I think a problem is lots of EMS pilots like the split shift because they are hoping for a quiet night and plenty of sleep, then they can enjoy the next day with the hope of a good nights sleep again. The problem arises when we have a couple of busy nights and we aren't fully adjusted still, not sleeping well during the day but still hoping for a quiet night.
I never sleep well on hitch and find i'm better off staying up and sleeping during the day, i'm not sure if i would like 7 nights straight.

Just to add some fuel to this discussion - has there been any change to the unofficial statistic that 25% of helicopter pilots with autopilots don't use them?

This thread has some great discussions that are part of the debate we need to continue: SPIFR v DPIFR v NVFR v TAWS v EGPWS v NVG etc.

I believe that the industry has generally conquered most of the issues we are discussing here by using the appropriate method of removing and hazard or danger from a system:
1. Engineer it out.
2. If you can't: train to work around / cope with it, create SOPs, etc.
3. If you still can't remove the danger: analyse risk V gain to determine if you should be doing it.

I think we have ticked the engineering it out box to the best of our ability as an industry, though there are more improvements to come. I am a strong advocate of IFR and NVG but think we should be adding EVS (IR) systems too. We have engineered EGPWS and TAWS systems, point in space GPS procedures (though coupled helicopter ones should be introduced ASAP: see Nick L's repeated calls for this), we have fantastically reliable twins like the EC135, great 3 axis autopilot systems, and advanced planning tools.

It is the next area that seems to have let us down, and the training in particular. It is no good having a fantastic 3 axis autopilot equipped twin and then crashing it because your type rating is so poor that you cannot cope with malfunctions. Each person who claims that twins are more dangerous than singles is testament to this issue being one of our most pressing. Do we look at a version of the European model of type ratings requiring continual currencies? How many hours should a type rating be? etc, etc.

I think one simple step can immediately be introduced into world wide HEMS to make it better. The step originated in the EASA system and was implemented through a review of some Norwegian night HEMS accidents.

It is that there must be two pilots IN THE FRONT of all HEMS operations (day, night, ifr, etc). You may fill the second pilot's position with a "HEMS Crewmember" that must be trained to assist the pilot. In practice, that would be a crewmember with all the pilot theory completed, some basic flight training, and significant training on CRM and instrument interpretation.

This requirement has not burdened the Euro HEMS systems into oblivion. In my view it has made it world's best practice (no I am not European!). They often use a three man crew with the paramedic trained up to HEMS crewmember level and the doctor in the back. This system ensures two on board crew are trained to interpret the flight environment and naturally then a second person will have input into the mission decisions. Combine this with SPIFR machines and autopilots, EVS, NVG and TRAINING and I think we are getting there!

Let the debate continue..............

SASless writes:

Isn't the irony here that as a knowledgeable PAX you'd welcome the (presumably prompter) medical attention and then if it was dark and the weather was **** might decline the ride back to the Center in favour of road based transport?

I'm puzzled as to the economics here. The insurance feedback loop normally fixes stuff like this (eventually). Who takes the financial cost of killing the hospital staff?

Devil 49 writes:

Not sure how old you are... today on the radio (link will change over time):

http://www.bbc.co.uk/radio/aod/radio...?radio4/puntpi

Complex twins????

Just how complex is a BK-117/EC-135/EC-145/Bell 230/430/S76/A365?

Some training empires make the procedures very complicated whereas in reality they do not have to be that way at all.

As large and "complex" as a Chinook is....it is still flyable with just one Bod sat in the left hand seat.

Sasless, isn't the difference between the machines you listed and say a 350B3/407 maybe the workload in the cockpit for the single pilot in difficult circumstances or maybe even more importantly the expectation created? Is modern technolegy maybe hiding individual shortcomings during training which technolegy can not cope or compensate for in a real situation? The only way I see past this is objective sim training testing us under the circumstances that killed most of our fellow HEMS aviators and having the right to say somebody is restricted without being pressurized. Training teaches a lot, but there are certain life skills(decision making, situational awareness, responsibility, gut feel, etc) required when all turns pear shaped that can not be teached but must be identified before me as a individual can work and improove those skills lacking.

Complex airgrafts,
 

AS365, EC135's are not complex. S-76 a little bit more complex, but you have to think what is most useful in either program. EC135 is good for SPIFR with good MCC training with flight attendants.

