Helicopter EMS Issues in the USA [Archive]

alouette3

27th Aug 2009, 17:30

Vee r,

Once again, I would like to dissent. The problem is not a lack of regulation. Part 135 is pretty comprehensive. Besides, the society in the US is allergic to govt. intervention in business and the FAA has to walk that fine line between regulating and promoting air commerce.The companies are ruthless. They will cut corners in equipment,salaries and aircraft maintenance as far as possible to maintain the 1:475 ratio of earnings of worker to CEO that has become so much a part of the US captalistic culture.Also, a suddden spurt of onerous regulations mandating equipment that is expensive and,given the dubious helath care reimbursement rates here,will probably put a lot of companies out of business and put a lot of pilots out in the street. Once again, a prickly scenario which the FAA is loath to get into.
What is the solution? Self regulation. Foremost by us in the trenches,followed by the companies,individually and as a group and possibly, an agency (not the FAA) that can oversee HEMS ops. Kind of like the USFS does for the firefighting industry.Not great but better than what we have now.

SASLess,
With due respect, comparing the accident rate of a low volume, low risk tolerant nation like Canada with the high volume,high risk tolerant nation like ours is a non starter. The accident rate of Sun Country Airlines compares very favorably with that of American or United or Delta or Continental. Does it mean that Sun Country is safer or does it mean they don't fly a lot given their fleet size compared to the legacy carriers?
Alt3.

KRB

27th Aug 2009, 21:08

Perhaps the question should be why is it more acceptable in the United States to accept higher risk, treat workers like "Cannon Fodder" then it is in the rest of the world?

I see the same trend in forest fire operations. In the United States more forest fire fighters are likely to die in a single fire season then in 20 seasons in Canada.

SASless

27th Aug 2009, 21:28

AL3,

I would suggest Part 135 is pretty restrictive.....but enforcement of 135 in the EMS world is pretty well non-existent. Neither the operators or the FAA really do a decent job of living to the rule.

The problem is the conflict between complying with the rule....and getting the job done.

Simple case in point.....Night VFR surface light reference requirements.

There's lots of very dark places in the country and how many of us ignore the requirement to have that bit of help from the lighted objects on the ground and just cruise on over those dark places knowing there will be lights at our destination? Everyone of us are illegal to do so but we do it (I have to use past tense for me as I am now happily and safely retired.).

How many times do you break the rules before the odds catch up with you and turn you into a statistic?

JHR

27th Aug 2009, 22:25

SAS,

You might try a legal interpertation search for night helicopter surface reference. There is a legal interpertation dating back to about 1992 from the FAA in D.C that states if the aircraft is equiped with the flight instruments required by Part 135 for night or over the top operations it may be flown with out surface light reference. The aircraft does not have to be IFR certified.

A literal interpertation of the surface reference requirement would prevent night ops with S92's EC225's ect unless they were on an IFR flight plan.

In spite of all the above there has to be a better way of operating at night than is currently in use. The Bond EC225 and the most recent EC145 accident in Forida would indicate that technology by it's self is not the answer.

When is the last time you witnessed a VFR operator conduct any training or flight checks at night. At the very least an inprovement in training and testing is in order.

JHR

SASless

28th Aug 2009, 01:08

What does your OpSpecs say.....that would be the first hurdle to get over then you might try to fall back on the information you suggest.

But.....this is what the Regulation states:

Code of Federal Regulations

Sec. 135.207

Sec. 135.207

Part 135 OPERATING REQUIREMENTS: COMMUTER AND ON-DEMAND OPERATIONS AND RULES GOVERNING PERSONS ON BOARD SUCH AIRCRAFT
Subpart D--VFR/IFR Operating Limitations and Weather Requirements

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.

Gomer Pylot

28th Aug 2009, 04:37

The last 6 words are what counts. There is sufficient light until there isn't.

JimL

28th Aug 2009, 06:50

The Canadians provided an NPA in 2001 that attempted to address this situation; the explanatory text is illustrating:

Issue:

Aircraft operating under the visual flight rules (VFR) are required by the Canadian Aviation Regulations (CARs) 602.114 - Minimum Visual Meteorological Conditions for VFR Flight in Controlled Airspace and CAR 602.115 - Minimum Visual Meteorological Conditions for VFR Flight in Uncontrolled Airspace, to operate with "visual reference to the surface".

The term "visual reference" is not defined and there have been many accidents where aircraft have crashed due to pilot disorientation caused by a lack of visual cues. These situations typically occur during night VFR flight or flight over featureless snow covered terrain or frozen lakes.

Justification for Change:

The single most important instrument for maintaining aircraft attitude is an attitude indicator. As can be seen from the regulations above, any aircraft may be operated during the day without an attitude indicator and a private aircraft operated at night without one. In reality, virtually all aeroplanes have attitude indicators, as do most helicopters. The problem more likely lies in pilot training and judgment than in equipment shortcomings.

There is a common misconception that if the minimum visibility criteria are met, then conditions are suitable for VFR flight, particularly during daylight. There is also general agreement among pilots that flight in conditions with any reduction in visibility on a dark night over uninhabited terrain is not VFR. The difficulty in rationalizing these different points of view is in determining what constitutes visual reference. Some jurisdictions have used the concept of a "visible horizon".

The United States’ Federal Aviation Regulations (FARs) Part 135 (equivalent to CARs subparts 703 and 704) mention "surface reference" only for helicopters as follows:

"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 control the helicopter."

Jane’s Aerospace Dictionary uses the following definition:

"visual reference - Earth’s surface, esp that clearly identified and thus giving geographical position as well as attitude and orientation guidance, used as a reference in controlling flight trajectory, if necessary down to touchdown."

These two references address the aircraft’s attitude and orientation with the Jane’s Aerospace Dictionary definition additionally requiring geographical information.

The CARs, Part VII, Regulations for night VFR indicate that electronic means of navigation are acceptable and the terrain and wide expanses of water in Canada may make determining geographical position by reference to the surface difficult.

Transport Canada has been addressing the issue of pilot judgement in various ways and these hopefully will have an effect on inappropriate use of the visual flight rules. It is felt that clarification of the term "visual reference" will have the effect of preventing flight when conditions do not fit the intent of these rules. There will no doubt always be an element of subjectivity when assessing if visual reference is adequate, however, incorporation of the following suggested change may assist in guiding pilots and supervisors in conducting operations in difficult conditions.

The subsequent change in regulations inserted the following text:

No person shall operate an aircraft in VFR flight within uncontrolled airspace unless

(a) the aircraft is operated with sufficient visual referenceto enable a pilot to maintain the aircraft’s attitude and orientation with reference to the earth’s surface by the use of visual external cues;

...

It is not clear that the problem is solved with the addition of this text because it still relies upon judgement that cannot be made before flight and therefore dispatch criteria is not established.

The amount of external visual cues is also related to the handling qualities of the aircraft. As has been stated in the 'EC225/New Procedures' threads, an aircraft that has sufficient flight control augmentation can be flown safely with very few external references.

To paraphrase Gomar Pylot 'there are sufficient visual references until there aren't'.

Jim

SASless

28th Aug 2009, 13:46

NTSB to issue a report soon.....

•Safety Recommendation letters - Safety Board proposes 19 recommendations regarding Helicopter Emergency Medical Services (HEMS). These recommendations addresses various safety issues including pilot training; safety management systems to minimize risk; collection and analysis of flight, weather, and safety data; flight data monitoring; development of a low altitude airspace infrastructure; and the use of dual pilots, autopilots, and night vision imaging systems

The FAA is publishing new policies/regulations regarding NVG's....wonder what provoked that I wonder?

Gomer Pylot

28th Aug 2009, 15:45

What provoked that is obvious to me. The FAA started allowing the use of NVGs, and thus had to issue regulations concerning them. When they didn't allow them, there was no need of further regulation. Time marches on, along with technology, and thus regulatory requirements change. Once there was no need for regulations concerning the use of VORs.

I see no good way out of allowing pilots to exercise some judgement. IMO, I get paid for my judgement, not for anything else. If I can't use that, then why not just use pilotless drones, controlled from a central location? Some people will always exercise bad judgement, and good judgement comes from making bad decisions and learning from them. If someone else always makes all the decisions for a pilot, that pilot will never become a safe and proficient pilot, because (s)he will never learn to make decisions, and inevitably a decision will be required, because not even the FAA can anticipate everything. All that can be done, IMO, is to set out the minima and expect pilots to comply, and punish those who don't. I don't believe there is a magic bullet, and the only way to completely eliminate all risk is to immediately destroy every aircraft that exists, and never even consider flying again. I'm not in favor of that. Everybody dies eventually, so we may as well accept that and stop the panic attacks.

Hullaballoo

29th Aug 2009, 21:30

I find it interesting that the EMS industry in the U.S. fully supports safety, the efforts of the IHST, etc. Unless it impacts the bottom line. The number of single pilot, unaugmented (SASless and/or lacking autopilot), VFR certified rotorcraft point to that.

Sure, pilots are paid to use their judgement. But what pilot wants to say "No" to a mission in which he could save a life ... even if the weather is marginal, at night, and near the end of his duty day? I'm curious as to how much "judgement" an EMS Op Specs allows a pilot to use, without fear of losing his job?

And how many accidents have occurred when the injuries were not life threatening, and a ground ambulance would have been more appropriate.

Clearly Part 135 doesn't work, as written.

Surely there's at least one lesson to be learned from the Canadians (who, by the way, modeled their system from a public use operation in the Lower 48).

Gomer Pylot

29th Aug 2009, 23:08

I can't speak for all operators, but we say no all the time, and I know of many others who do. If you're in this business to save lives, you're in the wrong business. It's just another for-profit business, and I don't think about lives other than mine and the med crews. Our weather minimums are the highest I've ever flown to, by far, and if the weather is below those minimums, we just don't go, and I've never been questioned about it. We won't get fired for declining flights, but we will get fired for flying in weather below the minimums. If we land enroute because of poor weather, that's better than flying on and dying, but we may be questioned about why we flew in the first place. I'm confident that at least the major operators have seen the light and are enforcing the weather minimums, and not firing any pilots for turning down flights for weather. Pilots being humans, though, may feel self-imposed pressures to fly, but those who do need to be weeded out, and will be eventually, one way or another.

Canuck Guy

30th Aug 2009, 06:45

Sure, pilots are paid to use their judgment. But what pilot wants to say "No" to a mission in which he could save a life ... even if the weather is marginal, at night, and near the end of his duty day? I'm curious as to how much "judgment" an EMS Op Specs allows a pilot to use, without fear of losing his job?

Count me in please. Just because the weather might still just barely be legal to fly tonight doesn't mean I should. Every mission is different and that must be taken into account. So yes if it's marginal enough that I can't do a trip then so be it, dispatch better have a Plan B cooking. When we turn down a call due to weather we copy and paste the appropriate TAFs and METARs into a log so it's plain as day that we simply couldn't do it.

I don't mind leaving for a call if my duty day is nearing it's end though. If there's time to get a patient to a hospital that's fine. We just inform dispatch that if we turn into pumpkins on the hospital roof, the machine isn't moving until our relief arrives. Wouldn't be the first time I've left a helicopter on a pad and gone back to the hangar in a taxi. It's a pain in the butt, but the mission was completed and no one violated duty limits.

It may sound callous, but I'm with Gomer too when it comes to allowing the patient to enter into the equation. I don't let their welfare go past idle curiosity in my mind, otherwise my brain is in the wrong part of the helicopter.

SASless

30th Aug 2009, 12:02

GOM and Canuck,

How do you achieve "peace" with your med crews when you think as you do? I took the same view as you do and seemed to be confronted with the "we are here to save lives attitude" and "what do you mean we are just in a medical patient transportation business?" attitude by the Med Crews. The industry is full of those types who see themselves engaged in noble, angelic, heroic battle with death types.

Gomer Pylot

30th Aug 2009, 16:24

IME, most of the med crews don't want to go as often as I do. They're all former ground medics and ER nurses, and they fully realize that people die, and they don't want to die in a helicopter. I've never had any issues at all from the med crews about turning down flights, but I have aborted a couple of flights that I considered rather routine when the med crew decided the weather was too bad. Our med crews simply don't get rabid about saving lives. Ambulances take a lot longer, but the patient's car wreck isn't our fault, and we aren't going to die to get them to a trauma center a little quicker. The only medical personnel I've met who are really gung-ho about saving lives are newbies, and we don't hire any of those.

JHR

1st Sep 2009, 00:38

SASLESS

The legal interpertation from the Fed's.

They think 135.207 does not limit a helicopter from flying over the top with out surface reference. Day or night they don't care. It's my opinion that the US FAR's only define IFR as operating with less than the required basic cloud clearance. Dark night, no horizon is still VFR. We as pilots are supposed to not get into flight conditions we can not deal with.

I certanly do agree to many people are losing thier lives with the operating rules that are in place today. I also wonder how many operators either EMS or utility actualy train or give check rides at night.

The company I work for has OPS's spec's for day and night VFR and IFR operations, the ops's spec's just authorize the operations, they don't tell us the conditions that have to be met to make the flight.

JHR

March 3, 1992
William K. Comee

Dear Mr. Comee:

This is in response to your letter dated September 13, 1991, withdrawing your request for exemption. In your withdrawal request you asked for a confirmation in writing that the Federal Aviation Regulations (FAR) permit a properly equipped multiengined helicopter with an appropriately rated crew to fly VFR over-the-top.

Your request apparently was initiated because of some confusion over FAR Sec. 135.207. That section states:

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.

You correctly cite FARs Sec. 135.211, 135.181, 135.161 and 135.243 that allow for aircraft to fly VFR over-the-top. The term "aircraft" as used within the FARs includes helicopters. "VFR over-the-top" with respect to the operation of aircraft, means the operation of an aircraft over-the-top under VFR when it is not being operated on an IFR flight plan. (14 CFR 1.1) "VFR" means visual flight rules. (14 CFR 1.2)

If the agency's intent was to preclude VFR over-the-top operations in FAR Sec. 135.207 it would have stated so. It must be presumed that the drafters of the regulation were aware of the different terms as evidenced by their use in other FARs that pertain to VFR over-the-top operations. Section 135.207 does not mention VFR over-the-top operations. We therefore conclude that FAR Sec. 135.207 does not preclude properly equipped helicopters and instrument rated aircrew from flying VFR over-the-top.

We trust this satisfactorily responds to your request.

Sincerely,

Donald P. Byrne
Assistant Chief Counsel
Regulations and Enforcement Division

SASless

1st Sep 2009, 12:11

You are absolutely correct when you note VFR/IFR is based purely upon weather conditions alone. The visibility minimum only applies to the distance one can see "If" there was something to see.....such as lights. horizon, terrain. Anyone that has flown offshore at night knows what the difference is.

I have always maintained that in reality, if one must rely solely upon the instruments to control the aircraft you are no longer "VFR" despite the regulation saying you are.

The issue in my view is the regulation does not adequately meet the Kool-Aid Acid test of reality....and thus sets up a very dangerous situation where un-qualified, non-capable ( I hate to use the word "incompetent"...) pilots can suddenly find themselves in grave trouble.

Um... lifting...

1st Sep 2009, 12:42

Just to muddy the waters some further, realizing of course that these regulations do not apply to civil operations.
I believe, SASless, but do not know, that the intent of the definitions below is in keeping with what your opinion is.

OPNAVINST 3710.7 (series), NATOPS GENERAL FLIGHT AND OPERATING INSTRUCTIONS, which is the governing publication for all U.S. Navy and Marine Corps flight operations defines some terms a bit differently than the FARs and other civil regulations with which I am familiar.
While there is a provision for VFR-on-top or over the top or whatever you want to call it, in practice it is almost never used because it's rare to be on top and have a horizon.
The obvious question might be... "If you have visibility but no horizon, what do you put in your logbook?" The answer is... "Actual Instrument Flight"

Actual Instrument Conditions. Conditions external to the aircraft in flight that do not permit visual reference to the horizon.Instrument Meteorological Conditions.
Meteorological conditions expressed in terms of visibility, distance from clouds, and ceiling less than the minimums specified for visual meteorological conditions. IMC conditions exist anytime a visible horizon is not distinguishable.

Shillin3

3rd Sep 2009, 02:03

NTSB issues safety recommendations for Medical Helicopters | Pilotbug (http://www.pilotbug.com/?p=747)

The NTSB has issued 15 safety recommendations to various government regulators and helicopter emergency medical services (HEMS) operators following a dramatic increase in accidents. Among them are the creation of scenario-based pilot training curriculum, installation of flight data recorders for aircraft, the use of an autopilot in single-pilot operations and use of night-vision equipment for pilots.
According to the NTSB, of the 55 mediflight accidents which occurred in the last 3 years, of which 41 were helicopters, 29 could have been prevented with the adoption of these recommendations and the others contained in the press release.
As a result of the increase in accidents, a 4-day hearing was conducted in February by the NTSB with testimony from the FAA, the Helicopter Association International (HAI), the Association of Air Medical Services, the Professional Helicopter Pilots Association, the National EMS Pilots Association, Air Methods, and CareFlite. The following was determined to be the focus of the hearings:

Pilot Training
Collection of Flight Operations Data
Use of Flight Recording Devices and Data
Safety Management Systems
Weather Information
Use of Autopilots or Dual Pilots
Night Vision Imaging Systems
Reimbursement Rate Structures
Federal Policy and Guidelines The full press release can be seen here (http://ntsb.gov/Publictn/2009/AB09-HEMS.htm)

Hell Man

1st Aug 2010, 11:37

Wassup with the glut of EMS and SAR crashes going on in 2010?

It sucks!

Good Vibs

2nd Sep 2010, 10:14

Why are there still some countries (the USA) still using single engine & single pilot at night for EMS in all kinds of weather.
I would also rather continue with a ground ambulance dispite the longer transport time.
How many accidents and how many must die until they change their attitude about this?

Epiphany

2nd Sep 2010, 10:29

Good vibs,

Standby for the 'defenders of single-engine ops' who fail to see that it is not the number of engines but the fact that singles are invariably VFR. That means that they will be scrabbling around under the cloud at night and crash into hills or wires, or get disoriented.

EMS is a job for twin/IFR machines but it just doesn't seem to be catching on in the US where these accidents will continue to happen.

SASless

2nd Sep 2010, 19:15

I am beginning to wonder what is going on in tbe US Helicopter industry of late.

Was it Phoenix where the A-Star EMS aircraft crashed in clear skies and during cruise....followed by the Kaman KMax logging crash....then the Hiller in Idaho...and now this JetRanger.

Are we past Pilot induced crashes and now seeing mechanical failures or engineering failures as being the cause of fatal crashes?

Aser

2nd Sep 2010, 20:56

21 lives this year :sad:

Spike in medical helicopter crashes elevates safety concerns (http://www.fox11az.com/news/local/Spike-in-medical-helicopter-crashes-elevates-safety-concerns-102038028.html)

by Samantha Ptashkin

Fox 11

Posted on September 2, 2010 at 11:58 AM

TUCSON, Ariz.-- One medical helicopter down, three crew members dead. It's a horrific scene many people witnessed in Tucson in July and now a recent crash in Arkansas has elevated the concern for helicopter safety.

Tucson Medical Center flight nurse Suzanne Knepper heads up in a helicopter two to three times a week to help pre-mature babies get the medical attention they need. "When infants are in distress, it's usually a very acute thing," Knepper said. "We have to get there right away and the time in travel in southern Arizona is quite long."

Knepper says the medical chopper is vital in saving lives, but so far this year, helicopter crashes have also taken the lives of 21 people nation-wide. It's a sharp spike from last year.

The latest crash happened in central Arkansas Tuesday morning. Three crew members died. That crash marks the fourth fatal accident this summer, among those, the LifeNet chopper which crashed down in midtown Tucson, also killing three crew members. "Any death is very significant and obviously a tremendous loss and we're very concerned as an industry as a whole about the number of accidents that result in fatalities," said Craig Yale, a spokesperson for Air Methods.

Yale says the industry has taken more precautions over the past year, including the use of night vision goggles for crew members and warning systems which alert pilots of any obstructions. "We go through safety checks with our own equipment and then when we get up on the helicopter we make rounds with pilot and we all agree that what we've seen so far is safe and that we're all ready to fly," Knepper said.

Despite all the safety checks, Knepper and her team know something can always go wrong. "Accidents happen in a helicopter, in an ambulance," said Flight Nurse Pat Brown.

But they say they can't live in fear of losing their own lives. The minute they board, their focus is on saving the lives of others.

vaibronco

2nd Sep 2010, 21:59

I have less than 100 hrs as co-pilot in HEMS H24 / SAR operations in Italy and so far, what I more like about the captains I fly with (former mil and civi), is their attitude in sticking to the rules, saying "No" when ops manual meteo minima are "no go".
So much noise about twin or single in so many threads. All of us (in this forum) know about differences of single and twin equipments and of course the flight crew experience, ratings and training, therefore their different capabilities.
What is missing there is discipline and information.
Set a correct "No go" minima for single engined machines and stick to it.
Somebody will reply that even with twins there will always be the one who overevaluate the capabilities of his machine.
VFR pilots also and not only IRated ones should be more informed about all dangers of IMC and night operations and try at least one time, not for training, only for demonstration, an unexpected IMC, disorientation etc. etc. and undestand that as SASless says, fog kills (and not only fog).
Correct estimation of the risk (I'm sure nobody wants to die) would keep more pilots VFR/SE and IFR/ME far from all these dangerous situations.
Moreover, when I read in the NTSB reports, I'm surprised about the numbers of accidents caused by lack of recurrent training or experience for night and/or IFR operations.
This makes me think that CFITs happens for the same reason.
Write the rules and stick to it.

Jack Carson

2nd Sep 2010, 22:31

The single vs. twin argument should take a back seat to auto-pilot vs. no auto-pilot. The FAA took the low road when arguing for NVGs. Most US EMS machines are at best, marginally capable of flight in IMC. Having flown the full gambit of machines from VFR the B-206L and VFR AS 350B-2/3 to full single pilot IFR (SPIFR) B-230, A-109E and EC-135 it is my opinion that an auto-pilot does more for reducing pilot workload and enhancing safety than either 2 engines or NVGs. An autopilot takes the pilot out of the flight control loop and allows for the safe management of the machine while control is maintained. As stated in the OpsSpecs “ auto-pilot in lieu of a copilot for IFR flight”. A pilot in Inadvertent Instrument Meteorological Conditions (IIMC) has neither a co-pilot nor an auto-pilot. The outcome rest purely in the pilot’s ability to maintain control of the machine, while attempting to navigate and communicate.

Single engine vs. multi-engine could be argued for the Tucson mishap where a for a low altitude (<500 AGL) engine failure over an urban environment resulted in disastrous results. :ouch:

tottigol

2nd Sep 2010, 23:04

As long as ANY so called "Aeromedical Provider" is allowed to dictate rules to the FAA we shall continue to see an uncontrollable amount of crashes and accidents.
The FAA allowed HEMS operators to go the way of the cheapest possible expedient to make the public at large believe safety is being considered primary: NVGs.
The US HEMS industry is again being allowed to regulate itself and we know that when profits are at stake self governing is tantamount to anarchy.
Considering how long this crisis has been dragging itself, the FAA is just as culpable as those operators that crash on a regular basis.

The causes are always the same.

My prayers go the the surviving family members who in lack of a valid lawsuit shall only be left with the "usual" one year of pay to remember their dear folks.:(

krypton_john

2nd Sep 2010, 23:04

I'm somewhat bemused by the issue of single vs twin here. When was the last time an aircraft was lost due to an engine failure? Compare that to the number lost due to pilot error, weather, wires, and failure of items other than engine such as rotor blades, gear boxes and tail booms?

Is 'single' being confused with 'not IFR' here?

ShyTorque

2nd Sep 2010, 23:48

Is 'single' being confused with 'not IFR' here?

In UK the rules no longer allow single engined helicopters to fly under IFR so the terms are effectively the same thing.

krypton_john

3rd Sep 2010, 00:07

Yeah - and it's the same all over JAR land I guess?

But it is not the case under the FAA or the ROW is it?

