HEMS - Regulations and saving life
 

Forgive me if this is treading old ground,
But if Hems Heli is collecting a client( RTA or any such serious incident) I have seen along with many others the ultra tight landings that these brill pilots have made, my question is , Do they have total control of any landing site because of the emergency situation or is it accepted and agreed that no one pilot will be punished for what to most of us would be an illegal landing, or is it similar to the grey area that allows a police car to speed in a built up area, whilst executing their duty's!!

On the Police car front, he/she is indeed allowed to do what ever speed he/she feels is appropriate, BUT if they have an accident it is generally considered as their fault.

I only have experience of the London Air Ambulance, and I know that they have a set limit on the amount of space that they must have to land. There was a case, I believe, of a pilot being suspended from their crew for landing in a too small an area. Contravening procedures and all that.

The chief chappy that suspended him, then prodceded, the following week, to try and take off from the roof of the hospital with one engine at flight and the other at ground idle. Following this incident, he then suspended himself!!!!! <img src="smile.gif" border="0"> <img src="confused.gif" border="0"> <img src="eek.gif" border="0"> Luckily the co-pilot was on the ball and realised what was happening.


All very strange, and that was told to me third hand, so any discrepancies, I apologise now.


"Some days you are the pigeon, some days you are the statue!"

My company has published minimum clearances and one will respect them or go elsewhere. That's the only reasonable way management has to control risk exposure.
The company also spends a lot of time educating the agencies and people that'll call us as to LZ selection and preparation. They're so successful that the most difficult places I land are certain hospitals-but proximity is a larger consideration there than on most scenes.

The National EMS Pilot's Organization has a booklet anyone can order that has great info on LZ setup, etc.

That might be a great supplement to anyone's program, or one might find that it could improve it.

Here's a link:

<a href="http://www.nemspa.org/LZ_Booklet_orderform.htm" target="_blank">LZ Booklet</a>

While we are on the subject, can anyone tell me what the main differences are between a HEMS and an Air Ambulance in the UK? Also, is the authority to operate from confined areas given in a JAR Ops variation to each individual HEMS operator or is it contained within the description of operations in the Air Operators Certificate?

Boring I know, but I do have a genuine interest !! <img src="rolleyes.gif" border="0">

The minimums for landing sites are clearly laid down in the UK Air Navigation Order and in JAR Ops 3.

General permissions or exemptions from Rule 5 (Low flying, ability to alight clear of congested areas, flying over gatherings etc) are issued individually to each operation, but amount to the same thing.

Having permissions to go below minima does not preclude you as a pilot from considering third parties and private property when chosing a landing site. In fact one of our biggest worries is injuring a member of the public when landing or taking off.

Of course all of these permissions are only valid when undertaking a primary HEMS mission. (Danger of death to an individual)

There is essentially no difference between the terminology of air ambulance and HEMS, but an air ambulance could also be construed as an aircraft that performs a medical repatriation from another country.

There is certainly no lack of excitement in being a HEMS pilot!

Billy: there is a difference between HEMS and Air Ambulance. HEMS is a primary response to an immediate threat to life, Air Ambulance is a secondary role which allows for planning if necessary and the projected carriage of persons/equipment/organs etc. The former can be carried out by a government body such as the police. The latter can only be carried out by a commercial company under its individual AOC. That is why the police/HEMS units cannot do Air Ambulance! In exceptional circumstances "when ALL other modes of suitable transport have been exhausted" then a police unit can conduct an A Ambulance flight.

There are strict guidlines laid down in an AOC (HEMS unit) or PAOC (police unit) for performance requirements for land and take off. They are less restrictive than ANO / JAR 3 commercial equivalents but they do exist!
For us (police/HEMS) they are:
Class1 perf reqmnts and 2 x rotor and frame diameter (day) or 3 x the same (night). It goes on to discuss obstructions/clearences/heights etc, but this is basically it.
We don't just 'lob in' because we're the cavalry coming to the rescue!!!
It is recognised as THE most dangerous aspect of government ops (the landing/take off) and believe me it is strictly monitored. Don't be lulled into thinking: "ooh I'm saving lives therefore I am immune" Look what just happened to our ability to save lives over hostile territory lately???The rules have changed! The attitudes, I suspect, haven't

<img src="rolleyes.gif" border="0">

EMS ops. for the preservation of human life
 

How far can an EMS operator bend the regs for the preservation of human life?

:rolleyes:

In the US, not at all. However, some of the rules and waivers to the rule sometimes get pretty liberal. The UK has a different view towards "Lifesaving" flights I think. We still consider EMS as being an airtaxi medical transport flight and not "rescue". You violate the rules and then have an UH OH! and you will find yourself on the carpet big time with the Feds.

Glad you're in Canada and not the UK, sunshine........

Why jeapordize(english spelling) 2, 3, 4 peoples lives in addition to the broken one you've got on board? :eek:

Our regs are full of little exceptions to the air regulations for the preservation of human life.....

but these do not apply to EMS operations IMHO. ;)

In Oz we have provision to declare a 'Mercy flight' when you are knowingly going to break a reg. There are a host of proviso's (spelling?) but are ultimately pilot responsibility to assess risk/gain.

I imagine similiar reg's in other parts??

This is an extract and a link to the “official rule bending guide” for Australian mercy flights. You will need acrobat to read the attached link. [AC 91-170(0)]



4. DEFINITION
Mercy flight means a flight which will involve contravening one or more of these regulations, made for the purpose of relieving a person from grave and imminent danger arising out of an urgent medical, flood, fire relief or similar situation, at a time where
failure to make the flight is likely to result in serious or permanent disability or loss of life.


9. WHO CAN DECLARE A MERCY FLIGHT
Any relevant person in authority such as a doctor, police officer, fire fighting commander, rescue coordinator etc. may request the use of an aircraft for an emergency purpose, but only the pilot in command can declare a mercy flight.


AC 91-170(0) Aust.

bend the rules.....not at all!
 

An EMS operator CANNOT bend the rules just because of the task at hand.

Transport Canada allows, quite LEGALLY, certain procedures/ actions during a medevac flight( as all Canadian pilots know).

XNR, what exactly do you consider bending or breaking of rules?????

EMS op's falls under air taxi op's in Canada. All Canadian pilots( fixed and rotary) know that when the term MEDEVAC is used, that has priority over everything except an a/c in distress/ emergency.

I have heard from some heli-ems guys that they can do whatever is required..." to save human life". WRONG!!!!!!

Leaving rules aside, I second what Thomas coupling stated!

D.K

DK

Take a french vanilla cappucino and a chill pill ...... !!!???
You're sounding exasperated.

Steve76

Take it easy on D.K.

He is exactly right IMHO.

;)

Thank God for common sense...thanks DK:)

Mind you the australian excerpt makes one wonder...opens a bag of worms IMO.

A Pandora's Box indeed.........

You can file a "Med" "Hosp" "SAR" Fire/Flood and others that I have forgotten..........this will give you "Special Handling" by Airservices Oz / ATC........but does not give you any right to deviate from the Rules.

A Mercy Flight is one step higher...........and is more an administrative protection/priviledge than anything else.......

You still can't take off with less fuel than is required..or into weather that others would'nt dare.....but you can exceed Dutytimes, curfews, and other soft rules.........and you will automatically receive all the help in the world from Airservices / ATC along the way.

But you have to justify each and every infringement...and in writing.....and if things go wrong ... in court!!!!

Roll over and go back to sleep.......after all I never got them into that predicament in the first place.......and I will be the first one blamed after the excitment has ceased.....

TC: "Glad you're in Canada and not the UK, sunshine........"

- sunshine! ... a bit 'holier than thou'

I'm fairly pleased with the two lives I saved in the course of unrelated operations. To suggest that the rules which I may have 'flexed' endangered anyone is just drivel (unless you want to be pedantic). Had I actually breached any regs in so doing I would have been entirely entitled so to do - provided that I informed the relevant Authority afterwards - It's about sound judgement.

Pilots other than ex-mil plod types (TC) are capable of making judgment calls.

