NTSB says EMS accident rate is too high [Archive]

JimL

10th Oct 2008, 07:19

It is not correct to imply that nothing is being done.

Before effective action can be taken, it is first necessary to establish the root causes of the accidents. Once the causes have been established (and it is not as simple as it first appears), they can be addressed.

As will be seen, the causes will be many and varied; there will be clusters and trends, and this is where systematic measures will have the best chance of success (single accident mitigation achieves only a 'sticking-plaster'/'band-aid' effect).

Here is an extract from the latest IHST Newsletter:

http://ihst.org/images/stories/documents/ihst_newsletter-3.pdf

The OSI-HEMS Team
By Ira Blumen
“Opportunities for Safety Improvement in Helicopter EMS”

(OSI-HEMS) is a research project that has brought together aviation and medical experts to undertake the most comprehensive review of U.S. HEMS accidents to date. A root cause analysis is being conducted on an estimated 120 HEMS accidents dating back to 1998. Through this research and analysis, concrete recommendations will be made to compare the potential benefits, cost, effectiveness and feasibility of various factors that can prevent HEMS accidents or reduce the impact of accidents.

Key to the experimental design and analysis of our data (the HEMS accidents) is the scope, strength and experience of the research team that has come together. Bringing together such a team was one of the goals established by theoriginal core group that set out to develop this project. It was concluded that the best way to attract the support, knowledge and expertise that we needed to undertake and complete this research was to invite participation from throughout the air medical community. Air medical associations, aviation operators and manufactures were approached and the response was overwhelming. Our research team has now expanded to over 40 aviation and air medical professionals, with an average of 25 individuals present at each meeting. Our team currently represents:

Associations
- Air & Surface Transport Nurses Assoc (ASTNA)
- Air Medical Physician Assoc (AMPA)
- Air Medical Safety Advisory Committee (AMSAC)
- American Assoc for Respiratory Care (AARC)
- Assoc of Air Medical Services (AAMS)
- Commission on Accreditation of Medical Transport Services (CAMTS)
- Helicopter Assoc International (HAI)
- International Assoc of Flight Paramedics (IAFP)
- National Assoc of Air Medical Communication Specialists (NAACS)
- National EMS Pilots Assoc (NEMSPA)

Helicopter operators (currently 10 different 135 certificate holders)
- Air Evac Lifeteam
- Air Methods Corporation
- CareFlite (Dallas/Fort Worth)
- EraMed
- Intermountain Life Flight
- Med-Trans Corporation
- Metro Aviation
- Omniflight Helicopter, Inc
- PHI Air Medical
- REACH

Manufacturers
- Bell Helicopter
- American Eurocopter
- Turbomeca USA
-Federal Aviation Administration Aviation training
- FlightSafety International Aviation insurance- AirSure Limited

Members of the research group first met in early 2007 and the first “working” team meeting took place in January 2008. We anticipate continuing our work through the summer of 2009.

Editors note: due to recent events in the HEMS community, the IHST will be working with Dr. Ira Blumen, a well known HEMS accident analyst. His team is using a process similar to that developed by the US JHSAT team. The IHST plans to use the recommendations developed by Ira's team to form a HEMS specific implementation team late in 2009.

Jim

Devil 49

11th Oct 2008, 17:36

Yes, too many accidents in US EMS. Would somebody please post a US EMS accident rate? I suspect there is no sound statistical means to assess our accident rate, and I'm convinced that were there such it would be heavy on pilot error.
It's not a single/twin issue, you don't have to go very far into the history to see twins involved.
It's not a VFR/IFR issue, see previous.
It is a day/night issue- NVGs and scheduling.
It's a training issue, night training especially.
It's a managerial issue: all give safety lip-service, but often fail when the almighty dollar becomes an issue.
It's a regulatory issue. EMS is not just 'unscheduled fly-for-hire', and that is obvious to everybody flying the line. There are industry specific Parts for Ag and External work- EMS needs one too.
Finally- I'm coming around to the conviction that this is a single-pilot issue above all else. Pilots who can do this well by themselves are a minority and the safety advantages of a 2-pilot crew are inarguable.

hostile

11th Oct 2008, 17:45

Now whole case seems much better. Hopefully, and I am sure that OSI-HEMS team take care of this with good results. Good thing is that all parties are involved. Wishing them all best.:ok:

Mean while, fly safely out there.

Hostile

alouette3

11th Oct 2008, 23:54

Devil 49 et.al.
Agree that there should be a separate part for the industry. I have a sneaky feeling in the gut that if somebody with a super computer were instantly able to compare Part 135 Fixed Wing ops.(Freight, Charter,etc.) with Fixed Wing EMS ops. the crashes in the latter would exceed those in the former.
Maybe it is just an EMS issue-----.
Alt3.

maxvne

12th Oct 2008, 00:08

NTSB should insist on more experience and training for US EMS operators and crew to help stop these needless accidents

The Nr Fairy

12th Oct 2008, 07:04

NTSB can't insist - my understanding is their role is the same as that of our own AAIB in that they investigate, make findings and can make safety recommendations.

Only the FAA can regulate but, if the point you're trying to make is that the act needs cleaning up, then if the industry gets in there first with a proper "code of conduct" including equipment, training and flight decision criteria - which overrides commercial interest, then they're ahead of the game. However, the words "commercial interest" are the killer :)

helisteve

12th Oct 2008, 07:19

How about raising the night VFR min and doing away with the "competition" model for ems work

slgrossman

12th Oct 2008, 15:05

I think everyone here has identified a bit of the solution. The difficult part is implementing it in an environment that's governed almost solely by profit. On the one hand we want to make transport by HEMS safer, while on the other, we are reluctant to regulate someone out of business.

There are business models that work well in terms of profit, and there are those that work well in terms of safety. Occasionally, they are found in the same operation. But by the same token, the absence of accidents does not necessarily imply the presence of safety.

For years we've attempted to solve the problem with incremental measures, focusing on the proximate cause of the latest accident. It's time to look at broader solutions from a "systems" perspective.

Starting from the top:

1. How do we determine that a program is necessary in the first place? Will the community really be better served or is this just a business opportunity? Perhaps the "certificate of need" process needs to be more realistic.

2. How do we fund the service? Does the call volume directly affect the program's survivability? Is there pressure (real or perceived) to keep the "numbers" up?

3. Are the aircraft and crews equipped and trained to be able to surmount the challenges of the operating environment right up to the point of clearly defined mission abort criteria? Once a mission reaches an abort criterion is there a safe alternative?

4. Is the program staffed sufficiently and scheduled properly so as to prevent fatigue-related deficiencies in performance and judgement?

For years we've left it to the operators to make these decisions. Isn't it funny how they can always find a way to justify their operation, in spite of common sense. I think increased government regulation in these areas is the only measure that will ultimately produce an improvement in the the safety record of the HEMS industry.

-Stan-

widgeon

12th Oct 2008, 16:01

model time regime fatal cause
bell 206 day departure 3 wire ?.
bell 407 day approach 4 mid air
bell 407 day approach 3 mid air
bell 407 night en route 4 cfit ?
ec 135 night en route 3 cfit ?
as 350 night approach 3 water
bk 117 day en route 4 water
bell 206 night at scene 3 mech failure
27

others in same period 32

From NTSB site total Helicopter incidents year ending oct 11.
26 occurances , 8 EMS .

If you filter out turbine accidents only 8 of 11 turbine fatal accidents were EMS. And 100% of twin.

Aviation Query Results Page (http://www.ntsb.gov/ntsb/Response2.asp)

WhirlwindIII

13th Oct 2008, 13:06

Lot of good replies.

As to root cause analysis that is something that should have been ongoing such that we don't have years of delay while a few folks fiddle with stats to come up with some sort of conclusion/s, which may or may not have any implementable elements.

My frustration is that Common Sense has taken a back seat to what can be done right now - such as requiring all EMS pilots to at least gain and maintain 135.297 IFR status, irrespective of the helicopter they fly, so they might have the confidence to climb in to the weather when required in order to avoid dangerous CFIT situations.

Jackonicko

14th Oct 2008, 19:19

So are we saying that the problem is systemic, that the interests of safety have been overridden by commercial concerns for too long, and that the HEMS industry remains too governed by profit?

Are some HEMS programmes really established more to generate profit than to serve a real need in the community?

Do funding arrangements rely too heavily on call volumes, putting too much emphasis on operators to ‘keep the numbers up’, and on pilots to press on (perhaps into deteriorating conditions) and to avoid mission aborts?

Is there sufficient incentive for operators to train crews to the best possible standard, to acquire the most suitable aircraft, and to equip them properly?

Are the HEMS programmes adequately resourced to ensure proper engineering, and to avoid the inevitable penalties that arise when crews are over-worked, over-stretched or simply tired?

Devil 49

14th Oct 2008, 21:42

Yes, I think systemic failure is an accurate assessment of fault.

Starting at the top of the ladder, the FAA believes that EMS is just another helicopter charter. It isn't. To get the helicopter EMS job you have to have significant night experience, which most Part 135 operations avoid. Example- In 13 years in the Gulf of Mexico, I did 2 night flights as a VFR pilot, and the company tried to avoid those two flights. Night flight just isn't commonplace air taxi operation, not to mention 24/7 operations.
Often, air taxi's allowed to "take a look" and/or land short of destination. That was a mixed blessing, in that I learned weather very well as an air taxi pilot by flying into it at minimums well below my present weather minimums. Most EMS operations want to be reasonably certain of getting the patient to the receiving hospital, so "taking a look" doesn't happen.
On the subject of nights and regulations, it's stupid to pretend that "10 hours of uninterrupted rest" adequately addresses the pilot's condition going from a day assignment to a night shift. Yet, it's not uncommon (and perfectly legal) for a pilot to work a day shift, sign out at 2000 hours, take 24 hours off, and sign in the next night at 2000 hours. That's a major sleep and circadian disruption, it's well known that that affects mentation- and it's not addressed in training, policy or regulation.

EMS companies generally don't exceed the letter of the law. They act in the real world of 'profit equals existence'. If you don't make money, you don't exist for very long. The industry does pretty well within those limits, with these exceptions:
Scheduling, scheduling, scheduling!;
NVGs are decades over-due;
And training is done on the cheap and treated as a necessary evil, mandated by government. The training department can be a major asset in driving quality and safety, but not when it's scattershot by a very few overworked pilots, and especially not when done by 'management' types intent on enforcing the 'book' and all it's failings.

Pilots aren't blameless in any of this.

Gomer Pylot

14th Oct 2008, 22:21

As stated above, the NTSB has no regulatory power of any kind. They just investigate accidents and make recommendations, which the rest of the world is free to ignore, and generally does.

The FAA has been very reluctant to regulate operators - see the Eclipse soap opera, detailed in the current issue of AIN. HEMS in the US is a commercial operation, and few officials are ready to use socialist-seeming regulation to force anything on the operators. In the US, anyone with some capital is free to try to make more by any legal, or even illegal, means, and if someone gets hurt or killed, that's regrettable, but just part of the cost of doing business. I don't expect much regulation in the short term, and perhaps more deregulation, especially if the Republicans can maintain their current Congressional seats and McCain can manage to win. McCain has historically been hell-bent on deregulation, especially for the industries he's been paid to help. A little bribery goes a long way with politicians, and it's totally legal in the US, as long as you call it a campaign donation.

If the Democrats win big, there might be some tightening of the rules, but I don't foresee all that much, because they can be bought just like any other politicians, and we have the best government money can buy.

busdriver02

15th Oct 2008, 01:03

I don't think the crew rest issue mentioned above has much to do with it.

I do think NVGs would help, I sure as hell am not comfortable flying without them at night to an unimproved LZ.

But if the presumption that inadvertent IMC is the real killer, I think flying dual pilot would probably be the most expediant "fix."

Why am I so inclined to buy that answer? Well everyone I fly with is fully instrument capable, the aircraft I fly is a very good IFR platform, and I still cringe at having to fly in the weather. I don't do it very often, and I imagine most helo drivers don't do it very often, even when rated to do so. I'm ok with having to do it, mainly because if I'm the pilot on the controls, I can focus on just flying, while the non-flying pilot does all the "thinking."

hostile

15th Oct 2008, 01:37

Good thoughts Devil 49,

I was thinking about same. EMS operation should separate from other operations and it needs own SOP. It has so much differences. Night flying is different world and especially with (hopefully) NVG's. Like its been told many times, NVG's are not X-rays. You still need to have approved and good weather limits. Also crew coordinator should be included in that SOP. If operated in one pilot, somebody else must use radios between accident scene/other rescue crews. No pilot. There are many other things also, but main thing is that all is published.:rolleyes:

Jackonicko

15th Oct 2008, 08:57

So what's the point of SPIFR machines?

I don't doubt you, chaps, but would welcome an explanation.

Gomer Pylot

15th Oct 2008, 13:34

SPIFR is as demanding as any flying there is. It requires constant practice in order to be reasonably proficient, and the constant practice isn't possible in EMS, where there is relatively little flying at all. SPIFR machines are mostly for recovering from inadvertent IMC, but that's where the most proficiency is required, and where lack of it will kill you. In short, SPIFR machines are for eyewash, just a marketing tool. Many programs with SPIFR capable ships are prohibited from filing IFR. There is actually a point of view that they're more dangerous than less capable machines, because they may tempt pilots into flying in worse weather. With a 206, you know without question that you don't want to fly into weather. I'm not sure that I subscribe to that view, but it seems that some do.

Bravo73

15th Oct 2008, 16:17

Just for clarification:

SPIFR is as demanding as any flying there is. It requires constant practice in order to be reasonably proficient, and the constant practice isn't possible in EMS, where there is relatively little flying at all. SPIFR EMS machines are mostly for recovering from inadvertent IMC, but that's where the most proficiency is required, and where lack of it will kill you. In short, SPIFR EMS machines are for eyewash, just a marketing tool. Many programs with SPIFR capable ships are prohibited from filing IFR. There is actually a point of view that they're more dangerous than less capable machines, because they may tempt pilots into flying in worse weather. With a 206, you know without question that you don't want to fly into weather. I'm not sure that I subscribe to that view, but it seems that some do.

I hope you don't mind, Gomer. I didn't want Jack' getting the wrong idea about SPIFR aircraft in general.

Jackonicko

15th Oct 2008, 17:38

Thanks for the explanation/clatification, BOTH of you.

430EMSpilot

15th Oct 2008, 18:46

I'm not sure I agree with everything Gomer Pylot said.

SPIFR is demanding but I don't think it's eyewash, it expands our capabilities and increases safety. I fly a SPIFR ship in EMS and I've found it to be a great tool and a safety enhancement. By virtue of the the fact that we must take a 135.297 ride every six months with study and recurrent flight training added on, I believe we are more prepared to deal with IIMC than a VFR pilot.

I don't launch VFR in marginal weather, I'll file IFR and if our customer doesn't want to wait a little longer while I file and maybe meet us at the closest airport, they will find another mode of transportation.

If we encounter marignal VFR enroute, fly unaided at night, or can't see the ceiling, the auto pilot is a great tool. Let it fly, it has no idea whether it's in the clouds or not. If you have the misfortune of going IIMC the autopilot will not panic, you can command it to climb to MSA while you contact ATC for a clearance and vectors to VFR or an approach.

If the weather is deteriorating, you have the opportunity to get a clearance and climb to safety early instead of mucking around in the mud and going IIMC or CFIT.

I agree with whoever said that it was pilot error more than anything else. We must make good decisions, even when they are unpopular and may put our job in jeopardy. A company that won't accept a reasonable, safe decision isn't worth dying for, I'll move on.

Devil 49,
I think we work for the same company and thankfully haven't had the same training experiences you've had. Maybe the difference is CBM vs HBM?

V/R

Gomer Pylot

16th Oct 2008, 02:04

430, SPIFR can enhance safety, if used wisely. One checkride every 6 months isn't nearly enough to keep anyone proficient, each pilot has to be determined to practice at every opportunity. Since many programs prohibit actual IFR, that can be hard, and if pilots are prohibited from filing IFR, then the SPIFR machine is indeed eyewash. Whether it is safer depends on the pilot. If the pilot stays in practice and doesn't push weather, then safety can be increased, but if the pilot pushes weather, then the opposite can result. VFR only pilots, in VFR only machines, don't have IFR to fall back on and should be more conservative, and stay out of dangerous weather. I suspect the actual situation is a mixture of all the above, and more. IMO safety depends mostly on the pilot's ability to stay immune to perceived pressure from the crew and management to take flights (whether it exists or not) and from his own instinct to go out and try to save lives. In truth, we seldom save lives, but do often reduce morbidity. In no case is it worth risking our own lives or those of the crew in the back. Ground ambulances still work.

Jackonicko

16th Oct 2008, 10:15

Would better safety tend to mean the use of the more modern twins (capable of meeting Class 1 at normal weights) for HEMS, rather than ageing 206s?

The only thing stopping a recapitalisation based around bigger, better-equipped helicopters is money, right, and the FAA's unwillingness to upset commercial operators by insisting on it?

hostile

16th Oct 2008, 12:36

Twins are welcome, absolutely. But, using Class 1 is more complicating. It's because all aircraft has different kind of approval how to meet all Class 1 parameters. Some parameters just doesn't fit in HEMS-operations. Better start talking Class 2, if this will be the issue.

JimL

16th Oct 2008, 15:47

It is unlikely that any HEMS operation will be capable of PC1 at the HEMS Operating Site (scene).

All Category A procedures require the surface, size and obstacle environment to be established by survey; PC1 requires that all obstacles be cleared OEI by 35ft -for approach, balked landing, take-off and continued take-off. It is obvious that this is not possible at the HEMS Operating Site.

'Hostile' is absolutely correct that PC2 is the best that can be achieved.

Jim

Devil 49

16th Oct 2008, 16:57

Twins are absolutely not the answer. First, take a look at the recent accidents, and you'll see multis at least proportionally represented. If that's not convincing, there are statistics that seem to demonstrate that light twins have a marginal if any safety advantage over singles (look for the OGP(?) published stuff on this, for instance). There's lots of qualifiers intentionally included in that sentence, and it contradicts intuition. My opinion as to why: The extra systems are extra management load in the best of times; When something goes wrong, systems management can become a distractor from your main job- flying the aircraft and NOT CRASHING into something (This one is very well documented, fixed and rotary wing); Finally, and the discussion itself strengthens my last point, what I call "twin engine invulnerability", is very wide spread. I've seen lots of guys fly twins into an unsurvivable engine failure situation because they have "two engines".

430EMSpilot-
I hope it isn't a 'class issue', HBM vs. CBM. I see a conflict of interest in that training are required to be management and not 'craft/trade/profession' oriented. The mindset shows in the application of redundant checklists. Identify and fix the root cause, not the symptom.

busdriver02-
We fly the same legs to the same places in the same weather and the same equipment, day and night. Yet, night is far more dangerous. My opinion-
Jet lag (circadian disruption) is a widely understood and accepted factor- By everybody but EMS?
There are also studies of mental efficiency with sleep loss, showing every hour after 3 hours being roughly equivalent to the standard alcoholic beverage. Again, doesn't apply to EMS?
Add that unaided human night vision can be as bad as 20/200 or 20/400...

tottigol

16th Oct 2008, 17:09

Spoken like a real VFR EMS Astar Pilot Devil.:ugh:
I believe 430EMSPilot nailed it.

Even within the same corporate identity the separation between HBM and CBM services, and their continued comparation in the quarterly financial reports evidentiates the different mindset.
This is however a problem endemic to this company and one that does not apply per se to EMS operations, or perhaps does it?

I said it before and I'll repeat it.
Get the customer out of the cockpit, out of the cockpit decisions and out of OPERATIONAL decisions.

The problem is that in 'community based' programs the pilot is generally part of the customer and (specially these days) the completion of a certain number of flights may or may not mean the continued existance of a particular base (where he/she happens to live).
Also, since CB programs are notoriously for profit the need to cut expenses is far more evident than in a program where the customer is highly visible within the community and willing to avoid the bad publicity resulting from a crash.

So let's add yet another comparison parameter in this year accidents and establish the percentage of CB and HB crashes as compared to the respective program numbers.

I.e. what is the percentage of CB crashes vs the number of CB programs and HB crashes vs the number of HB programs?
How did THOSE crashes take place and what type of equipment was being flown.
One more suggestion, one I've made before:
Anyone establishing a "rural" pad for "community" service ought to be made responsible for establishing an FAA accepted WX reporting station (one of those Super AWOS comes to mind, about 75,000$) and within a set amount of time have approved GPS approaches to it; two things shall come out of that: virtually ensuring that program is not a fly by night (no pun intended) and the commitment to safety.
Not to mention the aircraft has to be IFR and NVG certificated and EQUIPPED for night operations, until there exists a will to enforce those conditions ya'll are an accident waiting to happen and a statistic on the drawing board.

Edited three times for content and spelling.:uhoh:

430EMSpilot

16th Oct 2008, 18:52

Gomer,

I agree, all things being equal no one should have a problem. As far as pushing weather, it would be interesting to me to compare SPIFR qualified pilots and aircraft vs SPVFR pilots and aircraft that go IIMC and fail to survive or CFIT.

Just off the top of my head I can think of maybe one that had a .297 current pilot and an IFR equipped aircraft.

Devil - I agree about the checklists, but my experience with the check airmen has only been positive.

Complexity is an issue with the twins, it amazes me when someone wrecks a perfectly good aircraft because of a small problem not requiring immediate action.

Totti - I love the rural equipment requirements!

Devil 49

16th Oct 2008, 19:11

tottigol- Ten years in twins, flew them every duty day. Quite comfortable in them, don't fool myself about the issues of having 2 engines, and in the right situation, prefer twins. This job (EMS) is not, generally speaking, that situation.
Also, at various times, IFR crew. I'm not arguing against the advantage of IFR or IFR equipment in EMS. I would love to have the options proficiency, currency, and equipment would give me on my next IIMC encounter. I'm saying those aircraft, twins and IFR equipped, are at least proportionally represented in EMS accidents- they're not the answer. The common element is human failure. The obvious physiological issues that would explain the increased rate of error in EMS night flying need to be addressed.

430EMSpilot- You bet, we have some top notch folks. I would dearly love to have them as pilots who teach, not managers who fly.

tottigol

16th Oct 2008, 19:35

430 and Devil, I can think of at least two outstanding individuals who are part of the Certificate Standards folks.
One is an older (only by age) cavalry type from upstate NY and one is a (relatively) younger one from South Texas.
I only wish the rest were up to par.

Devil, we only know of the IFR twin(s) that crashed, but how many were able to get back home after encountering IIMC, just because they had the equipment and the training/mindset to use the equipment?
Climb, Confess, Check, Communicate.

How do you do that in a single pilot VFR only aircraft, do you rely on inconsistent training?

We mention twins because twins generally come with IFR equipment and an autopilot.
The day (or better, the night) we are able to come up with a single with enough HP and equipment to have a "panic/level-the-rotor and climb-go direct" button, and with enough useful load to carry a patient (we already have two passengers) and enough fuel beyond 10 miles, then I'll consider singles for night EMS work.
I don't know you guys, but I flew enough times from SLC to Price in Carbon County with a 206 @ night to age prematurely.

busdriver02

16th Oct 2008, 19:38

Devil, I did not mean to imply sleep deprivation is no big deal. Just that swapping from days to nights has not been a problem for me at this point in my career. I will offer that I only fly with two pilots, two scanners and NVGs. So the slight circadian disruption may be offset by the extras, that I'm still in my twenties probably helps quite a bit as well.

Furia

16th Oct 2008, 20:22

devil, I regret to disagree with several of your remarks on that post. Equipment and training matter, and amtter a lot.

When we are talking Twins I guess most of us have in mind that we are talking about having Perfomance I CAT A MTW helicopters. The kind of mchine that if properly operated would make the difference if you have one engine out.
Twins but CAT II are surely not the answer.

IFR currency (operational currency I would call it) should be a must for any HEMS pilot flying by night. And with special enphasis on procedures for inadverted entry into IMC conditions.

If you want SAFE HEMS by night, then think in CAT I perfomance helicopters fully IFR equiped, a crew of 2 fully qualified a current IFR pilots and an properly trained dispacher that knows how to read weather maps and know what icing conditions and its effect on helicopters are.
Then add NVG or a nice FLIR and then you will have a SAFER HEMS night program.

The above mentioned equipment and conditions would not guarantee a 100% accident free but it is the best we can have for now, provided of course that the operators/customers value more safety than profits.

tottigol

16th Oct 2008, 20:58

Furia, by now you ought to have figured out that HEMS in the USA is nothing like HEMS in Europe.
Also, JAR OPS3 are not quite as permissive as the FARs when it comes to performance requirements for helicopters in determined types of use.
Come to think of it the FARs do not set any minimum standards for performance except for IFR in a twin.
That is why we still fly singles off-shore and singles at night in EMS and over congested areas.
PC1 here in the States is a huge scarecrow, and all operators are doing their darn best to stave away (read lubricating the FAA) the ghost of the JARs.
The lax attitude and tolerance demonstrated by the FAA towards HEMS is also why some programs still manage to fly VFR at night without the use of aids to vision notwithstanding rules set forth in 135.207.

slgrossman

16th Oct 2008, 22:17

It seems to me the key words, and the common thread in the recent spate of HEMS accidents are “pilot workload.” The majority of HEMS flights are conducted in conditions where the workload is easily manageable by a single pilot in a VFR-only machine. The economy of such operations is indisputable. The trouble can come when a situation arises for which that single pilot is not equipped or prepared, or the VFR-only machine is not capable. The workload can increase insidiously, and depending on the skill of the pilot, may exceed his abilities. At that point a successful conclusion to the flight may be solely a matter of luck.

Many HEMS operators in the U.S. base their operation on the premise that they simply won’t operate in situations where the workload is high. The unfortunate reality is that the line of demarcation is impossible to clearly define. Inevitably, someone will blunder across it, either through poor judgement or due to inadequacies in the information available for making their decision. Most of the time it results in no more than a bit of a scare and a good “there I was” story for the next safety meeting. The lesson is soon forgotten.

The major airlines conduct all their flights under instrument flight rules regardless of the actual conditions. Thus, when they do encounter weather it’s a “non-event.” Apparently, they’ve found that preparing for the worst pays off in a business sense – it allows them to run on schedule (much of the time) and it has contributed significantly to the low accident rate.

Not to compare HEMS with airline flying by any means, but the same philosophy of preparing for the worst would seem to make a lot of sense. If you want airline-like reliability in transporting medical patients it requires a higher level of equipment, training, and crew composition than the minimum the government currently mandates.

There are any number of fine aircraft and a variety of supplemental equipment available which could permit safe operation in all but the most severe conditions. The advantage of a second pilot is obvious. It all goes toward keeping the workload manageable all the time. The problem, of course, is that it’s expensive to go that route.

The solution to the disproportional accident rate doesn’t lie with a magic bullet – a piece of equipment, increased inadvertent IMC training, etc. It lies with a far-reaching change in operating philosophy. It lies with creating an environment predisposed to the successful completion of every flight that is accepted.

So, the question is, are we ready to change the regulations to enable a “high-end” operator to compete in what has become a market driven, in most cases, solely by economics. Honestly, I think the answer is no. One has to look no further than the horrific accident rate of automobiles in this country. There are any number of simple and obvious measures that could be taken to reduce the carnage, but perish the thought of depriving someone (either by regulation or by making driving unaffordable) of what has become essentially their right to drive when, where, and for however long they please.

-Stan-

Gomer Pylot

17th Oct 2008, 07:25

It's easy enough for all of us to sit at our computers and come up with all sorts of requirements, but the fact is that the FAA is not going to regulate much, if any, of it. That's not the way things work here. Requiring ASOS for every base, and all IFR ships sounds nice, but it ain't gonna happen. Not in our lifetimes, and probably not in our grandchildrens' lifetimes. We live (or die) with what we get, and what we get is the minimum required by regulation, because the USA is a capitalist country, driven by profits, not safety or moral rectitude. Whether more regulation should be enacted is moot - it won't be.

WhirlwindIII

17th Oct 2008, 18:37

Jackonicko

I believe your post of 14 Oct at 15:19 hits the nail on the head. I think the complexity of this HEMS stuff needs to be scaled back or we all go to two-pilot, NVG, IFR, etc.

Unfortunately Gomer probably has it right when he mentions none of this is going to happen in our lifetime - but I believe weather standards may continue to go up.

WIII

Shawn Coyle

18th Oct 2008, 12:36

There are a whole host of things that come with twin engine helicopters, if they are treated as such properly. More than 5 hours of training is needed to come to grips with the complexities of single engine failures, especially if Category A procedures are included. AFCS operation also takes quite a bit of getting used to, and the AFCS and autopilot need to be used all the time, not just as a crutch when things aren't going well. More than 5 hours of training for someone new to a complex multi-engine helicopter is definitely needed.
A good case can be made that the relatively small number of takeoffs at scenes compared to total takeoffs would allow Category A performance to be waived for scene takeoffs, or at least some other guidance given on how to best use the OEI capability if needed. (Sorry but this isn't well stated- the caffeine hasn't kicked in yet this morning).

Vertolot

18th Oct 2008, 13:23

Have been following with interest the discussion around the EMS in the US in this thread, my opinion is the following:

- It´s very very tragic will all this resent EMS accidents and everything possible should be done to stop this negative trend (i.e. immediate and long term actions)
- the goal in any (EMS) flight operation have to be that, one single fatal accident is unacceptable

After having being involved in the HEMS in Europe I somehow have come up to the following:

- In Europe the HEMS flight operations is very “regulation/authority driven”
- In the US the EMS flight operations seems to be very “market driven”

I have many times been thinking that a system that should be somewhere between the US and European system could be a perfect solution (also when considering the long terms effects). On one hand one accident is too much but on the other hand someone has to pay for every flight in one form or another (free competition or government founded).

I think that the solution for safer EMS operations in the US consists of many factors that are involving some rather tuff and hard changes, ranging from customers to management to pilots to equipment (if the solution would have been very simple it should have been made a long time ago already J). Without knowing to much accurate details about the US EMS operations I have noticed the following:

Flying VFR at night unaided in areas with very little or no visual references, should have in my opinion minimas like, Cloud base 2500-3000 feet and visibility of at least 10 km (yes, I know that with these minimas you will have to cancel a lot of missions during night time). The minimas could be slightly lower if you operate over cities and highly populated areas with a lot of illuminated ground references or if you have NVG.
Before going on a night mission you should have the time to spend some 5 minutes extra on getting accurate weather information and talking to a meteorologist. Getting some accurate weather information over the region you are operating in.i.e. how fronts are moving and when they are expected to move in etc. A very good briefing and understanding of the weather in a big enough area is important. You might get a new mission during the flight with a higher priority or at the accident site you might get the destination hospital and to be able to make a go/no-go decision you must have good accurate weather information.
If I had understood right, the systems in the US works so that the first EMS helicopter on accident site will get the job. With this time pressure 1 minute could be the difference of getting the job or not. In general in HEMS it will very seldom makes a difference in helping a patient if you come 5 minutes earlier or later (it can sometimes, but very seldom). Very often there is already ground units on the accidents sites before a helicopter reach it. In this terms there should be the required time to get accurate weather etc. information before making go/no-go decision. If you are competing with other EMS helicopters to be first on the accident site it looks like you have no time to make a good go/no-go decision based on accurate facts.
Have Standard operating procedures (SOP) for the operations. They should not be written with the intention of satisfying any inspector from the Authorities. They should be written for the pilots and should be as simple and clear as possible. They should be practised in simulator at least twice a year representing scenarios in the operational area.
As I said earlier, these are only my opinions!

Cheers,

Vertolot

Gomer Pylot

19th Oct 2008, 01:34

Vertalot, a couple of corrections. It's not the first helicopter on the scene. In theory, the nearest helicopter should be called, but often it depends on the whim of the local EMS dispatcher or crew. I've never heard of multiple helicopters launching on their own, like wrecker trucks.

Talking to a meteorologist and getting accurate weather information isn't an option. The flight service station system has been privatized, and the last time I called for weather information, the briefer was in Minnesota, a couple of thousand miles away, and had no more information than I could get from reading the METARs. It's not possible to talk to an actual meteorologist, just someone in a windowless room miles away who just reads the data on his computer screen. With METAR stations as much as a hundred miles apart, the only way to get accurate weather information is to go look at it. That's the result of privatization and using the lowest bidder, or more often now, no bidder at all, just whomever has made the largest 'campaign contributions'.

Vertolot

19th Oct 2008, 08:55

Gomer Pylot,

Thanks for the corrections!

/Vertolot

mikelimapapa

27th Aug 2011, 13:36

Another EMS accident in Missouri claims 4 more lives

4 dead in helicopter crash - Local News Story - St. Joseph (http://www.newspressnow.com/localnews/28993198/detail.html)

Shell Management

27th Aug 2011, 13:58

I share your sentiments. This just has to stop,

1)When EMS operators start following the IHST toolkits on SMS, training and maintenance
2) When they invest in modern twin helicopters, certified to the latest standards (including crashworthiness)
3) When they operate with two crew
:p
Four die in Clay County medical helicopter crash - KansasCity.com (http://www.kansascity.com/2011/08/26/3102543/four-die-in-clay-county-medical.html)

Mechanical problem documented in chopper that matches partial tail number and markings at crash site- NBCActionNews.com (http://www.nbcactionnews.com/dpp/news/local_news/investigations/mechanical-problem-documented-in-chopper-that-matches-partial-tail-number-and-markings-at-crash-site)

FH1100 Pilot

27th Aug 2011, 14:08

verticalhold

27th Aug 2011, 15:43

FH

As you know, the 'preliminary reports', by which I take it you mean 'what is broadcast by the local TV', are often wrong.:ugh:

All three steps would massively reduce risk in a business that is patently not following ALARP principles and has a hoffiic accident history.:mad:

I sleep soundly at night knowing I am not complacent about safety.;)

Ah well; Shell Management, just like the real Shell claims to know all and is often found wanting. He/she can rarely provide proof of his claims and is so often wide of the mark that his/her pilot hatred is all that is obvious.

SM; you were the subject of a conversation in our office the other day, three management pilots, five line pilots, 4 members of the CAA and a member of EASA, a quality manager and a head of engineering all of whom have worked on Shell contracts were discussing what a total t***er you are.
And the more evangelical you become the more ridiculous you make yourself.

Why not wait for the accident report before telling us where aviation is going wrong?

In this case your comments are ill-timed and crass. Doubtless you see yourself as a saviour, I don't. So spare us your opinions and go take a good hard look at the real Shell. Maybe they will listen to you, because let's face it no-one one here takes you seriously.

VH

Horror box

27th Aug 2011, 16:48

Ah well; Shell Management, just like the real Shell claims to know all and is often found wanting. He/she can rarely provide proof of his claims and is so often wide of the mark that his/her pilot hatred is all that is obvious.

SM; you were the subject of a conversation in our office the other day, three management pilots, five line pilots, 4 members of the CAA and a member of EASA, a quality manager and a head of engineering all of whom have worked on Shell contracts were discussing what a total t***er you are.
And the more evangelical you become the more ridiculous you make yourself.

Why not wait for the accident report before telling us where aviation is going wrong?

In this case your comments are ill-timed and crass. Doubtless you see yourself as a saviour, I don't. So spare us your opinions and go take a good hard look at the real Shell. Maybe they will listen to you, because let's face it no-one one here takes you seriously.

VH

Rather unnecessary I think. :ugh:

Like him or not - personal feelings should not be relevant. I don't think I can disagree with the points SM makes about safety, and his suggestions are certainly very valid.

mikelimapapa

27th Aug 2011, 17:56

Agree with Horror Box, SM does make valid points that seem to be the root cause of most EMS accidents in the US.

The reason I started the thread is I recently read Randy Mains' book "The Golden Hour" which was written in the early 80's and outlines the same problems that EMS pilots still face today. It dumbfounds me that in 30 years the industry has learned nothing, while the Canadians and Europeans manage to do it safely.

Unfortunately, I don't think anything will change until profit margins are taken out of the equation and all programs are government contracts or charity based........some how I don't see that happening in the good old USA

zorab64

27th Aug 2011, 18:43

vh - you can be rude about people if you like but I'm afraid that, whether you like his comments, attitude or the individual, or not, there is no doubt that if the measures mentioned by SM were taken, the already risky business of EMS flying, which is multiplied many-fold by doing so at night, with one engine and invariably no autopilot, would be significantly reduced. IMHO, whilst SM item 3 (two crew) is great if you can afford it, items 1 & 2 would be a good place to start - SPIFR, with the proper equipment, is significantly preferable, and less risky, than more holes in the ground. :ugh:

What might have been a lifeline for one, in this case, turned out to be a death-line for four. It's not the first time nor, sadly, is it likely to be the last, until someone takes responsibility and legislates some significant risk-reduction measures. Flying cheaper aircraft to make a quick buck is not the way to go, IMHO, & I dread to think what EMS aircraft & crew insurance premiums are like in the USA, although I suspect they're subsidised by all that medical insurance that pays so much for the flights in the first place? :suspect:

Geoffersincornwall

27th Aug 2011, 20:13

Sad when people take all the trouble to burst into print when their sole aim is to shoot the messenger.

It's probably been said before but this site would benefit if people stuck to making their point and avoided personal abuse or pointless mud-slinging.

G. :sad:

tottigol

27th Aug 2011, 20:36

I hate to say this, but the "maintenance" article that SM is referring to in his post is total crap.
I am quoting from the article:"The guide vane sends gas from the compressor onto the blades and makes the rotors turn.:rolleyes:

That sentence alone shows total ignorance of subject.

Yes, we all know the sad situation governing the US EMS industry, yes it is sad that four persons perished, but SM has been correct before and while his post jumps to conclusions a bit prematurely, personal attacks are not entirely justified nor appropriate.

SASless

27th Aug 2011, 21:27

I have found the best way to accomodate SM is by use of the Ignore feature....as that prevents any aggravation while getting through his posts to anything substantive.....basically....if one does not see it...one does not get tempted to read it.

EESDL

27th Aug 2011, 21:32

so to para-phrase an old strapline.......
"you can (or maybe not) be sure of Shell"
;)

The Sultan

27th Aug 2011, 22:35

VH and Sas,

I would never ignore your posts as they are so entertaining because of gross ignorance. I do not know who SM is, or care, but the safety initiatives Shell has supported are beneficial to the industry.

The Sultan

Torquetalk

27th Aug 2011, 23:36

SM, why you would undermine valid points with the use of the ridiculous tongue-stuck-out symbol is beyond me. In the context it really is innappropriate.

Get a grip fella.

Heliport

28th Aug 2011, 00:20

The Sultan
entertaining because of gross ignorance
I agree posts by SASless are often entertaining. :ok:

Gross ignorance?
You'll have to make allowance for his inexperience. He's only got 10,000 hours, 2000 Army instructing, two Chinook combat tours in Vietnam, four years flying Hueys in the National Guard and 30+ years experience flying a variety of onshore/offshore ops in various parts of the world.

--------

Personal feelings should not be relevant and personal attacks are not acceptable but Shell Management has only himself to blame for his general lack of credibility. Various PPRuNe forums are littered with sweeping assertions by SM on a very wide range of topics which he is unable to back up when challenged.
That doesn't mean he's incapable of making a good point occasionally but it might explain why people react as they often do, in this and other forums.

H.

birrddog

28th Aug 2011, 01:40

I share your sentiments. This just has to stop,

1)When EMS operators start following the IHST toolkits on SMS, training and maintenance

Can't offer an opinion on this

2) When they invest in modern twin helicopters, certified to the latest standards (including crashworthiness)

No matter how many eninges you put in the bird, it only has one transmission, and the bulk of accidents do not come from engine failure

3) When they operate with two crew

The most sensible and valid point as most accidents are human factors related.

You could safe a ton of money flying singles and using that for a second set of eyes and ears.....

Far more valuable to me than a second engine, and a higher probability of keeping one from an incident.

pants on fire...

28th Aug 2011, 02:31

All three steps would massively reduce risk in a business that is patently not following ALARP principles and has a hoffiic accident history.

I sleep soundly at night knowing I am not complacent about safety.

Many would feel comforted to know SM sleeps so well at night. :eek:

Revealed: Shell (http://www.heraldscotland.com/news/home-news/revealed-shell-s-poor-safety-record-in-the-uk-1.1118890?localLinksEnabled=false)

robsrich

28th Aug 2011, 05:27

Just some thoughts from a study into the challenges faced by China which is about to rapidly expand the nation’s SAR and HEMS capability. In reality, the country is raising the equivalent of a small air force from almost nothing. (US 12,000 helicopters – China 127).

Their last fatal - an AW139, 17 Aug '11 four dead, believed to be a training flight, is now being investigated. Our thoughts are with their families, etc.

As history shows this can be a very costly business. Statistical evidence from the World Wars, Korea, Vietnam and later conflicts show that rapid expansion can result in enormous losses. This is usually caused poor supervision and training coupled with inexperience.

So what is the implication for China? Where do we start our research? What are the implications for the safety of aeromedical flight crewmembers?

It is estimated by the Association of Air Medical Services (USA), helicopters transport 400,000 patients annually in the United States. The growth in the HEMS industry has been spectacular. From 1995 to 2008 the number of helicopters used in aeromedical services increased by 130%.

Just over a decade ago the Americans were losing one aeromedical helicopter every week. In recent years, the loss rate has decreased substantially. In 2008 there were nine fatal accidents which killed 35 people. The following year in 2009 nine fatal accidents killing another eleven.

These figures could be compared with say; Qantas, and the expectations of their fare paying public. If you compare the HEMS loss rate over a typical year with Qantas carrying 38 million passengers without a single loss of an aircrew member, then you can see why the United States regulators have been reconsidering HEMS operations.

To put it bluntly, recent HEMS experience shows one crew member was killed for every 20,000 patients carried. By comparison, if Qantas had the same loss rate then almost 2,000 Qantas aircrew would have died to achieve the same uplift capability – 38 million??

This latent problem is probably being overlooked by the emerging Chinese HEMS industry which is probably focused on the setting up of the manpower and logistic resources to commence an aeromedical system.

With the power of hindsight, international advisers will need to tell the leaders of the emerging industry within China, the road ahead has many potentially fatal potholes. (As happened last week). And the loss of three Thai helicopters in one week recently?

They will need to harness the knowledge and skills that have been developed by the Western nations in accident prevention techniques associated with the SAR and HEMS operations. There is no doubt past lessons were written in blood!

Western organisations must be ready to provide guidance to the new organisers of the emerging industry, now being established as the airspace is being progressively released. No doubt AAMS and other international agencies will also need to lend a hand to ensure the traditional risk management procedures are covered in their safety system management protocols.

The international safety agencies will probably have to push very hard to get their point of view across to a group of people who have never experienced the pain of operating an aeromedical industry without the appropriate checks and balances. Today, the US is still suffering losses which must be measured against “risk verses gain” and is there an alternative to a high risk flight?

What are your thoughts??

topendtorque

28th Aug 2011, 11:16

thoughts?

good to see you back Rob.

tet

ShyTorque

28th Aug 2011, 11:53

I've read many of these reports. The reasons for "press-on-itis" need to be addressed. It's an organisational issue in some cases.

I've been in one SAR/Medevac/Casevac job where the department's measure of competence was the time of response. Totally dangerous. I took my time when needed and tried to impress upon those pilots less experienced than myself that they should do the same. I left the department. Not long afterwards one crew took a shortcut over a mountain at night after coming under pressure about a previous response time. They suffered a fatal CFIT accident.

Three lives and a valuable machine gambled against one life. They lost.

Gomer Pylot

28th Aug 2011, 16:44

Trying to compare HEMS operations with Qantas is simply silly. Qantas carries hundreds of passengers per flight, HEMS almost always one. Qantas operates airliners to and from major airports, HEMS from unprepared scenes at night, and to and from hospital helipads which are some of the poorest in the country. They're almost always an afterthought, with obstacles all around. But disregard everything except the first point, and you still can't make a comparison, because of the sheer volume of passengers that Qantas and the other airlines move on each flight.

I've said it before, and I'll say it again. European and other pundits have no business pontificating on the state of the US industry, just as the US pundits should, and generally do, keep quiet about their industry. It's a different culture, under different rules, with different philosophies, expectations, and goals. Right or wrong, profit is the driving force for all business in the US, and that will not change no matter how much fun the rest of the world wants to make of it. Short-term profit is the end-all and be-all of the US economy, and short-term profit is not possible if multi-engine, multi-crew aircraft flown only under IFR are required. So get over it, those will never be required, and will seldom be used.

SASless

28th Aug 2011, 17:00

Our friends and colleagues on the eastern side of the salt water divide do not have the basis to pass judgement on our system especially if they try to compare theirs to ours. It is Apples and Oranges pure and simple.

If they wish to stick to discussions about individual factors and not a general broad brush comparison then we can in fact have a very good exploration into why EMS accidents occur, continue to occur, and continue to occur for the same reasons.

We have to consider the changes put in place within the past few years that have helped reduce the rate of accidents and the numbers of people killed.

Things are a bit different than the last time we had a really good bashing of ideas.....as I was the instigator of two threads about helicopter accidents and industry culpability in the EMS and Offshore sectors of the US Helicopter Industry.

Perhaps it is a time to reference those threads and update them by evaluating the systemic changes, changes in the ownership of the various operators, and the effect (good or bad) of regulation changes and enforcement activity by the FAA and within the Industry itself.

Our friends around the World have valuable experience and thus can inject some fresh thinking into our large oyster....their ideas might not be useful considering the politics and economy but they are definitely worth hearing and discussing.

Things are better here than they were....but are they as good as they should and can be.....that is definitely going to be good fun arguing!

Let's start with some up to date statistics....if we can find them and compare years 2010 and 2011 to previous years. Perhaps something will jump out at us that will indicate what the trends are as to accident rates, fatalities, injuries, and frequency....perhaps comparison of current causes compared to past data.

ShyTorque

28th Aug 2011, 17:09

This profit driven philosophy is quite possibly where the much of the press-on-itis comes from. As for a mantra that the USA always knows best and no-one else is entitled to comment on any of it because they don't understand.....really!

How would relatives of a deceased patient or crew member feel if they knew that lives of their loved ones might not have been lost if things had been different i.e. profit for the service provider wasn't such a major issue?

We had a similar issue in UK a couple of decades ago. The only logical remedy was for CAA legislation to be tightened up, and it was.

As the saying goes, if you think safety is expensive, try having an accident.

SASless

28th Aug 2011, 17:38

As for a mantra that the USA always knows best and no-one else is entitled to comment on any of it because they don't understand.....really!

No one has suggested that Shy....but I do believe the converse/reverse was strongly suggested as being just as wrong.

mfriskel

28th Aug 2011, 18:03

I see a lot of US HEMS bashing from around the world. Does anyone have easy access to the following:

US HEMS accident rate- fatal and non-fatal per 100,000 hours? Or 100,00 patient transports.
UK HEMS accident rate- "
Canadian HEMS accident rate- "
German HEMS accident rate- "
Australian HEMS accident rate- "

Commercial helicopter accident rates for the same countries per 100,000 hours.

Private helicopter accident rates for the same countries per 100,000 hours.

Number of HEMS machines on duty in each of the same countries and availability ie day, night and weather conditions.

This information would make interesting charts. I imagine it is coallated somewhere and someone here probably has easy access.

I like to tell the pilots I train that there were sick and injured people long before there was helicopters. The patient has to be stable before we even load them. A broken helicopter and/or crew will do that patient no good. "Above all, do no harm".

ShyTorque

28th Aug 2011, 18:05

No one has suggested that Shy....but I do believe the converse/reverse was strongly suggested as being just as wrong.

SAS, So I've completely missed the point of the second paragraph of post #67? OK.... :oh:

Seemed plain enough to me.

Jack Carson

28th Aug 2011, 19:10

I can’t speak to European HEMES operations but I can address what I believe may be a contributing factor to the mishap rate here in the United States. The vast majority of US HEMS operations are would fall into a category identified as a traditional model. These are typically single engine machines strategically located to provide the operator with a solid business base for the machine. The AS-350 series make up a significant portion of this fleet. The AS-350 has limited payload range when kitted out for HEMS operations. It is typical to operate very near or at the aircraft’s maximum gross weight on every mission. A 250-300 lb patient in the US is the norm today in the US. At 33% fuel burn and using 11% (20 min.) with three 180 lb crewmen the fuel load would have to be limited to 45%. This leaves the pilot with only 1 hour mission fuel. Flexibility is not the norm.

Weight (Lbs) Arm (inches) Moment (inch-Lbs)
Total Empty Weight 3383.0 136.9 463132.7
* EMS Equip. 136 190.0 38787
Pilot Equip. 40 44.2 1745.9
Aircraft Basic Weight 3558 141.6 503665.6
Pilot 180 61.0 10980
Med 1 (fwd) 180 100.0 18000
Med 2 (aft) 180 100.0 18000
Mission Ready Weight 4098 134.4 550645.6
0
Patient 250 95.0 23750
Fuel (%) 45
Fuel (gal.) 146 Max. 66 0
Fuel 440 136.8 60217.992

Weight CG Moment
Takeoff Weight 4899 129.5 634613.592
* EMS Equip. includes items listed below in green
Available Payload 51 (lbs.) HOGE Wt.
23.23 (kgs.) 4950
Baggage Comp. EMS Equipment
Para Pack (9 lbs) 10
Backboard (14.5 lbs) 0
RSI Kit (16 lbs) 16
Tri Blue Bag (11 lbs) 11
Mast Pants (10 lbs) 10
KED Kit (9.5 lbs) 9.5
Green Bag (6 lbs) 6
Vent (2 lbs) 3.5
Traction Splint (5 lbs) 5
Misc. Equip. (3 lbs) 4.5
Total 75.5

By contrast the hospital based programs operate light and medium twin engine machines that provide sufficient payload range allowing for much greater flexibility and performance margins. I hope the Wt & Bal transfer to the PPRUNE format. It does not appear as if the excel spread sheet and chart translated very well. If anyone would like a copy just send me an email.

What Limits

28th Aug 2011, 19:31

It's a different culture, under different rules, with different philosophies, expectations, and goals. Right or wrong, profit is the driving force for all business in the US, and that will not change no matter how much fun the rest of the world wants to make of it. Short-term profit is the end-all and be-all of the US economy, and short-term profit is not possible if multi-engine, multi-crew aircraft flown only under IFR are required. So get over it, those will never be required, and will seldom be used.

With the greatest respect to our American brothers, there is the problem, right there.

What is the acceptable death rate of pilots, medical personnel and patients before something has to be done to change this?

SASless

28th Aug 2011, 20:31

Huge differences between the US and UK for night operations....for all intents and purposes....there are none in the UK.

Now the response will be...."OH Yeah!" and they will quickly point out the Plod (Police or Po-leece) do them all the time. Private Operators....of which there are literally a hand full in the whole place....do not operate after dark (unless I am grossly mistaken).

Canada has a very enviable safety record....thus we might look to the North for some ideas.

The UK EMS folks are just as dedicated as their mates around the Globe...but the CAA/JAA/EASA or whatever authority that is in control at any given day...severely limits Night and IFR operations to the extent if you get injured at night in the UK you will in all liklihood be transported by ground.

A question has been posed....."What is an acceptable Loss rate in lives and aircraft?"

I turn it around...."What is the acceptable loss rate in patient lives that are lost due to the absence of a 24 hour HEMES operation?"

mfriskel

28th Aug 2011, 20:44

Huge differences in other aspects beside night operations.

How are scene responses handles if they are allowed at all?
Are all flights inter-facility?
Some countries do not allown VFR night operations. Some countries do not even allow civil night operations at all.

I watched a response in Wyoming several years ago. The helicopter and the ambulance both departed at the same time. I asked about this and the guy told me that since the distances are so far, and weather reporting so scarce, that the helicopter launches and if he can not make it to the scene (possibly 75 or 100 miles away) the ambulance is already enroute. If the helicopter makes the patient pick-up, the ambulance turns around and goes home. This is one scenario you won't have in Europe.

Canadians might have some very long legs, what is the Canadian scene response like? Do Canadians do scene responses or are they mainly inter-facility? Remember, Canadian health care is socailized. Non-profit and they surely do not launch for cases that are not worthy of helicopter transport.

ShyTorque

28th Aug 2011, 21:02

Private Operators....of which there are literally a hand full in the whole place....do not operate after dark (unless I am grossly mistaken)

You are grossly mistaken. The night flying season is almost here again.

FH1100 Pilot

28th Aug 2011, 21:28

ShyTorque:So I've completely missed the point of the second paragraph of post #65?

Apparently. Nothing in what Gomer said in Post #65 implied that the U.S. model is the best. It's just what it is (profit-driven), and nothing, not all the whining from people in any other country is going to change that. As a culture and a country, the U.S. is apparently okay with the loss rates compared with injured people saved. Oh, the NTSB will harumph and recommend after every accident, but in the end very little will change.

Gomer Pylot

28th Aug 2011, 21:37

The acceptable accident and death rate will always vary between countries and cultures. It's a philosophical issue, and I'm not sure there is a right or wrong answer to that. Zero accidents by HEMS crews is one ideal, and a few accidents but fewer patient deaths because of lack of transport is another. It's a continuum without a firm boundary, like all moral issues. Should we let one person die to save many others, or save those we can and take a chance on many more deaths? Each person will have his own opinion, but I don't think any of them are necessarily right for everyone or everywhere. The US philosophy is the US philosophy, and the British philosophy is the British philosophy. Both are valid, but only for that locality.

To put it another, ruder, way, opinions are like a$$holes. Everyone has one, but the stink is in the nose of the beholder.

Another opinion I have is that you can't cure stupid. The profit motive has relatively little to do with press-on-itis, IMO, and the pressures are mostly self-imposed. My company has very strict weather minimums, and goes out of its way to remove pressure to fly. No one in the company has the authority to question the PIC's decision to fly or not, at any level. It's the pilot who decides to keep going in deteriorating weather, not the company's, and I believe that is the case in almost all the HEMS companies in the US. The hero mentality is dangerous, and I try to dampen it any time I see it. Anyone who is in this business to save lives is in grave danger of killing himself and his crew, but there are those who see the job that way. I don't know of a way to stop it, because you just can't cure stupid. Ignorance yes, but stupid, no.

ShyTorque

28th Aug 2011, 21:49

FH1100, Exactly, so I understood the post perfectly. SAS was mistaken, not I.

If profit and company competition is put before flight safety then accidents will happen. Simple enough. Like it or not, your system is some years behind Europe, we aren't whining about it. After a series of high profile nightflying accidents in UK the CAA put in place further legislation in an attempt to reduce them.

E.g. No single engined public transport at night. Police and EMS/AA deemed public transport. Unstabilised police aircraft legislated out of existence. All police base helipads to be lit to an acceptable standard by night etc.

None of it will prevent a crew having an accident if they really try hard though.

SASless

29th Aug 2011, 00:05

Shy,

What I was thinking....but failed to get to my fingers....was HEMS Operators not "Private Operators".

tottigol

29th Aug 2011, 13:54

Quote from GomerP:
"I've said it before, and I'll say it again. European and other pundits have no business pontificating on the state of the US industry, just as the US pundits should, and generally do, keep quiet about their industry. It's a different culture, under different rules, with different philosophies, expectations, and goals. Right or wrong, profit is the driving force for all business in the US, and that will not change no matter how much fun the rest of the world wants to make of it. Short-term profit is the end-all and be-all of the US economy, and short-term profit is not possible if multi-engine, multi-crew aircraft flown only under IFR are required. So get over it, those will never be required, and will seldom be used."

In more simple terms: You cannot fix stupid.

So, in accordance with that statement we should just let it be and let PATIENTS suffer the consequences, attitudes like that are the reason why I am happy to no longer operate in that segment of the industry.

Devil 49

29th Aug 2011, 15:45

What Limits wrote

Quote:
It's a different culture, under different rules, with different philosophies, expectations, and goals. Right or wrong, profit is the driving force for all business in the US, and that will not change no matter how much fun the rest of the world wants to make of it. Short-term profit is the end-all and be-all of the US economy, and short-term profit is not possible if multi-engine, multi-crew aircraft flown only under IFR are required. So get over it, those will never be required, and will seldom be used.
With the greatest respect to our American brothers, there is the problem, right there.

What is the acceptable death rate of pilots, medical personnel and patients before something has to be done to change this?"

Acceptable death rate? Zero. This isn't combat, where one calculates an acceptable loss (unless you're an insurance company). You can't usefully (or profitably) have a fatal accident, so good management is always working to reduce the possibility of that cost.
That said, the scenarios that US HEMS operates in and the risk management thereof will affect accident rates. How does that relate to the Missouri accident?

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ShyTorque wrote:

"This profit driven philosophy is quite possibly where the much of the press-on-itis comes from. As for a mantra that the USA always knows best and no-one else is entitled to comment on any of it because they don't understand.....really!

How would relatives of a deceased patient or crew member feel if they knew that lives of their loved ones might not have been lost if things had been different i.e. profit for the service provider wasn't such a major issue?

We had a similar issue in UK a couple of decades ago. The only logical remedy was for CAA legislation to be tightened up, and it was.

As the saying goes, if you think safety is expensive, try having an accident."

Sir, the scheduled airlines are all very much profit oriented, at least in the US, and their safety record is a respectable benchmark. It's not the "for profit aspect" that compromises safety, it's the methods used to maximize profitability.
The ultimate criterion might be "profits" but the methods are the same with bad management across the aviation spectrum, for profit and non-profit; government and private. Bad management encouraging bad practices isn't specific to any model.

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Jack Carson wrote:

"I can’t speak to European HEMES operations but I can address what I believe may be a contributing factor to the mishap rate here in the United States. The vast majority of US HEMS operations are would fall into a category identified as a traditional model. These are typically single engine machines strategically located to provide the operator with a solid business base for the machine. The AS-350 series make up a significant portion of this fleet. The AS-350 has limited payload range when kitted out for HEMS operations. It is typical to operate very near or at the aircraft’s maximum gross weight on every mission. A 250-300 lb patient in the US is the norm today in the US. At 33% fuel burn and using 11% (20 min.) with three 180 lb crewmen the fuel load would have to be limited to 45%. This leaves the pilot with only 1 hour mission fuel. Flexibility is not the norm."

I don't know where Mr Carson's numbers come from, I didn't wade through his table. I've flown EMS for 10 years, and I routinely operate at 2+10 in fuel. Yes, I'm often at or near MGTO or forward CG, but haven't had issues when I respect the RFM- and I do. Yes, when I have 200+ in each of the crew seats, I reduce base departure fuel load, and I may go as low as 1+55 in the summer, to allow a useable patient weight with NG limiting at Appalachian mountain heights.

45% departure fuel would have been an issue for the Missouri crash pilot, but I'm betting against fuel exhaustion in this event. I can't imagine why he'd leave base with almost 500 lbs to MGTO.

Charles Marlow

29th Aug 2011, 15:53

One obvious reason why the HEMS accident rate in the US is so high is because there are just so many flights.

The threshold for calling a helicopter to the scene of an accident is pretty low in many jurisdictions. First responders, concerned about lawsuits, treat every injury -minor or otherwise- as if it could be potentially life-threatening. Hospital doctors, too, are under pressure to err on the side of caution, ordering expensive treatment (to include helicopter transfers) that often goes beyond the actual needs of the patient. For-profit helicopter operators are only too happy to oblige.

Many studies have examined the effect of helicopter transfers on patient outcomes, and there clearly is a benefit. But it is a case of diminishing returns, with the benefit of transporting a patient with, say, a broken ankle approaching zero. Simply flying less will go a long way towards reducing the accident rate by reducing the exposure to risk. Unfortunately, it would require a wholesale overhaul, not just of the US EMS helicopter industry but of the entire healthcare system and the legal system to accomplish such a reduction on a nationwide scale.

ShyTorque

29th Aug 2011, 18:04

ShyTorque wrote:

"This profit driven philosophy is quite possibly where the much of the press-on-itis comes from. As for a mantra that the USA always knows best and no-one else is entitled to comment on any of it because they don't understand.....really!

How would relatives of a deceased patient or crew member feel if they knew that lives of their loved ones might not have been lost if things had been different i.e. profit for the service provider wasn't such a major issue?

We had a similar issue in UK a couple of decades ago. The only logical remedy was for CAA legislation to be tightened up, and it was.

As the saying goes, if you think safety is expensive, try having an accident."

Sir, the scheduled airlines are all very much profit oriented, at least in the US, and their safety record is a respectable benchmark. It's not the "for profit aspect" that compromises safety, it's the methods used to maximize profitability.
The ultimate criterion might be "profits" but the methods are the same with bad management across the aviation spectrum, for profit and non-profit; government and private. Bad management encouraging bad practices isn't specific to any model.

But you really can't compare helicopter EMS ops with the airlines. Airlines fly under IFR, above safety altitude in IFR equipped aircraft, with IR rated pilots (two of them), to and from IFR airports.

Not trying to fly through the hills in bad weather at night. Completely different ball games.

The point I was making is that if the EMS service provider had no profit to make, or profit to lose, based on retrieval of the patient, it would put less presssure on the crew to press on in marginal conditions.

