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NTSB says EMS accident rate is too high

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NTSB says EMS accident rate is too high

Old 28th Aug 2011, 02:31
  #61 (permalink)  
 
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All three steps would massively reduce risk in a business that is patently not following ALARP principles and has a hoffiic accident history.

I sleep soundly at night knowing I am not complacent about safety.


Many would feel comforted to know SM sleeps so well at night.



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Old 28th Aug 2011, 05:27
  #62 (permalink)  
 
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Just some thoughts from a study into the challenges faced by China which is about to rapidly expand the nation’s SAR and HEMS capability. In reality, the country is raising the equivalent of a small air force from almost nothing. (US 12,000 helicopters – China 127).

Their last fatal - an AW139, 17 Aug '11 four dead, believed to be a training flight, is now being investigated. Our thoughts are with their families, etc.

As history shows this can be a very costly business. Statistical evidence from the World Wars, Korea, Vietnam and later conflicts show that rapid expansion can result in enormous losses. This is usually caused poor supervision and training coupled with inexperience.

So what is the implication for China? Where do we start our research? What are the implications for the safety of aeromedical flight crewmembers?

It is estimated by the Association of Air Medical Services (USA), helicopters transport 400,000 patients annually in the United States. The growth in the HEMS industry has been spectacular. From 1995 to 2008 the number of helicopters used in aeromedical services increased by 130%.

Just over a decade ago the Americans were losing one aeromedical helicopter every week. In recent years, the loss rate has decreased substantially. In 2008 there were nine fatal accidents which killed 35 people. The following year in 2009 nine fatal accidents killing another eleven.

These figures could be compared with say; Qantas, and the expectations of their fare paying public. If you compare the HEMS loss rate over a typical year with Qantas carrying 38 million passengers without a single loss of an aircrew member, then you can see why the United States regulators have been reconsidering HEMS operations.

To put it bluntly, recent HEMS experience shows one crew member was killed for every 20,000 patients carried. By comparison, if Qantas had the same loss rate then almost 2,000 Qantas aircrew would have died to achieve the same uplift capability – 38 million??

This latent problem is probably being overlooked by the emerging Chinese HEMS industry which is probably focused on the setting up of the manpower and logistic resources to commence an aeromedical system.

With the power of hindsight, international advisers will need to tell the leaders of the emerging industry within China, the road ahead has many potentially fatal potholes. (As happened last week). And the loss of three Thai helicopters in one week recently?

They will need to harness the knowledge and skills that have been developed by the Western nations in accident prevention techniques associated with the SAR and HEMS operations. There is no doubt past lessons were written in blood!

Western organisations must be ready to provide guidance to the new organisers of the emerging industry, now being established as the airspace is being progressively released. No doubt AAMS and other international agencies will also need to lend a hand to ensure the traditional risk management procedures are covered in their safety system management protocols.

The international safety agencies will probably have to push very hard to get their point of view across to a group of people who have never experienced the pain of operating an aeromedical industry without the appropriate checks and balances. Today, the US is still suffering losses which must be measured against “risk verses gain” and is there an alternative to a high risk flight?

What are your thoughts??
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Old 28th Aug 2011, 11:16
  #63 (permalink)  
 
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thoughts?

good to see you back Rob.

tet
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Old 28th Aug 2011, 11:53
  #64 (permalink)  

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I've read many of these reports. The reasons for "press-on-itis" need to be addressed. It's an organisational issue in some cases.

I've been in one SAR/Medevac/Casevac job where the department's measure of competence was the time of response. Totally dangerous. I took my time when needed and tried to impress upon those pilots less experienced than myself that they should do the same. I left the department. Not long afterwards one crew took a shortcut over a mountain at night after coming under pressure about a previous response time. They suffered a fatal CFIT accident.

Three lives and a valuable machine gambled against one life. They lost.
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Old 28th Aug 2011, 16:44
  #65 (permalink)  
 
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Trying to compare HEMS operations with Qantas is simply silly. Qantas carries hundreds of passengers per flight, HEMS almost always one. Qantas operates airliners to and from major airports, HEMS from unprepared scenes at night, and to and from hospital helipads which are some of the poorest in the country. They're almost always an afterthought, with obstacles all around. But disregard everything except the first point, and you still can't make a comparison, because of the sheer volume of passengers that Qantas and the other airlines move on each flight.

I've said it before, and I'll say it again. European and other pundits have no business pontificating on the state of the US industry, just as the US pundits should, and generally do, keep quiet about their industry. It's a different culture, under different rules, with different philosophies, expectations, and goals. Right or wrong, profit is the driving force for all business in the US, and that will not change no matter how much fun the rest of the world wants to make of it. Short-term profit is the end-all and be-all of the US economy, and short-term profit is not possible if multi-engine, multi-crew aircraft flown only under IFR are required. So get over it, those will never be required, and will seldom be used.
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Old 28th Aug 2011, 17:00
  #66 (permalink)  
 
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Our friends and colleagues on the eastern side of the salt water divide do not have the basis to pass judgement on our system especially if they try to compare theirs to ours. It is Apples and Oranges pure and simple.

If they wish to stick to discussions about individual factors and not a general broad brush comparison then we can in fact have a very good exploration into why EMS accidents occur, continue to occur, and continue to occur for the same reasons.

We have to consider the changes put in place within the past few years that have helped reduce the rate of accidents and the numbers of people killed.

Things are a bit different than the last time we had a really good bashing of ideas.....as I was the instigator of two threads about helicopter accidents and industry culpability in the EMS and Offshore sectors of the US Helicopter Industry.

Perhaps it is a time to reference those threads and update them by evaluating the systemic changes, changes in the ownership of the various operators, and the effect (good or bad) of regulation changes and enforcement activity by the FAA and within the Industry itself.

Our friends around the World have valuable experience and thus can inject some fresh thinking into our large oyster....their ideas might not be useful considering the politics and economy but they are definitely worth hearing and discussing.

Things are better here than they were....but are they as good as they should and can be.....that is definitely going to be good fun arguing!

Let's start with some up to date statistics....if we can find them and compare years 2010 and 2011 to previous years. Perhaps something will jump out at us that will indicate what the trends are as to accident rates, fatalities, injuries, and frequency....perhaps comparison of current causes compared to past data.
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Old 28th Aug 2011, 17:09
  #67 (permalink)  

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This profit driven philosophy is quite possibly where the much of the press-on-itis comes from. As for a mantra that the USA always knows best and no-one else is entitled to comment on any of it because they don't understand.....really!

How would relatives of a deceased patient or crew member feel if they knew that lives of their loved ones might not have been lost if things had been different i.e. profit for the service provider wasn't such a major issue?

We had a similar issue in UK a couple of decades ago. The only logical remedy was for CAA legislation to be tightened up, and it was.

As the saying goes, if you think safety is expensive, try having an accident.
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Old 28th Aug 2011, 17:38
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As for a mantra that the USA always knows best and no-one else is entitled to comment on any of it because they don't understand.....really!
No one has suggested that Shy....but I do believe the converse/reverse was strongly suggested as being just as wrong.
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Old 28th Aug 2011, 18:03
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I see a lot of US HEMS bashing from around the world. Does anyone have easy access to the following:

US HEMS accident rate- fatal and non-fatal per 100,000 hours? Or 100,00 patient transports.
UK HEMS accident rate- "
Canadian HEMS accident rate- "
German HEMS accident rate- "
Australian HEMS accident rate- "

Commercial helicopter accident rates for the same countries per 100,000 hours.

Private helicopter accident rates for the same countries per 100,000 hours.


Number of HEMS machines on duty in each of the same countries and availability ie day, night and weather conditions.

This information would make interesting charts. I imagine it is coallated somewhere and someone here probably has easy access.

I like to tell the pilots I train that there were sick and injured people long before there was helicopters. The patient has to be stable before we even load them. A broken helicopter and/or crew will do that patient no good. "Above all, do no harm".

Last edited by mfriskel; 28th Aug 2011 at 20:24.
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Old 28th Aug 2011, 18:05
  #70 (permalink)  

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No one has suggested that Shy....but I do believe the converse/reverse was strongly suggested as being just as wrong.
SAS, So I've completely missed the point of the second paragraph of post #67? OK....

Seemed plain enough to me.

Last edited by ShyTorque; 29th Aug 2011 at 07:50.
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Old 28th Aug 2011, 19:10
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Limited Performance Margins

I can’t speak to European HEMES operations but I can address what I believe may be a contributing factor to the mishap rate here in the United States. The vast majority of US HEMS operations are would fall into a category identified as a traditional model. These are typically single engine machines strategically located to provide the operator with a solid business base for the machine. The AS-350 series make up a significant portion of this fleet. The AS-350 has limited payload range when kitted out for HEMS operations. It is typical to operate very near or at the aircraft’s maximum gross weight on every mission. A 250-300 lb patient in the US is the norm today in the US. At 33% fuel burn and using 11% (20 min.) with three 180 lb crewmen the fuel load would have to be limited to 45%. This leaves the pilot with only 1 hour mission fuel. Flexibility is not the norm.

Weight (Lbs) Arm (inches) Moment (inch-Lbs)
Total Empty Weight 3383.0 136.9 463132.7
* EMS Equip. 136 190.0 38787
Pilot Equip. 40 44.2 1745.9
Aircraft Basic Weight 3558 141.6 503665.6
Pilot 180 61.0 10980
Med 1 (fwd) 180 100.0 18000
Med 2 (aft) 180 100.0 18000
Mission Ready Weight 4098 134.4 550645.6
0
Patient 250 95.0 23750
Fuel (%) 45
Fuel (gal.) 146 Max. 66 0
Fuel 440 136.8 60217.992

Weight CG Moment
Takeoff Weight 4899 129.5 634613.592
* EMS Equip. includes items listed below in green
Available Payload 51 (lbs.) HOGE Wt.
23.23 (kgs.) 4950
Baggage Comp. EMS Equipment
Para Pack (9 lbs) 10
Backboard (14.5 lbs) 0
RSI Kit (16 lbs) 16
Tri Blue Bag (11 lbs) 11
Mast Pants (10 lbs) 10
KED Kit (9.5 lbs) 9.5
Green Bag (6 lbs) 6
Vent (2 lbs) 3.5
Traction Splint (5 lbs) 5
Misc. Equip. (3 lbs) 4.5
Total 75.5

By contrast the hospital based programs operate light and medium twin engine machines that provide sufficient payload range allowing for much greater flexibility and performance margins. I hope the Wt & Bal transfer to the PPRUNE format. It does not appear as if the excel spread sheet and chart translated very well. If anyone would like a copy just send me an email.
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Old 28th Aug 2011, 19:31
  #72 (permalink)  

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It's a different culture, under different rules, with different philosophies, expectations, and goals. Right or wrong, profit is the driving force for all business in the US, and that will not change no matter how much fun the rest of the world wants to make of it. Short-term profit is the end-all and be-all of the US economy, and short-term profit is not possible if multi-engine, multi-crew aircraft flown only under IFR are required. So get over it, those will never be required, and will seldom be used.
With the greatest respect to our American brothers, there is the problem, right there.

What is the acceptable death rate of pilots, medical personnel and patients before something has to be done to change this?
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Old 28th Aug 2011, 20:31
  #73 (permalink)  
 
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Huge differences between the US and UK for night operations....for all intents and purposes....there are none in the UK.

Now the response will be...."OH Yeah!" and they will quickly point out the Plod (Police or Po-leece) do them all the time. Private Operators....of which there are literally a hand full in the whole place....do not operate after dark (unless I am grossly mistaken).

Canada has a very enviable safety record....thus we might look to the North for some ideas.

The UK EMS folks are just as dedicated as their mates around the Globe...but the CAA/JAA/EASA or whatever authority that is in control at any given day...severely limits Night and IFR operations to the extent if you get injured at night in the UK you will in all liklihood be transported by ground.

A question has been posed....."What is an acceptable Loss rate in lives and aircraft?"

I turn it around...."What is the acceptable loss rate in patient lives that are lost due to the absence of a 24 hour HEMES operation?"
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Old 28th Aug 2011, 20:44
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Huge differences in other aspects beside night operations.

How are scene responses handles if they are allowed at all?
Are all flights inter-facility?
Some countries do not allown VFR night operations. Some countries do not even allow civil night operations at all.

I watched a response in Wyoming several years ago. The helicopter and the ambulance both departed at the same time. I asked about this and the guy told me that since the distances are so far, and weather reporting so scarce, that the helicopter launches and if he can not make it to the scene (possibly 75 or 100 miles away) the ambulance is already enroute. If the helicopter makes the patient pick-up, the ambulance turns around and goes home. This is one scenario you won't have in Europe.

Canadians might have some very long legs, what is the Canadian scene response like? Do Canadians do scene responses or are they mainly inter-facility? Remember, Canadian health care is socailized. Non-profit and they surely do not launch for cases that are not worthy of helicopter transport.
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Old 28th Aug 2011, 21:02
  #75 (permalink)  

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Private Operators....of which there are literally a hand full in the whole place....do not operate after dark (unless I am grossly mistaken)
You are grossly mistaken. The night flying season is almost here again.
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Old 28th Aug 2011, 21:28
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ShyTorque:
So I've completely missed the point of the second paragraph of post #65?
Apparently. Nothing in what Gomer said in Post #65 implied that the U.S. model is the best. It's just what it is (profit-driven), and nothing, not all the whining from people in any other country is going to change that. As a culture and a country, the U.S. is apparently okay with the loss rates compared with injured people saved. Oh, the NTSB will harumph and recommend after every accident, but in the end very little will change.
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Old 28th Aug 2011, 21:37
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The acceptable accident and death rate will always vary between countries and cultures. It's a philosophical issue, and I'm not sure there is a right or wrong answer to that. Zero accidents by HEMS crews is one ideal, and a few accidents but fewer patient deaths because of lack of transport is another. It's a continuum without a firm boundary, like all moral issues. Should we let one person die to save many others, or save those we can and take a chance on many more deaths? Each person will have his own opinion, but I don't think any of them are necessarily right for everyone or everywhere. The US philosophy is the US philosophy, and the British philosophy is the British philosophy. Both are valid, but only for that locality.

To put it another, ruder, way, opinions are like a$$holes. Everyone has one, but the stink is in the nose of the beholder.

Another opinion I have is that you can't cure stupid. The profit motive has relatively little to do with press-on-itis, IMO, and the pressures are mostly self-imposed. My company has very strict weather minimums, and goes out of its way to remove pressure to fly. No one in the company has the authority to question the PIC's decision to fly or not, at any level. It's the pilot who decides to keep going in deteriorating weather, not the company's, and I believe that is the case in almost all the HEMS companies in the US. The hero mentality is dangerous, and I try to dampen it any time I see it. Anyone who is in this business to save lives is in grave danger of killing himself and his crew, but there are those who see the job that way. I don't know of a way to stop it, because you just can't cure stupid. Ignorance yes, but stupid, no.
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Old 28th Aug 2011, 21:49
  #78 (permalink)  

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FH1100, Exactly, so I understood the post perfectly. SAS was mistaken, not I.

If profit and company competition is put before flight safety then accidents will happen. Simple enough. Like it or not, your system is some years behind Europe, we aren't whining about it. After a series of high profile nightflying accidents in UK the CAA put in place further legislation in an attempt to reduce them.

E.g. No single engined public transport at night. Police and EMS/AA deemed public transport. Unstabilised police aircraft legislated out of existence. All police base helipads to be lit to an acceptable standard by night etc.

None of it will prevent a crew having an accident if they really try hard though.
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Old 29th Aug 2011, 00:05
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Shy,

What I was thinking....but failed to get to my fingers....was HEMS Operators not "Private Operators".
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Old 29th Aug 2011, 13:54
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Quote from GomerP:
"I've said it before, and I'll say it again. European and other pundits have no business pontificating on the state of the US industry, just as the US pundits should, and generally do, keep quiet about their industry. It's a different culture, under different rules, with different philosophies, expectations, and goals. Right or wrong, profit is the driving force for all business in the US, and that will not change no matter how much fun the rest of the world wants to make of it. Short-term profit is the end-all and be-all of the US economy, and short-term profit is not possible if multi-engine, multi-crew aircraft flown only under IFR are required. So get over it, those will never be required, and will seldom be used."

In more simple terms: You cannot fix stupid.

So, in accordance with that statement we should just let it be and let PATIENTS suffer the consequences, attitudes like that are the reason why I am happy to no longer operate in that segment of the industry.
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