Sound judgement and self discipline (not to get 'carried away')with common sense beats 'blind rule following' in humanitarian situations.

9/11: you'd have had a hard time stopping me going to the roof to rescue people with your arguments about rules !


EMS of course should be done within systematic consraints, still common sense cannot be outlawed - surely! (don't call me)

TC is 100% wrong: jeopardise is spelt with an ‘S’ in the UK. Only our colonial friends have a love affair with Zeees!!:D

to Q Max!
 

I understand what you are saying.

I was referring to daily EMS op's rather than extraordinary situations outside of daily charter/ air taxi/ e.n.g( some few examples)...... op's!

D.K.

.....and your Aussie kinfolk have a thing with "Zeds".....and the point is??? Just like some folk insist upon putting a "Shed" into Sked-ule! We are all, just simply separated by a common language!

ah so very interesting, psssst,psssst , yah come here, bit closer,
I'll put som more fuel on fire and see what will happen hihi..;)
http://www.canadianaviation.com/cgi-...c;f=8;t=000291
read and enjoy. The actions of the crew let to the survival of the victim. Excellent work I woud say:D

Q Max, or anyone for that matter....
 

Right, so it's that worst case, 9/11 scenario. While flying by the tall burning building in your 5 place helo you see a small group of survivors on the roof and decide to be the hero of the hour. Swooping down, you land on the roof to find there are 6 of them. Are you going to fit them all in? bit of a squeeze, but hey, it's an exceptional situation, what's the problem, you can already see the headlines.............
Now, alerted by the sound of your rotors, 4 more appear, then another dozen all clamouring to get aboard. Now you have a crowd of thirty plus all stood closely around your burning and turning, 5 place helo demanding one of the 4 remaining seats. Women and children first? (I don't think so!!) Are you going to be able to reason with a panicking crowd? Be able to tell them that you can only lift 6 and that you'll come back in a while for the rest? What's going to happen when you pull pitch and some of the more desperate cling to your skids? How long before someone catches the tail rotor with their head? :( How long before one of those "un-familiar with helicopter" passengers pushes down on the collective?

Yes, or course we all like to think that we would "do what had to be done" when the need arises. One or two survivors, nice big obstruction free roof, big twin engine helo, experienced well trained crewman down the back, no panic...... Well done Captain, home for tea and medals.

The alternative scenario is the stuff of nightmares.

If you have not thought this one through already then do so while you have the chance and before you are called upon to do it for real.

TC you are right...
 

.... that is where we differ.

Your arrogance to assume that if your not wearing the right hat you are unable to make those judgement calls (assess the factors neutrally and make the appropriate decision) is characteristic of a certain unjustified confidence which was not deprogrammed from you when you left the previous employer who required it. - If you follow my insinuation....

It might be better judgement!

And are you seriously suggesting that (for example) to save a life under circumstances that legally would require two engines should not be done? (...all other factors out of the equation). When quite obviously the risk derived from the engine arrangement is insignificant.

I am not unhappy about the two occasions in which I saved lives.

Fortyodd: yup you are also right. There are many factors which need to be dispassionately considered. I'm just suggesting that wearing the hat that TC wears does not (neccessarily) confer upon you the neccessary judgement.

TC: the Sikorsky rescue prize winners burned their (required) reserve - would you lock them up?

Girls, girls, come now.....what's in a spelling?


jeop•ard•ize (BrE also -ise) /depdaz; AmE -prd-/ verb [vn] (written) to risk harming or destroying sth/sb: He would never do anything to jeopardize his career. (OUP English language teaching dictionary).
:D

In the UK.....
 

Within the UK EMS is performed principally by Air Ambulance Units.
All taskings must come via a regional Ambulance Service control centre to satisfy the legalities of claiming exemptions under the Air Navigation Order, Rules of the Air and JAR-OPS where operations operate under it.
An emergency helicopter flight which proceeds directly to the scene of the incident/accident is known as a primary mission.
For these taskings, more correctly known as HEMS (Helicopter Emergency Medical Service) taskings, exemptions from the ANO to permit low flying for recon, approach and take off over congested areas, flight in closer proximity to 3rd parties & reduced flight visibility.
Relaxations may also be applied regarding aircraft performance providing deviation from optimum performance is for the shortest possible period.
These dispensations may only be claimed where life is percieved as being lost and "where immediate and rapid transportation" is required.
If immediate and rapid transportation is not neccessary and the injury/illness is not felt to be life threatening an exemption may not be claimed and therefore the helicopter may only alight and depart from areas which do not require the pilot to claim any dispensations, or from pre-surveyed landing sites within the Helicopter and Hospital Helicopter Landing Site guides.
Where this is the case the tasking is more correctly referred to as an Air Ambulance Tasking.
These flights are subject to normal public transport rules and performance criteria.
Because of the definition of a HEMS task as being one in which the helicopter proceeds directly to the scene of an incident, if a casualty has been moved from the accident scene to another location deemed to be more suitable for helicopter alighting, any attempt to land there will not permit the pilot to use dispensations and may be impossible to perform legally.
Similarly, when landing at hospital sites public transport performance must be maintained unless the patients condition is deemed to be life threatening.
Occasionally the only way to do so it to land at larger sites permitting a flight profile which is safer in the event of a forced landing.
As someone remarked above, it is not good practice to bring more casualties to an incident, however there is a disturbing trend amongst Ambulance Services to respond HEMS helicopters to trivial complaints and then place the crews under moral and ethical pressure whether to breach the rules established for their safety and that of the patient and others.
Frequently, this will occur because if not lifted the patient faces a long and distressing wait in a field for a land ambulance.
HEMS crews work hard to keep themselves and others safe but there is inherent risk in flying, which those who inappropriately task these resources do not worry about because they just want to clear up jobs and they are not risking their life and license when it all goes wrong trying to lift a broken ankle of a football pitch....................:(

Zaplead

Your post brings up a what I perceive to be one of UK HEMS bigger problems. If you ask ten UK EMS pilots how and when they are allowed to apply the available exemptions you will get at least five different views, possibly ten.

One of the confusions is created by the pre-JAR terminology of a Primary Mission. This term, to the best of my knowledge, is not recognised under JAR but as you suggest enabled the following situations-

1. Call to a collapse in a city street, 2 P.M. outside pub - we could apply every exemption under the sun, land in the street cause loads of disruption etc. etc. despite being 80% sure that this was a person who had five too many drinks in the pub. That said, there is 20% chance that this is a life threatening collapse so we could do it. (Yes, I know a wise man will land in the large factory site 800m up the road and get the medics to hitch a lift, but I'm talking about what the rules say I can do!)

2. Call from road ambulance crew to assist them with a patient in a city street who has been hit by falling scaffolding pole. Patient has massive head and chest injuries an airway problem and possible spinal injuries - he needs to be in a trauma unit now! During the ten minutes that we will take to travel to the scene, the road crew will package the patient and transport him to a large factory site 800m up the road suitable for our landing. -"I am very sorry road crew, but by loading your patient onto the vehicle and conveying him up the road you have turned this into a secondary mission - I am now unable to land at an unsurveyed landing site in a congested area to pick him up. Please feel free to turn round and drive four miles through the traffic jam to a pre-surveyed secondary site"

Thankfully, JAR does away with Primary, Secondary and Tertiary (inter-hospital) missions and splits it into HEMS and Air Ambulance where HEMS is a response to a location at which a person is in urgent need of medical treatment etc. (I do not have the full definition in front of me so please don't savage me for not quoting it) and Air Ambulance is a routine movement of a patient, usually pre-planned, carried out to normal AOC criteria. The term "Life Threatening" is not used within the definitions although it does still appear in CAA exemptions.

I feel very strongly that because EMS pilots are, by the very nature of the operations, isolated from each other we are diverging in our understanding and interpretation of the rules (with all of us convinced that we have the correct perception of them).

I would be a very happy man to see a conference organised involving EMS line pilots, Aircrew Paramedics etc from around the U.K. to discuss the future but I suspect we all work too many hours to attend.

