West Mids Air Ambulance going night flying?

[SASless]

TC....is there something in the British blood....DNA or something that makes ya'll see better in the dark or something?

Yes....our Helicopter EMS industry has a terrible record....not one person denies that.....and I am one of those who have been saying so from the very early days of the business.

What I am asking you guys and ladies to do....is explain to me in detail....how you are going to do the same tasking....without making the mistakes we have...and in too many cases continue to make.

Charity or not....you have to justify your existence or you will be gone.

That comes in the way of "flights done", "patients carried", "dispatch rate", or some such method of measurement. That means you have a "need" to get out and fly. You may deny it....but it is there.

What is it about the UK system.....IFR route structure, localized weather reporting, aviation infrastructure, CAA Policies, the Law....Pilot Training....that is going to make your way superior to the US way.

Those are the questions and yes....they are very serious....and deserve a serious answer. If you cannot....guess what the result is going to be?

You seem very certain you guys have it "right" and we have it "all wrong"....so please lay it out for us over here in the USA.....show us the path to redemption will you?

C'mon - you're having a laugh, aren't you?

Nope....this is a deadly serious conversation....as I don't think you lot will be as safe as you think you will....and fly.

[Thomas coupling]

SASless.

Ooops, you really are not clued up here, are you. Your "US" model (the one which has been debated by both you and your country folk, time and time again) which is riddled with crashes - stems from ONE main cause. ONE which stands out head and shoulders above all other causes of crashes for night EMS: Corporate pressure.
Corporate pressure to make the patient KPI's / pressure to make a profit / dispatch rates and so on.
The knock on effect invites poorly specified helicopters, single pilot ops, low experience pilots.
The ultimate cause, fairly and squarely in the cross wires is the pressure to force a low timer, airborne in marginal weather, in non stabilised, single engined aircraft similar to the one taht stoofed in IOWA on the 3rd. If ever there was a crash that pulled together all the reasons for the EMS industry in the USA to suck: This was it

And guess what, SASless - in answer to your question as to why we won't go the same way in the UK - we have a totally different mindset to HEMS/AA. I would wager a years salary that the press on itis, a lot of your EMS crews experience, simply won't happen here.
The pilots (often there are 2) are high timers. The aircraft are twin engined (and NO, I am not comparing single Vs twin - but twins tend to come with all the bells and whistles associated with expensive multi engined helos), there are no dispatch competitions and above all, the aircraft aren't ambulance chasers where they get paid for every patient they rescue/save. They are charities, the pressure changes.
In addition, the CAA regulate a lot closer to the coal face than the FAA does. They run a very tight ship over here, not much seeps between the cracks. In the US, I suspect in the land of the free, you are free to do mainly what you like within reason - no? How often do these EMS outfits get audited?

The "US" model - thankfully, remains a US model (not just u/s). It stays over on your side of the pond, bud

[SASless]

Out of all that.....you have said "Profit is not the driver" and "the CAA is stricter (or words to that effect)".

Now tell me about the weather reporting, access to Airports after hours, IFR Route Structure, Radar Approach Controls, and other aviation infrastructure that is different and more useful to you than our system in the USA.

You have to fly somewhere, by some means, under someone's control, and be granted Clearances to fly and land.

Tell me about that.

Oh....and I am certainly not wishing our system upon you.....I just don't want to see you make the same mistakes we have and do here.

[vortexadminman]

Wot he said!!! Thomas that is. But no we dont need permission to fly or land ( providing not in controlled airspace, and we stick to rules about landing sites)

[jayteeto]

we have enough airports, we are not under commercial pressure.
Sasless, let's not be UK arrogant, we MIGHT have a pressonitis accident here. I am saying it would not be because of the scandalous commercial pressure over there. The conditions for night AA are much more favourable, the weather is less extreme, as is the terrain. met forecasts are not that bad!
the UK is not utopia, but I genuinely believe we should give nvg a try, closely monitored, followed by a review by the CAA.

[Bladecrack]

You have to fly somewhere, by some means, under someone's control, and be granted Clearances to fly and land.

SASless - I flew HEMS on Xmas day in the UK, in a rural region with limited wx info, controlled airspace inactive, all airports closed, no ATC, fuel available at home base or other regional AA units only. Whats new? Thats pretty similar to most weekends here really where we are on our own while on a mission with the exception of Amb control who I wouldn't rely on for any help. The unit I work at have been operating for over 10 years accident free. That says something don't you agree?

I agree totally with what Jayteeto says, we have different attitudes, training, equipment, and environment to the US, we just make the best of what we have. No disrespect to US EMS pilots intended, I am sure they do their best under difficult conditions.

BC

[SASless]

Blade.....how do you conduct an instrument flight with those factors at play?

Here we have to have a weather report and forecast for the route of flight, takeoff point and destination, an IFR Clearance, a filed flight plan, and the ability to talk with ATC while inflight. Add in flight following requirements and all of a sudden it gets a bit complicated.

How about in the UK....can you operate IFR in the situation you described?

Can you fly IMC without an ATC Clearance and Traffic Separation?

At what height does controlled airspace begin where you fly....when the area is below VFR Minimums?

What Instrument approaches are available and what approaches are you authorized to perform and to what minima?

Is all Night flight conducted under IFR?

What fuel reserves do you have to maintain for a Night Flight?

If you go IIMC...what is your SOP....Alternates....Alternate Weather Minimums?

[Helinut]

SASless,

I think there are some big differences which will help to reduce the chance of problems in the UK:

It will be small scale(we barely do any helicoper flying here, except offshore). As far as HEMS goes, it seems that at present only 1 HEMS operator and 2 HEMS trusts have advanced plans to go night.

It will stop around midnight: no 24/7 ops

The CAA don't really want it at all. (It is just that they no longer have policy control). They will make it as difficult as possible.

Our HEMS heles operate in tiny areas, which make a number of risk factors easier to manage.

There actually is not much pressure (or need) to use heles at night. So the pressure to go or "press-on" is reduced. Just call a truck and the casualty will be in a hospital a few 10s of minutes behind a HEMS ETA. Not worth taking much risk at all, for that benefit.
[There really is not much demand for carting patients/casualties around at night in a hele in the UK. We do virtually no inter-hospital transfers at night, even though they have been legally possible for years, prior to these new rules: Such UK flights are NOT defined HEMS: unlike I believe in the US].

Mind you, time will tell. We have made our own mistakes in the past (don't tell TC I said that). Having fixed things we tend to forget them. [Strathclyde Police EC135 IIMC x 3 + crash: BASL]. We probably act a bit quicker to fix stuff than the US HEMS industry has in the past, which must be in our favour.

[M609]

NLA in Norway had a couple of nasty "VFR" night accidents (fatal, sh*t wx) in the late 80s, early 90s. (Believe last one was 91)

BO-105, single pilot, no NVG, no practical way of doing IFR.

That to me as an outsider is a more similar operation to the US way of doing things (outlined in topics here on pprune) than the HEMS operation they do now in 2012.

H24, NVG, coupled auto pilot, some kind of "TCAS-light", dedicated IFR route structure in parts of the country, GNSS approaches - not the same thing.


It´s all about funding right?

There are believe it or not (for you US readers), some upsides to "socialist healthcare systems", in that no one has to make a profit. I´m sure the HEMS service in Norway is extremely expensive, both the helos and the fixed wing side, but they DO get the job done, and in some rather nasty wx/terrain/dark places.

I see no reason that the UK should not manage to get a safe night time operation, even if the wx is dodgy most of the time. (Would be nice to visit the UK once without it raining...... )

[Bladecrack]

SASLess - to clarify, by HEMS I mean an unplanned urgent tasking requiring an immediate departure, (under VFR) as opposed to a pre-planned Air Ambulance tasking which may be VFR or IFR.

Helinut - I disagree with several of your points, there are more than 2 trusts planning to start night ops in the UK. During his last visit, our CAA ops inspector talked at length about future night ops and how it would work, was generally very positive, and seemed very happy with the operator's proposed plans for crew training etc.

We operate in a large rural area, small by US standards, but one of the largest regions in the UK, meaning emergency resources are very stretched at times. From scene to the nearest hospital can easily be over an hour by road, so by air will make a substantial time difference. The demand for inter-hospital transfers, both day and night will soon increase as smaller hospitals close and services are centralised to major trauma centres. This is one of the main driving factors behind the plans for UK night ops.

[[email protected]]

Helinut - you might not do many hospital transfers at night but we do - because you guys aren't available at night. The SARF completes a great many medtransfers at the request of the NHS.

Sasless - you can fly quadrantal FLs IMC above 3000' in UK (with some exceptions) in class G airspace and most airfields with an ILS will either be open or you can use their approach aids out of hours because they don't usually get turned off. You might only get a basic service or traffic service using SSR but apart from the climbout and descent, the quadrantals provide vertical separation.

There is often no-one to talk to in the wee small hours in UK at helicopter altitudes but IFR can be done quite safely. Most large airports stay open, even if the first radio call wakes up the only controller on duty

[SASless]

Thank you Crab....you reminded me of what I seemed to recall. In the UK...the sidewalks get pulled up after Sunset when it comes to aviation pretty much.

On the "closed" airports....do you have pilot controlled lighting and approach aids so that a Pilot can key his VHF radio and turn on the runway lights and such?

How does one know which Approach Nav Aids are active after the Airport is closed?

Now I do grasp the Class G Airspace thing.....and flying Quandrantals...but I submit to you and others....that is neither "Controlled" or "IFR"......it is IMC and Un-Controlled IMC.

I will grant you also that 3000 feet in most parts of the UK will see you clear of terrain as well.

Somehow....I see flying IMC in Uncontrolled Airspace, with no "Clearance" (organized traffic separation), no contact with ATC, and showing up at Airports that may or may not have Lights or Approach aids working and not having anyway to ascertain what the existing weather is at those places, to be something Commercial Operators might want to shy away from.

Am I right in thinking this might be a recipe for problems?

Along with the lack of "Profit Motive" by the HEMES/AA operators and pilots....it would appear the UK method of funding Aviation Infrastructure needs looking at as well.

How many AWOS systems are there in the UK?

Who pays for installing them....and do the owners charge Operators/Pilots for using them?

Where do you get your weather reporting from after hours?

[Helinut]

My experience of ILSs ooh is that the mil leave them on (informally and helpfully), and civi airfields turn them off (elf & safety and legal liability). I am sure that there will be exceptions to those generalisations. [Based on lots of police night flying in most parts of the UK]

It may be permissible (under mil rules) to use ILSs for SAR left on but unmonitored, without ATC, traffic and weather information. Not at all sure that would satisfy EASA Ops. JAA/EASA OPS3 does NOT consider hospital transfer as anything other than normal pax transport. Full AOC/CAT standards.

Crab - re: the use of SAR heles, I am sure you are right, (I know you are right) but that just strengthens my point. Why would HEMS cabs be used at cost to the charities, if you are providing the service already at no cost to the NHS? Little incentive to take on a service already provided by someone else. Sure this area may grow, but not this decade.

[SASless]

Crab,

Military rules are far different than Civvie Rules.

Using Navaids, approach aids after closing hours won't pass muster with the CAA I fear.

Thus, in planning a night flight with any kind of questionable weather would mean having a legal IFR destination and Alternate....that meet the requirements legally.

How does a Civvie Operator get around that small obstacle?

If you go IIMC....you do need a way to find a cup of Tea!

[TeeS]

Helinut

Please don't continue to spread the still widely quoted view that:

JAA/EASA OPS3 does NOT consider hospital transfer as anything other than normal pax transport. Full AOC/CAT standards.

Neither JAR or EASA mentions anything about where the patient is going from/to - the HEMS decision is based purely on medical requirements.

Back when Hippocrates was in medical school, inter-hospital transfers were treated differently to 'primary missions' but that went out of the door with the introduction of JAR.

Cheers

TeeS

[jayteeto]

some places have limited night air traffic control, others have tons of it. London info is open if you need to talk. our area has two international airports open 24/7 with another couple nearby. IF we got caught out weather, we would be ok. NVG would be possible in our area. If the weather is below limits by day, we don't fly, why does night change that. We don't do IFR hems generally.

[SASless]

Neither does the American System (using the UK definition of HEMES.....what we would call "Scene Flights"). It is the inadvertent IMC Ops that VFR crews experience that seem to be the real issue.

Off thread someone suggested he felt the US EMS Accident rate was not all that bad as a rate.....considering the sheer number of flights being performed.

That may be.....but we seem to be able to replicate the causes for fatal accidents with great frequency.

In a perfect world there would be no accidents as we could prevent them all....but then this is not a perfect world by any means.

I would prefer the Industry embrace change....cease killing folks the same old way over and over....and find new ways to do that. At least we could be seen as being innovative instead boringly repetitious.

[homonculus]

Great set of posts. I agree the UK should be able to operate at night to a higher safety record than in the US

But

Why?

The vast majority of night primary HEMS will be trauma. Night trauma is different aetiologically to day trauma. RTAs with seriously injured ocupants more commonly involve remote areas and entrapment but are in the main covered by prehospital care doctors. The Sheffied audit on the London HEMS showed the only real benefit was the delivery of doctors on scene but we already do that at night. Although we often struggle logistically to deliver enough emergency crew to the scene initially that is not the same as struggling to have adequate vehicles to transfer. Indeed my main issue on scene is utilising my ambulance crews, fire support and police and I regret to say dealing with a helicopter would more often be a burden than a benefit.

Against this dubious need is my concern that night HEMS will be a higher risk than day HEMS whatever rules apply. The significant increase in costs will have to be raised from charities what only okay we're reporting to the prime minister that they were struggling.

However pro rotary we are, I do believe there are better uses for limited funds than night HEMS. But that is just a trauma doctor's view

[jayteeto]

Agreed 100%

[Al-bert]

Helinut said

Crab - re: the use of SAR heles, I am sure you are right, (I know you are right) but that just strengthens my point. Why would HEMS cabs be used at cost to the charities, if you are providing the service already at no cost to the NHS? Little incentive to take on a service already provided by someone else. Sure this area may grow, but not this decade.

Before I finally 'touched down for good' in '99, night medevacs were on the increase. Something about reduced hospital beds, reduced ambulance services etc etc. My last few shifts saw me flying to Newcastle twice and London a couple of times, call outs usually came just after midnight. Because of weather (icing all levels and cloud base mostly below 300ft) a trip from Valley to London was flown at 200ft on NVG down the Irish sea and up the Bristol Channel before I was able to climb to a sensible altitude (both Severn bridges went above us). Worst thing was we had to return the same way (total 6hrs flying) because we had the only transplant surgeon and specialist nurse with us from Bangor. Medevacs were charged for at, I believe, £4500 per hour; medevacs, or rather Hospital Transfers, were the only ops that were charged for.

ps. before the wise words of safety, captaincy, risk factors head my way I did initially refuse the task. I was, in the end, only obeying orders!