NTSB Calls for Radar Altimeters for EMS Helicopter Night Ops
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Geoffers
We've got to stop meeting like this!
One of the little known shortcomings of civil certification is that there is no requirement in Part 27 or 29 for an attitude indicator as part of the basic certification of a VFR helicopter. I had a hard time believing this at first, but it is there (or not there, as the case may be).
I'm not sure how we permit night flying without an attitude indicator, but there you go. The problem is a lot more fundamental than we think.
Related to this - why don't we teach decision making for bad weather flying using a simulator???? Lots of low cost ones around that would teach the problem quite convincingly....
We've got to stop meeting like this!
One of the little known shortcomings of civil certification is that there is no requirement in Part 27 or 29 for an attitude indicator as part of the basic certification of a VFR helicopter. I had a hard time believing this at first, but it is there (or not there, as the case may be).
I'm not sure how we permit night flying without an attitude indicator, but there you go. The problem is a lot more fundamental than we think.
Related to this - why don't we teach decision making for bad weather flying using a simulator???? Lots of low cost ones around that would teach the problem quite convincingly....
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With regard to the real world, today, of EMS ops, Gomer's comments make a lot of sense. IFR ops alone are clearly not going to get the job done to get to accident scenes at night, so if you're going to have night EMS, visual flying is going to be essential - and will need to be practiced. Having said that if it was me doing it I'd want my IFR twin as well, to provide a safe(ish) exit in the event of loss of reference and to ease transits when appropriate!
But there are clearly huge extra costs in exclusively using IFR twins for night EMS ops. Are they justified? Looking at what appears to be the current profile of activity, probably not, on the assumption that the market talks.
But what facts are actually known in the US? What % of EMS night flights use singles? How many casualties are carried per year? In what % of those is the helicopter reckoned to significantly contribute to the saving of a life? What is the average cost per patient of EMS helicopter use, for both for singles and IFR twins? How many casualty lives are saved at what EMS crew life cost? What is the value of a life?
The statistics will go a long way to establishing what is reasonable in terms of singles or IFR twins for night EMS ops.
Anyone know any?
But there are clearly huge extra costs in exclusively using IFR twins for night EMS ops. Are they justified? Looking at what appears to be the current profile of activity, probably not, on the assumption that the market talks.
But what facts are actually known in the US? What % of EMS night flights use singles? How many casualties are carried per year? In what % of those is the helicopter reckoned to significantly contribute to the saving of a life? What is the average cost per patient of EMS helicopter use, for both for singles and IFR twins? How many casualty lives are saved at what EMS crew life cost? What is the value of a life?
The statistics will go a long way to establishing what is reasonable in terms of singles or IFR twins for night EMS ops.
Anyone know any?
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I.F.R. capability - the get out of jail card
I don't think we are seriously suggesting - at this stage in our development, that 24 hour EMS ops are really viable. Possible, yes. Tricky, most definitely. Getting to the scene of a primary mission at night can be very very hazardous. You can set out with all the best will in the world and then find you get suckered into a ball-breaker. The point is that if you had no IFR capability, either on the way in or on the way out of the Primary Mission site, then you are a bit snookered.
My first EMS op was with an aging Bo105 but it was IFR equipped and I had a rating, albeit on another type. We only operated by day and I promised myself that we would studiously follow the rules. Despite this, circumstances conspired to put me into situations where both the equipment and the ticket were used in anger. This is real life.
One day we will have head-up displays, LADAR and fully coupled automatic WAAS approaches to discreet primary accident sites..... together with ground crews who know which way is North and realise that things that stick up into the fog often have wires strung between them........ but not for a while. Until then the EMS game, like the cops, is a VFR business but they do need an IFR capability ..... the all important card that gets you out of jail.
G
My first EMS op was with an aging Bo105 but it was IFR equipped and I had a rating, albeit on another type. We only operated by day and I promised myself that we would studiously follow the rules. Despite this, circumstances conspired to put me into situations where both the equipment and the ticket were used in anger. This is real life.
One day we will have head-up displays, LADAR and fully coupled automatic WAAS approaches to discreet primary accident sites..... together with ground crews who know which way is North and realise that things that stick up into the fog often have wires strung between them........ but not for a while. Until then the EMS game, like the cops, is a VFR business but they do need an IFR capability ..... the all important card that gets you out of jail.
G
"Just a pilot"
"I don't think we are seriously suggesting - at this stage in our development, that 24 hour EMS ops are really viable."
Not only possible, but long history of success. It is the most hazardous phase of EMS, but seems equally risky in all types of equipment single/twin and vfr/ifr.
Yes, I have been IIMC at night on the job. Fortunately, our fleet's better equipped than what I flew for Uncle Sam in Vietnam, so staying on the gauges long enough to get back to VMC has been an exciting inconvenience, at most. Almost all my IIMC encounters have been on takeoff and would not have occurred with any type of assisted night vision- and that opinion's based on my experience with "Starlight" equipment, 40 years ago. There's no comparison with present technology.
The most damning failure in US EMS is the fact that NVGs are only now being fielded in any real numbers. Keep your radar altimeters, TAWS, xenon spotlights, dual GPS, glass cockpits- I want to SEE what I'm taking off and landing into, and NVGs do that better than anything else. The military's NVG use has proven it, decades ago.
Not only possible, but long history of success. It is the most hazardous phase of EMS, but seems equally risky in all types of equipment single/twin and vfr/ifr.
Yes, I have been IIMC at night on the job. Fortunately, our fleet's better equipped than what I flew for Uncle Sam in Vietnam, so staying on the gauges long enough to get back to VMC has been an exciting inconvenience, at most. Almost all my IIMC encounters have been on takeoff and would not have occurred with any type of assisted night vision- and that opinion's based on my experience with "Starlight" equipment, 40 years ago. There's no comparison with present technology.
The most damning failure in US EMS is the fact that NVGs are only now being fielded in any real numbers. Keep your radar altimeters, TAWS, xenon spotlights, dual GPS, glass cockpits- I want to SEE what I'm taking off and landing into, and NVGs do that better than anything else. The military's NVG use has proven it, decades ago.
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I would suggest that one of the more important things in any helicopter flown at night or with the possibility of encountering IMC, single or twin engine, is an AFCS that is capable of damping rates and providing short term (2-3 minutes) attitude hold - The RAF/ RN Gazelle had such a system, and it was very effective.
I understand Chelton is well on their way to having a similar sort of system certified on the Bell 206 series. Relatively inexpensive. Can't wait.
And I suppose we'll have to make sure the pilots know how to use the things.... properly, that is.
I don't dispute for a moment the need for NVGs, and would love to see them mandated for anything outside a built-up area.
I understand Chelton is well on their way to having a similar sort of system certified on the Bell 206 series. Relatively inexpensive. Can't wait.
And I suppose we'll have to make sure the pilots know how to use the things.... properly, that is.
I don't dispute for a moment the need for NVGs, and would love to see them mandated for anything outside a built-up area.
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I really hate to do this, because as an employer I really didn't like CHL. They were not honest with me and vindictive after I left.
That said, they have a very long-term, safe EMS operation in Ontario, Canada. They have never, in 1000's of hours and decades of EMS sevice had an accident during EMS revenue flying (a couple in trg). Why?
When I was there, I was introduced to new concepts for maximizing the use of the IFR, NVFR, and VFR systems to aid me when I wanted it. We practiced using the systems, especially returning to base empty from a call. All captains considered themselves in the business of teaching their copilots and learning fromeach other. They have an extensive network of IFR approaches to helipads and hospitals and a huge network of night VFR helipads. These helipads are located along highways, at smaller hospital, reserves, etc.
They do not ever do night scene calls. What you do is fly to the nearest NVFR helipad and a land ambulance gets the patient to you. Then they go back to work and you fly the patient fast and direct to the hospital. If meeting another ambulance at a location closer to the hospital is better, then do it. We were not attached to any one hospital so the patient went to the nearest appropriate location. Transits from scene to helipad were rarely, even in northern Ontario, more that 5 or 10 minutes. The cost of the pads, which use retro-reflective cones at night for reference, is minimal.
The captains that had time-in were well versed in using IFR to get close then VFR to the scene in day when required, straight VFR when it wasn't. Night was treated with the respect it deserved but we still did a lot of work. The a/c were 76A's: old, basic IFR, but capable. Other types would fit the role just fine. 2 pilot crews was one of the biggest safety items carried.
Nick and Gomer, you are both advocating the same thing, changes in equipment rather than attitude. NVG's will soon be contributing to civil accidents. (Hover to hover autoflight systems would do the same) Just as existing autopilots need to be understood, so do the NVG's, etc. There are lots of things they don't see. They see through weather that no VFR a/c should even consider being in. They break. The batteries die. Pilots will, deliberately or inadvertantly, misuse them.
Nick, you said: "...a task that is naturally too difficult to be performed every time to perfection." to refer to offshore and HEMS flying. I disagree, it is not too difficult to do safely (perfect is not necessary) but the crews (not pilots, solo) need to be ready to say no, not today or yes, but with these conditions when required without fear of recriminations or being hung out to dry by supervisors.
As said before by others, deliberate breaking of rules or gross negligence must be policed and punished appropriately. That does not happen now. Lack of training, experience, or support must be identified on advance and acted on.
We can do it safely.
It's late and I could probably say this better, but I hope this will do.
That said, they have a very long-term, safe EMS operation in Ontario, Canada. They have never, in 1000's of hours and decades of EMS sevice had an accident during EMS revenue flying (a couple in trg). Why?
When I was there, I was introduced to new concepts for maximizing the use of the IFR, NVFR, and VFR systems to aid me when I wanted it. We practiced using the systems, especially returning to base empty from a call. All captains considered themselves in the business of teaching their copilots and learning fromeach other. They have an extensive network of IFR approaches to helipads and hospitals and a huge network of night VFR helipads. These helipads are located along highways, at smaller hospital, reserves, etc.
They do not ever do night scene calls. What you do is fly to the nearest NVFR helipad and a land ambulance gets the patient to you. Then they go back to work and you fly the patient fast and direct to the hospital. If meeting another ambulance at a location closer to the hospital is better, then do it. We were not attached to any one hospital so the patient went to the nearest appropriate location. Transits from scene to helipad were rarely, even in northern Ontario, more that 5 or 10 minutes. The cost of the pads, which use retro-reflective cones at night for reference, is minimal.
The captains that had time-in were well versed in using IFR to get close then VFR to the scene in day when required, straight VFR when it wasn't. Night was treated with the respect it deserved but we still did a lot of work. The a/c were 76A's: old, basic IFR, but capable. Other types would fit the role just fine. 2 pilot crews was one of the biggest safety items carried.
Nick and Gomer, you are both advocating the same thing, changes in equipment rather than attitude. NVG's will soon be contributing to civil accidents. (Hover to hover autoflight systems would do the same) Just as existing autopilots need to be understood, so do the NVG's, etc. There are lots of things they don't see. They see through weather that no VFR a/c should even consider being in. They break. The batteries die. Pilots will, deliberately or inadvertantly, misuse them.
Nick, you said: "...a task that is naturally too difficult to be performed every time to perfection." to refer to offshore and HEMS flying. I disagree, it is not too difficult to do safely (perfect is not necessary) but the crews (not pilots, solo) need to be ready to say no, not today or yes, but with these conditions when required without fear of recriminations or being hung out to dry by supervisors.
As said before by others, deliberate breaking of rules or gross negligence must be policed and punished appropriately. That does not happen now. Lack of training, experience, or support must be identified on advance and acted on.
We can do it safely.
It's late and I could probably say this better, but I hope this will do.
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Viable - v - possible
Devil49
I am not saying that it isn't possible but emphasising that it cannot be put into widespread operation and so that night ops are part of the typical EMS operation.
Swamp76
I agree with what you say and I note that you don't see NVGs as a panacea. Of course they will help, a great tool to have in the box. When we started UK EMS Ops back in 1987 we actually had three mission profiles. 'Secondary transfers' became tertiary missions and were replaced in the taxonomy by 'secondary missions' that were conducted in exactly the way you outlined with pre-surveyed sites.
The clinical advantages back in those days came from the time/distance equation but funnily enough not so much from from initial response time but the 'time to hospital'. Their was a hidden trap in all the government targets that meant that a fast response within 20 minutes got a tick in the box but the 15 minute into hospital was ignored. Clinicians may say 'so what' but us ambulance service guys new only too well that this 15 minutes to hospital in the rural south west saved the ambulance one and a half hours on blues and twos, plus a one hour turn around plus another two hours to get back into the operating area allocated. The patient benefited and the whole service was enhanced. As most calls were not critical it meant that you could get the guy with the nosebleed out of the system quickly so that the road vehicle would be there for the heart attack victim who may be the next call.
Digressing slightly but now we are on the subject it's worth mentioning. When you stand in the ambulance control centre and watch the activity levels fluctuating you can observe that there is little rhyme nor reason behind the lack of pattern. It's not unusual to see all the ambulances covering one part of the country disappear as they answer callouts and the controller frantically sends vehicles from another area to cover the huge gap. But, if you have an Air Ambulance you can temporarily allocate this huge area to that and sit out the tense period of waiting without having to play 'checkers' trying to cover the gap. Note - no flying undertaken, no missions accomplished but still this powerful tool contributed to raisiing the service level without even turning a blade. This is not bulls***t, it happened to us many many times.
Next time the analysts come down to check out the value of your unit's contribution to the Primary Care effort don't forget to chuck that one into the calculations.
In the Navy we called it 'The power if the Fleet in Being'. Just by being there folk had to pay attention.
G
I am not saying that it isn't possible but emphasising that it cannot be put into widespread operation and so that night ops are part of the typical EMS operation.
Swamp76
I agree with what you say and I note that you don't see NVGs as a panacea. Of course they will help, a great tool to have in the box. When we started UK EMS Ops back in 1987 we actually had three mission profiles. 'Secondary transfers' became tertiary missions and were replaced in the taxonomy by 'secondary missions' that were conducted in exactly the way you outlined with pre-surveyed sites.
The clinical advantages back in those days came from the time/distance equation but funnily enough not so much from from initial response time but the 'time to hospital'. Their was a hidden trap in all the government targets that meant that a fast response within 20 minutes got a tick in the box but the 15 minute into hospital was ignored. Clinicians may say 'so what' but us ambulance service guys new only too well that this 15 minutes to hospital in the rural south west saved the ambulance one and a half hours on blues and twos, plus a one hour turn around plus another two hours to get back into the operating area allocated. The patient benefited and the whole service was enhanced. As most calls were not critical it meant that you could get the guy with the nosebleed out of the system quickly so that the road vehicle would be there for the heart attack victim who may be the next call.
Digressing slightly but now we are on the subject it's worth mentioning. When you stand in the ambulance control centre and watch the activity levels fluctuating you can observe that there is little rhyme nor reason behind the lack of pattern. It's not unusual to see all the ambulances covering one part of the country disappear as they answer callouts and the controller frantically sends vehicles from another area to cover the huge gap. But, if you have an Air Ambulance you can temporarily allocate this huge area to that and sit out the tense period of waiting without having to play 'checkers' trying to cover the gap. Note - no flying undertaken, no missions accomplished but still this powerful tool contributed to raisiing the service level without even turning a blade. This is not bulls***t, it happened to us many many times.
Next time the analysts come down to check out the value of your unit's contribution to the Primary Care effort don't forget to chuck that one into the calculations.
In the Navy we called it 'The power if the Fleet in Being'. Just by being there folk had to pay attention.
G
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At last somebody explains one of the most important roles of air ambulances-fill in the gaps of the road system as it can cover an enormous area fast and change as the requirement dictates with less resources ie personnel/ambulances, etc.
Where we operate we have a critical shortage on paramedics, trauma doctors and nurses. The air ambulances are often called because there are no other available crew to attend to the scene as a ambulance might be 1 hour + away or busy on another scene.
I can hear the sceptics say well just appoint more personnel and ambulances. Well work out for yourselve how many ambulances you would need to cover an areachoose any) and all worse case scenarios. Now find 2 crews min/ambulance fully trained and qualified for the job. If you have that many paramedics/doctors/nurses out of a job in your area, pls send them to us.
Radio alts should be a must at least. I can not understand that a factory new(EC AS350 for instance) machine get's certified without it!!
Where we operate we have a critical shortage on paramedics, trauma doctors and nurses. The air ambulances are often called because there are no other available crew to attend to the scene as a ambulance might be 1 hour + away or busy on another scene.
I can hear the sceptics say well just appoint more personnel and ambulances. Well work out for yourselve how many ambulances you would need to cover an areachoose any) and all worse case scenarios. Now find 2 crews min/ambulance fully trained and qualified for the job. If you have that many paramedics/doctors/nurses out of a job in your area, pls send them to us.
Radio alts should be a must at least. I can not understand that a factory new(EC AS350 for instance) machine get's certified without it!!
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victor papa - you might be surprised to learn that there is no need for even an attitude indicator for a helicopter to get a Part 27 or Part 29 VFR certification (even for night flying). The requirement for an attitude indicator comes (at least in the US) in the commercial requirements....
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That is my point! Before jumping to twin IFR machines and all the afore mentioned systems(brilliant idea but cost reality?), should we not start with mandating the basic instrumentation required for certain missions ie attitude indicators and radio alts? These instruments are not unaffordable and does not require rocket science. Is it not a way to keep the industry affordable and safer? Maybe once all machines are equipped we can review whether it improoved safety or not. If it did not, we should at least have a better understanding of what we need!
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Any connection:
3 killed in helicopter crash near South Padre Island identified
© 2008 The Associated Press
SOUTH PADRE ISLAND, Texas — The bodies of a pilot and two medics killed when a medical helicopter crashed into Laguna Madre near South Padre Island have been recovered and identified.
The helicopter crashed Tuesday night during a 30-mile trip from Harlingen to South Padre Island to pick up a patient, Cameron County Sheriff Omar Lucio said. The helicopter had just aborted its trip due to bad weather when it went down, so there was no patient aboard.
Cameron County Justice of the Peace Bennie Ochoa identified the victims Wednesday as pilot Robert Lamar Goss, 54, of San Benito; and medics Raul Garcia Jr., 40, of Weslaco, and Michael T. Sanchez, 39, who had a post office box in San Benito. Ochoa said autopsies would be conducted on the victims.
U.S. Coast Guard helicopters located the crash site about 2 1/2 miles west of South Padre Island. Divers recovered two of the bodies, both thought to be medics, Lucio said. The pilot was recovered around 11:30 a.m., said U.S. Coast Guard public affairs officer Ben Sparacin. The Coast Guard was maintaining a secure perimeter around the crash site Wednesday and a local salvage crew would be recovering the helicopter, he said.
The National Transportation Safety Board will be handling the investigation, Sparacin said. The helicopter was part of the Valley AirCare emergency service. A representative of Valley Air Care referred phone calls from The Associated Press to Metro Aviation, which he said was the aircraft's operator. A woman who answered the phone for Metro Aviation said the company had no comment.
3 killed in helicopter crash near South Padre Island identified
© 2008 The Associated Press
SOUTH PADRE ISLAND, Texas — The bodies of a pilot and two medics killed when a medical helicopter crashed into Laguna Madre near South Padre Island have been recovered and identified.
The helicopter crashed Tuesday night during a 30-mile trip from Harlingen to South Padre Island to pick up a patient, Cameron County Sheriff Omar Lucio said. The helicopter had just aborted its trip due to bad weather when it went down, so there was no patient aboard.
Cameron County Justice of the Peace Bennie Ochoa identified the victims Wednesday as pilot Robert Lamar Goss, 54, of San Benito; and medics Raul Garcia Jr., 40, of Weslaco, and Michael T. Sanchez, 39, who had a post office box in San Benito. Ochoa said autopsies would be conducted on the victims.
U.S. Coast Guard helicopters located the crash site about 2 1/2 miles west of South Padre Island. Divers recovered two of the bodies, both thought to be medics, Lucio said. The pilot was recovered around 11:30 a.m., said U.S. Coast Guard public affairs officer Ben Sparacin. The Coast Guard was maintaining a secure perimeter around the crash site Wednesday and a local salvage crew would be recovering the helicopter, he said.
The National Transportation Safety Board will be handling the investigation, Sparacin said. The helicopter was part of the Valley AirCare emergency service. A representative of Valley Air Care referred phone calls from The Associated Press to Metro Aviation, which he said was the aircraft's operator. A woman who answered the phone for Metro Aviation said the company had no comment.
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As a pilot who has been flying EMS for the last 18+ years and whose aircraft has had a Radar Altimeter (here in NC it's a state requirement), I will vouch for it's usefulness. On one occasion it proved to be worth it's weight in gold when one of my pilots succumbed to what's commonly called a "black hole approach" coming into a landing area over water. Focused on the landing area he descended to 200 feet when he 'thought' he was at about 500 when the radar altimeter "alarmed" and warned him of his error.
It is also a very valuable tool when you have gone single pilot inadvertent IMC and have to make that ILS approach to set up for DH. But it is not terrain avoidance equipment... and frankly speaking of which,the same terrain avoidance equipment that works so well in airliners is totally useless to us. The altitudes that are 'death' to them is where we make our living.
The South Padre accident is the one I've read about over and over and over in the last 30 years in air ambulance helicopter flying. It is were the problem is. I am willing to bet that all the equipment necessary for at least basic instrument flight were present in that helicopter. I am even going to assume the pilot has an Instrument rating. And I'll bet the ranch that pilot was not instrument current.
One extremely high time airline captain and widely experienced general aviation pilot has written that he can perceive a significant degradation in his instrument flying skills after a few weeks away from flying instruments. Many pilots in the Air Ambulance industry have not been instrument current in years or even decades!
Two nearby vendor system allow 15 minutes of simulated instrument flying per pilot per year during daylight using foggles (if one peek is worth a thousand cross-checks, what is constant peeks worth?), and that's it. In a conversation with one of their guys, a retired Navy helo pilot, I was told the last time he was instrument current was when he was in the Navy 12 years ago!? And this is flying in a coastal environment where night time inadvertent IMC is just a fact of life. It's not if, it's when .
I cannot believe that the FAA has not mandated instrument currency requirements for pilots of air ambulance aircraft operated at night given the large number of accidents that read just like this South Padre accident. Even though we are not an IFR operation, I would not consider allowing one of my pilots to fly night VFR in our area if he were not IFR current.
The problem is not equipment. The problem is not pilots of and in themselves. The problem is currency training and operators who say "it's too expensive"..., and the FAA who won't mandate currency.
It is also a very valuable tool when you have gone single pilot inadvertent IMC and have to make that ILS approach to set up for DH. But it is not terrain avoidance equipment... and frankly speaking of which,the same terrain avoidance equipment that works so well in airliners is totally useless to us. The altitudes that are 'death' to them is where we make our living.
The South Padre accident is the one I've read about over and over and over in the last 30 years in air ambulance helicopter flying. It is were the problem is. I am willing to bet that all the equipment necessary for at least basic instrument flight were present in that helicopter. I am even going to assume the pilot has an Instrument rating. And I'll bet the ranch that pilot was not instrument current.
One extremely high time airline captain and widely experienced general aviation pilot has written that he can perceive a significant degradation in his instrument flying skills after a few weeks away from flying instruments. Many pilots in the Air Ambulance industry have not been instrument current in years or even decades!
Two nearby vendor system allow 15 minutes of simulated instrument flying per pilot per year during daylight using foggles (if one peek is worth a thousand cross-checks, what is constant peeks worth?), and that's it. In a conversation with one of their guys, a retired Navy helo pilot, I was told the last time he was instrument current was when he was in the Navy 12 years ago!? And this is flying in a coastal environment where night time inadvertent IMC is just a fact of life. It's not if, it's when .
I cannot believe that the FAA has not mandated instrument currency requirements for pilots of air ambulance aircraft operated at night given the large number of accidents that read just like this South Padre accident. Even though we are not an IFR operation, I would not consider allowing one of my pilots to fly night VFR in our area if he were not IFR current.
The problem is not equipment. The problem is not pilots of and in themselves. The problem is currency training and operators who say "it's too expensive"..., and the FAA who won't mandate currency.
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I notice some degradation in my flying skills in general after a week off. Instrument proficiency degrades very quickly, and it is difficult to maintain if not practiced on a very regular basis. Most EMS operations simply cannot allow pilots to maintain instrument proficiency, because it requires a safety pilot, and you can't do it under Part 135. This is difficult area, and cost is always an issue, whichever side of the argument you're on. Flying over water at night should be avoided at all costs, unless you're in an IFR machine and IFR current.
