HEMS - Regulations and saving life
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Robbo Jock
I've always understood that children aren't taken to a specialist children's hospital unless there's a good reason, but I may be wrong about that. What I do know is that Birmimgham Children's Hospital is nationally (and internationally) renowned so the reference to 'country' in the report may not be a typo.
"Or is this a disgruntled manager about to lose part of their empire empire deciding to blame the CAA and pull the 'children may be affected' ploy "
Apart from genuine concern for the children, why would hospital managers be concerned about whether they are brought in as quickly as possible rather than via another hospital by road transfer?
empire?
Do you think 'empire' might be over-stating it just a little? It's a helipad.
deciding to blame the CAA
Deciding? Was the helipad was going to be closed anyway?
the 'children may be affected' ploy
There's a clue in the name of the hospital.
budget for next year?
How will it affect their budget? Ah! I think I've just worked out where you're coming from. If some of the 40 children die in Accident & Emergency at the first non-specialist hospital, or during the road transfer, Birmingham Children's Hospital treats fewer patients, therefore proportionately lower budget next year. Is that it?
I see Air Ambulance operators have also called for action to save the helipad. Why would it matter to them which hospital helipad they use - unless of course they have an informed and genuine concern for the patients?
Like you, I'm not a professional pilot and not qualified to judge whether the regulations are reasonable or OTT cautious. I always attach a lot of weight to the opinions of the professionals out there doing the job because they're in a better position to judge than anyone else.
I've always understood that children aren't taken to a specialist children's hospital unless there's a good reason, but I may be wrong about that. What I do know is that Birmimgham Children's Hospital is nationally (and internationally) renowned so the reference to 'country' in the report may not be a typo.
"Or is this a disgruntled manager about to lose part of their empire empire deciding to blame the CAA and pull the 'children may be affected' ploy "
Apart from genuine concern for the children, why would hospital managers be concerned about whether they are brought in as quickly as possible rather than via another hospital by road transfer?
empire?
Do you think 'empire' might be over-stating it just a little? It's a helipad.
deciding to blame the CAA
Deciding? Was the helipad was going to be closed anyway?
the 'children may be affected' ploy
There's a clue in the name of the hospital.
budget for next year?
How will it affect their budget? Ah! I think I've just worked out where you're coming from. If some of the 40 children die in Accident & Emergency at the first non-specialist hospital, or during the road transfer, Birmingham Children's Hospital treats fewer patients, therefore proportionately lower budget next year. Is that it?
I see Air Ambulance operators have also called for action to save the helipad. Why would it matter to them which hospital helipad they use - unless of course they have an informed and genuine concern for the patients?
Like you, I'm not a professional pilot and not qualified to judge whether the regulations are reasonable or OTT cautious. I always attach a lot of weight to the opinions of the professionals out there doing the job because they're in a better position to judge than anyone else.
Helicopter Pilots Get It Up Quicker
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Unfortunately the subject of aermedical transport - both routine and emergency response - is a VERY political/money based decision here in the UK.
Its difficult for me to say what I really want to because of my position! But the bottom line is £££ come before patients - hence no formal NHS funding - be it for air ambulances or hospital helipads.
Another example of this penny pinching is the (reported) review of the long standing arrangement between Sussex Ambulance and Sussex Police where a paramedic flys on a full time basis with the police asu. Sussex ambulance bosses are now 'auditing' to see if the paramedic should be moved elsewhere during busy periods and leaving Sussex without paramedic air support, (except SAR of course).
PW
Its difficult for me to say what I really want to because of my position! But the bottom line is £££ come before patients - hence no formal NHS funding - be it for air ambulances or hospital helipads.
Another example of this penny pinching is the (reported) review of the long standing arrangement between Sussex Ambulance and Sussex Police where a paramedic flys on a full time basis with the police asu. Sussex ambulance bosses are now 'auditing' to see if the paramedic should be moved elsewhere during busy periods and leaving Sussex without paramedic air support, (except SAR of course).
PW
Jellycopter
“Rule 5.
If said helipad fails to meet new requirements it still should not affect life-saving flights. Rule 5 will be the 'critical' rule here and crews are absolved from adherance of Rule 5 for the purposes of saving life.”
Unfortunately, we do not just have to comply with the ANO. Each hospital landing site that we wish to utilise, whether for HEMS or Air Ambulance is listed in a company landing site guide. We are then granted an exemption from various aspects of rule 5 when operating to that site. If a HEMS pilot wishes to utilise the “for the purposes of saving life” clause in rule 5, then I believe he should do it in the knowledge that he might require the services of flying lawyer!
Robbo Jock
“Does the Childrens Hospital actually need this helipad? There's talk about the 'golden hour' after an accident; how does this differ from children to adults ? If there are other casualty units "around the city" (presumably therefore only within a few minutes flying time of each other) each of which can stabilise accident victims (adult or child) within the golden hour, does having this additional one actually help?”
Yes, frankly the treatment of paediatric trauma is hugely different from that of adults, hence the trauma unit at Selly Oak in Birmingham does not take patients under 16 years of age. The majority of children taken to this unit by air, have been involved in pedestrian RTA’s and have either multiple injuries or isolated head injuries.
The Golden Hour actually refers to the time from initial trauma to reaching ‘definitive care.’ What defines ‘definitive care’ depends on the injury; in one case it might be an orthopaedic surgeon at a general hospital, in an other, it might require the intervention of a neurosurgeon. In my opinion, the term ‘golden hour’ is overused, if a patient is going to die without appropriate treatment in 23 minutes then it surely becomes a ‘golden 23 minutes.’
(Please note: the opinions expressed are those of the author, not necessarily those of his employers or the NHS!)
“Rule 5.
If said helipad fails to meet new requirements it still should not affect life-saving flights. Rule 5 will be the 'critical' rule here and crews are absolved from adherance of Rule 5 for the purposes of saving life.”
Unfortunately, we do not just have to comply with the ANO. Each hospital landing site that we wish to utilise, whether for HEMS or Air Ambulance is listed in a company landing site guide. We are then granted an exemption from various aspects of rule 5 when operating to that site. If a HEMS pilot wishes to utilise the “for the purposes of saving life” clause in rule 5, then I believe he should do it in the knowledge that he might require the services of flying lawyer!
Robbo Jock
“Does the Childrens Hospital actually need this helipad? There's talk about the 'golden hour' after an accident; how does this differ from children to adults ? If there are other casualty units "around the city" (presumably therefore only within a few minutes flying time of each other) each of which can stabilise accident victims (adult or child) within the golden hour, does having this additional one actually help?”
Yes, frankly the treatment of paediatric trauma is hugely different from that of adults, hence the trauma unit at Selly Oak in Birmingham does not take patients under 16 years of age. The majority of children taken to this unit by air, have been involved in pedestrian RTA’s and have either multiple injuries or isolated head injuries.
The Golden Hour actually refers to the time from initial trauma to reaching ‘definitive care.’ What defines ‘definitive care’ depends on the injury; in one case it might be an orthopaedic surgeon at a general hospital, in an other, it might require the intervention of a neurosurgeon. In my opinion, the term ‘golden hour’ is overused, if a patient is going to die without appropriate treatment in 23 minutes then it surely becomes a ‘golden 23 minutes.’
(Please note: the opinions expressed are those of the author, not necessarily those of his employers or the NHS!)
There are no limits
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Well done the CAA
At last, some good may have come out of the Belgrano (For our overseas viewers, this is the CAA building at London, Gatwick).
For years our HEMS pilots have been forced to make dangerous approaches to many landing sites in this country. I believe that Birmingham Children's is one of these in that you have to land in the street outside, it first having been closed by the Police.
I have never landed there but I have landed at Selly Oak, which must rate in the Top Ten Worst. Having flown most of the HEMS aircraft in this country, I have my own hit list, do you?
Its about time the CAA forced the hand of the Bliar Government. Ultimately the only way forward is a helipad with DIRECT ACCESS to A & E / ER. Too many times have I had to wait with a VSI patient while an Ambulance turns up to take my patient from the helipad to the A & E Department. Why are we still doing this?
Unfortunately most Governments (especially this one) have a tombstone mentality. So children will have to die before something gets done. Lets hope its not mine or yours.
Remember that lifesaving advice "Never let emotion get in the way of good judgement."
For years our HEMS pilots have been forced to make dangerous approaches to many landing sites in this country. I believe that Birmingham Children's is one of these in that you have to land in the street outside, it first having been closed by the Police.
I have never landed there but I have landed at Selly Oak, which must rate in the Top Ten Worst. Having flown most of the HEMS aircraft in this country, I have my own hit list, do you?
Its about time the CAA forced the hand of the Bliar Government. Ultimately the only way forward is a helipad with DIRECT ACCESS to A & E / ER. Too many times have I had to wait with a VSI patient while an Ambulance turns up to take my patient from the helipad to the A & E Department. Why are we still doing this?
Unfortunately most Governments (especially this one) have a tombstone mentality. So children will have to die before something gets done. Lets hope its not mine or yours.
Remember that lifesaving advice "Never let emotion get in the way of good judgement."
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Hi Helinut
having spoken to the guys at pas about where an air ambu can land on shouts (this discusion followed an RTA in shrops. during my training at pas) is what you say about rule 5, that although HEMS pilots can deviate from group A to i think its group B) please excuse if i am off the plot a little, even if the patiant due for recovery is a life threatening case. that he ( the Pilot) could still be prosecuted by the CAA if they so wished.
the guys did advise that if the a/c when on the ground ( the Crew) found that the patiant was not of such nature ie life threatening the a/c must be put back into its correct profile . i e under or on weight take off profile as the book etc before it can lift from the incident.. Rule five seemed reading first that it was a cover for the pilots but it seems this may not be the case.
Considering that the Pilot is only doing his job this threat of prosicution hanging over his head seems a little unfair consdiering that he is only doing his job.
With regard to robbo jock as an ex fire officer example RTA Multiple casualties multi injuries
CAS evac to copthorne Hospital say 7 mins
Land ambulance takes 40 to 50 mins dependant on traffic that day, casualty air lifted lived one of the ones by land died, I think that answers you quistion. and this was about six years ago so the traffic has increased by know.
Keep up the good work guys
Sincerely
Bravo 99 (AJB)
(Slightly modified as advised by Bronx)
having spoken to the guys at pas about where an air ambu can land on shouts (this discusion followed an RTA in shrops. during my training at pas) is what you say about rule 5, that although HEMS pilots can deviate from group A to i think its group B) please excuse if i am off the plot a little, even if the patiant due for recovery is a life threatening case. that he ( the Pilot) could still be prosecuted by the CAA if they so wished.
the guys did advise that if the a/c when on the ground ( the Crew) found that the patiant was not of such nature ie life threatening the a/c must be put back into its correct profile . i e under or on weight take off profile as the book etc before it can lift from the incident.. Rule five seemed reading first that it was a cover for the pilots but it seems this may not be the case.
Considering that the Pilot is only doing his job this threat of prosicution hanging over his head seems a little unfair consdiering that he is only doing his job.
With regard to robbo jock as an ex fire officer example RTA Multiple casualties multi injuries
CAS evac to copthorne Hospital say 7 mins
Land ambulance takes 40 to 50 mins dependant on traffic that day, casualty air lifted lived one of the ones by land died, I think that answers you quistion. and this was about six years ago so the traffic has increased by know.
Keep up the good work guys
Sincerely
Bravo 99 (AJB)
(Slightly modified as advised by Bronx)
Last edited by Bravo 99 (AJB); 9th Jun 2004 at 18:07.
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Hey Bravo 99
Don't take it the wrong way but if you read what you've written before you hit the button it could make it easier to read, and easier to work out what you're saying.
Don't take it the wrong way but if you read what you've written before you hit the button it could make it easier to read, and easier to work out what you're saying.
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I have to agree with What Limits on this. After all, HEMS and Casevac to Hospitals are a form of public transport, and helicopter landings at certain hospital sites, especially those which are able to provide special care to patients, are rather predictable in the sense that everybody knows they will take place.
So why not demand the same level of safety (for crews, patients and passers-by) as for instance in offshore flying, where flights take place to remote helidecks?
I do agree that funding for this should be provided, and I am aware of the problems there. But to accept unnecessary risks and put the burden on the crews by putting them in a "damned if you do, damned if you don't" scenario, should be out of the question.
Remember the Aussie SAR accident discussion about providing the profesionals at the sharp end with the right tools for the job?
So why not demand the same level of safety (for crews, patients and passers-by) as for instance in offshore flying, where flights take place to remote helidecks?
I do agree that funding for this should be provided, and I am aware of the problems there. But to accept unnecessary risks and put the burden on the crews by putting them in a "damned if you do, damned if you don't" scenario, should be out of the question.
Remember the Aussie SAR accident discussion about providing the profesionals at the sharp end with the right tools for the job?
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I think that we all agree that safety is the primary factor in all enviroments and especialy in this role.
having seen first hand both police and air ambulance operations its seemed clear that funding for the police operations seemed unlimited and there units where fantastically equipped but when you arrive at an air ambulance unit it was ussually a portacabin or something similar.
Why when this role/service is a key factor in saving life, is there no funding available. it seems so strange and unjust almost.
Sincerely
Bravo 99 (AJB)
having seen first hand both police and air ambulance operations its seemed clear that funding for the police operations seemed unlimited and there units where fantastically equipped but when you arrive at an air ambulance unit it was ussually a portacabin or something similar.
Why when this role/service is a key factor in saving life, is there no funding available. it seems so strange and unjust almost.
Sincerely
Bravo 99 (AJB)
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Under the Health and Safety Act 1974 it is the empolyers duty of care and obliges the employer to take 'reasonable care of those that might foreseeably be affected by his act or omissions'.
A Risk Assessment is required for , in this instance, the Heli Pad, and 'so far as reasonable practical' safety measures must be put in place.
Therefore I understand from the law that the hospital has a duty to provide a safe operating area for the helicopters, their crews and hospital and ancillary staff that are required to attend a helicopter activity.
The HSE could attend the helipad. There are sanction that can be taken against those found to be in breach of the law. They could serve a Enforcxement Notice, either in the form of an Improvment Notice or an Prohibition Notice. It would appear from my knowledge that a Prohibition Notice be served as the workplace (helipad) activly involves, or will involve, the risk of serious personal injury.
If the helipad at this hospital or one elsewhere provided for the use of helicopters delivering or collecting patients then that helipad has to be safe to use by suitable helicopter flown by suitably trained crews. Limitations in use could be due to weather, time of day, type of helicopter, proficiency of crews or a combination of these items.
So where the CAA comes into this is not clearly understood.
Are they seeking a fundamental change in the law?
£££ do play a major role in this situation and it will be a balancing act of cost of safety enhancements versus the risk of serious injury occurring.
So coming up with a 'off the shelf' requirement aint solving the problem. So a jar of prunes to the CAA. They must suffer alot from the runs!
A Risk Assessment is required for , in this instance, the Heli Pad, and 'so far as reasonable practical' safety measures must be put in place.
Therefore I understand from the law that the hospital has a duty to provide a safe operating area for the helicopters, their crews and hospital and ancillary staff that are required to attend a helicopter activity.
The HSE could attend the helipad. There are sanction that can be taken against those found to be in breach of the law. They could serve a Enforcxement Notice, either in the form of an Improvment Notice or an Prohibition Notice. It would appear from my knowledge that a Prohibition Notice be served as the workplace (helipad) activly involves, or will involve, the risk of serious personal injury.
If the helipad at this hospital or one elsewhere provided for the use of helicopters delivering or collecting patients then that helipad has to be safe to use by suitable helicopter flown by suitably trained crews. Limitations in use could be due to weather, time of day, type of helicopter, proficiency of crews or a combination of these items.
So where the CAA comes into this is not clearly understood.
Are they seeking a fundamental change in the law?
£££ do play a major role in this situation and it will be a balancing act of cost of safety enhancements versus the risk of serious injury occurring.
So coming up with a 'off the shelf' requirement aint solving the problem. So a jar of prunes to the CAA. They must suffer alot from the runs!
Head Turner
Please don't suggest HSE involvement in anything to do with helicopters - what are we going to do for jobs when helo's are re-defined as mobile buzz saws. Each one will be required to be surrounded by steel mesh safety screens. Opening the mesh will automatically activate the rotor brake which will be required to stop the blades in 0.2 seconds.
Cheers
TeeS
Please don't suggest HSE involvement in anything to do with helicopters - what are we going to do for jobs when helo's are re-defined as mobile buzz saws. Each one will be required to be surrounded by steel mesh safety screens. Opening the mesh will automatically activate the rotor brake which will be required to stop the blades in 0.2 seconds.
Cheers
TeeS
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Without trying to get myself shot down in flames. but the HSE although has an interest in safety for services such as HEMS or in my old case fire service HSE has guide lines but as the nature of the job is specific risk associated in the case of the fire service it was usual for the fire service to have and impliment specific SIPS/SOPS etc.
the service would look to the HSE for guidance but only when an incident/accident ocured did they become involved.
In the case such as this (HEMS) Instead of this being the fire service to be the specific govening body it would be the CAA .
it therefore would indicate that the CAA are at the for front of this decision i would find it strange if the HSE had any further interest other than the normal duty of care.
I may be completely wrong but i would be extremaly suppriced if this was HSE.
Sincerely
Bravo 99 (AJB)
the service would look to the HSE for guidance but only when an incident/accident ocured did they become involved.
In the case such as this (HEMS) Instead of this being the fire service to be the specific govening body it would be the CAA .
it therefore would indicate that the CAA are at the for front of this decision i would find it strange if the HSE had any further interest other than the normal duty of care.
I may be completely wrong but i would be extremaly suppriced if this was HSE.
Sincerely
Bravo 99 (AJB)
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A question for Flying Lawyer:
Have you heard any rumours (as suggested earlier in this thread) that the CAA will prosecute should a Police / Hems helicopter be used to drag someone out of a life threatening situation?
It will be interesting to see the public reaction to the video of someone losing their life, with a helicopter nearby not attempting to rescue the poor
I don't know of many crews who will standby and do nothing if they feel they can effect a rescue even if it involves a slight risk. I'm not talking about reckless flying here, just experienced crews making a considered decision
Have you heard any rumours (as suggested earlier in this thread) that the CAA will prosecute should a Police / Hems helicopter be used to drag someone out of a life threatening situation?
It will be interesting to see the public reaction to the video of someone losing their life, with a helicopter nearby not attempting to rescue the poor
I don't know of many crews who will standby and do nothing if they feel they can effect a rescue even if it involves a slight risk. I'm not talking about reckless flying here, just experienced crews making a considered decision
Helicopter Pilots Get It Up Quicker
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Probably unlikely to happen in the near future but having spent 15 years in the ambulance service I would risk my licence to save a life...
I also doubt that there are many pilots here who wouldn't do the same...
Act first and argue (with CAA) later? I would... anyone here who wouldn't?
PW
I also doubt that there are many pilots here who wouldn't do the same...
Act first and argue (with CAA) later? I would... anyone here who wouldn't?
PW
I think that treating HEMS/air ambulance as public transport ops is fraught with danger; if exceptions cannot be made for the immediate saving of life then what next. When SAR ends up in civilian hands will we not be allowed to rescue people because we cannot guarantee to be safe single engine while we winch them in? It is a question of balancing risk against benefit and unfortunately there are many for whom the risk of litigation greatly outweighs the benefit of saving lives. The HSE started out as a good idea to improve safety in the workplace but has become just another very complicated layer of bureaucracy to make getting difficult jobs done almost impossible.
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As far as I know, the HSE has nothing to do with this specific issue at Birmingham.
The problem seems to be that the new CAA Regs will prevent the helipad at that hospital being used, even though it's been used without incident for many years.
The problem seems to be that the new CAA Regs will prevent the helipad at that hospital being used, even though it's been used without incident for many years.
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I agree with Pilot wolf
if i was in that position i would risk my licence to save a life any time of the day with out quistion the safety obviously is primary for crew and A/C but the CAA I would not think twice about upseting them.
Sincerely
Andy
Bravo 99 (AJB)
if i was in that position i would risk my licence to save a life any time of the day with out quistion the safety obviously is primary for crew and A/C but the CAA I would not think twice about upseting them.
Sincerely
Andy
Bravo 99 (AJB)