Whether a heavy AS355F1 is safer than an AS350, A119 or B407 is another question altogether!

alouette3

3rd Sep 2010, 00:15

Vaibronco,
Your post seems to imply that all the wise things you suggest do not happen here.Setting minima,understanding and teaching pilots the dangers of IIMC,recurrent training. All EMS companies that are worth their salt do all of the above and sometimes more.So to suggest otherwise is offensive to some of us.Fact remains, that for every one (and that is one too many,admittedly) that makes the news, there are thousands of HEMS flights that operate routinely and safely on a single day. In fact ,I would wager, my company flies more every year than all the outfits in the the continent of Europe,put together.Besides, have you looked at a map recently and seen the size of this country? I can tell you, my friend, mine is definitely bigger than yours. So the attitude of your captains whom you so admire are not only restricted to your side of the pond.
To the rest, the last three crashes (Oklahoma, Arizona and now Arkansas),seem to be aircraft related as opposed to pilot issues. So notwithstanding the "witnesses" who saw the aircraft "fly through a fog"--I shall reserve judgement.After all, 500+ "witnesses" "saw" the missile that brought down TWA 800.
And, I have said this before, as long as Europe and Canada and Oz have government funded HEMS outfits, comparing that to the ones in the US is futile.
Alt3.

ShyTorque

3rd Sep 2010, 00:27

But it's not a performance issue, it's more to do with system duplication/redundancy and the sophistication of the stabilisation/autopilot.

I have flown single engined floppy stick helicopters i.e. no stick trim, let alone an autopilot, in IMC, quite legally, under military rules. I also used to fly a public transport AS355N (twin) with a "floppy stick", at night (normally in UK, by definition, under IFR as there is no VFR at night here).

There was a likelihood that sometimes we might go inadvertently IMC at night due to the nature of the job, and we were required to train for that eventuality. However, it's all been outlawed now after some high profile accidents at night.

Not before time. The FAA seem to be lagging behind, now to an alarming degree, it seems.

Old Man Rotor

3rd Sep 2010, 10:50

I am sure I am not alone in this frustrating scenario.

More unnecessary deaths for what?

Absolutely for what???

Can someone please confirm that: “night-vision gear” actually means “Night Vision Goggles” (NVG's) flown in Night Visual Conditions by qualified (NVG) Flightcrew?

Do we expect the FAA must surely act soon?

Nope.

Old Man Rotor

3rd Sep 2010, 10:50

Old Man Rotor

3rd Sep 2010, 10:50

Old Man Rotor

3rd Sep 2010, 10:50

fly911

3rd Sep 2010, 11:16

More unnecessary deaths for what? Absolutely for what???

ummmm, To save lives?

tottigol

3rd Sep 2010, 11:34

ummmm, To save lives?

If you actually believe that, you are part of the problem.:ugh:

SASless

3rd Sep 2010, 11:36

EMS does not save lives!

EMS provides a safe, efficient method of transporting passengers who have on-going medical illnesses or injuries.

If you think anything else....and work in the Helicopter EMS business you are part of the problem....not the fix.

You are not heroes, angels, or sky gods.....but good folks doing a valuable service to the community.

If a life is "saved" because of the rapidity of the transport....then that happens to be good fortune, good luck, or simply Fate working its way.

fly911

3rd Sep 2010, 11:58

Sasless, I guess if you say it enough, maybe you will get to believe that. For those of us that know better, we're not going to change your mind.

That having been said, of course there is room for much improvement. I have a list of complaints I have with the air ambulance companies. Each one of us that flys or flew HEMS knows the risks and always has the option to turn down an unsafe flight. Because a helicopter crashes while cutting the margin too close, and I'm not saying that is what happened in the most recent Arkansas crash, does not mean that you would have made a different choice under similar circumstances. We can improve the safety record. No doubt about that. I think that the NTSB is on the right track with NVG, auto-pilot and proximity warning. You may feel differently. That doesn't make you part of the problem. It just makes you another facet of the solution.

Gomer Pylot

3rd Sep 2010, 18:01

If you're in this business to save lives, you're in the wrong business. I don't save lives, I just carry breathing cargo. We may reduce morbidity, but we rarely, if ever, save lives.

Night vision goggles are great technology, but like any other technology, can be dangerous if not used properly. NVGs let you fly into increasingly poor weather without knowing it until it's too late, if you don't look under them and keep track of the unaided visibility. It's too easy to get into IMC without knowing it, and then it can be too late, especially in a 206, with insufficient instrumentation to fly safe IFR. Transitioning from VMC to IMC unexpectedly is difficult enough in a well-equipped IFR ship, nevermind a 206.

All that said, it's too early to speculate on the exact cause of the crash. Video of the crash scene shows an almost perfectly vertical impact - no trees or power poles or lines show any evidence of any damage, other than fire damage above the pine tree above the scene. There are numerous possible explanations of that, and I haven't seen anything to point toward anything more than any other.

fly911

3rd Sep 2010, 19:09

Gomer, I guess that it's a matter of perspective. True, it's ususlly the med crew that does most of the saving going on, but if you're not helping to save lives, maybe you are in the wrong business. Go argue the "Golden Hour" with a trauma surgeon. At $15,000 a pop, you'd think that there would be a lot less air ambulances if no lives were being saved. If you aren't helping to save lives, then you might just be doing something wrong. I've argued with ATC to make the fighters wait to take off until I get through their route of departure rather than have me circumnavigate their airspace. There are a lot of pilots that won't put forth the effort. The paycheck will be there at the end of the week if this patient makes it or not. If you aren't helping to save lives, then you just might be in the wrong business.

Gomer Pylot

3rd Sep 2010, 21:16

Trying to save a life is, IMO, the root cause of most EMS accidents. It's a business, and this is a job. You forget that at your peril, and at the peril of the crewmembers in the back, and of the patient in the back.

fly911

3rd Sep 2010, 22:15

Gomer, then by all means don't forget that! Your cause and effect remark is a little like saying that flying has been shown to be the root cause of air crashes. If you can't try to help someone survive without loosing sight of how to fly your aircraft safely, then by all means don't! Thousands of EMS flights are performed safely every year by caring individuals. Your opinion is your opinion. Don't try to ram it down everyone elses throat. Safety needs to be improved. We can improve it. And we should. But if you are there to tell HEMS pilots not to give a damn if their patient lives or dies, otherwise they are in the "wrong business" you are way out of line.

SASless

3rd Sep 2010, 22:38

Sasless, I guess if you say it enough, maybe you will get to believe that. For those of us that know better, we're not going to change your mind.

You made several very correct statements in your response....this is not one of them.

The "We're out there fighting death...stealing lives away from the ol' Grim Reaper himself....we pluck them from the very edges of that deep abyss..." mindset is what get folks killed.

If one is a professional then one makes professional decisions based upon facts, data, protocols, and recognizes limits. If one cannot separate one's emotions from one's professional life....you ain't no Professional!

It is a job....a very risky job....that carries a certain kind of satisfaction about doing something good while at work....but it is just a way of paying the rent....nothing more. You might as well haul dead trees, boxed freshly caught Salmon, or Bubba's out to the oil rigs....EMS is just another one of the taskes we can do with a helicopter.

Open your eyes and watch how people go about the work....folks in Trauma Centers do not wear fancy Nomex Flight Suits....big ol' boots....chic Flight Helmets....or do PR's (admin flights devoted to showing the flag) like Helicopter EMS folks.....but do the very same kind of work but do so inside a building. Ground based Paramedics/EMT's and their ground ambulances do the same work....but definitely do not go the flashy road.

See where I am headed with this?

If you fall into the trap that most EMS operations set for themselves....and do not screen effectively for it....and do not weed out those that are susceptical to taking on that John Wayne....Type "A" mentality with all its vulnerabilities.....in time disaster will happen. It is a matter of time only!

Back to your quoted comment.....I heard exactly that when I took the position I do....while working at several EMS locations. You are exactly correct in one thing....I shall never change my mind on this topic.

EMS is about providing skilled emergency medical care to sick and injured people....providing them safe....operative word...safe....efficient air transportation to locations where they can be rendered medical treatment.

Note....no where in there did I say....mention....suggest.....opine....anything about "saving lives". The "Golden Hour" concept says lives will be saved if proper medical TREATMENT is obtained. That is the Trauma Center, Heart Specialist, or similar modern facility and staff the EMS crew delivers the patient to and not just the EMS crew alone. The EMS crew is part of the system....and play an important role....but are not the be all...end all!

In flight break up?

Let's line up the odds....of a catastrophic in flight failure....and have it happen on a dark foggy, rainy, night over a very dark un lit area, while on a Helicopter EMS flight in a Bell 206 with no Stability/Autopilot system. Does anyone care to offer opinions as to the odds Inadvertent IMC while flying on NVG's could lead to such an in-flight break up sequence?

No one knows what happened to this aicraft that resulted in the death of three very fine people....and we should be careful to qualify our statements in that regard. An investigator looking into this tragedy will be having some of these very same thoughts while looking at the evidence.

If we look at history....and the long record of fatal EMS crashes in the United States....how many similarities will we find to other IIMC events?

alouette3

3rd Sep 2010, 22:55

Now this is an interesting discussion.
fly911, I assume, by your moniker,you are an EMS pilot.I respect your passion and your attitude. But,I have to say, you are a little off track here. Can you explain to me why, for the longesst of times, the pilot in an EMS outfit is not given the condition of the patient? I am assuming your company does the same. Can you explain why the "lifesaving angels" in the back have the option to turn a flight around under the "three to go and one to say no" principle?These have been put in place for a reason.
What Gomer is trying to say is that we are in the transportation business.The words Air Ambulance or Emergency Medical Services or Mission ,all preload the pilot into a lifesaving mindset and that has proven to be dangerous.If you look at the accident statistics of any 135 operation (fixed or rotary), it is squeaky clean compared to a 135 EMS operation (fixed or rotary). A good reason for that: ever heard of the White Knight Syndrome?
Yes, we provide a valuable tool for the communities ,especially in rural America, for a crtically ill patient to fly to center for higher care. We certainly shave off time for an accident victim to make it under the golden hour.But,if your focus to accept or decline a flight is based on "saving a life",I am sorry, you are barking up the wrong tree.Leave all that BS to the folks in the back. Most haven't even left the Ambulance yet. You and I are paid to fly as professionally and safely as possible without thought to the outcome of the patient.You know as well as I do how hard it is to abort or divert when a patient is already on board. We don't need to make our lives tougher by putting ourselves under pressure from the word go. If I really wanted to save lives ,I would have joined the Coast Guard.
So why am I doing this? Because I like to fly.Plain and simple. If I were offered a job flying oil workers in the GOM tomorrow on terms I like, I would take it in a heartbeat.
Sorry for this long and preachy post.No hard feelings.
Alt3.

tottigol

3rd Sep 2010, 23:30

Alouette, it's really "One to fly and two to cry".:E

alouette3

3rd Sep 2010, 23:43

Tottigol,
Recently heard of a case where the crew expressed their reservations about the weather and did not want to return to base (patient transport was complete). Well, our hero leaves them behind and heads right back home. I am not sure he still has a job but it certainly fits your "one to fly and two to cry" category.:ok:
Alt3.

SASless

4th Sep 2010, 01:17

Also known as the "One Dissenting Vote Rule"....anyone "chickens out"....the entire crew chickens out! The collary rule is...."Chicken out early!"

I always accepted the fact when the other guy asks me...."What do you think of this weather?".....it was not a question but a statement! He is probably thinking he doesn't care for the weather at all and is trying to politely raise the issue.

I also pondered....if one replaced the fancy custom flight suits with the old Army two piece Nomex....in Olive Green....went to flat black helmets....changed boots to say....the old Army throw-a-way black plastic soled boots....how many of our Helicopter EMS medical crews would hang around? In plain language....make the work dress dull and drab....remove the luster from the job....would we see a dimunition in the type "A" personalities that we find so prevalent in the EMS operations? How many of these folks are really doing it for the work and not the flash?

tottigol

4th Sep 2010, 01:49

Amen to that SAS! Oh,and that "heroes" thingy.:rolleyes:

Epiphany

4th Sep 2010, 06:33

FH1100,

Yes the number of engines makes a difference. Singles are single pilot VFR, twins are 2 pilot IFR. Singles are crashing with monotonous regularity in USA at night and bad WX because they are flying beneath cloud and becoming CFIT statistics or getting disoriented and crashing.

Twin engine machines firstly have two pilots - one of whom can be detailed to get a last minute weather check whilst the other preps the machine. Then they can discuss the weather and their options before departure. if they choose to go then they have the option of flying above fog or in cloud to get to the destination and if they can't land then they divert because they have the equipment and fuel reserves to do that.

John R81,

If this VFR machine came apart in the air whilst flying in fog (cloud) then my guess is that it came apart due to unintentional aerobatics caused by loss of situational awareness - not mechanical failure.

