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HEMS - Regulations and saving life

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Old 7th Oct 2002, 22:19
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Cool

TC is 100% wrong: jeopardise is spelt with an ‘S’ in the UK. Only our colonial friends have a love affair with Zeees!!
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Old 7th Oct 2002, 22:37
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Cool to Q Max!

I understand what you are saying.

I was referring to daily EMS op's rather than extraordinary situations outside of daily charter/ air taxi/ e.n.g( some few examples)...... op's!

D.K.
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Old 8th Oct 2002, 03:35
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.....and your Aussie kinfolk have a thing with "Zeds".....and the point is??? Just like some folk insist upon putting a "Shed" into Sked-ule! We are all, just simply separated by a common language!
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Old 9th Oct 2002, 06:05
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Cool

ah so very interesting, psssst,psssst , yah come here, bit closer,
I'll put som more fuel on fire and see what will happen hihi..
http://www.canadianaviation.com/cgi-...c;f=8;t=000291
read and enjoy. The actions of the crew let to the survival of the victim. Excellent work I woud say
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Old 9th Oct 2002, 13:46
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Q Max, or anyone for that matter....

Right, so it's that worst case, 9/11 scenario. While flying by the tall burning building in your 5 place helo you see a small group of survivors on the roof and decide to be the hero of the hour. Swooping down, you land on the roof to find there are 6 of them. Are you going to fit them all in? bit of a squeeze, but hey, it's an exceptional situation, what's the problem, you can already see the headlines.............
Now, alerted by the sound of your rotors, 4 more appear, then another dozen all clamouring to get aboard. Now you have a crowd of thirty plus all stood closely around your burning and turning, 5 place helo demanding one of the 4 remaining seats. Women and children first? (I don't think so!!) Are you going to be able to reason with a panicking crowd? Be able to tell them that you can only lift 6 and that you'll come back in a while for the rest? What's going to happen when you pull pitch and some of the more desperate cling to your skids? How long before someone catches the tail rotor with their head? How long before one of those "un-familiar with helicopter" passengers pushes down on the collective?

Yes, or course we all like to think that we would "do what had to be done" when the need arises. One or two survivors, nice big obstruction free roof, big twin engine helo, experienced well trained crewman down the back, no panic...... Well done Captain, home for tea and medals.

The alternative scenario is the stuff of nightmares.

If you have not thought this one through already then do so while you have the chance and before you are called upon to do it for real.
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Old 9th Oct 2002, 17:19
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TC you are right...

.... that is where we differ.

Your arrogance to assume that if your not wearing the right hat you are unable to make those judgement calls (assess the factors neutrally and make the appropriate decision) is characteristic of a certain unjustified confidence which was not deprogrammed from you when you left the previous employer who required it. - If you follow my insinuation....

It might be better judgement!

And are you seriously suggesting that (for example) to save a life under circumstances that legally would require two engines should not be done? (...all other factors out of the equation). When quite obviously the risk derived from the engine arrangement is insignificant.

I am not unhappy about the two occasions in which I saved lives.

Fortyodd: yup you are also right. There are many factors which need to be dispassionately considered. I'm just suggesting that wearing the hat that TC wears does not (neccessarily) confer upon you the neccessary judgement.

TC: the Sikorsky rescue prize winners burned their (required) reserve - would you lock them up?
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Old 9th Oct 2002, 18:36
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Girls, girls, come now.....what's in a spelling?


jeop•ard•ize (BrE also -ise) /depdaz; AmE -prd-/ verb [vn] (written) to risk harming or destroying sth/sb: He would never do anything to jeopardize his career. (OUP English language teaching dictionary).
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Old 10th Oct 2002, 18:53
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Cool In the UK.....

Within the UK EMS is performed principally by Air Ambulance Units.
All taskings must come via a regional Ambulance Service control centre to satisfy the legalities of claiming exemptions under the Air Navigation Order, Rules of the Air and JAR-OPS where operations operate under it.
An emergency helicopter flight which proceeds directly to the scene of the incident/accident is known as a primary mission.
For these taskings, more correctly known as HEMS (Helicopter Emergency Medical Service) taskings, exemptions from the ANO to permit low flying for recon, approach and take off over congested areas, flight in closer proximity to 3rd parties & reduced flight visibility.
Relaxations may also be applied regarding aircraft performance providing deviation from optimum performance is for the shortest possible period.
These dispensations may only be claimed where life is percieved as being lost and "where immediate and rapid transportation" is required.
If immediate and rapid transportation is not neccessary and the injury/illness is not felt to be life threatening an exemption may not be claimed and therefore the helicopter may only alight and depart from areas which do not require the pilot to claim any dispensations, or from pre-surveyed landing sites within the Helicopter and Hospital Helicopter Landing Site guides.
Where this is the case the tasking is more correctly referred to as an Air Ambulance Tasking.
These flights are subject to normal public transport rules and performance criteria.
Because of the definition of a HEMS task as being one in which the helicopter proceeds directly to the scene of an incident, if a casualty has been moved from the accident scene to another location deemed to be more suitable for helicopter alighting, any attempt to land there will not permit the pilot to use dispensations and may be impossible to perform legally.
Similarly, when landing at hospital sites public transport performance must be maintained unless the patients condition is deemed to be life threatening.
Occasionally the only way to do so it to land at larger sites permitting a flight profile which is safer in the event of a forced landing.
As someone remarked above, it is not good practice to bring more casualties to an incident, however there is a disturbing trend amongst Ambulance Services to respond HEMS helicopters to trivial complaints and then place the crews under moral and ethical pressure whether to breach the rules established for their safety and that of the patient and others.
Frequently, this will occur because if not lifted the patient faces a long and distressing wait in a field for a land ambulance.
HEMS crews work hard to keep themselves and others safe but there is inherent risk in flying, which those who inappropriately task these resources do not worry about because they just want to clear up jobs and they are not risking their life and license when it all goes wrong trying to lift a broken ankle of a football pitch....................
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Old 11th Oct 2002, 10:46
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Zaplead

Your post brings up a what I perceive to be one of UK HEMS bigger problems. If you ask ten UK EMS pilots how and when they are allowed to apply the available exemptions you will get at least five different views, possibly ten.

One of the confusions is created by the pre-JAR terminology of a Primary Mission. This term, to the best of my knowledge, is not recognised under JAR but as you suggest enabled the following situations-

1. Call to a collapse in a city street, 2 P.M. outside pub - we could apply every exemption under the sun, land in the street cause loads of disruption etc. etc. despite being 80% sure that this was a person who had five too many drinks in the pub. That said, there is 20% chance that this is a life threatening collapse so we could do it. (Yes, I know a wise man will land in the large factory site 800m up the road and get the medics to hitch a lift, but I'm talking about what the rules say I can do!)

2. Call from road ambulance crew to assist them with a patient in a city street who has been hit by falling scaffolding pole. Patient has massive head and chest injuries an airway problem and possible spinal injuries - he needs to be in a trauma unit now! During the ten minutes that we will take to travel to the scene, the road crew will package the patient and transport him to a large factory site 800m up the road suitable for our landing. -"I am very sorry road crew, but by loading your patient onto the vehicle and conveying him up the road you have turned this into a secondary mission - I am now unable to land at an unsurveyed landing site in a congested area to pick him up. Please feel free to turn round and drive four miles through the traffic jam to a pre-surveyed secondary site"

Thankfully, JAR does away with Primary, Secondary and Tertiary (inter-hospital) missions and splits it into HEMS and Air Ambulance where HEMS is a response to a location at which a person is in urgent need of medical treatment etc. (I do not have the full definition in front of me so please don't savage me for not quoting it) and Air Ambulance is a routine movement of a patient, usually pre-planned, carried out to normal AOC criteria. The term "Life Threatening" is not used within the definitions although it does still appear in CAA exemptions.

I feel very strongly that because EMS pilots are, by the very nature of the operations, isolated from each other we are diverging in our understanding and interpretation of the rules (with all of us convinced that we have the correct perception of them).

I would be a very happy man to see a conference organised involving EMS line pilots, Aircrew Paramedics etc from around the U.K. to discuss the future but I suspect we all work too many hours to attend.

Cheers

TeeS
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Old 11th Oct 2002, 11:02
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Tees: nail on the head...excellent posting, if I might say so. The bottom line is that the insurance lawyers have got their teeth into this making it an absolute minefield....

You're damned if you do and you're damned if you don't...

It remains to be said, that the commander gets it squared away in his head, gets his employer on board too and has a quiet word with his flight ops inspector, so that they are singing from the same hymn sheet

Q Max: I think you'll find that when I was in the mil, a little word called "attrition rate" and a statement at the front of JSP 318 saying "overide the rules provided you act in the exigencies of the service"...had a lot to do with how I operated within my SAR role.
This culture does not exist in civvy street...thankfully. There are rules, don't break them, because big brother is no longer there to protect you. For once, you have to take on your own responsibilities. Why do you think more and more pilots are taking out third party insurance?

You have to think about yourself standing in that box staring at experts from the CAA / insurance / AAIB / Barristers, and be able to fend off their questions, any one of which could sink you without trace!
Do you HONESTLY know the rules. inside out, or do you really think that by making front page news as a hero, you'll be let off because you're a goodie?

You mentioned, the Sikorsky crew...I did make it quite clear that SAR crews were exempt from my deliberations.

JeapordiZZZZZZe
StandardiZZZZe
LobotomiZZZZZZZe.


ZZZZZZZZZzzzz

Last edited by Thomas coupling; 11th Oct 2002 at 11:15.
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Old 11th Oct 2002, 13:17
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Ahh - litigation. The great leveller.

What would you do if it was your son on the roof TC?

Unfair question maybe, but, what..........?
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Old 11th Oct 2002, 14:12
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TC
"overide the rules provided you act in the exigencies of the service"...had a lot to do with how I operated within my SAR role. This culture does not exist in civvy street...thankfully.
Why "thankfully"?
Wouldn't it be better if the law in civvy street was that 'operational necessity in emergency circs' (or similar words to cover lifesaving or recovering a sick/injured person) be a complete answer to any whinging/prosecution by the CAA?
And a complete answer to the insurance companies?

I agree with you the 'hero if you bend the rules and it works' and 'damned if you bend them and it doesn't' is a problem - but that's the fault of the system.
I admit I admire people who us their own judgment and ignore the rules to try to help others and think I would if the necessity arose. Breaking the rules doesn't mean you're not flying safely because too many of our rules in the UK are far too restrictive anyway.
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Old 12th Oct 2002, 01:00
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Can't you see? That's the problem. In this day and age where litigation is second nature, operators have to protect themselves. Dare I say it, the CAA's primary role is to promote safety on all fronts and this is right down their alley. They will eat you for breakfast, if only to set an example.
The Home Office has reminded all C Constables that their aircraft are not in the rescue role and diversions from the rules will not be tolerated: FACT. If you don't believe me ask any emergency service pilot where it is laid down that they can step outside the limits to carry out a life threatening rescue (authorised by the C Constable/Health authority). It's not, because they can't, it's against the law!

Why do you think police cars no longer chase high speed stolen vehicles. It's because they have a "duty of care" to others (the public) and of course they'll be sued off the face of the earth if they continue to cause collateral damage in so doing. It is no longer the environment where you can bumble into a rescue because you think you're leading the moral cause. There is NO circumstance where you can knowingly place your aircraft in a position where there is a serious risk to third parties.

In response to the emotional blackmail from twist grip:

In such circumstances where I am confronted by something as unique as that of rescuing my family by using the helo I'm flying; God help me if this happened, because I would have to look deep inside myself. I would be prepared to lose my job over it, no question, but could i live with myself if I killed someone else in the process, as well as fail to rescue my family? What an impossible dilemma A no win situation.

I'm faced with situations similar to the thrust of this topic, on occasion in my present role. We did 150 HEMS trips last year. We didn't go to some because of the very reasons I'm discussing here. The risk assessment was too high unfortunately for the victim, I'm sad to say. But I'm not in the job of being a hero, I'm trying to do the job to the best of my ability within the confines of the regs. That's legislation for you - dispatched by the authorities - on behalf of the public.

If we don't like it - change it.
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Old 12th Oct 2002, 10:56
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TC
I'm not missing the point, I was making one.
At the moment, Police/EMS pilots are at risk if they break the regs and something goes wrong. With a petty aviation authority like ours, there's a good chance some small-minded type in Enforcement or Prosecution will want to prosecute. And the UK is fast going the American way of people wanting to sue for everything under the sun.
My point is that the law/legislation should be changed so emergency services pilots are not at risk when they break regs in the course of a rescue/urgent recovery.
(I have always respected and admired guys who ignore the rules in order to carry out a rescue and think/hope I'd have the courage to do the same if the circumstances made it necessary.)

But, in your earlier posts you've repeatedly implied breaking rules = not flying safely. That's what I think is plain daft.
You seem to equate breaking/bending the rules with endangering the a/c or other people. One doesnt' follow from the other. Many, if not most, of our rules are so stupidly restrictive that the only danger involved is the danger of being prosecuted.

You say "The rules aren't there for you to 'bend' and then expect to get away with after a phone call to the CAA. "
Well, they should be, and the phone call would be enough if the law was changed as I'm suggesting.

Last edited by Hoverman; 12th Oct 2002 at 11:06.
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Old 12th Oct 2002, 11:46
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What a chilling thought....ringing up the CAA....saying oh by the way dear chap....why just yesterday I tossed yer rule book out the windy.....made like that American singer...what was his name...Sinatra....and errrr....yes...these were the circumstances and this is why I did what I did....WHAT? You mean that regulation printed in Version 8954, dated yesterday, but not promulgated yet....denies me dispensation for said act and you must make a voluminous report about my violations and see the appropriate punishments are applied.....HOW MUCH, FOR HOW LONG? Or I can get a barrister?

I like the American way....do said sinful act or acts......and get on bent knee....pray forgiveness and ask for divine intervention (please lord, strike the FAA both blind and deaf for a while ?) and when confronted by the video tape....continue to insist that is not you and that it must be your idiot brother!
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Old 12th Oct 2002, 12:35
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TeeS: My HEMS exemption, issued by CAA, applies "when engaged in HEMS" as defined in JAROPS 3.

That JAROPS definition makes no mention of "proceeding directly to the scene of an accident" or" response to a location" as mentioned by you and Zaplead. Your JAROPS purpose is to "facilitate emergency medical assistance, where immediate and rapid transportation is essential" So nothing to stop you landing by that ambulance in the large factory site. The HEMS definition is quite clear.

However, to satisfy the CAA exemption requirement "life is perceived as being lost" still applies if you cannot acheive Group A performance during landing or takeoff.

So how do the air medics apply that rule? Fractured wrist? perhaps not. Tib and fib? maybe. Femur, possibly? 80 yr old hypothermic? Suspected(but not confirmed)broken neck? Not clear at all!!

TC has got it right. Damned anyway!
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Old 12th Oct 2002, 13:47
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TC ...

NOW you are making sense and I (almost) entirely agree with you!

There is a danger in the UK that people cosider themselves safe if they are obeying the rules. This is not necessarily true - and their judgement is diminished by believing they are somehow magically protected.

Common sense and judgement are still required to fly safely !
Obeying the rules alone will not save you.

... and yes of course that means saying NO to things when no one else can see why - especially 'since its legal' !
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Old 12th Oct 2002, 15:31
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Bertie
I think you have misread my posting, the examples I gave referred to the pre-JAR system which split missions into Primary (responding to the scene), Secondary (meeting an ambulance) and Tertiary(inter-hospital) missions and did not take into account the patient condition.

JAR has simplified and clarified the situation, however my point was that confusion still exists because people in the industry continue to use pre-JAR terminology.

TC, thanks for the kind comments.

Cheers

TeeS
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Old 13th Oct 2002, 00:08
  #39 (permalink)  
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Well well now, there are some hot heads out and about now aren't there....

Here is some basic math:

4 > 1

Don't risk 4 lives to "maybe" save one life..it's just bad math.

...unless of course you are trained, trained, trained as a rescue pilot flying equipment suitable for a rescue mission with back-end crew members who are rescue specialists with rescue training. If you are an EMS pilot, remember that you are a fast ambulance driver capable of doing many things but first and foremost responsible for conducting flight in a safe manner with the utmost respect for the lives of your crew and within the constraints of your national air regs.
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Old 13th Oct 2002, 09:19
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I agree - until the last nine words.
Provided all your other factors are satisfied, I wouldn't criticise someone for flying outside the contraints of the national air regs.
I don't buy this idea that flying within the regs = flying safely, and flying outside the regs = endangering.

As I've said, if the regs prevent a job being done which could be done safely then the law is an ass and ought to be changed.
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