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Oklahoma City EMS crash. Where is the industry headed?


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RIP to those involved.

 

http://www.cbsnews.com/8301-201_162-57570693/deadly-medical-helicopter-crash-in-oklahoma-city/

 

With the EMS industry having an "unacceptable" safety record and this year apparently shaping up to rival 2008, where do you think medevac is headed?

 

More hours? Better equipped? Will EMS disappear?

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I'm not a EMS pilot, but I don't see more hours or better equipment as the future. I hear they are having a hard enough time filling with their current minimums and money is not there for better equipment.

 

I don't think much will change. Law enforcement also supplying EMS transport could become more common like in Europe. Unfortunately money will drive this change (not safety).

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It depends what you mean by "unacceptable safety record." What is "unacceptable" (to you?) seems perfectly acceptable to the FAA and the hospitals that own and contract with these helicopters. If not they would not exist. There are those who believe that a certain number of accidents is inevitable, no matter how much we preach and stomp our feet and insist that a zero-accident-rate is achievable.

 

Which it isn't.

 

And hasn't been since the dawn of aviation.

 

But it begs the question: What would an "acceptable" safety record be? No accidents at all? Okay, don't fly nuthin. Then there'll be no aircraft accidents.

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It depends what you mean by "unacceptable safety record." What is "unacceptable" (to you?) seems perfectly acceptable to the FAA and the hospitals that own and contract with these helicopters. If not they would not exist. There are those who believe that a certain number of accidents is inevitable, no matter how much we preach and stomp our feet and insist that a zero-accident-rate is achievable.

 

Which it isn't.

 

And hasn't been since the dawn of aviation.

 

But it begs the question: What would an "acceptable" safety record be? No accidents at all? Okay, don't fly nuthin. Then there'll be no aircraft accidents.

 

I'll try to find the quote. I think its coming from the FAA actually. I just remember seeing it emphasized several times in recent articles and editorials.

 

I wonder if one of these accidents will be the tipping point much like the Colgan crash in Buffalo for something major to happen.

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As I see it, there are far too many folks in this business who believe they understand the problem. The reality is; these events will continue to occur as long as we continue with the status-quo. The status-quo being; there are way too many suits driving the bus. Shoot, a few years ago the (supposed) brightest minds of the industry, along with the alphabet soup of government organizations came together to come up with a direction and/or solution. Unfortunately, where do we find ourselves now? Less than zero I’d say…..

 

With that, do I have a solution? You bet and, it’s quite simple. However, I’d sound just like everyone else if I presented it. That is, if everyone in the room is a freaking expert, then who will listen to little ole me? The answer is no one. No one with any juice anyway. I’m just a pilot just like the rest of us. A nobody, and that’s the tragedy...

 

The Holy Grail of solutions is doable with the right people, in the right places. However, no one is listening……….

Edited by Spike
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Darkness figures in a disproportionate share of US EMS accidents. It leads to the full spectrum of accidents. My opinion, the underlying issue isn't pure lack of illumination, it's a predictable result of the lack of scientific consideration of human physiology as affected by the flip day to nights. Equipment- NVGs, 2 engines, real IFR capability, etc.,- address specific risks but create hazard as well. No amount of alphabet soup (IMSAFE) spreadsheet "risk assessment, or "eye in the sky" op con will make a pilot that's stupid because of lack of sleep, poor sleep, and circadian disruption more effective in the cockpit. This job is 99% judgment.

Edited by Wally
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And add to that sleep stupidity the all-too-common attitude of "we have to be heros and get there and help the sick and injured", and it gets even more dangerous. This is not a job for heros, or even those who really want to help the sick and injured. It's a Part 135 transport job, pure and simple. The same criteria should be used for accepting flights should be used as for a tour flight, or a flight out to an oil rig. But helicopter pilots, even more than airplane pilots, want to get the job done, and too often try to get a flight done when it shouldn't even be considered. That happens even when the passengers are just suits, or rock stars, or anyone else. We are, to use a military phrase, 'mission-oriented', even when we shouldn't be, and press on when we should be sitting on the ground. The pressure from the med crews can be intense if we let it, although that is certainly highly variable, meaning some crews don't want to fly at all and will try to avoid a flight even if all the factors are perfect, while others want to go no matter what. Like Wally said, judgement is required, and that's what I think I get paid for, not flying. I get paid for using my judgement, and sometimes that requires flying, but it's just a freebie side-effect.

 

I still don't understand the reasons companies use rotating schedules, especially within the same hitch. That's just insane. We fly the same schedule for an entire hitch, but still rotate from hitch to hitch. That makes little sense to me, other than trying to keep everyone night current. I would happily fly nights full time, or days full time, to keep the same schedule. Unlike most of the pilots I know, though, I don't run around all day and then expect to sleep at night, when I'm working nights. I change my schedule, and sleep during the day. I don't ever plan on doing anything while I'm on hitch except work and sleep, and I seldom do anything else. I may nap during the night, as I do during the day, but I don't really go to bed. Sleep inertia is just too dangerous, and it's unavoidable if you wake up from sound sleep suddenly, and have to do something requiring mental alertness, like flying. IMO, the most effective way to prevent night accidents is to use full-time night pilots, who work nights all the time. The main problem with this, of course, is finding enough pilots willing to do that.

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Darkness figures in a disproportionate share of US EMS accidents. It leads to the full spectrum of accidents. My opinion, the underlying issue isn't pure lack of illumination, it's a predictable result of the lack of scientific consideration of human physiology as affected by the flip day to nights. Equipment- NVGs, 2 engines, real IFR capability, etc.,- address specific risks but create hazard as well. No amount of alphabet soup (IMSAFE) spreadsheet "risk assessment, or "eye in the sky" op con will make a pilot that's stupid because of lack of sleep, poor sleep, and circadian disruption more effective in the cockpit. This job is 99% judgment.

 

And add to that sleep stupidity the all-too-common attitude of "we have to be heros and get there and help the sick and injured", and it gets even more dangerous. This is not a job for heros, or even those who really want to help the sick and injured. It's a Part 135 transport job, pure and simple. The same criteria should be used for accepting flights should be used as for a tour flight, or a flight out to an oil rig. But helicopter pilots, even more than airplane pilots, want to get the job done, and too often try to get a flight done when it shouldn't even be considered. That happens even when the passengers are just suits, or rock stars, or anyone else. We are, to use a military phrase, 'mission-oriented', even when we shouldn't be, and press on when we should be sitting on the ground. The pressure from the med crews can be intense if we let it, although that is certainly highly variable, meaning some crews don't want to fly at all and will try to avoid a flight even if all the factors are perfect, while others want to go no matter what. Like Wally said, judgement is required, and that's what I think I get paid for, not flying. I get paid for using my judgement, and sometimes that requires flying, but it's just a freebie side-effect.

 

I still don't understand the reasons companies use rotating schedules, especially within the same hitch. That's just insane. We fly the same schedule for an entire hitch, but still rotate from hitch to hitch. That makes little sense to me, other than trying to keep everyone night current. I would happily fly nights full time, or days full time, to keep the same schedule. Unlike most of the pilots I know, though, I don't run around all day and then expect to sleep at night, when I'm working nights. I change my schedule, and sleep during the day. I don't ever plan on doing anything while I'm on hitch except work and sleep, and I seldom do anything else. I may nap during the night, as I do during the day, but I don't really go to bed. Sleep inertia is just too dangerous, and it's unavoidable if you wake up from sound sleep suddenly, and have to do something requiring mental alertness, like flying. IMO, the most effective way to prevent night accidents is to use full-time night pilots, who work nights all the time. The main problem with this, of course, is finding enough pilots willing to do that.

 

Well said X2.

 

Combine these sentiments with minimal training, lack of proficiency and marginal equipment; we then have a recipe for disaster. Read; highly predictable. Tragically, this is the long standing state of this industry.

 

The answers are simple but they must come from guys with “boots on the ground” who have context and tacit knowledge of the reality of the situation (situational awareness). Not from a suit with a PowerPoint presentation…..

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the most effective way to prevent night accidents is to use full-time night pilots, who work nights all the time. The main problem with this, of course, is finding enough pilots willing to do that.

 

I'd love to have a night flying job (I'm up to just over 300 night hours now) thing is, I have neither the total time nor the desire to fly EMS! Gotta love irony!

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I would take a straight night shift schedule in preference to this insane mid-shift swap. It's proven that not everybody can do so, for various reasons. That begs the issue, in my view, by applying a faulty scheme to all in order to accommodate the few. Not everybody can be an EMS pilot, period. Sorry.

 

Anybody seen suggestions of what might have initiated this event? What manner of inflight emergency made it imperative to land immediately?

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I dunno, Wally, but looking at those nearly-pristine rotor blades sitting there all undamaged like that is pretty disturbing. That impact must have been HARD.

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The NTSB lead investigator briefing of the media mentioned an eyewitness who observed a "flash" immediately before the helicopter descent. The witness was apparently interested and informed enough to head for the area speculated as landing site and participated in the rescue of the single survivor. Flash, as in strobe? Totally unrelated coincidental reflection on the witness car window? "Flash" reported by witness acknowledged by NTSB.

Edited by Wally
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I still don't understand the reasons companies use rotating schedules, especially within the same hitch. That's just insane. We fly the same schedule for an entire hitch, but still rotate from hitch to hitch. That makes little sense to me, other than trying to keep everyone night current. I would happily fly nights full time, or days full time, to keep the same schedule.

 

The mid shift switch is not "insane"..........I've been working one for 9 years now and wouldn't have it any other way. Our base and the six other bases (including the competition) all work it. We all live locally, no one is sleeping at the base for a week.

 

I love it. I work Fri-Sat-Sun days. I get off Sunday night at 1900 and don't come back in until Monday night until 1900......four nights and I'm done. NONE of us alter our sleep schedules. We sleep when we're tired during the day, and sleep every night.

 

Early on, I tried to force myself to sleep during the day, then stay up until after midnight, but I just screwed my system up. I just do my normal thing during the day, then come into work at night. I go to sleep around 10pm and get up at 7am. The phone will ring several times over night, or we may fly. No big deal. If I need nap the next day, I take it.

 

Just because it doesn't work for your system, don't knock it. If our operator outlawed it like you suggest, it would screw all of us that it works just fine for.

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With the EMS industry having an "unacceptable" safety record and this year apparently shaping up to rival 2008, where do you think medevac is headed?

 

More hours? Better equipped? Will EMS disappear?

 

EMS won't disappear.

"Equipment" isn't the answer.

I suspect that the high point of new EMS pilot experience is past, so "hours" aren't (and haven't been) the answer. The accident/incident pilots have been all over the map in experience. One possible exception- those with only a few years in this industry seem to be over represented. Perhaps this is proportionate.

Operators are trying to find the silver bullet: checklists for checklists for checklists; operational control centers; flight releases; numeric risk assessment; SMS; do-dah, do-dah day. As long as the cost is reasonable, or better yet, free.

It's going to be a very close race, between the operators and the FAA writing a separate Part for HEMS. Someone else will be filling my seat by then...

 

First and foremost issue: HEMS night ops have double the accident rate of day ops. The rule seems to hold for all levels of equipment. My experience, going back to Viet Nam, is that that accident proportion held for aviation operations then. Night flying is a little different if you're a diurnal animal (humans are but NVGs help enormously), if you are well trained, and if you are mentally 100% up to the challenge. If the pilot pool as a whole trends towards being physiologically compromised in any particular phase of operation, one would expect to see an increased accident rate in that phase. I rest my case.

 

Unfortunately, I don't see regulatory oversight ever addressing another crucial issue- training. The industry is weak when it comes to training aviators to the challenges specific to the job. Regulations seem to set a target for minimal compliance. A commercial level of performance and knowledge isn't adequate nor is 135 rules on operations. Sample issue- almost all HEMS ops are 3-legged: leg to the patient; transport leg; and RTB, all at some indefinite unpredictable point in the duty period, to any part of the service area.

Now, tones and a flight request:

Where the heck is that?

What's your W&B range, you don't know what the next patient weighs...?

Fuel and refueling?

Weather requirements and for what period?

And finally, duty restrictions.

You have 5 minutes, no pressure. No, I don't have company pressure to launch hastily. I do know the requesting agencies track it, nothing the company can do about that...

Ever had a training session in how to do that job? It seems that I learn the aircraft limitations, weather minimums, and get some hood time. Nothing to teach a nugget how not to need any of that knowledge

Edited by Wally
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No amount of alphabet soup (IMSAFE) spreadsheet "risk assessment, or "eye in the sky" op con will make a pilot that's stupid because of lack of sleep, poor sleep, and circadian disruption more effective in the cockpit. This job is 99% judgment.

 

I don't get this statement. Risk assessments when done properly highlight the latter issues you point out.

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Yeah HEMS isn't going away. With roughly 2 % of flights resulting in a life saved over ground ambulance, we're here to stay. You could say a few crashes per year is unacceptable but that 2 % saved is over hundreds of lives each year. Hundreds of lives for a few crews??? Last year there were 9 ground ambulance EMS personnel killed in crashes. Accidents happen.

 

Now you could say but if we just equipped the entire HEMS fleet with all twin engine, IFR, dual piloted aircraft you'd drastically reduce accidents. We've beat this to death already. Unless the govt suplements us, no company can afford to equip their entire fleet like that. Plus, I really don't think the reduction in accidents will be all that much.

 

I believe we are at a point where the accident record is going to start a marked improvement. Aircraft today are better equipped than ten years ago. Most operators are full up NVG. Most operators have stringent hiring practices and do quarterly training. Still, with all the improvements it's a demanding field. It's common sense by the EMS nature that we would have a higher accident record compared to other 135 operators. How many other jobs are you awaken in the middle of the night, have 30 secs to make a weather decision, have no route on a map, asked to land on a road, then transport a patient to a hospital you may have never gone to before? There are opportunities there to screw up. It's not like flying a fixedwing from an 8,000 ft runway to another 8,000 ft runway with a couple of hours of planning before hand. Our accident rate is going to be higher than other segments. The job is dangerous but I believe the risk is at an acceptable level and the demand warrants the additional risk.

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I don't get this statement. Risk assessments when done properly highlight the latter issues you point out.

 

I don't see a numeric weighting and totaling adding to the evaluation of risk in an operational situation. Follow the rule of most conservative response- if I have to spend a lot of time planning a flight and expect that everything has to line up exactly to complete it, I probably shouldn't go.

"When in doubt, chicken out".

 

Everything on a risk assessment matrix is potentially a no-go issue and everything on it could also possibly be safely operated with. If that is so, then the resulting calculation is meaningless.

"Temp/dewpoint within 2° F" for instance, in context, might be a non-issue or might a very hazardous factor. Time of day, weather trends, escape options, etc. need to be considered. Never seen a RAM that applied.

If every item is a potential no-go, assigning a numeric value that allows operation tends to minimize an issue. One would rationally object to a practice that commonly prevented rational acts, at some point that practice would be routinely ignored. So, my RAM value is 39 (medium) instead of 19 (low) which means what, exactly? This operation is twice is twice as hazardous? I ain't goin... Do that enough, and the risk assessment becomes an excuse to do nothing, if you're so inclined, or will be ignored by somebody motivated. You have reversed the intended result.

The point of using judgement is to apply an accurate appraisal of ability against possible outcomes and determine the best course. 19, 39, 59 have nothing to do with existing capabilities at that point.

Risk assessment matrices are good training exercises. Pushups are an effective training exercise. If I had to do 50 pushups before every flight...

Edited by Wally
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In short, Wally is spot on and I agree. Training is lacking. We spend a lot of what little training time doing off airport work. That which we do every day we fly. That time would be better spent on emergency procedures to include full down auto rotations, IIMC and IFR work. The IFR training should also be for the VFR guys. I know they already are required to do IIMC training but when I did mine with a previous company it didn't amount to much. Plus, we only set up the approach and didn't even fly beyond the FAF inbound before moving on to something else.

 

Someone said that the accident rate is going to improve due to having NVGs and that many operators are doing quarterly training. I not so sure I agree. Neither EMS company I have or do work for does quarterly flight training, I have been saying we need that in the industry for years though. A number of accidents involved pilots that were NVGS equipped. NVGs have been around for years. Many companies have been fully outfitted sine 2007/2008.

 

My opinion, it comes down to training. Not just any training but proper training.

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My opinion, it comes down to training. Not just any training but proper training.

 

Agreed. I personally think that the value of a risk assessment doesn't lay in the assigning of numeric codes to determine a hazard level and then make a decision off of that. I think the value lays in actually thinking before you take off about what you are going to do while in an objective area before you actually have to make that decision. It probably isn't as important for senior pilots but for junior pilots it can be a great tool. Again, EMS isn't exactly a new guy's profession either. I understand it may not apply to you as much, but I think there is some value in it.

 

Every pilot will develop their own comfort level and base decisions off of that. For EMS (speaking outside of my profession here...correct me if I am wrong) Has anyone ever thought about equipping ground emergency personnel with the ability to assess the environment for helo inserts and extracts? I.e. landing zone size, terrain, location of accident relative to landing zone, wind effect, obstacles, light levels, things that can build crew SA before the crew gets into the area, or things as simple as pictures and/or recordings? How much does an EMS crew help develop this picture? and what's the typical scenario from getting the notification to launch time? or is this strictly a proficiency issue?

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