HEMS - Regulations and saving life

[rotorspeed]

SASless

Interesting reply; and if what you say is representative, a real concern. Surely pilots should not really be doing anything they think is a significant risk at the time? I assume that pilots when operating within limitations of equipment, training and skills do not generally think they are taking significant risks flying helos? Even if the perception of the risk is exaggerated, decision making will usually be impaired because of the consequent stress.

Taking your examples.

The snow storm; presumably the concern was the fact that you were unaware for some time that you had entered and were flying in it. Did the temperature/forecast suggest this was a risk? Could more frequent switching on of the landing light have provided earlier warning for you to turn back? Was it a drama when you did turn back? You obviously acted early enough to avoid a potential accident, but would alternative pilot action have reduced the risk to a level that it was acceptable?

Fog building up. Nasty one, that, as it tends to get worse. Was it forecast? Was it even possible for you to have got a good forecast? Was base far away? Was that clear? What were your outs? Presumably trying to find somewhere to put it down safely that was not yet significantly foggy. How could that risk have been avoided/minimised to acceptable levels?

Night flight to St Mary's. If you violated the rules and you then felt the mission risky, who pressured you into the flight?

I'm not trying to be clever here, just trying to identify why these flights were perceived as risky and what could have been done to avoid that.

I must say I not too keen flying VFR singles at night. IFR capability at least gives you the kit not to be stressed flying without visual reference, particularly assuming you have an autopilot. And the second engine largely eliminates that nagging background thought of "where am I going to go if stops". It also makes it a lot safer taking your time carefully checking out the site from 100ft with no airspeed with the landing lights. So I'd vote for IFR twins; agreed.

Not enough experience with NVGs to have a valid view on use, I'm afraid.

[SASless]

Each one of the three flights I felt comfortable taking...Snow showers were around but the big ol's orange moon was shining...so vis was great....except for that one big cell hanging along my flightpath at the worst point. Radar looked good before we went....

The moon was up on the way to St. Marys but had set prior to the return trip...but stark clear all around....just a very dark area with mountains. Just no lights on the ground around there for quite some way....and with no moon....and a bit of haze....made for an interesting flight. Just reverted to offshore night flying....glance outside every now and then but fly instruments till some lights showed up.

The fog....well that was a an educated guess....short scene flight...all over a populated area mostly....out and back...20 minutes maybe.....just guessed wrong on that one. Did not guess wrong on any more like that...."smoke" under the street lights and it is red for the night! Movie and popcorn event.

I even carry it to the old wind light...temp/dew point within 2-3 degrees....red night....movie and popcorn.

Low cloud....precip is one thing...fog is in a catagory all by itself....if fog is around...or a good possibility....movie and popcorn time.

[rotorboy]

Steve 76 had an intersting observation.

I would be real interested to see accident stats : Stand alone vs hospital based (funded) programs. I would venture a guess that Stand alone programs have a exponentialy higher accident rates...

Surprised you guys havent brought up CAMMTS yet

RB

[NickLappos]

SASless,
You started off arguing that nobody was paying attenton ("The FAA has never taken a hard look at the EMS business....changes usually come within the industry and are generally driven by insurance costs.")

I know that is not true. A major task force worked about 10 years ago, and the results saved the EMS system. Rather than place blame, why not let your excellent points stand for themselves?

The FAA does not sit by when these things happen. I work with 76 oerators who sweat profusely when the FAA examiner comes by after a minor mishap, let alone a pilot error accident. Don't you recall that?

Let me ask, because I think you are expert in this field (at least by surviving all these years!) What should we do?

[SASless]

Nick,

When the FAA shows up...they go through paperwork...they check forms...they check to see if the rules and regulations are being complied with. They do not look to see if the rules are adequate...appropriate....or effective. They look to see if the minimum standards are met....whether the flight took place in accordance with the opspecs and FAR's.....

They do not look to see if the FAA requirements contributed to the accident or if changes are needed in the rules or regulations. If that is so...the NTSB would have a lot less to say about the FAA and its lack of prevention of accidents.

The reason we all sweat a visit from the FAA is there are so many ways of getting caught shorthanded....even if you are dedicated to compliance. It is the paperwork they thrive on. It is the real world things that are killing people.

In this latest crash in Maryland....do you think the FAA is going to criticize themselves for the low level route restrictions? The NTSB might but the FAA darn sure isn't.

The FAA will say something along the lines of "Pilot Error...failed to maintain terrain clearance." As usual...they will be correct...but not necessarily right.

If the FAA is so safety conscious....why is it...my recollection of the old crisis in the EMS industry....the bulk of the changes were intitiated by the industry and not the FAA. If you read the equipment standards for night flight....you can get by with a very marginal amount of equipment. Now put yourself out there in marginal conditions....with no instrument proficency in unfamilar territory...and you have a recipe for disaster. The FAA under part 91 says nothing about having surface lights for control of the aircraft....part 135 does...but we all know that rule is ignored constantly. The FAA knows it....why do they do nothing? They will come in after a crash and some more dead folks and then take an operator to task.....when was the last time they suspended an air carrier's certificate? Ever?

You recall the FAA decision to allow the liferafts to be removed from 727's on the New York...Miami run....due to statisically insignificant probability of a three engine aircraft ever ditching in such a short offshore flight? What was it...three weeks later....a FE flamed out all three engines on one on that very route. The crew got the engines restarted.....but then the FAA changed its mind.

Similar mindset here....just like offshore...allowing Jetrangers for example to run around the Gulf of Mexico over sea states that are beyond the capability of the emergency floats. Is that wise? Do the operators care?

We too often smile at safety....and ignore the realities.



A few things on my wish list...

At least a basic three axis autopilot on every machine with HSI, Standby attitude indicator, and radalt. GPS slaved to the HSI.
GPS coordinates listed for all obstructions in a handy format....and updated.

No single pilot IFR.

Training sufficient to maintain actual....not legal instrument currency...and proficiency not just legal currency.

SX-16 Nitesuns or equivalent on all night aircraft. IR filter if crew has NVG's.

Moveable landing lights on all night aircraft. Lots of them!

Scene lights on all night aircraft.

Sliding doors that can be opened on all aircraft.....to allow the med crew in back to really be able to see wires on approach.

More use of preplanned LZ's at night.

More use of preplanned routes designed to avoid known obstacles. It is a miracle hour....use a minute or two to ehance safety.

Notification of weather turndowns to all EMS units in the area.

Requesters should be required to notify operators when they have been turned down for weather.

No single engine aircraft at night.

More Awos...Asos's at critical points....moutain passess...for example.

NVG's for all night flights.

Organized counseling to defeat the "Hero" image that creeps into EMS crews.....it is a transport mission...not a life saving mission.

Better rest accomodation for crews....particularly for night crews.

I am on record now as to what I think would help...your turn.

What do you think can be done to enhance safety for EMS flights?

[rotorspeed]

Seems a pretty good, sensible list to me SASless, apart from not wanting single pilot IFR.

With the A/P you rightly want anyway, I would much prefer 90kgs more fuel to a second pilot for IFR ops!

[Nuada]

"Ten Years After"

SAS,
Very well said, (throughout the post) and a quite complete listing as well. I have been laboring in the US EMS market for 10+ years now and can testify heartily about the slippery slopes which exist in this section of our indusrtry, and which apparently are not obivious to those, (RotorDog) who have yet to experience the environment. I would add to the miasma before us the contributing factors of cumulative sleep depravation and the ongoing influx of primarily dual pilot seasoned crews.
Asnyone in the business will tell you, most if not all of the major EMS operators are pilot starved, and as such the majority of bases function with short staffing. This results in extended tours, often flip-flopping randomly from day shifting to night shifts.
There is no opportunity to smoothly transition the body and mind (decision-making capacity, remember?) from one extreme to the other. Period. As you grow older, the impact increases. This all has absolutely everything to do with managing a totally 'ad hoc' tactical style of helicopter operation.


It is largely an industry without strong leadership from either the vendor companies or the industry lobby groups, to say nothing of the FAA/NTSB.
If you are seeking guidance, this is absolutely the worst place in the helicopter industry to search.
There is no opportunity to learn and watch your peers manage the 'up-time' and the 'down-time'. The two pilot operations are as rare as pay increases these days. Truthfully, how did we all learn back in those halycon days of yore?
It is NOT good enough to accept a standard of 'Darwin-esque' crew development. It isn't only the good or wise pilot who survive...sometimes the wrong lessons are learned and allowed to seed instead.


Imagine that you have only a dual pilot basis of experience to draw upon? Now put yourself into the darkest hole you might imagine with some random white noise in both ears offering you either inaccurate, disinterested, or distracting information. Now, that I have your head on a swivel...you are in complete control of managing the entire process from choices made to execution of a plan....which may include calling the whole thing off as a poor idea to begin with. It is a large dosage of responsibility, most especially for those who until recently had the benefit of another mind, body and spirit in the cockpit with who to interact.


I am sure there is no single easy answer. I am not sure if any inter-governmental action will effectively incorporate all the divergent elements at play.
I try to treat each call as a separate entity. I try to learn from everyaction I take. I try not to hold too fast to my own ego and imortality. I try to do better tomorrow than I did today. I try very hard to live another day.


It's a quixotic tightrope, not to everyone's liking. I have been in this business for over 36 years. With apologies to all other opinions...this EMS format consistently asks more of all of my judgement and skillset than any other element of our industry in which I have worked.
Make good decisions.
It's still true after all these years.

[w_ocker]

Glad to see this discussion going the way it is.
It seems you guys have some serious challenges ahead. Here is how my mob in Australia do it - note there are several different methods in Aus, but I am one of those poor buggers who works several bases in geographically diverse locations, and this is how we manage.
We operate ME(412)SPIFR, 3 ax AP. 24 hour shifts with strict fatique disciplines. Some of the aircraft are new, some old, some carry just one paramedic, some a cast of thousands. This leads to one problem - the ever-present lack of power margin/range on some ops. Next is the problem of night flight. Yes, we are IFR, but that doesnt alleviate problems of icing, arrival and landing to black-hole roadsides, fog, non-surveyed flight routes and landing areas etc. It seems to me that many of these difficulties would be reduced (not elliminated though) by simply being able to see! I have an NVG background and I still cant believe that we get away with what we do unaided relatively without incident. Frankly SAS, it scares me too! NVG in my ops would allow me an increased ability (not failsafe of course) to see and avoid fog and cloud (ice), avoid terrain (mountain flying at night) and perform far more effective search ops. As for the arguement of inadvert. IMC, I do agree, but it is my belief that this is an IFR job, and thus ought to be conducted by IFR multis with proficient crews.
A healthy company culture of "pilot's decision is final" is vital also.
I often lament some of the short-comings of our system (basically the lack of NVG), but I see that you Yanks have it tougher than me in many ways. I hope you can improve things the way you see fit.
It is worth mentioning that all this gear is obviously expensive and the sad truth is that companies and clients most likely see what we do as an "aint broken dont need fixin' " situation.
That said, fly safe guys and remember that your patient is already in a bad way. Its not your fault and the simple maths of his/her life verses the 3, 4 or 5 of your crew just doesnt add up.
Keep up the discussion guys. Any other examples of how others do it out there?

W

[Devil 49]

Night vision goggles would do more for the night accident issue in U.S. helo EMS than the rest of the list, SASless. I'd have to put rational, scientific pilot scheduling next. Both have universal implications- no matter what, where and how you're flying, safety is enhanced when pilots can see and think clearly.

[Decks]

Am untrained and have never used NVG but am seriously curious as I sense that they would be a major help. We routinely fly coastal missions at night up inlets and into islands and are fairly heavily dependant on the radar. It could fail and also is it telling the truth? Certainly the issue of NVG failure is a big one... whats the thoughts or procedures on this...??? Any EMS pilot willing to talk us through a night scene job with the use of NVG would be really appreciated...

I completely disagree on the notion of " I would rather have the fuel than a copilot". Weak thinking. Managing a crew well takes effort and diplomacy but on the sh*tiest of nights can be a huge plus.

I agree with SASLESS on the point of the FAA or other regulating authorities. The client sees $$$$, the operator sees $$$$ and the key to this business is effectively managing profit against safety. The regulators are in the strongest position to put more sensible regs in place. Are you even required to have a rad alt to fly Part 135 at night...??? Doing that kind of work without a radalt is a complete joke... good, safe, well known regs can help reduce the pressure directly on the pilot. You point at the book and say sorry but no.

Luck cannot be accounted for and shouldnt be routinely the factor which governs a life or death outcome. I am certainly a member of the "There but for the Grace of God go I club". I can think of numerous occassions when it was the factor which kept me out of trouble... And there have probably been other times I dont even know of....

[SASless]

Someone asked what the equipment requirements are for night flight in the USA for EMS aircraft. This is for VFR aircraft.....such as the Jetranger, 407, AS-350, BO-105's, and some K-117's. This is what the FAA thinks is needed. If you check the dates on this regulation...you will see the FAA gave the industry two years to fly without anything before this reg became law. Wonder if anyone died in that two year period because of the lack of instrumentation.



