Norwegian Air ambulance - nice balancing act !
Purveyor of Egg Liqueur to Lucifer
Sasless,
By dropping off the Doc at the scene (along with the bag & rucksack he can be seen carrying in the vid) rather than a mile down the road to an even dodgier wire ridden clearing , c20+ minutes of the 'Golden Hour' was saved.
Yes he could get as you say, get there quicker by vehicle after landing at a clear landing site...but only if;
a. There is a vehicle available.
b. There is a clear area in which to land in.
c. Messages get passed
Well done you (pat on back smilie)
IMHO the vid shows that the dynamic risk assessment made was correct, and the gain by getting the Doc to the patient so soon is immeasurable.
You ask the question; "...Please do remember very few EMS transfers (Damn Few actually) get done by helicopter at night in the UK....so just how critical is a few minutes in your system. If you discard the need for timeliness at Night...why get your knickers in a knot over a few minutes in the daylight?"
Ok then!...Firstly;
What is the Golden Hour?
Secondly;
At night, Police helicopters are available for life threatening casevacs.
Regular air ambulances do not, afaik, carry out their 'normal role' because of the extra equipment required to satisfy safety regulations.
Hampshire & Isle of Wight Air Ambulance
But of course, you knew all this already....didn't you
By dropping off the Doc at the scene (along with the bag & rucksack he can be seen carrying in the vid) rather than a mile down the road to an even dodgier wire ridden clearing , c20+ minutes of the 'Golden Hour' was saved.
Yes he could get as you say, get there quicker by vehicle after landing at a clear landing site...but only if;
a. There is a vehicle available.
b. There is a clear area in which to land in.
c. Messages get passed
Having done one skid rooftops at night on NVG's....it is not the difficulty of the maneuver that is in question....it is the Risk/Gain issue.
IMHO the vid shows that the dynamic risk assessment made was correct, and the gain by getting the Doc to the patient so soon is immeasurable.
You ask the question; "...Please do remember very few EMS transfers (Damn Few actually) get done by helicopter at night in the UK....so just how critical is a few minutes in your system. If you discard the need for timeliness at Night...why get your knickers in a knot over a few minutes in the daylight?"
Ok then!...Firstly;
What is the Golden Hour?
So, when international air ambulance services speak of the importance of the golden hour, they are not referring to a grandiose or mystical period of time that just happens to be exactly the length of an hour, but to an ever-changing (but well-defined) window of time in which a critical-care patient needs to reach appropriate healthcare for his or her best chance at recovery, reversal, and preservation of quality of life.
At night, Police helicopters are available for life threatening casevacs.
Regular air ambulances do not, afaik, carry out their 'normal role' because of the extra equipment required to satisfy safety regulations.
Hampshire & Isle of Wight Air Ambulance
Landing on unknown terrain with the risk of unseen hazards, like telephone or power cables, would be unsafe. After the evening rush hour, our roads are usually less congested allowing comparable response time by land ambulances.
But of course, you knew all this already....didn't you
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There is a curious paradox among pilots (not just helicopter ones), which is:
a) criticize openly and heavily the work of other pilots, most times without having enough information to do it;
b) be extremely annoyed when a) is applied to them.
Then there is the pprune thread response checklist:
1. Make slightly ironic remark about subject at hand, without explicitly criticizing it
2. Wait for outraged response from another poster
3. Make comment on poster's company/country/experience/writing skills/etc to annoy him further
4. If poster questions your judgement/experience/etc resort to the argumentation: "I/We do it like this in my company/country, therefore this is THE ONLY WAY it can be done"
5. Return to 4.
As they say where I live: "There are many ways to milk a cow".
Btw, nice flying skills, landing on that rail, that is something I don't do often, and it's hard.
Merlin
a) criticize openly and heavily the work of other pilots, most times without having enough information to do it;
b) be extremely annoyed when a) is applied to them.
Then there is the pprune thread response checklist:
1. Make slightly ironic remark about subject at hand, without explicitly criticizing it
2. Wait for outraged response from another poster
3. Make comment on poster's company/country/experience/writing skills/etc to annoy him further
4. If poster questions your judgement/experience/etc resort to the argumentation: "I/We do it like this in my company/country, therefore this is THE ONLY WAY it can be done"
5. Return to 4.
As they say where I live: "There are many ways to milk a cow".
Btw, nice flying skills, landing on that rail, that is something I don't do often, and it's hard.
Merlin
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JimL
"There is no such thing as a CAT A operation."
It may be different now, but what I am referring to is in my dim and distant memory in the UK police air ops manual, there used to be a clause which required any air ambulance (as opposed to casevac) job to be flown in a way which allowed equivalent Cat A performance, with minimum specified "D" distances for landing sites, and takeoff/approach paths clear of obstacles. I was saying that the rules may be different for Air Ambo ops in Norway.
I don't think its that difficult to put a skid on a crash barrier - I did similar things many times under military rules. Its just that as a civvy I would have been shown the door rapidly if a video like that came to the notice of the chief pilot, because it would have broken our rules.
"There is no such thing as a CAT A operation."
It may be different now, but what I am referring to is in my dim and distant memory in the UK police air ops manual, there used to be a clause which required any air ambulance (as opposed to casevac) job to be flown in a way which allowed equivalent Cat A performance, with minimum specified "D" distances for landing sites, and takeoff/approach paths clear of obstacles. I was saying that the rules may be different for Air Ambo ops in Norway.
I don't think its that difficult to put a skid on a crash barrier - I did similar things many times under military rules. Its just that as a civvy I would have been shown the door rapidly if a video like that came to the notice of the chief pilot, because it would have broken our rules.
And of course not forgetting the wires that seem to run directly over the site!
Merlin Driver, thanks for authoring one of the better posts to appear on PPRuNe for a while. 
Putting the skids on the crash barrier might be risky but if it gets a doctor to the seriously injured in a timely manner, it is worth the risk.
500 Fan.
Putting the skids on the crash barrier might be risky but if it gets a doctor to the seriously injured in a timely manner, it is worth the risk.
500 Fan.
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Merlin Driver wrote
I have to disagree - on this web site, its among many others also! If only the pilot of this helicopter had had the foresight to check if all was OK on PPRuNe before the flight...
There is a curious paradox among pilots (e.t.c)
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Are you kidding me?
so here is my grenade into the debate:
If I ran this operation, the pilot would be looking for a job.
Air Ambulance operations need risk avoiders, not risk takers.
And I ask - where did the helicopter land to fly the patient to hospital?
Too many of our American brethren think and act as if it is OK to risk 3 lives to MAYBE save one. This is the mission of the Coast Guard, not Air Ambulance.
This scene appears to show that the land response unit don't know how to set up a scene to allow for a helicopter to land.
And much research on "the golden hour" has been shown to be specious -
The attitude "gotta get there" has killed over 500 people in the helicopter EMS business in the US over the past 20 years. I wonder how many offshore rig operations would still be using helicopters to fly there people back and forth if the offshore helicopter industry had killed the same numbers.
Safe aviation operations require sound decision making that results in accepting risks ONLY when there is no better solution.
My $0.02.... Fire away ...
wde
If I ran this operation, the pilot would be looking for a job.
Air Ambulance operations need risk avoiders, not risk takers.
And I ask - where did the helicopter land to fly the patient to hospital?
Too many of our American brethren think and act as if it is OK to risk 3 lives to MAYBE save one. This is the mission of the Coast Guard, not Air Ambulance.
This scene appears to show that the land response unit don't know how to set up a scene to allow for a helicopter to land.
And much research on "the golden hour" has been shown to be specious -
The attitude "gotta get there" has killed over 500 people in the helicopter EMS business in the US over the past 20 years. I wonder how many offshore rig operations would still be using helicopters to fly there people back and forth if the offshore helicopter industry had killed the same numbers.
Safe aviation operations require sound decision making that results in accepting risks ONLY when there is no better solution.
My $0.02.... Fire away ...
wde
And I ask - where did the helicopter land to fly the patient to hospital?
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If I ran this operation, the pilot would be looking for a job.
All this guy did was to hover over a road barrier in order to give himself greater rotor clearance. No big deal. I think the driver should be commended for getting the doctor in there so effectively.
PPRuNe members sometimes complain about the level of bureaucracy now associated with flight operations but if some PPRuNers were running civil aviation I think it would be even worse. Mountains made from molehills me thinks!
We should be looking at ways of giving helicopter operators greater freedom and fewer restrictions. This broken record of "its wrong to take risks to save lives" is just that, a broken record. Everyone knows that a professional pilot (in any field of operations) must exercise sound judgement and for EMS pilots I would have thought this would feature among the ABC's of being a helimed pilot. But being careful and sensible doesn't preclude the kind of operation we saw on that video. It was a simple relatively low-risk event.
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Norwegian Air ambulance - nice balancing act !
Quote:
If I ran this operation, the pilot would be looking for a job.
Best ya don't come visit Canuckland then....landing on a big H a la airport....f@&$ing luxury mate.
If I ran this operation, the pilot would be looking for a job.
Best ya don't come visit Canuckland then....landing on a big H a la airport....f@&$ing luxury mate.
So....lets see here.....Minor Injuries, Patient taken by road ambulance after being extracted from the vehicle (how long did the extraction take?), No EMT's in Norway, sounds like there is no radio comms between ground units and the helicopter (or am I wrong on that?), No LZ was set up for the helicopter (Are Ground Units trained and equipped to do that?), Where did the helicopter land to retrieve the Doctor?
The level of care provided is far more important than just time alone. The Golden Hour is not etched in stone and really does trend along the curve that is based on both timeliness and sophistication of the care provided.
What level of equipment is the aircraft equipped with, what does the Doctor carry in his Trauma Bag, and how much can he do by himself?
Lots of variables folks....I would suggest some thought ought to be given to what is being said....in the American usage of the phrase "Emergency Medical Service", which includes both Patient Transfer and Scene Response....we apply a single standard to those Operations as we see them one and the same.
You Brits divide the two and apply differing standards....for whatever reason.
Yes, you don't seem to Kill off yourselves as often as our folks do...but then we operate 24 Hours a day with well over 800 aircraft in the Fleet. Care to tell us how many Aircraft in your fleet and how many Night Operations you conduct each year?
You "Life Savers" out there need to remember People ride in ground ambulances when you cannot or do not fly them. People die every day...and putting yourselves at unnecessary risks does not make you anymore the Hero....just a lot more likely to hurt yourselves and others.
The belief you do it "better" is a myth.
You do less of it and in the daylight.
Who we should look to for counsel are the Canadians. They seem to have found the happy middle ground on all this. The Australians do a pretty good job of it too.
The level of care provided is far more important than just time alone. The Golden Hour is not etched in stone and really does trend along the curve that is based on both timeliness and sophistication of the care provided.
What level of equipment is the aircraft equipped with, what does the Doctor carry in his Trauma Bag, and how much can he do by himself?
Lots of variables folks....I would suggest some thought ought to be given to what is being said....in the American usage of the phrase "Emergency Medical Service", which includes both Patient Transfer and Scene Response....we apply a single standard to those Operations as we see them one and the same.
You Brits divide the two and apply differing standards....for whatever reason.
Yes, you don't seem to Kill off yourselves as often as our folks do...but then we operate 24 Hours a day with well over 800 aircraft in the Fleet. Care to tell us how many Aircraft in your fleet and how many Night Operations you conduct each year?
You "Life Savers" out there need to remember People ride in ground ambulances when you cannot or do not fly them. People die every day...and putting yourselves at unnecessary risks does not make you anymore the Hero....just a lot more likely to hurt yourselves and others.
The belief you do it "better" is a myth.
You do less of it and in the daylight.
Who we should look to for counsel are the Canadians. They seem to have found the happy middle ground on all this. The Australians do a pretty good job of it too.
Last edited by SASless; 5th May 2013 at 00:06.
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We have no idea what happened here other than a snippet of video a few seconds long.
All we saw was a fairly benign hover exit that put a medical professional on scene. I fail to find any fault based on what is presented, and I'd be inclined to say job well done.
The rest is just conjecture. Whether one of us would do the same would be determined by being there, that day, to make that call. When discussing the hypotheticals, I'd hope we could all be civil.
All we saw was a fairly benign hover exit that put a medical professional on scene. I fail to find any fault based on what is presented, and I'd be inclined to say job well done.
The rest is just conjecture. Whether one of us would do the same would be determined by being there, that day, to make that call. When discussing the hypotheticals, I'd hope we could all be civil.
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Man......... how do you know that area down the road is suitable? Minor injuries, ok, he shouldn't have done that landing if he knew it was minor injuries....... he DID know that, didn't he? Or did he rightly assume the patient needed him? I didn't realise from the video that the service had a vehicle, with comms, ready for him down the road.
Where are all these accidents we are told about? 99.999999999999% of the time, I have a safe option. In the UK we have an exemption that allows us to take a risk, LEGALLY, if the circumstances warrant it. Strangely enough, one of my only times to use it was on a similar road to this one. The patient lost limbs, but survived. I like to think my actions helped that.
SASLESS, I always look to use a safe site, many times I have not landed because the risk was high, I am not a cowboy, but this video is not that bad. It is an increased risk, balanced on the perceived needs of the patient. If he had come back to pick the doctor up, THEN I would criticize him. Doctor delivered is mission accomplished.
Where are all these accidents we are told about? 99.999999999999% of the time, I have a safe option. In the UK we have an exemption that allows us to take a risk, LEGALLY, if the circumstances warrant it. Strangely enough, one of my only times to use it was on a similar road to this one. The patient lost limbs, but survived. I like to think my actions helped that.
SASLESS, I always look to use a safe site, many times I have not landed because the risk was high, I am not a cowboy, but this video is not that bad. It is an increased risk, balanced on the perceived needs of the patient. If he had come back to pick the doctor up, THEN I would criticize him. Doctor delivered is mission accomplished.
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In addition, the role of the HEMS aircraft is not to transfer the patient to hospital, so why ask that stupid question? We get appropriate care TO the patient. A transfer is a bonus.
Secondly, who says we do it better than the Americans? We operate in a far less hostile environment normally.
You mention night flying, we don't do it for a reason. The trial is happening, wait for the results.
Those who say sack him don't know the rules, this would be legal in the UK. Can you sack someone for operating inside the rules.
Secondly, who says we do it better than the Americans? We operate in a far less hostile environment normally.
You mention night flying, we don't do it for a reason. The trial is happening, wait for the results.
Those who say sack him don't know the rules, this would be legal in the UK. Can you sack someone for operating inside the rules.
@SASless
So....lets see here.....Minor Injuries, Patient taken by road ambulance after being extracted from the vehicle (how long did the extraction take?)
So....lets see here.....Minor Injuries, Patient taken by road ambulance after being extracted from the vehicle (how long did the extraction take?)
Those landings are not daily business over here, but i dont think its right to bash this. Probably I would have done the same in this situation. I have done over 10000 HEMS-missions up to date and well over 90% of them were landings in unprepared landingsites.
skadi
Last edited by skadi; 5th May 2013 at 11:17.
Two thirds of my EMS flights were to "Scenes".
At every Scene we had radio communication with the ground units.
The Ground Units were all trained to set up Landing Zones, had equipment to mark the Landing Zones (Especially at Night), had a LZ Ground Guide with Radio, which required a lot of effort, cost, and training. Fire Brigade unit(s) were almost always on site to support the Ground Medical Crews.
On more than a few occasions we arrived before the Ground Medical Units and were "First Responders" and carried out the landing without the assistance of a trained LZ Coordinator.
The Med Crew usually consisted of a Nurse and Paramedic with advanced qualifications and direct contact with a Trauma Doctor when needed. The Aircraft were licensed and equipped for Advanced Life Support.
The goal was to stabilize the Patient and get them to the Trauma Center as quickly as possible.
As we discuss this business of EMS flying, we have to remember the level of care that can be provided is limited by two things really...capability of the Medical Crew and Aircraft, and the Procedures they can apply under their Protocols (SOP's).
A comparison of the various systems used around the World would be interesting to determine which affords the maximum utility and most useful care for the Patient with the least risk to the EMS Crew and Aircraft.
Availability of resources and Manpower prompted by funding sets the limits.
In rural Texas we worked with Volunteer Fire Departments/Rescue Squads and found them quite Professional just as their big city equivalents although their experience and knowledge base was not as deep in most cases. Most of our Flight Paramedics were Ground Paramedics and worked part time for us and full time for the Ground Units.
Our Flight Nurses worked in the Trauma Center when not on Flight Duties.
The occasional flight with a Doctor aboard was more for training the Doctor to understand how working on a patient in a Helicopter differed from inside the Trauma Center but also allowed cross training and monitoring the Medical Crew.
Many EMS Pilots undertake Paramedic Training as well.
My criticism of the video action is not directed at the individual Pilot....but at a system that forces such kinds of flying be done in order to carry out the Operation. If being critical stimulates some thinking about how to do things a bit different but a lot safer happens....score one to me.
If you think just because the Rules allow you to take on more risks "Legally"...and therefore think it is just fine to do so....you need to re-think what you are saying. We get to be old at this game by not taking UN-NECESSARY risks. We are not "Life Savers"....whether the Patient lives or dies is really not in our hands. By means of our skill, training, and experience....and that of the Medical Crew...there may be a positive outcome but if that happens is pre-determined by external forces... call it Fate, God, Luck, Timing or whatever you care to use. The US Coast Guard fully understands that they cannot save everyone every time....so why should EMS Pilots and Medical Crews think otherwise?
Not every Patient that gets to ride in an EMS Helicopter is going to survive...that is something you have to get used to. Watching them go on the way to the Trauma Center is a hurtful thing but a sad part of the job sometimes.
At every Scene we had radio communication with the ground units.
The Ground Units were all trained to set up Landing Zones, had equipment to mark the Landing Zones (Especially at Night), had a LZ Ground Guide with Radio, which required a lot of effort, cost, and training. Fire Brigade unit(s) were almost always on site to support the Ground Medical Crews.