Hostile

Complexity is relative to task saturation, which is relative to a whole load of preceding variables. Any flying machine can be considered complex when it gets ahead of the pilot/operator.

The answers to all that's been brought up here starts at the top of each operator, the industry and respective governments involved.

Without reasonable leadership closely tied to making decisions relative to real field operational requirements progress in HEMS is going to be slow indeed. Needless to say from my point of view we have a leadership problem in the HEMS industry.

Quote:

Needless to say from my point of view we have a leadership problem in the HEMS industry.

WWIII:
I think you have touched upon another very significant factor in this discussion. Much as I hate to make this about "Us vs. Them" ,one has to note that almost the entire top echelon of the HEMS industry is manned by non-aviators. Good people in their own right, but ,driven by different motivations:money and patient care. The latter being part of what I call the " Ambulance" culture: Get in(quickly!!) ,get out(quickly!!) and save lives(cue hallelujah chorus!!).I wonder how many pilots buy into that.

If the top echelon of the US HEMS industry had their druthers, at the very top of the list would be getting rid of pilots altogether. They believe, truly, that if they just didn't have to deal with the #&%^#&$ pilots everything would be rosy, and they would make tons more money. They really hate having to deal with people they can't completely control.

I agree with most.

IMHO (I like that one!)

The problem in HEMS flight ops comes in its complication; and substandard support the top folks render. They get very frustrated by what happens, or doesn't happen, on the line, and lash out in not-so funny ways like disciplining pilots, calling pilots lazy, etc. There's no excuse for it. Management are responsible to take care of the folks in the field doing the job. They are the ones who take the ultimate risk and generate the revenue, and no one is more important in a HEMS operator than them albeit each link of the safety chain does rest with everyone involved. When pilots screw up, it is the responsibility of those at the top, and I mean the top.

The myth of us and them is just that, a myth. Top management being completely responsible for what happens in the field unfortunately has morphed in to they feeling they can delegate not only authority to their operations sections, but responsibility as well, simply because they feel they are the corporate or business side of things. Couldn't be more wrong. That's where it breaks down in to one operator competing against another with respect to such as not putting in to the field what is required to do the job (machinery, training, support, mentorship, sanity, etc.), but putting in to the field what is competitive - i.e. single engine this and that; and what the FAA drive down their throats.

HEMS is full of adrenalin (most self induced) and rush practices that are not tolerated in other areas of helicopter ops. Human requirements and the laws of physics are no different in HEMS as Offshore, or executive operations. Our biggest advantage to the medical community is decreasing morbidity, not mortality. The good thing is the former decreases life-long cost to us all thus supports we being available to save lives as well, but that does not happen as often as most would like to think, but it does, and is nice to know.

HEMS operators need to study and emulate the best elements of other helicopter operations with the best safety records - it's at least a start! They also need to DECOMPLICATE the distraction of every pilot's admin, etc. load so he/she can concentrate on the job at hand - flying from A to B to C, etc.

Some operators have unionized pilot shops - if the operator had done their homework before such became a fact a lot of what is being discussed here wouldn't be in print!

Time will tell!

EC-135 isn't complicated???
It (and all other light twins that are capable of Category A) has redundancy and complexity to rival a Boeing 737.
When you compare it to a Cessna Mustang (their latest small bizjet), it's more complex in systems. And to get insurance on a Cessna Mustang, you'll do 25 hours of simulator training, plus a whole lot more in-flight training before they sign you off.
And that's before you consider the complexity of the mission - all Cessna Mustangs will takeoff and land on long stretches of paved, lit runway, with good navaids and well-established procedures. Most EMS missions don't know where they going to land when they take off, let alone have to worry about navigation, talking to a different type of ground agency on every mission, not know about wind and weather in detail when they arrive on scene. I could go on...
We delude ourselves if we don't think the helicopters flown are complex. And we need to recognize that the missions are equally complex.

Well said!

The bottom line is that whatever machine we talk about it has limits and when utilized up to them, particularly under multiple variables, the simplest of machines can become very complex in handling requirements given a small amount of time to do so. HEMS is indeed not a joke in the amount of decision making required given the mission time frames involved.

I can take a GIV from the east coast to Europe and make far fewer decisions than doing one EMS mission 20 miles out with RTB hospital.

