I am sure I am not alone in this frustrating scenario.

More unnecessary deaths for what?

Absolutely for what???

Can someone please confirm that: “night-vision gear” actually means “Night Vision Goggles” (NVG's) flown in Night Visual Conditions by qualified (NVG) Flightcrew?

Do we expect the FAA must surely act soon?

Nope.

ummmm, To save lives?

ummmm, To save lives?

If you actually believe that, you are part of the problem.:ugh:

EMS does not save lives!

EMS provides a safe, efficient method of transporting passengers who have on-going medical illnesses or injuries.

If you think anything else....and work in the Helicopter EMS business you are part of the problem....not the fix.

You are not heroes, angels, or sky gods.....but good folks doing a valuable service to the community.

If a life is "saved" because of the rapidity of the transport....then that happens to be good fortune, good luck, or simply Fate working its way.

Sasless, I guess if you say it enough, maybe you will get to believe that. For those of us that know better, we're not going to change your mind.

That having been said, of course there is room for much improvement. I have a list of complaints I have with the air ambulance companies. Each one of us that flys or flew HEMS knows the risks and always has the option to turn down an unsafe flight. Because a helicopter crashes while cutting the margin too close, and I'm not saying that is what happened in the most recent Arkansas crash, does not mean that you would have made a different choice under similar circumstances. We can improve the safety record. No doubt about that. I think that the NTSB is on the right track with NVG, auto-pilot and proximity warning. You may feel differently. That doesn't make you part of the problem. It just makes you another facet of the solution.

If you're in this business to save lives, you're in the wrong business. I don't save lives, I just carry breathing cargo. We may reduce morbidity, but we rarely, if ever, save lives.

Night vision goggles are great technology, but like any other technology, can be dangerous if not used properly. NVGs let you fly into increasingly poor weather without knowing it until it's too late, if you don't look under them and keep track of the unaided visibility. It's too easy to get into IMC without knowing it, and then it can be too late, especially in a 206, with insufficient instrumentation to fly safe IFR. Transitioning from VMC to IMC unexpectedly is difficult enough in a well-equipped IFR ship, nevermind a 206.

All that said, it's too early to speculate on the exact cause of the crash. Video of the crash scene shows an almost perfectly vertical impact - no trees or power poles or lines show any evidence of any damage, other than fire damage above the pine tree above the scene. There are numerous possible explanations of that, and I haven't seen anything to point toward anything more than any other.

Gomer, I guess that it's a matter of perspective. True, it's ususlly the med crew that does most of the saving going on, but if you're not helping to save lives, maybe you are in the wrong business. Go argue the "Golden Hour" with a trauma surgeon. At $15,000 a pop, you'd think that there would be a lot less air ambulances if no lives were being saved. If you aren't helping to save lives, then you might just be doing something wrong. I've argued with ATC to make the fighters wait to take off until I get through their route of departure rather than have me circumnavigate their airspace. There are a lot of pilots that won't put forth the effort. The paycheck will be there at the end of the week if this patient makes it or not. If you aren't helping to save lives, then you just might be in the wrong business.

Trying to save a life is, IMO, the root cause of most EMS accidents. It's a business, and this is a job. You forget that at your peril, and at the peril of the crewmembers in the back, and of the patient in the back.

Gomer, then by all means don't forget that! Your cause and effect remark is a little like saying that flying has been shown to be the root cause of air crashes. If you can't try to help someone survive without loosing sight of how to fly your aircraft safely, then by all means don't! Thousands of EMS flights are performed safely every year by caring individuals. Your opinion is your opinion. Don't try to ram it down everyone elses throat. Safety needs to be improved. We can improve it. And we should. But if you are there to tell HEMS pilots not to give a damn if their patient lives or dies, otherwise they are in the "wrong business" you are way out of line.

You made several very correct statements in your response....this is not one of them.

The "We're out there fighting death...stealing lives away from the ol' Grim Reaper himself....we pluck them from the very edges of that deep abyss..." mindset is what get folks killed.

If one is a professional then one makes professional decisions based upon facts, data, protocols, and recognizes limits. If one cannot separate one's emotions from one's professional life....you ain't no Professional!

It is a job....a very risky job....that carries a certain kind of satisfaction about doing something good while at work....but it is just a way of paying the rent....nothing more. You might as well haul dead trees, boxed freshly caught Salmon, or Bubba's out to the oil rigs....EMS is just another one of the taskes we can do with a helicopter.

Open your eyes and watch how people go about the work....folks in Trauma Centers do not wear fancy Nomex Flight Suits....big ol' boots....chic Flight Helmets....or do PR's (admin flights devoted to showing the flag) like Helicopter EMS folks.....but do the very same kind of work but do so inside a building. Ground based Paramedics/EMT's and their ground ambulances do the same work....but definitely do not go the flashy road.

See where I am headed with this?

If you fall into the trap that most EMS operations set for themselves....and do not screen effectively for it....and do not weed out those that are susceptical to taking on that John Wayne....Type "A" mentality with all its vulnerabilities.....in time disaster will happen. It is a matter of time only!

Back to your quoted comment.....I heard exactly that when I took the position I do....while working at several EMS locations. You are exactly correct in one thing....I shall never change my mind on this topic.

EMS is about providing skilled emergency medical care to sick and injured people....providing them safe....operative word...safe....efficient air transportation to locations where they can be rendered medical treatment.

Note....no where in there did I say....mention....suggest.....opine....anything about "saving lives". The "Golden Hour" concept says lives will be saved if proper medical TREATMENT is obtained. That is the Trauma Center, Heart Specialist, or similar modern facility and staff the EMS crew delivers the patient to and not just the EMS crew alone. The EMS crew is part of the system....and play an important role....but are not the be all...end all!


In flight break up?

Let's line up the odds....of a catastrophic in flight failure....and have it happen on a dark foggy, rainy, night over a very dark un lit area, while on a Helicopter EMS flight in a Bell 206 with no Stability/Autopilot system. Does anyone care to offer opinions as to the odds Inadvertent IMC while flying on NVG's could lead to such an in-flight break up sequence?

No one knows what happened to this aicraft that resulted in the death of three very fine people....and we should be careful to qualify our statements in that regard. An investigator looking into this tragedy will be having some of these very same thoughts while looking at the evidence.

If we look at history....and the long record of fatal EMS crashes in the United States....how many similarities will we find to other IIMC events?

Now this is an interesting discussion.
fly911, I assume, by your moniker,you are an EMS pilot.I respect your passion and your attitude. But,I have to say, you are a little off track here. Can you explain to me why, for the longesst of times, the pilot in an EMS outfit is not given the condition of the patient? I am assuming your company does the same. Can you explain why the "lifesaving angels" in the back have the option to turn a flight around under the "three to go and one to say no" principle?These have been put in place for a reason.
What Gomer is trying to say is that we are in the transportation business.The words Air Ambulance or Emergency Medical Services or Mission ,all preload the pilot into a lifesaving mindset and that has proven to be dangerous.If you look at the accident statistics of any 135 operation (fixed or rotary), it is squeaky clean compared to a 135 EMS operation (fixed or rotary). A good reason for that: ever heard of the White Knight Syndrome?
Yes, we provide a valuable tool for the communities ,especially in rural America, for a crtically ill patient to fly to center for higher care. We certainly shave off time for an accident victim to make it under the golden hour.But,if your focus to accept or decline a flight is based on "saving a life",I am sorry, you are barking up the wrong tree.Leave all that BS to the folks in the back. Most haven't even left the Ambulance yet. You and I are paid to fly as professionally and safely as possible without thought to the outcome of the patient.You know as well as I do how hard it is to abort or divert when a patient is already on board. We don't need to make our lives tougher by putting ourselves under pressure from the word go. If I really wanted to save lives ,I would have joined the Coast Guard.
So why am I doing this? Because I like to fly.Plain and simple. If I were offered a job flying oil workers in the GOM tomorrow on terms I like, I would take it in a heartbeat.
Sorry for this long and preachy post.No hard feelings.
Alt3.

Alouette, it's really "One to fly and two to cry".:E

Tottigol,
Recently heard of a case where the crew expressed their reservations about the weather and did not want to return to base (patient transport was complete). Well, our hero leaves them behind and heads right back home. I am not sure he still has a job but it certainly fits your "one to fly and two to cry" category.:ok:
Alt3.

Also known as the "One Dissenting Vote Rule"....anyone "chickens out"....the entire crew chickens out! The collary rule is...."Chicken out early!"

I always accepted the fact when the other guy asks me...."What do you think of this weather?".....it was not a question but a statement! He is probably thinking he doesn't care for the weather at all and is trying to politely raise the issue.

I also pondered....if one replaced the fancy custom flight suits with the old Army two piece Nomex....in Olive Green....went to flat black helmets....changed boots to say....the old Army throw-a-way black plastic soled boots....how many of our Helicopter EMS medical crews would hang around? In plain language....make the work dress dull and drab....remove the luster from the job....would we see a dimunition in the type "A" personalities that we find so prevalent in the EMS operations? How many of these folks are really doing it for the work and not the flash?

Amen to that SAS! Oh,and that "heroes" thingy.:rolleyes:

FH1100,

Yes the number of engines makes a difference. Singles are single pilot VFR, twins are 2 pilot IFR. Singles are crashing with monotonous regularity in USA at night and bad WX because they are flying beneath cloud and becoming CFIT statistics or getting disoriented and crashing.

Twin engine machines firstly have two pilots - one of whom can be detailed to get a last minute weather check whilst the other preps the machine. Then they can discuss the weather and their options before departure. if they choose to go then they have the option of flying above fog or in cloud to get to the destination and if they can't land then they divert because they have the equipment and fuel reserves to do that.

John R81,

If this VFR machine came apart in the air whilst flying in fog (cloud) then my guess is that it came apart due to unintentional aerobatics caused by loss of situational awareness - not mechanical failure.

What concerns me most is not why these pilots keep doing it - it is why the medical crews blindly follow them to the scene of the accident. The medical crews that i fly with (in a 2 pilot, twin engine machine) want a detailed weather brief before they will go anywhere. They have no intention of following me to an early grave.

Epiphany, that may be the case in Australia but not in the US. There are plenty Single Engine IFR machines out there (quite possibly also including some dual pilot ops, others here may know better), as well as Single Pilot IFR twins.

Yep...plenty of twin engine/IFR machines including 412s, AW139s etc operating in the SAR/EMS industry in oz single pilot (albeit a crewman often occupies the LHS in a kind of non flying co pilot role).

In combined Casevac/SAR unit I flew for there was categorisation of patients. Category A was highest (life or death), so we knew up front what we were facing.

Point to bear in mind: the patient is but one life. The crew was/is three, or four lives if it was a SAR mission. Apart from that, the loss of the aircraft itself might mean that other patients may not be rescued afterwards.

Having first flown helicopters with night vision devices in the late 1970s, (with PNGs, which pre-dated "NVG") I've always been concerned about them being used in circumstances where an IFR reversion/recovery is not possible. I've previously given advice to some via this forum. My advice is that I would not choose to work for an NVG, non IFR capable helicopter unit. Too risky in my book. As an instructor, I helped get RAF rules changed back to something more sensible when new weather limits for NVG operations were introduced which allowed flight in visibility worse than for unaided flight!

These tragic accidents seem to reinforce my point.

Mmmm ...

Yes but in Australia DOES NOT ALLOW VFR flight at night at 500' agl does it ? ... perhaps for a start THAT is something the FAA needs to address ....


:=

Except for all of the SPIFR machines....which are in vogue.

Epiphany:

All five Victorian EMS helicopters are twin/IFR/Single Pilot.

spinwing,

Australian NVG approved operators can transit at 500' agl NVFR: exact height depends on a variety of factors, including CASA approval criteria :ok:

Mmm ...

Yes and as you say that is specifically approved and only for NVG ops.

It is not an allowable 'STANDARD' for NGT VFR flight as it is in the US of A ... and if IMC is encountered a climb to an appropriate LSALT is required isn't it.


:=

Epiphany, you make a stronger case for two pilots than you do for two engines.

The issues you raise have been brought up before: That all EMS helicopters should be twin-engine/two-pilot/IFR capable/autopilot-equipped. Oh, and no night-VFR.

It's a nice fantasy, but it is just that, a fantasy. Here in the U.S., requiring such things (and the large, expensive helicopter you'd have to have) would mean that many communities would simply be without air ambulance service as the cost would be prohibitive. If you're cool with that, fine. But I don't think that's ever going to happen no matter how much you'd wish it would, and not everyone agrees with your viewpoint in any case.

The bigger issue is flying VFR into fog at night. Whether or not that caused this latest accident in Arkansas is almost beside the point; it would have been an irresponsible thing to do even if there were no crash.

But two-pilot crews are not immune from making such mistakes. I remember a particularly tragic accident some time ago in which an IFR-capable S-76 with two experienced pilots onboard attempted a night takeoff from a fog-shrouded airport runway. All they had to do was take-off straight-ahead with a positive rate of climb, and in less than one minute they would have been above the fog, up in a nice, clear, starry sky. Instead, they inexplicably stopped the climb, then floundered around for some time before crashing headed back toward the airport at an altitude lower than the elevation of the field they departed from! (It was hilly country in Kentucky, U.S.)

If we can keep pilots from making bad decisions, then the accident rate will be reduced, simple as that. Technology and capability can help, but no amount of technology is going to prevent the pilot from screwing up (again, I point to the Maryland State Police SA-365 accident). I don't know what the pilot of this latest EMS helicopter was thinking as he pushed along into the fog that night. We'll never know. But whatever he was thinking, we have to change it.

Well if the FAA and local authorities are 'cool' with VFR helicopters falling out of the skies with monotonous regularity then I suppose the situation will continue. There comes a point when the argument of having any EMS helicopter rather than the right one just doesn't hold up.

And it is not simply a matter of providing expensive IFR capable machines - the crews need to be well trained and current otherwise when they do fly IFR they may well 'flounder around for a while' before crashing.

Aloutte 3 - Re: No hard feelings...
 

No hard feelings indeed. I got out of HEMS work about five years ago, and it's probably time for me to leave this thread. I agree with the concepts you describe like not informing the pilot of the type mission until a decision has been made as to whether to accept the flight or not. That's good common sense, as the pilot may have a soft soft spot for say, a child burn victim. But I don't think that it's fair to compare the non-EMS part 135 safety record to the Air EMS part 135 safety record. It's just not a fair comparison. Bad weather causes bad vehicle accidents. Health of a patient doesn't depend upon weather, whereas most air taxi work does indeed depend upon good weather. It's a fact of life, that if you are going to fly HEMS, you will be flying in marginal weather conditions. That is an increased risk factor. Consequently, there will be more HEMS accidents. Alt3, if you don't see this, then read no further. No hard feelings. Before we move on and try to fix it, we have to take our emotions out of the equation. If I appear to be in denial about something, please point it out so that I can recognize it. If I disagree with you about it we can discuss it further. And I ask that you search your own attitudes for signs of denial. There are "White Knights" and "Cowboys" and will be as long as there are helicopters. I'm sure that you don't care for the type in EMS and neither do I. But because we don't care for that type of pilot doesn't mean it's ok to blame all the accidents on them. It could very well be that the "white knight" would be quicker to turn down a marginal mission out of fear of not being able to complete it and looking bad. Come on alt, if I am flying logs, then I want to be the best logging pilot I can be. If I'm fighting fires then I want to be a good fire fighter. I don't want to be a half assed HEMS pilot. Which is not to say that I'm not concerned about safely completing the mission as being the most important thing on the agenda. If you (not you personally) are the type of pilot that will only fly in "clear blue", more power to you. The world needs more pilots like that. But if you are the type of pilot that won't get out of bed in a light drizzle, please don't take an HEMS job and spend all your time complaining that you can only fly patients when it's "clear blue". You're not doing yourself or your profession any favors. We can improve the HEMS safety record, but it's not going to happen by pointing fingers. When I hear counter-productive comments like "If you feel that way, you are part of the problem" I hear him really quoting from the Wizzard of Oz: "If...I...only had a brain...".
I think I'm outta here. If I offended anyone, I'm sorry.

Fair enough,911. I think you have made your case pretty eloquently. I see lots of points we can agree upon and the chief amongst those is the fact that we want to be the best at whatever we do.Also, there is certainly an increased exposure to risk in HEMS.We, the line pilots have to manage it . Not the FAA or the operators ----just us.
The only place we will have to agree to disagree is the fact that I don't see myself as being in a life saving job.Life altering ,certainly, but life saving ---no. I would like to keep it that way.I will continue to do the best I can under the circumstances and limit myself to the letter and the spirit of the laws that govern my job.I certainly hope everyone else does the same.
There should be no hurt feelings in a professional forum such as this and I hope you will return to this thread because we all have something to contribute to raise the safety standards and perceptions in the US HEMS world.
Fly safe and above all fly smart.
Alt3.

So,Fly911 your point is that no matter what equipment we are going to make mandatory for the safe conduct of specific EMS operations, there shall always be the White Knight or the Cowboy who's going to want to impress the two SLBs in the back.
YOU ARE ABSOLUTELY RIGHT!
However I believe that it's not merely an equipment standpoint, it's the whole industry mentality that needs to be rearranged, and drastically so. The Aeromedical industry is in reality another expression of the flawed medical structure in the USA, flawed because it's based on protagonism and appearances and not real patient care values.
I have flown EMS for several years and thank God never ones I had to use a VFR only single engine aircraft with no stabilization other than my seat of the pants, however I did feel peer pressure coming from the primadonnas in the back and coming from those pilots who wanted to be counted in "the circle of friends".
That's why I am not there any longer (ask SAS) and that's why I shall keep away from any other EMS job trap again.
The problem is that EMS is run by the customers and as long as there are no structures in place to limit the overbearing intrusion of a non aviation entity in the operational control of an aviation activity we shall continue to see what we see.
Let's change the structure of HEMS, let's isolate the moneymaking from the flying and we shall reap the rewards with drastically decreased accident numbers and RATES.:rolleyes:

It doesn't matter what aircraft you fly. If you stick to the rules you should be OK. If you fly for a company which only makes money when you carry a casualty, sooner or later you'll probably crash, or at best frighten yourself silly on regular occasions. Its called commercial pressure. And it doesn't mix with HEMS.

There are hundreds of reasons why crashes occur....and some are very subtle and hard to articulate....particularly when you are the one being confronted with them day after day. (....or night after night)

Commercial pressure is one, having weather go below your limits is one...fatigue is another...night time is a big one....flying over isolated and dark areas is another....unforecast inclement weather is another....variable unforecastable weather due to terrain is yet another. How long a list do we want to create?

The size and numbers of the holes in that old chunk of Swiss Cheese is what matters!

Epiphany, I think you have to accept the fact that the US is not Australia, which is not England, which is not anywhere else. Practices in one country have no bearing at all on practices in another country. Culture, tradition, even language is different in different countries, and criticising another country's laws and ways of doing things is not a productive exercise. There have been EMS accidents in Australia, and the rate per hundred thousand hours is likely not significantly higher than the rate in the US. You hear of lots of US HEMS accidents because there are close to a thousand EMS helicopters flying every day here.

I personally think HEMS should be run by the government, at whatever level, but here in the land of the free capitalism rules, so that ain't gonna happen, and making a profit will continue to drive the industry. There are very few HEMS ships flying with two pilots, regardless of the number of engines, because the second salary cuts into profits, and every program would do without pilots at all if they could figure out a way to do it. EMS directors hate pilots, always will, and we get what we get. Take it or leave it.

Mmmm...

Gomer .... you are quite right there HAVE been EMS accidents in Australia ...
and when you analyse them the reasons look very much like the reasons accidents keep happening within the US industry.

That is the reason things changed in Australia ... over time it was realised that airmanship and professional decision making HAD to overule the so called 'profit incentive' .... until that happens in the US I think history will continue to repeat itself.


:oh:

I differ a little there spinwing: the accidents in Australia did not change much - it steered one state government away from single engine VFR helos, there were only three of those in use in that state, and it did not even mandate NVG! There was nothing ground breaking or monumental in the changes. That is a very different proposition from what the USA is going through - for a start, each helicopter in QLD had only one client and none were competing on a cost basis with any other. There was no loss of work, nor redundencies for machines and operators. Similar changes (mandate IFR Twins) would have a massive impact and are therefore unfortunately unlikely in a for-profit system such as the USA.

I think a whole lot of this thread has been written with passion and intelligence, and it has made a lot of sense from both sides of each discussion point raised. One thing really stands out though - our responses are always shaped by our experiences and our operating cultures; that is why we have such different view points. I will throw a few into the mix from my limited experiences.

Perspective. Australia achieves as much EMS SAR flying per year as they are doing each day and a bit in the USA!!! The USA has over 1000 machines (according to an earlier post - though that seems extreme) and Australia has less than 35. I cannot do the maths, but it seems that we Australia have to look at accident rates over a 40 odd year period to see if it is close to the annual rate for the US. Therefore it an Apples V Oranges arguement to compare anyone else with the US, particularly give the unusual commercial and job competitve nature of a majority of the US industry.

The Golden Hour. There is no evidence indicating a sudden increase in mortality or morbidity in the 61st minute of a reponse. Whilst many response organisations use it as a mantra and marketing tool to easily convey the need for speed to the layman, the reality is so clouded by regional settings as to be almost irrelevant to some. For example, in one part of our area we deliver medical care and capability in the helicopter that exceeds the Emergency Department. So, is the golden hour until we arrive, or until we deliver the patient to lower care levels in the medical facility?? All I am trying to convey is that there are no "absolutes". What "must" be done in one region "should not" be done in another.

The only discussion point that has so far concerned me was inferring that "we never save lives". The use of the royal "we" here is what is incorrect IMHO. I have flown for many organisations that can lay claim to survivors purely because a helicopter was able to bring rescue and/or sufficiently high level of medical care within a time frame that would have otherwise resulted in death. That is not a reason to grab a cowboy hat and show everyone how long your willy is, but at the same time it is inconsistent with the notion that it is like flying logs or rigpigs. I recognise that some organisations do not have high level medical care on board and may only do inter hospital transfers, but that is not a reason to cast an "absolute" that no-one else saves lives. It must be self evident that moving someone to a medical facility "saves lives" - so the question is: what bit of the ED saved the lives? Why was it not bought on the helicopter? Can the helicopter bring SOME of the bits on offer at the ED and thus be in a position to "save lives" ??? Is rescue from an iminent building fire, flooded river, sinking boat, or soccer match "saving lives"???

We have talked in depth about reponse times and how "dangerous" short ones are, but I stick to my previous points on this: time of response does not equal safety of response. Response process ensures safety.

Another absolute that drew my attention was that we pilots should "never" know the condition of the casualty. That has not been an important factor in my experience in influencing a PROFFESSIONAL. I note with some danger of a faded memory that the majority of the US HEMS accidents are on the return leg after patient delivery. In other words - patient condition was NOT a factor in the majority of press on itis accidents in the US. In the organisation I currently work for, patient condition is as openly discussed amongst the crew(aviation and medical) as is the weather and the aircraft performance, how tired we are and how inexperienced we might be at the proposed type of flight. CRM. So I see it would be appropriate in some cultures, but please dont force it on ours by saying "never".

Two other things about this notion to consider are:
1. Why do we never give crew of the year to the guys who had to say "no" in often extremely trying circumstances? I can employ heaps of pilots who will say yes, but where do I find the one big enough to say no?
2. If it was your child dying, would you try harder? Do other peoples children then deserve less effort? Ethically a really tough one I think (and I really struggle with it at times). Absolutes are a big call. What if you say no to a take off because by the time you get back to base you will have exceeded you duty time by 1 hour - and then you find out it was to a severe road accident involving your family to which the the ambulance is more than an hour away. Is that one hour a sound risk V gain decision in light of your family trapped and bleeding? Or is it absolutely innapropriate? Is it really "never" appropriate for aviation and medical professionals to weigh up the risks and make a crew decision on what "is" appropriate??

Lastly, the calls that HEMS must be done "this" way (which nearly always resembles the way the proponent is doing it now!). Here are my calls for moving to the ideal HEMS culture in FULL recognition that I dont know the benefits of other ways NOR will anything I say make the slightest change to other ways of doing it!
Twin engine PC2 preferred. IFR with SPIFR autopilot. SP plus "HEMS crewmember" or co-pilot for operating (not medical) crew, in accordance with EASA's smart and latest requirements (Australian front seat crewies do not comply in nearly all cases). No unaided HEMS/SAR. Primary response at night only by NVG HEMS/SAR, only where trauma rates after dark can be shown to be inadequately covered by road response, and only where helo brings significantly higher levels of medical care than that available on the road. Inter hosptials by night must have NVG. HEMS pilots to be instrument rated and current (yes, even where their area of ops precludes IFR). HEMS crews given extensive CRM training (not the one day giggle over the Air Florida and Tennerife accidents), HEMS organisations run not-for-profit BUT with strict governance regulations in terms of management and board members (no "old boys" clubs), HEMS organisations not to make money from flying - the money is made from standing charges (yes we run a model in Australia where providers lose money each time they fly!).

I know these "are no absolutes" and there will be many other suggestions, but this is my drivel...write your own :8

I generally agree with helmet fire and spinwing. Things aren't likely to change much in the US, because the god Profit is all-powerful, and we will continue to bow down to him regardless of the number of deaths. Profit is far more desirable than safety here. It matters not how many people die, crews, patients, or bystanders, as long as the corporations can make a profit.

I have never claimed that we never save lives, only that I never have that as a goal. I'm not aware of any that I or the med crew have saved, but we're far from the only ones flying. We've got a few to the hospital alive that didn't survive long in the hospital, we just prolonged it for a few minutes, and we've flown many who wouldn't have died if taken by ground. We can mitigate morbidity, especially for stroke and cardiac victims, but we rarely save lives. Again, 'rarely', not 'never'. Painting anything with so broad a brush as to assume absolutes is wrong. But we should play the odds, and look at the most likely outcomes, I think. I almost always know the condition of the patient, because I hear the scanner, and hear the patient report over the radio from the ground EMS units. I just don't let that influence me. I think I do a fairly good job of that, but I'm only human, and I sometimes have to remind myself that it's just another piece of freight.

Things are different in different countries, and always will be. The 'one world' concept is a long way off. I would prefer that things were done differently here, and more like other countries, but my preferences have no influence on anyone or anything. I just try to deal with conditions as I find them, the best way I can, and go home alive at the end of every hitch.

EMS v RESCUE
 

AUSTIN TEXAS STAR FLIGHT RESCUES 13 FROM FLOOD.
Additional video here---> Starflight rescues 13 from floods | KXAN.com

FAA proposes new rules for helicopter operations - with EMS focus
 

Finally some good news for EMS operations. Same rules, same operation. That's it would be for now. There will be a long way, but this is good start.

:D

I like knowing the job we are running to. I have to in the UK. As the pilot I need to know if it is HEMS or Air Ambulance as each has different weather limits, which with a well briefed and CRM'd medical crew all understand when I say nope not today. I have not been asked or questioned once (in a few years now) why we turned back, as sadly with all these crashes going on around the world they are more than aware this game can be fecking dangerous if you push it. Fly safe all.

Hi Alouette 3
Are u french ?

A response to the list above from the FAA recommendations with some thoughts based only my opinion (knowing that opinions are like arseholes - everyone has one!) and tempered with my limited experience:

1. Fit Helicopter Terrain Awareness and Warning Systems (HTAWS).
Agree with inference of terrain awareness systems, but do not agree with common manifestations of HTAWS such as EGPWS for HEMS. Aural warning systems work very well for interhospital IFR programs and off shore, but the constant aural warnings from low level operations during primary response missions can be often counter productive. Rather, I would push for visual aides, and preferably for systems that require very little interpretation with little or no false warnings. Check this out from Garmin to see what I am talking about: G600 MFD info and an interactive demo here: G600 demonstration
No interpretation required. Visual. This is the TAWS systems that should be mandated. Well done Garmin!!! Just need the helicopter ceertification to be completed now!!
Add EVIS to this for the ideal cockpit capability..


2. Comment on light-weight aircraft recording systems (LARS).
Agree. Non tamper proof. Tracking systems employed to show track, hieghts and speeds.

3. Conduct operations under Part 135, including flight crew time limitation and rest requirements, when medical personnel are on board.
Agree only if some of the more restrictive Part 135 issues are resolved before mandating requirements. SAR ops to be added to this.

4. Establish operations control centers if they are certificate holders with 10 or more helicopter air ambulances.
Situation dependant upon nature of tasking control.

5. Institute pre-flight risk-analysis programs.
Only agree if this is not a "Pre Take off" risk system where take off is delayed for a game of guesstimating risk values to see if take off is allowed. My experience with this is that invariably (yep, that is invariably) the numbers or ratings or whatever are just altered until take off is permitted, meanwhile take off is delayed and brain power diverted from building Situational Awarenss. I agree however that a comprehensive risk management system is implemented considering missions and implementing controls well before the phone call comes.

6. Conduct safety briefings for medical personnel.
There are really operations out there that do not brief the crews???

7. Amend their operational requirements to include Visual Flight Rules (VFR) weather minimums, Instrument Flight Rules (IFR) operations at airports/heliports without weather reporting, procedures for VFR approaches, and VFR flight planning.
There are really operations out there that have not established such things?


8. Ensure their pilots in command hold an instrument rating.
Agree. Regardless of terrain and environment precluding IFR use, the skill sets provide a coping mechanism for all sorts of unexpected situations: NVG failures, lighting failures, dust out, white out, as well as IIMC. I also personnaly believe that an IFR rating should be required to fly patients at night - even where flown under VFR.


And I have added a few extras as per previous posts:
9. Operate PC2 compliant.
10. Comply with EASA rule of two upfront - either two pilots or pilot plus HEMS Crewmember meeting specified aviation course.
11. Ban unaided HEMS/SAR
12. Conduct NVG primary response only when trauma rates require it, geography and equipment levels translate into low road coverage by ground responders, and where helicopter brings demonstrably higher medical care levels than those deployed by ground.
13. Proper CRM training for ALL crew (including medical crew on board).
14. Never going to happen in the USA: HEMS operators run by NGO with strict and policed governance guidelines and protocols.

:8