What concerns me most is not why these pilots keep doing it - it is why the medical crews blindly follow them to the scene of the accident. The medical crews that i fly with (in a 2 pilot, twin engine machine) want a detailed weather brief before they will go anywhere. They have no intention of following me to an early grave.

lelebebbel

4th Sep 2010, 07:31

Epiphany, that may be the case in Australia but not in the US. There are plenty Single Engine IFR machines out there (quite possibly also including some dual pilot ops, others here may know better), as well as Single Pilot IFR twins.

Singles are single pilot VFR, twins are 2 pilot IFR

Turkeyslapper

4th Sep 2010, 07:52

Yep...plenty of twin engine/IFR machines including 412s, AW139s etc operating in the SAR/EMS industry in oz single pilot (albeit a crewman often occupies the LHS in a kind of non flying co pilot role).

ShyTorque

4th Sep 2010, 08:52

In combined Casevac/SAR unit I flew for there was categorisation of patients. Category A was highest (life or death), so we knew up front what we were facing.

Point to bear in mind: the patient is but one life. The crew was/is three, or four lives if it was a SAR mission. Apart from that, the loss of the aircraft itself might mean that other patients may not be rescued afterwards.

Having first flown helicopters with night vision devices in the late 1970s, (with PNGs, which pre-dated "NVG") I've always been concerned about them being used in circumstances where an IFR reversion/recovery is not possible. I've previously given advice to some via this forum. My advice is that I would not choose to work for an NVG, non IFR capable helicopter unit. Too risky in my book. As an instructor, I helped get RAF rules changed back to something more sensible when new weather limits for NVG operations were introduced which allowed flight in visibility worse than for unaided flight!

These tragic accidents seem to reinforce my point.

spinwing

4th Sep 2010, 10:35

Mmmm ...

Yes but in Australia DOES NOT ALLOW VFR flight at night at 500' agl does it ? ... perhaps for a start THAT is something the FAA needs to address ....

:=

SASless

4th Sep 2010, 11:26

Twin engine machines firstly have two pilots - one of whom can be detailed to get a last minute weather check whilst the other preps the machine.

Except for all of the SPIFR machines....which are in vogue.

Squeaks

4th Sep 2010, 11:28

Epiphany:

All five Victorian EMS helicopters are twin/IFR/Single Pilot.

spinwing,

Australian NVG approved operators can transit at 500' agl NVFR: exact height depends on a variety of factors, including CASA approval criteria :ok:

spinwing

4th Sep 2010, 11:41

Mmm ...

Yes and as you say that is specifically approved and only for NVG ops.

It is not an allowable 'STANDARD' for NGT VFR flight as it is in the US of A ... and if IMC is encountered a climb to an appropriate LSALT is required isn't it.

:=

FH1100 Pilot

4th Sep 2010, 12:19

Epiphany, you make a stronger case for two pilots than you do for two engines.

The issues you raise have been brought up before: That all EMS helicopters should be twin-engine/two-pilot/IFR capable/autopilot-equipped. Oh, and no night-VFR.

It's a nice fantasy, but it is just that, a fantasy. Here in the U.S., requiring such things (and the large, expensive helicopter you'd have to have) would mean that many communities would simply be without air ambulance service as the cost would be prohibitive. If you're cool with that, fine. But I don't think that's ever going to happen no matter how much you'd wish it would, and not everyone agrees with your viewpoint in any case.

The bigger issue is flying VFR into fog at night. Whether or not that caused this latest accident in Arkansas is almost beside the point; it would have been an irresponsible thing to do even if there were no crash.

But two-pilot crews are not immune from making such mistakes. I remember a particularly tragic accident some time ago in which an IFR-capable S-76 with two experienced pilots onboard attempted a night takeoff from a fog-shrouded airport runway. All they had to do was take-off straight-ahead with a positive rate of climb, and in less than one minute they would have been above the fog, up in a nice, clear, starry sky. Instead, they inexplicably stopped the climb, then floundered around for some time before crashing headed back toward the airport at an altitude lower than the elevation of the field they departed from! (It was hilly country in Kentucky, U.S.)

If we can keep pilots from making bad decisions, then the accident rate will be reduced, simple as that. Technology and capability can help, but no amount of technology is going to prevent the pilot from screwing up (again, I point to the Maryland State Police SA-365 accident). I don't know what the pilot of this latest EMS helicopter was thinking as he pushed along into the fog that night. We'll never know. But whatever he was thinking, we have to change it.

Epiphany

4th Sep 2010, 13:25

Here in the U.S., requiring such things (and the large, expensive helicopter you'd have to have) would mean that many communities would simply be without air ambulance service as the cost would be prohibitive. If you're cool with that, fine.

Well if the FAA and local authorities are 'cool' with VFR helicopters falling out of the skies with monotonous regularity then I suppose the situation will continue. There comes a point when the argument of having any EMS helicopter rather than the right one just doesn't hold up.

And it is not simply a matter of providing expensive IFR capable machines - the crews need to be well trained and current otherwise when they do fly IFR they may well 'flounder around for a while' before crashing.

fly911

4th Sep 2010, 15:02

No hard feelings indeed. I got out of HEMS work about five years ago, and it's probably time for me to leave this thread. I agree with the concepts you describe like not informing the pilot of the type mission until a decision has been made as to whether to accept the flight or not. That's good common sense, as the pilot may have a soft soft spot for say, a child burn victim. But I don't think that it's fair to compare the non-EMS part 135 safety record to the Air EMS part 135 safety record. It's just not a fair comparison. Bad weather causes bad vehicle accidents. Health of a patient doesn't depend upon weather, whereas most air taxi work does indeed depend upon good weather. It's a fact of life, that if you are going to fly HEMS, you will be flying in marginal weather conditions. That is an increased risk factor. Consequently, there will be more HEMS accidents. Alt3, if you don't see this, then read no further. No hard feelings. Before we move on and try to fix it, we have to take our emotions out of the equation. If I appear to be in denial about something, please point it out so that I can recognize it. If I disagree with you about it we can discuss it further. And I ask that you search your own attitudes for signs of denial. There are "White Knights" and "Cowboys" and will be as long as there are helicopters. I'm sure that you don't care for the type in EMS and neither do I. But because we don't care for that type of pilot doesn't mean it's ok to blame all the accidents on them. It could very well be that the "white knight" would be quicker to turn down a marginal mission out of fear of not being able to complete it and looking bad. Come on alt, if I am flying logs, then I want to be the best logging pilot I can be. If I'm fighting fires then I want to be a good fire fighter. I don't want to be a half assed HEMS pilot. Which is not to say that I'm not concerned about safely completing the mission as being the most important thing on the agenda. If you (not you personally) are the type of pilot that will only fly in "clear blue", more power to you. The world needs more pilots like that. But if you are the type of pilot that won't get out of bed in a light drizzle, please don't take an HEMS job and spend all your time complaining that you can only fly patients when it's "clear blue". You're not doing yourself or your profession any favors. We can improve the HEMS safety record, but it's not going to happen by pointing fingers. When I hear counter-productive comments like "If you feel that way, you are part of the problem" I hear him really quoting from the Wizzard of Oz: "If...I...only had a brain...".
I think I'm outta here. If I offended anyone, I'm sorry.

alouette3

4th Sep 2010, 16:07

Fair enough,911. I think you have made your case pretty eloquently. I see lots of points we can agree upon and the chief amongst those is the fact that we want to be the best at whatever we do.Also, there is certainly an increased exposure to risk in HEMS.We, the line pilots have to manage it . Not the FAA or the operators ----just us.
The only place we will have to agree to disagree is the fact that I don't see myself as being in a life saving job.Life altering ,certainly, but life saving ---no. I would like to keep it that way.I will continue to do the best I can under the circumstances and limit myself to the letter and the spirit of the laws that govern my job.I certainly hope everyone else does the same.
There should be no hurt feelings in a professional forum such as this and I hope you will return to this thread because we all have something to contribute to raise the safety standards and perceptions in the US HEMS world.
Fly safe and above all fly smart.
Alt3.

tottigol

4th Sep 2010, 17:03

So,Fly911 your point is that no matter what equipment we are going to make mandatory for the safe conduct of specific EMS operations, there shall always be the White Knight or the Cowboy who's going to want to impress the two SLBs in the back.
YOU ARE ABSOLUTELY RIGHT!
However I believe that it's not merely an equipment standpoint, it's the whole industry mentality that needs to be rearranged, and drastically so. The Aeromedical industry is in reality another expression of the flawed medical structure in the USA, flawed because it's based on protagonism and appearances and not real patient care values.
I have flown EMS for several years and thank God never ones I had to use a VFR only single engine aircraft with no stabilization other than my seat of the pants, however I did feel peer pressure coming from the primadonnas in the back and coming from those pilots who wanted to be counted in "the circle of friends".
That's why I am not there any longer (ask SAS) and that's why I shall keep away from any other EMS job trap again.
The problem is that EMS is run by the customers and as long as there are no structures in place to limit the overbearing intrusion of a non aviation entity in the operational control of an aviation activity we shall continue to see what we see.
Let's change the structure of HEMS, let's isolate the moneymaking from the flying and we shall reap the rewards with drastically decreased accident numbers and RATES.:rolleyes:

QTG

4th Sep 2010, 20:31

It doesn't matter what aircraft you fly. If you stick to the rules you should be OK. If you fly for a company which only makes money when you carry a casualty, sooner or later you'll probably crash, or at best frighten yourself silly on regular occasions. Its called commercial pressure. And it doesn't mix with HEMS.

SASless

4th Sep 2010, 21:10

There are hundreds of reasons why crashes occur....and some are very subtle and hard to articulate....particularly when you are the one being confronted with them day after day. (....or night after night)

Commercial pressure is one, having weather go below your limits is one...fatigue is another...night time is a big one....flying over isolated and dark areas is another....unforecast inclement weather is another....variable unforecastable weather due to terrain is yet another. How long a list do we want to create?

The size and numbers of the holes in that old chunk of Swiss Cheese is what matters!

Gomer Pylot

4th Sep 2010, 23:20

Epiphany, I think you have to accept the fact that the US is not Australia, which is not England, which is not anywhere else. Practices in one country have no bearing at all on practices in another country. Culture, tradition, even language is different in different countries, and criticising another country's laws and ways of doing things is not a productive exercise. There have been EMS accidents in Australia, and the rate per hundred thousand hours is likely not significantly higher than the rate in the US. You hear of lots of US HEMS accidents because there are close to a thousand EMS helicopters flying every day here.

I personally think HEMS should be run by the government, at whatever level, but here in the land of the free capitalism rules, so that ain't gonna happen, and making a profit will continue to drive the industry. There are very few HEMS ships flying with two pilots, regardless of the number of engines, because the second salary cuts into profits, and every program would do without pilots at all if they could figure out a way to do it. EMS directors hate pilots, always will, and we get what we get. Take it or leave it.

spinwing

5th Sep 2010, 00:16

Mmmm...

Gomer .... you are quite right there HAVE been EMS accidents in Australia ...
and when you analyse them the reasons look very much like the reasons accidents keep happening within the US industry.

That is the reason things changed in Australia ... over time it was realised that airmanship and professional decision making HAD to overule the so called 'profit incentive' .... until that happens in the US I think history will continue to repeat itself.

:oh:

helmet fire

6th Sep 2010, 20:07

I differ a little there spinwing: the accidents in Australia did not change much - it steered one state government away from single engine VFR helos, there were only three of those in use in that state, and it did not even mandate NVG! There was nothing ground breaking or monumental in the changes. That is a very different proposition from what the USA is going through - for a start, each helicopter in QLD had only one client and none were competing on a cost basis with any other. There was no loss of work, nor redundencies for machines and operators. Similar changes (mandate IFR Twins) would have a massive impact and are therefore unfortunately unlikely in a for-profit system such as the USA.

I think a whole lot of this thread has been written with passion and intelligence, and it has made a lot of sense from both sides of each discussion point raised. One thing really stands out though - our responses are always shaped by our experiences and our operating cultures; that is why we have such different view points. I will throw a few into the mix from my limited experiences.

Perspective. Australia achieves as much EMS SAR flying per year as they are doing each day and a bit in the USA!!! The USA has over 1000 machines (according to an earlier post - though that seems extreme) and Australia has less than 35. I cannot do the maths, but it seems that we Australia have to look at accident rates over a 40 odd year period to see if it is close to the annual rate for the US. Therefore it an Apples V Oranges arguement to compare anyone else with the US, particularly give the unusual commercial and job competitve nature of a majority of the US industry.