§ 135.159 Equipment requirements: Carrying passengers under VFR at night or under VFR over-the-top conditions.
No person may operate an aircraft carrying passengers under VFR at night or under VFR over-the-top, unless it is equipped with—

(a) A gyroscopic rate-of-turn indicator except on the following aircraft:

(1) Airplanes with a third attitude instrument system usable through flight attitudes of 360 degrees of pitch-and-roll and installed in accordance with the instrument requirements prescribed in §121.305(j) of this chapter.

(2) Helicopters with a third attitude instrument system usable through flight attitudes of ±80 degrees of pitch and ±120 degrees of roll and installed in accordance with §29.1303(g) of this chapter.

(3) Helicopters with a maximum certificated takeoff weight of 6,000 pounds or less.

(b) A slip skid indicator.

(c) A gyroscopic bank-and-pitch indicator.

(d) A gyroscopic direction indicator.

(e) A generator or generators able to supply all probable combinations of continuous in-flight electrical loads for required equipment and for recharging the battery.

(f) For night flights—

(1) An anticollision light system;

(2) Instrument lights to make all instruments, switches, and gauges easily readable, the direct rays of which are shielded from the pilots' eyes; and

(3) A flashlight having at least two size “D” cells or equivalent.

(g) For the purpose of paragraph (e) of this section, a continuous in-flight electrical load includes one that draws current continuously during flight, such as radio equipment and electrically driven instruments and lights, but does not include occasional intermittent loads.

(h) Notwithstanding provisions of paragraphs (b), (c), and (d), helicopters having a maximum certificated takeoff weight of 6,000 pounds or less may be operated until January 6, 1988, under visual flight rules at night without a slip skid indicator, a gyroscopic bank-and-pitch indicator, or a gyroscopic direction indicator.


Now...I ask you....is this the cockpit you want to be sitting in on a marginal night. The boys and girls are out there nightly in just such aircraft. Just the inclusion of a RadAlt makes a world of difference...throw in an HSI...it gets better yet....add a simple three axis autopilot and gee....life is good....now add TCAS...EGPWS....even a fixed tube low light vision device...and life is great. NVG's....and super....a second engine and another pilot....life is grand! What we are talking about is a fully kitted and crewed IFR twin operation I reckon.

[rotorspeed]

Decks

Whether or not you prefer the fuel or the co-pilot for IFR ops must be influenced by the type of aircraft and how it is being operated. On an S76 90 kgs clearly doesn't buy you much extra time and maybe you're operating well below max wt for IFR ops anyway, so it's irrelevant. But if you're not, and operating say an IFR EC135, AS355F1, A109A/C, for example, that extra 30 mins of fuel can be a more valuable safety net. Furthermore it's going to allow you to go further, be at the scene longer, and have a greater choice of alternates if you have to go IMC. If the terrain is more demanding and weather bad, co-pilot benefit increases, agree.

And then in the real world there is the extra cost of a co-pilot to consider. Safety comes at a price, and that price has a limit, but that is another whole new subject!

[SASless]

Once had a Chief Pilot for one of the major EMS operators that prided itself on its four year college degree requirment and all IFR program sales pitch, tell me that he would rather have an autopilot than a co-pilot any time.

I did not understand that logic nor agree with his thinking. Seemed odd...I have a degree so should be able to understand his logic but it did escape me.

Does the addition of another set of eyes....a random thinking brain....and a butt at risk that can sense mortality, beat a blind, deaf, mute electronic robot that has preset thought processes and absolutely no fear of death?

[The Rotordog]

SASless asketh:

Does the addition of another set of eyes....a random thinking brain....and a butt at risk that can sense mortality, beat a blind, deaf, mute electronic robot that has preset thought processes and absolutely no fear of death?

Well...you *know* someone had to chime in with the smartass answer <sigh>...it might as well be me. And that answer is:

...Ask the two pilots who crashed the S-76 on that foggy night in Kentucky awhile back. Oh wait, you can't. They both died.

Does a copilot trump an autopilot? Perhaps. But not always. And it sure would be nice to be able to punch up heading-hold and dial in an altitude (preferably something higher) and be able to look at a map or puke out the vertigo or hear the dreaded answer-back of "No, YOU got the controls."

Your former C.P. obviously felt more confident with the auto-George. You'd prefer a live human one. What's that silly expression the brits are always using..."horses for courses" or something like that? Maybe we should have both?

[SASless]

Dog,

Did you ever read the CVR transcript of that crash? If you did...ask yourself the question...what would I have done as the non-flying pilot in that case?

I formed a very hard opinion of what went wrong there.....at some point....one guy has to be flying the machine...either poles in hands or mashing buttons and twiddling knobs.

Especially, when you see things are not right.....

My vote is two mortals and one robot....technology is great stuff....and two heads ought to be better than one.

[Steve76]

Guys,

The big question of Auto VS "George", is what does G bring to the problem.
Personally, I will take Auto over G anytime as it suits my personality and I know that I can really on Auto to hold a heading and track an ILS accurately.

I think if your two pilots are very experienced and comfortable in the IFR game then you have a great combo. Should one be a 500hr joyride pilot with a fresh IFR; then he is almost useless. Give him more time and he comes good but at the start it is single pilot without an autopilot and a bucket full of stress.

How to get experience then? Take guys from the Oil industry into EMS ops. Almost everything is two pilot and guys will learn from someone definately more experienced.

The other situation in IFR and NVFR op's is to have a great situational awareness of the aircrafts position and what is going on around you as well. Being able to "step" outside the situation and transition to fundamentals at times of distress is critical. To be able to look down at the HSI and immediately know exactly where you are and what the highest obstacles are around you and where the safe exits are, is critical.

Always have a backdoor or a plan to find one.

Like SAS I have been caught by fog. Not at all fun and it is my worst fear in NVFR work. TS, +RA and Hail can be dealt with. When you are looking for the ground that isn't there, then that is terrifying.
How to get out.... That is a story for another thread.

It is a real shame that so many accidents occur in the US. It is a function of having the most helicopters in the world, but they are the newest and best equipped.
The US weather radar system is superb and when was the last time you guys did an NDB?

[SASless]

Life goes on....get another couple of helicopters....hire another couple of pilots.



Rescuers continued to search Tuesday for the last victim of a helicopter crash which killed at least one person when it went down in the Potomac River late Monday night south of Washington, D.C.

It was the second crash in less than a week for LifeNet/Air Methods Corp. of Englewood, Colo., which owns and operates medical choppers to transport patients, said Ellen Engleman Conners,
chairwoman of the National Transportation Safety Board, which is investigating the crash. Another LifeNet helicopter crashed Jan. 5 in Faulkner, Miss., after apparently hitting some trees, she said.

That pilot was killed. Conners said this is the 11th crash of a medical flight in the past year, and 34 people have died.

"There is a significant spike (in these accidents) over this past year, and it is a significant concern," Conners said. "These
flights try to save lives; when you have a double risk, it's a concern."

For all you EMS pilots out there.....here is a really good analysis of EMS accident rates by Susan Baker of John Hopkins Center...titled "Angels of Mercy or Angels of Death". I strongly reccommend viewing her presentation....very well done.

The link is www.dsls.usra.edu/20041026.pdf



Some startling numbers....

82% of fatal EMS crashes occur at night...

38% of EMS flights are at night....

50% of EMS crashes at night are fatal crashes...

34% of EMS fatal crashes are after dropping off the patient...and heading home

1 public use EMS aircraft crashed compared to 45 commercial aircraft (commercial pressure here you think?)

[Gomer Pylot]

1 public use EMS aircraft crashed compared to 45 commercial aircraft (commercial pressure here you think?)

Maybe, but it's hard to tell without more data. Perhaps it's more of a reflection of the relative numbers of aircraft involved. There are far more commercial operations than there are public use.

[Shawn Coyle]

As a very newbie EMS pilot (passed the checkride today), and one who is going to be operating in a very dark area (at least at night), it is obvious that some things would be very useful - NVGs being one of them. We're scheduled for next year...

But what about some of the enhanced vision stuff we're seeing on business jets? Why not see if some of that can't be included at a reasonable cost?

Next would be WAAS enabled GPS with a good terrain database and obstacle database. Surely someone can come up with something that's reasonble in this area, specfically for helicopters. After all, they operate in a relative small area and the extra memory for the detailed information we need should fit (if they can do the whole country for a bizjet, Southern California should be a breeze..)
And more weather stations please!

[SASless]

Shawn,

Erlanger in Chattanooga has fitted a fixed tube synthetic night vision system and has terrain warning kit as well. You might check with them and see how they get along with what they have.

What type aircraft are you herding around in the desert there doing EMS?