Gomer Pylot

29th Aug 2011, 19:09

And if your Aunt Tess had balls, she would be your uncle. The current political climate in the US simply will now allow the government to do anything more than it's doing, probably less. Profit is the driving force of everything. I'm not saying it's right, I'm just saying it is. :ugh:

ShyTorque

29th Aug 2011, 19:53

Folks complain about over-regulation of aviation in UK (some of them have contributed to this thread). We can see the alternative in some of these accident reports. 52 lives lost since 2006 on supposedly life saving missions.

Charles Marlow

29th Aug 2011, 20:40

There's no reason to be defeatist; the US HEMS market is far from homogeneous. Even within the US there are many local and state governments that have taken a different approach to providing HEMS services to their constituents. The Austin, Texas STAR flight program, or Miami-Dade County Fire Rescue are just two examples that come to mind. They tend to be well-funded and highly regulated, just like many of the European HEMS programs. Anecdotal evidence suggests they maintain a similar level of safety.

Such programs provide a template for any other local or state government to follow, irrespective of FAA regulations; the state of the healthcare industry or the intrinsically capitalist nature of the country.

alouette3

28th Dec 2011, 13:45

irstly,let me add to the condolences offered here to the three souls in the aircraft and also to the person waiting for the heart transplant.The pilot was experienced and he certainly did not wake up that morning thinking that this would be a good day to die.There,but for the grace of God, go I.
Second, I too fly a VFR single (AS350B2) for an EMS outfit.We have only recently been provided with NVGs and before that,at my location, there were times when,if granny turned the porch light off at night, I was,for all intents and purposes, IFR.So,I too am on both sides of the Night VFR issue.
Twins versus singles is a non starter at this point as we don't know if the engine had anything to do with this.But, twins do have the ability to haul a lot more weight ,i.e. a second pilot,more bells and whistles etc.However, I do recall an S76 "fully loaded" for IFR with two pilots on board ,departing an airport,no less, running into a hill a few minutes after take off because they forgot to climb.
Ultimately, it boils down to Training and Technology going hand in hand.And, to be an EMS pilot and be able to say NO every now and then also requires a certain Temperament. It is up to the operators to offer the first two and to help select the appropriate guy for the job.And, it is getting harder everyday as the pool of experienced ,qualified pilots dries up.
Hope you all have a safe and a happy 2012.
Alt3.

EN48

28th Dec 2011, 14:03

do we always have the choice when we work...?

Yes - you always have a choice, even when you work. However, every choice, whether in aviation or in life, comes with tradeoffs, and some might not like the tradeoffs involved in refusing a flight. I would not have accepted the risks identified for this flight in this thread, however, this choice would be much more difficult if my income/career was on the line.

BTW, my understanding so far is that this flight, while somewhat urgent, was not a matter of immediate life or death. It appears as though the transplant recipient had a substantial time window and continued waiting for a new organ to become available after the flight. As others have pointed out, not an EMS flight responding to a trauma event.

Devil 49

28th Dec 2011, 14:31

"Who, exactly is supervising this aspect of FAA operations, to CONTINUE to allow crash after crash in the US EMS world. When will you guys learn, enough is enough. I thought EMS had been flushed through and a safer regime adopted. Obviously not."

The accident flight was not an EMS flight. This was a charter to harvest a donated organ.

Far as I know, nobody in the FAA is "allowing crash after crash in the US EMS world" or any other facet of US aviation. Mostly, I find relying on equipment- lots of engines, gauges, second pilots and autopilots, cooperative passengers and ATC to be very bad risk management. They all present issues and that stuff won't make the PIC smarter or errors made any less difficult. If the very real prospect of a killing oneself by accepting too much hazard isn't sufficient discouragement, all the regulations, risk assessment matrices in the world won't keep you out of a smoking hole.
Not saying I don't wish for power redundancy, etc. I do, often, and I can make it work. But I've also been way down in the bottom of that bucket scrabbling hard to get out, I have no illusions about invulnerability.

There seem to me to be many factors in common with a long list of accidents in this flight. The fact that this was a single, older pilot and a 206 isn't high on my list of potential issues.

[email protected]

28th Dec 2011, 16:03

RIP and condolences to all those involved in another tragic accident.

I have to agree with Devil49. I too fly HEMS in the rural areas of the SE USA. The easy days/nights are the ones where the weather is either really good, or really bad. Those in between and especially at night, where reporting stations etc aren't always available make some decisions very difficult indeed, even when always erring on the absolute side of caution. I doubt there are many here who have not had to abort a flight for weather at some point in their career despite our best intentions to never have to make that decision 'up there'. There is no sense of invulnerability here.

Having flown under FAA and European regs, it seems that the FAA and operators alike are doing all they can to mitigate the risks of our business. Some more than others perhaps, but at the end of the day no matter what guidelines or tools are put at our disposal the old adage goes you can take a horse to water but..... so in the interim I hope that we can all take any lessons to be learned from this event and remind ourselves that we operate in a challenging job with little room for error.

ShyTorque

28th Dec 2011, 16:08

It's very sad to repeatedly read about these tragic accidents which often appear to follow a common theme.

Just to set the record straight for some:

In UK, single engined helicopters are no longer allowed to operate in IMC, period.

In UK, there is no such thing as "Night VFR" for civilian operations. Flight under VFR is not allowed by night / night flying must be carried out under IFR. However, IFR are deemed to be met below 3,000 feet if sufficient external visual cues on the surface are available for the attitude of the aircraft to be assessed and maintained.

The difficulty comes from recognising when sufficient external cues no longer exist. Pilots must be totally prepared (in all respects) for a safe and timely transition to instruments.

VFR is safe enough, IFR is safe enough (neither without some level of risk), but transitioning from one to the other needs some serious thinking about to be safe.

Public Transport (PT) by night in UK is no longer allowed in single engined (and therefore non-fully IFR equipped) helicopters. We suffered some very high profile public transport accidents some years ago and singles were subsequently outlawed.

This tragic accident was obviously not a police operation but seeing as this type of operation has been mentioned, it should be remembered that in UK, police operations are deemed to be Public Transport and must operate under the terms of a Police Air Operations Certificate. The Chief Constable of the unit is deemed to be the PAOC holder. UK Police helicopters must be twin engined, (day or night) and for night ops or IFR must have a stabilisation system fitted. They are actually most often operated under "Visual Contact Flight" (VCF) rules by day or night, which give defined, but slightly less strict, weather criteria than for other other public transport operations, including minimum separation from cloud.

UK police pilots are required to carry out mandatory regular instrument training with a safety pilot on board (whether holding a full IR or not), so that in the event of inadvertant entry to IMC they should be fully competent to recover to a diversion airfield for an instrument approach or at the very least for a letdown to VCF over a safe area.

Having operated under military, police and purely civilian / PT rules, single pilot, in both single engined, twin engined, non stabilised and unstabilised helicopters I would personally always take the "full IFR" option (where possible) for a job like the one in question. Irrespective of local rules or which type of AOC I was required to operate under.

This accident, for the purpose of saving one life, resulted in the tragic loss of three lives. Many others in the not-too-distant past have done the same.

In UK the flight in question just would not have been allowed. Period.

Seems to me that the only reason that the USA rules still allow this type of public transport job is resistance from the industry, to keep down the cost and keep up profit margins. If we can make the changes in little old and broke UK, why can't the USA? :confused:

SASless

28th Dec 2011, 16:39

UK police pilots are required to carry out mandatory regular instrument training with a safety pilot on board (whether holding a full IR or not), so that in the event of inadvertant entry to IMC they should be fully competent to recover to a diversion airfield for an instrument approach or at the very least for a letdown to VCF over a safe area.

Why would the CAA not require a full IF rating for such operations if the intent is to provide an Instrumented Qualified Pilot?:ugh:

I guess another way of phrasing the question would be why would the same CAA insist on an IF rating if there is no "intent" for a VFR operation to convert to an IFR operation.

As to your final paragraph....here in the USA...as mentioned dozens of times in the past by mulitiple posters....we operate on the "You Can unless prohibited"....as compared to the UK "You Cannot unless specifically authorized" mindset under the Air Regulations.:=

The CAA and FAA rules sometimes defy commonsense and logic it seems!

Bladecrack

28th Dec 2011, 17:21

The debate against single/twin engine and single/multi crew will go on for ever until the laws are changed and enforced. Unfortunately, we as pilots often don't have the choice to decide. Sure we can say no to certain flights, but as in this case for example (which might have happened), when someone knocks on your door late at night and asks you to go fetch a heart urgently before it and/or the recipient dies, what are you going to say??? I can only do it in the twin... But lets say the twin is down, not fueled, or parked in the back of the hangar and it will take an hour to get it airborne...and the perfectly good old 206 is parked in front, fueled and ready to go... 9 out of 10... if not 10 out of 10 of us, who all have done these flights before in a singles and on our own (with out the added rush of loss of life pressure) would say lets go.....

Flyting - :ugh: As a professional pilot I for one would do my utmost not to allow those sort of consideratons to influence my judgement, and I would further venture that its exactly this sort of "lets go" attitude that is a major factor in the accident rate for US EMS related flights being so high.

Unfortunately I can see from other replies that this sort of mindset seems to be ingrained in a majority of US pilots and until a change in the rules is forced upon a reluctant helicopter EMS sector, nothing will change and accidents such as this will continue to happen at an alarming rate.

BC

ShyTorque

28th Dec 2011, 17:26

SASless, they weren't my rules, I only had to stick to them.

You often criticise our stricter UK rules and anyone who dares to mention them here, but the proof is in the pudding - we don't suffer the same losses. From experience, the risk of these kind of flights (i.e. are they VFR or are they IFR) is deemed to outweigh the benefit by the regulatory body.

The answer to your first question is about the same as the last but one line of my previous post. The rules here were changed after a fatal night-time accident to a UK police helicopter. Problem was, when it occurred, the majority of police ASUs were relatively very new entities. Many of the aircraft coming into use were not fully compliant with IFR flight. The one I flew had to have it's stabilisation system removed to save sufficient weight to fit the police equipment and had to be flown completely floppy sticked (i.e. twin engined, previously IFR equipped but now NOT so).

You can perhaps understand the problems it would have caused if Chief Constables were suddenly told the helicopters they had just paid for had to be scrapped...... Back then the large majority of police pilots were ex-mil. Giving those pilots some IF training was a half-way compromise.

A police aircraft is an observation platform. If the aircraft goes IMC the job is, by definition, thrown away. The limited IR training mandated was to give pilots some recency; many of them had previously held a military IR.

Last thing I heard was that once the "old" aircraft were replaced by more capable ones (i.e. fully IFR equipped) the further intention was for all UK police pilots to become IR holders. As I've been out of that industry for over a decade I'm not qualified to give a more up to date progress report on that front. Again, it's down to money.

SASless

28th Dec 2011, 18:05

You often criticise our stricter UK rules and anyone who dares to mention them here, but the proof is in the pudding - we don't suffer the same losses. From experience, the risk of these kind of flights (i.e. are they VFR or are they IFR) is deemed to outweigh the benefit by the regulatory body.

Well almost correct Shy.....I criticize the unrealistic UK Rules and those who hit us with a "Father knows best" attitude about them.

I am quite willing to bet one of the reasons you don't suffer the same losses is you don't do the same tasking. For sure your loss rate will be better if one does not leave the ground but then if you don't fly....injured and ill folks pay the price for that kind of mindset.

Do it in an unsafe manner and the EMS crews and some patients will pay the that price as well.

The UK Helicopter industry ashore is quite limited compared to the sheer size of the US helicopter industry.

There are between 400-500 EMS helicopters in the USA providing a 24/7 service to the country. Compare that to the the UK please and tell us it is an Apples to Apples comparison.

That we lose too many people and aircraft.....for way too many of the same reasons year after year is a true statement and if you recall I am critical of the US EMS industry for its seemingly cavalier attitude towards that.

The past two years has seen a marked improvement in the loss rate as the industry and the government has been forced to reconcile the old way of doing business with the adverse PR they have had to face up to due to the number of fatalities the industry has experienced in the past.

One metric that is not measured is the numbers of lives lost due to the lack of a 24/7 EMS service in the UK and Europe due to the strict rules of flight. That might be a telling number?

The sad truth is trying to provide the 24/7 service but doing so in a safe effiecient manner is always going to be a balancing act.

The CAA/FAA rules should assist in improving safety but do so without preventing the provision of the service for unnecessary bureaucratical reasons.

Just what is different between VFR weather (1000/3 miles) in the UK and the USA....same aircraft, same standard of pilots, same weather....yet we can fly and you cannot. Does it not seem just a wee bit odd to you?

The UK legal environment for Helicopter EMS operations is different than that here in the USA and one set of rules does not fit both situations.

People died before the advent of ground ambulances, EMT's, Paramedics, and Helicopter EMS with its Paramedics and Flight Nurses and the current EMS crews should accept they will not be able to "save" every life in jepordady. Way too many forget they are in the medical transport business and not the life saving business.

ShyTorque

28th Dec 2011, 18:54

I criticize the unrealistic UK Rules and those who hit us with a "Father knows best" attitude about them.

The CAA run a tight ship but that's the law of the land. There's no point in arguing so I don't, nothing "Father knows best" about that.

There's many a time when there is no IFR option that I could have launched in poor weather and easily have got to my destination under our military regulations. But despite flying a more capable aircraft, these days I fly under stricter civvie rules. Frustrating at times, to be honest.

Way too many forget they are in the medical transport business and not the life saving business.

I agree totally with you on that. Even where the mission is a life saving one (and we've both been there many times), common sense should indicate that the job ought to be done in such a way that the big picture / overall risk to all concerned is kept in mind. If common sense fails, (perhaps due to commercial pressures) legislation could do something about it. In UK we don't have a situation where perceived "medal missions" get mixed up with making a profit.

But I can't completely follow your underlying rationale. Do you want safer night EMS ops in USA, or not? It appears that you do, but appear to strongly oppose any suggestion that the stricter rules already applying elsewhere just might help make it safer. When legislation levels the playing field, the only difference once the dust settles is that the price of the job goes up. So how much are the lives of an EMS crew worth? You appear to be saying there is a difference from one side of the Atlantic to the other.

SASless

28th Dec 2011, 19:32

It appears that you do, but appear to strongly oppose any suggestion that the stricter rules already applying elsewhere just might help make it safer.

How many 24/7 Helicopter EMS Operations are there in the UK? How many can do scene landings off airport at night?

If the rules were changed...would there be more EMS operations that would set up shop and thus provide a needed service to the community? You reckon the Operators would find a way to do it safely despite a change in your rules?

Have you ever done a realistic comparison of the US aviation infrastructure provided by the government to that provided by the UK government?

Can you land at an airport when the Control Tower is closed? Can you land at an airport that does not have on-site manned Fire Services? There are dozens of examples of where your system is so restrictive it kills the industry but will you accept it being so?

Lord God Shy....what happens if you have the sheer gall to walk on the Dispersal without a Hi-Vis Jacket?

Your rules don't make it safer....they make it impossible!

That is my underlying message Shy......the rule should make it safer...not bloody impossible!

Again...you fail to make the connection that the UK rules prevent real Helicopter EMS operations based upon the "rule" rather than 'performance".

It is the Pilot/Operator that should be the deciding authority upon when the service is provided...not the Government. The government should provide the opportunity for the private sector to offer its services.

If one legislates the standards to the point the service cannot be done at all....then where is the sense in that?

Your inability to accept the CAA's rules as being excessive is the usual Achille's Heel Brits have when defending the rules you have to work under.

The CAA has earned a nickname of "Crats Against Aviation" for valid reasons...some fairly applied and some not.

hillberg

28th Dec 2011, 19:32

Helicopters even with A full box of IFR gear, Helipilots and such make a rotten platform, The IFR ststem was designed for Fixed wings flying to equiped locations via airways , The helicopter environment is too close to mother earth & what hospital will put out for a pad with all the trimmings?
New rules never fix anything, A better infrastructure will. Till then learn to say later.

ShyTorque

28th Dec 2011, 20:56

SASless,

So what is your "text book" solution to the issue in question, ie. how would you make "VFR" Night Ops safer?

Can you land at an airport when the Control Tower is closed? Can you land at an airport that does not have on-site manned Fire Services? There are dozens of examples of where your system is so restrictive it kills the industry but will you accept it being so?

Yes, I can. I can also legally land off airfield by night, too. I try to avoid it like the plague.

I've done it many times in the past (UK Military/ Civilian Casevac & SAR, Far East / UK police/ Private). I'm fully aware of the risks involved and those risks are not to be underestimated.

Towards the end of my military service non-NVG ops became known as "reversionary night flying". Twenty years ago, a decision was made such that every night flight was made on NVG. Ad-hoc landing sites were not normally allowed unless a second aircraft could illuminate the site with black light. The military decided over two decades ago to desist from doing multi-crew what your EMS folk are still struggling to do single pilot and without NVG.

I'm fairly sure that the UK rules don't forbid night landings for EMS / Air Ambulance flights. Instead the individual authorities providing the service have risk assessed it and for now have decided not to do it. I was in conversation with the chief pilot of an air ambulance unit about three weeks ago and this was a subject he brought up. He said that it will be done in the not too distant future.

Hi-viz jackets? I don't see what that has to do with the issue at all, but some UK airfields (licensed or otherwise) don't mandate Hi-viz. Some actively discourage them. It's not a CAA requirement, but a local Health and Safety one. I don't like wearing mine just because some graduate did a course on it, but I will wear it if I think it's safer to do so, such as on our unlit dispersal at night (shock horror, yes, totally unlit, in the dark).

Your inability to accept the CAA's rules as being excessive is the usual Achille's Heel Brits have when defending the rules you have to work under. The CAA has earned a nickname of "Crats Against Aviation" for valid reasons...some fairly applied and some not.

My inability....? I don't defend the rules (CAA always known as "Campaign Against Aviation", btw, not 'Crats).

I do however comply with their rules A) because I want to keep my licence and B) because I hope to reach my retirement in one piece without being put in a situation where I feel under commercial pressure to push the limits, risking my aircraft and crew / pax to get a job done. Let alone in an outdated aircraft. Did you operate differently? Does EMS USA operate differently to that? What's wrong with a planned IFR transit, in a properly equipped aircraft, followed by a letdown to VMC below?

SASless, Why not refrain from attacking the messenger and look outside the box?

homonculus

28th Dec 2011, 22:02

As this thread swings from mandatory twin pilot IFR to landing on scene at night it is important to remember that EMS is totally different in the UK from the US.

In the US many helicopter systems are bolted on to hospitals because they are needed to provide adequate population numbers for specialist services. Many systems operate secondary transfers, often involving patients with low levels of pathology, again so regional centres can exist outside big cities. Neonates need to be transferred far more frequently over longer distances and trauma is far more common and severe.

In the UK we dont have community hospitals and since 1997 more and more hospitals have provided all but the most specialist services so that the trauma concept of 1990 has been abandoned and the much lower number of trama victims are taken to the local hospital. Neonatal transfers are less common, involve shorter distances, and paediatricians normally manage most transfers with specialist ground vehicles. Inter ITU transfers by helicopter have been shown to save lives, but the specialised equipment is quite different from a HEMS helicopter and to put it bluntly the NHS wont pay.

So in the UK there is little evidence of lives saved; the London hospital's HEMS was very carefully audited but the only 'life saving' was severe head injuries and the cost was many times that of even heart transplantation. As a result we are likely to continue to see EMS helicopters used by ambulance services as opposed to hospitals, for rural areas and to help ambulance managers meet time targets. That is not to say they do not have major benefits including pain reduction and freeing ground units but life saving doesnt stack up financially or logistically.

As such running daylight only systems seems to be sensible, together with a proper chinese wall such that despatchers and pilots do not know the medical indications of the mission. The idea of landing on scene at night terrifies me and the potential benefits are questionable. However, having flown in the back of these ships both sides of the atlantic I despair at the holier than thou attitude towards the US with its totally different needs and driving forces. I am sure most US operators wouldnt turn away full IFR ships and would like the opportunities to reject more flights, but hospital operators asnd indeed patient needs demand otherwise - for the present at least.

Jack Carson

28th Dec 2011, 22:53

EN48 made a very good point concerning the utilization of auto pilots in light single engine machines. That one device would take much of the anxiety out of IIMC events. An autopilot doesn’t care if the machine is in IMC conditions. All the pilot has to do is properly manage the autopilot throughout the flight. In the US, operators have opted for NVGs to mitigate night operational risks. NVGs may assist in not encountering IIMC but would do little once IIMC is encountered.

Single versus twin engine has little bearing on the discussion at this time. Statistically, because the actual number of in-flight engine shut downs for all turbine engine helicopters is so low it would be difficult to establish that the number of engines has any bearing on EMS accident rates.

Our regulatory system in the US should absorb much of the blame. Our system has turned its back on safety putting the operators concerns ahead of safety when regulating operators. The fact that a helicopter can operate at night with only 1 mile visibility (FAR135.205) and with no reference to minimum ceiling borders on insanity. Our air medical mishap rate however dismal it may seem, could be far worse if it were not for the professional decisions put forth by most PICs before each and every flight.

rotorspeed

29th Dec 2011, 00:35

The big issue with using twins is largely that (in Europe at least) you need a twin to have IFR capability. You can't go IFR (and shouldn't go IMC) in a single. End of story. And no-one here sees that changing. I had thought that applied in the US too, but maybe not? I'm sure someone will confirm. Apart from engine redundancy, an IFR twin will also have redundancy of many other systems such as instrumentation, hydraulics, generators and inverters, providing added safety when stuck up in the clag for some time.

As it happens, I'd be fairly comfortable in IMC in a well maintained and preferably newish single like a 350B2/3, with a good autopilot, but the law doesn't allow it in Europe. Having said that, I'd still take the psychological comfort (as would most pax) and some practical benefit of a second engine!

SASless; you say the pilot/operator should make the decisions not the government. Ideally yes, but history proves that pilots' judgement is too often not adequate. Legislation therefore reduces the scope for such decisions - and getting them wrong. They can also take pressure off a pilot by enabling him to simply say, for example, I'm not legally permitted to take the B206 on the flight tonight. It will need to be IFR twin or not at all. Don't get me wrong, the extent of legislation can be very frustrating, but it does have its benefits.

And finally - as I've asked before with no response - does anyone know of any safety statistics relating to European and US EMS ops? Clearly they need to be interpreted carefully and can be misleading, but would be useful.

SASless

29th Dec 2011, 00:53

So who in the area had a Stokes Litter or other Rescue Litter? Do the RAF or CoastGuard SAR aircraft carry such a device aboard the aircraft? I wonder if any thought was given to asking for their support in the mine shaft rescue?

I can understand a reluctance to moving a casualty by harness and rope lift....considering the circumstances as there was a great risk of spinal injuries. Immobilzation of the head, neck, and spine are very important where there is such a risk.

Part of every fire fighters basic training in this country requires rappelling, rope work, and rescue techinques. Every EMS wagon/aircraft carries and routinely uses immobilzation equipment. Fire Fighters are also dispatched to such calls and each unit carries trained EMT's amongst the fire wagon crew.

We have practiced Short Hauls of Emergency Personnel using helicopters for isolated area rescues in various fire units around the country.

How far away is RAF Kinloss and RAF Leuchars from the site of the mine shaft?

before landing check list

29th Dec 2011, 00:56

SASless wrong thread maybe?

SASless

29th Dec 2011, 01:02

BFC....exact right thread...see Brassed Off's post and link.

The answer pertains to the discussion about lack of service...rules getting in the way of getting the job done...and lives being lost as a result.

A fully qualified medical team could have been delivered by an EMS helicopter directly to the scene if it had been available. Shy of that....there is the RAF SAR units that could have been tasked despite their lack of first class life support equipment in their cab.

There seems to be a misunderstanding about the capability our US Helicopter EMS operations can bring to a casualty amongst our UK friends. The modern EMS helicopter is not just a transport wagon but a fully equipped medical unit with two very skilled medical crewmen....usually one being a Flight Nurse and the other an experienced Paramedic with advanced training.

A situation described in the article linked by Brassed Off would have been an immediate call for an EMS helicopter in the USA....without any doubt what so ever....and one would have responded within minutes of being called. (With the usual assumptions about flyable weather).

before landing check list

29th Dec 2011, 01:04

OH yes, sorry. Thought you were talking about the winching situation in OZ.

rotorspeed

29th Dec 2011, 01:34

Before landing check list

I'm saying what I did, no more, no less. Slightly difficult to decode your post, but I'm not saying what the cause was, I do suspect the most likely cause is LOC in IMC, I do not think for one minute this 206 was IFR, I do not think it's just UK that does not permit SE IFR - indeed I am waiting to hear if the US does permit it.

Right?

before landing check list

29th Dec 2011, 01:46

Right, the US does permit SE and or SP IFR. Why not? It is about training. If it were about engines.....how many is really enough for IFR? Over the north Atlantic in the winter, 3 or 4 would be grand. I think your "No SE IFR" is just a knee jerk reaction. Obviously one cannot just throw more pilots and engines into the mix and call the problem rectified, can we? It is still mostly about training. Of course having more then one engine that will sustain flight while in the flight regime you are in one one engine dies is nice also. Maybe I just do not fully appreciate knee jerk reactions as much as I should, that's all.
BTW my post #81 was the result of a knee jerk reaction.

Gomer Pylot

29th Dec 2011, 03:21

Single-engine IFR is not prohibited in the US, but it is very rare for commercial operations. BH206s are not approved for IFR because they have only one electrical power source. There have been a few approved, with stability augmentation and spare generators, but it's uncommon. I don't know of any approved for commercial operations, which are different from private or corporate use. The US Army does operate 206s IFR, but it is not subject to FAA oversight. Nor is any other government entity.

EMS helicopter operations are becoming rather highly regulated in the US, but this flight was not an EMS operation. It was a straight Part 135 charter. Criticizing the Mayo Clinic for operating an older aircraft is just silly, because they didn't own it, they just chartered a helicopter on short notice. They took what they could get at the time, and almost certainly had no idea how old the airframe was. And the airframe age makes no difference at all. That's a complete red herring.

Allowing or not allowing night flights in single-pilot, single-engine helicopters is a decision that has to be made through a cost/benefit analysis. How many lives are likely to be saved over the long run, and how many lost? In England, probably not many will be saved, because the distances are so short. The entire island would almost fit into the area in Texas that I routinely cover. Here, an ambulance would take hours to cover the distance to a trauma center over rural roads, while a helicopter can do it in well under an hour. However, there is no way to break even, much less make a profit, using twin-engine two-pilot helicopters. And profit is the overriding issue, make no mistake about that. The federal government will not be involved in providing EMS services. So the choices are to allow HEMS flights in smaller, cheaper-to-operate aircraft, or to go back to the early 20th century and run ambulances hundreds of miles to get trauma, cardiac, and stroke victims to a hospital that can provide the necessary care. Local hospitals are fine for minor illnesses and sprains, but they simply can't handle much else. That's not ideal IMO, but I'm not in charge of the system. In short, as I've said before, those on the eastern side of the pond are simply ignorant of the way things work here, and why, and their babblings will continue to be ignored here. We already fought two wars to be rid of English rule, and aren't about to give in to it now. :rolleyes:

Thomas coupling

29th Dec 2011, 09:10

Jack Carson has hit the nail on the head. He describes exactly, what the US environment is like. Commerce comes first and safety follows a close 2nd, or maybe 3rd.....
The end.

before landing check list

29th Dec 2011, 10:13

And this is different from anywhere else how? Hard to believe some of us are playing holier then others.

SASless

29th Dec 2011, 13:14

TC.....Does not the Operator have the option of setting higher standards...does not the Pilot have the option of saying "NO!"? As an industry....do not the EMS providers through their many Professional Associations and Certification Councils have the ability to set safe minimums or minimum standards for all their members?

Why is the government supposed to be the decision maker as to "Best Practice" standards and upon what basis do they know what that Standard is supposed to be?

When I was in the seat both as a Pilot and later as a Manager....I set higher limits for myself and later for my Pilots. It was not always easy or well received by all....but the majority of folks I either worked for or supervised learned to live with me.

Case in point....a company pilot flew a Bell 206 to our home base after dark one night over some very dark ground....it being a forested area surrounding a fair bit of saltwater. I told him I preferred he not do that....and that I would gladly pay for his Room and Board if he would wait until daylight to make those kinds of trips. He took it as an insult to his abilities....when all it was intended to do was make it a bit safer for him in the future. As he was doing the trip under Part 91....the surface light reference requirement noted by Part 135 did not apply. (One of the odd things in the FAA rules...) thus he was legal and within the law. At that time there was not a Company SOP Manual....and as Part 135 did not apply....the decision to make the flight was his to make. In time he came to understand my reasons for my view on the matter. That and he found himself a Girlfriend in the remote location and thus had far more incentive to accept our coin for spending the night up there.

Point being...it does not remain with the Guvmint to tell us what to do right down to the very letter of the word....and in fact the less they interfere in our business is the better leaving us, those actually doing it to arrive at a safe standard. That is an American viewpoint....and flies in the face of the mindset in the UK and Europe. That is where we shall always differ from you folks over there....and hopefully despite the current Regime in office here....the current trend will only be a temporary one.

In our system....the Insurance Providers carry far more clout than do the FAA! If one cannot get the necessary insurance or cannot pay for it when offered....one is out of business! Commerce and Safety do go hand in hand when viewed from that perspective.

[email protected]

30th Dec 2011, 06:55

there is the RAF SAR units that could have been tasked despite their lack of first class life support equipment in their cab. Sas, not sure what you mean by this and what extra kit you think an ambulance, air or otherwise, has on board that we don't.

Back to the thread and there seems to be a disconnect between what SAS and others are advocating - eg self-regulation being the answer because no-one wants the Govt (FAA) to determine what is and isn't safe whilst on the other hand, the evidence being that self regulation isn't preventing accidents from happening.

Is it the quality of those in the cockpits? Is it just that the operators won't apply quality control because they might lose profits and go out of business?

Sas, you said earlier that people died before the advent of ambulances, paramedics and helicopters - why not accept that is still the case and that EMS can't save every life in the US?

VFR night flight with 3nm and 1000' might be quite acceptable for many pilots to complete EMS jobs but add in variable weather and availability of accurate met info, mixed terrain and a non-stabilised, non-IFR, single pilot aircraft and surely anyone can see the holes in the swiss cheese lining up!

You can either continue to defend your right to bear arms (in this context fly without regulation) and accept that accidents will still occur in marginal weather - or mandate minimum operating standards and equipment rather than jumping through loopholes in the existing FAA regs in order to get the job done cheaper.

SASless

30th Dec 2011, 12:10

Sas, not sure what you mean by this and what extra kit you think an ambulance, air or otherwise, has on board that we don't.

