EMS Safety - Is it to be more of the same?
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EMS Safety - Is it to be more of the same?
Today’s Rotornews from the HAI informs us that US EMS operators have ordered 20 twins and 27 singles for delivery between now and 2011.
Unless it is proposed to operate the singles only during day and in VFR it is hard to see how we can look forward to a significantly improved accident record in the EMS sector of the industry over the next 20 years.
What would it take to convince operators like Med-Trans, Air Evac and their client hospitals to use only aircraft that are big enough to carry two pilots, without interfering with the mission payload, and justify the investment in proven safety devices (e.g. second engines, autopilots / flight directors, GPWS, flight data recorders, sufficient fuel to have IFR reserves, etc.)?
As I see it, we are in for more of the same in terms of accidents involving aircraft operating in the EMS role in the USA.
Unless it is proposed to operate the singles only during day and in VFR it is hard to see how we can look forward to a significantly improved accident record in the EMS sector of the industry over the next 20 years.
What would it take to convince operators like Med-Trans, Air Evac and their client hospitals to use only aircraft that are big enough to carry two pilots, without interfering with the mission payload, and justify the investment in proven safety devices (e.g. second engines, autopilots / flight directors, GPWS, flight data recorders, sufficient fuel to have IFR reserves, etc.)?
As I see it, we are in for more of the same in terms of accidents involving aircraft operating in the EMS role in the USA.
Hidden, unless we are talking Hospital based programs or hospitals that own their own Pt.135 certificate, I am afraid the future of HEMS in the USA is slated to go Single Engine VFR with NVGs.
The two operators you mentioned are for profit, and since there's a limit to what they can charge the patients, they have to lower their overhead expenses.
My solution would be IFR ALL programs and helicopters with WAAS implemented GPS approaches and WX reporting for rurally funded helipads, NVGs where required, ACTIVE vs data based EGPWS.
Twin engine would be ideal; but let's face it, how many accidents have we had in HEMS because of total engine failures vs CFIT or other factors?
However this horse has been beaten before and has since been reduced to unrecognizable pulp.
This industry is profit driven and safety is more often than not merely paid lip service.
The two operators you mentioned are for profit, and since there's a limit to what they can charge the patients, they have to lower their overhead expenses.
My solution would be IFR ALL programs and helicopters with WAAS implemented GPS approaches and WX reporting for rurally funded helipads, NVGs where required, ACTIVE vs data based EGPWS.
Twin engine would be ideal; but let's face it, how many accidents have we had in HEMS because of total engine failures vs CFIT or other factors?
However this horse has been beaten before and has since been reduced to unrecognizable pulp.
This industry is profit driven and safety is more often than not merely paid lip service.
"Just a pilot"
2 pilot-crews in IFR certified, all weather-capable (including "known icing") twin-engined helicopters capable of Cat A departures at max gross any place in the AO, any time of the year, with 3 hours of fuel. While we're at it, how about: in-flight refueling; hot and cold running flight attendants; and a fully stocked wet bar on board...
I'd settle for: helipads at hospitals, not to mention at trauma centers; NVG capability; and pilot scheduling that considers human physiology. That last factor is the single most important change required in the industry. No amount of added bells, whistles and engines make up for a stupid pilot- in fact they increase the possibility of error by increasing the work load and decreasing the margin for safely acceptable error.
The industry- and pilots- schedule night duty too casually. Most people lose intellectual capacity with sleep disruption, sleep loss, and the circadian upset that comes with abrupt day to night transition- yet that's the rule for pilots in the industry.
I'd settle for: helipads at hospitals, not to mention at trauma centers; NVG capability; and pilot scheduling that considers human physiology. That last factor is the single most important change required in the industry. No amount of added bells, whistles and engines make up for a stupid pilot- in fact they increase the possibility of error by increasing the work load and decreasing the margin for safely acceptable error.
The industry- and pilots- schedule night duty too casually. Most people lose intellectual capacity with sleep disruption, sleep loss, and the circadian upset that comes with abrupt day to night transition- yet that's the rule for pilots in the industry.
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People aren't dying because of engine failures - that's a red herring. People are dying because they hit obstacles, and the ground is also an obstacle. Having a pad isn't enough - with 100' powerlines, light poles, buildings, and other stuff in the approach and departure paths, I'd rather be landing elsewhere. We did shut down one hospital, which had the landing area in grass, between 150' unlit trees, preferring to transport the med crew by ambulance a half mile or so from a location with concrete, and open approach areas. That's not possible for major trauma centers which have some of the most dangerous pads I've ever seen. I would certainly prefer all twins, all IFR, all 2 pilot crews, but that simply isn't going to happen, ever.
Sleep cycle disruption is a major problem, I agree. I would far prefer staying on either nights or days full time, but I'm afraid we're stuck with switching, and the resultant consequences. Thus I do things much slower at night, and there is no way I'll be lifting within 5 minutes in the dark.
Sleep cycle disruption is a major problem, I agree. I would far prefer staying on either nights or days full time, but I'm afraid we're stuck with switching, and the resultant consequences. Thus I do things much slower at night, and there is no way I'll be lifting within 5 minutes in the dark.
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It's pretty depressing
The future is VFR single engine for the States. Some programs that don't have NVGs now will eventually get them, the majority won't.
The only possible rememdy is a government mandate for IFR capability for night work. That has a very very low order of probability.
Failing that, the future...euphemistically speaking...belongs to the single/VFR model.
The only possible rememdy is a government mandate for IFR capability for night work. That has a very very low order of probability.
Failing that, the future...euphemistically speaking...belongs to the single/VFR model.
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'The only possible remedy is a government mandate for IFR capability for night work'.
And while we're asking for presents: a government mandate for a Certificate of Need for all providers so operators don't have to lowball the competition to stay afloat and can actually afford IFR twins.
Oh, and a pony.
And while we're asking for presents: a government mandate for a Certificate of Need for all providers so operators don't have to lowball the competition to stay afloat and can actually afford IFR twins.
Oh, and a pony.
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Some programs that don't have NVGs now will eventually get them, the majority won't.
But they should be required to get them, surely there can be no justification for continuing to 'tweek the nose of technology' in this day and age. Would not industry ambivalance on this front be easier to legislate out (ie. make NVG compulsory) than legislating IFR requirements in??
But they should be required to get them, surely there can be no justification for continuing to 'tweek the nose of technology' in this day and age. Would not industry ambivalance on this front be easier to legislate out (ie. make NVG compulsory) than legislating IFR requirements in??
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In the US, legislating more control is difficult. The standard is that anything not specifically prohibited is permitted, and getting Congress to pass anything on this subject would be amazing. There are bigger fish to fry right now. It hasn't been that long ago that the FAA wouldn't even consider allowing the use of NVGs, and they're still heavily restricted. Full use by all operators is going to be a long time coming.
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Understood. But as a lesser of two 'evils' the adoption of an industry self imposed 'standard' requiring NVG might drive toward a solution? Does US EMS have such an organisation or association and are they genuine about their desire to reduce EMS accident rates (particularly night CFIT)? This is probably the next step in a process once FAA understanding improves but pre-emptive positioning on the issue by the industry can only help.
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The associations here are primarily are of the operators, by the operators and for the operators.So trying to get them to buy off on safety will be a long road to hoe.The only organization that can have a voice would be PHPA but they are tainted with the dreaded"union" tag which is considered (God alone knows why) a five letter word in the industry here.So here we are and will be for the distant future.
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An "equivalent level of safety"--??
Many of the U.S. operators just will not invest in twins, IFR, NVG, TCAS...useful things which do give a measure of redundancy and/or capability.
In the absence of meaningful FAA regulation, the market rules. Hence the situation.
As always, in the final analysis it is up to the pilots to safeguard their own lives and the lives of others aboard the aircraft. We can only attempt do so in this environment by operating so as to provide "an equivalent level of safety" to that which could be supplied by more robust, capable equipment.
Concrete examples include:
--Avoiding any weather which might cause a degradation to VFR at night. Inexperienced EMS pilots sometimes fail to consider that even light rain at night will cause loss of visual reference in helicopters not equipped with windshield wipers. Barring installed weather detection/avoidance equipment, the only solution is to turn down flights when precipitation is moving through the operating area.
--Rigorous adherence to the intent of FAR 135.207, in short: if natural illumination is low and the local area lighting is sparse, re-route the flight over areas of sufficient surface lighting.
--Maximizing the chances of surviving a night engine failure by flying as high as possible, and selecting routes over terrain suitable for a forced landing. This will require considerably higher weather minimums in terms of ceiling, and longer transit times as direct routing will not usually be suitable. Additional refueling stops will also usually be required.
EMS is not a mission or a calling, it is a business and a job. The underlying mindset of EMS pilots must always be that if the safety of the crew and the aircraft is not assured, the flight must be turned down.
Turned down flights mean revenue lost. Longer transit times mean decreased revenues. Operators who do not invest in capable equipment will as a consequence bear these additional costs of doing business. Pilots must never attempt to make up for the shortcomings of equipment by attemping more than is prudent. That's how "accidents" happen.
In the absence of meaningful FAA regulation, the market rules. Hence the situation.
As always, in the final analysis it is up to the pilots to safeguard their own lives and the lives of others aboard the aircraft. We can only attempt do so in this environment by operating so as to provide "an equivalent level of safety" to that which could be supplied by more robust, capable equipment.
Concrete examples include:
--Avoiding any weather which might cause a degradation to VFR at night. Inexperienced EMS pilots sometimes fail to consider that even light rain at night will cause loss of visual reference in helicopters not equipped with windshield wipers. Barring installed weather detection/avoidance equipment, the only solution is to turn down flights when precipitation is moving through the operating area.
--Rigorous adherence to the intent of FAR 135.207, in short: if natural illumination is low and the local area lighting is sparse, re-route the flight over areas of sufficient surface lighting.
--Maximizing the chances of surviving a night engine failure by flying as high as possible, and selecting routes over terrain suitable for a forced landing. This will require considerably higher weather minimums in terms of ceiling, and longer transit times as direct routing will not usually be suitable. Additional refueling stops will also usually be required.
EMS is not a mission or a calling, it is a business and a job. The underlying mindset of EMS pilots must always be that if the safety of the crew and the aircraft is not assured, the flight must be turned down.
Turned down flights mean revenue lost. Longer transit times mean decreased revenues. Operators who do not invest in capable equipment will as a consequence bear these additional costs of doing business. Pilots must never attempt to make up for the shortcomings of equipment by attemping more than is prudent. That's how "accidents" happen.
I've been thinking about this lately, and wondered about the hidden agenda in Hidden Agenda's first post in this thread. To wit: Forget about two engines; how would two-pilots work? Would safety be improved by the addition of a second pilot in the aircraft? Contrary to what Hidden Agenda asserts, a second engine is not a "proven" safety device when you look at the accidents that have already occurred.
Sure, another pilot would require a bigger helicopter, probably a twin since there aren't that many singles with big enough cabins. ...And who'd want such a twin unless it had IFR capability...and of course Cat A performance...and an autopilot... You see where the discussion goes pretty quickly.
But didn't the U.S. Army used to fly two-pilot IFR in those old single-engine Hueys? I mean, it may not be the most neighbor-friendly aircraft around, but supposing we migrated back to the "Super Huey" or 210 or something?
Sure, another pilot would require a bigger helicopter, probably a twin since there aren't that many singles with big enough cabins. ...And who'd want such a twin unless it had IFR capability...and of course Cat A performance...and an autopilot... You see where the discussion goes pretty quickly.
But didn't the U.S. Army used to fly two-pilot IFR in those old single-engine Hueys? I mean, it may not be the most neighbor-friendly aircraft around, but supposing we migrated back to the "Super Huey" or 210 or something?
Well, now you are being sarchastic Bob.
It's not the operators that run the medical field, as much as the medical customers wanting to save pennies.
Oh yes, the operators as well when they are identified as the medical customer at the same time, like in a standalone operation.
Ironically those are the ones with the largest fleets of light singles in the EMS industry.
We're just pawns in this industry.
It's not the operators that run the medical field, as much as the medical customers wanting to save pennies.
Oh yes, the operators as well when they are identified as the medical customer at the same time, like in a standalone operation.
Ironically those are the ones with the largest fleets of light singles in the EMS industry.
We're just pawns in this industry.
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Human Factors
If roughly 80% of accidents involve human factors why is the EMS industry so fascinated with technology? Sure, technology is very useful in reducing accidents, but it isn't the whole picture. I'd like to see a national survey of EMS pilots done by a very competent organization that is capable of coming up with the right questions and collating the returns properly. Starting at the ground level seems the best approach.
Twin versus single engine? No statistical difference in safety that I know about. But, some cities and hospitals require twin engine helicopters for operation to heliports within their jurisdiction.
Twin versus single engine? No statistical difference in safety that I know about. But, some cities and hospitals require twin engine helicopters for operation to heliports within their jurisdiction.
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Agreed, but what amount of Training or Temperament makes up for the gift of sight? For EMS night ops; 'to see or not to see' that is the question. The NVG equipped pilot has such a quantum SA advantage over the 'unaided' pilot that it simply should not be an option to fly EMS night ops without NVG. To compare this one issue with other debates such as twins or singles and stricter application of IFR procedures is missing the point and the path of ignorance. Operators need to be pro-active in getting themselves informed on this one issue. It should not be left to the likes of Mike Attwood to have to push this technology into the industry. It is here, it works, it's affordable; end of story.
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Firstly, I don't admit to knowing much about the US EMS industry but I would have thought that the insurance companies (of the aircraft) would be a driver to safety. I would have thought simply showing them footage of NVG and unaided flight would convince them to quadruple an operators insurance bill if they deemed to operate unaided flights. 
Other than that, the FAA should legislate NVG for EMS operators (and for Father Christmas).
Other than that, the FAA should legislate NVG for EMS operators (and for Father Christmas).
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If all else fails:
True, training and temperament cannot replace having sight on a dark night.That is where the investment in technology comes in.All three need equal attention by the Operators.I believe NVGs are a no-brainer as far as a quantum leap in technology is concerned.They are inexpensive and they work!
If the Operators want legislation by the FAA on this before they are forced to invest dollars then that is what they will eventually get.Meanwhile, the we-have-been-doing-this-for-so-many-years-safely-without-any-stinking____(put your device in here i.e. TAWS,GPS,NVG RADALT.etc) -we-don't-need-it mindset of the managers and (forgive me) the older generation of pilots has to change.
That change is hard to predict.It will have to be evolutionary rather than revolutionary.
Alt.3
True, training and temperament cannot replace having sight on a dark night.That is where the investment in technology comes in.All three need equal attention by the Operators.I believe NVGs are a no-brainer as far as a quantum leap in technology is concerned.They are inexpensive and they work!
If the Operators want legislation by the FAA on this before they are forced to invest dollars then that is what they will eventually get.Meanwhile, the we-have-been-doing-this-for-so-many-years-safely-without-any-stinking____(put your device in here i.e. TAWS,GPS,NVG RADALT.etc) -we-don't-need-it mindset of the managers and (forgive me) the older generation of pilots has to change.
That change is hard to predict.It will have to be evolutionary rather than revolutionary.
Alt.3
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Alt3, Sad but true on the mindset but clearly they have not been doing it safely (and remembering that evolution will likely come at a further cost in lives).
Sunnywa, interesting concept that would certainly add to the pressure on operators/managers to do the right thing. Additionally, why don't those responsible for issuing EMS contracts simply demand the technology levels. Perhaps lobbying the source of the work will force the standards up of those who genuinely contribute and drive out those who do not.
Sunnywa, interesting concept that would certainly add to the pressure on operators/managers to do the right thing. Additionally, why don't those responsible for issuing EMS contracts simply demand the technology levels. Perhaps lobbying the source of the work will force the standards up of those who genuinely contribute and drive out those who do not.
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It all comes back to money. If the contract issuer requires more equipment, then the contract will cost more. In the US, nothing is more important than short-term profits. Nothing. Not ever.
