UK Air Ambulance night flights

[Pittsextra]

BBC News - Air ambulance night flights are set to begin (http://www.bbc.co.uk/news/uk-england-22652365)

Edited to add :- is this new or just a rehash of old news?

[Rigga]

New for civil aircraft use I believe, i.e. not Mil or State aircraft use.

[Pittsextra]

Just that the first story link under the story posted has the same title, but from 2012 and a suggestion it was to all kick off later in 2012...

[jayteeto]

I imagine that was the plan and the delay in starting may have been regulatory red tape. Better late than never when introducing a significant advance for UK operations. Good luck!

[homonculus]

Last Thursday I attended an excellent lecture at the Royal Aeronautical Society on day and night all environment flying including NVGs, LLTV, FLIR and synthetic vision. Both the presentation and the subsequent discussion emphasised the limitations of NVGs, the failures of equipment, and in particular that landing helis away from pre planned LZs and airports was far far more difficult than low flying GR2s in zero vis

Against this we have to ask why? Most rural trauma such as horse riding accidents, mountaineering and farming simply don't occur at night. Vehicle accidents are often covered by prehospital doctors and road congestion is less of a problem.

I am sure senior ambulance officers who have seen with relief how helicopters can help them meet government targets without any detriment to their budgets are keen to roll them out to 24 hour operations, but the question has to be asked as to whether the risk benefit ratio has been properly assessed. A parallel thread on this site is discussing how UK HEMS has far lower accident rates than the US. Many US accidents have been related to night and poor vis flights.

[[email protected]]

In 20 years of using NVG, I have never had either a tube or battery failure - the technology is mature and robust and, as long as you maintain them properly, NVG are extremely reliable.

NVG ops to unrecced sites is not rocket science but it does need training and practice - I am sure that the AOCs will have set out quite clear minimum weather and light levels for AA ops.

[jayteeto]

Crab, it looks like AA will not be allowed down to military limits. Talking to the crews and seeing/flying the aircraft, the risk will be reduced somewhat. The poster above who mentions poor vis/night accident rates is correct. I would guess that the mature experienced crews trialling this capability will take things carefully and step by step. They know an accident could pull the plug and they will fly accordingly.
When we started doing night fields in N Ireland in the early 90s, I was a doom merchant, saying we would have an accident straight away. I am happy to admit that I was totally wrong and the incident rate has been incredibly low ever since.
Lets give this a chance and judge it on actions, not predictions. If it is unsafe, the company will not be scared to pull the plug. management is robust and, in my view, totally supportive of crews. :ok:

[TeeS]

Hi Wannabe

Of the accidents over the past 20 years, one in three - involved the aircraft hitting something. With the exception of a pilot-check ride in Michigan in May 2007, all the others were operated by a single pilot.

That is a pretty meaningless statement unless there is a bit more information - what percentage of the total flights were carried out single pilot?

Using your argument, I can prove that single-pilot operations are far safer than multi-pilot - From memory, the following multi-pilot aircraft experienced unintended controlled flight into (or onto) the sea around the UK, BIH S76, Penzance S61, Coastguard S61, Cormorant 'A' Puma, Bond Puma. How many single-pilot helicopters did the same? I've got a feeling the answer is zero. Ergo, single-pilot operations are far safer than multi-pilot!

...and while I think of it, what did the 66% of accidents over the past twenty years involve, if they didn't hit anything?

Cheers

TeeS

[homonculus]

Thank you to all who posted in reply to my last post. I am certainly not an expert in NVGs but my understanding is that firstly not all objects are visible and secondly that crew need significant and ongoing training. Their use relies on a degree of background illumination

This increase in cost and possible reduction in safety has to be offset against need. Despite the previous posting, at night most areas have good cover from pre hospital care practitioners - doctors with advanced skills beyond those of paramedics - and their response times at night for road accidents and the odd stabbing (one in twenty years on my patch) is as good as HEMS

I am keen to achieve a coordinated HEMS system funded by the NHS as opposed to the current vagaries. This will not be helped by increasing costs especially if no benefits can be proved.

[[email protected]]

Jayteeto - I presume by military limits you are referring to the heights at which we fly low level on NVG - if so I would definitely hope that is not what night HEMS is planning!

Presumably the intention is to use NVG at normal (reversionary) night flying heights to improve lookout and weather awareness and the only new bit will be the letdown, recce and approach into the LS.

Tees - some of those crashes weren't at night and most involved procedural failures The number of pilots on board is irrelevant - night HEMS overland is a very different kettle of fish.

There will always be those who think they are better than the rest and can do single pilot NVG (mosty ex-military sadly) - goody for them but I would much prefer a second pilot.

[Bertie Thruster]

Everyone forgets that the charity UK HEMS world used to do night HEMS, quite a few years ago!

....and in unstabilised cabs with just a nitesun, single pilot and non rated!

...until a certain police cab with autopilot and a rated pilot got 'disorientated' engaging the autopilot one night and hit the deck!

[[email protected]]

Absolutely - keep the money away from central government (or NHS) control and you will retain the ability to tailor the AA capability and response to the local needs rather than a 'one size fits all but benefits no-one' NPAS solution.

[MightyGem]

There will always be those who think they are better than the rest and can do single pilot NVG (mosty ex-military sadly) - goody for them but I would much prefer a second pilot.
Depends whether you mean single "pilot", or single "crew". We are flying NVG Stage 1(Mil Cat 1), and are currently training for Stage 2(Cat 2), for the unlikely event that we have to land out at night(about 3 times in the last 2 years I think). Our minimum crew is one pilot(naturally) and one Observer, suitably trained and equipped.

I am sure that the AOCs will have set out quite clear minimum weather and light levels for AA ops.
Our weather limits are exactly the same as non NVG flying. With regard to minimum light levels, non are stated. Having flown in 0.2mlux, and having had to stay below 100' in order to see the ground :\, I know what it's like. However, with all the domestic and cultural lighting reflecting from the cloud, it's going to be the weather limits that stop us from flying rather than the light levels. Unless it's a deep, dark valley in North Wales...:eek:

Are the AAs planning on two pilots or a pilot and trained Paramedic?

[homonculus]

The NHS has indeed many problems, mostly relating to political meddling. Successive reorganisations and foolish moves such as PFI have wasted billions, demoralised staff and resulted in a health service far worse than many others in the western world. However, it remains a service to be envied because it provides universal access, free at point of use, and subject to objective assessment as well as political lobbying.

The public's generosity to HEMS is outstanding but we have systems of varying medical quality. Some have doctors on board which the Sheffield study demonstrated was the only way to prove lives saved. Others do not. There are also many operational issues. On more than one occasion I have been on the front line requesting air support only to find that system was down or unavailable.

I do not see why the ambulances and police are nationally funded, why the anaesthetist and surgeon are part of a national health system working to national standards and so on, but one link in the chain is not. A national system would provide uniform medical staffing, more uniform coverage and most importantly the possibility of proper audit. It is medically extraordinary that after 27 years and hundreds of millions of pounds we have no peer reviewed prospective study on medical outcome.

The other advantages would be a dedicated interhospital ITU transfer system for both adults and children which have been shown by such studies to save lives. HEMS aircraft are neither staffed nor equipped for this work.

Finally it would remove the risk, albeit small I accept, that funding might dry up. Perhaps more relevant is the ongoing evidence that the public has a finite pot for charitable giving. The UK's medical research has been decimated over the past 30 years and many lives have been truncated and lost as a result. Whether HEMS is more or less important than say high density lipid reuptake control research is irrelevant, but the latter may well have been cracked if funding had been more available. The public SARWannabe may indeed be happy to donate to HEMS, but if told that the money spent to save one life by HEMS could potentially prevent muturity onset diabetes which will affect 5 million in the UK in a few years and causes 4.6 million deaths a year worldwide.......

I dont believe we should have charities going head to head with each other - that would be self defeating and destructive. I do believe that an essential part of trauma care should be available to all, free at point of use and funded by government. Charities are better deployed to medical research

I recognise this thread is mostly used by pilots and in many ways you have good reason to question my stance because many of the aviation aspects, governed by ANO etc, are indeed standardised. It is when we consider the medical interface that we find the pitfalls and potential improvements.

[Thomas coupling]

Homonculus: Welcome. It is as ever, a pleasure reading your contributions to this forum, as a "non pilot" you have significant insight into the trade, nonetheless.
If I may comment on your last post?

NVG - One day (not far away) ALL (civvy) night flying will mandate NVD's. First public services will go that way, then corporate/charter and finally GA.
It is inevitable. It is to helicopters what halide lights are to cars. There is no mystery to them anymore as Crab says. They have been around and proven time and time again. The CAA, as ever, are (a) being extra cautious and (b) under staffed in this department.

Night HEMS / /Air Ambulances:
I concur with your observation, too. The demand is perceived not prevailing.
This is where it gets 'interesting'. In the UK, HEMS and Air Ambulance, are seen by the public to be charity driven. By that I mean on face value the engine or driving force is: altruism. However, over the years it has become a front cover for small businesses generating millions of pounds, expensive machines, numerous staff and big salaries. Don't get me wrong - to date it still retains its virtues but the purpose for its existence might (by some) appear 'blurred'. Do you see what I am saying (without saying it!).
The public seem happy for it continue as is - so it does. The country is covered in them, we all benefit and that's great. But make no mistake, night flying in this industry will fuel the engine for a greater number and more expensive operations with more equipment and more staff - but will the benefits increase pro rata? I think not. The public will dig deeper into their pockets....until.

This is why the government want nothing to do with AA or HEMS because it costs too much. If the NHS took control it would go the same way as the police units (NPAS) and the industry would rapidly decline from its current status due to financial starvation.

Finally, the USA:

A lot has been said about the safety record in the US with regard to EMS.
An enormous amount of froth and not much substance, to be honest.
The bottom line for their abysmal record is quite simply this:
Press - on - itis. Their industry is corporate/profit driven. Money is king and profits make or break each and every EMS outfit.
Pilots crash because they are under enormous pressure to meet operational/business demands. They get airborne in less than satisfactory weather conditions and occasionally in a/c that are not adequately equipped. Don't let anyone tell you otherwise. It is a hard pill to swallow for a lot of "professionals" out there, but it is the truth. Single Vs dual pilot is a red herring.

Stay tuned..................

[SilsoeSid]

...and relax!

On a lighter note;

School children are being asked to do some blue sky thinking to find a name for Yorkshire Air Ambulance’s new mascot. (http://www.harrogate-news.co.uk/2013/05/24/yorkshire-schoolchildren-asked-to-name-new-air-ambulance-mascot/)

We love our new mascot but it doesn’t have a name. So, we’re asking all our young supporters to come up with some suggestions.
It can be a boy or girl’s name, but needs to be something original and memorable. And, whatever name is chosen, our mascot will be kept very busy over the coming months at shows, fetes and events throughout the region.

http://www.harrogate-news.co.uk/wp-content/uploads/2013/05/Ambulance-mascot2-228x240.jpg

I'm plugging for YAA

YAA
GENDER: Feminine
USAGE: Western African, Akan
Means "born on Thursday" in Akan.
Behind the Name: Meaning, Origin and History of the Name Yaa (http://www.behindthename.com/name/yaa)

[Thomas coupling]

YAA who.....

[jayteeto]

Crab i think your statement is not correct, wait and see what the different limits are. We cannot low fly at any time so that is not on the table. Dont assume anything!
The approaches might not be flown like the military. I dont know the exact details so i will not assume facts, however the ac does have a large number of floodlights on the belly, lets wait and see eh?

[ShyTorque]

First public services will go that way, then corporate/charter and finally GA.

The first I would agree with. As for the other categories - I doubt that.

[Rigga]

No NVIS landings - all landings to be done with Floodlights from approx. 500ft AGL - or so I understand.

[TeeS]

Crab, for once I agree with you -

The number of pilots on board is irrelevant

:)

Actually, that wasn't the point I was trying to make - Given the choice, I would fly with two pilots and a 4 axis autopilot; however, it is too easy to say 'two pilots safer than one' and leave it there. Why don't we ever ask 'why do two pilots working together keep managing to fly serviceable aircraft into the sea?'

My personal view is that the level of stress/arousal, whatever CRM term you want to use, was higher back in the days when we were shuttling around offshore at 300' in the dark on our own, because we were bloody scared! That and the rules and procedures of the time seemed to keep us out of the water.

Move across to the HEMS world and ask why so many of the, generally rare, wire/tree strikes seem to happen in large open spaces rather than landing in confined spaces - is it because the stress/arousal level is much lower when going into what appears to be a 'nice safe site'?

It is easy to say It's pretty logical that by having a second set of trained eyes, second set..... etc. It may be logical but that doesn't necessarily mean it is correct.

Cheers

TeeS

[jayteeto]

Thanks Rigga!

[MightyGem]

No NVIS landings - all landings to be done with Floodlights from approx. 500ft AGL - or so I understand.
Hmmm...don't think so. Not much point in flying around on goggles if you can't use them to land.

[[email protected]]

Yes, that does rather defeat the object of NVG flight - unless all you want to use them for is enhanced lookout in the cruise.

White light and NVD can work well together but only when the white light is used to enhance the goggle picture. Swapping from NVD to white light can also be disorientating and a white light only approach (whether using nitesun or floodlights) is not as easy to fly as an NVD approach with white light assistance.

Have any of the AA units considered talking to the SAR Force about their planned procedures? We have probably the most experience in mixed NVD/white light ops (extensive use of NVD but no tactical considerations) and going into unrecced sites using a mixture of the two is bread and butter stuff.

MG - I know what you are talking about with Cat 1 and 2 but JHC is all Cat A, B and C nowadays - anyway Cat 2 was to GL for manoeuvering into anti-tank firing positions - that might be a step too far for AA (unless the AA stands for anti-armour);)

Tees - you are right - procedures keep you safe but only when you follow them:ok:

[Aucky]

Why don't we ever ask 'why do two pilots working together keep managing to fly serviceable aircraft into the sea?'

Which flights are you talking about? Recent flights?

[jayteeto]

Crab, thanks for telling us how badly we are doing things, of course the company has no NVG experienced pilots amongst their ex army, navy and air force personnel. We didnt talk to the military of course :rolleyes: and we are introducing this blind.
Those of you who are going to ground level on gogs, great, well done, crack on. The CAA seem to like our system, thats why they are allowing it. Note that one, THEY are allowing it.

[jayteeto]

PS. I would qualify to be Prime Minister if i genuinely thought nothing could go wrong using this system. The question- 'IF pilots follow procedures' counts for any job in life, personalities always fight the system in any aviation field. So lets forget that one.
Any system can be changed if it doesnt work, trial it, assess and debrief. This will not be set in stone, so lets see how it works. Give opinions by all means, but just because it isnt done your way, doesnt mean it is wrong.

[Adroight]

Crab, thanks for telling us how badly we are doing things, of course the company has no NVG experienced pilots amongst their ex army, navy and air force personnel. We didnt talk to the military of course and we are introducing this blind.

Jayteeto. Please don't get him started. It was bad enough on the SAR thread.

[homonculus]

TC

Thank you for your comments. The consensus from organisations such as Quinetiq seems to be that the civilian industry may well lead the military in DNAE technology. Certainly it seems the computing capability that allows for synthetic vision is being harnessed by civilian applications before the military in some respects.

I agree that one day we may all be using these technologies for safe all weather flying, but don't get me on my hobby horse as I have questioned for years why the regulators have been such Luddites

However I worry that point to point flying using such technology and ending up at a predetermined landing site with known terrain clearance and possible DGPS (which would facilitate for example police operations) is quite different from HEMS with the need to seek out an LZ at the time together with the cockpit work
OAS of what is an unplanned flight. We have all seen how London HEMS had had multiple collisions on the ground operating in the day despite 27 years of experience. Night vehicle accidents are often on minor rural roads with overhanging trees, surrounded by fields with livestock, cables and crops.

The use of Nightsun is also interesting. We were flying night inter hospital flights in 1987 when Uncle Ian suggested the use of a police helicopter with offset Nightsun to illuminate a medical helicopter landing. He might like to tell you the response!!

[TeeS]

Hi Aucky

I was talking about the various two-pilot incidents of controlled flight into water that have happened in UK waters over the past 25 years, in comparison to the lack of similar, single-pilot, events in the early offshore years. The two pilot ops were supposed to reduce human error, I'm not convinced that they have done!

I don't want to invoke thread drift here, my initial comment was intended to counter SARWannabe's suggestion that two NVG pilots up front were automatically, and substantially, safer than one pilot and a training HEMS crewmember.

Cheers

TeeS

[MOSTAFA]

Perhaps just perhaps, Crab you could have a slightly more balanced view on single pilot NVG by explaining what single pilot operational NVG flying you have done and based your opinion on.

Sadly, I feel a slight barb in your issue about "military pilots" that have in the past. I'm not in this for an argument or even discussion but I do have over 300 hours of single pilot operational NVG flying in twin engined helicopters and a total of over a thousand with 2 pilots I personally never found it particularly so difficult that I needed another pilot onboard. Just occasionally working offshore (military) onto the 'stranger' platforms we had to land on, took extreme care but with a good system of steerable black light it was fine as was going into un- recce'd site on land. I could not agree more at sea it was more difficult and you really did need to take extreme care in respect of becoming disorientated.

All I ask you to consider is there are two sides to every argument albeit whatever system, crew, aircraft operation the CAA eventually allow HEMS to operate under, it will be done in accordance with that instruction which in turn will be reflected by the operations manual.

[[email protected]]

Blimey - there are some sensitive souls around today!

Jayteeto - I am well aware that you have mil experience and that there are many out there in AA land with the same - my point was that most will have been SH where the mix of white light and NVG was not used for tactical reasons. Unless you have some people of very recent SAR background, they probably won't be that used to mixing white light and NVG either because the teaching up to a few years ago was that it was one or the other. I was, in fact, trying to help so there is no need to throw your teddy out of the pram and assume I am telling you that you are doing it wrong.

MOSTAFA - ex 8 flt then, or more likely ex-junglie - and your 'never found it a problem' attitude is exactly what isn't needed in AA ops.

I am well aware that the CAA will ensure AA night flight on NVD is carried out safely - that is what I alluded to near the beginning of this thread.

[MOSTAFA]

Ah well, I tried, sanctimony rules eh. Have a nice argument with someone else because quite frankly I don't have to care anymore in my dare I say it S92! Bye.

[ShyTorque]

Unless you have some people of very recent SAR background, they probably won't be that used to mixing white light and NVG either because the teaching up to a few years ago was that it was one or the other.

No, not so! Things have gone round in a circle due to the introduction of better lighting.

SH Puma were flying with night vision devices and white light (internal and external!) in 1979. Training and trials I personally took part in (UK and Germany) originally used PNG prior to the issue of NVG. We used white light because there was no such thing as an NVG / Black light searchlight or floodlight, or even NVG compatible cockpit lighting.

We were still teaching NVG on 240 OCU with white lights in the mid to late 80s. The "black light" external lights only came in to use on the Puma fleet in the early 1990s.

[TeeS]

I believe Devon and Cornwall ASU were using white light with NVG at least 15 years ago. Admittedly, they were not landing on NVG at that time.

Tees

[[email protected]]

Shy - point taken but goggle technology has come on a long way since then so using white light with them is far more manageable now the goggles don't close down.

Tees - it is the approach and landing phase I am talking about.

[jayteeto]

Its not teddies out the cot. You know, it is frustrating sometimes when people are constantly undermining your company. Let me tell you, Bond are a professionally run company who i am very proud to work for. I am easily as impressed with them as i ever was with CFS/RAF or any other unit. They do not blindly push on if something doesnt work, unlike some military units i was on.
Please just cut us some slack and comment once we have a few months under the belt. I promise to admit we were wrong if we actually are!

[ShyTorque]

Shy - point taken but goggle technology has come on a long way since then so using white light with them is far more manageable now the goggles don't close down.

Yes, exactly, that means it's no longer the "black art" it once was.

Having been an NVG instructor for about half my military career and then later as a civvy, I'd be very happy to don a pair of modern goggles. But in my role we don't even get to wear helmets (hence my earlier response to TC's comment that corporate pilots would soon be forced to use them).

[homonculus]

Jayteeto

I would be interested to know what training you are giving the medical crew to be able to work in a darkened cab. A ground ambulance is not only fully lit in the back at night but indeed has examination lights. I presume this would not be the case in a hello.

How do you do medical procedures in the dark? And how do you manage with relatively large monitors and pumps which are normally lit if the cockpit is NVGS enabled?

[Thomas coupling]

Homonculus, if they don't already have a natural cabin structure separating the front from the back, they use black out curtains.
[Plus with keyhole surgery, not much light escapes thru the keyhole ;)]

[ShyTorque]

Surely, in most cases, once the patient is picked up, the need for NVGs has gone?

[Pittsextra]

Given the commercial aspect of UK air ambulance operations - i.e. charity status what is the economic rational behind night flights?

[Thomas coupling]

Pitts: This is what I was hinting at earlier. Each "Air Ambulance" set up is a self perpetuating business empire where, under the auspices of "Charity" you set up a small business and appeal to the public to pay for it! Meanwhile you cream off a decent salary, perhaps even find a place for family associates (nearly said members then) and or 'friends'.
There is very little demand for night AA's but watch what happens...........

[jayteeto]

Amazingly enough, with all modern technology available, you use a thick curtain.

[Pittsextra]

TC - yes I hear you, but what I don't get is no doubt a bunch of people are ripping it out of these charities already? So with if there is little demand for night operations (and they already gettig paid for the operations they do provide) is the push from Bond merely a way to be the leader in this type of operation and win other regions? Otherwise they just set up a faster cash burn don't they, and I always thought these operations were cash constrained?

[air pig]

Night HEMS in the UK, a very good concept, but if they are operating to civil constraints not military, will that limit landing options, in relation to ground level obstructions, will training be provided to ground crews in that, the area they have to land on will be safe after a site appreciation and who makes it, also in the event of an incident, I can see the NHS backing away at the speed of light.

As has been stated by a previous poster is this a worthwhile operation? At night there is less of an obstruction by traffic, but the level of injury is frequently in relations RTA's is higher and the ability to transfer to a Trauma centre does increase the incidence of survival of the victim.

Inter hospital transfer is another situation in particular to intensive care patients, the vast majority take place by road due to the size of the UK under the terms of the UK Intensive Care Society (ICS) guidelines but air transfers are very rare and usually undertaken due to distance involved when it really should be by fixed wing transfer as rotary transfers may require numerous fuel stops, may not be able to carry a full transfer team and their equipment. For Hospitals in the UK air transfers also have a problem in the terms of transfer team training as this is not specified in the ICS document, which states only 'those undertaking these transfers should have specific specialist training' not how it should be accessed or who provides it. Air Ambulance training is different to primary AA HEMS operations in the terms of patient care.

Back to the main subject, will this be an increase in patient survival against cost effectiveness ??

Finally, please excuse a non pilot stepping into this debate as I am fixed wing flight and ICU nurse.

[[email protected]]

Air Pig, quite a lot of inter-hospital transfers, both day and night, are conducted by SAR helicopters and these are paid for by the NHS.

Something the size of a Sea King or S92 can carry transfer teams and equipment over surprisingly long distances and has the added advantage of landing at or very near to the hospital rather than an airport.

I think one advantage of AA night operations will be not turning into a pumpkin at nightfall which limits their availability, especially in the winter months.

Jayteeto Bond are a professionally run company who i am very proud to work for I don't think anyone has suggested anything to the contrary:ok:

[F4TCT]

To my absolute amazement the north east air ambulance based at Durham tees landed at an rtc outside a pub over the weekend. The pub was literally a minutes drive from an accident and emergency equipped hospital (north tees) and elected to fly to the already overcrowded James cook. Absolute waste of time, fuel and aircraft flying hours.

