Article about EMS dangers

[Jason Paterson]

Thought I would post this link if no one has noticed it yet. Very long article about the dangers of EMS flying. I would really like to hear what real pilots think about the article.

 

http://www.washingtonpost.com/wp-dyn/conte...9082004500.html

[Gomer Pylot]

Like most newspaper articles, it's somewhat sensationalized, and written by reporters who know nothing about what they're reporting on. Overall, though, it's pretty much the way things are. The current system is the direct result of capitalism. This is what you get when profits for private companies are the only things that matter. That won't change anytime soon.

 

I'm sure there are managers like the one mentioned, who care only about their own salaries and bonuses, and push pilots to fly no matter what. I've seen those in the Gulf of Mexico, but in my current job, I get no pressure to fly, and the local managers have no authority to pressure us.

 

The NVG situation is pretty much on the money. The holdup is the FAA, through very slow approvals. We have plenty of goggles onhand, but the FAA will only approve a base or two per month. It's somewhat frustrating, but there is nothing that can be done. FAA funding has been severely cut during the past 8 years, in order to make the overall federal budget look better. It takes time to get them back to speed. Overall federal regulation of everything has been put on the back burner, to understate things. Over the past several months, though, the FAA has been showing up at our bases almost daily.

[West Coaster]

I'm sure there are managers like the one mentioned, who care only about their own salaries and bonuses, and push pilots to fly no matter what. I've seen those in the Gulf of Mexico, but in my current job, I get no pressure to fly, and the local managers have no authority to pressure us.

 

Ditto for Canada, we are not pressured to fly in bad weather but in our company at least we do EMS a little differently. For night flights we have very strict routes to follow that link all our hospitals and airports one way or another. These routes (both inland and offshore) are build just like IFR routes with all the same terrain clearances.

 

If the weather is too cold to go IFR we refer to these VFR night routes. If the ceiling along the route is forecast or reported to be below legal limits for night VFR then it's a easy "No" to the dispatchers. Our managers never question a turned down call as it's a no brainer. If a dispatcher questions us or tried to pressure us in any way, a quick call to their supervisor solves the problem fast.

 

Not sure if there are similar types of company night ops for HEMS in the USA, but it works like a charm for us. Some night routes we can do at 1100' while others take us over 7000' to clear the mountains. They may add a little time to the length of a trip instead of going direct from A to B, but it's kept us safe and sound with 95% of our calls being serviced.

 

Keep safe out there gang!

[Gomer Pylot]

Set routes don't work for us. We do probably 75% scene flights, and we never know where the scene will be. I fly in relatively flat terrain, and so we don't have to worry too much about clearing mountains or ridges. That's not the case everywhere, of course.

[West Coaster]

Wanna swap Gomer? I think we're the other way around... maybe 25% scene calls and the vast majority are transfers lol. God I hate transfers. Did one today, spend about 1 hour in the air and 3 hours sitting around at a nearby airport with my thumb up my butt waiting.

 

Soooo boring

[delorean]

The original article (the first day) wasn't that bad. In fact, I'd say it was right on when it comes to the FAA & NTSB.

 

But the second and third day was just "drama queen" stuff. They concentrated the articles on the victims hobbies, families, and what they ate for breakfast versus talking about the accident itself or aftermath. For instance, the 206L in Indiana, "came apart in mid-air, losing its main rotor blade and exploding in flames." One more sentence, maybe? The blade was installed new from Bell and the NTSB found a manufacturer's defect. They made it sound like since this was an EMS helicopter, she was doomed. That blade could have been installed on any LongRanger in any industry and the same would have happened.

 

Same deal with the other case studies (all wx accidents.) Not that they should try to take anything away from the victims and their families, but they could have mentioned that all of those flights below company & FAA minimums........some knew this before they lifted, they just didn't encounter it in flight. They could have mentioned that it takes, "Three to say 'go', one to say 'no'."

 

No where in that article was the phrase "pilot error," which we all know was the cause of almost every HEMS accident except for the MR blade one.

 

They just painted the whole industry as dangerous......like you're playing "Russian Roulette" if you take a job in HEMS because of all theese risks and dangers combined. They should have interviewed some current crews to get an idea of the risk/dangers and how they completely avoid and manage them.

[Gomer Pylot]

No, West Coaster, I'll stay down here. I'm also not that thrilled with transfers, and I'll take scene flights any time. The med crews feel the same way. You just have to be very, very careful on the approach and departure, because there are always things down there trying to kill you.

[West Coaster]

You said it man. If it's not the terrain, obstacles or other aircraft it's the EMS ground crews trying to help but end up trying to kill you by accident.

 

Lost count of the number of times we've landed a mile or so away and caught flak from a fire chief or ambulance driver for not using their lovely little LZ they marked with flares or cones. We walk them to the LZ and admire it, then point their eyes straight up and what do you know.... enough wires to tight-rope walk across an 8 lane freeway! Not cool.

[Wally]

Respectfully disagree, West Coaster. Nobody kills pilots as well as pilots do. There's nothing new in the EMS accident pattern- mostly pilot error and most often at night.

That said, the situation and the system take advantage of an essential ingredient in our success- WE GET IT DONE, whatever "IT" is. If you're professional in this field, you've proven that you can overcome considerable challenges, and you did it to get that next flight. We're all here to fly, we have a fair amount of self confidence, so the biggest management challenge isn't getting us to go- it's keeping us under control. That's why the rule-makers set minimums.

Fortunately, pilots in general are used to adhering to rules, we even have code-names and phrases to define what's happening when we're not: "Watch this" is accepted as the cliche introduction to disaster; and if we're walking close to the edge, rationally, it won't be based on the statements like "I've done this before", or "it takes experience to do 'X'"- that's also an accepted cliche for "hot dog", "cowboy" a/k/a "dead man walking".

No, if we rationally push the envelope, we've done the numbers, considered the options, and made a plan. That's when we say things like "the weather's closing behind me"...

The real issue for EMS nights is that we're not rationally making mistakes.

The system and the situation allow all these factors to work against us- night, unaided, with minimal consideration with for the transition to a night duty schedule; that's complicated by the accepted pattern of long duty schedules. Not doubting anybody's ability, but seven consecutive 12 hour days may be convenient and the norm, but I doubt it's a scientifically preferred schedule. Fourteen hour days, the regulatory max, is a safety myth.

Add an unscientific switch to a night schedule- IFR/VFR, single or twin- and you get what EMS has: a convenient schedule that kills 4 times as often at night as in the day.

I've seen this pattern since Vietnam, it isn't new. I can't count the number of times I've been offered a night shift THAT night, NO preparation and management WANTS me in the seat, or worse- had my relief show up for nights already claiming fatigue.

NVGs level the risk peak a little (look at the military experience) but they're expensive for the operators and novel to the regulator, they're tectonic in deployment time reference.

 

There's an old joke about a drunk looking for lost car keys in a bar parking lot. If you're telling the joke, you offered to help find the lost keys, search for a while and ask if the drunk has any idea where he dropped them?

"Over there, in that dark corner"

"Why are you looking here?"

"The light's better here."

It's a great analogy for the EMS night safety issue:

We- the pilots- picked the position we're in and essentially prefer it this way, but we're the drunks.;

The operators sell us the cheap booze to make a profit, pretending that they're not responsible;

The FAA helps everybody out by looking where the problem isn't.

 

To quote Walt Kelley's 'Pogo' "We have met the enemy, and he is us." But, we have lots of help.

Edited August 25, 2009 by Wally

[Gomer Pylot]

I've long believed that a more rational schedule is 12 to 12. Both pilots get a chance at some day and night time, and the time change isn't so drastic. I don't find that many people agree with me, though.

 

I never trust the ground units to find all the wires, but I would never accuse them of trying to kill me. I know they do the best they can to find obstacles, but I also know they aren't perfect, and I'm the one who will pay most of the price. I'm cautious, but I never give the ground guys a hard time. Down here, they're all amateur, volunteers, and they do the best they can with what they have.

[West Coaster]

Don't think I'd actually accuse anyone of trying to kill me, mistakes are made by the best of us (and I don't pretend to be the best). Wasn't trying to pass the buck, just illustrate that nothing is ever what it seems in aviation not just the HEMS side of it. Though I have once had a fire chief scream at me for not landing in his ring of flares that he set under wires lol.

 

We've been pushing for formal training for police, paramedic and fire crews on how to set up a proper LZ for years. But with so many jurisdictions and service areas it's impossible.

 

Agreed that the shifts could use some fair tweaking too. I've always wondered about doing a month of just nights, then a month of just days and so on. Your circadian rhythm would be able to get used to things maybe?

 

I'm lucky in not having a large family at home though... just the wife. At least I can come home and sleep till 5pm if I was out all night long. Some guys/gals go home to numerous kids needing breakfast and school lunch made, drive kids to school, go shopping, take cat to vet, bla bla bla. Have to say I'm glad we're 2-crew with our HEMS. Saved our butts more than once having another brain and eyes watching things at 4am on night number six. (not trying to start that argument though)

[delorean]

I've long believed that a more rational schedule is 12 to 12. Both pilots get a chance at some day and night time, and the time change isn't so drastic. I don't find that many people agree with me, though.

 

I never trust the ground units to find all the wires, but I would never accuse them of trying to kill me. I know they do the best they can to find obstacles, but I also know they aren't perfect, and I'm the one who will pay most of the price. I'm cautious, but I never give the ground guys a hard time. Down here, they're all amateur, volunteers, and they do the best they can with what they have.

 

Man, I would quit in a heartbeat with a 12 to 12 schedule. That would suck! You're either starting your shift or driving home in the middle of the night. We switch out on the 7s like most everyone else. 6 to 6 wouldn't be so bad, but 5 is too early and 8 is too late. I always wanted to do a shift where the day guy worked 11 hrs, night guy 13 (that would work at our base since we have really short flights, most of which are during the day.)

 

We do a split shift. Two guys work 3 days, 4 nights; the other two, 4 days, then 3 nights. You have 24 hrs off in the middle, when the other guy comes back on hitch. Out of towners hate this schedule, but if you're local, it's great.

[Gomer Pylot]

I would quit in a heartbeat if I were given that schedule. Switching in the middle like that is insane. There is no way in hades the night guy on the second half is going to be alert at 3AM. I know that most people don't like 12 to 12, but it makes sense to me. Driving home or to work in the middle of the night beats flying a few hours later with no sleep.

 

I flew straight nights for several years, and it's not bad - you get used to it, and your circadian rhythm stabilizes well enough, or at least mine did. Doing it a month or two at a time makes sense to me, and I would prefer it, but it's not a popular option, just as 12 to 12 isn't.

[Wally]

Splitting in the middle is probably the most common 7-day arrangement. I don't know how much of EMS night accidents are on that schedule and I'd be very interested to see a breakout...

But other than fitting the conventional calendar, it has nothing to recommend it. As pointed out, you have minimal time to make a major physiological adjustment and are attempting that from a less than optimum situation- slap black to white, and conceivably carrying a fatigue load from days.

I've worked both sides of the split, 3/4 & 4/3, and by the time I'm accommodating the time change, I'm off nights switching back to days. If- and that's a big "IF"- I'm making or have made the circadian shift by the 4th duty night, that means that 1 night out of 7 we have a pilot who's nearly fully competent. If you don't know what I'm talking about, you're either a member of the 5% of the population that can make that kind of major time shift without issues, or you've been very lucky in your ignorance.

 

Yes, I've thought about quitting. I'm trying to educate my colleagues and make a rational schedule, but we all have to agree before we can do that. Change is hard. The inertia of "the way we've always done things" and having to actually adjust one's schedule by something other than the day of the week are apparently considerable challenges... That's why we 'look for our keys where the light's better'. In the meantime, I attempt to self evaluate intellectual status, and that means I turn sometimes down flights that are otherwise doable.

Edited August 28, 2009 by Wally

[West Coaster]

I'd be interested in hearing about the accommodations different companies set up for their ambulance pilots too.

 

Our company has both rotary and Lear jet ambulances but the fixed wing guys are a few hangars down at an FBO. Our crew rooms are at our company HQ. One crew's rooms are just behind the hangar behind the building and fairly quiet. The other rooms are 12 feet away from our dispatch office which really...... really sucks. Our company also operates a helicopter airline service so those guys check in for duty at around 530'ish along with dispatch. So every frigging morning like clockwork people are stomping up and down the hallways talking, laughing and hollering down hallways to each other. Doesn't matter how many times I freak out on them because I just landed and got to bed 30 minutes ago after being out all night. It's the same every morning. There's a small handful that whisper and keep it under control but for the most part because were out of sight we're also out of mind.

 

That's how I woke up this morning after a lovely 4 hours of sleep, and that's most likely how I'll wake up tomorrow. Grrrr. Off to bed now to waste the remainder of a sunny day in the sack getting some real sleep.

