HEMS crash.
 

An EMS EC135 crashed last night in Wisconsin, USA. All three on board were killed.
Thoughts and prayers with the ones left behind.
Alt3.
http://www.nbc15.com/home/headlines/18842074.html

In the last years, HEMS at night in EEUU seems to be one of the most risky bussiness...

R.I.P. :(

The aircraft was owned by Air Methods, INC., the pilot was employed by AMC and the medical crew were employees of the medical facility.

Weather reports about the time of the crash reported to be:

Here are the METARS for around that time frame:

METAR KLSE 110253Z AUTO 00000KT 4SM -RA BR SCT013 OVC035 10/08 A2972 RMK AO2 RAB0154 SLP063 P0004 60008 T01000078 56015

METAR KLSE 110353Z AUTO 00000KT 8SM -RA FEW014 OVC050 10/08 A2970 RMK AO2 SLP056 P0008 T01000078

SPECI KLSE 110430Z AUTO 04004KT 6SM -RA BR BKN014 BKN032 OVC050 09/07 A2968 RMK AO2 P0003

METAR KLSE 110453Z AUTO 00000KT 6SM -RA BR SCT014 BKN032 OVC048 09/07 A2967 RMK AO2 SLP048 P0005 T00940072

SPECI KLSE 110541Z AUTO 35004KT 7SM -RA BKN014 OVC030 09/08 A2966 RMK AO2 P0001

METAR KLSE 110553Z AUTO 01004KT 7SM -RA BKN014 OVC030 09/08 A2966 RMK AO2 SLP044 P0002 60023 T00940078 10117 20094 401720067 56018

The terrain in that area is about 1100 FT AGL

Ground search crews were hampered by dense fog which obscured the elevated terrain.

Is there any indication of whether they were IFR or VFR? The EC135 is a very capable SPIFR machine, and if I were flying it at night in marginal weather, returning to base at an airport, I would almost always file IFR, even with good weather, just for the practice. I have no details at all on this accident, though. If I understand the press releases correctly, they were about 4 miles from their home base, but I'm not certain of that.

Wisconsin accident
 

I think SPIFR puts the pilot under an enormous stress load in inclement weather. However tragic, I look forward for the NTSB report.

That may have been a contributing factor. The actual temp and dew point temps were very close together on the METARS that you posted.

A sad day and I wish it didn't happen.
:(

Sasless wrote, "The terrain in that area is about 1100 FT AGL."

You've got me stumped on this one. Did you mean 1100' ASL or maybe that terrain around the airport is 1100' AAE.

Regardless, it's sad news but what's really sad is that it's not a surpise and with the current mentality in US medevac helicopter operations and current FAA regulations it won't be a surpise next time either.

bb

Late night post....and did not catch the elevation error!

I believe what was being implied was the higher ground between the takeoff point and the destination rose 1100 feet above the takeoff point.


Tragic as this accident is....as all are....the FAA changes to operational control and weather review by operators has made a difference in the accident rate for EMS operators.

I posted the weather without comment as I felt it would be useful to those who care to examine such tragic events with an eye towards trying to understand how something like this can happen....perhaps to them in the future.

The value of a CVR and data recorder's value to investigators cannot be over stated.

Perhaps what is needed now is a recorded telephone line at the operators dispatch office so investigators can hear the conversation between the pilot and the person exercising operational control over the aircraft.

That's already very common. Most dispatch phone lines, at least for larger operators, are recorded 24/7, as are the radio communications. I'm pretty sure Air Methods records theirs. I have no idea whether he called in to dispatch before launching back to base.

I agree with Flungdung - SPIFR is far less stressful, and often less busy, than trying to scudrun in the dark, at least for me.

hi sasless,

not trying to be smart but isn't it the pilot who, in the end, exercises operational control over the aircraft???

i am certainly not speculating on this tragedy but taking history into account i hope there are lots of alarm bells ringing.

another case of the rescuer becoming the victim.

i'm with you oogle, i wish it didn't happen.

When are the Americans going to figure out that SPIFR in helicopters isn't worth it??? The EMS accident record is appalling.

Condolences to all involved.

RH

Under FAR Part 135 require an Operator to maintain operational control over all aircraft and flights. In the past that was ignored by both the FAA and Operators less Operations Manuals and 135 Ops Specs setting forth the weather minima and related information by which the Pilot-In-Command was to conduct the flight.

After several years of high loss rates of aircraft and personnel the FAA was criticized by the NTSB and industry critics for failing to ensure Part 135 Dispatch requirements were being complied with. That brought about the creation of centralized dispatch centers for the various EMS operators.

Since that occurred, the EMS accident rate has improved greatly.

Industry practice has been to consider the EMS flight as Part 135 (Air Taxi rules if you will) but revert to the more liberal Part 91 (Non-commerical rules) for the flight home after dropping off the patient(s). The weather minima for Part 91 regarding night flight and weather minima are much less restrictive than under Part 135.

Picking a stat off the top of my head....if my memory serves me right....80% of fatal accidents occur "after" dropping off the patient and as the aircraft is on its way home or to a refuelling point prior to the flight home.

CFIT accidents resulting from indavertent IMC while operating VFR continue to plaque the industry for a number of reasons. We have a lot of "dark" areas with few or no weather reporting thus unexpected weather can be a direct result of that. Throw in uneven terrain and no NVG's....and the trap is set.

Despite some operator's propaganda...."IFR" programs sometimes really are not as the budget does not provide adequate training or opportunity to stay "current and proficient" although by means of a checkride to minimum standard every six months makes one legally "current".

There is a world of difference between doing a practice approach on the way to the fuel point without screens or foggles and encountering IIMC at night while being only legally current.

Planned SPIFR beats heck out of scud running but as an industry that is what happens more often than not. Being fully equipped....including training and real currency is the cornerstone of SPIFR but that is the hard part to maintain in a working EMS operation.

The price we pay for falling short of the mark is dear.

That is the key, as SASLess says, the difference between current and proficient can be huge, the extra stability gadgets of an IFR ship can help but again if they are not regularly practised can be possible hinderence or distraction.

Old Skool:
Could'nt agree with you more. It should be required for pilots at an IFR program to conduct a full IFR flight by day and night once during every shift ,if not more,irrespective of the weather. This will increase familiarity with the equipment, the air traffic system and the process. A bi annual check ride certainly keeps you legal but not necessarily safe.

The lost aircraft had landed at another HEMS operation to unload the patient they had been dispatched to carry. I wonder if there was any contact between the two crews. If so, I would bet there would have been some discussion about weather if only to invite the visiting pilot to the office for a weather check and cup of coffee.

An interesting question.....what if you landed to drop off a patient and while shut down you discovered the host operation had cancelled flight operations based upon the existing weather? Would you takeoff or beg a bed for the night until weather improved?

Just what-if'ing here....not making any suggestions regarding the accident in question.

My understanding is it was an IFR EC135 enroute home at 2230 local (2-3 hours after sunset) from a refueling stop at the KLSE for the leg to Madison WI, after transporting a patient to La Crosse.
The topos of the area show hills rising approx 500-600 feet above the airport of last departure, approx 4-5 miles from the airport, roughly N-S, course roughly SE. Very little cultural lighting indicated on the charts in the area of the hills, 5-10 miles across and wooded hills probably obscuring what little might have been there. City of La Crosse West of hills, small towns/lightly populated farmland East, going from light into dark, with little to see across the hills.
A direct line from KLSE to Madison goes across the area of the crash, with a local roadway in the valley bottom, elevation rises 300' or so either side. The "talking heads" report impact near the top of one, wreckage down the slope.
I'm suspicious of the METAR, as some of the automated obs I see bear little resemblance to the cockpit view. I understand that there's software that averages the trend and reports a calculated number for vis. Viewing public sector loops for clouds shows bands E-W moving North into the area about this time.
Before y'all get all bent around IFR, equipment, proficiency and requirements, and given I've never flown in the upper Midwest:
It's VFR/MVFR 95% of the time where I am. When it's IMC, it would take longer to file and fly than transport by ground, so there'd be little obvious revenue gain/business justification.
IFR capability increase the safety of the leg home, if I stayed current and proficient. I wouldn't be able to stay current in normal ops, I'd have to do training legs w/safety pilot, prohibitive as we have staffing issues now. Requiring IFR would eliminate most programs here for very little real gain. Besdies which, I can recover to base a lot cheaper by ground than training costs alone (one time in the last year, for example).
As to the reported crisis in US EMS, I don't have the numbers, but my guess is that we're safer than air taxi as a whole. Air ambulance accidents make good press, and, largely, are fairly well equipped and staffed. Nights and recovery legs do feature far too heavily in the accidents reported for me to be casual about that. It's interesting that the last two fatals in the company were IFR Twins, late day/early night, attempting the return to base VFR, and perhaps encountering weather. Were they both at the end of a long day shift? I don't know.
I've never been pressured in any way to complete a leg in 7 years with the company, period. Management, at every level, will come down like the proverbial ton of bricks on anybody disputing an abort/decline.
I detest the "talking box" fix. Give me a well equipped airframe; good, timely data; Night vision goggles; and night scheduling with scientific, physiologic considerations.

Upgrade
 

"If one thinks safety is expensive, try the price of an accident" (no idea who coined it).

I've been taught the total average cost of helicopter accidents is 10 times the obvious direct loss/es. Should make decisions easy about IFR ops, currency, etc.

It's in the math.

Having an IFR machine for EMS is an advantage for a few programs, not so much for others. It depends on how the program is run. If the program does almost all transfers, between large cities, then it can work. If the program is doing mostly scene flights, it makes no sense at all, because you simply cannot file IFR and do a 10 minute, or shorter, flight to a scene, and then to a hospital, under the present setup. Having an IFR aircraft just for the return home simply makes no economic sense. I think the pressure to fly any time for EMS has gone away, and the only pressure on the pilot is what he places on himself. Gethomeitis is as strong in EMS as in any other sector, I believe. I don't know how to eliminate that, or to insure good decision making all the time. Good judgment comes from learning from bad decisions, and if we're lucky we survive the bad decisions we make and learn from them. If we're not, the bad decisions kill us. Night flight requires more concentration and care, but people get sick and injured at night, and if we want to provide the care, we have to fly at night, or else just shut down all night operations and ignore the sick and maimed, as they seem to do across the pond. Helicopters are not raining from the night sky here. There are far more EMS helicopters flying in the US than there are helicopters in Europe, and an accident a year, or fewer, isn't that surprising. The US has decided, for better or for worse, that the benefits outweigh the costs, and night flights will continue. We just have to be very careful about conducting those flights. I don't think company policies or hospital pressure has much to do with it any longer, it's just a matter of making the pilots realize that they aren't lifesavers, they're just moneymakers for the companies. That's the hard part.

We are a SPIFR HEMS program and have been for the last 14+ years. Personally I have flown for 6+ years DPIFR on the NSea and the last 10+ yrs SPIFR HEMS USA.
SPIFR at night is far more comfortable than SPVFR at night. We recently went from a SPIFR EC145 to a SPVFR BK117, and not having the ability to go IFR if neccesary was a little nerve racking. However if one adjusts ones personal minima and behaves more conservatively then it can be done safely.
R H I am curious about your background. Do you have any SPIFR experience?

SPIFR vs SPVFR night, etc.
 

FAA have advocated for years that pilots get their instrument rating and keep it current, both fixed and rotary wing. Why operators are not interested in this, across the board, is obviously economic, but also somewhat naive.

Considering night EMS is certainly a bit hectic at times being IFR current provides a much safer option for those night flights that wind up involving unanticipated weather.

The big deal about taking an operation IFR is not how many IFR flights one makes for an EMS operator, it's the number of VFR flights that go on the basis of having the ability to bail out IFR if necessary. The straight forward IFR flights emerge as a matter of course.

Properly managed (i.e. dispatched, followed, supported in real time etc.) HEMS SPIFR should enable return on investment, greater safety, and greater completions for the sake of patients and business.

I think it's all a matter of time before SPIFR becomes a night requirement.

I think i would rather NVG became a night requirement, that may change though if ADS-B and WAAS delivers as promised. The infrastructure right now only really suits the airlines. The aircraft in question i think was an IFR ship, should we be more focused on NVG, it doesn't help in inadvertant IMC but wouldn't it make a bigger safety improvement for the buck.
I read that AM said NVG are in short supply because of the war and would have used them if they were readily available.

I heard NVGs were in short supply as well. ADS-B and WAAS (with LNAV/VNAV and LPV DA, etc.) are excellent as well (I'm very familiar with both), plus, airborne satellite communication to a reliable dispatch center.

The IFR option should be standard. Gives pilots a real chance excepting lines of T-storms and icing. As to airlines dominating the ATC system, that is true, but it is changing slowly with the advent of GPS low level routes; some in metropolitan areas, others in more remote regions.

When one uses the callsign LifeGuard here in the states the airlines get NO priority. Decades ago I came from the end of Long Island under LifeGuard status straight to 34th St. heliport in Manhattan (patient destined for the hospital across the street). ATC made holes all the way to include arrivals at JFK and departures from LaGuardia - needless to say this was a very serious patient. ATC made no bones about doing it.

I would also like NVGs, but they are in short supply. I doubt I'll see them before I retire. I also don't believe SPIFR will be required in the US in the foreseeable future. Too many politicians have been paid off, and will be in the future, although I doubt it's even necessary. This isn't a priority of any influential politician, there are too many other things biting them in the butt, and it would take Congressional action to bring it on. Ain't gonna happen any time soon.

"Cynic" :(

To maintain safe currency in the SPIFR environment in a machine like the ec135 what are the requirements imposed by HEMS companies. Im thinking about how many approaches (precisison/non precision, & transits etc)??

Beans:
Most companies play it by the book:i.e. the FARs. This typically involves a full IFR check ride every six months and to maintain currency, the pilots are required to do at least six approaches every six months ,track a VOR, etc.
All this keeps them current but does it keep them proficient? IMHO, helicopter pilots are very comfortable at 1000 agl. And since the use of the IFR system(aircraft equipment and ATC) is sporadic, there is a tendency to avoid IFR as far as possible.It is all about the comfort level of the pilot flying IFR.Our airline counterparts get into that mode right from day one. That is a cultural difference that will take time to eliminate. Meanwhile, a quick easy fix would be to mandate NVGs and TAWS for all VFR operations and if the helicopter is IFR capable then it should be mandated to fly IFR all the time. Which means, that if an IFR program is requested for a patient transfer, they should file and fly IFR irrespective of the weather.This will not eliminate crashes(after all ,the scene work is still going to be mainly VFR for the forseeable future) but it will go a long way in reducing the number of accidents which have that "continued VFR into IMC" sting in the tail.
Alt3.

alouette3

Good stuff.

I agree with you in respect to TAWS, and perhaps NVG. I also agree in principle reference full time IFR but in practice mandating HEMS IFR everywhere will not be taken lightly by the medical industry, or relatives of patients, considering the delay to patient care that provides.

As to SPIFR HEMS I look more to monthly mandatory simulated or actual IMC/IFR time with a training captain, desktop simulators or greater, etc. etc.

No doubt being a SPIFR EMS helicopter pilot is very serious business and more difficult than lining up with another fixed wing airline crewmember on 27L for yet again, another IFR sector.

There are macro issues concerning the interplay between management and pilots, medical crewmembers and pilots, etc. etc. but the bottom line is that if the pilot does not have the training and equipment to deal with what weather he/she gets dealt out in the flying environment the results can be dire.

IMHO the recent decrease in HEMS accidents has less to do with operational control and perceived dispatch interplay than it does to the vast increase in VFR minimums operators have adopted/been forced to adopt.

WIII

Alouette sums up the situation very well. If VFR night weather minimums were set to a safe level and NVG's were introduced into the system then we would see far fewer accidents at night. Perhaps WIII's statement confirms part of that when he talks of operators having to adopt higher weather minimums since the FAA changes have been implemented.

SASless

I agree.

Seems things are pointing towards the full package of SPIFR, TAWS, NVG, etc. as the answer; eventually.

Only fly in the ointment is the statistical fact single engine helicopters are seen to be no more dangerous than twins (although it appears that is a very general and broad crunch) therefore major operators are reequipping that way (particulary with Long Rangers and B2 A-Stars) - point being, who wants to fly a HEMS Single Engine SPIFR? I know early D-Model A-Stars had SAS and autopilot available but not sure what the possibilities are for that machine these days, or the extent to which it would impact available load.

Time will tell!

WIII

The one vice more engine debate re IFR/IMC does get confusing. Is it the redundancy the second engine (or more) brings by having a second generator or the ability to continue flight following a single engine failure which by definition single engine aircraft cannot do?

I am of the mindset the twin engine, fully IFR kitted aircraft, combined with training and experience both accumulated and recent to effectively continue flight in IMC conditions (whether intentional or inadvertent) is the answer.

Without the training and experience all of the fancy gadgets in the world will not prevent bad things from happening. The flip side of that coin is without sufficient equipment on the aircraft....no amount of experience and training will overcome that and then too bad things happen.

Add in the collateral issues of weather reporting, landing aids, communications, operation safety culture and all the rest have to be in place as well.

Therein lies the challenge to the HEMS industry....how to accomplish all that and do so in such a fashion as to remain economically viable.

Perhaps there is a compromise between the UK/EU models and the US models that ought to be considered. The US view of providing 24/7 service of equal capability might need modifying.

At least under the US FAA system there is the flexibility to be able to accomplish that as compared to the very highly restrictive UK/EU/JAR/EASA system.

I for one would much rather be in the USA when I have my life threatening experience and need emergency transport to a Trauma Center. If that need is at night......there is no comparison between the US system and the UK system that gives one comfort about the availibility of HEMS service at night if you are not in the USA.

Certainly the devil is in the collateral details which historically operators have been reluctant to delve in to.

I want nothing to do with SE SPIFR.

If one doesn't know how to use all the gadgets, and when to use them, etc. the best of equipment becomes a liability rather than an enhancement. Kinda like flying with a really dim copilot - negative synergy.

I'm not familiar with the UK HEMS system/s but worked eight years over there so know the lingo. From what I see US adoption of the JARS is a painfully slow thing, but we're getting there. I am reasonably fond of the UK way of doing things.

Ifr + Nvg
 

Hello folks,

If you really looking for safety in HEMS operation, all should have both of them. NVG without IFR knowledge and skills might cause problems also. Think, if you are in the middle of somewhere and you are loose your NVG expectedly. That's happen in real life occasionally. You might have inadvertment phenomenom and to fix this situation, you need to have some way out.

For my opinion; ME SP(or MP)IFR with NVG. No money, no funny.

Hostile:ok:

If we look at the majority of HEMS accidents, we see most of them happen at night in less than ideal weather conditions, and when returning from dropping off a patient.
People run into things they can't see in time to avoid.
Fitting a TAWS system with accuracy suitable for helicopter operations would help prevent that (it's been done in tour helicopters in Hawaii, and they're definitely VFR)
Making people fly dedicated routes with specific altitudes at night would also go a long way to reducing accidents.
And didn't the FAA just change the rules about what visibility requirements are at night??? What happened in this accident vis-a-vis those new rules?

The FAA changed the rules? When? What rules exactly? I haven't seen anything about it. Our ops specs haven't changed, and I've seen no changes to Part 135. What do you know that I don't?

Gom,

The "rules and regs" have not changed per se....but attention to them has. Also an OpSpec change has the effect of a rule change in that it sets forth specifications the operator must adhere to in its conduct of air operations.

The rule change being referred to is actually the increased oversight the FAA has mandated be done to ensure operators fully comply with existing FAR's and Op Spec's.

SASless et al

Essentially correct. It seems many operators are now using 800/2 & 1000/3 for day local and cross country, and higher than that at night for VFR HEMS.

The minimums pretty much beg IFR with airborne approach funtion to point in space and ADS-B to ATC, etc. It'll come in due time. The problem I see is this influx of single engine helicopters to HEMS here in the US. I can't see the industry going IFR with them.

To my mind there is not a lot of good macro thinking going on - mostly competitive thinking betwixt operators to see who can be cheaper than the other.

WIII

The stuff that kills people at night hasn't changed since I started flying and I suspect, since people started flying: Stupid decisions, the consequences of which are amplified by not being able to see to avoid and adapt as the flight progresses. The same accidents at the same comparison rate, were occurring when I flew in Vietnam.
The military has made huge progress in overcoming the issues, some of their proven solutions are adaptable to the civilian world. There are considerable differences to be considered in adopting those to the civilian world.
First, NVGs. The major difference between day and night operations is the ability to "see and avoid", weather, mountains, wires, antennae, whatever- Day ops can see "it", night ops can't, and "it" kills.
I would love to have a second engine, half my flying life has been in multis. They're not the answer, safety-wise, without huge SOP changes, training and pay cost increases. Maintaining and managing the systems also introduces issues, and those issues, if not successfully dealt with make multis more dangerous than singles.
I would love to have SPIFR capability. That's just me, because there's NO business rationale to make it cost effective in my area. And, NO!, we don't launch with an IFR recovery as a potential resolution to IMC. In my area it makes no patient care/business sense whatsoever. We land when the WX goes below comfortable VFR. Consider- I understand that this accident was an SPIFR aircraft, Air Method's last fatal was an SPIFR, and most of the CJ crashes just before their sale were SPIFR...
Some of the other military solutions that aren't really adaptable-
Two pilot crews. This is the single most effective safety enhancement possible. Almost none of the US fleet would support it, especially with the "health-care crisis" (read as: somebody else should pay for it) and the resulting plunge to the bottom as costs are cut, so-called "equality of care" is ensured, and responsibility is broadly distributed to everyone else, which means, of course- nobody is actually responsible. But, I digress...
"Go pills" and "no go pills". The military can use them, we can't. That's fine, there is a huge difference in our mission parameters.
Which leads, finally, my one-note song: scheduling for nights. Pretend that lack of sleep, circadian disruption, and general fatigue are adequately addressed by the "10 hour of uninterrupted rest" regulation and you get what we have- pilots operating at the minimum state of alertness making the most challenging decisions of the job- Night ops.

Devil49:
Great post.
The mystery of SPIFR capable helicopters crashing in IFR conditions would have to be solved by the human factors folks.There is an obvious gap that needs to be plugged there and needs involvement of the regulators ,operators and the pilots.
As to the night scheduling issue:could'nt agree with you more. The Part 121 ands 135 regs of the FAA are probably the most liberal in the world. Consider this: in a 90 day period a part 135 opearator can schedule me for 77 days of work with 8 hours of flying everyday and still be legal. Nobody does it ,but, they can. Most other countries have duty time regulations that are a lot more pilot friendly. Some have clauses about extra rest periods for flights originating or terminating after midnight.We need to look at that closely.
There are EMS bases around the US where it is not unusual for pilots to work 7 straight nights in a row and fly every night of the shift. I don't buy the fact that on the last night, at O dark thirty ,the pilot is not tired.While most companies talk the talk about take -yourself-off-the-shift-if-you-are-tired stuff, try doing that a couple of times and see what happens.The first guys to give you grief will be your fellow pilots.
The "tombstone imperative " forced the FAA to regulate duty time for HEMS operators. Maybe they need to look at the issue once again. Especially since, as Shawn rightly pointed out, most accidents happen at night.
Thoughts?
Alt3.

Company's responsibility,
 

Good posts devil49, alouette3 and sasless,

I went through all these problems as a post holder in Europe past 5 years. It wasn't easy time for the company's, post holders, pilot's , CAA (JAA) or even financiers. Some times it went too far, but it will found its gold happy medium with a good result. How to interpret the new meaning of regulations was the main problem.

We all wanted to fly as safe as possible. CFIT caused by bad weather is the case I don't want to see anytime or any reason. The most difficult maneuver with HEMS helicopter is 180 degrees turn back! This is the case what all must accept without any accusation. Companies should have policy to give all support for pilot(s) in this situation.

If you think this is gonna be expensive, try accident.

Hostile:ok:

IMO flying 7 straight nights and flying every night is safer than flying 3 days and then 3 nights, or vice versa. I find it far easier to fly nights if I stay on nights, and let my body adjust to that. I spent a number of years flying nights full time, and I far prefer that to rotating between days and nights. Constantly changing one's circadian rhythm is tiring and in the long run, dangerous in several ways.