Proposed Federal Law Affecting US Helicopter EMS Operations

[SASless]

HAI has posted the contents of the Senate Bill 1300 which if implemented will greatly alter the way US EMS Helicopter Operations have been done in the past. It seeks to put into law measures which should greatly improve the safety of helicopter air medical operations.
The following link will take you to the article and the text of the proposed law.
http://http://www.rotor.com/Default.aspx?tabid=510&mid=905&newsid905=54920&&SkinSrc=%5bG%5dSkins%2f_default%2fNo+Skin&ContainerSrc=%5bG%5dContainers%2f_default%2fNo+Container&dnnprintmode=true

[arismount]

The link posted doesn't appear to work for me. However I've just read the full text of the latest Senate version available on line. The Bill as now written does absolutely nothing for HEMS safety and also will force other operators to scud-run.
In Title I of the Bill is a surcharge of $25 per flight for general aviation aircraft. Air ambulance are exempt, [U]however[U] general aviation aircraft will have to pay this $25...unless they remain outside of controlled airspace! This is a recipe for hundreds more aircraft to operate below 1200 AGL, scud-running along, with higher incidents of CFIT & mid-air collisions.
Now let's turn our attention to the HEMS-specific provisions of the Bill, Title V, Section 508, as follows:
>>SEC. 508. INCREASING SAFETY FOR HELICOPTER EMERGENCY MEDICAL SERVICE OPERATORS.
(a) Compliance With 14 CFR Part 135 Regulations- No later than 18 months after the date of enactment of this Act, all helicopter emergency medical service operators shall comply with the regulations in part 135 of title 14, Code of Federal Regulations whenever there is a medical crew on board, without regard to whether there are patients on board the helicopter.
(b) IMPLEMENTATION OF FLIGHT RISK EVALUATION PROGRAM- Within 60 days after the date of enactment of this Act, the Federal Aviation Administration shall initiate, and complete within 18 months, a rulemaking--
(1) to create a standardized checklist of risk evaluation factors based on its Notice 8000.301, issued in August, 2005; and
(2) to require helicopter emergency medical service operators to use the checklist to determine whether a mission should be accepted.
(c) COMPREHENSIVE CONSISTENT FLIGHT DISPATCH PROCEDURES- Within 60 days after the date of enactment of this Act, the Federal Aviation Administration shall initiate, and complete within 18 months, a rulemaking--
(1) to create standardized flight dispatch procedures for helicopter emergency medical service operators based on the regulations in part 121 of title 14, Code of Federal Regulations; and
(2)
←→to
require such operators to use those procedures for flights.
(d) IMPROVING SITUATIONAL AWARENESS- Any helicopter used for helicopter emergency medical service operations that is ordered, purchased, or otherwise obtained after the date of enactment of this Act shall have on board an operational terrain awareness and warning system that meets the technical specifications of section 135.154 of the Federal Aviation Regulations (14 C.F.R. 135.154).
(e) Improving the Data Available to NTSB Investigators at Crash Sites-
(1) STUDY- Within 1 year after the date of enactment of this Act, the Federal Aviation Administration shall complete a feasibility study of requiring flight data and cockpit voice recorders on new and existing helicopters used for emergency medical service operations. The study shall address, at a minimum, issues related to survivability, weight, and financial considerations of such a requirement.
(2) RULEMAKING- Within 2 years after the date of enactment of this Act, the Federal Aviation Administration shall complete a rulemaking to require flight data and cockpit voice recorders on board such helicopters.<<
Comment: This portion of the Bill as written is ludicrous and shows the total absence of Senate, FAA, and NTSB knowledge concerning the true state and needs of U.S. HEMS.
1. Using 135 procedures when medical crew is on board will discriminate against HEMS. HEMS will be the only 135 operation which will be restricted from applying FAR 91 procedures when revenue passengers are not on board.
2. Risk assessment "checklists" are already in use by most if not all operators. In reality they do NOTHING to increase safety because the "process" is already done informally by EMS pilots as a matter of course. The only things this accomplishes is to delay launches while the "checklist" is prepared, and to give FAA/NTSB another hook to fault the pilot if the "checklist" isn't done.
3. FAR 121 Dispatch procedures are too cumbersome, too time delaying, and too expensive for 135 HEMS operations. They would do nothing for safety, but would impose a vast burden of expense upon operators.
4. As usual, Congress, FAA, and NTSB continue to focus on "bells & whistles", i.e., adding TAWS, CVR & FDR to HEMS aircraft. These would only add weight to our already overloaded aircraft and would do NOTHING to help the pilot avoid crashes. TAWS systems already on our particular aircraft just increase pilot workload, i.e., they have to be disabled (requiring 8 keystrokes on the box) to prevent nuisance warnings...which all of them are...we can see the terrain! CVR & FDR don't help the pilot, they just help the NTSB.
I urge all American HEMS pilots/operators to write the Senate and raise these objections to the Bill.
If Congress is serious about HEMS safety they should require twin engines and either IFR capability (autopilot), or NVG for night operations.

[tottigol]

Comment: This portion of the Bill as written is ludicrous and shows the total absence of Senate, FAA, and NTSB knowledge concerning the true state and needs of U.S. HEMS.
1. Using 135 procedures when medical crew is on board will discriminate against HEMS. HEMS will be the only 135 operation which will be restricted from applying FAR 91 procedures when revenue passengers are not on board.

Arismount, I agree with all your points except the one above.
Unless you happen to be flying for a certain standalone operator, medical crews ARE passengers, they are paying for the trip with or without a patient onboard, hence Part 91 should not apply.

[SASless]

Perhaps we should discuss why Helicopter EMS operators are using these checklists and other recent changes in dispatch control and other "new" measures. Likewise we should discuss the sharp decrease in Fatal Accidents since the FAA started to toughen up on the Helicopter EMS industry.

How many lives have been saved this year alone?

Perhaps we might consider the difference between being "135" and "91" when returning to the helicopter base without patients. Are not the greatest number of fatal accidents experienced during this phase of flight?

Ayris makes a very good point about "Bells and Whistles" but for reasons he and I would disagree upon probably.



My apologies to all for not checking to make sure the link would function correctly.:(

[Bravo73]

My apologies to all for not checking to make sure the link would function correctly.:(


Here ya go, SAS:


http://www.rotor.com/Default.aspx?tabid=510&mid=905&newsid905=54920&&SkinSrc=%5bG%5dSkins%2f_default%2fNo+Skin&ContainerSrc=%5bG%5dContainers%2f_default%2fNo+Container&dnnprintmode=true


:ok:

[SASless]

Again it proves how quickly technology is leaving me in the dust!:ouch:

[OFBSLF]

SASless: here's a service that should set you right up: http://www.comicspage.com/comicspage/main.jsp?catid=1138&custid=69&file=20071218cssyl-a-p.jpg&code=cssyl&dir=/sylvia

[Revolutionary]

1. Using 135 procedures when medical crew is on board will discriminate against HEMS. HEMS will be the only 135 operation which will be restricted from applying FAR 91 procedures when revenue passengers are not on board.

Yes, discrimination is a bad thing... but HEMS is the only FAR Part 135 operation with such a high accident rate. On a practical level, the difference between operating under FAR Part 135 and 91 is not that great, and most companies' ops specs already have wx minimums and duty time limits more in line with Part 135. If you really want to be Part 91 because you want to be able to scud-run back to base on a particularly dark and stormy night you have to ask yourself what the hell you're doing anyway.


2. Risk assessment "checklists" are already in use by most if not all operators. In reality they do NOTHING to increase safety because the "process" is already done informally by EMS pilots as a matter of course. The only things this accomplishes is to delay launches while the "checklist" is prepared, and to give FAA/NTSB another hook to fault the pilot if the "checklist" isn't done.

Risk assessment, unfortunately, is not done -or not done properly- by a number of operators and pilots, resulting in launches on the aforementioned dark and stormy nights with tragic results. I agree that EMS pilots don't need another paperwork burden just to satisfy the Feds but it doesn't hurt to have a formalized way of making a go/no-go decision that can be taught, implemented and enforced company-wide. So what if it takes a minute or two.

3. FAR 121 Dispatch procedures are too cumbersome, too time delaying, and too expensive for 135 HEMS operations. They would do nothing for safety, but would impose a vast burden of expense upon operators.

I personally think that the idea of an 'expanded' dispatch system is the single most important safety enhancement that has come out of this bill. The idea is not that the dispatcher should be doing your w&b or making your weather decisions for you; it's that the dispatcher should be helping you out every turn of the way. If you're flying a marginally capable LongRanger at 3:00 AM over rural Arkansas in the winter it's nice to have the backup of a virtual 'co-pilot' who can check weather ahead of you, read off METARS, check fuel availability and generally help you out.

4. As usual, Congress, FAA, and NTSB continue to focus on "bells & whistles", i.e., adding TAWS, CVR & FDR to HEMS aircraft. These would only add weight to our already overloaded aircraft and would do NOTHING to help the pilot avoid crashes. TAWS systems already on our particular aircraft just increase pilot workload, i.e., they have to be disabled (requiring 8 keystrokes on the box) to prevent nuisance warnings...which all of them are...we can see the terrain! CVR & FDR don't help the pilot, they just help the NTSB.

I agree that CVR/FDR will do nothing to enhance safety; most EMS accidents are no great mystery. But TAWS can be very helpful. I wish they would mandate NVG's too. That stuff really helps. Who cares about the weight? If your TAWS is that cumbersome maybe you should go with a different manufacturer?

I urge all American HEMS pilots/operators to write the Senate and raise these objections to the Bill.
If Congress is serious about HEMS safety they should require twin engines and either IFR capability (autopilot), or NVG for night operations.

Agree with you there but it ain't going to happen.

[tottigol]

The Feds are once more looking at the door but not taking in the barn itself.
Rev pretty much nailed it, but just to sum it up there are three items that would help reduce the pressure on the pilots (actual or perceived), and eventually the accident rate:

IFR certified a/c or at the very least a "level the wings and climb" pushbuttoon type system, coupled with an extensive network of WX reporting stations ANYWHERE an EMS helicopter has to be stationed: AWOS3 or ASOS.

NVG and training to use them.

Customer accountability, by customer I intend those programs that are structured in a vendor-hospital type relationship. All communications between dispatch/program management and the pilots ought to take place on a recorded line.

Specific definition of the medical crew in the back, the FAA has been guilty of mudding the waters so far, by allowing the Medical Passengers to be deferred emergency evacuation and providing patient/patient relative safety briefings, are you kidding me?
If these people are to be crewmembers, they are to be subject to FAA ruling, training and discipline, no more and no less than a flight attendant would.
Otherwise they ought to be treated to the same level as an animal attendant in the cargo hold.


I guess they were four points, but hey who counts?

[Gomer Pylot]

In some operations the med crew are paying passsengers, and in some they are crewmembers, employed by the same company as the pilot, and have the power to make decisions about the flight, specifically the power to delay or abort it. There is a broad range of situations. The only use I've made of Part 91 to get home is to fly past my 14 hour duty day in order to get back to the base. Those 20 minute flights, more or less, give me more rest in the long run, and save everyone time and aggravation. It's quicker to fly home than to find transportation to a hotel, get checked in without any necessities, etc. It's not frequent, and the 14 hours usually expires on the way anyway. I don't make any changes at all on weather, though. It's either above minimums or it isn't, and the difference in regulations is non-existant for me.

[alouette3]

Notice there was no mention of the nut behind the wheel? How about pilot training being a factor? The older generation is going away. The younger lot ,coming in with a lot less flying time , needs to have focussed training to make good decicions in EMS.That means simulators, training schools focussed on EMS operations etc. Also, of all the On Demand Part 135 Fixed Wing operations in the US ,i.e. Cargo puddle jumpers, Charter, Corporate etc, the only ones that make holes in the ground with monotonous regularity are the Fixed Wing EMS guys. There is something about EMS that defies regulation and oversight. It probably is the mistaken idea that EMS is about saving lives.As far as the pilot is concerned it is just another segment of the transportation business.

[Devil 49]

As long as we- that is, US helicopter EMS pilots- are allowed- no, required to do the hardest part of our job- nights- while we're operating at an intellectual equivalency of being drunk, we're going to kill people in pilot error crashes. There's a lot of room for improvement in all phases of our industry- better equipment, more WX data, appropriate decision making processes- that will all improve the OVERALL rate, but the discrepancy between day and night accident rates will continue making nights much more dangerous. They don't address the root cause, in my opinion, we schedule ourselves to death.
Humans are diurnal, and sleep is important to mental acuity. Add "jet lag/circadian rhythm disruption", and the effect is magnified. Finally, pilots, tend towards invulnerability. if you're in the industry, you've had the relief/night pilot report for duty complaining of poor sleep, or talking about a full day's activities, and you know your relief is counting on a full night's sleep. Is there any wonder that night time accident rates are 4 times the day rate?
As to the final leg, the RTB Part 91 segment, being statistically even more dangerous, consider that fatigue and poor decisions made earlier would have their consequences magnified at that point.

I'm very concerned that some so called "improvements" will actually make the job more dangerous. In my experience, I haven't been any farther onto the horns of a dilemma that I have been when I relied technical capability. Following radar into precip that I would have aborted unaided, for instance. Yes, I know that was a poor decision- that's my point. Example- If the fleet universally requires autopilots, etc., then pilots will count on the capability.
Heck, I fly with pilots who consider the GPS a no-go item for VFR flight!

I guess what I'm saying is- make the improvements, but don't fool ourselves. We're not addressing the real issue. We need to schedule nights with safety and efficiency primary considerations.

[SASless]

Ever try to voice the position that "EMS flying is just another passenger transfer and not a Life Saving Mission" to your medical crew?

That has been the ruin of more pilots than the EMS Industry will ever admit (even to itself).

If you think an EMS operator will support a pilot when that conflict occurs you might also believe in the Tooth Fairy!

[TOMMY1954]

You are right, for medical crew some EMS flights are really "life saving". I´m an anesthesiologist , and worked in EMS helicopters during seven years, and I understand pilots point of vue, as medical crew we would never interfere with pilots decision to fly regardeless of the severity of the injuries or illness of the patients we were suposed to transport, we were very carefull not to transmite our ansiety to the pilots and they rarely knew the situation of the patients. It´s sometimes hard but the security of flight is the most important fact. Here in Portugal and rest of Europe , Helicopters must be biturbine class 1 , 2 pilots, IFR capability. Actually the Country´s EMS helicopter is Bell 412 EP.