[Gomer Pylot]

That sort of arrangement is only giving lip service to the regulations. Having the crew sleep at the hangar or the base is a poor solution. We have an apartment away from the base, and I think that's the only feasible way to do it. Our base is actually pretty quiet - in a cow pasture all by itself, although there is road noise from the nearby interstate highway. I still don't want to sleep in the hangar, though. 7 days or nights there is just too much, and it's often up to 12. If the company can't afford a cheap apartment or something similar nearby, then the program is in serious trouble.

 

If I work nights, I spend the day, sunny or not, getting some real sleep in any case. Otherwise I'm dangerous during the night. It's bad enough to risk killing myself, worse to risk the med crew, but at least they're getting paid to do the job. The patient I may kill isn't being paid, in fact is paying a huge amount of money to ride, and endangering him/her by flying while fatigued is simply criminal.

Edited August 28, 2009 by Gomer Pylot

[delorean]

I've worked both sides of the split, 3/4 & 4/3, and by the time I'm accommodating the time change, I'm off nights switching back to days. If- and that's a big "IF"- I'm making or have made the circadian shift by the 4th duty night, that means that 1 night out of 7 we have a pilot who's nearly fully competent. If you don't know what I'm talking about, you're either a member of the 5% of the population that can make that kind of major time shift without issues, or you've been very lucky in your ignorance.

 

Circadian shift? That's exactly we're trying to avoid! You guys that are trying to switch your bodies from days to night, nights to days (especially those on the 4on/4off routines) are screwing up you systems something terrible. I know several pilots [attempt] to cat nap all day, then pound coffee to stay up all night--they're 40-something and look 60-something. There is no reason not to sleep on shift--unless you're flying.

 

I sleep when I'm tired, and stay awake when I'm not. Day or night shift, I'm in bed within 1-2 hrs of shift change. Daytime, I'll sleep 3-4 hrs until noon; nights, until 6am. If we fly in the middle, no big deal, I got a "nap", I'm rested, and I can go the remainder of the night if need be.

 

I don't force myself to sleep in preparation for a shift. I tried that.....it doesn't work for me. On the first night I can fly all night no problem, then I catch up on sleep the next day which sets me up for that night.

 

Like I said, we do short flights--average of 0.8 roundtrip, 95% scenes, and back to base within 2-3 hrs total. And we do that once or twice out of my 4 nights. If I was at a busy base with longer flights, I might [have to] alter my sleep schedule. But for over 6 years, this schedule has worked for me. I've worked 30 day shifts in a row, 28 night shifts in a row, and a 2-month rotation of 5 days, 5 nights, a 48 hr HEMS, then 2 days off......that sleep pattern still worked for me.

 

The way it works for me, if I didn't get 8 hrs sleep in a 24 hr window, I need to get that missing amount in the next 12 hrs plus 1-2 to "catch up". I would still go to bed at the same time later that night. And I need to go at 45 min to 75 min in a row for it to count as an hour.

 

Just because you haven't tried this, or your body doesn't work the same as mine, do not accuse me of cheating death and being ignorant. All 15 bases in this metro area, including the competitors, are on this schedule--no accidents. Switch it to 12 to 12, let CAMTS take away our beds, and there will be mishaps........of course, that's if you have any pilots left.

[Wally]

Delorean-

Yes, there are people who can do it that way. Perhaps you're lucky enough to be one of the 5% who aren't ever bothered by jet lag. For the rest of us, it's a different story. For the rest of us, jet lag is not only cliche, it's scientific fact, and our body wants to sleep at 3 am. It starts throttling back in preparation for that, and no matter what we do, our metabolism bottoms out at 3 am. The next daylight period, being diurnal animals adjusted to an approximate 24 hour clock, we metabolically peak, whether we're trying to sleep or not.

Edited August 29, 2009 by Wally

[Gomer Pylot]

The only way I've found to be competently alert at 3AM is to change my circadian rhythm. It can be done, and I do it all the time, but it's hard, and it's hard on the body. I've been flying in the dark since the time of the Southeast Asian unpleasantness, and did it for years in the Gulf of Mexico. If you move from the US to someplace halfway around the world and stay for some time, your clock will change, and you'll adjust to the time zone there. You can do the same without moving, but you have to work at it. If you don't, you'll find yourself in a bad situation early some morning, and people's lives will be in the balance. That's a guarantee.