On more than a few occasions we arrived before the Ground Medical Units and were "First Responders" and carried out the landing without the assistance of a trained LZ Coordinator.
The Med Crew usually consisted of a Nurse and Paramedic with advanced qualifications and direct contact with a Trauma Doctor when needed. The Aircraft were licensed and equipped for Advanced Life Support.
The goal was to stabilize the Patient and get them to the Trauma Center as quickly as possible.
As we discuss this business of EMS flying, we have to remember the level of care that can be provided is limited by two things really...capability of the Medical Crew and Aircraft, and the Procedures they can apply under their Protocols (SOP's).
A comparison of the various systems used around the World would be interesting to determine which affords the maximum utility and most useful care for the Patient with the least risk to the EMS Crew and Aircraft.
Availability of resources and Manpower prompted by funding sets the limits.
In rural Texas we worked with Volunteer Fire Departments/Rescue Squads and found them quite Professional just as their big city equivalents although their experience and knowledge base was not as deep in most cases. Most of our Flight Paramedics were Ground Paramedics and worked part time for us and full time for the Ground Units.
Our Flight Nurses worked in the Trauma Center when not on Flight Duties.
The occasional flight with a Doctor aboard was more for training the Doctor to understand how working on a patient in a Helicopter differed from inside the Trauma Center but also allowed cross training and monitoring the Medical Crew.
Many EMS Pilots undertake Paramedic Training as well.
My criticism of the video action is not directed at the individual Pilot....but at a system that forces such kinds of flying be done in order to carry out the Operation. If being critical stimulates some thinking about how to do things a bit different but a lot safer happens....score one to me.
If you think just because the Rules allow you to take on more risks "Legally"...and therefore think it is just fine to do so....you need to re-think what you are saying. We get to be old at this game by not taking UN-NECESSARY risks. We are not "Life Savers"....whether the Patient lives or dies is really not in our hands. By means of our skill, training, and experience....and that of the Medical Crew...there may be a positive outcome but if that happens is pre-determined by external forces... call it Fate, God, Luck, Timing or whatever you care to use. The US Coast Guard fully understands that they cannot save everyone every time....so why should EMS Pilots and Medical Crews think otherwise?
Not every Patient that gets to ride in an EMS Helicopter is going to survive...that is something you have to get used to. Watching them go on the way to the Trauma Center is a hurtful thing but a sad part of the job sometimes.
We are not "Life Savers"....whether the Patient lives or dies is really not in our hands.
If there is no-one else on scene (medically trained) and there has been a major smash, you have no way of knowing how critical the casualty may or may not be - wouldn't you want to assume the worst case - and a quick flyby of the scene would help assess the likely mechanism of injury and possible severity of the injuries.
In this case, I really don't think the guy did anything wrong and, as has been mentioned, we are making armchair decisions after the event without any of the operational information.
While you are doing the Fly By....are you looking for all the possible landing areas and trying to sort out the "Best" one considering all the usual criteria...wind, barriers, obstacles, uneven ground, slope, footing, wires, fences, access to the scene?
If you land the Doctor by doing a one skid hover landing onto a Rock and the Patient dies....are you a failure?
If the flight was similar to this one....the Injured person only had minor injuries...and his evacuation by ground was delayed due to the extraction process...would there be the Urgency that forbids a five minute delay fetching the Doctor from a nearby but safer landing site.
Should not the SOP's start with that notion to begin with....determine if the aircraft can land to the ground safely at the immediate scene....if not proceed to the nearest suitable location.
Crab...you could drop off the Medical Team by Winch....Civvies don't have that option. You also have different rules and regulations than do the Civvies. Don't try to apply your situation to those that don't have comparable limits.
If you land the Doctor by doing a one skid hover landing onto a Rock and the Patient dies....are you a failure?
If the flight was similar to this one....the Injured person only had minor injuries...and his evacuation by ground was delayed due to the extraction process...would there be the Urgency that forbids a five minute delay fetching the Doctor from a nearby but safer landing site.
Should not the SOP's start with that notion to begin with....determine if the aircraft can land to the ground safely at the immediate scene....if not proceed to the nearest suitable location.
Crab...you could drop off the Medical Team by Winch....Civvies don't have that option. You also have different rules and regulations than do the Civvies. Don't try to apply your situation to those that don't have comparable limits.
Last edited by SASless; 5th May 2013 at 17:15.
While you are doing the Fly By....are you looking for all the possible landing areas and trying to sort out the "Best" one considering all the usual criteria...wind, barriers, obstacles, uneven ground, slope, footing, wires, fences, access to the scene?
One additional point: big dogs
skadi