NTSB Hearing on Most Wanted: Improve the Safety of EMS Flights

[SASless]

Ah....but by God we have some fancy nomex flight suits and wear spiffy shiny helmets to pose with! Besides....we saving lives Man!

[WhirlwindIII]

Sooner or later (probably MUCH later at the rate things go here in America these days) a shaker in the powers-to-be is going to see through all this hype and get some rationalization going, and/or put the professionalism in to the systems required to interface and deal with HEMS. We can only hope and continue to work on it bit by bit.

[Brian Abraham]

From Aviation International News today.

AAMS Pushes Mandated NVGs, IFR for Helo EMS
The Association of Air Medical Services (AAMS) is recommending the FAA mandate night vision goggles, enhanced vision systems or IFR-only operations for all night flights of EMS helicopters. The recommendations come on the heels of nine fatal helicopter EMS (HEMS) accidents since December 2007 and one week before the NTSB is scheduled to hold what promises to be highly charged public hearings related to those accidents and overall HEMS safety. AAMS also wants the FAA to mandate recording devices and prioritize and accelerate the implementation of Automatic Dependent Surveillance-Broadcast (ADS-B) infrastructure to HEMS operating environments and implementation of associated weather reporting and communications enhancements. The FAA also is encouraged to produce materials for community emergency response services and medical facilities within the operating area of an air medical service to address issues of “helicopter shopping” and study flight crew fatigue factors. AAMS seeks congressional approval to make AIP money available for the construction of HEMS heliports, low-level special IFR-GPS routes and approaches and AWOS at hospital heliports. The association also recommended that all HEMS operations (commercial and government) be conducted under Part 135 and that all operators adopt flight operations quality assurance programs.

[WhirlwindIII]

Having listened to three days of ice melt at the NTSB HEMS hearings I'm still of mind there's little in our future to identify and fix real HEMS problems - too many pseudo-expert fingers in the pie that need to butt out.

It is nice to see all the players in the same room at the same time though.

[Brian Abraham]

there's little in our future to identify and fix real HEMS problems

Interesting to see that in evidence given the Canadians have never had a fatal HEMS accident since beginning operations in 1972. What is it that they do that gives them such an enviable record?

[Civis]

SUMMARY of NTSB HEARINGS

HEMS Reports, Days 1 -3

[SASless]

“The regs force people to fly VFR,” he said, giving the example of a flight in marginal weather that could legally be flown under visual, but not instrument, flight rules. “We must evolve to a point were we encourage IFR flight,” he said, also noting the need for more extensive low-level IFR infrastructure.

Bruce Webb, Chief Instructor, American Eurocopter

He is right around the corner from Nick Lappos....perhaps they need to get together in a joint effort.

Nick has done some very interesting work on improving helicopter IFR.

[aspinwing]

Simple

Brian Abraham

"Interesting to see that in evidence given the Canadians have never had a fatal HEMS accident since beginning operations in 1972. What is it that they do that gives them such an enviable record?"

Simple, in my province.

Twin engines, two pilots, single (single payer insurance) dispatcher (including fixed wing) source which filters the requests and pays the bill - no shopping.

[WhirlwindIII]

All

HEMS is an aviation activity. In the states there are a lot of tails wagging the dog (medical types pretending to be the authority), and the dog is letting it happen, on all levels. That's our primary problem.

Canada simply looks at the 24/7/365 nature of the beast and equips/staffs appropriately. The US simply tries to get the most bang for the buck - which is wrong, but the industry and government won't admit it.

I was a bit shivered to hear one witness from a prominent operator say they decided VFR is the only way and they were spending on TAWS etc. rather than IFR. So, we take the chances that TAWS will keep us out of CFIT than using IFR and being up and away from it all.

The US operators are simply FAR too shy of IFR operations, keep looking only at the number of pure IFR flights they do as a result of equipping to that standard, and forget the VFR flights that get done whilst prepared to go IFR should the weather deteriorate whilst enroute, etc.



Low level helo type IFR infrastructure is very possible, particularly with ADS-B. Probably never see it in my life-time.

WIII

[SASless]

WWIII,

Slow down Lad, read who it was that said that.


That operator relies upon the trusty Jet Box....and it is far cheaper to add NVG's and TAWS on a VFR machine than to replace the entire machine with an IFR machine with NVG's and TAWS.

Now think about what he said and why!

There are some other issues he skipped over....like takeoff performance in high places, and hot not so high places.

[WhirlwindIII]

SASless

Think we're talking about different operators.

One I'm talking about has a lot of IFR machines being flown VFR-only thus the pilot proficiency is not to 135.297 standard. Bit wasteful considering the IFR option really can't be routinely exercised when prudent and useful excepting in the case of IIMC. The future sees more IFR machines for this operator, being flown VFR-only, as well as new and retrofit VFR machines with NVG, HTAWS, etc.

Not allowing pilots the training to meet IFR proficiency standards whilst assigned to an IFR machine doesn't make sense. They need to spend on IFR pilot training and take full advantage of options that could have prevented some previous problems.

WIII

[Gomer Pylot]

IFR for hospital transfer flights is certainly doable, eventually. But I do about 70% or so scene flights, and there is no way to do those IFR, in any really meaningful way. If the scene is 10 miles away, on a road or out in a field, trying to get there IFR takes longer for just the planning than it would for the fllight, and then how are you going to do an instrument approach to an unprepared scene for which you don't even have precise coordinates on departure? IFR from the scene to the hospital is possible, if the regs are changed to allow departure from a scene, and there is an instrument approach to the hospital, but with current equipment and procedures, it's out of the question. The US is too large, and has too many different areas and environments for a one-size-fits-all solution. I enjoy IFR flying, but it's not suitable for the EMS flying I do. It may be for other type operations. There has to be some amount of flexibility.

[WhirlwindIII]

Gomer

All true. I definitely agree flexibility is the key. Getting operators to view it that way is another thing. Bottom line is IFR capability may just be the price for the safety we need - most likely far cheaper and obviously better than the accidents we have seen of late.

WIII

[OBX Lifeguard]

My approach to this problem has been to hire pilots with demonstrated competence in IFR operations and to require they maintain that competence. To that end I make it easy for my people to get simulated instrument time by availing myself to be in the left seat at their convenience. We also try to make an effort to have some of these training flights at night and when possible under actual instrument conditions.

We are not an IFR operation, but inadvertant IMC at night is a when not an if in my experience. And when inadvertant IMC happens, the sudden transition to IFR flight requires recency of experience.

I'm still on the sidelines concerning NVDs. My military experience with them in over water flight leaves me less than exuberant and over water is a fact of life in my location. I've requested funds to convert our cockpit to NVD compatibility and to secure NVDs for next year nevertheless.

I fail to see where TAWS would do a thing to help the situation. A half dozen instruments are already telling the pilot in your typical CFIT accident he's screwing up; how is one more going to help. The problem is instrument competence, not instrument quantity.

The two other things we do that have helped is 1) review of patients transports to make sure we are not flying innappropriate patients and 2) pre-designating landing areas to decrease the number of pure scene landings.

A last point. If you go back to my first sentence... I also pay my pilots very well to keep those competent pilots working for me .

[Brian Abraham]

Simple, in my province.

Twin engines, two pilots, single (single payer insurance) dispatcher (including fixed wing) source which filters the requests and pays the bill - no shopping

aspinwing, just how its done in my neck of the woods in Auz, except single pilot Bell 412. Crews tell dispatch after consulting weather what they are capable of doing so there is then no fecking about getting the correct resources to the task eg ground ambulance if flying is out. No going to have a look see, finding you can't do the job and then having to resort to alternatives, not doing justice to the patient by delaying aid, or killing them in the process as seems to be the US want in its competitive drive to turn a buck.

[ramen noodles]

From HeliOps Magazine Early Last Year

Imagine that, on the Planet Mongo, a great percentage of car accidents are occurring. The Mongoians are concerned, and they launch a scientific team to find out what is happening. The accident team finds that surprised drivers suddenly strike unseen trees. “The cars needed good tree detectors,” they decide, and they set about developing new tree detectors for car dashboards. The Mongoians discovered that drivers are driving into ponds. They state that “There is a great need for better pond detection, and even map displays to show the ponds, and better driver training to be sure drivers read the Pond Digest” and so a great effort is launched to plot the ponds on the new dashboard navigators and to train drivers to avoid those pesky ponds. The Mongo dwellers also find that “Drivers were not studying their weather reports and sunset charts, and were therefore driving into snow drifts and across plowed fields in the darkness.” The accident investigators determine that much training time and money must be spent making sure that drivers carefully plan their drives, and consult the known snow, weather and sunset data.

But one safety expert on Mongo said, “By systematically noting every accident, we could piecewise fix each direct cause, and miss the major, fundamental problems that our system presents to us.” “When you re inside a box, it is hard to know the color the box,” she said, wisely.

You see, on the planet Mongo, where all those car accidents occur, and where the investigators find the need to make the drivers better, and where they are burdening the cars with more and more equipment, there are no roads. Not a road, not a highway, no white stripes, no Motorway signs, no traffic lights. No Jersey barriers, no off ramps, no banked curves. Each driver starts his car and drives into fresh new ground, heading wherever he wants, unmarred by any large scale path planning, unworried about speed limits, planned maneuver radius, traffic control, stop signs and the like. This lack of roads (which have not been invented on Mongo) is a stunning problem to the accident investigators, because they don’t even know that roads could exist. With no roads, the driver bears the responsibility for avoiding all trees, snow drifts and ponds. With no roads, every drive is fresh and new, and cannot learn from the last drive. Without roads, every driver’s judgment is all that stands between success and failure, each tree avoidance relies on a new, fresh judgment, and every driver must make thousands of these judgments on every drive. To miss one such judgment means an accident, and to a Mongo Investigator, it means the need for new driver training and new dashboard equipment.