I wish those empowered to make decisions in this industry would realize these sorts of things! Trying to convey that is impossible at present, irrespective of how much the top folks would like to believe to the contrary.

Hems Advice
 

Many years ago, at the very start of a new UK HEMs operation, I was standing in the hangar besides our shiny new (actually second hand) AS355 on our very first day of the Operation.

The Ambulance Service (Client) Director of Operations walked up to me and said;

"Remember Son, when whizzing about trying to save lives, you already have three live bodies on the helicopter, and they must always stay that way"

I marvelled at this insightful remark given that he had never operated a helicopter before and to my surpirse he replied, "whats it got to do with the helicopter? Its exactly the same advice I give to my ambulance drivers day one after they have qualified to drive with blues & twos".

I never forgot his remarks and always in the back of my mind, if its that serious, they will probably croak anyway, so why take too much risk in trying to help.

This, in simplex terms, is the paradox of HEMS. You can spount all you like about machniery, wx minima and management, but in my view, the selection, training and discipline of the pilots involved is the most fundemental building block in the safety of HEMs.

Matrurity, experience, both in flying and life, and a determination to go back to the wife and gets at the end of the working day are the benchmarks of safety.

In my view ther are only really 2 types of pilots:

1. Those who will try things out for themselves.

2. And those who only do what they have been shown and taught.

I know which type I want taking me to Hospital in a Heli!!!

To all you current HEMS boys out there - stay safe and remember the most precious life you will save today - is your own!!!

All good stuff.
Ultimately it boils down to the three T's:
Temperament: Hire and retain pilots with the right temperament for the job.A shrink to evaluate risk- tolerant versus risk- averse personalities during the hiring process and higher salaries might help.
Training: Realistic and repetitive.Check rides every year and only during the day----really?
Technology: Put the right tools for the job in the right place and in a timely fashion.Don't wait for the horse to bolt before slamming the barn door shut.

You can put it in any order of preference,but it all falls into the purview of people at a higher pay grade than mine.
Alt3.

EC 135 complex,
 

When I mentioned the EC 135 with SPIFR is not complicated, I also suppose they have at least GPS with moving maps, NVG's AND very well trained crew. Without good training, all aircrafts are complicated.

Hostile:ok:

GPS with moving map isn't complicated???
It's a whole world of complexity, with a load of mental baggage that hardly qualifies as carry-on.
If GPS with moving map isn't complicated, why does the latest Sporty's catalog have at least one page of nothing but how to use your Garmin 430/530 / Avidyne / Whatever???
If it's not complicated, why do you need training to use it?
Sorry, but it is complicated. Very complicated. It needs training and recurrent training.
Maybe we need to make it less complicated, but that's not the issue right now.

Training
 

That's my main issue on it. If and when pilots (and crew) have possibility for training, it is not that complicated anymore. If you only try to read manuals, it is not enough. Using example MS flight simulator games gives you main idea how to use GARMIN GPS's with approaches. It is not that difficult. I didn't say it is like flying VFR with CAVOK, but that is the why this thread is. How to prepare for bad weather and get out of it or cancel whole flight.

Hostile:O

It seems we agree there is a training deficit in HEMS (though I would contend that it is a wider problem than just HEMS). I agree thoroughly with Shawn re the complexity issues, and I would note that almost every operator has their cockpit configuration completely different (unlike most airline cockpits) with very unstandardised equipment fits. It is likely even within a single operator to find three different GPS systems in three different aircraft on the line.

Given that there are very poor technical standards governing ergonomic attributes of avionics (many systems have no spec at all) then you can see the "mental baggage" that Shawn refers to having a large cost in terms of free cognitive space available for situational awareness and control manipulation. The only short term answer here remains training!

I mentioned the EASA HEMS crewing requirement above, and would love to hear some open discussion on it's attributes. The standards require Two Pilot or One Pilot Plus HEMS Crewmember in the FRONT during ALL HEMS missions (day, night, ifr). I personally reckon it is the world's best practice and should be mandated across world wide HEMS ops. You?

Agree. I was in Europe when those EASA rules were launch. In that time many things changed in many countries and companies. Like I told earlier it wasn't easy time, but finally it will be good result. It is not ready yet. I hope that same will happened here in US some kind of way. It is not easy way, but hopefully all have equal possibility to follow the road.

Hostile:ok: