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US EMS Crashes-2013

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US EMS Crashes-2013

Old 5th Jan 2013, 22:03
  #41 (permalink)  
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All he had to do was crank one engine now and then....run the heater....and WAIT till Day Light. He could have taken his NVG's....and perhaps that might have made a difference no matter the poor lighting.....he could have fired up the NightSun and hover mosey'd down the mountain side to decent weather....any number of things he could have done that would have altered the outcome.

All so tragic.....good intentions getting in the way of good thinking!
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Old 6th Jan 2013, 17:05
  #42 (permalink)  
"Just a pilot"
 
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"Grenville Fortescue" posted:
"Devil, you should perhaps advertise a seminar on the implications and neuro-physiological impact of EMS flight scheduling and CRM. Let me know how it goes."

No dice on the seminar. I've tried to sell changes to guys who proclaim that they're "not gonna let the job kill them" and then show up for night duty proclaiming that they've had no sleep... Thanks, Ace, for sharing that- do I get you fired by not allowing you to relieve me or hope that tonight is as slack as most???

My assessment is that a major reason that nights are 4 times as dangerous as days has to do with increased error at night, some of which may be reasonably attributed to a stupid approach to schedules.

It's interesting that Iowa crash was new to EMS and wasn't a local.

Last edited by Devil 49; 6th Jan 2013 at 17:10.
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Old 6th Jan 2013, 17:41
  #43 (permalink)  
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Devil.....as much as I agree with your views.....we could stretch that to a guy that shows up having not had any sleep due to a sick child or some similar reason....and it be a Day or Night Shift.

We have a responsibility to show up rested and ready for work....where do we draw the line, when, and how?

That does not even consider your important issue about scheduling!

Tis not a simple answer to any of the questions.

What is your example of as near perfect a schedule?

If you could snap your fingers and make like Froggy and his Magic Twanger.....what routine would you publish for you operation?

Tell us why it is better than what is common amongst the industry today?
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Old 6th Jan 2013, 18:25
  #44 (permalink)  
 
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EMS Standardization or Lack there Of

We can argue day versus night, single versus multi-engine and single versus duel pilot operations until the cows come to roost. Some argue that the airline industry is so much safer than EMS because of the sophistication of the equipment they operate and the fact that they are multi-piloted. When comparing the two operations the one element that stands out, is the complete standardization of airline operations. Airline pilots follow a very regimented set of procedures from the time they arrive in the cockpit until they depart at the end of the flight. This level of standardization was relatively easy to establish due to the much repeatability of their flights.

Now look at the situation surrounding the EMS operation in the US. EMS in the US could be called almost anything but standardized is not one of them. Like I have said in the past, my experience with EMS operations is relatively limited when compared to most on this site. Having said that, I was fortunate to have had flown single engine VFR in a mountainous region of the SW and SPIFR in the flat lands of the SE United States. In all cases, I took it upon myself to establish a set of standard rules which I flew to. These were not taught to me but rather developed by me to keep my mediocre butt out of trouble. Early in my career a very wise instructor once told me “always fly two mistakes higher than you feel you may need should something unusual happen”. Here are my rules of the road and they served me quite well into healthy retirement:

1. I flew the same profile day and night. I would climb at best ROC airspeed directly to 1000 ft above the highest obstruction in my route of flight and that established my cruise altitude. I did receive many a comment form fellow pilots about why I could always be found up in the rarefied air while they cruised along Hwy 60 at 500 ft AGL
2. If I didn’t have the weather to accomplish this, during the flight including the return leg, I didn’t launch. Was I ever questioned concerning this “YES” did I care “NO”
3. While flying VFR in an autopilot equipped aircraft, I always let the autopilot fly the machine anytime I was above 500 ft AGL. Rule one still applied. In this case any response to IIMC was nothing more than turning the heading bug 180 and contacting the appropriate controlling authority. Funny thing is the autopilot never knows is in IMC.

Other may have many such guide lines that have served them well over the years and I would hope that they share them.
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Old 7th Jan 2013, 00:23
  #45 (permalink)  
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Jack,

All very sensible....but as you noted...."Individual" and not Standard.
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Old 7th Jan 2013, 14:58
  #46 (permalink)  
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For me, the perfect schedule would be 7 days, 7 off, 7 nights, 7 off. Once I shift to nights, I'm good to go. I know perfectly capable pilots who can't do 7 nights- small children at home or other things that interfere with efficient and sufficient sleep. That isn't a go at my base.

One should at least start transitioning to nights as well rested as possible, either by doing nights at the start of your duty rig, or with at least a couple of rest days between day and night duty shifts.

I've proposed a 4 night, 2 off, 4 day, 6 off. The objection is are that those schedules don't faithfully follow the 7 calendar day week.

One of my colleagues proposed a more complicated 3 night (or 4), 2 off, 4 day(or 3) and 6 off. If carefully arranged, everybody got every other weekend off. But that reduced the length of the break....
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Old 7th Jan 2013, 15:15
  #47 (permalink)  
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Does the time of shift change figure into your thinking.....would a change at say Noon/Midnight be better than the more common 0700/1900 change time?
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Old 7th Jan 2013, 16:05
  #48 (permalink)  
 
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Some very wise words indeed on this very emotive topic.

I am a flight medic with a substantial amount of time in the role, and a pilot as well; based in Australia. The biggest risk I see is the 'Mission Focus', which I have seen in the Community based helicopter services (compared to the Government operation). These community based machines have some commonality with the US EMS model, in that their income is task-based - they charge a fee-for-service, the more they fly, the better the income stream, the less they have to dip into donations or contract fees for wages and other costs. They are also more cost-aware, operating to a lower budget with less-ideal aircraft

The idea that 'We have to go' has several facets.

'The community expects...' ie the community funds the machine by donation or subscription and they expect to see it working; or when Mrs Bloggs boy Joe breaks his watchcamacallit there is a perceived expectation that the 'community' machine will be there 'saving lives'. Reality is that the 'community' per se doesn't particularly give a rats bum about how much the machine flies. Some major sponsors would have an interest, but the organisation should be keeping them informed of the realities of the show rather than fantasizing to try and 'sell' the 'product'.

'We save lives'...the whole 'life-saving' thing in an aeromedical sense is mostly nonsense. Rescues - certainly, the flood rescues in 2011 demonstrated the unique value of RW assets in that setting, but aeromedically, not so much. Fact is after 20+ years in the emergency medicine game, I can say with a degree of authority that while pre-hospital provision of medical care does reduce pain and arguably decrease morbidity and length-of-stay in hospital, true life saving is pretty rare. True life-saving in aeromed even rarer. What does make a difference is decreasing the time taken to get a person from a scene to definitive care and RW can do this - but often it is as quick to road as it is to fly and much less delay in packaging and preening. In more remote areas, FW is more often the better choice to get to a suitable centre. Why is there so much inter-hospital stuff done by RW in the USA? Wouldn't road transport be much cheaper and easier?

'Time is critical' yes, but not THAT critical. In my organisation, the initial medical decision revolves around firstly what level of care is required (medical team [nurse + doctor], +/- paramedic, +/- specialist [surgeon, anaesthetist, obstetrician etc], then the platform best suited to the circumstances (road ambulance, boat, FW, RW). Once a decision is made on that basis, then the go / no-go is purely the pilots decision. It is a simple matter of 'Is the flight able to be completed safely' when all the operational aspects (weather, range, light, etc) are considered. The patient condition does not come into it; there are no variable levels of safety (those "I would go for a critical child but not for a sprained ankle" scenarios). Once a 'Go' decision is made, the only additional considerations that are made is the urgency of the departure, whether there are any flight & duty time constraints and whether the urgency of the task means it is acceptable to exceed them. The medical crew does not engage in any Go/No Go discussion with the pilot as has been alluded to in this topic, that is the pilots job; just as the pilots don't put their two cents worth in about the medical aspects of the task. I cannot conceive of debating a no-go with a pilot as someone suggested in this topic of we 'primadonnas in the back'.

