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HEMS - Regulations and saving life

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HEMS - Regulations and saving life

Old 2nd Jul 2005, 00:11
  #261 (permalink)  
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I would think one factor keeps showing up be it urban or rural...aircraft operating right at the very limit of performance due to combinations of operating weight, altitude, temperature, and landing site conditions...confined area landings and takeoffs for instance. Anyone that has flown Jetrangers....with the loads that EMS ops requires understands what that is all about

The latest accident posted above was in Colorado, summertime...thus hot...elevation was somewhere between 7,000 and 11,000 msl thus a significant Density Altitude. It will be interesting to see what the investigation reveals.

I think other issues like "Wires" and wire strikes are another common hazard to both urban and rural operations.

Night flight in marginal weather plainly is a great threat to rural operations....fewer ground lights...weather reporting sources further away....much easier to find yourself inside a cloud without planning on it.
SASless is offline  
Old 4th Jul 2005, 15:32
  #262 (permalink)  
Join Date: Jun 2005
Location: canada
Posts: 184
The EMS Industry

I have a few questions and concerns regarding the EMS industry, mainly in the U.S., but elswhere as well.

Being a utility pilot on lights and intermediates, I'm not personally involved unless you count the odd medevac from a logging or seismic camp, fire or construction job.

I suppose I just wonder why with all the fancy helicopters, avionics, training and preparation, we continue to see a rash of accidents and incidents that are giving the whole concept of helicopter medevac a bad name? Are these pilots just not experienced in confined area operations, risk vs reward thinking, and safety management? There is no job worth giving your life for, or even risking it for that matter - this includes medevac.

I have a feeling that people get far too emotionally involved with the task at hand, severity of the wreck, state of the patient, and make poor decisions. If you are not 100% certain that a manouver or approch/departure will work, DON'T DO IT.

Now, I realize that was a blanket statement, here in Canada, STARS (Alberta) and Canadian Helicopters (Ontario, Novas Scotia) seem to have a flawless safety record. I would just like some of you with more experience in this type of work to help me understand the differences in operations, and why there is so many accidents.

Cheers RH
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Old 4th Jul 2005, 16:18
  #263 (permalink)  
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Location: Denver, CO and the GOM
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Hi remote,

Of cour$e, we can only make gue$$e$ a$ to why EM$ in the U$A $uffer$ $uch a high accident rate.

We also canNOt seem to find a way to prevent launches into fog, sNOw and ice. How do we kNOw what to do? NOthing is as simple as it seems.
Flingwing207 is offline  
Old 4th Jul 2005, 16:47
  #264 (permalink)  
Join Date: Jun 2005
Location: canada
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Now there $eem$ to be a me$$age between the line$ in your reply... Read you loud and clear, but to that I say this.

When you're operating in winter, doing seismic, 34 seconds a bag or get the boot, on the end of a 130ft LL in lousy wx, you STILL make decisions based on safety. There is HUGE $$$ involved in these types of operation, and by their very nature they are incredibly risky jobs, so why do the EMS pilots sway to the $$$ pressure? Are the operators paid on a per patient basis? If so, the Gov't should be getting involved to stop contracts being bid that way.

Thanks RH
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Old 4th Jul 2005, 18:35
  #265 (permalink)  
"Just a pilot"
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Something like 1/3 the EMS hours flown are in the dark, and 2/3 (+) the accidents occur at night. (Excuse the spelling, I'm post-night shift), because-
Many, if not most programs, split hitches day/night. Example I work the first 4 days, 0800-2000, Mon-Thu., then 2000-0800 Fri-Mon.
NVGs are almost non-existent. I've been IIMC, nights, something like 10 times in 4 years- once in the terminal sector of the leg, at the scene LZ; twice enroute, the least exciting of all; and the rest on departure. Aided vision would have prevented each and every one.
Never, repeat, never IIMC days, on EMS. I have used alternate patient delivery points, days- arranged ground transport from a suitable, safe landing point.

We do the hardest part of our job when we're at our worst, intellectually and physically. This, in an industry that preaches safety, recognises that the pilot's the most dangerous part of the helicopter, and has practically intimate connections to the "science" of medicine.

Lest you think I'm a whiner- I started flying in '68, and did half my Viet Nam tour on missions that required low level or NOE, at night. Aside from combat casualties, the night EMS risk profile seems a spectacular match for the typical accident profile "in country."

We're all guilty of many sins of omission in the industry-
The pilots have got to start refusing runs, a major reeducation issue. The quitter profile just isn't conducive to a career in aviation...
The operators, well, scheduling, equipment- NVGs!- and training, see above first and foremost...
And the government- when exactly was the last timne anybody crashed and burned because they didn't have two days' fuel sample on hand for inspection?

Give me (us) NVGs; some, even a little, science in scheduling; and real line oriented flight training...
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Old 4th Jul 2005, 19:40
  #266 (permalink)  
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Lest I am in any way misunderstood, let me say that I have the utmost respect for the pilots, medics, flight nurses, EMT's, mechanics and support staff that are all focused on the same thing - flying the mission safely.

It is usually not the decision of any of those folks to choose a mission - the only decision they get is whether to launch it, and even then only if the WX is near minimums, or there is an issue with the aircraft.
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Old 4th Jul 2005, 22:15
  #267 (permalink)  
Join Date: Aug 2000
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Concur with your views on EMS work Devil 49.
For some reason there is too much "press on itis". The task must be done to save lives come hell or high water?

Night HEMS - a recipe for disaster methinks.

Roll on NVIS.

Thomas coupling is offline  
Old 5th Jul 2005, 09:27
  #268 (permalink)  
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I am aware of some operations that only give details of location and not patient profile. Obviously most cases of EMS are serious incidents, but surely some accident/patient status descriptions pull at 'the heartstrings' more than others. This procedure in turn leaves it to the crew to decide whether or not to proceed with the mission, and not endanger the occupants of the aircraft, without the pressure of thought to the seriously injured awaiting the medevac. Is it purely down to $'s that this is not standard procedure for all ops?
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Old 5th Jul 2005, 12:34
  #269 (permalink)  
Join Date: Sep 2004
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In the EMS system I worked in about 15 years ago it was a big no-no to inform the pilots of the patient condition prior to the pilots deciding to do the flight.
The medics would answer the Batphone and inform the pilots: " We have a request to go to Little Moosepoop."
The pilots would have been monitoring the weather from start of shift and if necessary call to confirm WX before ageeing to do the flight.
Aircraft were twin engine full IFR capable.
This was to preclude the: "There is a badly hurt 4 year old little girl who will die if you don't go!" scenario.
It worked.
We would also have informed the dispatch of any WX restrictions to flight at the beginning of shift updating as required.
" We have no restrictions to the West, North or South but flights to the East are problematic due to Volcanic ash and migrating humming birds." or whatever. Translated as " Open North, West and South, Standbye East." This was to give dispatch an idea of what to expect when they called.
Shifts were 12 hours for 14 days of a 28 day rotation. 4 Nights, 4 off, 3 days, a short change.( 24 hrs off), 3 nights, 4 days off, 4 Days then a week off aside from which you got your yearly vacation also.
We had 9 pilots - 4 crews and a spare.
It was a great job.
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Old 5th Jul 2005, 13:02
  #270 (permalink)  
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From your postings on the thread about Professional Pilots, it's quite obvious you're very ant-pilot and want to do everything you can to cut down costs on your own operation. However, that's no reason for laying in to Devil 49, who made some very sensible suggestions. It's only you who has said he wouldn't like to work a permanent night shift. He said that his list of things to make HEMS safer are scheduling, equipment and training. Whilst scheduling some pilots permanently on nights and some on days might help, it only answers one of the problems (and, yes, I've done it - I was on permanent nights on an SAR operation for 4 years). However, having done something to help with the fatigue aspect, the other is the fact that it requires additional equipment to operate more safely on rescue operations at night and it seems that NVG's are the best. But you wouldn't like that would you! Another example of "Professional Managers" providing distorted recommendations based on their own interests.
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Old 5th Jul 2005, 15:56
  #271 (permalink)  
Join Date: Jun 2005
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Some interesting answers so far, thanks.

I always have to laugh when people get so worked up over money - it's not like you're taking it with you when you go. If there is equipment out there that provides workers with a safer, more effiecent method to do their job, use it. Educate the contractor to the changing needs of the industry. I'm sure NVG wasn't readily available 30 years ago - but it is now, so the Province/State/Base Hospital should be consistantly updated as to the status of new technology.

At least that way, proactive decisions can be made that involve all parties. But, I guess when money becomes involved....

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Old 5th Jul 2005, 16:58
  #272 (permalink)  
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Gymble, you just got scratched from my Xmas card - mate.
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Old 5th Jul 2005, 17:31
  #273 (permalink)  
"Just a pilot"
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Gymble- two issues with your post:
Permanent nights are not an answer. They do away with the transition stupids, but there's still adverse effects for a diurnal animal (us) functioning at night, and it shows in many facets of health. I've not seen a study that accounts for personality in selecting night work, so that may be a factor, or a study that weighs the adverse effects of transitioning against continued nights. So, we all take our turn in the barrel. My point is that there are better ways to transition to nights than a 24 hour flip, the industry standard.
Next, even optimally swapped to nights, I'm still optically diurnal. The military have proven the advantages of aided vision at night, and it's far cheaper than what we're doing now. I work for the single biggest EMS operator in the US, and any single fatal night crash we've had is approximately the cost of equipping our entire fleet. The illusion is that the next one (fatal crash at night) somehow won't happen, and we'll just keeping doing the same thing, LA LA, LA LA, LA LA...
I'll repeat a fact- the military have proven the benefit of aided night vision. Been there and done that- Unaided, back in the day, and saw the same accident rate and profile of helo EMS now, unaided.
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Old 5th Jul 2005, 21:52
  #274 (permalink)  
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Sadly, just when an interesting, and hopefully informative thread starts to develop, some soap-box standing clown like “Gymble” comes along pushing there particular pet-hate (it would seem to be pilots) and has everybody up in arms. Mate, I don’t know what your problem is? Why do you even post here? Why don’t you go off and start your own website. Perhaps call it “Wankers in the helicopter industry”. Unfortunately, this industry seems to have a disproportionate number of these, probably second only to the entertainment industry.
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Old 5th Jul 2005, 21:54
  #275 (permalink)  
Join Date: Nov 2000
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Too often in the U.S. we find that EMS vendors attempt to shoehorn themselves into an already saturated market. In order to be competitive they are forced to cut corners and cross their fingers. To do EMS (or any other aviation endeavor, for that matter) properly is an expensive proposition. To fail to commit to doing it right is to court disaster.

The benefit to safety that NVGs offer far outweighs their cost. They are well on their way to becoming the industry standard. The capability and utility of the modern generation of goggles is vastly greater than those available as recently as just five or ten years ago. I envision that eventually, failure of an operator to provide these devices when appropriate will create a legal liability for them.

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Old 6th Jul 2005, 00:55
  #276 (permalink)  
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At the risk of incurring Heliport's wrath....that response to Devil was insulting to all of us here....if not personally at least on an intellectual level.

Your simplistic (I really should say "moronic") suggestion of working with management by say...going to permanent night shift as the best (cheapest to management) solution is complete bollocks.

What does a Night Shift worker do on his time off....keep sleeping days while the kids and wife go about their Day shift lives?

Of course not....the Night Shift worker reverts to Day shift....thus ensuring his first several days on shift are exhausting affairs.

The best preventive device is arriving at work with a "sleep bonus".....and not a sleep deficit. Taking a good long nap and arising just before heading into work is the key to making it through the shift with the least harm to your system.

I would suggest you read up on your crew rest studies before you offer such opinions.
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Old 6th Jul 2005, 01:32
  #277 (permalink)  
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Continually asking for non existant data to support NVG is the usual tactic of the naysayers.

Who keeps statistics on lives that would have been saved if .... xxx..... had been used? (insert whatever bit of equipment you are trying to justify). The truth is that no one keeps stats on how many times the aircraft was saved because XXX was fitted. When was the last time you heard how many lives were saved because we have IFR capability in helicopters? How can we keep such statistics for NVG if people doing the job are not qulaified on them and are therefore unable to asses the impact?

How about reversing your rhetoric:
1. Using statistics, please justify why your organisation does not wish to provide safety equipment in service for more than 35 years.
2. using statistics, please show the 30 plus (and growing month by month) civil operators currently using NVG on EMS/SAR in the US that they are completely mad for spending so much money? Then include the hundreds of public use operators. Then the 4 NZ operators. Then the Swiss, Canadians, Norwegians, etc, etc.
3. Please justify why all those operators are so wrong, and you are so right. With cold hard facts of course.

What you are looking for is some sort of SUBJECTIVE reason to adopt NVG. Well, the recent FAA sponsored task force looking at helicopter accidents noted the following common thread amongst night EMS accidents:
A. All fatal accidents involved VFR aircraft at night.
B. None were accredited by the Comission on Accreditation of Medical Transport Systems, a body dedicted to assisting EMS operators to offer a quality system.
C. None were using NVG or other NVIS.

Or, maybe you are looking for economic return because safety is just a secondary concern. How about NVG reducing the time taken on EACH night mission where VFR is used? NVG arrivals to an accident site can be literally 20 minutes quicker. Each visual approach will shave minutes off operating times.

Lastly, you ask two crucial questions and here is what I think:
Yes, we will able to do current work more safely.
Yes, we will be able to save more lives than we currently do, BUT not because of reduced weather. You may notice that no where in the world (yet) are night weather minimas lowered for NVG. NVG will save more lives in three ways:
1. Allow rescue in more difficult terrain than is currently safe with a nitesun,
2. Allow more timely rescue and therefore reduce medical intervention time due to the ability to arrive quicker on scene, and search areas with ease,
3. Reduce the incidence of CFIT; our industry's biggest killer.

But you know what really gets forgotten? It's the poor bastard that gets injured in a remote area and lies there for hours in agony waiting for medical help while we stuff around doing exhaustive map recces, approach plans, calculating descent LSALTS, destination LSALTs, etc, etc to facilitate nitesun ops, only to find we can only land kms away and have to proceed on foot instead of launching with a NVG visual recce and landing right next to him. Stats? That happened last week in Sydney. Well over 4 hours to get help to him: would have been 1 hour with NVG.

If ever faced in with a similar situation, lets hope your mother, father, partner, son, daughter, etc understands your needs for data and cold disspassionate discussion.
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Old 6th Jul 2005, 05:55
  #278 (permalink)  
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Mmmm.... I believe I have to wholeheartedly agree with you!

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Old 7th Jul 2005, 16:17
  #279 (permalink)  
"Just a pilot"
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Remote Hook;
Professional detachment and concentration on the job are personality traits that are very useful in EMS.

As has been posted, most operators "compartmentalize" flight info. There's only one interdiscipline responsibility- I am required to honor any expression of reservation, the "three to go rule." I have no idea what kind of patient I'm being requested for, other than a location and a destination- which is a clue- it's intra-facility. My acceptance of dispatch is purely "can I get there and to the receiving facility" while maintaining company policies. This isn't a job to take a "look-see," as that could delay the patient receiving definitive care. If I'm not reasonably certain I don't accept dispatch. Period.

Once enroute, the medical crew is briefed on the patient and the LZ, if it's a scene. I'll listen, but I let the med crew handle this end. They speak "emergency services" and know the person talking.

Patient loaded, I'm perfectly comfortable letting the med crew handle the patient care. I'll ask if there are any flight considerations, but that's it. If things go to heck, I'll present any alternatives available, and abort the run. Period. Again, this isn't a job for "look-sees," timely transport is the first duty.

You're obviously not flying the line. My peers and I, who do the job, are indeed required to "to work in the conditions that require NVGs."
Here's a scenario- three million dollar helicopter; 4 occupants at two million dollars liability each; eleven million dollars. Divide that by $85,000 (average estimate) cost of complete NVG ship-set, yields 129 installations. One accident, no lawyers, no estimate of loss of our "brand value," pays for the fleet, even assuming the company doesn't find a way to do it cheaper.

That accident will occur, no matter what else changes in the industry: All twins; All multi pilot; All IFR, all the time; As long as helo EMS does night off-airport work. That's the major killer.
If statistics aren't persuasive, here's some anecdotal info-
I can remember being IIMC 10 or so times at night: Once on approach; twice enroute (the least memorable cases, so this estimate is the least valuable); and the rest on departure, including two airport takeoffs. All could have been avoided with NVGs.
There is no discussion possible of the advantage of aided vision in off-airport landings at night. I've done them under flares; I've done them with zillion candle power lights; and I've done them dark, with nothing but natural light, unaided (combat)- and aided vision is so far superior that argument displays ignorance.

The choice the air EMS industry faces is this- NVGs or airplanes only, at night.
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Old 7th Jul 2005, 19:35
  #280 (permalink)  
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Hear hear Devil....
Thomas coupling is offline  

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