The Golden Hour. There is no evidence indicating a sudden increase in mortality or morbidity in the 61st minute of a reponse. Whilst many response organisations use it as a mantra and marketing tool to easily convey the need for speed to the layman, the reality is so clouded by regional settings as to be almost irrelevant to some. For example, in one part of our area we deliver medical care and capability in the helicopter that exceeds the Emergency Department. So, is the golden hour until we arrive, or until we deliver the patient to lower care levels in the medical facility?? All I am trying to convey is that there are no "absolutes". What "must" be done in one region "should not" be done in another.

The only discussion point that has so far concerned me was inferring that "we never save lives". The use of the royal "we" here is what is incorrect IMHO. I have flown for many organisations that can lay claim to survivors purely because a helicopter was able to bring rescue and/or sufficiently high level of medical care within a time frame that would have otherwise resulted in death. That is not a reason to grab a cowboy hat and show everyone how long your willy is, but at the same time it is inconsistent with the notion that it is like flying logs or rigpigs. I recognise that some organisations do not have high level medical care on board and may only do inter hospital transfers, but that is not a reason to cast an "absolute" that no-one else saves lives. It must be self evident that moving someone to a medical facility "saves lives" - so the question is: what bit of the ED saved the lives? Why was it not bought on the helicopter? Can the helicopter bring SOME of the bits on offer at the ED and thus be in a position to "save lives" ??? Is rescue from an iminent building fire, flooded river, sinking boat, or soccer match "saving lives"???

We have talked in depth about reponse times and how "dangerous" short ones are, but I stick to my previous points on this: time of response does not equal safety of response. Response process ensures safety.

Another absolute that drew my attention was that we pilots should "never" know the condition of the casualty. That has not been an important factor in my experience in influencing a PROFFESSIONAL. I note with some danger of a faded memory that the majority of the US HEMS accidents are on the return leg after patient delivery. In other words - patient condition was NOT a factor in the majority of press on itis accidents in the US. In the organisation I currently work for, patient condition is as openly discussed amongst the crew(aviation and medical) as is the weather and the aircraft performance, how tired we are and how inexperienced we might be at the proposed type of flight. CRM. So I see it would be appropriate in some cultures, but please dont force it on ours by saying "never".

Two other things about this notion to consider are:
1. Why do we never give crew of the year to the guys who had to say "no" in often extremely trying circumstances? I can employ heaps of pilots who will say yes, but where do I find the one big enough to say no?
2. If it was your child dying, would you try harder? Do other peoples children then deserve less effort? Ethically a really tough one I think (and I really struggle with it at times). Absolutes are a big call. What if you say no to a take off because by the time you get back to base you will have exceeded you duty time by 1 hour - and then you find out it was to a severe road accident involving your family to which the the ambulance is more than an hour away. Is that one hour a sound risk V gain decision in light of your family trapped and bleeding? Or is it absolutely innapropriate? Is it really "never" appropriate for aviation and medical professionals to weigh up the risks and make a crew decision on what "is" appropriate??

Lastly, the calls that HEMS must be done "this" way (which nearly always resembles the way the proponent is doing it now!). Here are my calls for moving to the ideal HEMS culture in FULL recognition that I dont know the benefits of other ways NOR will anything I say make the slightest change to other ways of doing it!
Twin engine PC2 preferred. IFR with SPIFR autopilot. SP plus "HEMS crewmember" or co-pilot for operating (not medical) crew, in accordance with EASA's smart and latest requirements (Australian front seat crewies do not comply in nearly all cases). No unaided HEMS/SAR. Primary response at night only by NVG HEMS/SAR, only where trauma rates after dark can be shown to be inadequately covered by road response, and only where helo brings significantly higher levels of medical care than that available on the road. Inter hosptials by night must have NVG. HEMS pilots to be instrument rated and current (yes, even where their area of ops precludes IFR). HEMS crews given extensive CRM training (not the one day giggle over the Air Florida and Tennerife accidents), HEMS organisations run not-for-profit BUT with strict governance regulations in terms of management and board members (no "old boys" clubs), HEMS organisations not to make money from flying - the money is made from standing charges (yes we run a model in Australia where providers lose money each time they fly!).

I know these "are no absolutes" and there will be many other suggestions, but this is my drivel...write your own :8

Gomer Pylot

6th Sep 2010, 20:30

I generally agree with helmet fire and spinwing. Things aren't likely to change much in the US, because the god Profit is all-powerful, and we will continue to bow down to him regardless of the number of deaths. Profit is far more desirable than safety here. It matters not how many people die, crews, patients, or bystanders, as long as the corporations can make a profit.

I have never claimed that we never save lives, only that I never have that as a goal. I'm not aware of any that I or the med crew have saved, but we're far from the only ones flying. We've got a few to the hospital alive that didn't survive long in the hospital, we just prolonged it for a few minutes, and we've flown many who wouldn't have died if taken by ground. We can mitigate morbidity, especially for stroke and cardiac victims, but we rarely save lives. Again, 'rarely', not 'never'. Painting anything with so broad a brush as to assume absolutes is wrong. But we should play the odds, and look at the most likely outcomes, I think. I almost always know the condition of the patient, because I hear the scanner, and hear the patient report over the radio from the ground EMS units. I just don't let that influence me. I think I do a fairly good job of that, but I'm only human, and I sometimes have to remind myself that it's just another piece of freight.

Things are different in different countries, and always will be. The 'one world' concept is a long way off. I would prefer that things were done differently here, and more like other countries, but my preferences have no influence on anyone or anything. I just try to deal with conditions as I find them, the best way I can, and go home alive at the end of every hitch.

fly911

9th Sep 2010, 13:53

AUSTIN TEXAS STAR FLIGHT RESCUES 13 FROM FLOOD.
Additional video here---> Starflight rescues 13 from floods | KXAN.com (http://www.kxan.com/dpp/news/local/starflight-rescues-13-from-floods)

__MjgY_71eE

KXAN (AUSTIN) - Three STAR flight helicopters spent the night responding to 20 calls for rescue as the flood water was rising over vehicles and homes.
“You could see flashing lights everywhere. It was amazing,” said STAR flight senior pilot Chuck Spangler.
A majority of the calls came from Williamson County, where 13 people were extracted from the water and hoisted into the rescue helicopters.
Two Travis County EMS workers and a Weir firefighter were among those who had to be rescued when the zodiac boat they were in took on too much water. They were attempting to make rescues of their own near highway 29.
A family of four was also rescued from a second story window in their home near FM 971.
STAR flight says they have some of the best tools to save lives in emergency situations.
“Thanks to the residents of Travis County, we have the finest equipment in the world,” said Spangler. “It is extremely dangerous. The most dangerous thing I have ever done.”

Two's in

8th Oct 2010, 00:33

WASHINGTON–The U.S. Department of Transportation’s Federal Aviation Administration (FAA) today proposed broad new rules for helicopter operators, including air ambulances, which, if finalized, would require stricter flight rules and procedures, improved communications and training, and additional on-board safety equipment.

Proposal Includes requirements for Air Ambulance Operators to:

Fit Helicopter Terrain Awareness and Warning Systems (HTAWS).
Comment on light-weight aircraft recording systems (LARS).
Conduct operations under Part 135, including flight crew time limitation and rest requirements, when medical personnel are on board.
Establish operations control centers if they are certificate holders with 10 or more helicopter air ambulances.
Institute pre-flight risk-analysis programs.
Conduct safety briefings for medical personnel.
Amend their operational requirements to include Visual Flight Rules (VFR) weather minimums, Instrument Flight Rules (IFR) operations at airports/heliports without weather reporting, procedures for VFR approaches, and VFR flight planning.
Ensure their pilots in command hold an instrument rating.

Also under the proposal, all commercial helicopter operators would be required to:

Revise IFR alternate airport weather minimums.
Demonstrate competency in recovery from inadvertent instrument meteorological conditions.
Equip their helicopters with radio altimeters.
Change the definition of “extended over-water operation” and require additional equipment for these operations.

https://www.faa.gov/news/press_releases/news_story.cfm?newsId=11958

hostile

8th Oct 2010, 23:23

Finally some good news for EMS operations. Same rules, same operation. That's it would be for now. There will be a long way, but this is good start.

:D

peterprobe

9th Oct 2010, 19:47

I like knowing the job we are running to. I have to in the UK. As the pilot I need to know if it is HEMS or Air Ambulance as each has different weather limits, which with a well briefed and CRM'd medical crew all understand when I say nope not today. I have not been asked or questioned once (in a few years now) why we turned back, as sadly with all these crashes going on around the world they are more than aware this game can be fecking dangerous if you push it. Fly safe all.

BEBEL29

13th Nov 2010, 08:57

Hi Alouette 3
Are u french ?

helmet fire

16th Nov 2010, 04:37

A response to the list above from the FAA recommendations with some thoughts based only my opinion (knowing that opinions are like arseholes - everyone has one!) and tempered with my limited experience:

1. Fit Helicopter Terrain Awareness and Warning Systems (HTAWS).
Agree with inference of terrain awareness systems, but do not agree with common manifestations of HTAWS such as EGPWS for HEMS. Aural warning systems work very well for interhospital IFR programs and off shore, but the constant aural warnings from low level operations during primary response missions can be often counter productive. Rather, I would push for visual aides, and preferably for systems that require very little interpretation with little or no false warnings. Check this out from Garmin to see what I am talking about: G600 MFD info (https://buy.garmin.com/shop/shop.do?cID=195&pID=6427) and an interactive demo here: G600 demonstration (http://www8.garmin.com/buzz/g600/)
No interpretation required. Visual. This is the TAWS systems that should be mandated. Well done Garmin!!! Just need the helicopter ceertification to be completed now!!
Add EVIS to this for the ideal cockpit capability..

2. Comment on light-weight aircraft recording systems (LARS).
Agree. Non tamper proof. Tracking systems employed to show track, hieghts and speeds.

3. Conduct operations under Part 135, including flight crew time limitation and rest requirements, when medical personnel are on board.
Agree only if some of the more restrictive Part 135 issues are resolved before mandating requirements. SAR ops to be added to this.

4. Establish operations control centers if they are certificate holders with 10 or more helicopter air ambulances.
Situation dependant upon nature of tasking control.

5. Institute pre-flight risk-analysis programs.
Only agree if this is not a "Pre Take off" risk system where take off is delayed for a game of guesstimating risk values to see if take off is allowed. My experience with this is that invariably (yep, that is invariably) the numbers or ratings or whatever are just altered until take off is permitted, meanwhile take off is delayed and brain power diverted from building Situational Awarenss. I agree however that a comprehensive risk management system is implemented considering missions and implementing controls well before the phone call comes.

6. Conduct safety briefings for medical personnel.
There are really operations out there that do not brief the crews???

7. Amend their operational requirements to include Visual Flight Rules (VFR) weather minimums, Instrument Flight Rules (IFR) operations at airports/heliports without weather reporting, procedures for VFR approaches, and VFR flight planning.
There are really operations out there that have not established such things?

8. Ensure their pilots in command hold an instrument rating.
Agree. Regardless of terrain and environment precluding IFR use, the skill sets provide a coping mechanism for all sorts of unexpected situations: NVG failures, lighting failures, dust out, white out, as well as IIMC. I also personnaly believe that an IFR rating should be required to fly patients at night - even where flown under VFR.

And I have added a few extras as per previous posts:
9. Operate PC2 compliant.
10. Comply with EASA rule of two upfront - either two pilots or pilot plus HEMS Crewmember meeting specified aviation course.
11. Ban unaided HEMS/SAR
12. Conduct NVG primary response only when trauma rates require it, geography and equipment levels translate into low road coverage by ground responders, and where helicopter brings demonstrably higher medical care levels than those deployed by ground.
13. Proper CRM training for ALL crew (including medical crew on board).
14. Never going to happen in the USA: HEMS operators run by NGO with strict and policed governance guidelines and protocols.

:8

tottigol

16th Nov 2010, 21:59

Only one is really needed.

1) Remove the customer in any possible way from affecting the operational control of the aviation side.

You can only remove that by removing the profit factor.
Hence just like helmet fire said, it shall never happen in the States.

Let's see which program shall be next in creating a smoking hole somewhere in the states.

Let's then listen to the mourning and "they were heroes" bull**** over and over again.

Thud_and_Blunder

20th Dec 2010, 19:48

Link from Connect MidMissouri (http://www.connectmidmissouri.com/news/story.aspx?id=556795)

If you make it through the atrociously-written (OK, I'm being a bit unkind - she's just printing verbatim what the witness said) article, you'll find that "one of the engines" blew up. On a 350, what exactly does that leave the pilot by way of spare power-plants, hmm?

From the photos, it would appear that the pilot did a very good job of keeping the aircraft level after touchdown.

HeliStudent

22nd Dec 2012, 18:33

Bell 407 training in the US

New Job - Bell 407 Helicopter training for HEMS operations for Med-Trans - YouTube

I have read that there are going to be many more Bell 407's in the US to cover EMS work. I suppose this must be one of the best EMS helicopters?

SASless

22nd Dec 2012, 20:44

Stude,

They are the cheapest....not the best.

As to the FAA comments.....

Truck Drivers have far more strict (read restrictive) Hours of Service than do Pilots.

Heli-News

18th Jul 2013, 15:15

Bigger EMS helicopters required in US

To accommodate the nation’s super-sized patients, emergency medical providers are now being forced to purchase larger helicopters. More than two-thirds of American adults are overweight or obese, which has caused a dilemma for air transport providers.

“It’s an issue for sure,” Craig Yale, vice president of corporate development for Air Methods, told NBC. “We can get to a scene and find that the patient is too heavy to be able to go.”

Some emergency helicopters are unable to carry patients weighing more than 250 pounds, and others are able to accommodate patients weighing up to 650 pounds. As a result, emergency medical providers have been forced to expand their fleets and purchase larger air ambulances, which can be costly.

Patients become too heavy for medical emergency helicopters ? RT USA (http://rt.com/usa/patients-obesity-helicopter-emergency-226/)

Never Fretter

5th Apr 2015, 10:02

With a mega order of 200 B407GXP I don't see Air Methods paying too much attention to passenger size.

Air Methods Buying 200 Bell 407GXP Helicopters | Flying Magazine (http://www.flyingmag.com/aircraft/helicopters/air-methods-buying-200-bell-407gxp-helicopters)

I'm surprised to see no comment here on the two fatal HEMS accidents in the US last month.

More US Night HEMS Accidents (http://aerossurance.com/helicopters/us-night-hems-accidents/)

But at least the FAA have ensured there will never be another HEMS accident in the US (HAA HAA HAA).:D

crunchingnumbers

5th Apr 2015, 12:17

With a mega order of 200 B407GXP I don't see Air Methods paying too much attention to passenger size.

On the contrary, that's why the 407 was selected. For most operations (other than hot/high) the 407 provided better metrics than the other choices B2/B3 and 130. CG issues affect the latter such that routinely 250-300lbs are the max passenger weights possible for the sectors flown. It's not just patient weights that are increasing, but in many cases it's the crews as well, with the pilots being the most critical CG wise of course. In addition, there is an ever increasing requirement by regulators to carry more equipment - in many states the air ambulance falls under the same regulation as the ground ambulance with little distinction made. 175-250lbs of equipment is the norm.

In my opinion the EC130 is a good aircraft in the EMS configuration and a better fit for medical care, with improved access over the 407. From a business perspective I can sell that over many other choices including twins eg. 135. Unfortunately experience has shown that the cg issues which impact the B2/B3, remain for the 130. Of course the health care industry in the US has a very different economic model which promotes single use. That's just a reality which accepts the cost/risk benefit.

As for accidents, it remains a challenge for night ops. The new and improved EC130T2 which comes online this year, will see some additional benefits for aviation and medical crews alike with many new airframes and retrofits. This includes G500/G1000 with synthetic vision, and simple auto pilots - more tools and training. One hopes that coupled to NVG's etc this will reduce the inherent risk of single pilot night time ops, but there is always the human element which cannot be removed from the equation. Where many pilots develop their experience in a single pilot VFR environment or enter the industry from a specialized multi crew background, human factors/training/cultural and proficiency considerations weigh heavily. There is also the shear scale of operations in the US to consider, which whilst not mitigating the need for improvement, certainly contribute to the statistical inevitability.

Devil 49

5th Apr 2015, 16:04

Never Fretter posted:
(1)... "With a mega order of 200 B407GXP I don't see Air Methods paying too much attention to passenger size.

Air Methods Buying 200 Bell 407GXP Helicopters | Flying Magazine

(2)... I'm surprised to see no comment here on the two fatal HEMS accidents in the US last month.

More US Night HEMS Accidents

(3)... But at least the FAA have ensured there will never be another HEMS accident in the US (HAA HAA HAA)."

(1) The 407 vs the 350 was purely a better deal by airframe offering. Announced in the company as saving hundreds of millions of dollars. From the line, it doesn't really make much difference to the pilots if you're not operating in a hot and high environment. The AS350 CG issue is usually a less serious issue than patient girth, our safety belts have a finite length and no approved extenders. I might be able to keep you in CG at 350 lbs, but if you're bigger around than 52-54 inches, you're going by truck. I don't see that changing with the 407 deployment.

(2) Two more HEMS night accidents are not remarked on here?
Okay, one appears weather related by an operator for whom this was the fourth fatal crash of 5 aircraft based in Oklahoma in the last 3, 4 or 5 years. Pick an accident in that series, and there may be a reason to excuse the operator. On the other hand, it could well be that this operator is the coal mine canary for the industry that believes it has no problems. That's my opinion.
The other accident may have a weather factor, but I lean more towards a human factor.
We'll have a better idea when the accident reports come out.

(3) I agree entirely and completely, "HAA, ha ha ha". Now that I no longer operate an "emergency service" it removes so much pressure to go... Not.

alliance

6th Apr 2015, 08:04

This same story has been going for decades. While ever the US HEMS industry continues, (for the most part), to be run by private for-profit operators, a for-profit health care system and companies seeking a way to make a quick buck with less capable helicopters not suited to specific missions and tasking, you will continue the horrific safety record in the US with little or no change. Take out any profit and commercial incentive and your system will become what it can be.

Never Fretter

6th Apr 2015, 12:45

(1) Forgive my naivety but isn't the cabin size a factor too when selecting a medical helicopter. Surely the cabin of a 407 will still be particularly tight with a large patient needing ventilation etc during flight plus medical crew and equipment? After all isn't that Bell's marketing point for the 429? I could see a 407 being slightly easier to justify for short transits but I see that there are cases of patients being flown past the closest hospital.
State Investigates Medical Helicopter Company | KRGV.com | Rio Grande Valley, TX (http://www.krgv.com/news/local-news/State-Investigates-Medical-Helicopter-Company/32096034)

(2) Is in commercially advantageous to use two helicopters (after a road accident with multiple casualties say) rather than one larger helicopter?

(3) On the point that "take out any profit and commercial incentive", surely that isn't stopping commercial airlines achieve amazing levels of safety. Does this mean that the medical industry in the US are culturally accepting of a certain level of attrition and happy to continue to use providers with a poor safety record without penalty?

(4) Why so many night accidents? More US Night HEMS Accidents (http://aerossurance.com/helicopters/us-night-hems-accidents/) Is it a sign of the number of night flights or their relative risk?

Gomer Pylot

6th Apr 2015, 14:49

Cabin size is sufficient. The problem with size is patient girth, as Devil49 pointed out. That's the only thing that really matters.

Using one big helicopter instead of multiple smaller ones isn't viable economically. You can't plan for a situation that happens only a very few times per year, you have to plan for the everyday case.

Carping about the economic model in the US does no good. I would also like to see the entire medical industry model change, but it's not going to happen. Capitalism will continue to rule, so we need to find the best way to deal with that and its effects. The FAA is required by law to consider economics in its regulations, and can't impose any that would cause severe economic penalties, regardless of whether they would save lives. It's wrong, but it's the reality.

I think the number of night accidents reflect both the numbers, and the relative risk. I almost always had about as many night as day flights, and I suspect the numbers are at least on the same order of magnitude with most programs. But night EMS has its dangers. It's dark. That makes it hard to see. Duh. But it's true. Googles help a lot, but they have their limitations. Everything is one color, and the field of vision is very narrow. It's really easy to miss seeing something that's just a few degrees to one side. The biggest danger, IMO, is the physiological difference. If you're asleep, and wake up from deep sleep for a flight, sleep inertia is difficult to overcome, and can take a long time to pass. Pilots who live locally, and stay on the same diurnal schedule regardless of the work schedule are more likely to be affected, and are also more numerous. Companies want to save money by having crews live locally so they don't have to provide quarters, and pilots don't like being away from home for a week at a time. IMO, this causes accidents, and lives. But it won't change. Money talks.

Night HEMS accidents could be completely eliminated, of course. Just eliminate all night HEMS flying. Lots of people across the pond advocate that, and some don't allow night flights there. But one has to take a broader view, I believe. Of course people die in night HEMS crashes. But the real question is whether those deaths outnumber the lives saved overall. That's a difficult number to quantify. But one still needs to consider the tens of thousands of night HEMS flights annually in the US, and the relatively small number of accidents. I'm certain that night HEMS flights will continue, and continue growing. How to properly regulate them, and minimize the risks, is the question. We will never eliminate risk, we can only minimize it.

Devil 49

6th Apr 2015, 15:21

whether it's public service/government, "not for profit", charity, or a conventional for-profit business model. The profitability is determined in different ways that makes it harder for people to see the decision points.

Public service/government will use a limited budget (hopefully) to provide the best value, another name for profitable application of resources. If the budget "Super Bug Smasher" law enforcement/air ambulance is not justified by providing "x" number of transports to the public at large, that budget will be redirected to something else. There aren't limitless funds, even in enlightened Europe- do you see many air ambulances with flight into known icing capability over yonder? No? I would think it would be very useful...

Not for profit... same-same, only cash flow can be directed to various entities as equipment, salaries and bonuses, whatever makes the bottom line all 'zero-ey". I can't count the number of not-for profits gone belly-up because of what is termed poor profitability in a conventional business scenario.

And finally, the much maligned "for profit enterprise"- Efficient application of resources required or you fail. HEMS/HAA or whatever the PC term is this week can be done safely by a for profit, witness the current airline industry compared to earlier for an idea of possible room for improvement. As in any operation, HEMS/HAA management for safety requires proper prioritizing and management of resources. THAT is not routinely done in the US, Gomer Pylot brings up some of the issues. It's not that management intends to compromise operational safety for profit, it's that they don't SEE the factors acting to increase risk. Another example of that issue as I see it- None (zero, zilch, nada) of my company's management fly the job, ever. All of my company's instructional staff are management. Even my chief pilot, for whom I have great respect, has a historic and dated view of the job and challenges faced.

Another example from night problems in the US HEMS/HAA industry- pilots plan on sleeping on the job (for various reasons, not germaine) and do so. Now at Oh-dark thirty, the request comes in, awakens the pilot, the pilot checks weather and compares METARs to forecast while awakening the crew (response time isn't the criteria except that it IS tracked and used to critique). What was missed that is really, really important? trends. You have to monitor trends to have any real idea of weather. Forecasts are guesses, observations are history, trends show where the weather will probably be going in spite of forecasts...

tottigol

6th Apr 2015, 17:47

Devil49, I agree with part of your post, the last part mainly.
The part with which I don't agree is where you refer to the airline industry:

1. Following the Buffalo accidents of a few years back and the uproar that followed it, even the Regionals had to bite the bullet and accept a minimum of an ATP license for their SICs and the flight time experience that comes with it, the HEMS industry is going into the opposite direction with no end in sight.

2. An airline FLIGHT CREW decision to not depart is not usually followed by subliminal or overt pressure by the passengers (read customers) to launch, penalty removal from the position as it often happens with HEMS pilots.

You are right HEMS pilots do not want to travel, but that would remove most cases of get-home-itis (you ARE away for a week or so).
Sleeping quarters need not be anything fancier than a double wide, which is the industry standard anyway.
GomerPylot is correct, have you ever seen your med crew trying to do compressions on a 400 pounder in flight? There just isn't enough space above the poor person and the cabin ceiling.:(

Devil 49

6th Apr 2015, 18:24

Tottigol:
Devil49, I agree with part of your post, the last part mainly.
The part with which I don't agree is where you refer to the airline industry:

1. Following the Buffalo accidents of a few years back and the uproar that followed it, even the Regionals had to bite the bullet and accept a minimum of an ATP license for their SICs and the flight time experience that comes with it, the HEMS industry is going into the opposite direction with no end in sight.

