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"Medical evacuation helicopter crashed"

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"Medical evacuation helicopter crashed"

Old 17th Oct 2008, 18:08
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Danger My .02 worth.

There are many aspects to this. Poor decision making, poor weather flying, improper influences to "get the mission done", all while under operational control that is non-existant in most cases.

Why are dispatch calls getting to the base when the weather is below company minimums? When I challenged a communicator on why even call, I was told that "we just get the calls and forward them. It is the pilot's decision to accept or not." Pilots, with operational control listed in the A008 section of their OpsManual, overseeing the communcations centers with an active veto authority would be true operational control, not the brainless call forwarding service we currently suffer. If the company would not approve after the crash, why send the call out to the field offices? I was taught a long time ago that the best way to make a decision was to look at the possible conclusions of the accident investigation prior to the flight.

Also, young pilots are not sufficiently trained in the early years with no one on shift to mentor them in their development. 2 Pilot crews would bring this along, as well as provide that second set of eyes on pilot thoroughness. Too often, pilots shortcut preflight planning. Whether these omissions are because a flight request came in too early in the shift to complete the normal preparation, or whether the call awakens the crew at 0300 and the computer did not update the radar, HEMS weather or other information pertaining to the flight, the end result is an ill informed pilot. We tend to perform to standard when we are in the teaching/learning modes. Attention to detail would be increased, not to mention the increased crew coordination within the cockpit.

With two pilot cockpits comes twin engine capability, in most cases. I do not care what statistics are thrown on the wall when it comes to single vs. twin engine safety history. There are no existing databases, accurately sampled, that reflect the occurance of engine malfunctions on twin engine helicopters which resulted in a safe landing. If a twin becomes degraded by an engine failure, it now still flying when the single would be in an irretrievable autorotation. We know about those at night.

Night flights should have an Autopilot capability mandated from the feds. Several have commented on the workload on the single pilot, at night, in degrading conditions. Even in ideal VMC night conditions, workload his very high, stressors increasing throughout the flight, and the mere addition of an AP would assist greatly. With all the increased radio communication demands imposed after the AZ mid-air earlier this year, it is like playing switchboard opperator in a 1930's Keysone Cops movie. Give a man (or gal) a hand and provide a system that would at least hold altitude and heading. Even if two pilots are in the aircraft, it is a margin without which an airliner would not leave the gate.

Night flights also should have NVG mandated. I currently fly with the ANVIS 9 and it was the best safety advancement my company has ever made. Now, if we could only get the FAA to figure out that they do not need to regulate safety out of existance. Watching the FAA trying to figure out how they can regulate these things is like watching a monkey screw a football. It would be funny if not so sad.

Damn it, indeed! Common sense has taken a back seat to an entrenched FAA sorely out of touch with the demands imposed on insufficient aircraft; aircraft which were never designed for the task of EMS. Common sense abandoned for the saving of a dollar. Common sense ignored by operators who have the political connections to prevent positive change.

Damn it indeed.

Last edited by DTibbals53; 17th Oct 2008 at 19:31.
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Old 17th Oct 2008, 18:17
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Interesting posts - thanks for the ideas.

To me this thread seems to be leaning towards recommending the medical side look at some way of factoring in a mode-of-transport risk decision track betwixt ambulances and helicopters rather than making such decisions based solely on the perceived medical necessity of transport time savings. Hope that makes sense!

I certainly agree there is a general death of common sense at play in this HEMS industry when it comes to overall risk assessment and decision making by a lot of folks involved, at all levels;and I think folks on the line like us are the only ones capable of pointing out the real problems and possible solutions.
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Old 17th Oct 2008, 18:41
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I think very well summed up by DTibbals53.
I quite my last program because they equipped the ground crews with NVG (who knows why) but wouldn't even talk/listen about NVG for the aircraft.

It is a shame that the FARs are written in blood, how much more is needed?
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Old 17th Oct 2008, 20:17
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I was once taken aside by the CEO of the hospital based program where I flew, he in short words accused me "that instead of looking for reasons not to complete a flight I should look FOR REASONS TO COMPLETE A FLIGHT" and threatened to have me removed.

For as long as we allow that type of thinking in this industry and as long as we allow that degree of oversight by a customer, there will be death to pay.
We need to leave the medical equation OUT of our business, PERIOD.
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Old 17th Oct 2008, 21:52
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Tottigol,

Well said. Nothing to add.

GP
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Old 18th Oct 2008, 02:01
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Some good comments from some of the EMS pilots on this site.

I will give you my experience while flying EMS (Central Europe) at night.
We flew NVFR only, in a IFR equipped (less an autopilot), Bell 427. All pilots were given regular training, in a covered cockpit, on instruments and ILS captures.
There would always be 2 pilots (unless the 206LT was being used due to maintenance) with the Lead pilot for the shift making the go/no-go decision, with obvious input from the second pilot.
We had a 15 minute window to check weather along the route and to make sure that company minimums could be kept throughout the flight. The condition of the patient was not generally told to us, and even if so, was not relevant to the mission going ahead. The pilot’s decision was FINAL. He was backed 110% by the company management on this. Any medical personal pressuring a pilot would be removed from flight operations permanently.
We also only did inter-hospital transfers, or landings in to known areas at night. This is due to change with the introduction of NVG’s I believe. The weather minimums will remain the same however.
I don’t think NVFR is a big problem, but you have to pick your battles. If the weather is looking marginal just don’t go, it’s not worth it. You can’t save everyone.