What is our point? Helicopters desperately need Helicopter Flight Infrastructure, with routes, approaches, departures. If we are not careful in our accident investigation, if we settle for the low-level intermediate causes, we could miss this potentially big finding.

What did route and approach infrastructure bring to airplane aviation 70 years ago?

Routes bring pre-packaged navigation guidance. They relieve the pilots from the burden of planning altitudes, obstacles, and let-down points. Like canned soup, the work is done for you, by experts.

Infrastructure, especially instrument approaches and departures, relieves pilots of continuous judgment about mundane things. EMS and Offshore accidents are rife with crews that make the seemingly bone-headed mistake during critical takeoff and landing scenarios. Initial approach routes, precision approaches and standard instrument departures reduce the need for judgment, regulate the activities into trainable segments under clear airspace control. In doing so, those judgments not made allow pilot cognitive workload for the things that can’t be regulated, making the entire flight safer.

Will routes shackle helicopters and prevent our missions? No, not if they are helicopter routes that harness the awesome memory of modern flight management computers that can hold hundreds of routes and approaches. It is possible to surround every city with dozens of precision approaches to highway intersections, hospitals, businesses, and oil platforms using WAAS and little else.

The FAA crossed this infrastructure bridge years ago. The FAA realized that airplane operations required approaches and departures with firm guidance and weather minimums that support the bill-paying public. VOR’s were invented to keep airplane airliners on track to destinations, ATC was invented to prevent airplane mid air collisions and guide flights safely to touchdown. Airplane non-precision procedures for scheduled carriers were virtually eliminated in the 1960’s and 70’s when the FAA realized that the tendency for pilots to peek was too much. As a result, hundreds of ILS systems were installed at small airports and 200 and ½ minimums became the standard.

Shouldn’t we helicopter people sit down and ask ourselves, like those investigators on the planet Mongo, “What is wrong with this picture?” How can we allow night “VFR” operations offshore, into sky as black as the inside of a cow, and then wring our hands and “seek data” when we lose a helicopter airliner every few years to FITWO? How can we watch EMS operators launch on VFR flights into the darkness with low ceilings to pick up injured patients, when the ease of full instrument approaches to highway intersections and hospitals has been demonstrated in dozens of trials?

Helicopters deserve the same respect as airplanes, especially when the Satellite Nav tools are just waiting to be used. Why is radar the separation tool and 3 mile separation the rule when WAAS is accurate to within a few meters and ADS-B data packages can be swapped automatically? Why does VHF radio range set the minimum airway altitude when a company like FEDEX can track a truck and talk to its drivers anywhere on the planet? With tools like this having been available for the last ten years, why are there NO helicopter precision approaches to any heliport or hospital, and no helicopter low altitude routes anywhere?

[SASless]

Ramen,

You asked the question.....why we don't have the infrastructure and not a single helicopter precision approach in the country.

Turn your question around and tell us how to do it and get it done by the FAA and Helicopter Industry if you would?

What Role does HAI play in this quest for that change?

What Role does the individual operator play?

What Role does the helicopter manufacturers play?

What Role does the individual pilot play?

Interesting side note to consider.....the Canadians have not done what you suggest and they have not had an EMS fatality yet. Why can they do that without any accidents but the Americans cannot?

[ramen noodles]

SASless, you ask great questions!

Turn your question around and tell us how to do it and get it done by the FAA and Helicopter Industry if you would?

The Frendlie Aviation Agency has a program just signed to create low altitude routes approaches and departures specifically for helos

What Role does HAI play in this quest for that change?
The Flight Operations Committee is one of the key sparks to make it happen, come to the meeting at HeliExpo and watch the sausage being made. A ppruner is the task master for this piece of the puzzle.

What Role does the individual operator play?
establishing the initial routes requires operator help - aircraft, route and approach locations, expert guidance for operations.

What Role does the helicopter manufacturers play?
Equipment installation, flight envelope, prime advocacy, selling machines that do the job

What Role does the individual pilot play?
Usually Coco the Clown, at least in your case. ;-) Seriously, the lead pilots are key in designing the routes and approaches to be productive, safe and easy to fly. Also, the pilots can help by advocating IFR operations for all offshore and onshore commercial work. I am constantly amazed at the attitude some have that equipment and procedures are too expensive and too much bother.

Interesting side note to consider.....the Canadians have not done what you suggest and they have not had an EMS fatality yet. Why can they do that without any accidents but the Americans cannot?
The typical old solution for EMS accidents is to simply sit at home and tell the patient "tough beans, old chap." I guess the Canadians are better at that.

Seriously, the issue is not to derive safety by stopping operations, it is to make those operations safer while doing them. No?

[SASless]

Ramen,

If we in the USA are successful in accomplishing this....and meet ICAO standards while doing so....would that serve as an impetus to the UK CAA and European agencies to adopt that technology and allow their HEMS Operations to begin night operations you think?

[ramen noodles]

Sasless,
You bet. Or at least, the helos could fly overhead and drop leaflets that said, "Tough beans, old chap."