Nice of you to join in Craab....perhaps you can answer some of the questions posed earlier about the Strathclyde Mine Shaft tragedy.

I am quite sure the SeaKing you lot enjoy with all of its amazing kit....does not have Heart Pumps, Ventilators, LOX systems, and other standard fit that most US based EMS helicopters do. I also would be quite surprised your Crewmen are as highly qualified and certified medical specialists as are routinely assigned to US based EMS helicopter crews.

That is because you are Rescue folks and not Medical Intervention folks....as the tasks are very different.

What is the medical capability of the standard RAF SAR Rescue crew?

The rest of the discussion revolved around the lack of a Litter/stretcher where the woman who died in the Strathclyde mine shaft tragedy could be lifted safely to the surface.

My question about the RAF SAR units nearby....was whether you carry such a stretcher/litter onboard your aircraft as a standard fit as does our USCG and Air Force Rescue folks do.

Since you are involved here now Craab....can you answer those questions for us?

Do you lot have a winchable stretcher onboard your aircraft?

If requested by the Strathclyde Fire Brigade...would you have responded to the scene?

If requested....how long would it have taken for such a response?

Was the RAF contacted by the Strathclyde Fire Brigade about the feasibility of such a response?

Did the RAF Mountain Rescue Team(s) respond to that incident?

If they did...what were the results?

Gomer Pylot

30th Dec 2011, 15:20

Crab, we can advocate all we want, but here it's not a matter of what is best, more a matter of what is possible. It simply is not possible for the FAA to suddenly rule that single-engine, or single-pilot, aircraft can't fly VFR at night, or fly at all. It makes no difference at all whether that would be safer, or would save lives. It simply is not possible. Laws and politics are different in different countries, and just because Great Britain has such laws, that doesn't mean that any other country can or should have them. Political and constitutional realities have to be considered, regardless of whether they're right or make any sense. In the short run, regulations in the US will not change. Perhaps over decades, but not this year, or next. What we have to do is accept the regulations as they are, and provide for our own safety, by refusing flights that while legal, are too dangerous. Not everyone is capable of doing that, and not everyone has the same level of experience or proficiency. Thus what is safe enough for one may not be safe for another, and unfortunately not all have the same ability to judge the dangers correctly. It's the system we have, and we have to deal with it as it is.

[email protected]

30th Dec 2011, 17:26

Gomer Pylot - I can see your points entirely but if that is the feeling amongst all pilots in the US there is no reason to be wringing hands every time an EMS heli crashes in dodgy weather.

If you accept your system for what it is and believe that it cannot be changed for the better, the only thing you can do is mourn the poor sods who have died and will continue to die in accidents that could (more often than not) be avoided.

Sas, our standard rearcrew complement is a paramedic qualified winchman who is able to intubate and cannulate and give pain relief like morphine - and a winch op who will be ambulance technician qualified - so 2 medically qualified crew in each aircraft. Some of the junior winchmen may only be technician level until they have been in the job for a year or so but they are in the minority.

When you say 'heart pumps and ventilators and LOX systems' what are you actually talking about? Heart pumps and ventilators are the sort of thing only doctors can treat patients with and usually only in hospital - we carry these items when we transfer a patient from one hospital to another and they are quite big and heavy.

LOX - we carry more than sufficient O2 for casualties, along with entonox - is that what you mean or are you referring to something like the S-92 which has its own oxygen system in the aircraft?

How many US HEMS crews carry a doctor on routine recoveries from traffic accidents or the like? I can imagine, as happens here, if you do an inter-hospital transfer, that any appropriate medical staff (consultants, specialist nurses, transplant specialists etc) are taken along.

As for the Strathclyde incident - yes of course we carry a winchable stretcher - its our job! We have the Stokes litter with a vac-mat and as an alternative we carry a Neil Robertson stretcher. The Stokes can be winched vertically. There is also a Kendrick Extraction Device for stabilising spinal/neck injuries.

Don't get too hung up on that incident - a US HEMS aircraft would have been no use either since the problem was the Fire Service management and the ridiculous Health and Safety culture that prevents lifesavers doing their job.

Our standard response time in the wee small hours of the morning is 45 minutes to take off (normally less) plus the time taken to get to the casualty.

I cannot answer the rest of your questions because I was not involved in the incident - if the police had requested SAR or MR then they would have been tasked unless there was a very good reason not to. Some of the emergency response protocols in UK are not that 'joined-up' especially across different agencies and boundaries and it is a constant source of frustration that we are often last on the list to be called instead of the first. The RAF SARF and the ARCCK seek constantly to educate ambulance and police control rooms so they understand out capabilities.

ninja-lewis

30th Dec 2011, 20:02

Further to Crab's reply, athough I have no involvement in SAR/HEMS, I am a local and can address some of SASless questions about the mine shaft death (based on the facts that came out in the Fatal Accident Inquiry rather than the media reporting):
So who in the area had a Stokes Litter or other Rescue Litter? Do the RAF or CoastGuard SAR aircraft carry such a device aboard the aircraft? I wonder if any thought was given to asking for their support in the mine shaft rescue? The two fire engines that arrived about 15 minutes after the 999 call was made both carried sufficient "Safe Working at Height" kit to effect a rescue. The road ambulance (carrying two paramedics) that arrived at the same time also carried a Kendrick Extraction Device, which could have been used.
Less than half an hour later, the Fire Service Heavy Rescue Vehicle arrived, carrying in particular a thermal basket stretcher and a MIBS stretcher (also suitable). The Mountain Rescue Team that attended had their own McInness stretcher and rope access equipment.
　
That's not counting the specialist Scottish Cave Rescue Organisation if only they had been contacted sooner. Heck even the local Coastguard Rescue Service could probably adapt their cliff rescue equipment to do the job. Failing that they could even get the next over MRT and the neighbouring Lothian and Borders Fire Service Line Rescue Team. No doubt the Mines Rescue Organisation would also have been able to advice on a suitable rescue (particularly by allaying concerns about the stability of the shaft).
Crab covered what the RAF carried.

Part of every fire fighters basic training in this country requires rappelling, rope work, and rescue techinques. Every EMS wagon/aircraft carries and routinely uses immobilzation equipment. Fire Fighters are also dispatched to such calls and each unit carries trained EMT's amongst the fire wagon crew. All firefighters in attendance had been trained in the use of the SWAH kit, which was routinely carried on their fire engines. Both the fire service and the ambulance had immobilsation equipment (frequently used for car crashes, which both services are highly trained in dealing with). All firefighters also had basic trauma care training, including the one who went down the shaft before the senior fire officers arrived. On top of this one of the ambulance paramedics volunteered to enter the shaft (before being prevented by a senior fire officer).

We have practiced Short Hauls of Emergency Personnel using helicopters for isolated area rescues in various fire units around the country.

How far away is RAF Kinloss and RAF Leuchars from the site of the mine shaft?
If requested by the Strathclyde Fire Brigade...would you have responded to the scene?

If requested....how long would it have taken for such a response?

Was the RAF contacted by the Strathclyde Fire Brigade about the feasibility of such a response?

Did the RAF Mountain Rescue Team(s) respond to that incident? This was not an isolated area. It was ten minutes by road from a suitable hospital. The shaft was on a small hillock about 130 metres from a housing estate. The ground was too soft for the heavy fire engines but Land Rovers were able to drive right up with ease.

The RAF, RN and MCA routinely work with the other emergency and rescues (mostly Mountain Rescue).

The distances (as the crow flies) involved were 145 miles from Kinloss and 80 miles from Leuchars. Leuchars only has a RAF Moutain Rescue Team while Kinloss has both a MRT and RAF SAR helicopter flight. Neither are particularly relevant, however.
　
The two RAF MRTs would not have attended as Strathclyde Police maintained their own Mountain Rescue Team who in any event were the team best able to get to the scene quickly (there were also two other civilian MRT teams nearbyish).
　
Kinloss SAR would also unlikely to be involved as the SAR flight at RAF Boulmer was closer (110 miles) and even closer was the Royal Navy SAR flight (more or less the same capability as the RAF Sea Kings) at Prestwick Airport, a mere 10 miles away.
　
The Scottish Ambulance Service also maintains (government funded unlike the charity-run air ambulances in the rest of the UK) its own Air Wing of 2 EC135s and 2 fixed wing Beechcrafts. These are mainly used to transfer patients from the islands and remote areas of Scotland although they also do emergency response. Like other air ambulances in the UK this is primarily a day-VMC capability - although they sometimes operate to pre-arranged landing sites at night I believe. They are not equipped with winches. The nearest helicopter was at Glasgow Heliport (20 miles).
　
At the particular incident in question, the Police Sergeant at the scene contacted the Police HQ to ask whether the use of the RAF/RN SAR helicopters was appropriate. He was advised that it wasn't. No specific reason was given at the FAI but the sheriff "assumed that there were environmental obstacles and dangers to the helicopter and crew inherent in the descent of a winchman into a deep hole in the ground."
　
Not to mention that the weather conditions were recorded as foggy and extremely dark with dense and high vegetation in the vicinity of the hole.

At about the same time, the ambulance control room also made a call to Aeronautical Rescue Control Centre at RAF Kinloss to ask for assistance with search or flood lighting from a helicopter. This was also declined - possibly due to the weather conditions (fog) or perhaps the helicopters were already involved in other calls). Strathclyde Police could probably put their own helicopter up if the need was that great. In any event the fire service Heavy Rescue Vehicle carried flood lights, which were erected at the scene and provided sufficient lumination.
　
The answer pertains to the discussion about lack of service...rules getting in the way of getting the job done...and lives being lost as a result. The rules that got in the way of "getting the job done" were not national regulations - indeed national legislation specifically allowed the fire service the flexibility to carry out the rescue operation. It was Strathclyde Fire and Rescue Service's own policies, rigidly but wrongly implemented by two senior fire officers who were both unfamiliar with the equipment and the training of the firefighters involved that prevented the firefighters from carrying out a rescue. Part of the problem was financial - the Fire Service did not want the SWAH equipment to be used for rescues because then they would have to pay the firefighters more for specialist skills.

They refused to allow the equipment to be used on the paramedic and the patient because they were not part of the Fire Service. They also ignored the expertise of external organisations who could at least provided advice on the rescue - because they didn't have the expertise to determine that those organisations would have been relevant!

I can't really see how this case can be used to criticise UK legislation or even "Health and Safety" (which is more often than mistakenly applied and a cover for the other issues). It was down to the judgement of two people who bearing in mind their subsequent appearances at the Fatal Accident Inquiry should not have been in those positions. If anything it sounds more similar to the situation in the States where it is incumbent upon individuals to self-regulate.

A fully qualified medical team could have been delivered by an EMS helicopter directly to the scene if it had been available. Shy of that....there is the RAF SAR units that could have been tasked despite their lack of first class life support equipment in their cab. Why would you need an EMS helicopter to transport medics (at considerablely greater risk) when they could easily have got a taxi, let alone used official transport, from the hospital to the site in 10 minutes!

The patient didn't die because of a lack of "first class life support" - the senior fire officers simply did not have regard to the passage of time upon the patient's odds of surviving. Considering the equipment carried by the road ambulance and the proximity of the hospital, it's somewhat surprising they even bothered to use the air ambulance (the delay in the rescue was long enough for the sun to rise) for the very brief journey to the hospital.

There seems to be a misunderstanding about the capability our US Helicopter EMS operations can bring to a casualty amongst our UK friends. The modern EMS helicopter is not just a transport wagon but a fully equipped medical unit with two very skilled medical crewmen....usually one being a Flight Nurse and the other an experienced Paramedic with advanced training. That doesn't sound much different to any UK Air Ambulance - which routinely carry two highly experienced paramedics if not a doctor. I don't think flight nurses are common in UK Air Ambulances - transfers and retrievals are usually done by specialist (cardiac, neonatal, etc) air-minded teams from the receiving hospital who bring their own equipment and don't really care whether it's a SAS air ambulance, RAF/RN Sea King or fixed wing (which can include anyting from one of the ambulance service's beechcraft up to a RAF Hercules depending on the conditions) that carries them.
　
You can have all the medical capability in the world; but it's no use if you crash on the way to/from the scene because your procedures, training and airframe are unsuitable for the conditions. That's why I'll take a RAF/RN Sea King or Coastguard S-92 every day of week if I'm stuck at night in the winter on Ben Nevis with a broken leg and hypothermia rather than the SAS Air Ambulance valiantly trying to reach me packed with doctors and fancy equipment. Let them stick to their day job and the almost-scheduled nature of the inter-hospital transfers they do at night for which they're resourced and trained to carry out. That is Crab's point I believe.
　
A situation described in the article linked by Brassed Off would have been an immediate call for an EMS helicopter in the USA....without any doubt what so ever....and one would have responded within minutes of being called. (With the usual assumptions about flyable weather). So a HEMS helicopter would have been sent for what was initially described to the emergency services as a "fall from an embankment" on the outskirts of a major town on a dark night with fog (admittedly covered by "the usual assumptions about flyable weather") where both the fire service and a road ambulance can be in attendance within 15 minutes of the call being received and, from initial impressions of those at the scene, likely effect a rescue within two hours (bearing in mind the conditions at the bottom shaft meant it took 30 minutes to get the patient into the stretcher), which even a winch equipped helicopter is unlikely to improve upon?

Shell Management

30th Dec 2011, 20:10

Some recent US HEMS accidents after IIMC:eek::

Hospital Wing, Brownville, TN
Mountain Lifeflight, Doyle, CA
OmniFlight, Georgetown, SC
Maryland State Police, District Heights, MD
PHI, Huntsville, TX
AMC, LaCrosse, WI
Metro Aviation, South Padre Island, TX
Evergreen, Whittier, AK

Meanwhile another VFR HEMS 206 gets caught out:
Medical Helicopter Makes Unexpected Landing - WKBN - 27 First News - Local News - Youngstown, Warren, Columbiana, Ohio - Sharon, Pennsylvania (http://www.wkbn.com/content/news/local/story/Medical-Helicopter-Makes-Unexpected-Landing/r5Y5i-QsnkmaV8AD6r0Rww.cspx)

http://www.wkbn.com/media/lib/129/b/8/f/b8f09287-62cd-4f26-9aa3-ae9c2b30fc0a/Story.jpg

Still they put it into a carport.;)

Me thinks that asking questions on Scottish mine rescues is just diverting attention from an ugly truth.:=

SASless

30th Dec 2011, 20:22

Were the two individuals indicted for Involuntary Manslaughter?

The question that is begged is why someone with a grain of common sense and a huge pair of testicles did not insist the two stand down, cease and desist, and effect a timely rescue of the victim.

Have effective measurses been taken to ensure such a tragedy shall not happen again for similar reasons?

Are these two folks still in the employ of the government agency that they represented?

Were they sued in civil court over their misfeasance/malfeasance?

It sure sounds like a very sad story....and a needless death.

A couple of fire ladders...some rope rigging....bit of rope...a stretcher...prep of patient by the medical folks on site....a few strong backs and up she rises. It sound like all the gear, expertise, and people were there but no one could put it together to save the poor Woman.

CSCZdFg1B2c

Shell Management

30th Dec 2011, 20:28

Sadly US HEMS tends not to have the gear or expertise for the job, and seem to favour their testicles for decision making.:mad:

Jack Carson

30th Dec 2011, 21:16

Shell Management, I have to take exception to your comment. I retired into the US HEMS system and found the flying very rewarding and safe. The key to that safety was my ability to make go/nogo decisions unhampered by upper management (Omniflight, CJ Systems, AMC). Any pressure to go would have been self imposed. Having flown out of a remote South Western mountain base in single engine Bell 206s and A-Stars it was nice knowing that the only weather reporting available was my mark one eyeball. No one could or would ever dispute my call.

Each one of the mishaps you listed have there own story. As an example, the La Crosse mishap was a single pilot IFR certified aircraft with a SPIFR certified pilot that was not permitted to fly IFR due to a recent change in the operational vender. The FAA requires the new vender to train and certify the previous venders already certified pilot. As such the crew and aircraft capabilities were not available.

In the end it all boils down decisions made by the PIC. I believe that the term the NTSB frequently uses with respect to the cause of many mishaps is; “An unprofessional decision by the PIC”. Once again many can argue the number of pilots and engines but it all come down to the PIC.

topendtorque

30th Dec 2011, 21:44

Sadly US HEMS tends not to have the gear or expertise for the job,

(gear)
I think that a generalization blind to the demographics of demand and supply capability. Especially if it were based on a comparison to old blighty where we others could generalize that all is laid on by ER, and the scope of operational area is postage stamp size.

(expertise)
The slur against our rotary brethren stateside is not necessary.

and seem to favour their testicles for decision making.http://images.ibsrv.net/ibsrv/res/src:www.pprune.org/get/images/smilies/censored.gif

This is a most confusing statement, do you mean for or from?

Are you implying that they have used their unmentionables instead of their head to made the wrong decision to go, or used them for decision making instead of using their head?

alouette3

30th Dec 2011, 21:51

SM,
I have to take exception to your last comment too.For every accident that makes the news in a big way (and each one is one too many---admittedly) there are hundreds of flights being routinely completed by people ,like me, with a minimum of fuss.
Given the unique geography and regulatory framework of the US ,I think that is pretty darn good. For you to imply otherwise is flat out despicable.
As to the guy who parked in the carport, well, they completed the transport, took a decision to avoid weather,landed,went home to their families and returned to collect a perfectly serviceable aircraft later. In my book that was an A+ performance and I work for that particular company's competition!
Maybe ,as SASLess has said, we do not appreciate Govt .spoon feeding us and maybe,just maybe my testicles have more sense than your management brain.
Have a happy 2012. And,SM, just try and be happy every now and then.Please!
Alt3.

DOUBLE BOGEY

31st Dec 2011, 01:57

As an Ex HEMS Pilot (UK AS355 Unstabilsed Day/Night Capability) I have been fascinated by this thread.

Jack Carson. You do us all a disservice. If it is indeed "All down to the decisions taken by the PIC" please consider which outfit below you would like to make your particular decisions in:

1. Balloon, equipped with sextant and plum-bomb line for altitude. A Packet of sticking plasters, pair of washing up gloves and 2 x aspirin.

OR

2. State of the art ME-MPH IFR with modern lifesaving and first aid treatment equipment. Moving map/GPS/FMS/EFIS etc.

This thread just goes to prove we are all our own worst enemy because we are by nature optimists. We try to make the very best of what we are given.

But we need to be saved from ourown folly and eagerness. Thats what good regulation provides. An opportunity to set up an operation with the best possible chance of success. Embrace regulation and go one step further, mke it work for the better. Force the regulators to get tough.

I completed 1500 HEMS missions in my trusty old AS355 with no autopilot, often at night. At the time bright, shiny new machines in the same category were getting invented almost every day. Bells, whistles and computers. All designed to make life easier and therefore safer. I looked on in awe and wonder and not one day went by where I did not miss the autopilot. 30 seconds to look at a map without wobbling around. 1 minute to be able to program the awkward Trimble Transpac GPS at 300 feet AGL trying to reach the casualty without the harrowing fear of CFIT.

"Ahh! but a man's reach should exceed his grasp, or what's a heaven for"

Flying EMS at Night in a B206 is not even a remotley sensible thing to try and do. If you are actively doing this kind of thing I feel very, very sorry for you, your medical team and your patients and concerned for all your safety.

I urge you to truly understand how these accidents come about and take all steps in your power to not become one of them. Fight for better equipment. Fight for better training. And for God's sake, use accidents like these as justification for your struggle rather than your prowess. Do not stumble on in denial believing what you are doing is safe. The facts prove that it is not.

On the other hand, technology, unsupported by training and checking and most important of all, recency, is worst than no technology at all. Many SPIFR/MPIFR accidents have written this argument in blood.

For all of you in HEMS/EMS. Keeping making those tough calls. Fly within your own limits and not necessarily the lower limits afforded by the regs.

If you are under contract to a health service, try to remember you Company was probably the lowest bidder. Treat their pressure accordingly!!

Above all, every EMS/HEMS Helicopter starts every mission loaded with live, healthy humans on board. The worse the accident you are attending, the less likely the victims will survive. Therefore consider just how appropriate the risks are that you take to try and save one person who might not survive against the risks of losing the healthy humans you already have on board. For HEMs crews these are the tough calls that have to be made. I wish you all luck and skill in your continued judgements.

For Shell Management. You message is sound but the messenger sucks! Sort that sh*t out man!!

My Best Regards to you all.

Gomer Pylot

31st Dec 2011, 02:28

The only 'hand-wringing' that I see comes from your side of the pond, just as in this thread.

There are literally hundreds of flights that take place every night in the US, in mostly single-pilot, single-engine helicopters, and very few result in accidents. Probably more take place in a 24-hour period than in an entire year in England. I don't know the exact numbers, but I doubt it would be very far from that. So there will naturally be more accidents in the US, because there are orders of magnitude more flights. Properly planned and flown, night flight is safe enough. But there will always be those whose ego, need to be a hero, or whatever, outweighs good judgment, and no amount of regulation will stop idiocy. Regulation has slowed it down, though, and there are fewer accidents caused by weather than before. Most programs use NVGs now, and that helps. There is an effort to get autopilots that work in small helicopters, and that will help even more, if decent ones can be certified. Things are getting better, slowly, but accidents won't cease to happen, not overnight nor in the long run. We will continue to find new ways to kill ourselves and our passengers.

[email protected]

31st Dec 2011, 07:19

We will continue to find new ways to kill ourselves and our passengers. No, you will keep using the same old ways of doing that - NVG single pilot at night just invites worse decision making and increased cockpit workload - the result will be the same, sadly.

The ' it's bigger and better in the US' argument doesn't hold water, neither does the ' no amount of regulation will stop idiocy' concept.

You said yourself Regulation has slowed it down, though,
Now I'm not saying that if some regulation does some good then more regulation will do more good but your own argument points to the fact that ONLY regulation will make HEMS safer.

Self regulation hasn't reduced gun crime, self regulation didn't stop bankers wrecking the world economy and self regulation won't stop needless deaths in an industry that is supposed to save life not waste it.

As for hand-wringing, every EMS crash reported on PPrune comes from posters in the US - if there is not concern for why it is happening, why post it on a discussion forum?

SASless

31st Dec 2011, 09:21

The facts are fairly simple. The US EMS industry does retain the old tried and true methods of killing themselves. The Stats show Night alone is the biggest factor in fatal accidents....especially when combined with Marginal Weather....simply because the Human Eye cannot see much in the dark.

The Industry tries to compensate for that by going to NVG's....which as anyone with experience with new generation NVG's...is the only way to fly in the Dark. Thus...there is an improvement underway.

Marginal weather compounded by two factors...one fixable by techology....that being the lack of adequate weather reporting for the routes/areas most EMS helicopters must fly...and pre-flight decision making which cannot be fixed by techology have yet to be adequately dealt with.

There is improvement in the weather reporting arena...but there is a long way to go yet.

Pilot decision making is always going to be the Achilles Heel of EMS flying as not one of us are clairvoyant. Add in the fact that even the very best made decision is limited by the accruacy of the information that it was based upon. Which takes us back to the weather reporting and trying to guess what the weather actually is and shall be when we go flying especially at night.

Then...we have the raw fatal fact that way too many of us are not making the right decisions for any number of reasons. Some of these NTSB described "Unprofessional Decisions" border on suicide as when reviewed by others on clear blue and twenty two days....defy logical explanation.

Did I mention the FAA in any of the above or how a new Regulation alone will improve the situation? We have plenty of rules and regulations, industry standards, certification requirements, and all that....but all it takes is bad judgement or a bad decision and the result is the same.

I flew EMS in an un-Sas'd VFR Only BO-105 (the next thing to a Jet Ranger) right up to a fully decked out Bell 412 SPIFR machine. My experience and that of others....remained the same....bad weather compounded by bad decisions and believing legal IFR currency confused as being IFR Proficiency is a dead certain killer of EMS crews.

Until that situation is cured....there may be new ways found to kill ourselves...but they will be few and far between and the old fashioned ways will still continue to thin the herd.

The best of all worlds is to stay out bad weather while flying twin engined...two piloted...fully kitted out SPIFR helicopters while using NVG's.

The problem is paying for it.....as someone must either in Dollars or if you do not....in blood.

[email protected]

31st Dec 2011, 10:03

Sas, I agree with all you have said there but bad weather compounded by bad decisions and believing legal IFR currency confused as being IFR Proficiency is a dead certain killer of EMS crews. giving the same poor decision makers NVG just invites them to push on further or go lower because they can see the ground. Then when it all goes wrong and they are back to IIMC it is still that lack of proficiency that will kill them.

Surely the need for proper IF currency and proficiency is the regulation that is needed here - yes it will require the operators to foot the bill but an hour a month per pilot is still much cheaper than a new helicopter and crew.

ShyTorque

31st Dec 2011, 13:12

NVGs are good but aren't the full answer. As Crab says, there needs to be an IFR option too, because if the goggles do finally become unworkable due to worsening weather, the pilot will then find himself far more deeply into IMC than if he had been using unaided eyesight. Been there, done it , seen it, then not seen it, if you get my drift.

If the pilot has no IFR fall back / abort / climb on instruments to a safe altitude plan, then it's possibly game over.

Because the pilot is now flying at night, in IMC, in a non-IFR equipped, unstabilised aircraft, having done no regular IF training, below safety altitude, in the hills, over sparsely lit terrain. With a pair of toilet roll tubes to look down. At least until he can find a spare hand to sort them out and start even thinking about an instrument scan, possibly whilst in an unintentional UP at low level above rising terrain.

SASless

31st Dec 2011, 13:55

.....believing legal IFR currency confused as being IFR Proficiency is a dead certain killer of EMS crews.

Crab and Shy.....I fully and completely agree with your thoughts on the matter.

The situation is the Training Captain shows up at the remote base...does some ground school maybe...an hour of flight...or so....then in the most common scenario...does a check ride and you are now Legal, Current, and in most folk's mind...."Proficient" to conduct IFR flight following IIMC.

If that happens to be your trusty steed with no SAS, no Auto-Pilot, and you happen to be single pilot.....it all too often means a tragedy is about to happen.

You want to have some fun....attend a Safety Meeting of Active EMS Pilots and ask simple questions and watch them start squirming.

My favorite is along the lines of this.....

Do you carry a Sectional Map (standard issue 1:500,000 VFR Nav Map) on each flight?

How often do you use the Map while in flight?

How often do you use the Map at Night in flight?

If one starts by asking them to respond by holding their hands up....by the time they answer the last question there are darn few hands up if they are honest.

Reading a Map at night in an single piloted unstablized helicopter...with the basic issued factory lighting...when you are in your 50's (think "glasses" here)....is not a simple task. If you added NVG's to that....do you look under them....or flip them up to read the map?

Do we then rely upon the GPS to find our way around? What if it is just a standard unit and does not show a map with obstacles identified?

Most EMS units will advertise a 150NM radius of operation....there is a lot of ground in a cirlce that big...to be flown on "local knowledge" standards!

ShyTorque

31st Dec 2011, 15:59

SASless, The market here is much smaller than that of the USA for obvious reasons. However, the UK's Air Ambulance network (funded by charity in the main) is much greater than it was before the regulations were tightened up.

BTW, you skipped answering my questions asked of you on the previous page at post #72. You changed the subject to mines rescue!

SASless

31st Dec 2011, 16:43

Is this the question Shy?

So what is your "text book" solution to the issue in question, ie. how would you make "VFR" Night Ops safer?

The most effective way would be to adopt the UK method....ban it! If one does not do it...one cannot have an accident.

My recipe....

Work like heck encouraging Pilots and Crews to take more time considering the weather, route, and reason for the flight before launching. I would require a pre-takeoff briefing of the Med Crew by the Pilot or (P-I-C) on the reasons "Why" the flight is going to be undertaken and not just the reasons why a flight was declined.

If one cannot articulate the reasons and factors that contribute to the decision to go....as well as why not to go....then that should be a warning sign.

Over a period of time....an inconsistent explanation would stand out during the brief and hopefully someone would question that.

That process would also slow down the pace just a bit....which in the middle of the night...with a pilot wakiing from a nap or sound sleep....would not be a bad thing but still allow for a timely departure.

Educating pilots and Med Crews about dangerous weather and reviewing in detail as many fatal accidents as possible citing the chain of events that led to the crash would also be a good thing. Judgement cannot be taught but it can be improved by education.

I also believe in written debriefs or after action reports. Documenting the existing weather prior to takeoff....and later comparing the forecasts and anticipated weather against that encountered would also work as a tool to improve awareness of weaknesses in the weather reporting and evaluation of weather by crews.

Most fatal accidents are a result of bad weather at night...thus that is where the focus needs to be. Prevention is far more effective than any other measure....that comes down to using the best information possible and making a logical, business-like, professional decision.

Some of the changes that have taken effect over the past few years has improved the situation....the accident rate is showing that. NVG's are an improvement, raising the miniumums for Night VFR helped, and requiring Operators to operate centralized dispatch/operations centers has helped.

As long as helicopters fly in the dark, in remote areas, far from weather reporting stations, and humans are involved....the potential for tragedy shall stay with us.

Knowing when to Chicken Out is the key to any pilot's continued longevity! There is not a rule book anywhere that can beat that for effectiveness!

Getting the folks to know when to Chicken Out and encouraging them to do so is the key.

ShyTorque

31st Dec 2011, 17:29

The most effective way would be to adopt the UK method....ban it! If one does not do it...one cannot have an accident.

Again, the UK haven't banned it; only you seem to think they have.

But they have mandated that better equipped aircraft are used for public transport by night.

Shell Management

31st Dec 2011, 17:43

Many thanks to the hard work people at the JAA.

Bladecrack

31st Dec 2011, 19:37

This thread makes for depressing reading...

Also I wish people who either haven't read it fully, or are totally ignorant of the difference in the general level of equipment between a VFR single engine helicopter, and an IFR certified multi engine helicopter would stop banging on about engines...

Chances are this was not an engine failure, but more likely LOC/CFIT. Therfore the point we are trying to get across is:

Single engine:-

Generally unstabilised, WITH NO SAS, autopilot, no duplicated systems, or IFR certified instruments and equipment

Multi engine:-

Generally stabilised WITH SAS & autopilot, duplicated systems & IFR certified intruments and equipment

It may be possible to have some such equipment fitted to a single engine helicopter, but MOST DO NOT. That is the difference. If you want to fit such equipment to a VFR single and fly it around at night in bad weather there will be less chance of crashing into a hillside, but as many here have said repeatedly it comes down to:-

a. cost
b. they don't want change

Therefore similiar accidents will continue to happen and lives will be lost. An totally unbelievable and entirely avoidable situation. :ugh:

chopjock

31st Dec 2011, 20:34

Bladcrack

It may be possible to have some such equipment fitted to a single engine helicopter, but MOST DO NOT. That is the difference. If you want to fit such equipment to a VFR single and fly it around at night in bad weather there will be less chance of crashing into a hillside, but as many here have said repeatedly it comes down to:-

a. cost
b. they don't want change

Therefore similiar accidents will continue to happen and lives will be lost. An totally unbelievable and entirely avoidable situation.

I don't think it's anything to do with not wanting change. If we are talking about here in the UK it will never happen because although this could save many more lives, the CAA would never allow it.

SASless

31st Dec 2011, 20:44

From the Griffin Accident Database......

UK Helicopter Fatal Accident Causes+/-

Fatal Accidents

Loss Of Control IMC (25.00%) 10

Spatial Disorientation (10.00%) 4

Other Weather (7.50%) 3

42.50 % of UK Helicopter Fatal Crashes are due to the the three causes listed above.

Any need for improvement in those numbers?

From the IHST 2009 report....a long quote but worth reading. bold print is my doing.

There were 174 U.S.-registered helicopter accidents in 2001, which worked out to 8.0 per 100,000 flight hours. The good news: “This is a decrease of 12.1 percent over the CY2000 accident rate of 9.1 per 100,000 flight hours,” the report states. The bad news: In those accidents, 137 helicopters were “substantially damaged.” That’s 79 percent of the total 174. “Of the remaining, 32 (18 percent) were destroyed, one (0.6 percent) had minor damage and four (2.3 percent) had no damage reported,” it continues.

[B]Only 14 (4 percent) of the helicopters in U.S. 2001 accidents were twin turbines. In contrast, 84 (48 percent) were single-engine turbines and 76 (44 percent) were single-piston helicopters. The majority of CY2001 accidents occurred during personal/private flying, 38 missions (22 percent) and instructional/training, 29 missions (17 percent). The landing phase accounted for 45 (26 percent) of the accidents, hover 30 (17 percent) and maneuvering 29. There was a direct correlation between a higher percentage of accidents and lesser amounts of flying experience in the specific make/model involved in a crash. “For example, the group with the most accidents, personal/private, also has very low median time in rotorcraft,” the report states.

As for casualties: 91 (52 percent) of the CY2001 accidents didn’t result in injuries. “There were 38 accidents (22 percent) with minor injuries, 17 (10 percent) with serious injuries, and 28 accidents (16 percent) that resulted in fatal injuries,” the report continues. The bottom line: of the 174 accident helicopters, there were a total of 373 people on board at the time of the accident with a total of 48 fatalities, or 12.9 percent. Reviewing the statistics, HAI’s Zuccaro noted that “66–75 percent” of the accidents that occurred in 2001 were caused by “human factors.” But he was quick to point out that human factors are not a synonym for ‘pilot error’. Although that is a part of the mix, other elements such as pilot workload, aircraft design, inadequate training for the missions required and technological shortfalls were also to blame.

“We’re not pointing our fingers at pilots,” he said. “They’re just one factor.” In particular, Zuccaro said that many aircraft feature designs that require pilots to do too much. He also chastised managers who send their pilots on night missions without proper tools such as night vision goggles. Still, of the various Standard Problem Statements (SPS) the U.S. JHSAT used to classify accident causes in its CY2001 report, “The SPS, pilot judgment and actions, dominated the problems, appearing in over 80 percent of the accidents analyzed.”

Bladecrack

31st Dec 2011, 21:05

chopjock - i was referring to the US.

SASless - if the accident rate isnt zero there is always a need for improvement, wouldn't you agree? Not sure what your point is? Out of those statistics I think you will find there are very few, if any ME/IFR helicopters?

BC

SASless

31st Dec 2011, 21:17

Finding stats conveniently broken down for use is hard.

The CAA rightly breaks out Offshore Operations from On-shore as they are two very different environments and types of operation. The US NTSB data base has proven to be less than useful in a lot of ways and as always....one cannot just hang a hat on numbers alone.

I am sure there are comparisons somewhere about the accident rates of the UK and USA that if found would be interesting to consider.

Even the IHST quote combines Private Sector flying and Public Transport data which doesn't work well either.

Bladecrack

31st Dec 2011, 21:30

SASless - I agree with what you say re stats being hard to interperet... However as we in Europe had JAA/JAR implemeted quite some time ago, maybe a fairer comparison would be US Vs JAA member states (grouped together) when it comes to accident stats rather than US Vs UK? Just a thought...

BC

Jack Carson

31st Dec 2011, 22:18

Statistics can explain almost any side of an argument. Many have mentioned the tempo of US HEMS operations. Unless you have lived within our system it is hard to grasp the magnitude of what actually transpires each and every day and evening. At AMC alone there is an aircraft airborne with a patient continuously 24/7. For the most part the decisions to transport do not reside with the aircrews but with hospital staff and first responders. It is kind of a, you call, and we haul system. As such, the final responsibility for the actual conduct of flight resides with the PIC. He or she is given a whopping 3-5 minutes to decide GO versus NOGO.

zalt

1st Jan 2012, 00:12

Has this, non fatal, accident been missed?
Helicopter Crashes Near Rock Springs - The Rocket-Miner (http://www.rocketminer.com/stories/helicopter-crash1,16777)

Helicopter Crashes Near Rock Springs

ROCK SPRINGS: No one was injured in a helicopter crash north of Rock Springs early Tuesday evening. At the scene, Sheriff Rich Haskell said Undersheriff Craig Jackson was on Yellowstone Road about 3 miles north of the city when he saw a helicopter circling west of the roadway around 6 p.m. He then observed the helicopter drop straight to the ground from a relatively low altitude. Jackson investigated and found the craft to be a Guardian Flight helicopter with five people aboard, none of whom were patients. None were injured in the crash. Haskell said federal officials are being notified and will be in charge of the investigation. He said he planned on releasing additional information on Wednesday.

http://rocketminer.static.adqic.com/uploads/inline/1323841359_573e.jpg

Shell Management

1st Jan 2012, 09:34

Its not on the NTSB website. Thats one way to reduce the accident rate.;)

havoc

1st Jan 2012, 12:57

http://www.faa.gov/data_research/accident_incident/preliminary_data/media/J_1214_N.txt

Passengers of downed helicopter identified - The Rocket-Miner (http://www.rocketminer.com/stories/helicopter3,16782)

ROCK SPRINGS -- The pilot and passengers of the Guardian Flight helicopter that crashed near Rock Springs on Tuesday have been identified.

Sweetwater County Sheriff Rich Haskell said Calvin Cannon of Rock Springs, 45, was piloting the craft. Max Calnin, 28, Robert W. Moses, 58, Robert B. Moses, 33, and a 13-year-old boy Haskell declined to identify, were the passengers. A press release said none were patients and the flight was not believed to involve a medical transport.

Around 6 p.m. Tuesday, Undersheriff Craig Jackson was on Yellowstone Road about 3 miles north of Rock Springs when he saw the helicopter, a Bell 407, circling west of the roadway. He then observed the craft drop straight to the ground from a relatively low altitude.

No one was reported injured. A range of emergency services providers responded to the crash, including the Sweetwater County Sheriff's Office, Sweetwater County Fire District No. 1, Wyoming Highway Patrol, Sweetwater Medics and Sweetwater County Search & Rescue.

Haskell said investigators from the Federal Aviation Administration and National Transportation Safety Board are en route to Rock Springs to begin their investigation. Meanwhile, county detectives and deputies are conducting a preliminary inquiry and gathering information to be submitted to federal authorities.

http://rocketminer.static.adqic.com/uploads/inline/1323926498_7226.jpg

The flight was a non-HEMS

rotorspeed

2nd Jan 2012, 13:12

Despite what some others may think, statistics must be the key to steering the evolution of safer US HEMS operations. Of course the information needs to be critically examined, for undoubtedly misleading conclusions can readily be promoted, but that's normal.

There is no doubt the scale of the US HEMS operation is huge - 850 helos flying around 400,000 hours per year. With major operators like Air Methods and Omniflight, the vast majority of flights are no doubt very professionally run and perfectly safe. However being a HEMS crew still rates as about the most risky occupation in the US, with a fatality rate of 113/100,000 employees, twice that of general aircrew.

It is widely known that the FAA and the NTSB are concerned about the high accident rates. Accidents are much more likely at night and mainly due to CFIT, LOC in IMC or hitting obstacles. But it also seems that the response from the NTSB and FAA shows concern but perhaps not sufficient urgency for action. Recommendations have been mainly for more training, better flight planning, radalts, NVGs and an autopilot if two pilots are not carried. All in an indeterminate timescale. In reviews readily available, it is interesting that there is precious little mention of the benefit of IFR twin use, even at night, albeit it a cost. Indeed it is hard to even find any mention of the number of IFR twins versus VFR singles utilised by HEMS business.

And business it clearly is. Since funding for many flights has been provided by Medicare (quoted at around $20k per flight) there has been a dramatic increase in the EMS helicopter fleet. Which the industry understandably says means better response times. Interestingly the amount paid by Medicare to the operators seems to be fixed. So if you operate a B206 you make a lot more profit than an EC135 or A109, for example.

It is clear from the posts on this forum that there is great support for not changing regulations to mandate use IFR twins, as used exclusively in Europe. This is entirely understandable - the cost increases would undoubtedly reduce the US EMS fleet significantly with the loss of jobs, though a requirement for two pilots may compensate for this, to an extent. Furthermore the current evidence does indicate that mechanical (eg engine) failure is a minimal cause of accidents. Having said that, as has been mentioned here, it is not so much the second engine but the IFR capability and redundancy that comes hand in hand that is the big advantage, especially for the more hazardous night flights.

However the US might actually be able to do us in Europe a huge favour here. There is no doubt European aviation is stifled by extensive regulation. Excessive, maybe. US HEMS ops experience is huge -much greater than we have. From comments on this forum, there seems to be a dominant US perception that use of single engine VFR helos for night EMS is fine, subject to implementation (eventually) of the kind of recommendations the NTSB make - particularly IMC training, TAWS/radalt, NVGs, autopilot. If well equipped singles are indeed safe enough, with such a scale of operations in the US, using twins and singles at night as well as day, compelling evidence should be able to be provided to support the approval of suitably equipped singles for IFR operations in both the US and Europe. If the data and statistics were solid, a lot of money could be saved. And again, the unique scale of US EMS ops should provide the evidence.

The problem is, it doesn't seem to. I have found no statistics to compare US single with twin EMS accident rates. Because perhaps the data doesn't exist. It needs to be though. If it does I'd like to see it. Surely there should be a logging system for all flights, which would include single/twin, IFR/VFR, day/night, duration, safely completed/risk factors/accident etc. The results would be fascinating, and provide much needed facts to supplement opinion.

Of course the Canadians would say they know the answer already. In nearly 250,000 flight hours since 1977 they have never had an EMS accident. But there again, they do only operate IFR twins with two pilots, and only use pre-surveyed sites at night. And with just 20 or so aircraft the pool is a fraction of that of the US, though rates should be comparable.

I suspect fewer Canadians get the benefit of a HEMS service as a result of a more expensive and limited service. But there again, what percentage of US HEMS flights are critical for life saving? What data is there on this? The US HEMS business is clearly a delicate balance between providing a huge ($2.5bn) industry that employs people and buys helicopters and parts etc, and one that cost-effectively saves lives.

Despite a number of requests on this forum, no-one has cited any detailed statistics to shed light on this issue. Maybe they do not exist. Cynics might say that a big part of the reason why is that some don't want to risk any awkward conclusions compromising the scale of a big industry.

Now clearly I've just very quickly tried to understand more about the issues as a European, non-HEMS ops pilot in order to constructively progress the debate. I look forward to comments from those with more direct knowledge!

SASless

2nd Jan 2012, 14:34

what percentage of US HEMS flights are critical for life saving? What data is there on this? The US HEMS business is clearly a delicate balance between providing a huge ($2.5bn) industry that employs people and buys helicopters and parts etc, and one that cost-effectively saves lives.

My highlights in the quote......where is it written that the mission statement for HEMS...Helicopter EMS...is to "SAVE" lives?

My intent is to throw out a challenge to anyone in the Helicopter EMS business who thinks their express reason for being is "SAVING" lives!

I would submit...that kind of mindset is what kills Helicopter EMS crews.

I also will accept that lives are saved by the application of professional skills, protocols, and use of hi-tech equipment in the provision of the service Helicopter EMS crews are there to provide....that being the provision of safe, timely, efficient medical transportation of injured, ill, or hospitalized people.

Am I the only one who thinks that way?

Taken from the Air Methods Web site.....again...high lighting is mine.

Air Methods' mission is to provide safe, professional air medical transportation services, products, and systems with the highest level of quality and integrity. We are dedicated to providing excellent service to our customers, a fulfilling work environment for our staff, responsible membership in the medical aviation community and a reasonable return on capital to ensure long-term economic viability and healthy growth.

rotorspeed

2nd Jan 2012, 16:41

SASless

Well if your only comment on my post is quibbling with my use of the term "saving lives" do I take it that you are broadly in agreement with the rest of it?

By saying "saving lives" I did not mean that was the only justification for use of HEMS. Other valid reasons would include for example improving the prognosis post serious injury and reducing expensive hospitalisation. Or, for those paying themselves and not by other's taxes, simply having a faster more comfortable transfer to hospital.

The vastly higher cost of HEMS compared with road ambulances certainly needs compelling justification if it is to be paid for by the public and not the end user. And of course making a significant contribution to the saving of lives must be a major reason.

To say that HEMS crews who believe they are saving lives are a liability to themselves is one of the most ridiculous things I've read! Many people have to work professionally knowing their services could influence life or death - just ask the SAR boys or surgeons, for example. I'm sure Crab feels quite able to rescue people and save lives without taking silly risks!

alouette3

2nd Jan 2012, 17:11

Rotorspeed,

I have yet to see such a well balanced post such as yours on this forum.Typically, it is a US Vs Europe discussion, with both sides defending their point of view vociferously.So, well done and thank you.
I am afraid that statistics you ask for probably do not exist.I think that is intentional. Most operators would like the status quo to persist.In fact, a Chief Pilot of a major EMS company is on record stating that twins/IFR capable helicopters don't necessarily enhance safety and cost way more to operate than the revenue they generate.Lawmakers who want to fix things are in the grip of lobbyist and the lobbyists work for the operators,not the patients or the folks generating the revenue.And so, the drumbeat carries on-----.
But, as a current EMS pilot, I will endorse what SAS less says.Right from the very beginning of an EMS career ,we are indoctrinated to beleive that we are NOT in the life saving business.We are not SAR.We are transportation on demand. It just so happens that the folks we transport are in need of medical help.Since most pilots are human enough to be pressurized into thinking otherwise, policies have been put inot place to take the emotion out of the picture. Ultimately, it is the pilot himself who has to make the call.If he puts that additional "white knight syndrome" pressure on himself, he will be guaranteed to make decisions that put people at risk.
Alt3.

SASless

2nd Jan 2012, 17:13

rotorspeed,

I very much agree with your post....in content, tone, message, and style.

The "Life Saving" mentality I refer to is the unhealthy one...the one where when the Tone goes on the pagers...the "Type A's" charge forth to challenge Death and steal victims from the Grim Reaper....no matter the risk to themselves as after all...they are "Heroes" when they smack ol' Mother Earth at near Warp Speed one dark night in really ugly weather.

That excludes a great number of folks who are quite professional...dedicated to serving their fellow Man the best they can but in a logical, professional, safe manner.

Anyone experienced in the Helicopter EMS business knows exactly what kind of folks I am talking about.

As Alouette correctly states....the aviation folks tend to be more in tune with the mission statement than the medical crews riding in the back of the cab. Granted they are far more exposed to the part of the task that would give them that feeling while the Flight crew(s) are more removed from the hands on part of the medical mission.

You want to become very unpopular amongst medical folks....publically state that position and find out how quickly your stock falls with the med crew! Far more than a few pilots learned that the hard way....and once the Med Crew decides to run you off....you might as well pack your bags because the Operator shall invariably put the contract far above standing behind the pilot. (Unless there has been some Lightning strikes I have not heard about!)

Thomas coupling

2nd Jan 2012, 18:08

I would also imagine that pro rata, the US accident rate seems higher because they fly inexorabily more ems trips than the europeans. Add to this the American way of doing things (which is not right nor wrong, simply "different");
then it might be that their safety record is on a par.
I simply find that the accidents - when they do happen, seem to be easily avoidable:ugh:

SASless

2nd Jan 2012, 18:43

Some fairly recent IHST statistics.....

http://www.ihst.org/portals/54/ihss/IHSS%20Update%202011_Overview.pdf

homonculus

2nd Jan 2012, 20:11

There are controlled studies on secondary transfers. They reduce mortality by 50%. Primary missions suffer from very little published data but what there is suggests a system crewed by doctors prevent death in serious head injuries only. So it is true they don't in general save lives.

It is not the same as being a surgeon. As a surgeon I can do anything within the limits of my equipment without any consideration except for my patient. As a pilot the need is for me to not use my equipment because of the addition of weather.

When I started in the US I actually had an experienced Nam pilot respond to my flight request with 'Nope not with this weather......is it serious?'

As a result my system has always operated a Chinese wall where the pilots don't know the medical indication and the medical crew don't know the met. And if one of my doctors even jokingly criticised a pilot he would be fired on the spot.

Sadly in the US some doctors still believe they are god although in fairness the driving force for helicopters is not the medical profession but the finance directors of the hospitals who need the ability to get high revenue patients in adequate numbers to fund regional services

rotorspeed

2nd Jan 2012, 21:16

Alouette3

Thanks for your comments. I certainly have respect for both US and European operations, and constructive debate may benefit both, long term. Your comments ref statistics - or lack of them - in the US don't surprise me!

SASless

Pleased we are converging on a common understanding of the issues here.

And both; I respect your comments ref pressure on some pilots if they are too focussed on the life saving element. It would be nice to think they would be professional enough not to be influenced, but alouette3 at least is at the coal face and SASless has loads of experience, so I'll take your points. I guess with far less regulational constraint than in Europe there is more scope for subjective go/no go decisions and therefore opportunity for the overt Type As, as you say SAS, to sometimes take too big a risk to try and save a life.

Homonculus; no big deal, but I still think the surgeon parallel has some relevance. There can still be pressures to expedite procedures to minimise operation duration. Having said that, the presentation of error is not as dramatic as a helo accident, I grant you!

Gordy

2nd Jan 2012, 22:19

The Rock Springs accident was not HEMS.... there is more than meets the eye to this... from another site:

In one of the early articles on the crash an online newspaper, Rocketminer.com listed the names of the people onboard (excluding a 13 year old boy).

Doing a FAA database search of those names shows that the man who the police listed as "piloting the craft" only had a mechanic's A&P ratings - no pilot certificate. One other guy onboard matched a name in the database for an older guy (age 58) who had a private rotorcraft certificate but whose current "FAA-address" is in Miami. The name of another man (age 28) also does show up. He lives in Denver and has a bunch of fixed-wing ratings (including ATP) - but no rotorcraft.

What the hell was going on here?! Did a non-rated mechanic have some friends/relatives who were fixed-wing pilots visiting and want to take them up and show them all the bells and whistles of their new helicopter? And did they go up with him under the assumption that he was rated?

No wonder the accident doesn't show up in the NTSB files yet. There may have been as many as two "real" pilots onboard (albeit not rotorcraft rated) in addition to the non-rated guy at the controls. The FAA is probably STILL sitting around trying to figure out who and how to violate over this one. But rest assured, violations are coming!

See for yourselves at the archived story:
Passengers of downed helicopter identified - The Rocket-Miner (http://www.rocketminer.com/stories/helicopter3,16782)

Jack Carson

2nd Jan 2012, 22:58

I would like to begin by saying that this has been one of the best forum discussions I have participated in. More discussion groups like this consisting of professionals from around the world can and will effect change in the long term.

On another note, to follow up on SASless’ point concerning Life Saving Type “A” pilots, I believe that in many instances just the opposite may be a factor. Many operations here in the US have pilots that have been located in one position at one base for as long as 20 years. Boredom and complacency builds as veteran pilots routinely fly repetitive routes both day and night. As confidence builds, a pilot’s perceived ability to cope with more demanding conditions grow as well. This can lead to a point where an experienced pilot may back, he and his machine, into a corner.

SASless

2nd Jan 2012, 23:14

Gordy,

A bit of snooping and it appears the aircraft belongs to an outfit based in Salt Lake City but does business in Alaska. The few places I looked show no public record for the actual names of the owners or head of Ops. I did find some names of folks in the Dispatch Center.

The company maintains a web site for those that are interested.

I did find this facebook reference to Guardian Flight in Rock Springs.

https://www.facebook.com/note.php?note_id=281344665214562

zalt

3rd Jan 2012, 00:27

Looks like Rock Springs will be interesting.

Talking of US data there was a study done by NYU and published in Aviation Psychology and Applied Human Factors that looked at 4,755 helicopter accidents (all types of operations) from the NTSB database. The researchers compared the underlying causes and also the factors that differentiate daytime and nighttime helicopter accidents.

The number of fatal accidents occurring at night was reported as significantly higher than during the daytime. The combination of night flights and adverse weather conditions is shown to be particularly fatal in accidents.

If it is economics that drives the use of singles it is a pity that a well equipped IFR certified machine means a twin, irrespective of the pros and cons of engine number. I may have missed it here but oddly lack of weather data is also commonly raised as a reason to stay low and fly VFR.

The NTSB meeting on HEMS IIRC threw up many issues with the US HEMS business model. Yet it does feel that many are arguing for the status quo of special VFR, or at least NVIS assisted VFR, for purely economic reasons. Yet there are indications that HEMS is being used in the US for cases that in Canada, Europe, Australia etc would not justify a helicopter (the Maryland State Trooper accident for example), surely a waste of resource that if addressed would allow improvements in equipment, training etc.

Shell Management

3rd Jan 2012, 18:42

As this source states:

...since an operator doesn’t get paid unless the helicopter carries a patient, there’s an incentive to fly the mission regardless of how adverse the conditions. And because operators are paid the same rate no matter what equipment they use, operators tend to use older helicopters, and to run them as inexpensively and as ill-equipped as possible.

The EMS Helicopter Industry's Business Model Leads to Unnecessary Crashes : Aviation Law Monitor (http://www.aviationlawmonitor.com/2010/12/articles/ems-industry-1/the-ems-helicopter-industrys-business-model-leads-to-unnecessary-crashes/)

More on "Golden Hour" and Other Myths from the EMS Helicopter Industry explains:

The industry has oversold the need for EMS helicopters. The benefits simply do not outweigh the risks.

"Golden Hour" and Other Myths from the EMS Helicopter Industry : Aviation Law Monitor (http://www.aviationlawmonitor.com/2011/01/articles/ems-industry-1/golden-hour-and-other-myths-from-the-ems-helicopter-industry/)

Devil 49

3rd Jan 2012, 19:38

...since an operator doesn’t get paid unless the helicopter carries a patient, there’s an incentive to fly the mission regardless of how adverse the conditions.

There's no incentive in that equation for me to ever accept a flight. Eleven years, I've never had that decision questioned.
Take this to the bank, too: Crashes kill pilots, and in 43 years I've buried a fair few comrades. Kinda focuses my attention each and every time.

And because operators are paid the same rate no matter what equipment they use, operators tend to use older helicopters, and to run them as inexpensively and as ill-equipped as possible.

Ah yes, that nasty profit motive... You either believe in fairies or you don't.

More on "Golden Hour" and Other Myths from the EMS Helicopter Industry explains:

The industry has oversold the need for EMS helicopters. The benefits simply do not outweigh the risks.

I'm not competent to discuss 'the need for EMS helicopters' or the 'Golden Hour", I'm just a pilot. I would guess that the on-scene medical professionals directly responsible for the call and the insurance companies and government agencies that bear the costs of EMS have a better perspective. And, more objective than the source cited by "Shell Management".

SASless

3rd Jan 2012, 19:43

Best advice for dealing with SM....."Consider the Source...ad ignore the Coment!":=

Gomer Pylot

3rd Jan 2012, 20:01

IME we rarely save lives, but we do reduce morbidity, especially with cardiac and stroke victims. Where I work, it takes far more than an hour to get a patient to a stroke or cardiac center by ground ambulance, and that's if the traffic is light approaching and in the big cities. It's not unusual to have traffic jams on the freeways that take hours to clear. All the while, the stroke or cardiac patient's chances of a full recovery are diminishing. A helicopter can get them there in a half hour or less. It's the same for trauma patients, but for most of those the outcome will be similar in an ambulance or a helicopter, and the main difference is in how long they will be in pain, and how many hospitals they will have to pay. Local hospitals can't deal with major trauma or broken bones, they just do first aid and ship the patients out to a larger hospital. It's not ideal, I admit, but that's what we have here. Skipping the local hospital, which the ground ambulance can't legally do, actually saves money, even if it doesn't save lives. And make no mistake, the health care industry here is about money, nothing else. The public isn't paying for HEMS, at least not directly, the end user is. The government is being kept out of the health care industry because it would reduce the enormous profits the insurance companies and the big hospital corporations make. Haven't you heard the outcry against 'Obamacare', which actually does little to help patients, and much more to help corporations? Even a little public help is too much for the teahadists.

I would be happy enough if the FAA suddenly mandated twin-engine, IFR helicopters for all EMS operations, although I would probably join the unemployed. First, the required number of those helicopters just don't exist, and it would take years before the factories could produce them. Second, the FAA simply does not have the authority to make such a mandate. This isn't England, it's the US of A, where the government is subject to the will of the people, not vice versa. At least theoretically. In reality, the government is subject to the will of the corporations which bribe the politicians. Either way, such a mandate is simply not possible, regardless of whether it's a good idea or even morally right.

The situation is as it is, and will remain so for at least the foreseeable future, and no amount of petitioning will change it, unless accompanied by millions of dollars. I have the same right as Shell Oil or the Koch brothers to bribe members of Congress to do what I ask. I just don't have the millions of dollars. The system isn't good, or right, but I don't have any idea how to change it. Those who can, have a vested interest in keeping things the way they are. So complaining about how things are done in the US may make Europeans feel better, but it will do nothing else.

MamaPut

3rd Jan 2012, 20:56

Gomer Pylot,

Your last post is probably the most lucid and honest I've seen in a long time with its views on politics, corporate might and balancing ethics and morality with profit and reality. Well said. You, sir, are a true American "common man". Keep up the good work :ok:

ShyTorque

3rd Jan 2012, 22:31

So complaining about how things are done in the US may make Europeans feel better, but it will do nothing else.

A very raw nerve has obviously been touched here. I don't think that anyone on the European side of the Atlantic has complained about how things are done in USA; why would we bother? It has merely been pointed out (on what is, after all, a forum for professional pilots) that things are now done differently on the other side of the Atlantic, for reasons of better capability and hopefully, for better safety. Night charters shouldn't be killing people. EMS shouldn't be killing people. Regardless of statistics, one accident is one too many.

Night helicopter ops will always have risks due to the nature of the job but it's disappointing if certain known risks cannot be reduced.

I didn't like the rule changes we were forced to obey in UK regarding night operations. It affected all of us, and we complained too. It affected the price of later contracts and therefore salaries in some sectors. However, there were a number of high profile accidents, as already mentioned and that was seen as unacceptable.

I, for one, believe that the USA deserves better equipment for the job in hand. If the industry isn't interested in providing better equipment and training to use it (and from what has been said here, it obviously isn't, due to loss of commercial margins) and the FAA won't mandate a change, then things will never progress. Companies will continue to buy cheaper aircraft and expect pilots to just carry on regardless.

The USA, as a huge economy, quite rightly likes to reflect on the fantastic advances it has traditionally made in all other branches of the aviation industry. Not to forget it put men on the moon almost 43 years ago. So it seems very strange that it won't even consider phasing out non-autopilot and otherwise under-equipped, non IFR helicopters for night roles. :hmm:

I await the accident report of the all-too recent "organ retrieval" accident.

170'

3rd Jan 2012, 23:02

Gomer Pylot...

Hammer,Nail,Head :ok:

Gomer Pylot

4th Jan 2012, 01:51

ShyTorque, I thought I had made my point, but obviously I didn't. It's not possible to suddenly just abandon several hundred aircraft and replace them with non-existent aircraft. They do not exist. There is an effort to find an acceptable, certifiable autopilot for existing aircraft, and that will probably be done as soon as someone comes up with one. The other problem is purely economic. It's not economically feasible to quit using current aircraft in some areas. We either use what can make a profit, or we quit HEMS entirely in a huge portion of the USA. The government will not, cannot, take over EMS operations here. It has to be done by the private sector, and that can only be done if there is a profit. I do believe the government should be doing the job, but the majority of the citizens do not, thus it won't happen soon. In an ideal world, things would be different, but this world, and this country, are not ideal, and never will be. We have to do the best we can with what we have, and keep trying to slowly make things better.

SASless

4th Jan 2012, 02:33

GP,

What about the EMS programs that lose money on their operation but the hospital makes a profit after making up the loss incurred by the EMS operation as a result of the knock on effect of increased business at the hospital and clinics from patients drawn into the system?

Yes...in general...the EMS business is just that....making money but not necessarily at the Helicopter Unit level.

I would argue against the concept the Guvmint shoud provide the service.

Fundamentally I am opposed to the government getting into any "business" that is not a basic function of government. Search and Rescue...for example is a necessary government function but medical transportation is not in my view.

Just as I woud not have the government doing pothole repair.....I would have them paying for the repair but contracting it out.....in some states the liquor stores are run by the State or County.....and again I would take them out of that business and let the private sector run the liquour business.....with the State just taking some Tax money off the proceeds (and leaving all the cousins and brother-in-laws to find a private sector job instead of being a ward of the State).

Why is it wrong for the insurance industry selling a product and making a profit....and health car being provided by private organizations rather than the government?

I do agree we need to get the money out of politics and government out of business....along with business out of government....but as you so clearly stated...that just ain't gonna happen shy of a bona fide Revolution that would make the French one look like a garden party.

The way I see it...as long as there is a need for a service....and someone can provide it at a reasonable price...there will be buyers of that service. As the law of economy of scale works...folks wil find a way to group together to obtain bulk rates.

The key is to eliminate the barriers to fair and free competition where the providers with the best/cheapest product will prosper and those that cannot compete will fail.

You might recall in the earl days of the EMS business an outfit called Rocky Mountain Helicopters that found itself unable to get insurance because of their safety record. They soon went out of business....and other outfits formed and have become quite successful.

[email protected]

4th Jan 2012, 02:47

The commercial realities of this business are what they are in the markets they serve. I’ve witnessed them first hand on both sides of the pond where decisions were made based purely on economic realities. In the US margins, are wafer thin and generally not investor friendly relative to the risk involved and the rate of return generated.

At the end of the day we are in business wholly because someone wishes to generate a reasonable rate of return on an investment. In any business risks are only mitigated to the extent that a loss might be acceptable when measured relative to the investment required to mitigate the risk entirely, after which there is an overall and rapidly diminishing rate of return or interest.
With 5% net margins commonly experienced by helicopter operators, even a larger operator earning $1 billion in revenues a year cannot afford too many strategic mistakes, let alone continued fleet renewal or upgrades. $50 million a year will get you a few helicopters, maybe some regulatory compliance, a few essential maintenance upgrades and maybe fix some maintenance/pilot errors. It hardly extends to satisfying investors who might reasonably expect a much higher rate of return parking their cash else where, with significantly lower risk. As Gomer said private companies are neither able, nor sensibly willing to consider some of the suggestions made – they simply could not continue in business,; at least in the US.

Pilots/Engineers are there to fulfill a job, that someone else is willing to provide, and must decide for themselves if the risk is acceptable to them. In the meanwhile the private job providers here in the US will continue to decide whether it is worth while being in the business, irrespective of what regulatory, crews or others may wish. In both cases of course, the balance of value/risk is worth more to some than others and perhaps a matter of perspective.

ShyTorque

4th Jan 2012, 07:54

Gomyer, please note that I wrote "phasing out", not "suddenly abandon". The CAA didn't mandate a sudden abandonment, it gave a date in the future for a requirement for stabilized helicopters. :=

SASless

4th Jan 2012, 08:43

Are we finished demanding twins and accepting the fact the number of engines is not the issue? Have we finally accepted it is not engine failures that are killing off the EMS crews? Perhaps there is progress being made....that being understanding the causes of the problem and not the symptoms of the problem.

It is CFIT or LOC following IIMC that is killing them, and that it does four times as often at Night than in the daytime that is the biggest killer.

Let's focus on the root cause of the problem shall we?

ShyTorque

4th Jan 2012, 12:41

Are we finished demanding twins and accepting the fact the number of engines is not the issue?

SASless, who actually said it was the issue?

rotorspeed

4th Jan 2012, 14:16

SASless

Ok let's indeed focus on the issue. Would you like to propose a detailed spec of helicopter you would mandate if you were making the decisions at the FAA, in order to provide far safer HEMS at night, at a viable cost? And what timescale would you implement it over?

Art of flight

4th Jan 2012, 14:22

Perhaps I could start the spec list with....the ability to fly IFR in IMC in accordance with national legislation when VFR flight is not possible due to weather.

[email protected]

4th Jan 2012, 14:34

An interesting topic without doubt but whilst we are on the subject of who pays for what, can we just remember that the UK Government doesn't pay for HEMS and AA, they are funded by charities.

Perhaps this is a model that could be considered by the USA since the relatively few UK taxpayers (compared to the US) manage to fund twin-engine IFR helciopters quite satisfactorily. No bribing of politicians, no profiteering, just people raising money for a service and paying an equitable amount for a suitably safe service at that.

JimL

4th Jan 2012, 14:51

Art of Flight,

That is really not the answer. Rather than construct a new text, below is contents of an email on the subject sent to the Rapporteur of the ICAO HEMS WG in 2009.

In my view the issue is not so much about the ability to fly in IFR (for which the certification criteria exists) but one of addressing the issue of flight in VFR when it is no longer possible (or really difficult) to "...be able to see outside the cockpit, to control the aircraft's attitude, navigate and avoid obstacles and other aircraft".

My main comment would be that problems are mostly associated with reduced visibility and, not necessarily, a descending cloud base. This leads to two additional problems:

1. How is visibility measured in flight (I don’t know the answer); and

2. What if the cloud is descending generally – executing the 180º will not result in a flight back into a clear area.

This is why I emphasized that the decision is never presented to the pilot in clear and unambiguous terms. On the other hand, if the aircraft is well equipped – either with two pilots or with an autopilot (but in any case with some form of augmentation); there is a buffer both in height and in control.

My view has always been that although Parts 27/29 have a clause that states in 2x.141(c):

The rotorcraft must: (c) Have any additional characteristics required for night or instrument operations, if certification for those kinds of operation is requested. Requirements for helicopter instrument flight are contained in appendix B.

It is well known that there are no enforced requirements for certification associated with night operations (or operations in a reduced visual cue environment by day). This is not such an issue in those States where aircraft used for night HEMS are twins certificated under Appendix B of Part 27/29, but in the USA where singles with no additional (stability) requirements are used, too much reliance is placed upon FAR 135.207:

Sec. 135.207 - VFR: Helicopter surface reference requirements.

No person may operate a helicopter under VFR unless that person has visual surface reference or, at night, visual surface light reference, sufficient to safely control the helicopter

which, in an unlit area, relies upon the use of NVG to meet the visual surface reference requirements.

Although the objective of the rule does state that visual cues must be “sufficient to safely control the helicopter”, we all know that this (subjective judgement) is totally reliant upon the other part of the equation - i.e. the stability of the helicopter. Whilst that stability is addressed by Appendix B to Parts 27/29 for any aircraft that is certificated for flight in IMC, it is not for most singles (and even some twins).

The handing qualities of the helicopter and the usable cue environment are inversely proportionate to each other. As the quality of handling increases, the requirement for visual cues reduces. At the extreme (with an auto-pilot), the only cues that are required, are those which provide for obstacle avoidance (not unimportant but of a secondary order).

This is not a message that is usually well received by regulators, or operators, as it really points to the necessity to address stability in a reduced visual cue environment – particularly at night. The traditional answer to this dilemma is to place a requirement, at night, for twins (knowing that most will come with certification for flight in IMC) - this is the European solution; in addition, in some States (the UK for one), airspace at night is designated IFR; which leads to the (JAR) requirement for an auto-pilot for single-pilot operations.

Night IFR in the UK does not mandate the full set of rules contained in ICAO Annex 2 but instead a quasi-night-VFR regime exists that permits operations below 3,000ft to be conducted much as they are for day VFR.

No simple answers but, if States wish to address the main issues, stability is key; it does not have to be twins, Appendix B to Parts 27/29 can be used for singles.

It is only when the issue of stability has been addressed that EVS or SVS come into play; they address (the secondary issue mentioned above of) obstacle avoidance but can never replace the necessity for good handling qualities.

Jim

ShyTorque

4th Jan 2012, 15:01

Thankyou for posting that, Jim. I was beginning to think earlier that I was a lone voice!

The last but one paragragh is what I've been advocating here but it's difficult when the bullets keep flying about the USA not being able to afford "our" twins and the shooters refuse to read what's actually being written.

Art of flight

4th Jan 2012, 15:39

Quite agree Jim, just starting the list for rotorspeeds request. Of course that list could be started at any point including, aircraft equipment, pilot training and qualification, CRM/HF, briefing facilities, regulation and legislation etc....

I for one am grateful to be flying UK police ops in aircraft that are legislated for by the years of hard won arguments for regulation by people such as JimL. Wasn't long ago we in the UK were flying single pilot without stability at night and without any instrument qualifications, of course we still haven't got the later for police ops!

SASless

4th Jan 2012, 16:42

JimL's post pretty well sums it up.

The only way I would differ with his input is the priority I would place on the two issues....(as I read it....)his being "stability" over "cues" and I would make it the reverse...."Cues" over "Stability" but the end result is the same. The better one can see the ground and obstacles....the less sophistication one needs.

I use the example of comparing two extremes of weather....one with a stark clearly defined ceiling with excellent visibility beneath the over cast and the opposite where there is very limited visibility with no definition between the cloud base and the surface touching phenomenon (fog, haze, smoke, mist) that obscures visual cues.

I know which one I gladly fly in....and the one I adamantly refuse to fly in. If I can see clearly....if only a few feet above the terrain..I can avoid obstacles and do so comfortably. No autopilot or stability augmentation needed.

If I am struggling to see what is in front of me...even if at only a few feet above the terrain...I am decidedly unhappy. Even if at a "safe" height and I cannot see but a short murky distance....I am not happy. Having a three/four axis autopilot and a second pilot in the cockpit would not alleviate that discomfort.

Visibility is the key to the issue in my view....not cloud height.

Give me a three/four axis auto pilot and send me out in bad vis at night VFR....is not the right answer. Give me that same autopliot and send me out on an established IFR route....IFR and that is the better concept.

Mere Stability is not the answer alone....there has to be a way to be assured o your location, route, and clearance from both Terrain and Obstacles.

The current Achilles Heel to increasing the sophistication of the aircraft is the lack of Helicopter based IFR route structures and approach procedures. The current system is directly aimed at the Airplane market and not Helicopters.

When we get to where we can do point in space IFR approaches, IFR approaches to off airport locations, and have route structures that facilitate that....we are stuck trying to figure out how to operate safely VFR in IMC conditions...as that is where the hiccups occur.

The sticky bit is when in limited visibility...the transition from VMC to IMC can happen very quickly and usually at the exact worse time and place. Throw in darkness and there is even greater chance for such thing to happen.

If one were to be using an aircraft with a three/four axis autopilot...recovering from IIMC should be far more successful as it would only require a bit of button pushing and assuming George cooperates it is then a matter of confessing one's Sin, gaining an IFR clearance, and completing the flight following IFR procedures....ignoring some minor issues like fuel, fuel reserves, traffic de-confliction while climbing to a safe height IMC with no advance notice to ATC, weather reporting/planning and more than a few other issues.

rotorspeed

4th Jan 2012, 18:05

Come on SASless, how about coming up with a succinct list of what you want then! We've been debating suitable regulations to improve HEMS safety - tell us what you would specify, as I asked before!

SASless

4th Jan 2012, 19:48

Rotorspeed....if you read my last post it should hit you right square between the eyes what I think will improve safety for EMS operations.

There is not a cook book approach to this situation as it is a very complicated situation on any number of levels.

We have had two pilot crewed IFR Multi-engined helicopters crash as well as single engine VFR only aircraft crash. Thus...equipment alone is not the answer.

We have had Rule/Regulation changes....and we still have crashes so that alone is not the answer.

We have had infrastructure changes....and yes...again...we have crashes so that is not the answer all by itself.

I see the cure as being a multi-disciplined approach to the situation.

Add in all the variables of each Operation...location, tasking, climate, and all that and there is just no simple answer as you are asking for.

My personal preference.....and just my personal view for what I would prefer to fly....a twin engined fully IFR equipped two pilot helicopter equipped with all the bells and whistles it could carry to include NVG's, Moving Map, TAWS, CVR, RadAlts, Dual GPS's, ILS, Marker Beacon, Synthetic Night Vision installed on the aircraft, Air Conditioning, Radar, and Stormscope and be limited to VFR only.

Until the FAA can either provide or authorize the creation Helicopter Only off airways IFR route structure and Point in Space IFR approaches with automated weather reporting at each landing site all Ops would be VFR except for using current IFR routings and facilities under IFR.

Now...over to you.....how does one achieve that....fully IFR operations to the degree I propose?

Nick Lappos, while at Sikorsky the first time, did extensive flight testing of those kinds of IFR procedures using an S-76. Those trials proved it works.

How would you improve safety....I gave you my recipe...what's yours?

rotorspeed

5th Jan 2012, 11:13

SASless

To be blunt nothing hits me square between the eyes from your last post. As usual with your posts I find you tend to avoid concise, pertinent responses but ramble on a bit, undoubtedly with a lot of experience and some valid views beneath it all.

The fact is regulations need to be as clear, prescriptive and concise as possible. Training needs to be as well. Time and money is precious, apart from which people get bored trying to understand what they should do from lengthy messages.

I asked you to propose a detailed spec of helicopter you would mandate on a timescale if you were making the decisions at the FAA, in order to provide far safer HEMS at night, at a viable cost. You still have not done this - expressing your personal preference to be for IFR twins with every bell and whistle available and fly VFR only. A pointless comment, frankly!

I started off saying night HEMS ops should be IFR twins. Your position was that VFR singles was OK. So taking on board some research plus US and European comments, my off the cuff spec now for night ops US HEMS would be:

Phase 1, within 1 year:

Single engine providing has a proven failure rate of less than X
3 axis autopilot or two pilots
Radalt
NVGs
IFR approved GPS with moving map
At least 1 pilot instrument rated
Detailed data logging of every flight with reporting for central analysis

Phase 2, within 3 years:

As above but with:
Single engine providing has a proven failure rate of less than Y, (more stringent)
3 axis autopilot with stablisation system
Dual hydraulics
Dual generators
2 x IFR approved GPS
TAWS
CVR

After 3 years of operations the accident and incident data would be reviewed to establish whether there is any justification for moving to twins.

Aircraft spec is JimL's area of expertise, so perhaps he could contribute here.

I suggest someone with more US HEMS experience proposes some criteria for weather, ops and IFR let down procedures etc.

Bear in mind I've only spent 10 minutes on this with no added research, so this very much a starting point - evolutions welcomed!

fly911

5th Jan 2012, 11:35

Basic VFR autopilot.

IntheTin

5th Jan 2012, 11:58

Nothing really new!

NTSB report on Mayo Clinic crash released | News - Home (http://www.news4jax.com/news/NTSB-report-on-Mayo-Clinic-crash-released/-/475880/7646156/-/djxqq8/-/index.html)

Jack Carson

5th Jan 2012, 12:11

Rotorspeed, you are right on with your plan. At this time at least one of the major operators in the US (AMC) is well on its way with such a program without being forced into it by the federal government. Their aircraft are presently equipped as follows:

• Very reliable and proven single engine machines AS-350s and B-407s
• Duel Garmin IFR GPS Units – Paying to keep GPS data bases current has been an issue.
• All aircraft are equipped with Radar Altimeters
• All aircraft are NVG equipped with trained crews
• All pilots are instrument rated
• All flights are centrally monitored and tracked by company flight operations with a very sophisticated company proprietary system and monitored by operations personnel (former line pilots) 24/7.
• Most aircraft incorporate HTAWS with plans for 100% incorporation in future
At this time I see two significant holes left to be filled, the incorporation of either two or three axis autopilots and dual hydraulics. Dual hydraulics is optional on the AS-350B2/3 but standard on the B4. I am sure that cost has been a driving factor. Companies have opted for NVG’s in lieu of the more expensive auto pilots. NVGs may help with not encountering IIMC but do little or nothing once IIMC in encountered.

170'

5th Jan 2012, 12:12

SASless

5th Jan 2012, 12:32

If one thinks stating the solution to Helicopter EMS accident rates can be done in two or three short sentences then there is no hope of there being effective communication between individuals who view the situation from different perspectives as the issues are far to varied and complex to be so nicely summed up in a manner akin to that of a Readers Digest magazine.

Rotorspeed.....if you do not like the answer...don't ask the question!

You pointedly asked for my input....you got it....deal with it!

If you find fault with my views...argue your points....but don't attack me personally as that is considered very impolite in these circles.

You can disagree but you do not have to be disagreeable....and that is exactly how you come across.

Does your Helicopter EMS experience equate to the time you spent doing that research by any chance?

Some slight problems with your thinking on "Singles".....you have any concept of the impact of putting two pilots in a 206L, 407, 350 helicopter has on the ability to carry a patient?

If you do...you would not have suggested that at all.

When Operators specify a maximum body weight for pilots....as a famous country comedian says...."Here's your sign!"

Your equipment list sounds very much like that I proposed as my personal preference....are you poaching from my list?

Do you assume there is insufficient data on record to be able to make a decision re Engine Failure rates for the various single engine helicopters used for EMS operations currently? Why do we need you "phase" concept. We can make that determination right now....as the EMS Operators have done. They are using these aircraft and we do not hear of a problem with accidents due to engine failures.

[email protected]

5th Jan 2012, 18:12

Now Now, men. Steady on. It's just a frank discussion and sometimes you can agree to disagree :)

ShyTorque

5th Jan 2012, 18:59

Sasless- Like a lot of people of our generation, often tends to write as he would speak in the crew room or bar. It lends an air of authenticity to his posts and I'm far from alone in thinking that pprune gains tremendous benefit from his 'rambling on a bit'

True, but bear in mind that SASless is no longer in the crewroom. He routinely fires out personal criticisms from his retirement yacht but doesn't like ricochets or return fire. :=

BTW, I'm not sure that two pilots in the present aircraft will be possible. Having operated the 355N in a casevac role (police aircraft, prior to air ambulance in our part of the world), it wasn't practical because when the casualty is on board his legs and feet need to go under the instrument panel, meaning that the front left seat had to be left out. We were obliged to leave one of our observers and his seat behind, sometimes in the hills if we diverted in from our normal job to pick up an urgent casualty case.

Also, the main issue under discussion seems to be loss of visual cues, trying to fly VFR, below safety altitude in IMC. Stabilise the aircraft (autopilot), make it fully IFR capable but leave it single pilot. Not sure how the old mindset of "let's always struggle VFR" could be cured, though.

SASless

5th Jan 2012, 20:04

Shy.....I lived long enough to retire....which in our profession does speak for itself and managed to do so without being involved in an accident or chargeable incident. I do have some basis for conjecture about safety issues and concepts based upon those several years experience.

We can disagree without being disagreeable can we not?

If you poke a grouchy ol' bear with a stick....they sometimes bark a bit you know.

Here of late I have been using my walking stick to trip up children as they run by.....darn pesky whippersnappers!

Oh....did sell the yacht....and moved ashore for a while but it will take a bit to wash the salt off my hide.

Devil 49

5th Jan 2012, 20:07

First, why do most of the industry's serious mishaps happen at night when we fly half as much in the dark? Why is pilot error so much more dangerous at night?
There's no scientific physiological consideration given to scheduling pilots for night duty in the industry. There's no consideration for circadian rhythm or effective sleep's importance to efficient rest. The result is that sleep deficit, poor sleep quality and circadian disruption, which all have adverse effects on mental efficiency are all ignored as potential contributory issues to poor pilot decision making. Part 135 minimum mandate "10 hours of uninterrupted rest" as a standard is clearly inadequate in light of these known issues.
It seems that the most common rotation schedules are 7 days, 7 off, 7 nights, 7 off and a variation of 7&7 where the scheduled duty pilot works "X" 12 hour day schedules, takes a 24 hour interval, and works "Y" nights.
The first schedule, straight 7 successive night duty periods is unsatisfactory for a substantial part of the population that lack facilities dark and quiet enough to get a "good nights sleep" without interruption. These pilots accumulate the bad effects as the duty period progresses, becoming less and less efficient.
The second schedule, with a 24 hour interval to adjust to night duty, starts the pilot fatigued and in the middle of the duty schedule, and allows inadequate time to flip the circadian clock completely. Most pilots on this schedule start night duty tired and then disrupt their circadian cycle, resulting in poor sleep (and poor tinking when awake) accumulating a sleep deficit and sleep poorly until their body clocks adjust- and then cycle off to normal diurnal existence. The only arguable operational benefit of this schedule is that the night duty period is brief, 3 or 4 nights. And it fits a calendar handily, in my opinion an esoteric variation of "get home-itis": I really really want it to be this way because it's easier...
There's no point in mentioning the pilots I know who are invulnerable and believe that they can go all day and all night. Or those who show up making statements like I really need to sleep tonight...
I've never had an operator acknowledge that these problems exist, up to and including Uncle Sam. Machismo and invulnerability is apparently acceptable in this one regard, "Real men (pilots) just do it" even though physiological science seems otherwise.

Night operations should not be viewed as the same as day operations with less light, because they are not. First,what you see and how you see is different at night. You have to learn to see differently and in a world without color, or learn to use aided vision, which entails unique issues. The weather is also subtly different at night in most areas, with much less convective effect bad weather becomes worse weather due to stratification.

Having more capable equipment- autopilots and real IFR capability, for instance- often only complicates the decision process, especially problematic with night scheduling issues. Add that people tend to complacency in familiar scenarios, and one might be inappropriately counting on "George" or a pop-up IFR saving your bacon when a better call would be to decline a request based on intelligent assessment of existing conditions, or abort enroute.

The current vogue for corporate operational control regimes and risk assessment tools don't begin to address the scheduling issue. The answer is having brief night duty schedules, started with a well rested pilot, and either effective self assessment or encourage pilots to make the "knock it off call" when there is any doubt.

topendtorque

5th Jan 2012, 20:52

Not sure how the old mindset of "let's always struggle VFR" could be cured, though.
That statement cuts to the quick a definition of the real problem.

Maybe some rule changing that people are not going to like will be needed wrt to VMC.

Now you have a visual range up to the pilots interpretation, perhaps that range should be extended but instead prescribe conditions that will allow that visual range I.E. I know in a quarter moon I can easy see that far. Right, new VMC rules. Flights during less than 1/4 moon must be filed IFR.

same same for fog, cloud etc, why not have a required differential on your forecast dewpoint temperature to be filed on a flight plan prior to flight along with ambient temperature. Then if in breach of the differential, the insurance or risk of being exposed to no insurance esp. third party, becomes the controller.

At the end of the day night is as clear as being hurt right where it counts, in the pocket. Any system that is self driven is much cheaper and usually far more effective.

ShyTorque

5th Jan 2012, 21:04

SASless,

We can disagree without being disagreeable can we not?
If you poke a grouchy ol' bear with a stick....they sometimes bark a bit you know.

Yes, of course we can. But, as I said before, the problem comes when the bear wakes up unprovoked and tries to bite all passers by.

In some cases you might just end up with a grouchy ol' bear on each end of the stick.... :E

I know we're singing off the same hymn sheet but not necessarily always quite in tune... ;)

ShyTorque

5th Jan 2012, 21:59

TeT,

Good start, but you'll be aware that the moon phase alone doesn't determine the actual usable light levels. Cloud, atmospheric pollution, cultural lighting etc all play a part too. Sometimes a flight can be made with no moon but purely on cultural lighting (UK Police have this option written into their "Visual Contact Flight" night rules, it's the pilot's own go/no-go decision).

As a point of interest, in UK, "filing IFR" wouldn't make a difference. Because there is no night VFR. The rules here state in essence that outside of CAS, at 3,000ft or below, IFR are deemed to be met if sufficient visual cues are available to carry on safely. Essentially the same as if the flight was flown under "Special VFR" rules in a control Zone, although the term is avoided in this context.

Obviously, the problem is how to know if sufficient visual cues will be maintained along the whole route.

Having the ability to abort "Night VFR" and pull up to MSA in a properly equipped IFR aircraft is surely safer than not. The worst case is having to "suck it and see" in marginal conditions, in a non-IFR compliant aircraft then fly into reduced visual cues, with no easy get out. If NVGs are in use, and they lose effectiveness due to reduced available light levels or IMC, this is when even highly skilled/experienced pilots can lose it and buy the farm. Night disorientation is very easily found in an unstabilised aircraft. This is why we (RAF SH) fought hard to get the night cloud and vis limits correct. The limits for NVG ops had to also allow "unaided flight".

Thankfully, in UK at least, there is nothing to prevent a properly equipped and trained helicopter pilot alternating between the "Visual Cue by night IFR" (my term) and the "Full IFR" as he sees fit. As long as he can obtain visual cues before he descends below 1,000 feet above the highest obstacle within 5nm of the aircraft, it remains legal and safe. Obviously, provided accurate situational awareness is maintained.

These days, in my small part of aviation, this essentially is how I operate much of the time by night. Sometimes a SVFR departure can be made, followed by an IMC transit, then an ILS to an airfield requiring a bit of a drive for the passengers. Obviously, the icing level may prevent an IMC climb to MSA and that is when finer judgement is needed. Sometimes a "no-go" decision will be made on the ground. Sometimes, that decision will prove in retrospect to have been over-cautious and leave me open to criticism (and it has), but as we all know, it's so much safer than the ultimate penalty paid for being under cautious...

Here it isn't a requirement to file a written flight plan for IFR provided I remain clear of Class A airspace. Special VFR entry to any control zone can be requested on the radio. No guarantees, but procedures are in place to allow it, day or night.

Aerobot

6th Jan 2012, 01:34

I like to provide an alternate point of view. This is not just to be disagreeable, but if someone else is saying what I would, why bother to post?

That said as preface, I tend to get a bit edgy when the proposed solutions seem to built of silicon chips and rules. Furthermore, I'm a civilian and though it doesn't get as much airplay in these days of Call of Duty III, I think there is a great heritage of civilian aviation that doesn't have to give up the podium to anybody. I became acquainted with that heritage through my father, who was there when Mr. Hughes looked over a table of schematics, finally pointed his finger at a place on the airplane that nobody else was looking at and said, "Fire that man."

Enough digression. As I say, I resist solutions made of computers and regulations. I believe that the answer to the problem lies with the pilot, and the pilot alone.

I ask you: when you read these reports and try to figure out what happened do you, as I do, try to imagine how much time elapsed betwen the time the metal bent and the time the pilot suspected that he was where he shouldn't be, doing what he shouldn't? How far did the pilot go beyond the chicken-out point? Maybe the chicken-out point was on the ground...

Give him a Bell 47 with wooden blades, or give him an autopilot that could solo the Starship Enterprise, you haven't made him safer unless he knows that it's his helicopter and that he is under absolutely no pressure to fly it longer than he feels is safe. Train him in the EP's, sure, but make sure you train him in how to quit a flight at the first moment that his personal risk needle swings into the red.

Retrain or remove any person or thing in his entire life that puts any pressure on him to "just try it a little farther." Until you have done that you haven't done enough, and you certainly haven't done the single best, cheapest, thing you could have to make sure they all go home.

ShyTorque

6th Jan 2012, 07:54

Aerobot, Do you really think your proposition is realistic? :D

Get rid of rules and technology and concentrate on the pilots? When all existing pilots are sacked, because they don't comply, who will train this new "breed" of aviators who chicken out at the first sign of any risk? How will the "personal risk" meters be calibrated?

Go back to the Bell 47? How many patients and medical staff will fit in one of those, in addition to the pilot? How much fuel can it carry?

You will, of course, be financing this venture yourself.. Because no-one else will.

SASless

6th Jan 2012, 12:56

Dang Shy....you are sneaking onto my turf again!

ABot just said in a slightly different way what I said in reponse to JimL when he talked of "improving aircraft stability" and I suggested even if I had another pilot, a three/four axis autopilot and all the neat kit....I would still be very uncomfortable doing the VFR IFR Night thing you guys do....in marginal weather.

Abot did not suggest one should use a Bell 47 for EMS work....but said given the Bell 47 or....operative word he used was "or" ... a sophisticated IFR Twin...the Pilot(s) were a key common element.

I agree with what he had to say....as we have seen repeatedly, in crash after crash, pilot decision making/judgement is probably the leading factor in those events.

That ties in with my view that until we can improve the Helicopter IFR enroute structure to facilitate actual IFR flying and thus eliminate the VFR IFR Night (or Scud Running in daylight) with its inherent risks of IIMC, CFIT, LOC in IMC following IIMC.....we shall continue to have the problems we do.

Aerobot

6th Jan 2012, 13:18

Congratulations, Shy. I have never had anything I've posted be so amazingly misunderstood. I'd explain it, but I see that SAS gets it so I don't have to.

Thanks, SAS. I had a bad moment there while I wondered if I'd really said some bonehead thing. I meant something along the lines of "safety equipment is nice, but concentrate on pilot's judgment." Nice to see I got that message across.

[email protected]

6th Jan 2012, 13:22

It's well and good to propose new bigger more capable machines, but where does the dough come from? I suspect the IFR, two pilot twin with all available bells and whistles was only Sasless thinking out loud.

Change the way EMS is funded in the US.

Try the UK model of charity funding with Medicare paying a certain amount as well into the coffers. Enough is raised in UK to support HEMS and AA and all provide twin-engine, IFR capable helicopters.

Complaining that Medicare only pay a certain amount per flight and that dictates the spec of the aircraft just ignores what needs to be changed in order to improve the safety of HEMS in the US - remove the bottom line so operators don't have to cut corners and provide the minimum spec aircraft and allow new blood into the business.

Devil 49

6th Jan 2012, 13:58

Aerobot-
Amen, Brother! And "hallelujah" somebody else sees the forest...

Jack Carson

6th Jan 2012, 14:01

Changing the funding model will do little to effect the results if we don’t have a system ultimately driven by prudent PIC decisions. The Maryland AS-365 mishap provides an example of this. Maryland’s HEMS program is fully funded as part of the cost of every driver license fee. As such Maryland operates SPIFR AS-365 helicopters. However, being a state government organization they were not obligated to operate under FAR- Part 135 but rather under Part 91 allowing for VFR flight operations at significantly lower weather conditions than required by their commercial counter parts. There has to be a point where good judgment trumps rules, regulations and minimum equipment requirements.

rotorspeed

6th Jan 2012, 14:27

Just caught up with this interesting thread!

Jack Carson; pleased you agree we’re closing in a sensible proposal and interesting ref AMC.

SASless; to deal with your main points in your post #188.

Rotorspeed.....if you do not like the answer...don't ask the question!

Well how exactly am I supposed to know your answer before I ask a question?! Of course I am pleased to read alternative views – that’s how we learn.

You pointedly asked for my input....you got it....deal with it!

I did indeed deal with it, in my post. But you got tetchy, because I was objective and criticised elements your reply. Quite validly I maintain, and I suspect a few others might have agreed with me.

Does your Helicopter EMS experience equate to the time you spent doing that research by any chance?

My HEMS experience is zero. But I have considerable helo flying experience including at night and in poor weather, VMC and IMC. I also have considerable experience running a business, so understand commercial realities, and matters of safety and medical care. So I feel qualified to contribute to this subject, as well as welcoming input from those with direct HEMS experience.

Some slight problems with your thinking on "Singles".....you have any concept of the impact of putting two pilots in a 206L, 407, 350 helicopter has on the ability to carry a patient? If you do...you would not have suggested that at all.

No, I hadn’t considered where a second pilot might go in a 206/AS350. Good point, though one made, typically, somewhat sneeringly by you, but constructively and sensibly by ShyTorque, whose posts I have great respect for, dealing knowledgeably, intelligently and pertinently with issues.

It doesn’t really matter though, as in that case the alternative of having an autopilot would be required. Regardless of space, my own view would anyway be that in a single (and light twin) a good autopilot would be preferable, given a balance of payload, cost and safety.

Your equipment list sounds very much like that I proposed as my personal preference....are you poaching from my list?

What a telling remark! This is not about “poaching” from anyone’s list, but about using any information anyone proposes that contributes to the debate and adds to our Pprune consensus (should we ever get that far!) on a regulation way forward. It would be a great testimony to the expertise amongst Pprune if we could prove to lead the way here. Might even influence regulators worldwide – you never know! Where is there a better forum for getting input from a broad range of mainly sensible opinions and constructively debating to a valid conclusion?

