withstand a slower ride in a ground ambulance.

Yet some observers of the industry say medical air transports actually save very few lives -- while costing as much as 10 times more than ground ambulances.

A number of published studies including research at Stanford University and the University of Texas, show that the flights often transport minimally injured patients when ground transport frequently could get them to a hospital faster, and with less risk to others.

"In 20 years of experience in urban critical-care helicopter transport, I can count on the fingers of one hand the number of times I thought flying a patient to the hospital made a significant difference in outcome compared to lights and siren," says David Crippen, an associate professor of critical care and emergency medicine at University of Pittsburgh Medical Center.

Inspired by images of helicopters evacuating wounded soldiers in Vietnam, the air-ambulance industry took root in the 1970s and has grown steadily ever since.

The industry fleet has nearly doubled since 1997, and patient transports are rising an estimated 5% a year, according to Tom Judge, president of the Association of Air Medical Services, a trade group.

The current probe of this year's fatal crashes, begun in January, comes as the industry has drawn increasing scrutiny over not just safety, but also efficacy and possible overuse.

Also in January, the journal Prehospital Emergency Care published an abstract reporting that a study of 37,500 helicopter-transported patients determined that two of three had only minor injuries.

One of four had injuries too minor to require hospital admission.

"The evidence says too many patients are being flown, and yet they keep flying more," says Bryan Bledsoe, a physician who co-authored the Prehospital Emergency Care abstract.

Among other recent research critical of air-transport use, Stanford University trauma surgeon Clayton Shatney conducted a study of 947 patients flown to Santa Clara Valley Medical Center and concluded that helicopter service potentially saved the lives of only nine of them -- while potentially serving as detriment to five who could have arrived faster by ground.

Travel by helicopter often is slower in urban situations, in part because of a lack of places to land.

"In multicasualty situations, it has not been uncommon that ground ambulances arrive before an airship with patients from the same event," says the Stanford study, published in 2002 in the Journal of Trauma, Injury, Infection and Critical Care.

Critics say air ambulances are overused and offer few benefits to patients

To be sure, there are situations where there is little debate that medical air transport has clear benefits, such as in rural areas where patients must travel long distances quickly.

Some smaller hospitals that fly patients to bigger facilities say they must err on the side of caution with a patient they aren't equipped to handle themselves.

And there is research that shows a value for patients.

A 2002 study, conducted by an air medical service in Boston compared patients flown with patients driven and showed a 24% survival benefit among the most seriously injured who were flown.

"That's an enormous benefit," says Mr. Judge of the Association of Air Medical Services.

The cost of air ambulances varies -- generally from $5,000 to $10,000 a trip, and sometimes as much as $25,000, according to industry experts.

That is typically five to 10 times as much as ground ambulance.

But ground transportation also can be not just less expensive, but faster: A 1995 study of air transport of potential organ donors in Houston, conducted by trauma surgeon Christine Cocanour, found that 27 of 28 would have arrived faster by ground ambulance.

Air-transport industry leaders, including Stephen Thomas, a physician and associate medical director of Boston MedFlight, an emergency medical air-transport service, attribute the high rate of minimally injured patients to the difficulty of conducting accurate injury assessments at the scene of accidents -- especially considering that such calls often are made not by physicians but by paramedics and even police.

But the majority of air transports occur not from accident scenes but from hospitals, according to the Association of Air Medical Services and others.

Frequently, doctors at a smaller hospital assess and stabilize patients before dispatching them to larger medical centers.

Insurance companies -- which often must pay for the costly transport -- say they are reluctant to second-guess the decisions of these doctors, who may view air transport as the least-risky choice for both the patient's health and the hospital's liability.

Consider the decision on Jan. 11 to fly Ryan Memering out of Memorial Hospital of Carbon County in Rawlins, Wyo.

Mr. Memering had two fractured vertebrae and a deep gash inside his mouth from a car accident.

Doctors at Carbon County made the decision to fly him to a larger trauma center in Casper, 120 miles away.

Hospital officials in Rawlins say that ordering the air transport was a clear-cut decision: Though the 45-bed rural hospital has a small intensive-care unit, it lacks full-time specialists for higher-level acute or trauma care.

"Any time you have something out of their scope of practice, that's a liability for anyone. Do you want to take that risk?" asks Candace Hofmann, the hospital's ambulance director.

The plane dispatched to retrieve Mr. Memering attempted to land in the dark at Rawlins Municipal Airport.

It crashed three miles away, killing three of four crew members on board.

Not until the next day did Mr. Memering get flown to the Casper hospital, where doctors performed no surgery and released him in four days.

"The staff there said Rawlins had panicked basically," says Serena Memering, the patient's wife.

Her husband, she says, "feels guilty that three people died because of this. In my opinion, it was a waste of lives."

The Rawlins crash represented the third fatal accident of an air ambulance during the first two weeks of 2005, prompting federal regulators to open a probe.

Safety experts say the industry's crash record is less a threat to patients than to crew members, who if they worked 20 hours a week for 20 years would face a 40% chance of being involved in a fatal crash, according to Johns Hopkins University epidemiologist Susan Baker, a professor in the Johns Hopkins Bloomberg School of Public Health who has studied the industry.

Possible outcomes of the federal probe include a requirement that pilots wear night-vision goggles.

The four fatal crashes so far this year of air ambulances have killed six crew members and one patient.

Patients can end up paying for helicopter transport that wasn't medically necessary.

After 9-year-old Tyler Herman fell and broke his jaw in the wilds of Arizona, doctors at a community hospital decided the boy should fly to Phoenix to undergo plastic surgery for a gash on his face.

During the flight he was well enough to sit up and remark on the scenery. Upon arriving in Phoenix, he waited nearly 20 hours to undergo surgery.

"We could have driven him there in four hours," says Sharon Herman, the boy's mother. Her insurance didn't cover air transport, leaving the Hermans with a bill for $25,000.

On its own, the air ambulance doesn't appear to be a huge money maker.

Earnings at the industry's largest player, Air Methods Corp., climbed to $5.1 million from $3.4 million during the five years ended in 2003.

But a 2003 Journal of Trauma study conducted by the University of Michigan Health System, which runs a flight service, found that flown-in patients had better insurance and generated significant "downstream revenue" because the patients developed a relationship with the hospital and often returned years later.