Look even further back in airline history and the industry's safety wasn't stellar.
The Buffalo accident has much to teach the industry, especially regarding crew rest, yet I haven't heard discussion one from management or my peers. It's like that never happens...

2. An airline FLIGHT CREW decision to not depart is not usually followed by subliminal or overt pressure by the passengers (read customers) to launch, penalty removal from the position as it often happens with HEMS pilots.

I have never had an abort or decline brought up, much less critiqued by AVIATION management. Medical crew is another kettle of fish entirely but I'll chew my lip for a bit on that.

You are right HEMS pilots do not want to travel, but that would remove most cases of get-home-itis (you ARE away for a week or so).
Sleeping quarters need not be anything fancier than a double wide, which is the industry standard anyway.

My base has a pilot suite separate from the operations area.
You're halfway to a point with "get-home-itis" in that the issue of company providing poor support for weather aborts. That can be an issue, whether it's admitted or not.

GomerPylot is correct, have you ever seen your med crew trying to do compressions on a 400 pounder in flight? There just isn't enough space above the poor person and the cabin ceiling.

Yep, I have. The ceiling isn't the issue, it's lateral patient access seems a bigger problem in my unqualified estimation. The 407 won't be an improvement in that regard, but perhaps we'll have "thumpers" and other automation by then.

chopper2004

6th Apr 2015, 20:33

It is worth watching this the pilot's integrity though his comments after this flight was the flight nurse and paramedic refused to fly with him ever again..

https://www.youtube.com/watch?v=EMxuO77mdQo

EMxuO77mdQo

Gomer Pylot

7th Apr 2015, 01:39

I have never had a member of management question, or even comment on, a decision of mine to fly or not fly. I can't say the same for the 25+ years I spent flying in the GOM. The attitude from management is entirely different. I've also never had a complaint from the med crews. They have sometimes commented on other pilots' decisions, but if they ever said anything about mine, it was never related to me by anyone. The med crews knew I would fly if I thought it was safe and legal, and would refuse if not. Med crews, like everyone else, tend to value competence and level-headedness. Being unsure and changing your mind often scares them. If they trust you to know your job, and your commitment to doing it right, they won't question your decisions nearly as much. They can usually tell if you're turning down a flight just because you prefer to sleep, and if you do that a few times, your trust is gone. None of this is unique to flying, it's standard in every industry, every job.

I will say that 3800 hours at retirement isn't much. That says that it was a long time between flights, and it's impossible to stay proficient while not flying. HEMS is not a job for low-time pilots. You don't get a chance to fly that often, and when you do you have to be perfect every time. It's difficult even with tens of thousands of hours.

Never Fretter

10th Apr 2015, 12:12

What roster do US HEMS pilots normally work? I'm struggling to understand the comment above that they are woken up for night flights. Surely they don't work 24 on?

Can any one clarify what percentage of HEMS flights are flown at night in the US?

tottigol

10th Apr 2015, 14:50

Never Fretter, an verage of 30% of EMS flights is flown at night in the USA.
The pilots are required to show up rested for night duty.
Normal EMS rotations are 12 hours day shifts and 12 hours night shifts (ie: 07:00-19:00 and 19:00-07:00).
Under part 135.267 unscheduled one pilot operations, minimum rest undisturbed has to be 10 hours in the last 24 hours, with a maximum duty of 14 consecutive hours.

That rest includes driving back and forth from the pilot's domicile.
The pilots are responsible to get their rest once they get home or to their "luxury trailer":E

Devil 49

10th Apr 2015, 16:27

Thoughts on the video "That Others May Live"

"not much had happened that week, there wasn't a single flight... eager to take the flight."
(Pressure to accept dispatch, self-imposed, also called 'motivated pilot')

"The weather was no good because of the clouds. They asked if..."
(A motivated pilot properly exercises judgement, ultimately proven absolutely correct. The correct decision taken by the pilot is inappropriately influenced.)

"We too off... and there's no way... cancelled, turned around..."
(And again, the pilot's decision is that conditions are not acceptable by the PIC on the scene.)

"Can you maybe go the alternate landing spot? It was clear there, because we had flown over it..."
(The safe conservative decision to not attempt this flight is again inappropriately interfered by the company.)

The pilot's narrative indicates that he is nervous about the situation at the alternate landing site "I'd been looking at that light, it's so dark behind it..." "After several minutes... low level fog developing.."
(I'm not there, so I don't know, but at this point I'm telling the crew they have a choice, they can leave with me or ride the ambulance to the hospital. But this is a 'motivated pilot', not me. The trap is apparent if you will only see it.)

"Yep, there's 'glows around the lights'. Okay, let's go. Get on board. We're leaving and we're leaving now!" "Without the patient on board, Denver had already lifted the helicopter... when they noticed that the ambulance had finally arrived. Well shoot what are we going to do [the decisive error, the decision has been made by the PIC. Now the med crew is flying.]... seven minutes later...
(From this point on, with dispatch and the med crew having put the PIC in the scenario he attempted to avoid, he has to deal with it as it exists.)

Comments:
This pilot made all the right decisions until his foot was in the bear trap. Further, he proved all the capabilities required when tested after the fact. Which proves that nobody in the management chain KNOWS what's wrong. The answer is apparently changing the name of this phase of the industry from HEMS to HAA...

Hire, train and support good people, especially pilots. This pilot had integrity, knowledge, motivation and capability but was betrayed by those he worked with. No means no, shut up or fire somebody if you have the wrong people in the job.

The FAA, Airbus and the industry should be ashamed of the false representations made regarding cockpit videos. The camera was absolutely no help with this pilot's predicament. Airbus's talking heads postulate that management, which positively created this incident should hold more effective tools to blame pilots is wrong as this incident demonstrated multiple times. The answer isn't more outside the cockpit influence on pilot action, it's better training, support and information for the PIC to do the job. Which is expensive and inconvenient and largely a mystery to the industry.

To those discussing HAA/HEMS pilot schedules, the rule cited deals with crew scheduling and assumes rest. This rule works pretty well with daytime operations. My opinion is that the rule fails to deal with night operations generally and HAA/HEMS in particular, perhaps being a primary contributor to the fact the nights are 4 times more dangerous compared to day flights in my work. The rule spectacularly ignores proven physiological issues and presents an illusion of adequacy by doing so.

tottigol

10th Apr 2015, 17:54

Devil,
I agree 110% with you on all matters in your post, however this pilot proved he had all the training/experience/information needed and proved again that experience without external pressure leads to correct decision making.

As you say "The answer isn't more outside the cockpit influence on pilot action, it's better training, support and information for the PIC to do the job."

The answer is LESS out of the cockpit influence, by both the flying customer and remote decision making dispatch.

Revolutionary

11th Apr 2015, 00:33

chopper 2004, that's a pretty chilling video to watch. I commend the pilot for being open and upfront about the whole episode. One thing that struck me was his reference to an apparent unreliable attitude indicator and his decision to cage the instrument in flight.

It reminded me of this excellent article (http://www.verticalmag.com/features/features_article/FalseHorizon) by Elan Head in Vertical Magazine about another highly experienced pilot who, after an inadvertent entry into IMC, experiences a mismatch between his vestibular senses and his attitude indicator an proceeds to disable his one and only lifeline.

After eighteen years of flying I have several thousand hours of IFR time; several hundred hours of actual IMC time and probably at least fifty hours of hand flying in IMC. Even so I would estimate my ability to fly an AS350 in IMC conditions at a few minutes tops. Back when I actually did fly EMS in an AS350 I probably would not have lasted for more than a few seconds in IMC.

The thing is, I was instrument rated and -in theory- fully qualified to fly in IMC conditions. Why do I think I would I have only lasted for a few seconds? Because I had zero actual IMC experience and because I had no stability augmentation; no EGPWS or TAWS, no weather radar and only a tiny ADI to look at. Faced with inadvertent IMC I would have likely reached over and caged the ADI too, unable to process the overload of conflicting sights and sensations.

This is, by and large, the current state of the EMS industry: otherwise competent pilots who are not qualified to fly in IMC conditions are being sent out in aircraft that are not properly instrument equipped. It should not be a surprise that this leads to incidents and accidents.

fly911

11th Apr 2015, 14:57

Having flown EMS for seven years in an AS350, Bell 407, BO and BK, I believe that properly used, an autopilot would have saved many lives over the years. If Insurance companies were of the same mind, I believe that a discount offered for every helicopter sporting an autopilot would encourage operators to install them.

[email protected]

11th Apr 2015, 15:21

So he caged the AI in flight, stated he didn't look at it again and made a series of random control inputs to rectify his situation without actually looking at the altimeter or AI!

Yes, there were unacceptable ops pressures and the questioning of his decision not to go but he failed on every count to take appropriate IIMC actions. He and his crew were incredibly lucky not to crash.

I think Gomer Pylot's comments about total hours and continuity of flying experience are very germane to this incident.

What was he doing staring at a bright light anyway - no better way of screwing your night vision!

Was the AI problem because he had shut down and not completed the startup checks properly?

A proper set of instrument checks (especially if you think there is a real risk of IIMC) would have been the professional thing to do.

A lot of self-induced pressure here.

Jet Ranger

11th Apr 2015, 15:47

I think that small investment in second pilot for night operations (NOT in second engine, one is just enough) would significantly improve the safety record. As it is in Europe. IMHO.

JR

Gomer Pylot

12th Apr 2015, 01:12

And where would you put this second pilot? In most light helicopters used in HEMS in the US, the patient occupies the left seat. At least the patient's legs, with the rest of him/her in the back seat with the med crew. And the helicopter is departing at or near max gross weight now, and with a copilot on board the patient would have to be a child, no bigger. Replacing that many helicopters with larger models would take years, because they just don't exist now. Helicopters don't just magically appear, they have to be built on a production line, and that takes a long time.

Jet Ranger

12th Apr 2015, 06:52

Yes GM, I agree with you. Mission impossible. And again, money talks.

fly911

12th Apr 2015, 09:50

I believe that in an inadvertent IMC situation, a second pilot may only confuse the first pilot and vice versa. At best, maybe encourage the PIC to abort the mission sooner. I would rather have a non-vertigo prone autopilot. One whose default position is wings straight and level. One that is easily overridden in order to climb, communicate and confess. One that will resume straight and level if the pilot gets confused. Most pilots that lose it in IMC do fine in their bi-annual instrument check ride. It's the emotional fear element that trips up the pilot in a life-threatening unfamiliar environment. It's called sensory overload. An autopilot is like that check airman when you are under the hood. You almost never need them, but it's calming to know that they're there.

Jet Ranger

12th Apr 2015, 11:45

Yes, it's possible solution...but IIMC is not the main cause of HEMS accidents (at least not in the last two accidents).
As far as I know, in Europe, EASA 965/2012 regulative, PART-OPS, second pilot in night HEMS operations is mandatory. Does that make sense?

JR

tistisnot

12th Apr 2015, 14:06

An outsider to HEMS and cognizant of the excellent though disturbing video link, but if I were the FAA I think I would mandate within a short period of time, in line with the SMS requirements now demanded from operators, that every member of management, aircrew and operational groundstaff attend a CRM course together with customer management, medical teams discussing past major accidents and their causes with a view to an eventual overhaul of the operator's Safety Case with revision of SOP's as necessary plus encouragement of an individual mission risk assessment performed by operational staff taking into account aircraft limitations, crew training, weather and facilities. Mitigations as the risk increases including saying no should be clearly laid out. Bull**** I hear some cry ..... but nothing else seems to have had sufficient effect - this should be seen as the perfect opportunity to encourage frank discussions and understanding / acceptance, by management from both operator and customer, of the limitations of machine and human which in the end might reduce pressure to get on and complete missions regardless. Even better do this with several operators together if practical, and repeat as necessary. Surely this is a duty of care for the patient?

[email protected]

12th Apr 2015, 14:46

Fly911 - I completely agree. A decent autopilot offloads the pilot to allow him the extra capacity to make decisions.

Single pilot IFR is difficult enough when you plan it - when it is suddenly forced upon you it can be overwhelming.

A decent autopilot will have a go-around button which will put wings level and capture a sensible climbing speed. If the pilot in this incident had had such a facility (and known how to use it), we wouldn't be reading about it.

Tistisnot - the CRM is a good idea but financial/operational pressures have a way of making people ignore the sort of lessons that are learned on those courses.

Geoffersincornwall

12th Apr 2015, 15:02

A decent autopilot will have a go-around button which will put wings level and capture a sensible climbing speed. If the pilot in this incident had had such a facility (and known how to use it), we wouldn't be reading about it..

It's easy to forget that a prime cause of disorientation (from our sim training experience) is inadvertent deselection of the AP's because some wizard of a designer put two buttons on the cyclic that pilots confuse regularly, one de-couples the FD and the other (curiously labelled "SAS REL") will simultaneously remove both AP's. The subsequent melee is very exciting IMC and no amount of GA button pushing will help you. If only they had organised the 'AP Release' (my chosen new title for that button) so that one push takes out just one AP and a second push remove the other AP then guys would not get themselves into that situation.

So the message is that you should develop a good recovery strategy for unusual attitudes and practice it regularly in the sim. Forget the GA button, despite the statements in the RFM it may actually add to your problems rather than solve them.

Note - this may not apply to all types but check out your own systems before signing up to the "The GA button will save my life" club.

G.

[email protected]

12th Apr 2015, 17:48

Geoffers,

I agree that designers often don't understand much about how an aircraft is piloted and that the positioning of important buttons is often rather random.

However, If the pilot is averagely aware of his autopilot functions and uses them regularly then something like the GA button can be a lifesaver - it doesn't beat a decent instrument scan and regular IMC exposure though.

Our GA button is on the collective (even though it works through the cyclic channel) and, providing the AP hasn't been inadvertently selected off, works surprising well as a recovery from UPs.

Geoffersincornwall

12th Apr 2015, 19:08

Yes but.....

When disorientation bites you may have very little time to gather things up and restore order, ask yourself if you are going to send your thought processes around the 'what is causing this?' circle before adopting a recovery strategy. My suggestion is that you may be better off just sorting the thing out with not even a nano second of delay. I'm not sure about other types but certainly the 139 has a great deal of control power and if the AP misbehaves or drops out the response levels are so high that you can be upside down in two or three seconds. It's been done for real so no hyperbole here.

G.

[email protected]

13th Apr 2015, 06:38

Geoffersincornwall

13th Apr 2015, 13:25

Geoffers - yes, immediate UP recovery is most definitely the answer which is why it is practised AP out on every military type I have flown - is that the same for the guys that you get coming through?

We are currently facing a dilemma insofar as AP out training is not allowed in the aircraft because the certification requires one AP to be serviceable at all times. Luckily we can continue to train AP's out in the sim because we are not covered by the same certification and not exposed to any danger.

Unfortunately the 139 sim, with both AP's out, is not a good training vehicle because it's response is not as good as the real aircraft and is far to difficult for most TR students to manage. We stick with a sample of scenarios that may use SAS only or AP's 'IN' and extreme attitudes. In the training environment there is pay-back for building confidence rather than destroying it. We can save the more demanding stuff for the recurrent sessions where they are appropriate.

G.

[email protected]

13th Apr 2015, 16:11

So if they do go IIMC or inadvertantly deselect the AP out when IMC, they are probably going to scare themselves or even crash because they haven't been allowed to train for that situation - that is rather worrying.

Never Fretter

13th Apr 2015, 16:18

Geoff/Crab: While interesting, I'm not sure that is relevant to the average low spec US HEMS helicopter with minimal flight simulation available either.

[email protected]

13th Apr 2015, 18:08

No, but what is relevant is whether or not those HEMS pilots ever get to practice UP recovery on instruments, with or without the AP.

Like so many advanced flying skills, Instrument Flying is a very perishable one.

crunchingnumbers

14th Apr 2015, 12:08

Geoff/Crab: While interesting, I'm not sure that is relevant to the average low spec US HEMS helicopter with minimal flight simulation available either.

Not all helicopter operations in the US are 'low spec', at least in the case of larger operators. AMC operates 100+ 135/145's alone, in addition to other twins. That is certainly more than some countries entire EMS fleet combined. Simulator training is in place on the EC135, and recognizing the benefit of simulator training they had introduced a full motion simulator for singles (unfortunately the OEM was poor). AMC has also purchased 4 full motion Level 'D' simulators for singles and twins to be introduced shortly, with annual training in the sim for all pilots. 3 static 160º view procedural training devices have been in place for a long while further supplementing training on a biannual basis.

It's not all 'low spec' or devoid of training.

Gordy

14th Apr 2015, 13:40

https://www.faa.gov/news/press_releases/news_story.cfm?newsId=18634

Press Release – FAA Proposes $1.54 Million Civil Penalty Against Air Methods Corp.
Print
Share
For Immediate Release
April 13, 2015
Contact: Allen Kenitzer
Phone: 425-227-2015; Email: [email protected]
SEATTLE – The U.S. Department of Transportation’s Federal Aviation Administration (FAA) proposes a $1.54 million civil penalty against Air Methods Corp. of Englewood, Colo., for allegedly operating Eurocopter EC-130 helicopters on dozens of flights when they were not in compliance with Federal Aviation Regulations.
The FAA alleges Air Methods operated two helicopters on 70 passenger-carrying flights for compensation or hire, over water and beyond power-off gliding distance from shore, when they lacked required helicopter flotation devices and flotation gear for each occupant. The agency alleges the company operated another helicopter on 13 such flights when it lacked required flotation gear for each occupant. All 83 flights by the emergency medical transport company occurred around Pensacola, Fla.
“The flying public correctly expects that American operators will place safety above all else,” said U.S. Secretary of Transportation Anthony Foxx. “We will hold operators accountable when they fail to meet those expectations.”
“Operators must follow every regulation and take every precaution to ensure the safety of all those on board,” said FAA Administrator Michael Huerta. “Flying without required safety equipment is indefensible.”
Air Methods has 30 days from the receipt of the FAA’s civil penalty letter to respond to the Agency.

HeliHenri

14th Apr 2015, 17:21

Delays in Meeting Statutory Requirements and Oversight Challenges Reduce FAA’s Opportunities To Enhance HEMS Safety :

http://www.verticalmag.com/news/article/ReportonHEMSsafetycallsattentiontoFAAsmisseddeadlinesoversig

.

Never Fretter

14th Apr 2015, 17:39

crunchin

Fair point. Wonder if anyone has done the safety stats to compare the 'top end' with the 'bottom' end.

The 11 air accidents mentioned here are 90% light singles:- More US Night HEMS Accidents - Aerossurance (http://aerossurance.com/helicopters/us-night-hems-accidents/)

Geoffersincornwall

14th Apr 2015, 20:54

The way forward would be to align the sim more closely with the real thing but my guess is that if the certification process has it this way then it isn't going to change any day soon. Please address all correspondence to the competent authority.

What we can do - and i did it on Saturday night, quite successfully, - is to place the AP in SAS mode and fail the cyclic trim in the OFF position. If the situation is allowed to develop then what results is a good test of the pilots UA recovery skills and strategy.

G.

crunchingnumbers

15th Apr 2015, 11:25

The 11 air accidents mentioned here are 90% light singles:- More US Night HEMS Accidents - Aerossurance

Never Fretter - when it comes to singles the numbers will always likely reflect what we are seeing, particularly for IIMC. Regardless of the training (which is obviously still very important and deserving of sim work) it will still come down to the age old note of currency versus proficiency, Single drivers generally just don't have the experience and/or regular practice. What I note is that the most comfortable single drivers on the line, are those that are either highly experienced on instruments from a prior position, or are flying IFR regularly in some other part time role eg. reserve duty or fixed wing. In those cases some would be happy with a wet compass and an ADF :)

fly911

16th Apr 2015, 16:06

Synthetic Vision might have saved a few lives by preventing loss of situational awareness in IIMC.

http://garmin.blogs.com/.a/6a00d83451bb7069e201a3fcc13e5e970b-pi

[email protected]

16th Apr 2015, 19:23

But if you don't train people to use it or test their ability to use it you have achieved no increase over simple, steam-driven instruments. It's not lack of technology, it is lack of training and assessment.

Never Fretter

16th Apr 2015, 20:05

I'd tend to agree with cruncin and crab.

However there are views that there are too many unnecessary flights anyway.

Another good blog is here:-
Federal Investigators Find Oversight Lacking in Air Ambulances
http://www.christinenegroni.********.co.uk/2015/04/federal-investigators-find-oversight.html
i.e.
http://www.christinenegroni. BRAVO LIMA OSCAR GOLF spot.co.uk/2015/04/federal-investigators-find-oversight.html

For previous posts on selling air ambulance "memberships (http://christinenegroni.********.com/2010/10/selling-those-helicopter-ambulances-in.html)", the fiction of the Golden Hour (http://christinenegroni.********.com/2010/12/myth-and-marketing-of-golden-hour.html), why air ambulance crash victims are not heroes (http://christinenegroni.********.com/2010/07/please-dont-call-them-heroes.html), and how unnecessary air transport wound up costing unsuspecting folks a bundle (http://christinenegroni.********.com/2010/11/helicopter-ambulances-better-safe-than.html), follow these hyperlinks.

Perhaps the answer is a smaller fleet of better equipped aircraft, with better trained crew.

fly911

17th Apr 2015, 11:39

So, you don't think SynVis has anything over an artificial horizon. Hmmmm.

[email protected]

17th Apr 2015, 13:31

fly911 - that's not what I said.

Synthetic vision can be an aid - although it can encourage pilots to push further in poor weather, a bit like NVG.

But, if pilots are screwing up IIMC because their basic instrument skills are rusty or non-existent, then having synthetic vision won't improve things because you still have to believe your instrument display and do basic things like selecting and holding an attitude.

When you are fighting what your inner ear is telling you compared to what your instruments are telling you, all the SA in the world doesn't replace basic instrument scan skills.

fly911

18th Apr 2015, 18:16

All things being equal, I would rather go inadvertent with SynVis than a basic attitude indicator. I just think that it would be easier to relate to a real-life visual presentation and easier to ignore your vestibular sensations. That's just me.

[email protected]

19th Apr 2015, 10:03

I have been inadvertant and completed deliberate IMC aborts from the hover (day and night) - the initial part has to be about flying the aircraft as accurately as possible to get above safety altitude and that comes down to basic instrument skills.

Knowing where the high ground is and any obstacles (masts etc) is useful and that is what the synvis would give you but, too much information (however nicely displayed), can give sensory overload and distract you from what you really need to be concentrating on.

When the leans get you, it is not about how nice the display is, it is about how disciplined you are to believe your instruments, and that can be tricky if you don't practice regularly.

Devil 49

19th Apr 2015, 12:58

If "judgment" is a skill set that can be acquired or improved with training, as the FAA maintains, it should be the majority of the training time. If it's not a trainable subject, a fair few EMSers need to be replaced.
Judgment kills pilots, especially EMS pilots.

Training! Training! Training!
I don't need to memorize all the parameters of my aircraft. Almost all I need are marked on the gauge with green, yellow and red lines. I don't need to know runway gradient, I haven't been on a runway in years (it was a training event then) and I was last at an airport in January. These are regular training subjects for me...
We don't do "LAHSO", devoting a whole training segment is a complete waste of time. Time that the FAA says could be spent teaching "judgment".

Changing weather minimums to a million and infinity is no better than 800-2 when it doesn't change the next PICs decision to fly into darkness where he can't see lights to discover it's in a cloud. On the other hand, I've flown, VFR, hundreds of thousands of offshore miles in 300/2 with only 2 IIMC events, both of which were easily judgment preventable. (Because I always had a diversion or landing point within reach.) But, hey- increasing minimums has to increase safety, right? And add engines. And Autopilots. Twins and IFR crews exercise bad judgement at the same frequency, there's just a lot less of'em here.

I go to our training base to fly in conditions that 75% of my colleagues will never, ever operate in- the high plains. They are installing full motion sims there (which I hate but applaud as a training asset), and when I fly them I will be flying into airports I will never operate in. The approaches are in digital form, how much trouble is it to load the appropriate approach and practice that?

And there it is: generic training driven by inapplicable fixed requirements.

On the other hand, 75% of my colleagues do operate in unique environments. Maybe some of them could be consulted on training or be local trainers? (ladder safety?? Ladder safety is a training topic?) Perhaps they could teach the importance of relative humidity after midnight in the Smoky Mountains. Or they could teach that adding 5 minutes to a transit leg to make an early diversion around a potential weather system is a better plan than feeling your way through a squall line (22.6 nm diversion at the midpoint of the 100 nm leg).

Even if 'judgment' can't be trained, the factors that contribute could be trained... And perhaps numbnuts won't put the aircraft into the position of flying into darkness.