Should they fly at night - don't see why not. The police helicopter has on numerous occasions took critical patients to hospital during night hours and there's never been an issue. The pilots are more than capable to perform this.

Dan

[Pittsextra]

So how do air ambulances work in terms of call out, being paid, etc?

[F4TCT]

Don't the charity itself run the machine, but the nhs supply the medics?

[Pittsextra]

I don't really know. I know if you have a car crash and need hospital treatment their is a reclaim against the insurance of the parties involved usually; I wondered if that was a similar case if AA were involved?

Then wondered the mechanics of how who is responsible for calling them out in the first place.

Edited to add:- from Kent's website:- "The air ambulance is deployed by a specialist paramedic working on the HEMS desk at the control centre of SECAmb, who screens all 999 emergency calls coming into the ambulance service to establish if the air ambulance would be of benefit to the patient."

So does that mean if called to a motor accident there is a reclaim and a revenue stream?

[crabbbo]

The funding is through the charity donations of the public. There is no claim back or insurance claim made by the charity. If the job is an inter-hospital transfer (ie an Air ambulance rather than a HEMS job) then the charity may bill the hospital from their patient transfer budget as is also the case with most transfers flown by SAR (military or CG) aircraft.

[Thomas coupling]

Pitts,
All English and Welsh HEMS are local/regional charities (fund raisers, tins round pubs). Some AA's are local charities but often additionally sponsored by hospital trusts/companies (guys hospital / virgin (not any more)).
Scottish HEMS are Scottish government run.
N Ireland is AAC, I believe.
When some units have 2 brand new helos parked outside - you realise something else is going on inside the charity other than simply providing the community with HEMS etc. And of course the shining light of unusual practices is the Childrens Air Ambulance....:rolleyes:
HEMS units running a turnkey operations with 1 x EC135P2++ hangarage, rent, salaries, fuel, insurance, back up, spares etc come in at around £1.2 million/annum. 2 choopers about 1.8mil. That is a lot of tin shaking going on :eek:
I wish there was a nationwide charitable audit office scrutinising their books/operations because as sure as eggs is eggs, all these choppers/units cannot be the most effective way to provide national HEMS/AA cover, can it???

[jayteeto]

Fair dos, but most charities could look like that, not just AAs.

[Pittsextra]

Interesting there was some work done here:-

The Association of Air Ambulances in the UK (http://www.associationofairambulances.co.uk/audit.php?PHPSESSID=c387e14092c5fac0c9597acc3235b8ba)

But it only dates to 2007 so is out of date..

What happens at Childrens AA that is so different from the others?

It kind of seems if this is anything to go by:-

BBC News - Air Ambulance Service: Unease over new charity service (http://www.bbc.co.uk/news/uk-england-21262616)

As if commercial protectionism is the primary motive to object to this?

After all my idea of a charity is bang for buck, so if you have £4m in the pot then I guess the idea is to provide the service where you have most use? So therefore daytime operation - costing I'd say less than night time? - would be better to have 2 x a 12hr daytime service than 1 x 24hr service? or am i missing something?

[homonculus]

Whilst trying to avoid repetition yes £5 million a year is far far too much for a couple of counties. To put it into perspective it would pay for major surgery for 1000 cases of bowel cancer or 3000 heart attacks or 5000 hernias. A year. In just a couple of counties. To save possibly a couple of lives. The economics let alone the reduction in mortality and morbidity just don't stack up. Sorry. This is crazy.

What is also worrying me is that the cost of operating a helicopter is increasing - I have seen costs like for like more than double in 20 years. The cost of individual operations or treating one person with one pathology has overall gone down (please let's not argue about whether we need to spend more on an ageing population - this is about cost per patient). So we can expect over time the 1000 to become 2000 etc.

The public may indeed be generous but they are not fools. Push it too far and you may see the law of diminishing returns

[Pittsextra]

SAR yes take the point around the variable costs attached to using it - but in this context using it is a good thing? i.e. the air ambulance is doing air ambulancing!

After all wasn't that the main thrust of the argument against this Childrens AA - its not doing much...?

[jayteeto]

You might be able to do a gazillion operations for five million pounds........ But what five million pounds is that? It doesn't exist unless the public donate it. No air ambulance and it wouldn't be there. People fund raise and donate to what suits them.... Free choice. If they thought they were donating to bail out the nhs, they would not do it. On that one, the nhs could teach the charities to masters standard on how to waste public money. Charities are amateurs at waste compared to government departments

[Pittsextra]

Sure JTO but thats not answering the question is it...

Surely someone has sat down and run the numbers to see what strategy provides the best value? Otherwise its more PR than real use - i.e. a chance to gain a headline and a new message to take out to the willing donors....

[jayteeto]

Ching ching! Sarwannabee gets it and gets it good.
The question of best strategy for value for money. Wrong mind set, thinking like a manager.

What the public get is a service that is a luxury. Is it best value? Probably not, but they fill the tins for a service in THEIR LOCAL AREA that they will not have to depend on this week's management directives to see if it is available. Look at the npas scenario, some areas have terrible service now it's national. If they didn't like what was happening they wouldn't donate. If it costs 5 grand a patient, they don't care as long as the patient in need gets treated.
I don't personally fancy night hems, but will do it if asked. I will try to be careful and look after my crew and patients. The charity executives are offering a platinum service because they might just save one person, just one person, even at high cost. Our charity chief started this all up on a good old dream. Save one or hundreds, it didn't matter, one was enough, more was a bonus.
Pie in the sky? Maybe, but I donate every week because I like the way she thinks!

[Pittsextra]

It does seem however that some services are more efficient than others... After all it seems Thames Valley service spends more on the admin of the charity than the services it provides, whilst Midlands service costs almost nothing in comparison.. Does make you wonder.

[homonculus]

SARWannabe - do you really think anyone has done a proper analysis of the medical need for this? Of course not. Senior ambulance officers have worked out that they can remove x front line vehicles and save y pounds. There has been no analysis or cost benefit ratios because the Sheffield study shows is is not economic.

As to are operations being undertaken - have you heard of waiting lists - you restrict the capacity and the patients back up. The social services budget ('benefits') are no more relevant than expenditure on MOD. The fact is that that £5 million could be diverted via charities to other NHS work (which is what HEMS is!!!) to greater effect. For example a charity recently spent less than £4m to install a Cyberknife at a major London Teaching Hospital. It will treat up to 400 patients with cancer a year and 'save' perhaps 200 lives. Now if cornwall AA Trust decided to stop funding HEMS and raise money for a Cyberknife ( the closest one to Cornwall is in London) would they be saving more lives or less lives? Doing more good or less good? If the local BBC news station or the times publicised these issues......

Yes there are serious shortfalls in the NHS and they wont disappear in today's economic climate by a bit of lobbying. It is fantastic that the NHS doesnt have to pay for HEMS as this would further strain funds. However, spending more and more on bigger and cleverer aircraft with no evidence of benefit and no consideration of the effect on other charities should be criticised as much as profligate waste. We need to ensure every penny raised by these charities is used to the maximum effect, complain when money is misdirected or wasted, and seek to save as many lives as possible with the finite amount the public are willing to contribute.

[MightyGem]

Amazingly enough, with all modern technology available, you use a thick curtain.
A rather expensive curtain, I believe. Being for an aircraft, there's the requisite bump in price. We asked whether they were Essential or Recommended. On being told they were Recommended, we declined the offer. Can't say that we've noticed a problem.

[jayteeto]

Pitts, of course you are correct about admin costs. What your post identifies is that there are two seperate issues here and it is worth putting some space between them.
Offering a night service is not a misuse of funds, it is using the funds in the way the trustees see as their vision for the future. Period.

Big space.......


Administration is another thing, where I am with you 100%. Charities SHOULD be honest and open with their admin costs. The children's air ambulance having dance lessons from the stars of strictly come dancing at a cost of thousands made my blood boil. (If the tv documentary was correct of course). Employing family is another thing, absolutely fine if they can do the job well. If you own a business you can employ who you like and TRUST. Why not?

[jayteeto]

Dave, the curtain is needed for HEMS as you ..would have all lights blazing in the back

[Pittsextra]

Don't think he was SAR... but there is a huge variance in the expenses of these organisations...

[Pittsextra]

Hey all is cool, its interesting to get the views but I'm surprised that there is no general view from the industry.

In my view it suggests that the reason you are moving to night operation is because there is little risk (either capital or human) for the reward.

Without quantifying what the reward is it just seems (given the wide and differing views on how easy or hard night operations will be practically) a waste of time.

Although what I can see is the PR value.

[air pig]

Air Pig, quite a lot of inter-hospital transfers, both day and night, are conducted by SAR helicopters and these are paid for by the NHS.

Something the size of a Sea King or S92 can carry transfer teams and equipment over surprisingly long distances and has the added advantage of landing at or very near to the hospital rather than an airport.

I think one advantage of AA night operations will be not turning into a pumpkin at nightfall which limits their availability, especially in the winter months.

After 2015, the cost will rise as we all know that the service is being 'privatised' to a private contractor. At present the cost is approx £5000 per rotor hour, which is bound to rise, also have these costs been written into the new contract, knowing the NHS/MoD I would bet a beer or two they haven't and it is the ambulance service who mobilise these assets through RCC unless they have separate contracts between tertiary units and the AA providers.

[[email protected]]

Air pig - your post is all supposition.

[Pittsextra]

There is only any real positive PR value from this if the increased capacity is seen to help improve the chances/quality of life for a greater number of people who are in need to trauma help, which is subsequently provided by the services added capacity. If this is that case there is PR value, and there is true added value also. If this doesn't happen there wont be any PR value, and I would have thought it might well be dropped - "We can operate 24hrs at an increased cost, but we weren't needed" probably wouldn't be much in the way of positive PR. Let them try it, and see what outcome it has, we'll be better positioned to review the effectiveness after a year or so, and the additional costs to those charities of trialling the system will have totalled less than a single top footballer get paid in a year.

ha the old footballer wages analogy.... come on thats a total irrelevance.

When I say PR I mean the ability to make a story, such as "We are the first in the UK to offer night operations, saving lifes across the region,etc,etc.." thus making headlines, local news item etc. Allowing people to rattle the can and stiring people to dig a little deeper, because after all you guys saving lives 24hours a day..

That fact its un-thought out and might add little value is a year down the road and actually who would know anyway!!

Look its cynical but actually when you look at that data there is a lot to be cynical about and the fact that there is little colour around the risk/reward of 24hour operations kind of suggests it in particular is a noble cause that is being done on a more suck it and see basis..

[Pittsextra]

SAR I didn't know which is why I asked the question the answer today being very different to that of yesterday...

I'm sure that in most regions 24hr coverage is unnecessary, and that those regions that are moving towards it will not be operaring on a whim. they will i'm sure have conducted studies with conclusive evidence on which they are justifying their decisions to operate into the hours of darkness

[Pittsextra]

Hey SAR - i think we are at cross purposes....

My question was exactly that - what study has been done re: night operations because I'd posed the question that as charities with finite resources it would be sensible to show that you can do more good with the expansion of the service this way - than (for example) just running more of the same in the daytime.

I asked that question because it seemed that one service was pushing forward with 24hrs ops and yet when one asks for the rational there doesn't seem to be much coming back.

As for my data I am talking about the published accounts for these charities and frankly it the charity called the Air Ambulance Service seems to offer poor value for the people who are contributing.

The last set of accounts suggest they spent £453K on office expenses - who knows the detail but actually given there is an Air Ambulance association those involved can't really just sit back and wash their hands of it.

The first thing this association should do is make a standardised template for the accounts so that it is easy and transparant for people to make accurate read-across.

I'm sure those at the coal face do great things but sadly it is too easy for everyone to pull the "just think of the lives we save" card out, whilst at the same time turning a blind eye.

[Pittsextra]

but the few who are venturing into night HEMS are not going in completely blind

:) Very good.

Yep SAR the running of these operations would make an interesting read. :ok:

[Thomas coupling]

SAR: I suspect you aren't aware of those people who run the HEMS / AA outfits. Most (if not all) have no aviation background. Most are PR or HR background, some are medical background. The vast majority have little or no business acumen. Before anyone starts - SOME are very savvy, but you could count them on one hand.
What this means is that they are running the arrangement on public sentiment. And if they see the daytime model working [especially if they see the willing volunteers, money pouring in, helicopter companies swooning over themselves to provide turnkey products, councils offering grant aid to set up bases, etc etc; They run hell for leather with it]). And I would say to them: "Why not". It's for a "good cause". Hi tech, public power and no governmental interference is indeed one helluva aphrodisiac. They look up and say: "That's my local air ambulance".
When it comes to extending into night, these 'charity' air ambulance managers see it as a natural extension of their operations. What curbs their enthusiasm of course is the obstacles the CAA throws at them. But they keep trying and as long as the money keeps flowing they come up with solutions (the latest being suitable hems crewpersons / NVD etc). They see it as a growing empire which appears popular, so they don't stop.
What they don't do is a proper business analysis of night HEMS/AA ops. If they did, it simply wouldn't stack up. But the public "appear" to want it, the helicopter lease company want it...emotion wins in the end.
Multiply all the units in England and Wales incomes together and compare it to the life saving returns they produce and you'll soon realise it doen't make any sense at all.
But as long as the public "think" they are in control, they will continue to promote the service in all its fragmented and totally disjointed glory. [Especially when all around them is financially dire - here is one shining light where their hard earned money is literally 'flying high'.

The industry is conducting emotional blackmail..................

We really need a central (independent) audit office which should report and be answerable to the public.

[SASless]

TC....much closer to the truth than you think there Lad!

Look Westwards for the warning signs of what portends if you do not get it right in Blighty.

[air pig]

Air pig - your post is all supposition.

Please which part is supposition. the hourly rotor cost comes from the NHS unit I work for. Knowing NHS contracting I suspect as night AA transfer is to each intensive care unit and critical care network so rare it will have slipped someone's mind somewhere in the system.

[homonculus]

SAR - I am not sure if you believe this idea of some in depth secret paper showing the benefit of night HEMS, but I am afraid it is just rubbish. There is no published data on the benefits of night flights. Period. The ambulance service may be able to meet their targets with less ground resources but there is no evidence of benefit. If there were any, it would be published as a peer reviewed paper in the medical literature.

And sadly I strongly suspect based on the last 27 years that there wont be any such paper in the future. If only because a proper audit would shut me up!

[[email protected]]

Air Pig - this bit After 2015, the cost will rise as we all know that the service is being 'privatised' to a private contractor.
And this bit £5000 per rotor hour, which is bound to rise, also have these costs been written into the new contract, knowing the NHS/MoD I would bet a beer or two they haven't

Not facts (maybe your £5000 is correct) just your opinion.

[homonculus]

Thanks for clarifying SAR

So they currently go to x trauma cases a week using a road ambulance or pre care practitioner at say £300 per call. So now they are going to turn out a helicopter with the same or a less well trained medical team (as the helicopter only carries a paramedic not a doctor) for say £1500

So they spend £1200 x per week more but of course it isn't ambulance service money

Yes that sounds like the NHS.

[SARWannabe]

Not really - in the case I'm talking about they are sending out a car/helicopter (depending on practicality/timings) to arrive on scene within <20 mins, with a specialist registrar/consultant level doctor with extensive A&E experience, and a paramedic, who can provide a much more comprehensive trauma response than the best equipped ambulance service cover. Taking A&E to the patient, with the ability to perform selected roadside operations, administer anaesthetics, induce comas, take the patient quickly to the most suitable trauma/major-trauma hospital, bypass the A&E doctor when reaching the hospital (having made these diagnosis themselves). Which for the selected trauma parients to whom Control deem time-critical/severe enough is a good service, paid for by charitable donation.

[air pig]

Air Pig - this bit
Quote:
After 2015, the cost will rise as we all know that the service is being 'privatised' to a private contractor.
And this bit
Quote:
£5000 per rotor hour, which is bound to rise, also have these costs been written into the new contract, knowing the NHS/MoD I would bet a beer or two they haven't
Not facts (maybe your £5000 is correct) just your opinion.

The £5000 is correct, and you can bet the MoD costs will be a bare minimum profit margin, remember the crews and aircraft are already a paid for asset and civil operations are paid as 'aid to the civil power'. So a percentage is from the MoD budget supporting civil AA operations as flight crew pay engineering and command and control are paid from the defence budget.

Yes I remember the use of PFI/PPI in the NHS, costs far more than an asset paid from central funding rather than over a period of 30 to 35years, look at Voyager or new build hospitals and schools.

[air pig]

Not really - in the case I'm talking about they are sending out a car/helicopter (depending on practicality/timings) to arrive on scene within <20 mins, with a specialist registrar/consultant level doctor with extensive A&E experience, and a paramedic, who can provide a much more comprehensive trauma response than the best equipped ambulance service cover. Taking A&E to the patient, with the ability to perform selected roadside operations, administer anaesthetics, induce comas, take the patient quickly to the most suitable trauma/major-trauma hospital, bypass the A&E doctor when reaching the hospital (having made these diagnosis themselves). Which for the selected trauma parients to whom Control deem time-critical/severe enough is a good service, paid for by charitable donation.

When patients arrive at the designated hospital a 'handover' is given to the trauma team, who make a definitive diagnosis with the aid of CT scanning and ultrasound as per Bastion field hospital. The response team give a presumptive diagnosis based on the scene of the incident and the injuries found, and initial management given to the patient.

[jayteeto]

The helicopter has a doctor!

[air pig]

A doctor no matter how good does not have x ray eyes maybe a portable ultrasound only as now carried by HEMS London. Initial management is directed to securing an airway if required by endotracheal intubation or in certain cases a surgical airway and then ensuring adequate respiratory function, if necessary using bi-lateral thoracostomies for thoracic trauma. Spinal stabilisation and fluid replacement being either I/V or I/O routes. This all takes time and is eating up the 'golden hour' of improved potential survival.

An instance, unknown person who is unconscious and fitting, what is the cause, trauma drug overdose brain haemorrhage or emboli or epilepsy, all are possible and the doctor would have to treat what they see for the patients safety, definitive diagnosis is up to the trauma team following handover and further investigation. The above could require surgery, a trip to a cath lab, thrombolytic therapy, detoxification or sedation and further drug therapy. Difficult to diagnose at the roadside.

[homonculus]

I am afraid this doctor v paramedic is irrelevant

At night many services have a precare practitioner - often a consultant anaesthetist, not an A and E trainee. The helicopter doesnt alter this and indeed as many PCPs are on call from home the helicopter may have only a paramedic as there are no 'spare' trainees - their numbers are fixed. There is no time saving at the hospital either.

But this is not the point. The quality of medical care will not change by putting rotors on the vehicle. The issue is £300 goes to £1500 for no identified medical benefit.

[Thomas coupling]

Not really - in the case I'm talking about they are sending out a car/helicopter (depending on practicality/timings) to arrive on scene within <20 mins, with a specialist registrar/consultant level doctor with extensive A&E experience, and a paramedic, who can provide a much more comprehensive trauma response than the best equipped ambulance service cover. Taking A&E to the patient, with the ability to perform selected roadside operations, administer anaesthetics, induce comas, take the patient quickly to the most suitable trauma/major-trauma hospital, bypass the A&E doctor when reaching the hospital (having made these diagnosis themselves). Which for the selected trauma parients to whom Control deem time-critical/severe enough is a good service, paid for by charitable donation.

SAR:

Let me get this right. You're telling me that a helicopter can respond <20 mins. It can also carry a pilot (possibly 2), crewperson, paramedic and doctor/consultant.
You're telling me that team can perform roadside operations in the open air come rain or shine, day or night. They can then convey the survivor to hospital and bypass the receiving trauma team, pop them on a trolley and whisk them down to the CAT scanner circumventing the A and E team????

What films do you watch?

In reality it is far far far away from this perfect scenario.

There are NO stats indicating a night time demand for HEMS/AA to the extent that a helicopter is the best response vehicle. Stats can be 'massaged' to suggest the helo might 'improve' things so they meet PR targets but that is about all.
Homonculus is quite right, the cost is a quantum leap on traditional night time responses and entirely uncalled for. BUT......the forces of Marketing, H and S, public ignorance, helicopter service provider lobbying will prevail and the UK will see a proliferation of night support.....the public will willingly contribute too as they see it as a straight forward extension of day ops (which it isn't). Until they are properly educated in this area, their soft underbelly will continue to be exploited to the max.

[It's strange isn't it - if the government decreed there to be a "rescue and recovery" tax of say £40/yr, the public would kickoff. Shake a tin, hold a raffle, organise a charity run and people will willingly chip in a lot more than this over the year].

[[email protected]]

Air pig The £5000 is correct, and you can bet the MoD costs will be a bare minimum profit margin, remember the crews and aircraft are already a paid for asset and civil operations are paid as 'aid to the civil power'. So a percentage is from the MoD budget supporting civil AA operations as flight crew pay engineering and command and control are paid from the defence budget. what exactly do you think will be different under UKSAR? The aircraft and crews will already have been paid for and the DfT will, if required, be recompensed by the NHS for providing something (hospital transfer) that is not covered by the core contract ( and it is only your supposition that it isn't).

Any financial transfer will be between govt depts and not directly with the contractor - remember DfT are are responsible for providing UKSAR and they pay the bills. Frankly no different to transfer of funds between MoD and NHS at present.

[helmet fire]

So many facets to this discussion..... there literally could be several threads :8

First: I am an outsider. Not involved in the UK AA or SAR scene. And not much time to get across the whole discussion, however, I thought since we have some from the US contributing, I might throw a different perspective in. I fully appreciate that what I say may not be reflected in the reality that you guys face in the UK, as I am sure you will understand that some of your "truths" do not apply in my environment.

The thread was initially (and is entitled) about night flights, so I will start with that.

First Big call: Night EMS flights can be flown as safely, or very nearly as safely as day flights. "Can be" is the phrase, not "are currently", because it depends on which part of the world and where you look for trends.

So we turn to homonculus (are you going to tell us all what the name means and why the spelling?) and his/her constant argument in this and other threads that there is no benefit medically to AA flights. I disagree with this,because UK AA flights are not the only types of AA, and stating that AA flights don't show benefit is to capture all types of AA flights around the world. We use doctors on our AA flights as do most of Europe but not so with the typical Anglo and American models. So I accept that when you say "AA Flights" you are arguing about a slightly different animal from the alternative perspectives such as the one I am proposing here.

I know a lengthy argument about peer reviewed empirical evidence will ensue: however, I believe that the HIRT (Head Injury Retrieval Trial) in Sydney proved that Per Protocol and Treatment Received level evidence clearly indicated a demonstrable benefit, even if Intention To Treat was inconclusive due to contamination by the change to standard care during the trial. So we can go around and around on this and still hold different views at the end.

From my perspective, lets just assume that AA flights do help people, even if there can be disagreement on the empirical evidence at hand. Lets put it more bluntly: your child is trapped by compression and unconscious. Would you prefer (regardless of evidence of benefit):
a. Volunteer medical responder.
b. Ambulance Officer.
c. Paramedic Officer and Ambulance Officer.
d. AA arrives: Emergency/Anesthetic Consultant and Paramedic and 2nd Paramedic and Ambulance Officer.

Anyone NOT choose d? There will be some for the sake of argument on pprune, but really.... I think we would all like d, even in the face of "no peer reviewed evidence".

I would hasten to add that doctors (where trained appropriately) are the key to this proposition. I agree with homonculus and TC, that sending a paramedic only on an AA flight is definately beneficial in terms of getting a pre hospital expert (paramedic) to the scene faste, but it is still a bit "akin to attaching rotors to an ambulance" and upping the costs consequently, and I agree with homonculus, the benefits of this would generally come down to the speed of the scoop and run as no higher level of care will be provided. I am NOT saying that the befit of speed is not tangible as per the inference from homonculus. I think getting a paramedic there more quickly and conveying the patient to hospital more quickly is a great benefit. But if having the paramedic is needed, lets add the doctor (not replace the paramedic). Now, we have an asset that, although expensive, can bring a higher level of clinical care, not just the pre-hospital expertise faster.

Now speed. TC says:
Let me get this right. You're telling me that a helicopter can respond <20 mins. It can also carry a pilot (possibly 2), crewperson, paramedic and doctor/consultant.
You're telling me that team can perform roadside operations in the open air come rain or shine, day or night. They can then convey the survivor to hospital and bypass the receiving trauma team, pop them on a trolley and whisk them down to the CAT scanner circumventing the A and E team????

What I am about to say may not work in the UK, and may not be safe or applicable. But please accept that it can be done (and has been done) safely elsewhere. During the HIRT (Head Injury Retrieval Trial) in Sydney, NSW, the team was able to respond well within those times, day AND night, and for over 6 years. Typically, they were first on scene in a majority of cases (including even the CBD of Sydney) and recorded an average lift off time of 6 minutes from the phone call. That is, 6 minutes from START of the phone call of the victim, not from the end of the phone call from co-ordination to the helicopter crew.

As consultant level doctors and the highest level of paramedic training in NSW (this differs throughout the world), they could and did perform a variety of roadside "operations". In the open air. In the rain. At night. And their times at triage in casualty before CT, etc, are demonstrably less, depending on the semantics of the trial outcomes I referred to above. No-one bypasses the receiving trauma or A and E teams, and I think I can excise that from the quote: but I am talking about when a trauma team of significant experience and seniority walks in with a trauma patient, sometimes a team that is equivalent or more experienced than the team at the hospital.... you must accept that that creates a different dynamic at the triage, and a dynamic that will always favour the patient. Imagine if the head of that trauma centre walked in accompanied by the highest level of pre hospital expertise (paramedic) with the casualty because the head of the trauma centre was the doctor on the helicopter. Would that help? A little bit??

So, I accept that my view is based on (and limited by) my experiences - again, I do not know how this translates into the UK environment, but for us, AA flilghts are capable of being the "golden hour" level of care in many cases, can fly safely at night, and can respond quicker than ground resources even in heavily covered areas, but can respond with a higher level of care than that provided by ground alone. They SUPPLEMENT ground capabilities, they DO NOT replace. And, when they cannot fly, no worries, there is still an extremely efficient ground response that can deal with the problems or scoop and run as per normal.

The above concentrates on pre hospital, however we also perform a significant number of inter hospital flights as well. On one operation of ours, we fly approx 850 hours of inter hospitals per annum, 60% of which is night.

Does the UK system of paramedic or police office/medic system (without redesign) support the notion of AA flights at night in the UK? Not from the discussion above, but if you do want the benefits and you do want the capability to provide those benefits safely by night, there are other ways to do AA that are worth considering. Some of these would and facilitate the safety and the benefits of AA flights experienced elsewhere in the world.

in my opinion :}

[homonculus]

Helmet fire

I thoroughly enjoyed your post. For the avoidance of doubt I confirm I am talking about air ambulance work in England and Wales using the current model. I am not saying HEMS has no benefit even in the UK, merely that we need to identify who to attend and with what and why.

I certainly am not talking about the US where I spend many happy years flying some worthwhile missions albeit with antiquated equipment. Nor am I criticising in particular Australia who have very impressive set ups in metro areas and vital services in rural areas.

As to Homonculus, Google Penfields Homonculus and you will understand

[helmet fire]

we need to identify who to attend and with what and why

That is all of it in a nutshell! Very well said :D
So little of world wide HEMS is data driven or data based. I

[jayteeto]

I will go with that, by night AND BY DAY!

[Ricorigs]

In principle I agree it isn't a terrible idea and could offer something.

But out of curiosity, please excuse the ignorance, how often would the aircrew in question get to practice flying into unknown sites by night on NVG or mortal?

In the military it is probably the one skill you practice the most on a regular basis. So my next question is who will pay for the currency training?

Just wondered as an outsider considering if the grass is greener...

[SilsoeSid]

Ricorigs;

But out of curiosity, please excuse the ignorance, how often would the aircrew in question get to practice flying into unknown sites by night on NVG or mortal?

In the military it is probably the one skill you practice the most on a regular basis. So my next question is who will pay for the currency training?


When you say that the military regularly practise NVG/Mortal flights into unknown landing sites, would they be the same sites that would have been day recce'd just a few hours before?

In reference to the currency training for landing in unknown sites, can you please remind us what the military currencies for that activity are and in which column would it go in the old logbook?
:ok:

[Ricorigs]

Silso,

Fair point my bad england. I was referring to night flying in general not the unrecce'd sites being regularly practiced. Consider my bad typing hands slapped.


But on the unknown sites bit, it depends where you are and which service you are in whether they are recce'd by day first. The Navy/Marines are a bit more up for it than the RAF and Army to go in blind. Plus sometimes you can't recce everything within the last 7 days and it isn't exactly realistic training to go to a recce'd site all the time.

Which is all well and good on a plain somewhere. But in the middle of a city center, solo pilot NVG or mortal that would be pretty taxing. I don't know if the rest of the crew help out on this in a HEMs aircraft.

That's why I just wondered how often the guys would practice it..

[SilsoeSid]

But on the unknown sites bit, it depends where you are and which service you are in whether they are recce'd by day first. The Navy/Marines are a bit more up for it than the RAF and Army to go in blind. Plus sometimes you can't recce everything within the last 7 days and it isn't exactly realistic training to go to a recce'd site all the time.

Mmm, interesting! I wonder what the flying regs have to say on that. Do they say a night field landing site, must be, should be or needn't be recce'd?
Then again, if the site is recced by someone else (OC night?), surely that realism is still there, all you have given the site is a clearance that goes as far as; 'There shouldn't be any gotchas in here'.



But in the middle of a city center, solo pilot NVG or mortal that would be pretty taxing.

I think there might be some confusion as to what type of NVG/Mortal flights are involved here. I get the feeling it's more of a case of comfortably completing the last light HEMS tasks (without the 'why so many night flights during the month' interview without coffee), ground recce'd/lit ad hocs, known site to known site, or transfer taskings ... rather than the daytime type ad hoc landings, but in the dark, scenario.


To the HEMS chaps & chapesses, any idea how many elevated pads are night cleared?

[SASless]

So little of world wide HEMS is data driven or data based.

Oh....I do disagree....the Profit/Loss Statement is usually the key Data used.

Granted, it might be the revenue from heart and trauma procedures that is the measure but the almighty dollar is the base upon which decisions are made.

[homonculus]

SASless

I presume you refer to the US where most HEMS are loss making projects funded by hospitals to pull in very profitable major surgery. That works well but in the UK we have socialised medicine. There is no profit. A large operation such as a heart transplant is a big COST or loss for the hospital not a profit. Hospitals do not get paid for treating patients, they have to pay the costs themselves or via the CCG

SilsoeSid

There is no problem with return to base or return to hanger at night and London HEMS have done the latter. This dubious project is about flying to trauma sites at night, and not just city centres where in Essex you might be able to manage with half a dozen recycled sites per city - although why you would do so is beyond me as you would have to task land transportation to collect the crew and then a land ambulance to transfer the patient and after all that nonsense you could have the patient in the operating theatre much sooner and cheaper and safer in a land vehicle.

No this is about going to night trauma which is often down country lanes with little ambient lighting, trees, livestock, inclines, farm implements and cables and wires. You have to land within say 50 metres as there is no spare personnel to transfer you to the patient and you will have to manhandle the patient plus stretcher plus monitoring plus oxygen to the aircraft so no hills, mud or cow pats please. I would be interested to know how the military would approach it.

[SASless]

So I guess mitigation of Loss/cost....is not a consideration for charities?

Are you doing it just to be doing it...or to do as much "good" as possible with the funds extant?

It still gets back to cost v benefit does it not?

I once posed a question re the wisdom of IFR Ops....up in the wilds of Pennsylvania....where we would lift from the Hospital Pad...fly to a a rural Airport...meet an Ambulance with the Patient...transferred from a safe, warm, capable Medical Facility...transfer the Patient to the Helicopter...depart the Airport...transit to the Hospital...and make an IFR Approach to the Hospital Helipad with very high minimums due to the Hills surrounding the Heliport (then in the case of a Missed Approach)...transit to another Airport, transfer the Patient to yet another Ambulance....transport the Patient to the Hospital and transfer the Patient into Facility along with all the attendent check-in routines....to Yes....wait for the advanced medical treatment.

The Patient could have waited in the first Medical Facility with no undue stress until the weather improved and the flight could be made Hospital to Hospital in one go with just two transfers in the process.

I argued the "Do No Harm!" rule was being violated in the pursuit of proving our company was the first in doing routine IFR Ops.

We have to remember the Patient's best interests in all this we do and propose to do.

[[email protected]]

ricorig But on the unknown sites bit, it depends where you are and which service you are in whether they are recce'd by day first. The Navy/Marines are a bit more up for it than the RAF and Army to go in blind.so which ones aren't operating iaw the JHC flying order book?

[Adroight]

Good post Helmet Fire. Although this thread is concerned with UK AA flights it is useful to remind people that night AA flights have been operating successfully in Australia for well over 30 years now.

Having experience flying AA night flights in Australia and UK for me the main differences were attitude and currency. You have a (comparitively) very pro-aviation CASA in Australia which helps enormously and the prevailing attitude is that flown properly with correct rules and aids there is little risk with night AA flights.

Australian AA flights are (as HF said) up to 60% of all tasks and when flying 850 hours per annum that is a lot of night flying including off-airport landings. The equates to very current aircrew in night operations and night currency training flights tend to get in the way of real night tasks. However training is still important and regularly flown. UK AA flights fly much less than this and a tiny amount of night flying so night AA is seen by many as a very difficult and hazardous.

There have been night AA accidents in Australia in the past but these have been with VFR single-engine machines operated by organisations with poor CRM and flown by pilots who were uncurrent and/or lacking in decision making skills.

Australian HEMS are (mostly) single-pilot IFR machines of the Bell412/AW139 size. The Australian model means that it is possible to fly with a crew of pilot, crewman, rescue crewman (all using NVG) doctor and paramedic and carry two stretcher casualties. The UK model tends to utilise smaller machines of the EC135/MD900 class with pilot and 2 paramedics.

The two countries are very different in many respects but Australia has shown that night AA tasks can be performed just as easily as day tasks with the right aircraft, crew combination, night vision equipment, currency, rules, regulations and attitude.

[jayteeto]

Day recced sites went years ago. In the mid 90s we were going into 'blind' sites. AND we were the softie RAF :rolleyes:

[MightyGem]

how often would the aircrew in question get to practice flying into unknown sites by night on NVG or mortal?
If the HEMS/AAs are covered by the same regs as the Police aircraft, then NVG landings at Ad Hoc(un-recced) sites are not allowed for training.

I don't know if the rest of the crew help out on this in a HEMs aircraft.
The medics(they are classed as passengers, rather than crew) would be trained on NVGs to help and assist the pilot on all aspects of landing at an unknown site.

[jayteeto]

Ah yes, however under easa there may be some confusing this crew/pax status...........

[SASless]

Just like US FAA Regulations about Passengers and Crew....which causes some serious issues in the USA EMS Business.

Then throw in the Part 91 versus Part 135 Weather Limitations and such when there are no "Patients" aboard the aircraft.

[homonculus]

Can someone tell me how long it takes to train an ambulance man to assist a landing on NVGs ????? I thought from my discussions with military pilots that this was one of the harder things they did and needed considerable training and ongoing practice. Many ambulance crew merely rotate onto HEMS for short periods. On one system the doctors just fly odd weekends.

If it is that simple I find it odd that we don't allow anyone who can buy a pair and adapt the cockpit to have the benefits. Yest we now learn that even police pilots are not allowed to land at un recced sites.

I am trying hard to understand all this, being only an ignorant doctor, but there does not seem to be a thread of consistent logic.

[Aucky]

Yest we now learn that even police pilots are not allowed to land at un recced sites.

The police have been landing at Ad-hoc sites, without NVG for years, lighting the site by airborne lights (night-sun), and in some cases doubling up as night HEMS with a paramedic onboard. MightyGem said it's not allowed for training.

[[email protected]]

MightyGem said it's not allowed for training.there's a well thought out safety management system - 'you can do it operationally but we won't let you train to do it' - genius!

Presumably someone has created a NVG course for ambulance paramedics, which is approved and overseen by the CAA with an appropriate qualification issued at the end of it?

Since the front seat paramedic isn't flight crew and doesn't have a licence, even if he/she makes a mistake and causes an incident/accident, the poor pilot will take the blame - seems like 2-pilot ops is the sensible way forward.

[Thomas coupling]

Crab: welcome to civvy world.

The CAA are doing their best not to restrict helo ops by allowing ad hoc at night landings for public service ops BUT at the same time towing(sic) the line trying to maintain their safety mantra in that why push the envelope during training? The same goes for safe single engine parameters in that public service AOC's can hover/winch when not SSE only in "anger", ie: when life is at risk, BUT they cannot train under these restricted parameters.
I think you will find that already this is pervading military ops to a lesser degree as MAA manifests itself.
[Do Merlin's practice auto's anymore? Why do PPI's at height? I can see the winch weight checks being stopped due to TR issues etc etc etc]
Welcome to the nanny state.

A suitable person can 'assist' the pilot during certain ops when operating under (the old) JAR Ops 3.005d, I think it is.
There are conditions in that the CAA must satisfy themselves that the operating area is suitable for this 'support' to be implemented. For instance, they would not ordain a clearance for the HEMS crewman to support the pilot on NVG's if the operating area was below light minima's or in mountainous areaS etc. But there is a porotocol for hems crewpersons to assist on these operations and it does go on.

Again, the normal caveat exists: I can only talk about the UK. Most of the country isn't too far from some form of ambient lighting and this is what the CAA hang their hats on when discussing limits. When you start discussing long inhospitable terrain legs in dark inky black surroundings - this is an entirely different beast indeed:eek:
The yanks/Aussies have their own unique problems in this regard.

PS: Get yourself up here so we can beast you later today!!!

[Ricorigs]

Daylight recces are only required if you planning to go below certain heights on the route or if you wish to land directly onto your selected point.

J2317.110 JHC FOB mentions the un-recce'd landing site landing technique must be used if it hasn't been checked by day.

[SilsoeSid]

No unit is breaching anything
Daylight recces are only required if you planning to go below certain heights.

How much lower than landing do you usually fly Ricorigs?
:ugh:

[jayteeto]

Easa are sniffing around the crew/passenger status. As TC states, welcome to the world of civil aviation! Just because the mil would have a formal qual, doesn't mean the pax do........

[MightyGem]

Can someone tell me how long it takes to train an ambulance man to assist a landing on NVGs ?
If Paramedics are trained the same as Police Observers, then it'll be an hour or so of groundschool, then a 1 hour training sortie, split between the front and the back of the aircraft, then a 40 minute check ride, again split between front and back. However, that's going from Stage 1 to Stage 2. I believe that the AAs will be trained straight to Stage 2, so the training will be slightly longer.

The main problem at the moment(for us anyway) is a lack of NVG TREs. Having done the training we seem unlikely to get authorised due to the CAA unable to come up before our last NVG TRE goes to pastures new.

'you can do it operationally but we won't let you train to do it'
Crab, I thought you were harping on about the requirement for daylight recces earlier? We can go into a field at night as a training sortie, as long as it's been recced.