Do you assume there is insufficient data on record to be able to make a decision re Engine Failure rates for the various single engine helicopters used for EMS operations currently? Why do we need you "phase" concept.

No I don’t. You’re probably right – there maybe sufficient info on failure rates now. But I was more thinking that maybe C20s on 206s might not be as good as AS350 Arriels or 407 250 C-47s, and allowing the opportunity to phase out 206s if they are deemed not reliable enough for effectively SE IFR long term. Perhaps you could tell us what failure rates each of these engines have then and propose a suitable minimum failure rate for SE IFR?

The main point is that I believe this forum should provide a platform for opinion, objective robust debate and information. Sometimes SASless I feel you come over as if you were holding court in your own bar, expecting everyone to bow to your superior experience and wisdom. You can shy away from responding succinctly to questions raised, yet get defensive, affronted and haughty with those who take you to task. Be nice if you could be more objective and have a bit more respect for the many intelligent, reasoned comments others post.

Having said that, I’d love to be in bar and listen to your views and stories – I’m sure they’d be fascinating! And I agree with 170 – you certainly make a great contribution to Pprune.

And finally Crab's last para is right, HEMS businesses, whether Europe or US, should be ones that are primarily run to sensible operating procedures and regulations, not according to what payments are offered. If it can’t afford to be done safely enough it shouldn’t be done at all. Evolution should be on a sensible timescale though.

Agree with your theory, Aerobot and Devil 49, but better training could/should have been in place for years and accident rates are still unacceptable. So it seems it alone cannot be replied upon. Regulation change, including that referred to by Jack Carson ref Part 91, needs to come too.

SASless

6th Jan 2012, 14:33

Changing the funding model is not going to happen. In fact....one could almost suggest the reverse be true....that being the UK should go the private enterprise method except there is no private enterprise in the healthcare field in the UK that compares to our system.

We have to agree the two approaches to business/funding/ownership of EMS operatins are and shall remain quit different between the UK and USA.

Bottomline...someone has to pay for the service...either the user, the provider, or someone who does so as a third party be it a charity, government, or insurance company.

Helicopters run on money....not jet fuel as most folks assume.

[email protected]

6th Jan 2012, 17:17

Jack - in your Maryland example, does the state directly own and employ the helicopters and crews or does a sub-contractor (who would have to bid for the contract) provide? If it is the latter then it is no different to the other states in that the cheapest bidder will get the contract and have to minimise costs to make a profit.
Changing the funding model will do little to effect the results if we don’t have a system ultimately driven by prudent PIC decisions and allowing them to operate VFR in poor weather conditions is the one thing that won't prevent poor decisions - it is exactly the cause of the crashes at the moment.

Poor decision-making in poorly (compared to the more expensive alternatives) equipped aircraft is the reason why so many of these well-meaning crews end up as statistics.

If you make a poor decision in a VFR only helo, you have nowhere to go - if you make the same poor decision but have a real IFR option, then plan B saves the day.

I will say again, change the funding model and regulate for SPIFR aircraft and appropriately trained and competent pilots and the problem will likely go away almost overnight.

ShyTorque

6th Jan 2012, 17:39

Aerobot said:Congratulations, Shy. I have never had anything I've posted be so amazingly misunderstood. I'd explain it, but I see that SAS gets it so I don't have to.

Aerobo, I don't think I misunderstood it. After doing my time in professional aviation, best part of a couple of decades military, then para-military day & night casevac/SAR, later Police/Air ambulance, some private/corporate (which strangely enough actually puts the pilot under heavy personal pressures, especially at night) I could see flaws in what you had written and replied to it, albeit somewhat tongue in cheek.

Obviously any pilot needs to make safe and sensible decisions every time he flies or he will not last long, he'll either kill himself or get sacked. But for a job such as Night EMS (one of the most demanding there is) the best equipment should ideally also be provided - if we expect it to be done reliably and safely.

The UK for once seems to be ahead of the USA in this respect, for good reason - we suffered our own tragic losses in the past and it was eventually deemed necessary for the regulators to act. This took away some responsibility from the operators; as I said before, it levelled the playing field for all with regard to the level of equipment and type of aircraft that was seen as acceptable. I could quote you two examples of why in UK we now have twin engined, stabilised helicopters for public transport night flights (this is deemed to include police and Air Ambulance flights in UK).

We continue to lose aircraft in marginal conditions and I could also quote you three fatal helicopter accidents where pilots' decision making, planning and competency for the job has been an issue. So I agree with your sentiments in part but not as far as the suggestion that the use of good equipment is less important, not if you want the job to be done safely and efficiently.

I'm lucky enough to have operated some of the world's more capable and better equipped helicopters. I've also been given some inadequate ones and expected to cope and provide the same service.

There has been many a time when I would have been unable to do the job in a less capable machine. If I hadn't gone and got the job done, someone would have died. There have been times when I have been put under very heavy pressure to fly when I knew the job might not get completed. Sometimes, in those circumstances, I've gone and proved it couldn't be done. Sometimes I was wrong and we did finally get the job done, because the weather improved, for example.

However, I've always stood up to those putting me under pressure to fly when I regarded the flight to be unsafe. I've also turned back when continued flight was becoming unsafe. So far it's worked, I've never been sacked and I'm still here typing this stuff.

The thing about an IFR capable aircraft is that it gives the pilot another way of getting the job done, or recovering safely if it can't be done. It requires more planning, more fuel, more time to organise and complete. If it's not flown properly, it can bring its own further dangers. However, the ground always wins a CFIT contest.

You need IFR equipment or you can't train the pilots to fly it.

Trying to do an IMC job in a VFR only aircraft is a ticket to nowhere except to an accident. This is the real crux of the matter.

alouette3

6th Jan 2012, 18:36

Since we are all spit balling here and nothing seems to be off the table how about this:
Deem single engines VFR-Day only and allow them to operate only by day (since, it seems, that a lot of accidents happen at night).Organize them in a hub and spoke system.Have a "fully loaded" IFR capable Twin (or two) at a hub and sprinkle the VFR singles in the spokes. they take care of business during the day and in VFR conditions and the twins pick up the load, or the slack, at night ,or in IFR conditions, respectively.Crew the twins single pilot with a four axis A/P or have two pilots,depending on the location (urban vs rural, mountainous vs flat,benign weather vs four -seasons- rage etc)
Crew the VFR aircraft with younger,new to HEMS pilots and let them use that time as a stepping stone for the IFR Captaincy in the twins in the future. Allows them to make good decisions as they build time and experience.
I agree with Devil 49.Night shifts are not the same as day shifts and 3 or 4 or 7 nights in a row with flights at 2 am (the lowest point in your circadian rhythm) does not an effecient pilot make.If you happen to be awake after midnight, either completing or beginning a flight, you should have more than the ten hour rest period currently allowed by regulations.It should be more.Maybe even the whole next day and a half off. Of course, that will mean hiring more pilots per base and the operators will baulk at that.
Any takers?
Alt3.

squib66

6th Jan 2012, 18:45

Crab

The Maryland State Police are owned, maintained and crewed by State Troopers, but as they are treated as a 'public' (ie government) aircraft they are not subject to FAA regulation.

Accident Investigations - NTSB - National Transportation Safety Board (http://www.ntsb.gov/investigations/summary/AAR0907.html)

The National Transportation Safety Board determined that the probable cause of this accident was the pilot's attempt to regain visual conditions by performing a rapid descent and his failure to arrest the descent at the minimum descent altitude during a nonprecision approach. Contributing to the accident were (1) the pilot‘s limited recent instrument flight experience, (2) the lack of adherence to effective risk management procedures by the MSP, (3) the pilot‘s inadequate assessment of the weather, which led to his decision to accept the flight, (4) the failure of the Potomac Consolidated Terminal Radar Approach Control (PCT) controller to provide the current ADW weather observation to the pilot, and (5) the increased workload on the pilot due to inadequate FAA air traffic control handling by the Ronald Reagan National Airport Tower and PCT controllers.

The safety issues discussed in this report involve risk assessments, pilot performance and training, terrain awareness and warning systems, air traffic control deficiencies, SYSCOM duty officer performance, and emergency response. Also discussed are patient transport decisions, flight recorder requirements, and FAA oversight. Safety recommendations concerning these issues are addressed to the FAA, the MSP, Prince George‘s County, all public helicopter emergency medical services operators, and six other organizations whose members are involved in search and rescue activities

NTSB held a meeting recently after a series of accidents in the 'public' category (both government operated and supervised aircraft):

Forum: Public Aircraft: Ensuring Safety for Critical Missions (http://www.ntsb.gov/news/events/2011/public_aircraft/index.html)

This safety forum, "Public Aircraft: Ensuring Safety for Critical Missions", addresses oversight of public aircraft. The goals of the forum are to (1) raise awareness of the importance of effective oversight in ensuring the safety of public aircraft operations; (2) identify where responsibility lies for oversight of public aircraft operations; and (3) facilitate the sharing of best practices and lessons learned across a number of parties involved in the oversight of public aircraft operations.

Public aircraft are operated by a federal, state or local government for the purpose of fulfilling governmental functions, such as firefighting, search and rescue, law enforcement, wildlife or land management, or aeronautical research. Government organizations conducting public aircraft operations supervise their own flight operations without oversight from the Federal Aviation Administration (FAA).

One other example is this New Mexico Police mountain rescue accident, which is worth reading om how some of these units are run:
Board Meeting - Crash of Agusta S.p.A. A-109E helicopter, N606SP, near Santa Fe, NM, June 9, 2009 (http://www.ntsb.gov/news/events/2011/santafe_nm/index.html)

The National Transportation Safety Board determines that the probable cause of this accident was the pilot's decision to take off from a remote, mountainous landing site in dark (moonless) night, windy, instrument meteorological conditions. Contributing to the accident were an organizational culture that prioritized mission execution over aviation safety and the pilot's fatigue, self-induced pressure to conduct the flight, and situational stress. Also contributing to the accident were deficiencies in the NMSP aviation section's safety-related policies, including lack of a requirement for a risk assessment at any point during the mission; inadequate pilot staffing; lack of an effective fatigue management program for pilots; and inadequate procedures and equipment to ensure effective communication between airborne and ground personnel during search and rescue missions.

JimL

6th Jan 2012, 19:01

I see the sense of my last post has been misconstrued; I was not advocating flying IFR - that is not the answer for 'scene' work. My post was mainly concerned with the issue of the visual cueing environment. Visual cueing is important for three reasons:

(1) to permit the pilot to control the helicopter from cues outside of the aircraft;

(2) to permit the crew members to see all obstacles within the flight path; and

(3) to permit the crew to use pilotage to find their way to the scene.

i.e. flying VFR. Adequacy of the cues (as I said previously) is related to the handling qualities. The more attention that has to be applied to accessing visual cues, the less brain power is available to control the helicopter. If controlling the helicopter is provided by automatics, it is unlikely that control will be lost if the visual cues are reduced. Not IFR but VFR in a reduced visual cue environment where the visibility is not in question.

It is a matter of launching in accordance with the latest dispatch criteria but planning for the unexpected.

I understand SASLess' wish for a comprehensive low level IFR structure combined with a PinS type arrival but en-route and arrival procedures will have to be compliant with PANS OPS or TERPS. These prescribe the obstacle clearance criteria for en-route section, specify the surveying criteria to establish obstacle clearance in the arrival segment and require either a visual approach (really out of the question) or a proceed VFR (which will require VFR weather). This has not been a simple matter even for heliport procedures; for example the lighting criteria has still not been resolved.

In addition the helicopters will have to be certificated for flight in IMC (one of the points that is not being accepted at the moment). The pilots will have to be trained, checked and have instrument recency (otherwise one problem will be replaced by another); wasn't instrument proficiency and recency the main cause of the Maryland accident.

The real answer lies with a change of culture and the correct application of the FAAs dispatch criteria through oversight of operational control. The posters that have stated that the business model will not change are absolutely correct - it is the american way!

An improvement in the safety record will be hard won and will come gradually with education, culture change and regulatory oversight.

There is no silver bullet!!

Jim

rotorspeed

6th Jan 2012, 20:51

JimL

Can you ever see single engine helicopters being approved for IMC flight, with suitable equipment? Is it a question of a proven engine failure rate and if so what would that be?

SASless

6th Jan 2012, 21:03

JimL,

The pilots will have to be trained, checked and have instrument recency (otherwise one problem will be replaced by another); wasn't instrument proficiency and recency the main cause of the Maryland accident.

Current Regulations and Industry practice allows a Pilot to pass a Part 135 IFR Check ride and be deemed both Current and Proficient....and usually a Company Training Captain shows up at the base...conducts a very minimum ground training and perhaps an hour or so flight training ride then conduct the Check Ride. If the Pilot meets the minimun standard he is good to go.

We talk about "currency" and "proficiency" as if they are the same. They most assuredly are not. Some of these "IFR" bases rarely fly IMC much less IFR between their six-monthly checkrides. If the Operator/Customer provide for it....sometimes one can add an practice Instrument Approach to a leg that does not conflict with the task of getting a patient to the medical facility.

For an aircraft that is based away from an Instrumented Approach Airport....it is very rare then for the Pilot to even do a practice approach. Most cases the Pilot is the sole occupant aboard the aircraft and cannot use a Hood or other Vision obscuring device.

Depending upon the prevailing weather.....flights in actual IMC of any kind can be rare for the whole host of reasons one can list.

Again....when we talk of IFR Programs....there is a whale of a difference between the theory and reality and we can see the results of that in the accident statistics.

The whole concept of IFR route structure and Approach criterion must be reviewed from the perspective of HELICOPTER performance and not as is done currently by most Certification Authorities. Helicopters are very much different than Airplanes in their approach speeds, ability to operate at very slow speeds, and that they are designed to operate away from Airports.

Yes obstacle clearance is an issue and mobile obstacles like Cranes, Advertising Balloons and the like are a problem to contend with but that does not preclude doing these kinds of appoaches. There are areas in this country where it would be quite feasible and easy enough to survey. Granted someone has to pay for the survey, design, and certification of the Approaches but that happens now for the Airplane world.

Helicopter Operators are doing that....I am led to believe the Royal Flight has done something very similar for the 76(s) used to fly the Queen...have they not? It can be done....but there has to be an attitude at the Government level of "Git'er Done!" not the usual...."Not Possible!".

All these changes and improvements....starting with a simple Radalt or GPS to the Helicopter IFR Infrastructure all come with a cost....either for doing it and paying for the purchase of the unit.....or in lives lost due to it not being available and being needed.

We need to get Nick Lappos to recount his experience with that bit of Testing and see what he thinks of the ability to make that happen and what it would entail from the Helicopter Industry and Government.

Gomer Pylot

6th Jan 2012, 21:08

Change the way EMS is funded in the US.Won't happen. While perhaps a good idea, the chances are about the same as doing away with the monarchy in Great Britain. Charity won't work here. The country is too big, and too varied economically, politically, and geographically. So suggesting that is a waste of time. Putting autopilots in the aircraft is an excellent idea, and I truly believe that will happen, whenever the autopilots become available. For now, they simply don't exist, but there is an effort underway to get them developed and approved by the FAA. It will happen eventually. Not this, or next, year, though. The process takes time, even after the hardware is ready.

I agree that the primary cause of most accidents is poor pilot decision-making. Even if the operator imposes no pressure to fly at all, and truly most don't, at least the larger ones, self-imposed pressure is a constant. Some pilots are in this business to be a hero and save lives. Those need to be weeded out. I have no idea how to do that, however.

Sasless's opinion of what the government should do, versus mine, is the essential argument taking place in the US right now. One side says the government should do nothing, while the other says it should do more than it's doing. I think part of the reason for having a government is to take care of the poor and the weak. Others believe it's only to protect the rich and powerful, and that they're going to be part of that someday, if they're not already. In the meantime, our infrastructure is falling apart. Roads, bridges, and everything else are crumbling because there isn't enough income to pay to maintain it, much less to improve it. Until this debate is settled by overwhelming elections, nothing is likely to change. I'm pessimistic in the short run, but optimistic in the long run.

430EMSpilot

6th Jan 2012, 21:42

I've been reading this thread since it began. I rarely post but enjoy keeping up with what's going on and getting a sense of what's going on in our community. I respect the experience and the opinions represented here.

I just can't resist putting in my own two cents. I've flown in the military, ems, and in the corporate world and I think we would all agree that statistically, pilot error is the cause of 80% of accidents in the U.S. I wonder if it's the same in the U.K. and other places?

I would like to tell my freinds not operating in the U.S. about a few things that are not going to change:

There will never be a requirement for twin engine aircraft at the national or state level.

There will never be a requirement for 2 pilots at the national or state level.

There will never be a requirement for ems aircraft to be SPIFR equipped or that they must fly IFR.

These things are not going to happen...ever.

I know that's not popular, even with pilots in the U.S. but that's the truth.
When operators can't get pilots to fly aircraft not so equipped then it might change, or when patients refuse to fly then it might happen but I can promise you that it won't occur thru regulation.

My humble opinion is that we (pilots) are killing ourselves. The reason the pilot (owner) of the Mayo charter crashed is because he killed himself. The same applies to the guy who ran out of gas, or went IIMC, or CFIT (2 engine) or hit a tower (two engine)or tried to beat a TRW home. The aircraft they were flying didn't break or malfunction, it was willfully misused by the pilot.

We need to change the culture, in old pilots who mentor young pilots and in the young pilots. No job is worth killing yourself and those with you, don't take the job if you don't like the equipment and don't fly if you aren't sure you can make it home. Quit if you are being pressured to fly, if you and your crew are dead, you've still lost your job.

I have had the benefit of mentors who drilled that into me and contrary to the nature of the typical type A personalities of helicopter pilots, taught me to be humble about my skills and equipment.

I agree with all of you as far as equipment and crew, but the thing we can change at our level is the culture at our job so that there is no question as to whether a flight should be attempted or not.

Those of us posting here can have a huge impact on the accident rate by being an example and a mentor to those around us!

Fire Away!!!

ShyTorque

6th Jan 2012, 22:13

Some pilots are in this business to be a hero and save lives. Those need to be weeded out. I have no idea how to do that, however.

Gomer, sometimes they weed themselves out in a Darwinian fashion. Sad thing is, they sometimes take others down with them. Some of these "personality" pilots (unstable extroverts?) get to quite elevated positions before they do so. I've flown with a few like this and I'm thankful that I wasn't there when they weeded themselves out.

One "senior" in particular was less experienced than me in the role but decided to show me how to fly 6,000 lbs plus, long line underslung loads "properly" when he thought I was too slow on the approach. He took control, pulled the guts out of the aircraft during the next climb from the pickup point in the valley below, then he cut the corner to approach directly at 90 degrees to the ridgeline drop site (I'd gone in at 45 degrees to the slope to get a better wind direction and to give an escape route if we ran out of power). Unfortunately, he was far too fast, ran out of power and with no escape route, all other options. He bounced the load downslope of the ridgeline and nearly took out the ground handling party on the rebound. He went really quiet after that. I looked across at him, said nothing but he knew....

Same person later scared his crew half to death by getting the empty long strop hooked up on a 10 foot high wire mesh fence. He suddenly transitioned off a drop site after another hillside USL job. He ignored the crewman who was trying to hold him steady in the hover until the strop was pulled in..... luckily the fencing gave way before the aircraft nosed right over into the hill, but it was on it's way.....

There are other true stories of "derring do" involving the same person but I'll keep those to myself.

It's difficult to get rid of this type of pilot once they get to a certain level, but these are exactly the ones who need getting rid of, because they can encourage the wrong type of institutional mentality amongst young pilots. :(

SASless

6th Jan 2012, 22:34

430....nothing to fire away at....you got it figured out.

Luck trumps judgement and skill every time....butone should hedge your bets as much as possible.

430EMSpilot

6th Jan 2012, 22:40

I hope it's not luck, I prefer good judgement and skill...

CYHeli

7th Jan 2012, 06:03

Interesting thread with robust discussion.
Just one thought on how to change culture, in Australia most health services only allow helicopters to land at a hospital pad that can maintain Cat A performance. This would then extend to only twins being allowed in and the natural extension is that they are also IFR aircraft. Would a change in health service culture lead towards a change in aviation culture?

I realise the risk of comparing apples with oranges as has been hinted at with comparing US and UK models.

JimL

7th Jan 2012, 07:31

Rotorspeed,

The certification criteria for approval for single-engine flight in IMC already exists in Appendix B to Part 27; the operational criteria for single-engine flight in IMC is part of Annex 6, Part III, Section II, Chapter 3 and its Appendix.

To answer a point made in your previous post: the reliability of turbine engines reached a plateau a decade or so ago, it is unlikely that it will improve. Each functional part of the helicopter is assessed for failure; where that failure would result in a hazardous outcome the part is replaced well within its failure horizon (you saw after the failure of the AW139 tail rotor, replacement at half the observed lowest failure point). Where the failure of a part might be critical and it can be duplicated then redundancy is introduced - this is employed for generators, hydraulics, critical instruments (artificial horizon) and their power packs, and engines. A probabilistic approach is taken to forecasting failure using the outcome as a driver for the policy.

The outcome to the failure of an engine is related to the environment over which the failure occurs; that provides the basis of policy related to single-engine IMC for the carriage of passengers. The ICAO text (which was written with careful consideration) provides States with the ability to permit or deny single-engine flights in IMC over their territories for that very reason (look for the riders in the text).

SASLess, the criteria for PinS procedures is already tailored for helicopters. Where this might be adjusted is if the whole approach is undertaken automatically (as is being demonstrated by EC). The critical element is visual acquisition; for instrument airfields with their sophisticated lighting systems, there is potential. For heliports (under the present regulations), this remains just a dream. For off-airport approaches there are additional issues that are non-trivial. It is not just a matter of surveying but one of guarding the environment to ensure that the obstacle environment remains as surveyed. The location of any 'scene' work is unpredictable; although we might imagine how that could be done, it is a problem of a magnitude far greater than steps that might be taken to reduce the current accident rate to an acceptable level - even if that includes improvement in the handling qualities of (a particular group of) helicopters. Discussing these issues in the vernacular is a million miles away from the formal risk assessment that would be required before it could come into existence.

As has been indicated many times before; the majority of accidents have a human factors element. If we can change the culture of operators/pilots to accept the current system/limits (and understand the consequences of not applying them) we will have to change little else. The event that causes the accident is probably the first time that it has been encountered by that pilot. One solution therefore is to ensure that pilots understand and take advantage of the experience of others less fortunate than themselves. It would be difficult to imagine 'Gomer' as an accident statistic - except with respect to a mechanical failure. Operational limits must not be seen as a challenge (as it appears that engine-failure is to some).

Jim

muermel

7th Jan 2012, 07:35

I'm reading this thread since the beginning and I find it contains a lot of very interesting information and points about the whole issue.

I was reading the current Vertical Mag and found the Bell 429 (EMS) ad on the back. Doesn't this kind of "talk" contribute to the "Heroes" attitude that is one of the major factors in EMS accidents or am I seeing something that isn't there?
I mean no pilot will go out in marginal weather etc. JUST because of this ad, but doesn't this kind of talk keep the "We have to save this person whatever the costs" attitude alive, of which we all agree is killing EMS crews by the dozen?

I'm sorry to point it out this harsh but all this "Hero" crap really get's me going. These people deserve our respect but the "common man" doesn't seem to understand that this kind of hero worship is killing people.

Would like to post a picture but I think commercial pictures are not allowed.

This is the text in the ad:
"There's nothing you wouldn't do to help save a life. We share your dedication and commitment. So much so we invented aerial EMS almost 60 years ago. So when your mission is to maximize the golden hour and save lives, the Bell 429 stands ready to serve your heroic measures with extraordinary means."

Greetingshttp://www.pprune.org/[IMG]http://i43.tinypic.com/212ux3p.jpg

http://www.pprune.org/[IMG]http://i43.tinypic.com/212ux3p.jpg

http://www.pprune.org/%3Ca%20href=%22http://tinypic.com?ref=212ux3p%22%20target=%22_blank%22%3E%3Cimg%20 src=%22http://i43.tinypic.com/212ux3p.jpg%22%20border=%220%22%20alt=%22Image%20and%20video %20hosting%20by%20TinyPic%22%3E%3C/a%3E

Shell Management

7th Jan 2012, 07:54

Good observation. I would have hoped Bell would be thinking more about safety culture.

rotorspeed

7th Jan 2012, 08:22

Thanks Jim, interesting as ever.

What actually is the modern turbine engine failure rate? And what is the probability of a second engine on a twin failing within say 1 hour, eg realistic max OEI flight duration. Or any other short time? Obviously assuming not related causes eg fuel. Any chance of a link to Appendix B Part 27?

In broad practical terms, can you give any examples of when SE IMC might be approved, private or public transport?

With regard to the requirement for twin engines for at least UK and ? all European public transport, is that simply because an engine is a critical component capable of duplication, or because of any specific failure probability?

SASless

7th Jan 2012, 12:12

One solution therefore is to ensure that pilots understand and take advantage of the experience of others less fortunate than themselves.

Something that is poorly done by both the Industry in general and the Pilots individually.

Rather than publishing a "Lessons Learned" on each individual crash....and summaries on a regular basis and ensuring the widest distribution and consumption.....bad news gets hushed up. Part of that comes from fear of legal proceedings, bad public relations, and in far too many times the abject fear Management has in admitting mistakes or shortcomings of their Operations or Management system.

Pilots tend to believe such tragedies occur to others....until too late!

JimL

7th Jan 2012, 13:05

Rotorspeed,

Your later statements are based upon false premises; enable your PMs and I can discuss it with you.

In the meantime the first element of your post is described here:

http://www.pprune.org/rotorheads/176803-gom-yet-another-ditching-12.html#post6923997

Jim

grumpytroll

7th Jan 2012, 15:48

I saw that Bell ad and immediately thought the same thing. I wonder who they are talking to? Not pilots or medical crew but hospitals with deep pockets who buy these thing with the promise from the manufacturer and the companies that possibly staff them that we can go anywhere and do anything.

As for all this talk about IFR EMS in the US. It is such a complicated situation that there will never be a set of short regs to cover the industry. For those of you who are not from here, look at a map of the US. The sheer size of the country dwafts most European countries. Understand that the US features some of the largest mountain ranges in the world, one of the largest desert regions in the world, oceans along two borders. The environmental changes in the US in a one to two hour flight can take you from a deep flat desert environment to a snow covered mountain. Why would you want to require IFR dual engine for operations in a desert area that sports clear weather 350+ days per year? I am not even talking about Alaska where you have not only artic environments but tropical rain forests!

I fly EMS in a single and twin at night with NVG's. (dual Garmins, moving map, Sat tracking, TAWS) Most of my flights with a patient on board last less than 25 minutes, many ten to fifteen. It is still a benefit to the patient because in rural areas it would take the ambulance 1-2 hours to get the patient to the same level of care.

If the weather is not conducive to taking the flight, we don't go. A wise man once told me that if you study the weather for a flight request more that five minutes, your answer is NO.

I still have not seen on this thread a conclusinve statement on what the failure rate is for any turbine engine mounted in a helicopter, whether it has two or one and further how many of these are the direct cause of an accident.

Cheers

=

SASless

7th Jan 2012, 15:49

JimL.....I best watch my step around you....something along the lines of "Don't tug on Superman's Cape!" springs to mind!;)

Jim has done a great job of forcing some rational considerations up the flag pole and into law

I think Anfi was trying in his own way not to be humerous and suceeded.

If only "rational considerations" found themselves codified in law!

Grumpy.....excellent advice he an you have given here.

A wise man once told me that if you study the weather for a flight request more that five minutes, your answer is NO.

I also say...."If the other guy asks you what you think of the weather....it is not a question but rather a statement!"

Gomer Pylot

8th Jan 2012, 01:53

The Bell ad is obviously not aimed at pilots or med crew. They don't buy helicopters, nor decide which to buy. It's aimed at hospital administrators, who make decisions, and not always based on rational factors. I agree it's a poor ad, but it's certainly legal, and marketing is always a dog-eat-dog business, with little if any concern for safety. Sell the product, and worry about any fallout later.

Gordy

8th Jan 2012, 04:57

Sasless, Grumpy et al.... In line with your posts.....

I give you the best helmet sticker ever, I may have to get this printed:

http://i76.photobucket.com/albums/j35/helokat/funnies/HdRTA.jpg

SASless

8th Jan 2012, 13:15

Gordy,

The one I was going to put on my helmet was...."Do You want to fly with a Pilot who ALWAYS says Yes?"

Art of flight

8th Jan 2012, 13:31

or..........there are old pilots, there are bold pilots, but few old and bold pilots. Now look at the open side to decide which type is flying you today.

Aerobot

8th Jan 2012, 17:43

I don't wear cute stickers on my helmet. There's my name, and there's a little memorial sticker (put on by the helmet's previous assignee) with an N-number, which anyone can ask about if they want. If they do, I'll tell them it was a helicopter assigned to a hospital where I used to be stationed. It's not there anymore, not since the pilot accepted a flight he shouldn't have and killed everyone on board.

AirWon

8th Jan 2012, 20:01

Have to agree with Aerobot. No stickers, just scratches and dings.
Used to work with a guy in Maui who had "IT'S ALL ABOUT ME", on his......
Need I say more?

Gordy

8th Jan 2012, 20:30

Here is mine when I first got it, before it got all scratched and dinged, sometimes you just gotta have some fun.....:

http://i76.photobucket.com/albums/j35/helokat/h1.jpg

topendtorque

9th Jan 2012, 12:09

Just for interest I went back and read the summary of the report as printed by CNN. here it is.

In a 2006 report on the crashes, the NTSB found that 29 of those 55 accidents could have been prevented.
The NTSB identified four recurring safety issues:
• Less stringent requirements for EMS operations conducted without patients on board.
• A lack of aviation flight-risk evaluation programs for EMS operations.
• A lack of consistent, comprehensive flight-dispatch procedures for EMS operations.
• No requirements to use technologies such as terrain awareness and warning systems to enhance EMS flight safety.

Apart from that the CNN article is quite weighted with discussion on NVG's. There is nothing about engines, one or two, so talking about them is a waste of time.

There is probably nothing there that is incurable. It is still the nut behid the wheel and the big wheel behind the nuts when they promote their company's capability when they vie for these contracts.

Let the buyer beware they say, but how can the (buyers) the hospital administrations be aware of safety matters and legislation of aviation, when they see magic carpets portrayed as the ultimate cure for the 'golden hours' etc by slick salemen.

The simple rhetorical might be, what controls pilots? Well it's supposed to be chief pilots.

The chain of responsibilty (COP) legislation which is starting to bight in this country would lead you to the Ops manual and the two contollers of that. The CP and the Federal Administration.

That is what is supposed to control safety, why isn't it?

(COP) If I load a truck with cattle and note the driver is tired or don't note, either accidently or intentionally on my part, that he has driven over his rest periods, but don't stop him I can be held jointly accountable when he crashes and kills several people.

That COP legislation would lead one also to the directors, managers and owners of the aviation companies. Perhaps that may be the elixer that is needed to put in place adequate controls?

SASless

9th Jan 2012, 12:59

Operational Control became an issue as a result of that NTSB report as I recall. Until that point...each base operated independently and provided monthly reports of operational statistics. No direct supervision of flight operations such as Dispatch oversight was done by the CP or DirOps from the Corporate Office. They issued Directives, SOP's, conducted Training and Checkrides, did the recruiting and other tasks but no daily close handed control or monitoring. If an accident occurred....they were notified by the customer generally.

The fact FAR Part 135 places the operational control burden on the CP/DirOps and the EMS Operators had been ignoring that for years did not bother the FAA for any number of reasons.

That is not the case now....as the FAA is requiring the Operators to comply fully with the 135 Requirements re Flight Tracking. I would suggest the issue also applies to Utility Helicopter Operators as well when their fleets are widely scattered and operating in remote areas far away from the Main Base/Main Office.

Applying the FAR's to helicopter operations can sometimes be very difficult even when the Operators are dedicated to doing the very best they can and a very bad situation if they are not so dedicated.

For a great bad example....think back to the Maryland State Police Bell 206 crash that went unnoticed for quite a long time despite being within minutes of takeoff and within just a mile or so of the point of departure.

Aerobot

9th Jan 2012, 13:00

topendtorque, are you talking about making responsibility commensurate with authority? That's just crazy talk, man! :)

Oh, wait. I see you're in Australia. Here in the US we're not big into blame sticking to upper management. :rolleyes:

Seriously, as long as the CP's can point to the place in the Big Happy Fun Book where it says that the PIC has the authority to terminate any flight, the responsibility will stick to the PIC and won't go uphill. They can make things a bit safer by raising the weather minima, but most won't as long as their competitors don't. The FAA can raise everyone's minima, as in the case of AO21 but they've already done it once and probably won't again for a while at least.

No, I still think it falls to the pilots - you have to be willing to quit when you feel that your safety margin has gotten intolerably thin, and you have to have a company that will back you up on that decsion - or you have to find another company. But if the alternate companies won't, the pilots' only alternative is a union.

Ultimately, it falls to us at the sharp end to be the final authorities on the safety of flight. The government can't do it, the CP can't do it. It comes down to the "C" word in the acronym PIC. Command is not just wiggling the sticks.

Well, I think the coffee's written enough for one day. Fly safe. :ok:

IntheTin

9th Jan 2012, 15:36

A smart pilot and crew!

Officials: Helicopter makes emergency landing - Live5News.com | Charleston, SC | News, Weather, Sports (http://www.live5news.com/story/16476022/patient)

COLLETON COUNTY, SC (WCSC) -
A medical helicopter made an emergency landing Saturday night in Walterboro after a patient on board began fighting with the crew.
According to Colleton County Fire and Rescue officials, a man sustained multiple traumatic injuries around 6:45 Saturday after he jumped from a moving vehicle on Interstate 95 South near mile marker 60.

Emergency personnel found the man semi-conscious lying on the shoulder of the highway. The man was immobilized, given IVs and rapidly transported to Colleton Medical Center. Once at the hospital, he was then transferred to a medical helicopter. The crew lifted off for the trauma center at MUSC.

About five minutes into the flight, fire and rescue officials say the patient became combative, broke the immobilization straps on the backboard and began fighting with the crew. The pilot turned around and made an emergency landing at the Lowcountry Regional Airport east of Walterboro.

Several Colleton County sheriff's deputies, and fire and rescue crew members rushed to the airport to assist the crew. The helicopter was able to safely land and emergency crews restrained the patient.

The man was then transported by ambulance to MUSC. En route to MUSC, the patient's condition deteriorated. He was later admitted to the intensive care unit at MUSC, according to Colleton County fire and rescue officials.

His condition is unknown at this time. The incident is still under investigation.

SASless

9th Jan 2012, 17:07

Must have been a helicopter pilot.....when he realized he was in a single engined VFR only EMS Helicopter at Night....he insisted upon being allowed to leave and freaked out when refused permission.

Granted...the first step would have been a doozy!

JimL

9th Jan 2012, 18:39

We have discussed at length the issue of encountering a reduction of visual cues in the en-route phases (associated with lighting levels, weather or just a sparsely populated area with low levels of cultural lighting). Although mentioned several times, we have not spent a great deal of time on Operational Control.

Contrary to the implication of Aerobot's post, operational control is not just about aborting a flight in the en-route phase - which quite correctly lies completely within the ambit of the pilot. It has more to do with section C. of Appendix 1 Order 8400.10, Volume 3, Chapter 6 Section 5 which includes: the delivery and maintenance of a serviceable helicopter; locating the aircraft when a flight plan is not filed; the conduct of operations in accordance with the OpSpecs; the qualification and allocation of crews to flights; and, most importantly, the system and control of dispatch (all contained within Notice N 8000.347.)

As I indicated before, this was one of the subjects discussed with the Rapporteur of the ICAO HEMS WG in our exchanged of emails - an excerpt of which is shown below:

Although the policy of choosing, and following, the en-route policy is an important issue, in my mind the real issue is the escape strategy once it becomes doubtful (it is rarely clear) that the flight cannot proceed at the assigned level (or with the encountered in-flight visibility). In a number of cases (with IFR twins as well as VFR singles) it is the gradual and insidious degradation of visual cues that results in loss of control. Early recognition of the onset of such conditions is the key to avoiding the consequences of a loss of control in a degraded visual environment.

It is only when company culture (management and pilot attitudes) accept that early and decisive action can avoid the (probably not inevitable – making this a difficult call) consequence without recrimination (from management or from other pilots) and effect on personal reputation and ego, will the required change on attitudes be achieved (sorry about the complex sentence). This is much easier to achieve in a two-crew environment (two pilots, or one pilot and a trained HEMS crew member).

It is not difficult to conclude that two of the most important elements with respect to HEMS safety are the company culture (substantially affected by the business model) and operational control (once again substantially affected by the business model). Whilst the business model may not be something that can be influenced by a committee such as yours (or even by ICAO), culture and operational control most certainly are.

I have forwarded you the FAA guidance on operational control because it does (in my view) have relevance to the dispatch and continuation of any HEMS mission. Note, particularly, the operators responsibility with respect to the dispatch of any HEMS flight – regardless of the remoteness of the operation.

Jim

SASless

9th Jan 2012, 19:21

It is only when company culture (management and pilot attitudes) accept that early and decisive action can avoid the (probably not inevitable – making this a difficult call) consequence without recrimination (from management or from other pilots) and effect on personal reputation and ego, will the required change on attitudes be achieved....

JimL,

Add in the Hospital Management and Med Crews (Customer)....and I would call that a nearly perfect statement.

Along with visual cues being lost....the distinction between Customer/Crew gets all murky as well in the EMS world. Part 135 and reality are oft times too separate concepts regards that issue.

Med crews not employed by the Operator are not Crew ever....under the rules....but are passengers. Hence some built in conflict.

Devil 49

9th Jan 2012, 22:23

but it still gets down to the loose nut behind the wheel, as posted earlier. Environmental info (weather) is historical at an op con center and doesn't have the value it should have with local experience adding perspective. Either the op control is too conservative or relies on the PIC, which can put us right back at the start, PIC continuing into a bad situation. I have had the op con raise issues for discussion, which I find helpful in that if I can't explain my plan convincingly then it's probably not well founded anyhow.
And even with effective op con, how do you prevent the killer errors: descending at night to reestablish VFR surface reference; continuing into adverse weather VFR in the hope of better weather; continuing confused about fuel aboard and endurance; and that most fatal of all maladies, get-home-itis? If the PIC isn't appreciative of the very real and immediate prospect of killing oneself, then how does somebody without immediate information make the call before the crash that's soon to follow?
The answer is the root cause- why are pilots so much more intellectually challenged at night in these decisions? Invulnerability is certainly a problem, but most pilots are not sufficiently trained in self assessment for the abrupt night shift change and/or night ops in general... My opinion.

SASless

9th Jan 2012, 23:20

Devil,

I don't think pilots are anymore intellectually challenged at night....just the ramifications of a bad decision are greater than in the day time. It all gets down to being able to "see".....and as we all know it can get too dark to think let alone see.

Devil 49

10th Jan 2012, 16:32

SASless,
I have a hard time accepting the premise that the US HEMS higher night accident rate is due solely to vision.

Not being able to see complicates issues that arise, but I won't continue into an area lacking visual reference in the daytime, and I won't at night. In fact, acknowledging the physiological visual issues at night makes me far less likely to continue into the blackness.

I'm unhappy with the prospect of a precautionary weather landing, but I'll land before I continue at the risk of an IMC and the emergency that entails in a VFR ship. My perception is that this attitude is the acknowledged norm, yet inadvertent IMC and loss of control happens too frequently for me to not to believe something changes a fundamental attitude.

I won't transit cross country at an altitude less than reasonable obstacle clearance, much less lower than 500 AGL. This too is a common position amongst my peers, but CFIT happens at night in circumstances that make me think there's a poorer appreciation of the risks at night.

These events occur single/twin, VFR/IFR (even with autopilots), and even dual pilot, although it's much more exceptional in a 2-pilot crew. The common factor is that all of my observations are day/night rotations. But the only all night crews I've ever observed were PHI's night crews...

I've also observed frequent cavalier attitudes towards nights, as mentioned in my previous posts, in the pilot pool. It's reasonable to think that if I've seen pilots burning the candle at both ends, then it's happening elsewhere and is at least potentially contributory.

I have my own improvised self assessment routine based on my experience, and there is a difference in intellectual agility while I am shifting to nights. To date, I've always been adequate to the challenge, but I can see the approximation to the designated driver situation- it's better to decide before you're snockered...

Perhaps this is all me seeing what I expect to see based on a laymen's reading of the documentation. But the evidence is widely available that jet lag (in the vernacular) should be a factor considered with greater weight in duty schedules. Ten hours of uninterrupted rest is not sufficient to realign circadian cycles to enable approximate 100% intellectual capacity when awake and on duty. It's not sufficient time to realign sleep cycles so that one sleeps and rests efficiently between duty periods to maintain 100% intellect. It's also likely that the poor sleep will be of inadequate amount, accumulating fatigue impairment. These issues are widely discussed everywhere except in aviation. Until an airline crew plows it in after poor rest on the commute to a duty period...

SASless

10th Jan 2012, 19:21

How many pilots show up for a night shift having been up and about all day instead of crawling into bed and getting as much sleep as possible immediately before starting work?

The key is to start with a "Sleep Bonus" rather than a "Sleep Deficit"....and some guys work second jobs...take care of personal business and rely upon what sleep they can get while on duty during the night shift.

You see it at your base I am sure....and I have seen it at the bases I worked. The guys show up saying they are looking forward to a good nights sleep.

The first shift of night time is hard....as one is just beginning to have to adjust your sleep period from a normal routine. As the nights proceed...the ability to sleeep during the day time improves but as you rightly state...is not as good as a normal routine.

When working permanent nights....using blacked out windows on the bedroom....setting the Air Con to "Freeze"....turning off the telephone and disabling the doorbell....and offerering murder and mayhem to the a-hole next door that delighted in mowing his yard under my window when he knew I was trying to sleep.....I tended to get plenty of rest. The key being....no change of routine....until the weekends when the Wife was sleeping nights and I was sleeping days (not....as I was young then and sleep was a second or third priority).

Humans are not nocturnal creatures once we pass the age of about thirty or so.

If visibility is not a key factor....why have the use of NVG's cut down on the numbers of EMS accidents during night flight?

Devil 49

10th Jan 2012, 20:34

Humans are not nocturnal, period. Consider your visual equipment versus a nocturnal mammal's eyes. There is a portion of the population that never accommodates itself to night duty while the rest of the surrounding world runs a normal day schedule...

Everybody shifts schedules at varying rates, and that changes with age, as does sleep efficiency. It's cliche that old people often fall asleep but it's also cliche that they don't sleep as long or as well. Those may be related.

The more or less "accepted rate" for accommodation is an hour a day.
You can't have a "sleep bonus" to carry forward against lack of sleep and even out. All one can do is be well rested when entering a short night's sleep. One also never entirely recovers from a sleep deficit, although a couple of good nights sleep makes the issue moot.

An abrupt time shift engenders circadian losses for the vast majority of the population. One can feel fairly well if well rested at the start of shift that reverses the body clock, and in the wee hours of the morning be functioning mentally at level comparable with yourself at 2-3 alcoholic beverages. You wouldn't fly after a couple of belts, but we accept flight assignments in that condition through ignorance (or maschismo?).
The first night is rough because of all this. My experience is that I feel better the second night, but the circadian issues are still there affecting mentation. Try a challenging academic challenge on your second night... There's no escaping physiology for something like 99% of the population.

The industry, and people in general, get away with ignoring all this because we have more skill reserves more than is generally required to perform tasks. Until one finds that you need ALL your capabilities to survive, say one misinterprets the import of a saturated atmosphere and/or low ceilings and launches and flys into the cloud you can't see unaided, and suddenly it's black all around and the gauges are whirly-like or you descend in a desperate effort to reacquire VFR, or you forget the tower on your route, or you're so close to base you think you can beat the weather....

I suggest that the judgement lost at critical point due to the abrupt shift change a considerable part of the issue. To my mind that explains why it's all platforms and operations- it's human factors issue.

MightyGem

10th Jan 2012, 20:41

The guys show up saying they are looking forward to a good nights sleep.

Yeah, come across that in my time. The afternoon of my first night shift, I'm in bed getting 3-4 hours. Get home about 8 in the morning, usually asleep about 9/9.30, up about 4.30/5.00pm. Usually awake by about 2 though, but I stay in bed, resting, maybe dozing. Done it that way for 15 years now.

Doesn't really matter if my crew are struggling to keep awake out in the dark at 3am, but it does if I am. But, I don't have young kids to look after with a wife at work, so I'm lucky.

Jack Carson

10th Jan 2012, 20:53

From my perspective night operations were no different than day. You had to show up for work rested and ready to go. It was easier for me to do extended night shifts. I made it a point to sleep immediately following any night shifts and attempted to completely invert my rest schedule. A more experienced pilot once wisely explained that you are resting for the next shift even if the last one had no flights.

From the flight perspective I flew all flight profiles as if it were night. I always climbed to a safe obstruction altitude irrespective of weather and didn’t deviate for those profiles either day or night. If the weather wouldn’t allow this, then I wouldn’t. NO one ever questioned any nogo decisions I made over 6 years of operations. There were many instances where other pilots would comment on why I tended to cruise up in the rarefied air. My retort was that I wanted to have the altitude to accommodate at least two mistakes should an abnormal situation arise. “That is my story and I am sticking to it.”

Gordy

11th Jan 2012, 19:28

To follow up on the Rock Springs Accident on Page 8 See Here (http://www.pprune.org/rotorheads/346122-ntsb-says-ems-accident-rate-too-high-8.html#post6929831)

The NTSB has issued its Preliminary Report (http://www.ntsb.gov/aviationquery/brief.aspx?ev_id=20111214X21335&key=1)

NTSB Identification: WPR12LA065
14 CFR Part 91: General Aviation
Accident occurred Tuesday, December 13, 2011 in Rock Springs, WY
Aircraft: BELL 407, registration: N8067Z
Injuries: 5 Minor.
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 December 13, 2011, about 1620 mountain standard time, a Bell 407, N8067Z, was maneuvering at a low altitude and airspeed near the residence of some of the passengers when it descended into an open field about 12 miles west-northwest of the Rock Springs-Sweetwater County Airport, Rock Springs, Wyoming. The helicopter impacted the ground hard and was substantially damaged. The helicopter’s landing gear skids and lower cabin structure were deformed, and the tail boom was severed. Guardian Flight, South Jordan, Utah, owned and operated the helicopter. The pilot and four passengers sustained minor injuries. The flight was performed under the provisions of 14 Code of Federal Regulations Part 91. Visual meteorological conditions prevailed, and no flight plan was filed. The flight began from Rock Springs about 1600.

The passengers reported that the pilot, who was an employee of Guardian Flight, immediately departed the scene. The pilot has not reported the accident to the National Transportation Safety Board. Guardian Flight management personnel reported that the pilot was not authorized to fly the helicopter, and he was employed as their Rock Springs helicopter mechanic. Law enforcement authorities reported they apprehended the pilot in another state. Federal Aviation Administration personnel reported that the pilot was issued a student pilot certificate in 1988, and they have no record of him holding any additional pilot certificate. He does hold a mechanic certificate with airframe and powerplant ratings and inspection authorization.

An acquaintance of the accident pilot reported that he observed the pilot flying N8067Z on several previous occasions for personal reasons. Passengers were carried during these “joy rides.”

SASless

11th Jan 2012, 20:21

Oh my! He took the old girl up on more than one occasion....and got away with it?

Just how does that happen?

I dare say the Operator has more than a few problems on their hands...insurance, FAA, perhaps a few law suits from whoever "owns" the helicopter (Bank...Lease Holder....).

I guess they could go against the ex-Mechanic/Pilot!

Devil 49

15th Jan 2012, 14:41

Wikipedia on shift work sleep disorder:
Shift work sleep disorder - Wikipedia, the free encyclopedia (http://en.wikipedia.org/wiki/Shift_work_sleep_disorder)

Pilot fatigue:
Pilot Fatigue (http://aeromedical.org/Articles/Pilot_Fatigue.html)

squib66

22nd Jan 2012, 14:55

New HEMS Probable Cause, no comment beyond the highlighting:

NTSB Identification: ERA09FA537
14 CFR Part 91: General Aviation
Accident occurred Friday, September 25, 2009 in Georgetown, SC
Probable Cause Approval Date: 01/19/2012
Aircraft: EUROCOPTER AS-350, registration: N417AE
Injuries: 3 Fatal.

After conducting an interfacility patient transfer, the pilot refueled and then requested flight-following services from air traffic control, departing in visual meteorological conditions (VMC) for the return flight to his base. During the return flight, the pilot encountered instrument meteorological conditions (IMC). A review of Sky Connect data for the accident flight revealed that the helicopter was cruising at varying altitudes and never reached a steady state cruise altitude for any significant period of time. The majority of the flight was flown at altitudes below 1,000 feet with the greater part of the last 8-minute segment of the flight being operated below 800 feet. (The lowest altitude recorded during the last cruise segment of flight was 627 feet.) Witnesses who observed the helicopter before the accident described it as flying about 1,000 feet above ground level (agl), with its searchlight turning on and off, in moderate to heavy rain. A subsequent loss of control occurred, and the helicopter impacted terrain about 1.92 nautical miles (nm) southwest of Georgetown County Airport (GGE).

Postaccident examination of the main wreckage revealed no evidence of any preimpact failures or malfunctions of the engine, drive train, main rotor, tail rotor, or structure of the helicopter. Additionally, there was no indication of an in-flight fire.

During the first legs of his flight, the pilot experienced and observed VMC conditions along his route. However, postaccident witness reports and in-flight statements from the accident pilot indicated that the weather in the area had deteriorated since his southbound flight 2 hours prior. According to Omniflight’s Savannah, Georgia, base manager, who was also a pilot operating in the area on the night of the accident, the weather that night was deteriorating but was forecast to remain well above minimums for his flight from Savannah to Greenville, South Carolina, and then to the Medical University of South Carolina (MUSC) in Charleston. However, while he was refueling at the Greenville airport, the pilot of the accident helicopter contacted him by radio and advised him to double check the weather before returning to MUSC. The accident pilot stated that “bad thunderstorms” were in the GGE area and that he did not know if he would be able to return to his base that night. The Savannah base manager then advised the accident pilot that he could stay at the Charleston base that night. However, the accident pilot decided to return to his base at Conway-Horry County Airport (HYW), Conway, South Carolina.

Review of radar data and weather observations provided by the National Oceanic and Atmospheric Administration revealed that, after departing, the helicopter entered an area of convective activity and precipitation. The University Corporation for Atmospheric Research regional radar mosaic chart for 2333 also depicted a large area of echoes north of the frontal boundary, with several defined thunderstorms and rain showers extended over South Carolina and over the accident helicopter’s flight route. Additionally, correlation of the radar data to the location of the accident site revealed that several defined cells surrounded the site at the time of the accident.

The terminal aerodrome forecast (TAF) for Myrtle Beach International Airport, Myrtle Beach, South Carolina, which was located 29 nm northeast of the accident site, was issued about 1928 and indicated expected marginal visual flight rules conditions through 0100 on September 26. From 2000 through 2130, variable winds to 15 knots with visibility of 4 miles in thunderstorms, moderate rain, and a broken ceiling of 3,500 feet agl in cumulonimbus clouds were expected. From 2130 to 0100, the wind was expected to be from 040 degrees at 12 knots with a visibility of 6 miles in light rain showers and mist and a broken ceiling at 2,000 feet agl. About 2207, the National Weather Service issued an amended TAF that expected instrument flight rules (IFR) conditions to prevail during the period with a broken ceiling at 700 feet agl and light drizzle and mist after midnight.

The pilot had previously flown helicopters in IMC but was not current in instrument ratings at the time of the accident. The accident helicopter was not certificated for flight in IMC but had sufficient instrumentation to operate in the event of an inadvertent encounter with IMC. On the pilot’s last Part 135 airman competency/proficiency check, which occurred on December 12, 2008, he satisfactorily demonstrated inadvertent IMC loss of control recovery.

Although the pilot encountered an area of deteriorating weather and IMC, this did not have to occur as the pilot did not have to enter the weather and could have returned to Charleston Air Force Base/International Airport or landed at an alternate location. The pilot, however, chose to enter the area of weather, despite the availability of safer options. Based on the pilot’s statement to the Savannah-based pilot regarding bad thunderstorms in the area, he was aware of the weather and still chose to fly into it. In addition, the pilot’s inability to maintain a steady state cruise altitude during the flight and the declining altitude throughout the flight likely reflected his attempt to stay below the cloud level. These cues should have indicated to the pilot that it was not safe to continue flight into IMC. This decision-making error played an important causal role in this accident.

In the absence of evidence indicating a mechanical malfunction, severe turbulence, or some other factor that would explain the accident pilot’s apparent loss of control of the helicopter, spatial disorientation is a likely explanation, as it has contributed to many accidents involving loss of control. In many cases, loss of control follows a pilot’s inappropriate control inputs resulting from confusion about the aircraft’s attitude. Two major situational risk factors for spatial disorientation were present in this accident, including high workload and transitions between VMC and IMC that require shifting visual attention between external visual references and cockpit flight instruments. Attempts to continue visual flight into IMC are even more problematic for helicopter pilots than for pilots of fixed-wing aircraft because helicopters are inherently less stable and require near-continuous control inputs from the pilot. Helicopters, like the accident helicopter, that are not equipped for IFR flight and do not have control stabilization or an autopilot impose high perceptual and motor demands on the pilot. This can make it very challenging for pilots to maintain stable flight by referring to flight instruments alone. When the accident pilot attempted to continue visual flight into IMC, he would have been subjected to a high workload to maintain control of the helicopter. The extent of the weather and the duration of the flight also suggest that the pilot’s encounter with IMC was prolonged. This would have further complicated the pilot’s workload and increased the potential for spatial disorientation resulting from hazardous illusions, thereby increasing the potential for inappropriate control input responses.

According to Omniflight’s 135 Operations Manual, the pilot-in-command was responsible for obtaining weather information before beginning a series of flights. During interviews with National Transportation Safety Board (NTSB) investigators, Omniflight pilots indicated that, at the beginning of each shift, they would obtain weather information from a base computer and would advise the Omniflight Operational Control Center (OCC) of weather conditions in the operating area throughout the period of their flight. Before any launch, the OCC must approve the flight. If the OCC knew of adverse weather, it would contact the pilot to evaluate the weather. Based on launch approval and actual weather conditions encountered and reported by the pilot, the weather at takeoff and along the flight route was VMC. About 2242, an MUSC communications center specialist spoke with an Omniflight OCC operations coordinator and indicated that the helicopter would be returning to HYW as soon as the patient transfer was complete. The operations coordinator then advised the MUSC specialist that if the pilot called before takeoff, they would review the weather with him for his return flight. However, the pilot never called the OCC, and the OCC did not contact the pilot. While the OCC was not required to contact the pilot and review the weather, if the OCC had contacted the pilot before takeoff, the OCC could have advised the pilot about the adverse weather, given him the updated TAF information issued about 2207 with IMC, and noted the potential risks involved with the flight. On February 7, 2006, the NTSB issued Safety Recommendation A-06-14, which asked the Federal Aviation Administration (FAA) to “require emergency medical services operators to use formalized dispatch and flight-following procedures that include up-to-date weather information and assistance in flight risk assessment decisions.” On February 18, 2010, based on the FAA’s pending notice of proposed rulemaking concerning helicopter operations and pending timely issuance of a final rule mandating formalized dispatch and flight-following procedures that include up-to-date weather information and assistance in flight risk assessment decisions, the NTSB classified this recommendation “Open—Acceptable Response.”

The accident helicopter was not equipped with an autopilot. On September 24, 2009, the NTSB issued Safety Recommendation A-09-96, which asked the FAA to “require helicopters that are used in emergency medical services transportation to be equipped with autopilots and that the pilots be trained to use the autopilot if a second pilot is not available.” On December 23, 2009, the FAA stated that it would conduct a study of the feasibility and safety consequences of requiring a second pilot or operable autopilot. On October 7, 2010, pending the NTSB’s review of the results of this study, Safety Recommendation A-09-96 was classified “Open—Acceptable Response.”

The National Transportation Safety Board determines the probable cause(s) of this accident as follows:
The pilot’s decision to continue the visual flight rules flight into an area of instrument meteorological conditions, which resulted in the pilot’s spatial disorientation and a loss of control of the helicopter. Contributing to the accident was the inadequate oversight of the flight by Omniflight’s Operational Control Center.

SASless

22nd Jan 2012, 18:52

Why...why....why?

Thomas coupling

24th Jan 2012, 11:16

SASless: we know the answer, its yankie mentality - simples. Where have you been with this thread?
As a previous poster said, the FAA will NEVER regulate against the industry in this regard..land of the free etc etc.
It boils down to CRM...an eductional process practiced by some and totally ignored by others.
The WHOLE EMS problem in the US can be contained in one sentence:

PRESS ON ITIS.

It has nothing whatsoever to do with number of engines / number of pilots / autostabilisation, etc.

Until this is addressed, the US will continue to kill their own.

[I read another post recently where the boss of an EMS outfit had an SOP where the duty dispatcher was not allowed to tell the pilot what the circumstances of the trip were, nor what the condition of the patient was. This enabled the pilot to some degree to concentrate on the task in hand which was to fly his helo from A to B: SAFELY and without undue pressures.
So there are some responsible operators out there practicing what they preach. I like that:D

topendtorque

24th Jan 2012, 11:44

Based on the pilot’s statement to the Savannah-based pilot regarding bad thunderstorms in the area, he was aware of the weather and still chose to fly into it.

Why? From way over here we hear the utter desperate exasperation of your question.

Maybe the pilot had “got away with” incursions of lesser extent in the past and figured he could tough it out this time. WX forecast mechanisms or visibility minima didn’t get a look in and might not have made an iota of difference had they been tougher or less demanding.

Anyone that has been in the tropics for more than five minutes will possibly have been caught in a severe thunderstorm cell deluge and understand the terror of it, in daylight. To pull the same on at night without at least a storm scope and full IFR ability is sheer lunacy.

Just yesterday I was out at last light, well technically, but with heaps of cloud it’s easy to imagine the visual range and I was seeing heavy storms cells all round with strong lightning and was reminded once again of how fickle we really are in the scheme of things. I was reminded of such an uncomfortable event from about ’86.

I was inbound to Darwin in close company with the late Tevi Borthwick who was in another ’47 with not even a slip indicator back then. He couldn’t hear his VHF, I couldn’t transmit on mine, yeah we’d been out bush a while, but we could talk to each other on HF. We had been cleared from about twenty miles out and then bamm down it came. As we neared the tower to fly by it by about sixty metres its big bright flashing light disappeared at about 100 metres.

Certainly no risk of running into other traffic, but the runway and the entire tarmac area disappeared in a grey sheen and merged with the rain; the green grass straight down was our only reference. That just demonstrates the power of it all and that was at four pm, still three hours of daylight left.

Big cells are often of 15 to 20 nautical miles diameter, visibility down to fifty or sixty metres on the ground, that’s less than 200 feet if there are HT power pylons around.

There must be an answer to your question i thought as I tossed and turned last night. I have no idea how many EMS pilots there are in the US but worldwide in comparison to the number of off shore pilots there may be some similarity in numbers?

So I thought, well all of the off shore guys and their pax have to do HUET courses, which does involve a big bit of capital expenditure at centralised areas, why not have it mandatory for all NVMC, even all EMS pilots to do a mandatory sim ride involving total loss of visibility and then final disorientation.

I figured it’s all too easy on a check ride under the hood, (like this dude) recovering from unusual attitudes day or night or inadvertent IMC penetration, with a safety pilot beside you. That’s no big deal is it 'cos you know he ain't gonna let it crash so how stupid is it as preparation against this type of crash?

In that situation they don’t get the real logic which is aimed at teaching one to recover a sticky situation and thus they get a false sense of confidence, of winning.

That logic is absolutely counterproductive to learning the NOGO line in the sand.

They must be really frightened by an unwinnable situation and thus learn the deep lesson of avoidance. Therefore they must be pushed beyond their ability to a crash conclusion with a tough ride in a simulator.

That will show them that with limited panel and deluge conditions – as forecast on this trip- that it is NOGO, no ifs or bloody butts.

It would also be a good venue to show the flight controllers of followers, as spectators in the sim while the check ride is going on, just how tough it is so they get a real appreciation of the terrors and risks of the – marginal – forecast - in – the – blackness.

It would represent a fair cap-ex for sure in a cash strapped economy, but perhaps cheap compared to the cost of broken machinery already accumulated and the precious lost souls.

My 2 cents worth.

Sasless, all that a certain 'Spartan General' had in his Favour in the Western Desert was, “A line in the sand” which he drew with his baton in front of his assembled staff. He of course won that little tiff to become ‘Montgomery of Alamein.’ It can be done.

Now i hope this big satellite blocking rain storm blows over so we can see if Rafael wins his little match as that will make Mrs. TET very happy.
Cheers.
tet