Monday, September 4, 2017

Historic Perspective - The University of Iowa and AirCare

AirCare was the 11th EMS helicopter program in the country and has flown more than 30,000 patients over 3,000,000 miles. We are proud to be a part of the regional EMS system as we work very closely with area first responders, police, fire, and ambulance services to provide safe and rapid response to emergency situations.

History 1

It was no April Fool when AirCare had its first flight on April 1, 1979. Our first aircraft, the D model A-Star (the first A-Star to be utilized for air medical transport in the U.S.) had a transverse loading system (the second picture is of the loading system). No extra room for sure! The flight nurse sat forward going out to a scene and backwards when attending to the patient in a reversible seat. Of note, we flew with one flight nurse for the first seven years of the program. Flying alone with the pilot made for some very interesting flights and you haven't lived until you have done one-person CPR at 5,000 feet!

History 2

Our first A-Star left much to be desired. It was a cramped area with very little leg space for the patient, making it difficult at times to accommodate those Hare traction splints. We often used the MAST trousers as a pneumatic splint for lower extremity fractures, allowing for easier loading of the patient. It is hard to believe we made it through those early years.


What is that? It is an Allouette III helicopter which was used mostly for mountain flying as its powerful engine was capable of providing plenty of muscle in the thinner air of the mountains. We had the Allouette III helicopter for several months in the early 80s as a spare, while our primary A-Star was going through several modifications addressing the problem of limited patient space.

The unique characteristic of the Allouette was the ability to shut down the spinning rotor blades and keep the engine running. It had a neutral. We used this capability at scenes ensuring a rapid departure, but one major drawback was that its top speed was 80 to 90 knots. It took forever to get anywhere!

After our A-Star came back from the shop, we investigated new and more efficient interior loading systems. In 1983, Omniflight Helicopters won the AirCare contract. Our vendor helped design our first fore-aft loading system, using the available space more efficiently, plus having complete access to the patient.

Omniflight Helicopters used Bell Long Rangers when the A-Star had prolonged hourly maintenance done.

History 4

For the first seven years of our program, AirCare averaged more than 900 flights per year, with many flights missed because we were already on another flight. In 1986, Rocky Mountain Helicopters won the contract and has been with us ever since (now operating as Air Methods).

In 1987, due to the ever increasing number of patient transports, AirCare trialed a second A-Star based at the University of Iowa Hospitals and Clinics.

History 5

After one year, the second A-Star was moved northward to Schoitz Hospital in Waterloo, Iowa (now based at Covenant Medical Center). AirCare II was put into service in 1988, which provided better response times for the Iowans in the northern tier of counties.

(As of this writing) AirCare consists of an EC-130 based at the University of Iowa Hospitals and Clinics and an A-Star based at Covenant Medical Center. (Added - the team now has three bases including a ground specialty team. HelicopterEMS.com)

History 6

This historical summary is a first-person narrative by Mike Dillard, RN, who was the longest serving member of AirCare. Mike joined the program in 1980 and retired after 30 years with over 3,100 patient transports.

Images and text courtesy of University of Iowa Hospitals and Clinics. For more info click here

Saturday, August 26, 2017

Final Approach...

NTSB Identification: CEN16LA386
14 CFR Part 91: General Aviation
Accident occurred Thursday, September 29, 2016 in Lawton, OK
Aircraft: BELL 407, registration: N361SF
Injuries: 4 Minor.
This is preliminary information, subject to change, and may contain errors. Any errors in this report will be corrected when the final report has been completed. NTSB investigators may not have traveled in support of this investigation and used data provided by various sources to prepare this aircraft accident report.

On September 29, 2016, about 0600 central daylight time, a Bell 407 helicopter, N361SF, impacted terrain following a loss of control while attempting to land at the Comanche Country Memorial Hospital Heliport (18OK), Lawton, Oklahoma. The pilot and 3 crew members sustained minor injuries and the helicopter was substantially damaged. The helicopter was registered to and operated by Survival Flight Inc. under the provisions of 14 Code of Federal Regulations Part 91 as a positioning flight. Visual meteorological conditions prevailed for the flight which operated on a company flight plan.

The pilot reported that he maneuvered the helicopter to align with the helipad. During the descending right turn to the helipad, the pilot input left cyclic and the helicopter was unresponsive. The pilot lost control of the helicopter and it landed hard then collided with a wall.

The helicopter was retained for further examination.

Wednesday, August 23, 2017

Position Paper : Incorporation of medical team members flying in single-pilot aircraft for challenge-and-response before-take-off confirmation checks.

Our objective is the safety and success of all HEMS/HAA flight operations. In addition to the tragedy for those involved in a mishap, the catastrophic loss of an aircraft or team significantly damages the reputation and standing of all programs engaged in HAA operations.

For this reason, we have agreed to join with other industry stakeholders and advocate for a best-practice concerning the incorporation of trained and briefed medical flight team members for confirmation checks immediately prior to lift off in an EMS helicopter.

At present most EMS helicopters in the US are flown by a single pilot. These pilots routinely start the engine(s) and prepare for takeoff using a cockpit “flow” or “wipeout,” that is to say they “DO” start their aircraft from memory, and one or more times during the preparations sequence they are responsible to pick up their checklist and, scanning it rapidly they “VERIFY” that all required steps have been completed.

This enables a much more rapid departure than would be possible were the pilot to proceed down the checklist line-by-line. While some programs do adhere to a line-by-line method of checklist accomplishment by a single pilot, having one person responsible for doing and verifying creates the opportunity for a "single point of failure" with tragic consequences. "The DV method has a higher inherent risk of an item on the checklist being missed." (Federal Aviation Administration - FAA)

In HAA operations, safety is paramount, but a timely departure is important too, and do-verify has worked well for the vast majority of HAA flights over the years. Having said that, there have been instances in which a pilot, for various reasons, fails to properly configure the aircraft for departure. In response to these events, some operators have added a “confirmation checklist” to be used immediately prior to liftoff. Typically included on this confirmation checklist would be items that, if overlooked, could cause the loss of the aircraft and/or the crew.

A customary method of posting the confirmation checklist is for it to be printed on a vinyl sticker which is then affixed to the instrument panel in plain view of the pilot. Unfortunately, the same human-factors which cause a pilot to overlook an item on the do-verify engine start and before take-off checklist procedures can cause a pilot to overlook the same items on the confirmation sticker.
Such errors of omission have resulted in damage or destruction of several aircraft, serious injury to crew members and pilots, and, in at least one incident, a fatality.

The tenets of crew-resource-management dictate that we use “every resource available to us” for the safe, orderly, and expeditious accomplishment of our assigned flight tasks. A medical team member, while not “flight crew” per se, and while not regulated by the FAA (second crew member for NVG flight ops below 300 feet excepted) does, over time, become intimately familiar with flight operations. As well these medical team members have a vested interest in safety, as their lives are on the line right next to the pilot’s.

In many US flight programs, the decision has been made to have a medical team member act as an additional layer of safety by having that person read a before take-off checklist or confirmation checklist in the manner of “challenge and response,” This practice does not absolve the pilot of responsibility to ensure that all steps are accomplished. It simply incorporates a resource that is sitting there.

In FAA publication 8900-1 paragraph 3-3403, the FAA refers to this method as "Challenge-Do-Verify." We use the term challenge and response for clarity and brevity. A flight-team member refers to a list and issues a challenge. A second person - normally the pilot - verifies that the step is complete by looking and touching, then responds appropriately. Involving two people reduces the chance for a single point of failure.

"... (this) method keeps all ...involved 'in the loop'...and provides positive confirmation that the action was accomplished." (FAA)

At times the medical team is busy caring for a patient – but the request by the pilot for the “checklist please” is a clear alert that the aircraft is preparing to depart. This enhances everyone’s situational awareness, and in all but the most extreme patient-care situations (for example, CPR in progress), at least one team member can take the few seconds required for the challenges.

Examples of the items that might be included in a challenge and response confirmation checklist are: (these are only examples, your results might differ.)

Engine controls set to fly. (at least three twin-engine Agustas extensively damaged for one engine at ground idle during takeoff. At least three instances of a twin-engine Dauphin taking off with one engine at ground idle)

Hydraulic switches set and checked. (At least three Astars have been damaged or destroyed for hydraulic switch(es) set incorrectly. A news helicopter in the US was also destroyed for this error of omission and a person on the ground was killed.)

Fuel transfer switches set “on” (At least two BK-117 aircraft have been extensively damaged due to the transfer switches set to “off.” One pilot was paralyzed. In Scotland, a police helicopter crashed through the roof of the Klutha Pub after supply tanks became empty with transfer pumps off, killing several persons on the ground in addition to the crew on board.)

Internal and external light switches set, caution panel checked. (In a BK-117, having the instrument light potentiometers/rheostats set to “on” during periods of daylight renders the caution segments and master caution lights too dim to see. This error of omission strikes in conjunction with the fuel transfer switches being left off. When the low fuel lights and master caution lights come on the pilot can’t see this during daylight conditions.

Drugs and mission equipment checked. (This is an example of an optional item that may be included in a confirmation or BTO checklist. In more than one instance, an aircraft has departed without the required meds or equipment. This renders the aircraft and team not-mission-ready, and often requires a time-consuming delay, which is less than optimal for patient care. Obviously, the list of items on the confirmation checklist should be kept as short as possible. In this case, the medical team member calling out the challenge would either respond him or herself or would look to the second medical team member for a verbal response.
In summary…

With the visual clarity of hindsight, it is apparent that the vast majority of  HAA flight operations are conducted smoothly, safely, and to the benefit of the patients we fly. But our goal is ZERO aircraft destroyed and ZERO teams/pilots/patients injured or killed.

The cost of the recommendation we have laid out here is insignificant. The delay that this practice will entail - ten or twenty seconds - is insignificant. The significance of not losing lives to an error of ommission cannot be overemphasized.

Please consider incorporating this recommendation as a “best practice” for HAA operations.

Thank you.

This practice has been endorsed by:

Dan Foulds, Owner - HelicopterEMS.com, Owner - AMRM Training Solutions, Emeritus board member -The National EMS Pilots Association. Retired EMS pilot. Retired Army Aviator.

Miles Dunagan, Current president of the National EMS Pilots Association. Active EMS pilot.

Kurt Williams, Immediate past president of the National EMS Pilots Association. Former EMS pilot. Manager for a large HAA provider.

Rex Alexander, Past president of the National EMS Pilots Association. Former EMS Pilot. Former regional manager for Omnflight Helicopters. Industry expert.

Justin Laenen, Member, National EMS Pilots Association Board of Directors. Current EMS pilot.

Sam Matta, Co-founder of E.C.H.O. Active EMS flight nurse. Combat veteran.

Krista Haugen, Co-founder of the Survivor’s Network for Air Medical transport. Trained AMRM facilitator. Flight Nurse. Crash survivor - takeoff with one motor at ground idle.

Colin Henry. HEMS expert, safety consultant.  Former director of safety, Medflight of Ohio. Former chief pilot, Omniflight Helicopters. Colin writes, "On point! This is about Human Factors and not about good piloting skills."

Peter Carros. Retired military helicopter pilot. Former HEMS pilot. Safety Manager - Geisinger Life Flight, Danille PA.

Additionally, some variation of this practice is already in effect at numerous flight programs across the United States.

disclaimer: This is not intended to suggest any action not in accordance with federal aviation regulations. Consult appropriate oversight personnel before implementing any change to flight procedures.

Wednesday, May 24, 2017

OMAHA — Three families will receive $18.4 million to settle their lawsuits over a 2002 medical helicopter crash in Norfolk that killed three people aboard.

We can learn from our history, or we can repeat it... Do you remember this crash?

Read the report and ask yourself, "what would I do differently if I had been in this pilot's seat?"

From the NTSB report...
"The helicopter impacted the terrain following a loss of control. Shortly after departing the hospital on a medivac flight, the pilot requested that company dispatch have the company mechanic meet him at a nearby airport because he was experiencing "binding in the right pedal."
An airport employee stated that just prior to the accident, she saw the helicopter hovering over the ramp and thought it was going to land.

Four other witnesses reported seeing the helicopter climbing and thought it was taking off. Witnesses also reported seeing the helicopter spinning (directions vary) prior to it descending to impact. One witness reported the nose of the helicopter was stationary on an east heading and the tail of the helicopter was swinging back and forth. He stated the helicopter then veered to the left and he lost sight of it when he traveled behind some buildings.
Another witness reported seeing the helicopter rocking nose to tail and going in a circle, but not spinning, prior to impact...

The guarded hydraulic cut-off switch was found in the off position.
Records show the pilot had approximately 2,500 hours of helicopter time with a total of 43.8 hours of flight time in this make and model of helicopter. Winds at the time of the accident were from 200 degrees at 16 knots, gusting to 21 knots.

The Federal Aviation Administration Rotorcraft Flying Handbook states that a loss of tail rotor effectiveness "may occur in all single-rotor helicopters at airspeeds less then 30 knots. It is the result of the tail rotor not proving adequate thrust to maintain directional control, and is usually caused be either certain wind azimuths (directions) while hovering, or by an insufficient tail rotor thrust for a given power setting at high altitudes."

(Editor's note, While the inclusion of this bit of information by the NTSB isn't technically erroneous, it indicates that they did not fully understand the causes of this crash, and simply listed things that may have been a factor. As it turns out, the tail-rotor on the Astar has tremendous authority, is on a long arm (the tail boom), and few pilots have ever mentioned LTE in the same sentence with the name Astar)

The National Transportation Safety Board determines the probable cause(s) of this accident as follows:
A loss of tail rotor effectiveness and the pilot's failure to maintain control of the helicopter. Factors associated with the accident were the binding of the tail rotor pitch changed rod, the gusty wind conditions, and the pilot’s lack of total experience in this make and model of helicopter.

We humbly suggest that the problem was not a lack of technical proficiency. The problem seems to have been the choices this pilot made. The problem was judgment or the lack of it.
Because there was no voice-recorder on board, we don't know when the pilot first became aware of a flight control problem. Was it as he came up to a hover off the pad? