New Rules for USA EMS Coming...Good News?
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New Rules for USA EMS Coming...Good News?
Safety of medevac choppers on FAA's radar
By Alan Levin, USA TODAY
WASHINGTON — Federal regulators trying to halt a deadly spate of air ambulance crashes across the nation will soon announce greater restrictions on the medevac helicopter industry, according to government and industry documents obtained by USA TODAY.
The Federal Aviation Administration this fall began a yearlong program of additional inspections of air ambulance companies and expects to impose tighter restrictions on flying in poor visibility or in mountainous terrain, the documents show. The new requirements are spelled out in FAA drafts of rule changes.
Also, the National Transportation Safety Board is finalizing a special report on the industry that will recommend more far-reaching changes. The agency refused to discuss specifics but said the changes will address safety concerns.
"It is the NTSB's job to make sure that the safest service is provided to this important industry's customers," NTSB acting Chairman Mark Rosenker said.
The helicopter industry vowed in September to lower its accident rate by 80% in the next decade. But the helicopters that ferry the sick and critically injured continue to crash at near-record levels, and safety advocates say that regulators and the industry need to do more to reduce the crashes. (Gallery: Blackhawk Rescues in Iraq)
This year, 13 air ambulances have crashed. Six crashes were fatal, killing 11 people, including a patient who was being airlifted to the hospital after a car wreck in Arkansas.
"Some of the real underlying fundamental factors are still there, and they worry me," said Patrick Veillette, a pilot and safety advocate who has studied the accidents.
USA TODAY reported in July that air ambulance crashes and fatalities per year since 2000 had more than doubled compared with the 1990s. The newspaper found that many accidents were caused by pilots who repeatedly flew into prohibited or dangerous conditions. Federal rules exempted helicopters from some of the most basic safety requirements for airlines.
Officials at the Federal Aviation Administration, which regulates the industry, say they are tightening standards. "We're moving forward in a strong, coordinated effort with industry to raise the safety bar," FAA spokesman Greg Martin said.
"The bottom line ... is we have to improve safety," said Tom Judge, safety chief for the Association of Air Medical Services, the industry's trade group.
Government guidelines that recently went into effect encourage air ambulance companies to train their pilots using the same methods credited with reducing accidents at airlines. Other actions expected soon include:
•Starting within a few months, air ambulance flights over mountains at night will have to adhere to stricter weather restrictions unless pilots have been trained to use night-vision goggles.
•Next year, the FAA will require air ambulance companies to start specialized training to teach pilots how to avoid losing control in bad weather and poor visibility — factors in many accidents.
What in the heck are they talking about here? Are they saying one can reduce night VFR weather minimums if one uses NVG's? What about Night VFR in remote areas that are not "mountainous" by definition? What about raising Night VFR weather minimums overall....or enforcing existing Night VFR minimums?
Boys...I'm gonna teach ya'll how not to lose control when you go IIMC....listen up...I will only tell you this once....and again next year on yer annual check ride. Right!
By Alan Levin, USA TODAY
WASHINGTON — Federal regulators trying to halt a deadly spate of air ambulance crashes across the nation will soon announce greater restrictions on the medevac helicopter industry, according to government and industry documents obtained by USA TODAY.
The Federal Aviation Administration this fall began a yearlong program of additional inspections of air ambulance companies and expects to impose tighter restrictions on flying in poor visibility or in mountainous terrain, the documents show. The new requirements are spelled out in FAA drafts of rule changes.
Also, the National Transportation Safety Board is finalizing a special report on the industry that will recommend more far-reaching changes. The agency refused to discuss specifics but said the changes will address safety concerns.
"It is the NTSB's job to make sure that the safest service is provided to this important industry's customers," NTSB acting Chairman Mark Rosenker said.
The helicopter industry vowed in September to lower its accident rate by 80% in the next decade. But the helicopters that ferry the sick and critically injured continue to crash at near-record levels, and safety advocates say that regulators and the industry need to do more to reduce the crashes. (Gallery: Blackhawk Rescues in Iraq)
This year, 13 air ambulances have crashed. Six crashes were fatal, killing 11 people, including a patient who was being airlifted to the hospital after a car wreck in Arkansas.
"Some of the real underlying fundamental factors are still there, and they worry me," said Patrick Veillette, a pilot and safety advocate who has studied the accidents.
USA TODAY reported in July that air ambulance crashes and fatalities per year since 2000 had more than doubled compared with the 1990s. The newspaper found that many accidents were caused by pilots who repeatedly flew into prohibited or dangerous conditions. Federal rules exempted helicopters from some of the most basic safety requirements for airlines.
Officials at the Federal Aviation Administration, which regulates the industry, say they are tightening standards. "We're moving forward in a strong, coordinated effort with industry to raise the safety bar," FAA spokesman Greg Martin said.
"The bottom line ... is we have to improve safety," said Tom Judge, safety chief for the Association of Air Medical Services, the industry's trade group.
Government guidelines that recently went into effect encourage air ambulance companies to train their pilots using the same methods credited with reducing accidents at airlines. Other actions expected soon include:
•Starting within a few months, air ambulance flights over mountains at night will have to adhere to stricter weather restrictions unless pilots have been trained to use night-vision goggles.
•Next year, the FAA will require air ambulance companies to start specialized training to teach pilots how to avoid losing control in bad weather and poor visibility — factors in many accidents.
•Starting within a few months, air ambulance flights over mountains at night will have to adhere to stricter weather restrictions unless pilots have been trained to use night-vision goggles.
Boys...I'm gonna teach ya'll how not to lose control when you go IIMC....listen up...I will only tell you this once....and again next year on yer annual check ride. Right!
EMS NVGs
PHI is getting ANVIS 9s and I find it somewhat funny at the resistance from those who have never flown with NVGs.
That is until they fly with them, then it becomes: can't fly nights without them.
Not the sliver bullet fix for US EMS, but a good start.
Maybe somebody will look at consoldiating CAMTS, AAMS, NEMSPA, and focus the energy and efforts.
That is until they fly with them, then it becomes: can't fly nights without them.
Not the sliver bullet fix for US EMS, but a good start.
Maybe somebody will look at consoldiating CAMTS, AAMS, NEMSPA, and focus the energy and efforts.
"Just a pilot"
In a nutshell, the unaddressed issues of Helo EMS-
The FAA is largely an airplane institution. Helicopters not only have different flight characteristics and demands on the pilot, we operate in a different environment- I've gone months without talking to an airport tower, for instance.
Part 135 is not useful guidance to Helicopter EMS. We're not really a charter service hired by the passenger to accomplish a flight at the passenger's wish. Yet, the guiding regulation is written with that in mind.
Helicopter EMS is not facility oriented, and the FAA is. Get forecast for a scene? I have to infer conditions, or the briefer would, and these suppositions may or may not be accurate. The pilot's response to existing, encountered, conditions is the primary determiner of safety outcomes.
The "ten hour uninterrupted rest" requirement is minimal guidance. It has no effect on safety when people are required to alternate day and night shifts without consideration of the physiological issues of the massive circadian disruptions involved.
Night vision is encouraged by the FAA's proposal. Until it's mandatory, NVGs will continue to fielded at the present glacial pace, and the industry will continue to pay for crashes because it's not required to pay to avoid them. The one real difference between day and night flying is the ability to see in the environment.
Risk assessment matrices are useful management tools. Managers should use these tools in managing pilot scheduling, equipment deployment, crew hiring and recurrent training. If the possibility of death from a bad decision doesn't sway the duty pilot's decision process, a piece of paper won't either.
Give the EMS pilot an aircraft that's equipped to handle the requests safely- now, I can be dispatched on a night scene with no more than a landing light. Provide the EMS pilot with useful environmental data in a timely fashion, and train to assess or handle the challenges. Schedule crews to minimize the circadian disruptions and the resulting loss of mental acuity.
The FAA is largely an airplane institution. Helicopters not only have different flight characteristics and demands on the pilot, we operate in a different environment- I've gone months without talking to an airport tower, for instance.
Part 135 is not useful guidance to Helicopter EMS. We're not really a charter service hired by the passenger to accomplish a flight at the passenger's wish. Yet, the guiding regulation is written with that in mind.
Helicopter EMS is not facility oriented, and the FAA is. Get forecast for a scene? I have to infer conditions, or the briefer would, and these suppositions may or may not be accurate. The pilot's response to existing, encountered, conditions is the primary determiner of safety outcomes.
The "ten hour uninterrupted rest" requirement is minimal guidance. It has no effect on safety when people are required to alternate day and night shifts without consideration of the physiological issues of the massive circadian disruptions involved.
Night vision is encouraged by the FAA's proposal. Until it's mandatory, NVGs will continue to fielded at the present glacial pace, and the industry will continue to pay for crashes because it's not required to pay to avoid them. The one real difference between day and night flying is the ability to see in the environment.
Risk assessment matrices are useful management tools. Managers should use these tools in managing pilot scheduling, equipment deployment, crew hiring and recurrent training. If the possibility of death from a bad decision doesn't sway the duty pilot's decision process, a piece of paper won't either.
Give the EMS pilot an aircraft that's equipped to handle the requests safely- now, I can be dispatched on a night scene with no more than a landing light. Provide the EMS pilot with useful environmental data in a timely fashion, and train to assess or handle the challenges. Schedule crews to minimize the circadian disruptions and the resulting loss of mental acuity.
Gatvol
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Anybody ever question why NVGs? Like maybe its too dangerous to fly unaided night (or under exisiting minimums).......
NVG flying is great and all that but there is certainly an increased accident risk with those also......
Not a problem we will solve on PPrune for sure but indeed alot of EMS types hang their butts out to do the right thing. Going that extra mile to help out someone in need is costing them.
Based on what I know of their Pay, work conditions etc, I take my hat off to them.
NVG flying is great and all that but there is certainly an increased accident risk with those also......
Not a problem we will solve on PPrune for sure but indeed alot of EMS types hang their butts out to do the right thing. Going that extra mile to help out someone in need is costing them.
Based on what I know of their Pay, work conditions etc, I take my hat off to them.
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alot of EMS types hang their butts out to do the right thing
When every pilot approaches every EMS flight with the attitude that he/she is just going out to pick up some KFC for whoever pays the bills, but that whoever pays the bills does not want to run any risk, including bad publicity, then the accident rate will decline. Operators, regulators, med crew can all do their part but any pilot who’s spring-loaded to the can-do position is a hazard in EMS operations.
Tools like NVGs can be great improvements to safety; alternatively they can be great ways to set up accidents. The only difference between the two is the pilot’s attitude: “A great way to do what I’ve always done at night but more safely” vs. “Now I can fly like it’s daylight and in conditions that would have kept me grounded before”.
Regulators can indeed greatly improve EMS safety by creating an environment that reduces and may even eliminate these attitudes, but in a manner that I feel is contrary to the American tradition of private enterprise. At the moment practically anyone with a helicopter can become an EMS operator. All that’s required is to attain Part 135 certification, then it’s between you and your (medical) clients. So there is a huge variety in standards and also the phenomenon of “chopper shopping” by health care providers. As an example, an ex-colleague of mine was killed in an EMS crash, night VFR, good visibility and ceiling but with patches of fog and/or low cloud. Would he have accepted the flight if he’d known that pilots at three other operations had already declined to go ?
The way to avoid situations like this is a system like the Coast Guard contract in the UK. The authorities set a national standard for EMS operations, including aircraft, flight (and med) crews, training and maintenance; the authorities contract one operator and one only for each geographical area; and the authorities establish an ops center that assigns flights. Private enterprise reigns during the contract bidding stage, once the contract is awarded everyone toes the line and outsiders are kept out until the next round of bidding.
What do you think, would such a system ever be acceptable in the USA?
Regulation
Some one needs to apply some sort of regulations. Friends flying in TX and AZ have been cut off on short final to scenes by other services not requested.
Also patient care becomes an issue, example: a local ambulance service needed to transport from a scene, we are 12 minutes flight time but the head of the service (private provider) called the service where his wife works, 45 minutes flight time.
The police and fire departments which cannot launch EMS were asking what he was doing by requesting the way he did. He told them we were not available.
I think the industry knows what needs to be done but will not govern itself to the extent needed. Additionally dispite the size of US EMS industry it seems that its the same few upper management that get fired and move to another service to continue the same incompetence.
We had a pilot leave the company because a Program Director chewed him out for refusing a flight (below company minimums) that another service took. I do not know what support the pilot received from the company because he gave his notice. I am sure from the reputation of the Program Director this was not the only reason the pilot left.
Only my opinion and I am sure there are very well run EMS services out there. We have a level headed Program Director that has put safety at the top of all his lists.
I would think the Maryland State Police program would be the benchmark for EMS. I think there maybe change coming in that state, with some private providers going in.
I almost thought that with Homeland Security program after 911 and the more recent hurricanes there would be a push for EMS reform and standardization. I guess the problems have not been addressed to the right group.
Also patient care becomes an issue, example: a local ambulance service needed to transport from a scene, we are 12 minutes flight time but the head of the service (private provider) called the service where his wife works, 45 minutes flight time.
The police and fire departments which cannot launch EMS were asking what he was doing by requesting the way he did. He told them we were not available.
I think the industry knows what needs to be done but will not govern itself to the extent needed. Additionally dispite the size of US EMS industry it seems that its the same few upper management that get fired and move to another service to continue the same incompetence.
We had a pilot leave the company because a Program Director chewed him out for refusing a flight (below company minimums) that another service took. I do not know what support the pilot received from the company because he gave his notice. I am sure from the reputation of the Program Director this was not the only reason the pilot left.
Only my opinion and I am sure there are very well run EMS services out there. We have a level headed Program Director that has put safety at the top of all his lists.
I would think the Maryland State Police program would be the benchmark for EMS. I think there maybe change coming in that state, with some private providers going in.
I almost thought that with Homeland Security program after 911 and the more recent hurricanes there would be a push for EMS reform and standardization. I guess the problems have not been addressed to the right group.
Thread Starter
Re: New Rules for USA EMS Coming...Good News?
In view of the new crusade to reduce helicopter accidents by 80%....we made it till the 12th....before we wrote off our first EMS helicopter for the year. Fortunately no one was hurt in the crash.
IDENTIFICATION
Regis#: 495LF Make/Model: Description: BO-105S
Date: 01/12/2006 Time: 0828
Event Type: Accident Highest Injury: None Mid Air: N Missing: N
Damage: Unknown
LOCATION
City: PONCE State: PR Country: US
DESCRIPTION
CRASHED ON A FAST FOOD RESTAURANT PARKING LOT, PONCE, PR
INJURY DATA Total Fatal: 0
# Crew: 1 Fat: 0 Ser: 0 Min: 0 Unk:
# Pass: 3 Fat: 0 Ser: 0 Min: 0 Unk:
# Grnd: Fat: 0 Ser: 0 Min: 0 Unk:
WEATHER: UNK
OTHER DATA
Activity: Business Phase: Unknown Operation: General Aviation
Departed: UNK Dep Date: Dep. Time:
Destination: Flt Plan: Wx Briefing:
Last Radio Cont:
Last Clearance:
FAA FSDO: SAN JUAN, PR (SO21) Entry date: 01/13/2006
IDENTIFICATION
Regis#: 495LF Make/Model: Description: BO-105S
Date: 01/12/2006 Time: 0828
Event Type: Accident Highest Injury: None Mid Air: N Missing: N
Damage: Unknown
LOCATION
City: PONCE State: PR Country: US
DESCRIPTION
CRASHED ON A FAST FOOD RESTAURANT PARKING LOT, PONCE, PR
INJURY DATA Total Fatal: 0
# Crew: 1 Fat: 0 Ser: 0 Min: 0 Unk:
# Pass: 3 Fat: 0 Ser: 0 Min: 0 Unk:
# Grnd: Fat: 0 Ser: 0 Min: 0 Unk:
WEATHER: UNK
OTHER DATA
Activity: Business Phase: Unknown Operation: General Aviation
Departed: UNK Dep Date: Dep. Time:
Destination: Flt Plan: Wx Briefing:
Last Radio Cont:
Last Clearance:
FAA FSDO: SAN JUAN, PR (SO21) Entry date: 01/13/2006
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Re: New Rules for USA EMS Coming...Good News?
Buitenzorg, your comment about pilots treating EMS flights "like they are going out to pick up some KFC for whoever pays the bills" is eerily prescient in light of the accident brief posted above. Crashed in a fast food restaurant parking lot...
Got to love that last reply and its timing.
The deal with the accident rate is simply dirven by the fact that there is money to be made in this business (regardless of what several management types would like for us to believe).
Where there's money there are sharks (or people of that calibre) and several programs are run that way.
There are start ups pretty much all over the USA, anywhere Ground Transport Companies decide to locate a new service with a helicopter in a previously "underserviced" area, usually utilizing the same "least cost" model that they use on wheels.
This industry shall never self regulate and I take pity on those pilots accepting jobs with programs or vendors that push continuosly for the rules to be broken (or at least for their edges to be rounded a bit).
The FAA and the NTSB have apparently no clue to what the solution is, because they just recently had out a memorandum of some sort referring to an old Army Aviation Mission Risk Evaluation model.
Maybe NVG shall be mandatory in the future, but NVGs do not constitute a cure for stupidity, they just make it more expensive.
The part 135 vendors can and will regulate their pilots, but they do nothing to regulate and "acculture" their customers who exert far more influence on the pilot than a "distant" employer.
If we need to regulate this industry, then the FAA ought to be (not more, but just be) restrictive in allowing operators to operate in the aeromedical field.
Presently the only requirement for a helicopter to be operated in the EMS field is to have Medical O2 and suction onboard, and of course a stretcher with adequate restraint of some sort.
We need influent people who can the ear of the administrator (read FAA), by influent I mean people of the calibre of Mr.Lappos (the closest example coming to mind) and others who have repeatedly proven themselves above the furball.
I am happy to fly for an IFR program and in a geographical location that allow us the alternative to continue the flight under IFR rules and land at a suitably equipped airport if need be, but several of our competitors do not have that luxury (of their own choosing) and I dread the day someone shall carve him/herself on the side of a hill or tangle with one of the ever growing mobile communication (unlit) towers, while trying to maintain VFR at night.
In the end though, it's not the aircraft or the pilot's capablitiy that is key, it's their conscience, and we cannot be in someone elses's mind to police that.
I have learnt that at my expenses.
The deal with the accident rate is simply dirven by the fact that there is money to be made in this business (regardless of what several management types would like for us to believe).
Where there's money there are sharks (or people of that calibre) and several programs are run that way.
There are start ups pretty much all over the USA, anywhere Ground Transport Companies decide to locate a new service with a helicopter in a previously "underserviced" area, usually utilizing the same "least cost" model that they use on wheels.
This industry shall never self regulate and I take pity on those pilots accepting jobs with programs or vendors that push continuosly for the rules to be broken (or at least for their edges to be rounded a bit).
The FAA and the NTSB have apparently no clue to what the solution is, because they just recently had out a memorandum of some sort referring to an old Army Aviation Mission Risk Evaluation model.
Maybe NVG shall be mandatory in the future, but NVGs do not constitute a cure for stupidity, they just make it more expensive.
The part 135 vendors can and will regulate their pilots, but they do nothing to regulate and "acculture" their customers who exert far more influence on the pilot than a "distant" employer.
If we need to regulate this industry, then the FAA ought to be (not more, but just be) restrictive in allowing operators to operate in the aeromedical field.
Presently the only requirement for a helicopter to be operated in the EMS field is to have Medical O2 and suction onboard, and of course a stretcher with adequate restraint of some sort.
We need influent people who can the ear of the administrator (read FAA), by influent I mean people of the calibre of Mr.Lappos (the closest example coming to mind) and others who have repeatedly proven themselves above the furball.
I am happy to fly for an IFR program and in a geographical location that allow us the alternative to continue the flight under IFR rules and land at a suitably equipped airport if need be, but several of our competitors do not have that luxury (of their own choosing) and I dread the day someone shall carve him/herself on the side of a hill or tangle with one of the ever growing mobile communication (unlit) towers, while trying to maintain VFR at night.
In the end though, it's not the aircraft or the pilot's capablitiy that is key, it's their conscience, and we cannot be in someone elses's mind to police that.
I have learnt that at my expenses.
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EMS night ops
I could not agree more with Helibelly. I had the privilege of of setting up the UK's first EMS operation in April 1987. When asked (by the CAA inspector) a year after we started working on the project what was the most important lesson I had learnt I replied that the probability of being sucked into an IFR scenario (inadvertant or otherwise) was very high and that if man and machine were not suitable equipped and trained then it would end it tears. We were daylight only so I'm certain that the same applies after dark.
G
G
Some interesting comments.
We do fly VFR at night, safely, and on a regular basis. Just because the UK dosn't do it, it dosn't mean it's not safe.
We will be introducing NVG's in the future as an "aid" for night missions but our minimums will not change (minimum 5kms vis with 1000ft cloud base). We currently fly a twin with 2 pilots, all IFR intruments (but not IFR certified) with 2 GPS's (1 moving map) These flights are to known helipads only.
NVG's when used with proper training will enhance safety.
US EMS safety?
-Change the weather minimums for night
-Introduce contracts for each area
-minimum eqiupment levels and training for crew incase of inadvertant IMC
-NVG's with proper training
-an EMS specific CRM training course (not just for flight crew, but management, despatchers, etc)
-a national risk management programe for all EMS operators
-making sure that all decisions to fly or not, rest solely with the PIC, based on current weather, aircraft, crew, etc.
I'm sure some of the EMS pilots on this site can add more.
Fly safe.
BM
We do fly VFR at night, safely, and on a regular basis. Just because the UK dosn't do it, it dosn't mean it's not safe.
We will be introducing NVG's in the future as an "aid" for night missions but our minimums will not change (minimum 5kms vis with 1000ft cloud base). We currently fly a twin with 2 pilots, all IFR intruments (but not IFR certified) with 2 GPS's (1 moving map) These flights are to known helipads only.
NVG's when used with proper training will enhance safety.
US EMS safety?
-Change the weather minimums for night
-Introduce contracts for each area
-minimum eqiupment levels and training for crew incase of inadvertant IMC
-NVG's with proper training
-an EMS specific CRM training course (not just for flight crew, but management, despatchers, etc)
-a national risk management programe for all EMS operators
-making sure that all decisions to fly or not, rest solely with the PIC, based on current weather, aircraft, crew, etc.
I'm sure some of the EMS pilots on this site can add more.
Fly safe.
BM
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Said before....
No easy answer as long as the US EMS system is cost recovery. If you have to do something.....
You give crews NVG's and the mangement will think that you can fly anywhere, anytime. You and I know that is not the case but they don't.
No easy answer as long as the US EMS system is cost recovery. If you have to do something.....
- Increase the minimums
- Give the pilots some inadvertent IMC training every few months
You give crews NVG's and the mangement will think that you can fly anywhere, anytime. You and I know that is not the case but they don't.
Oogle, agreed, but it is up to the pilots to say NO, and have the backing of management. We do. Our owner is also a pilot and flys shifts a couple of times a month. He understands.