Cheers

TeeS

Tees: nail on the head...excellent posting, if I might say so. The bottom line is that the insurance lawyers have got their teeth into this making it an absolute minefield....

You're damned if you do and you're damned if you don't...

It remains to be said, that the commander gets it squared away in his head, gets his employer on board too and has a quiet word with his flight ops inspector, so that they are singing from the same hymn sheet;)

Q Max: I think you'll find that when I was in the mil, a little word called "attrition rate" and a statement at the front of JSP 318 saying "overide the rules provided you act in the exigencies of the service"...had a lot to do with how I operated within my SAR role.
This culture does not exist in civvy street...thankfully. There are rules, don't break them, because big brother is no longer there to protect you. For once, you have to take on your own responsibilities. Why do you think more and more pilots are taking out third party insurance?

You have to think about yourself standing in that box staring at experts from the CAA / insurance / AAIB / Barristers, and be able to fend off their questions, any one of which could sink you without trace!
Do you HONESTLY know the rules. inside out, or do you really think that by making front page news as a hero, you'll be let off because you're a goodie?:rolleyes:

You mentioned, the Sikorsky crew...I did make it quite clear that SAR crews were exempt from my deliberations.

JeapordiZZZZZZe
StandardiZZZZe
LobotomiZZZZZZZe.


ZZZZZZZZZzzzz

Ahh - litigation. The great leveller.

What would you do if it was your son on the roof TC?

Unfair question maybe, but, what..........?

TC
Why "thankfully"?
Wouldn't it be better if the law in civvy street was that 'operational necessity in emergency circs' (or similar words to cover lifesaving or recovering a sick/injured person) be a complete answer to any whinging/prosecution by the CAA?
And a complete answer to the insurance companies?

I agree with you the 'hero if you bend the rules and it works' and 'damned if you bend them and it doesn't' is a problem - but that's the fault of the system.
I admit I admire people who us their own judgment and ignore the rules to try to help others and think I would if the necessity arose. Breaking the rules doesn't mean you're not flying safely because too many of our rules in the UK are far too restrictive anyway.

Can't you see? That's the problem. In this day and age where litigation is second nature, operators have to protect themselves. Dare I say it, the CAA's primary role is to promote safety on all fronts and this is right down their alley. They will eat you for breakfast, if only to set an example.
The Home Office has reminded all C Constables that their aircraft are not in the rescue role and diversions from the rules will not be tolerated: FACT. If you don't believe me ask any emergency service pilot where it is laid down that they can step outside the limits to carry out a life threatening rescue (authorised by the C Constable/Health authority). It's not, because they can't, it's against the law!

Why do you think police cars no longer chase high speed stolen vehicles. It's because they have a "duty of care" to others (the public) and of course they'll be sued off the face of the earth if they continue to cause collateral damage in so doing. It is no longer the environment where you can bumble into a rescue because you think you're leading the moral cause. There is NO circumstance where you can knowingly place your aircraft in a position where there is a serious risk to third parties.

In response to the emotional blackmail from twist grip:

In such circumstances where I am confronted by something as unique as that of rescuing my family by using the helo I'm flying; God help me if this happened, because I would have to look deep inside myself. I would be prepared to lose my job over it, no question, but could i live with myself if I killed someone else in the process, as well as fail to rescue my family? What an impossible dilemma :( A no win situation.

I'm faced with situations similar to the thrust of this topic, on occasion in my present role. We did 150 HEMS trips last year. We didn't go to some because of the very reasons I'm discussing here. The risk assessment was too high unfortunately for the victim, I'm sad to say. But I'm not in the job of being a hero, I'm trying to do the job to the best of my ability within the confines of the regs. That's legislation for you - dispatched by the authorities - on behalf of the public.

If we don't like it - change it.

TC
I'm not missing the point, I was making one.
At the moment, Police/EMS pilots are at risk if they break the regs and something goes wrong. With a petty aviation authority like ours, there's a good chance some small-minded type in Enforcement or Prosecution will want to prosecute. And the UK is fast going the American way of people wanting to sue for everything under the sun.
My point is that the law/legislation should be changed so emergency services pilots are not at risk when they break regs in the course of a rescue/urgent recovery.
(I have always respected and admired guys who ignore the rules in order to carry out a rescue and think/hope I'd have the courage to do the same if the circumstances made it necessary.)

But, in your earlier posts you've repeatedly implied breaking rules = not flying safely. That's what I think is plain daft.
You seem to equate breaking/bending the rules with endangering the a/c or other people. One doesnt' follow from the other. Many, if not most, of our rules are so stupidly restrictive that the only danger involved is the danger of being prosecuted.

You say "The rules aren't there for you to 'bend' and then expect to get away with after a phone call to the CAA. "
Well, they should be, and the phone call would be enough if the law was changed as I'm suggesting.

What a chilling thought....ringing up the CAA....saying oh by the way dear chap....why just yesterday I tossed yer rule book out the windy.....made like that American singer...what was his name...Sinatra....and errrr....yes...these were the circumstances and this is why I did what I did....WHAT? You mean that regulation printed in Version 8954, dated yesterday, but not promulgated yet....denies me dispensation for said act and you must make a voluminous report about my violations and see the appropriate punishments are applied.....HOW MUCH, FOR HOW LONG? Or I can get a barrister?

I like the American way....do said sinful act or acts......and get on bent knee....pray forgiveness and ask for divine intervention (please lord, strike the FAA both blind and deaf for a while ?) and when confronted by the video tape....continue to insist that is not you and that it must be your idiot brother!:rolleyes:

TeeS: My HEMS exemption, issued by CAA, applies "when engaged in HEMS" as defined in JAROPS 3.

That JAROPS definition makes no mention of "proceeding directly to the scene of an accident" or" response to a location" as mentioned by you and Zaplead. Your JAROPS purpose is to "facilitate emergency medical assistance, where immediate and rapid transportation is essential" So nothing to stop you landing by that ambulance in the large factory site. The HEMS definition is quite clear.

However, to satisfy the CAA exemption requirement "life is perceived as being lost" still applies if you cannot acheive Group A performance during landing or takeoff.

So how do the air medics apply that rule? Fractured wrist? perhaps not. Tib and fib? maybe. Femur, possibly? 80 yr old hypothermic? Suspected(but not confirmed)broken neck? Not clear at all!!

TC has got it right. Damned anyway!

TC ...
 

NOW you are making sense and I (almost) entirely agree with you!

There is a danger in the UK that people cosider themselves safe if they are obeying the rules. This is not necessarily true - and their judgement is diminished by believing they are somehow magically protected.

Common sense and judgement are still required to fly safely !
Obeying the rules alone will not save you.

... and yes of course that means saying NO to things when no one else can see why - especially 'since its legal' !

Bertie
I think you have misread my posting, the examples I gave referred to the pre-JAR system which split missions into Primary (responding to the scene), Secondary (meeting an ambulance) and Tertiary(inter-hospital) missions and did not take into account the patient condition.

JAR has simplified and clarified the situation, however my point was that confusion still exists because people in the industry continue to use pre-JAR terminology.

TC, thanks for the kind comments.

Cheers

TeeS

Well well now, there are some hot heads out and about now aren't there....

Here is some basic math:

4 > 1

Don't risk 4 lives to "maybe" save one life..it's just bad math.

...unless of course you are trained, trained, trained as a rescue pilot flying equipment suitable for a rescue mission with back-end crew members who are rescue specialists with rescue training. If you are an EMS pilot, remember that you are a fast ambulance driver capable of doing many things but first and foremost responsible for conducting flight in a safe manner with the utmost respect for the lives of your crew and within the constraints of your national air regs.

I agree - until the last nine words.
Provided all your other factors are satisfied, I wouldn't criticise someone for flying outside the contraints of the national air regs.
I don't buy this idea that flying within the regs = flying safely, and flying outside the regs = endangering.

As I've said, if the regs prevent a job being done which could be done safely then the law is an ass and ought to be changed.