This is a post from a while back where we said no, and another crew said yes, and died. It is well worth reading the entire thread. It all sounds depressingly similar.

http://www.pprune.org/rotorheads/204...terrain-2.html
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Old 18th Oct 2008, 03:55
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Angry

We are wondering how much pressure is placed on HEMS pilots in the States. " Damn too many accidents to date for it not to be a consideration.
Do medical personnel give the pilot the patients condition prior to departure,? which would undoubtedly impact on a pilots decision making process.
Do the pilots get pressure from management? though I'm sure the pressure would be subtle enough not to place the management accountable for anything....
Due to pilot shortages world wide are operators finding it difficult to fill the positions with experienced pilots?? Even experienced pilots find it hard to say "NO" to a job.

I feel if the cockpit instrumentation required for NVFR was the same for IFR then I would n't have the same hesitation to fly NVFR. Personally I think it sucks and would never fly again with an operator that only has aircraft nvfr capable.

But when your young and need the hours you do and fly anything right????
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Old 18th Oct 2008, 04:47
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Pressure, some subtle, some not so subtle.
Response times are recorded for every call, and yes sometimes questions are asked if it seems a slow response, no questions from the other pilots, questions come from the hospital.
Flight volume is also recorded and compared to previous months, this should in no way ever enter the mind of the pilot but there it is. If we can take the flight we will, if we can't we won't should be the answer.
Patient info is passed over the radio along with your heading and distance, why on earth does the pilot need to know anything about the patient, nasty harmfull diseases aside.
I got a light hearted comment tonight about my reading from the checklist and doing a quick 360 walkaround.
Luckily i think i can be very callous and i sleep soundly on the decisions i make, i hope this clear conscience continues.
This is just a business afterall? just don't let the med crew hear you say that!
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Old 18th Oct 2008, 12:24
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A question that might be related to the comments about the tower being unlit.
How many of you have ever reported a tower's lights as being off? Who do you report it to? Was any action taken? Did you record the fact that the tower was reported as unlit??
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Old 18th Oct 2008, 13:02
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Skool:
A few days ago, our Medical Base Manager made a comment that the job was getting more difficult because " the company is turning this into an aviation business". Therein lies a very important clue. I have said here before that, mentally, the crews are still in the back of the ambulance. Saving lives, going hell for leather, lights and sirens, to get there before " the hospital/volunteer squads/doctors(!) kill the patient". That is an inherent difference between the two groups.
As to the pressures,I believe, a lot of the pressure is self imposed. It could be something as mundane as --my paycheck will go away if my base gets shut down, or, as lofty as ---I am a part of the life saving equation. There is also an increase in the pressure (self imposed again) once the patient is on board.It is easier to abort on the first leg than on the second.These are the realities of the job and no amount of regualtion or deregualtion (i.e. take the medical equation out) or bells and whistles can fix them.
Just my 2 c worth---actually now I can only afford 1 c............!!
Alt3
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Old 18th Oct 2008, 13:47
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Shawn, there are local numbers to be called for unlit towers, however it's not the FAA jurisdiction but it belongs to the FCC.
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Old 19th Oct 2008, 02:43
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But when your young and need the hours you do and fly anything right????
When you're young and need the hours you should NOT get a job as an EMS pilot!

GP
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Old 19th Oct 2008, 05:24
  #33 (permalink)  
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Mr Coyle,
I have an 1200' tower just right of the approach course and 8.11 nm from the the nearest airport with scheduled service that's been NOTAMed as intermittently illuminated for 6 years. That's right, SIX years.
Sometimes it has 1 light (the top), sometimes more, and lately new lights, generally working. But 6 years. Yes, I reported it to the FCC after talking to the FAA. I even talked to the company contracted to monitor it. Still, 6 years is a long time. You can tell how urgent the situation is for the tower's owners.

At my program, no pressure to accept dispatch, and no medical information shared prior to dispatch. I'm paid to say no, it's the hardest part of my job. The medics I fly with share the same attitude, in that saying no is tough. They'd rather not go than abort a run, with or without a patient. The time wasted in that process is completely NOT what we're about. When in doubt, chicken out- and go back to bed.
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Old 19th Oct 2008, 07:30
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When in doubt, chicken out- and go back to bed.



Well said Devil
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Old 19th Oct 2008, 14:07
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Revolutionary rightly says:

"Unfortunately though the health care industry in this country is not driven by medical necessity but by profit so the hospital only thinks about filling a bed and the EMS provider only thinks about billing for a transport; nobody does the cost-benefit analysis and up goes another helicopter, launching into the night to pick up a patient with a broken ankle. And therein lies -I think- the root of this problem."

Excellent!




There are just too many ways for HEMS launch criteria to be circumvented, or abused, by medical amateurs purporting to be professionals. If a medical ground crew want to get off shift at scheduled time, and can't due to an impending transport, guess what, that patient can suddenly, by a slight change in medical condition verbage, qualify for transport by helicopter (as if no one knows this already) - this straight from the horses mouth! Not amusing.

Perhaps our medical system here in the US should all be not-for-profit!? No doubt the medical side of the equation IS first in driving the bandwagon, and they need to wise up. All this abuse could stop with them. I wonder if they ever thought they could be, as Revolutionary says " ... the root of this problem." .

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Old 19th Oct 2008, 19:24
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Associated Press list of recent HEMS accidents; I don't believe the list is complete, because no 2007 accidents are listed.

According to FCC data, the tower hit last week in Aurora (WBIG-AM) was in a three-tower array. I have often seen such arrays with one or more towers completely dark. The "lights out" issue isn't just a concern among pilots; Radio World magazine has also highlighted the issue, notiing the unresponsivenes of both FCC and FAA. When one or more lights are out, and can't be quickly fixed (due to wx or whatever), a competent owner will try to alert FAA to issue a NOTAM. But they often run into bureaucracy; "That office is in Minot...".

However, the pilot was close to his home base in Bolingbrook, and familiar with the towers as a landmark.

Last edited by barit1; 19th Oct 2008 at 19:35.
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Old 19th Oct 2008, 21:49
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Therein lies the crux of the matter

AAMS Works with FAA, Congress Toward Safety Enhancements

For as long as we allow the customer side of the business to run the show the priorities shall be reversed.
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Old 20th Oct 2008, 18:33
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Here in the USA

A couple of things:

1. Where I fly there are may, many antennas. Some are nearly 2000 AGL. Most of the other antennas are over 900 AGL. Sometimes the lights are OOS on those structures, and sometimes there is not a NOTAM to reflect that. The FSS will not allow a pilot to file a NOTAM on an unlit structure unless he is the owner of that structure (makes sense, right?). So anything that I see out there will not be disseminated to other pilots outside my own company.

2. Many of us do not have terrain/obstacle warning systems installed in our aircraft.

3. Many of us fly unstabilized aircraft, which makes makes looking down at a chart in your lap while 900 AGL at night in 4 miles viz not a very good idea.

4. Goggles have saved my life on one occasion, when I otherwise would have had intimate contact with a 1470 ft antenna with lights OOS in a dark region that I was diverted through. I was at 1400 AGL at the time, under a cloud ceiling that prevented cruising any higher.

5. Those of us who conduct mostly scene flights, are regularly flying in unfamiliar areas- we are not flying regular routes.

My point is that we still don't know all the factors surrounding this accident. We do know that the pilot was in the process of diverting to a different hospital, and that might have been why he hit the wire. Here in the US, 700 AGL is generally not considered to be "too low" to fly at night. My company expects a minimum of 1000 AGL, weather permitting. But we can fly as low as 600 AGL in or local area (25nm radius of the base). While transitioning through towered airspace, we must generally not climb higher than 800 AGL.

This job that we do is not the same job in every region- some are doing mostly hospital transfers, some are flying familiar routes, some are dropping into suburban neighborhoods at night while dealing with a busy Class B surface area(s). Agreements that we have brokered with ATC may require that we transit at lower altitudes in order to avoid heavy terminal traffic. Sometimes we get turned around enroute due to hospital saturation. Single pilot VFR at night in an unstabilized aircraft does not make in-flight flight planning very much fun.

I do know that an autopilot or a second pilot would make my job easier and safer, but I just don't see that happening unless insurance companies are willing to start paying $18,000 USD per patient transport.
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Old 20th Oct 2008, 18:37
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Perhaps our medical system here in the US should all be not-for-profit!?


Not trying to pick on you here, but there is no such thing as a not for profit. It is merely a tax category. There have been 3 "not for profit" services in my area that no longer exist. Why? They did not make enough money to justify their existence. When a not for profit makes money beyond expenses and expansions, the board divies up extra as bonuses, new foundation automobiles (Benz for the Docs!) and on a rare occasion a bonus for the employees. Not for profit is not for real
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Old 20th Oct 2008, 19:17
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Originally Posted by TheVelvetGlove
1. Where I fly there are may, many antennas. Some are nearly 2000 AGL. Most of the other antennas are over 900 AGL. Sometimes the lights are OOS on those structures, and sometimes there is not a NOTAM to reflect that. The FSS will not allow a pilot to file a NOTAM on an unlit structure unless he is the owner of that structure (makes sense, right?). So anything that I see out there will not be disseminated to other pilots outside my own company.
Does the FAA have an equivalent to the Mandatory Occurrence Reporting (MOR) system? In the UK, unlit antennae could be reported via this channel.
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