If only we had NVGs / Twin turbines / Autopilots / yada yada. Drawing a line operationally about what the aircraft and crew can and cannot do needs to happen well before the tasking comes in. All aircraft and all operations have limits. Sometimes you have say no.

As far as shift work goes, we do 4-on, 4-off (2 days 0700 - 1700, 2 nights 1700-0700) and it works well for us. We also have a no-blame fatigue system where any team member can elect to call in fatigued without discussion on causes. Better to suck-up some inconvenience in rostering than have a crew member working fatigued in an environment as unforgiving as aeromedical,

A very difficult and contentious topic is HEMS; many issues, many egos, a long way to go before any real solutions I think.

Last edited by Al Fentanyl; 7th Jan 2013 at 16:13.
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Old 7th Jan 2013, 17:12
  #49 (permalink)  
 
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schedule input off topic

Last Sept we switched from a 7 days, 5 off, 7 nights, 9 off rotation (the schedule was set up mainly do to the company vacation or lack of vacation policy) to the current: start Monday to Thursday days, switch to nights Friday thru Sunday off 7 days. The other pilots start Friday thru Sunday days switch to nights Monday thru Thursday. (Lead pilot did not like nights)

The change over day seems to be the worst and of course for me getting back to "normal" after the last night.
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Old 7th Jan 2013, 20:04
  #50 (permalink)  
 
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Having worked in the HEMS field and thus having a lot of friends on the ground as paramedics/doctors/nurses etc whether flying or just on the road, it seems that Al Fentynal's schedule is the most commonly used over various emergency services here. This include government as well as private services and as said for both road and air. The 4 on (2 day, 2 night), 4 off seems to work the best. If you have small kids or crisises impeding on sleep it seems to compensate before total fatique sets in as only 2 nights with a day change over from day to night seems to work great for all I know in the field still. Glad I am no longer in HEMS!

Just a thought! If HEMS crews are heroes so are all medical crews! If they are all heroes surely we can end with the garbage collector being a hero cause if he does not collect the garbage the "heroes" being the med crews cant work so who is not a hero in todays life? Nobody is isolated without requiring another doing a basic service allowing them to do their paid job!

Way to many human error lately whether it being design, manufacture, maintenance, flying etc! Tried and tested machines like the 350 is questioned after millions of hours (and dont through hydraulics unless you compare total hours to failures minus human error) after way too many accidents over the last 2 months- why now?
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Old 8th Jan 2013, 02:24
  #51 (permalink)  
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The GOM uses the 7/7 roster since forever.....and that is probably the reason the EMS operators did after the early days when you lived at the hospital nearly 24/7.
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Old 8th Jan 2013, 08:05
  #52 (permalink)  
 
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For years I have worked in the flight simulator portion of the airline industry. On the airline side, there is typically 1 full flight simulator per every 40 crews or so, depending on aircraft type and usage. This covers the captains 4 hour PC every 6 months, and the first officers once a year. I know that the simulator does not fly the same as the aircraft, but the newer Level D simulators are really close. I dug into the FAA National Simulator Program (NSP) website and found what may be shocking information. They track 44 helicopter simulators worldwide, 37 of those are active, and there are only 19 Level D simulators. There are also 4 Level C, and the rest I would not think have good enough fidelity to really practice real life handling qualities (i.e. auto rotations), more system and emergency flow procedures.

My question goes to those who have flown helicopter simulators (Level D and C), are they better than nothing?
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Old 8th Jan 2013, 12:34
  #53 (permalink)  
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Sims are magic learning tools.

I taught in two different training establishments using Sims and found them to be very useful.....if those using them wished to be taught. Too many Helicopter Operators want to use their own Check Airmen and thus avoid Third Party evaluation of their crews. For way too long....most Operators only sent their crews to the Sim for training when required to do so by the terms of their contract with the customer (think Oil Company here). It was the Oil Companies that were the moving force for much of the use of Sims.

Corporate Operators use the Sims to a much greater extent and usually as a requirement of their Insurance Companies. Advantageous discounts in their premium rates result when they do use the Sims.

As the Sims are so expensive...and the size of most Operators fleets are so small....Helicopter Operators usually have to rely upon Vendors to provide the Sims. Airlines on the other hand have the advantage of numbers and can afford to own and operate their own Sims and maintain a Staff of people dedicated to the task of training and checking pilots.

Many Helicopter Operators just cannot afford to pay for Sim Training thus are very reluctant to take on that expense and prefer to do their training in the actual aircraft which in some cases is actually cheaper than the Sim.

Overall....it is hard to compare Air Line Sim usage to the Helicopter Sim business.
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Old 8th Jan 2013, 16:44
  #54 (permalink)  
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The problem is that sims don't fly exactly the same as the real thing, and the cues are different. Once you are "current" on the sim, it is priceless for some training. One can train in scenarios that can be fatal, and one can set the situation up more precisely and quickly while the lesson being taught is fresh.
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Old 8th Mar 2013, 16:54
  #55 (permalink)  
 
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Icing?

Icing In Helicopters? Land Right Away. | Aviation International News

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Old 8th Mar 2013, 18:41
  #56 (permalink)  
 
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Too many Helicopter Operators want to use their own Check Airmen and thus avoid Third Party evaluation of their crews.
I've received training both ways, and must say that with one exception (a military support contract), the better training was with company Check Airmen. They knew our SOP's, set a higher standard, and knew the areas we were working in.

I'm sure there is good 3rd party support out there, but I'll take in house based on experience.
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Old 8th Mar 2013, 21:33
  #57 (permalink)  
 
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I agree. I've had sim training from Flight Safety instructors, and from company check airmen, and without exception the check airmen were much stricter, and obviously knew our SOPs and methods of doing things. The FS guys were good, but they had never flown offshore, and their primary interest was in getting us back, not in showing us up, and we would certainly never fail a ride with them. The company check airmen, OTOH, would fail a crew in a heartbeat.

Sims are wonderful tools, and should be used regularly. They are becoming much more commonly used, and I think that will continue.
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Old 8th Mar 2013, 22:01
  #58 (permalink)  
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"Too many Helicopter Operators want to use their own Check Airmen and thus avoid Third Party evaluation of their crews. "

I have seen both sides of that coin with 2 large operators:

One had a free-standing training department that acted as an internal standardization and safety department as well as documenting the required training. The department was a resource that addressed immediate issues referred to them as a final arbiter. They also contracted some training, but one always knew that any issue could be addressed through the training department as a professional.

The other viewed training as a management, standardization requirement. A flying issue was a management issue addressed through the management ladder. Very vertical, and not really an asset for line plots. The commitment to safety was/is not an issue, but difficult to address issues as anything other than oppositional and antagonistic as everything goes up and down a management ladder.

On the other hand, contract training benefits by specialization in what's being instructed, and suffers from not being really able to align and identify that with exactly what's being done on the line.
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Old 9th Mar 2013, 01:25
  #59 (permalink)  
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Gom.....you never rode in my Sim.

You met muster or you did not pass.....the CP of an Oil Company found that out the hard way. Odd....I never got an offer of employment there either despite some of his colleagues going to Court for me on a couple of times.
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Old 10th Mar 2013, 22:43
  #60 (permalink)  
 
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Icing?
Depends on the aircraft. The UK's Lynx was cleared to 60mm of rime and 30mm of clear ice.
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