HEMS safety issues for Thesis research

[HEMS research]

Dear HEMS pilots,

I am doing a thesis research (@ Cranfield University) about the safety issues in HEMS operations. Speciffically about the on-scene landing and take-off phase of the HEMS flight.

I am trying to get pilots views and perceptions about this phase of flight.

To do this, I am arranging interviews with HEMS pilots (in the UK). If you are a HEMS pilot and would like to contribute to this research, please contact me!

(I am able to travel, but phone interviews can be done as well)

Thanks for your help guys.... Keep up the good work!!!!

[SASless]

For a bit of contrast you might contact some of the US Based EMS associations about their LZ critieria and training standards, or perhaps equivalent groups in Australia. The differences might be significant and provide a valuable tool to seek what could be an "Industry Best Practice" concept for you. Recall the USA and Oz are 24 hour services and not limited to Day only.

[Bertie Thruster]

In my experience the take off phase is more critical in regards to flight safety than the initial landing:

The aircraft is heavier plus more power needed than on landing.

The 2 extra pairs of eyes are busy with the casualty.

The low level (250ft) fast jet airspace is more difficult to check.

Lots of doors have been opened on the ground and shut by various people.

The front left seat is probably unoccupied.

The way out and up is probably not the way down and in.

Strong wires can be quite thin.

The casualty is screaming.

[SASless]

The low level (250ft) fast jet airspace is more difficult to check.


The casualty is screaming.

Done a lot of HEMES flying 'ave yer Mate?

[What Limits]

Actually mate, he has.

I can concur wiv' wot 'e said.

I would add "The casualty is screaming" and/or fighting with the paramedics.

And

A fast jet went under me before I got to TDP (No TCAS)

[misterbonkers]

Hmm. HEMS obviously isn't what it used to be!

[chopjock]

The aircraft is heavier plus more power needed than on landing.

Imagine how much lighter it would be if it wasn't carrying a spare engine all the time. :E

[jayteeto]

K##b! I suppose it might not even be there if it had one engine. :rolleyes:By the way, that was not a bite to allow you to hijack another thread, it was sarcasm.
Low flying Mil aircraft are part of your thought process, we fly in the lakes most days and seeing jets go underneath you as you transition away from Hems sites certainly concentrates the mind. As a 6 month experience 'newboy' to Hems, I was surprised how distracting a screaming patient can be, ATC could hear one recently through MY microphone when I transmitted!!

[SASless]

I never heard a patient screaming in all the time I flew EMS....but then perhaps our Med types are equipped to administer pain killers and protocols are in place to provide the patient with such meds when permissible for the kinds of injuries they have received.

Combative patients can happen....particularly with head trauma....but if they are secured properly....they can be handled.

When hauling Prisoners....we kept Guppy Making meds drawn up and ready for jabbing.....and briefed the prisoner exactly what his situation would be if he caused one bit of a problem. The antidote was also ready....but we did not tell them that.

As to low flying Jets....if you operate in a known low flying route then there is a risk of encountering the jets. I know first hand how big a problem they can be....but it would seem there is bigger problem if there can be no coordination between the Jets and HEMES. As the UK loves rules, laws, regulations, policies, and the like....it would seem the CAA and MOD could work something out for you.

[Non-PC Plod]

Jayteeto,

Try taking off the "Grim Reaper" mask as you fly them to hospital - I find they scream less!:E

SASless, unless the patient is well drugged up, I can vouch that a complex leg fracture in turbulence on a windy day makes for some whining just below the gearbox!

[HEMS research]

Thanks for all your replies.... some of it is rather usefull for me.... (and I can look into it further)

I was also wondering if there are any particular difficulties you encounter during the landing / TO from the site.
(I read something about wires being hard to spot.....but why or what makes it difficult to spot them???)
These things would really help me.
Thanks again!:D

[griffothefog]

Once landed at a fatal RTA on a small typical Cornish lane, I knew it was bloody tight, but what I naively forgot was what would happen to the blades when I shut down! They buried themselves into said hedgerow and disappeared under a shroud of exploding wood :eek:

Fire crew cut back remaining twigs to allow for a blade check and final departure after everything was judged safe.....

It was the 80's :{

[Non-PC Plod]

Wires come in all shapes and sizes. If they are attached to a 200 ft pylon, they are not normaly a problem to see, but for example a single strand telephone wire from a telegraph pole which blends in with a hedgerow may be very difficult indeed to spot, especially in low light levels against a poorly-contrasting background.
Also, you may get two lines of wires close together, a big one and a small one. The big one naturally draws the eye, and you think you have clocked the hazard, but you miss the small 20 ft poles adjacent to it.
Any wire is going to spoil your day if you havent seen it.

[QTG]

Colouring wires green to appease the tree huggers doesn't help either.

[Jack Carson]

Landing zone security should also be on the list. While arriving, departing or just sitting in an LZ, security should be a concern. In my few years flying EMS on west side of the ocean we have seen multiple cases where the on scene, 1st responders, did not adequately secure the LZ. Ambulances have driven into the helicopter’s turning and static rotors. Unattended, unauthorized personnel were allowed to approach the aircraft. Most are not aware of the dangers associated with helicopter operations. I also know of one instance where mod control became an issue while picking up a patient at a crime scene.

[Non-PC Plod]

Other stuff on an LS which can cause problems is any loose objects. This can be stuff as small as sand/dust/snow which recirculate in the downwash and impede visibility - "brownout/whiteout". Or it can be rubbish - plastic bags, corrugated iron, cardboard. Anything lying around that catches enough downwash can suddenly fly up out of nowhere and go through the main or tail rotor disc. Even a plastic carrier bag going through the tail rotor can cause serious damage, because of the speed it s turning at.
As Jack says, you then have the human element of the problem. You never know when our wonderful public might throw a brick or a bottle into the rotors to see what will happen, or they will push a stick through the fenestron/air intakes if you are not watching whilst the aircraft is shut down. At night time, they will shine laser pointers or powerful torches at you to see what will happen, or they will take a flash photo, and blind your night vision as you land/take off.
Animals can be a problem - you dont want a spooked horse or herd of cows stampeding towards your (very thin) aluminium and plastic pilots door!
Its on the ground or close to it that all this unexpected stuff can happen, so you have to be ready for anything!

[Bertie Thruster]

http://i70.photobucket.com/albums/i97/nmhsu/may-jun2010001.jpg



.....and just cracked 2000hr "HEMES" in the 902!

[HEMS research]

Thanks Bertie Thruster,

This certainly is a good picture...... explaining "un-expected" factors......:cool:

[Floppy Link]

Lots of scope for getting in the poo....

http://i216.photobucket.com/albums/cc264/Boecopter/Ss855361.jpg

Potential to gravel blast other people's property...

http://i216.photobucket.com/albums/cc264/Boecopter/P1000494.jpg

Obstacles...

http://i216.photobucket.com/albums/cc264/Boecopter/Ss855523.jpg

[What Limits]

Congratulations Bertie

2000 hrs HEMES !

About 5000 missions?

What a man!

[TeeS]

Hi HEMS
No scientific evidence for this, however I would suggest that 90% of near misses in HEMS operations (excluding damage to 3rd party property from blown debris) happen during approaches to wide open sites. It is my belief that when making approaches to genuinely confined HEMS site everybody’s attention is concentrated on the dangers! Approach to a wide-open site and everybody’s concentration drifts to less important items.

Cheers

TeeS

[Bertie Thruster]

Hi What Limits, Long time no see! How's Canada?

I haven't added up all my HEMS missions at LNAA over the last 10 years but my average is about 400 a year.

.. However, the best one for me has been my own "rescue mission"........



2008http://i70.photobucket.com/albums/i97/nmhsu/DSC00051-1-1.jpg 2010http://i70.photobucket.com/albums/i97/nmhsu/DSCF1010-2.jpg

[tbc]

Photoshop!!

[jolly girl]

Hi HEMS,
Do you have a hypothesis for your thesis yet, or are you still in 'fishing expedition' mode?
Jolly

[HueyLoach]

For a bit of contrast you might contact some of the US Based EMS associations about their LZ critieria and training standards, or perhaps equivalent groups in Australia. The differences might be significant and provide a valuable tool to seek what could be an "Industry Best Practice" concept for you. Recall the USA and Oz are 24 hour services and not limited to Day only.
I agree with SASless suggestion and I may add; the effect of wearing NVGs especially in the takeoff and landing phases and their impact in safety.

[SASless]

Having used NVG's for all phases of flight....I strongly endorse making them a requirement for all EMS night flights....hands down they are the best safety feature going. Add in a three axis autopilot system (if not a four axis) and safety rates are bound to improve greatly.

[What Limits]

Bertie, thats just plain nasty - you sure you got them the right way round?

Anyone who has not seen the NTSB report into HEMS accidents (http://www.ntsb.gov/Recs/letters/2009/A09_87_96.pdf) should read it soon.


This is some of what the FAA (http://www.faa.gov/other_visit/aviation_industry/airline_operators/airline_safety/safo/all_safos/media/2006/safo06001.pdf) has to say

[vaibronco]

HEMS Research
I would like to read the result of your work once you finish it.
It would be absolutely interesting.

SASLess
I'm new in this job, I'm curious about HEMS night flight in other countries.
In Italy at night we can only fly from/to night certified helipads and airports, for what we call "secondary" services.
Therefore at night we can't be called for "primary" (wonder if you use the same words to call the transfers and the missions on the scene).
We are far from introducing NVG. I'm not sure but I would bet that at the moment only the military are equipped with.
How about your country? What missions are carried out with NVGs?
I was also surprised when at our CRM course they told us about the statistics of HEMS accidents in USA.
Many CFIT during "transfers", comparing to Europe.
Thanks

What Limits, thanks for the links


Vaibronco

[Bertie Thruster]

What Limits, definitely right way round! I've bought a picture off a bloke called Dorian Gray..............

(actually the doc found I was allergic to grains and nightshade plants)

[HEMS research]

My research is more exploratory based, so i am trying to get the pilots perceptions on "challenging" aspects of the landing and TO segment.

So i don't have a group experiment and no hypothesis.

I would be gratefull, if you could maybe post some issues.....

[jolly girl]

Hi HEMS,

The original study the NTSB published on HEMS is NTSB/SS-88-01: Safety Study, Commercial Emergency Medical Service Helicopter Operations, and the FAA's was DOT/FAA/DS-88/7: Risk Management for Air Ambulance Helicopter Operators. The NTSB report is quite a thorough undertaking and I was surprised with how many frank conversations with crews they included as examples. When you compare these with the more recent documents (linked above), you can get a clear picture of the ongoing issues in the industry.

Another good resource is the Air Medical Physicians Association's "A Safety Review and Risk Assessment in Air Medical Transport." They (AMPA) also publish a journal that could provide some insights, and there is a pilot (aircrew) equivalent in the States as well.

Also, if you can get a copy, the (US) Congressional Research Service published a report titled 'The Safety of Air Ambulances' (2006).

And (excuse me gents as I cite it again) a few years ago Bert Boquet at Embry-Riddle did an HFACS analysis of HEMS accidents. This has interested him for a while (he was the helo guy when he was at CAMI) and he'd probably enjoy the call. (Don't let his title intimidate you, he's from the bayou and has a low power distance.)

More recently, last year the FAA published a study in the HFES journal reviewing their work with HUDS and different display features in the sim. The results were quite surprising, and should be a 'must read' for anyone advocating the use of synthetic vision in EMS ops.

So anyway... hope that gets you started. I'd love to hear more once you firm up a topic.
:-)
Jolly

[HEMS research]

Thanks for all the interesting pieces of information!!! They certainly help to build an overall picture what is going on....

However, with for example the HFACS analysis, these are done after the accident has happened. Things which come out of this are... pilot decision making... or pilot judgement..... however I dont think this is really helpfull towards HEMS pilots. (i might be wrong, but I dont really know what they mean with decision error... if it isnt put into a clear context).

That is why I am trying get "your" views of what risky situations are..... while for example assessing the landing site. Why is it difficult to see or do something, what makes it difficult?

Thanks again for your help guys, and especially to those who PM me!!!:ok: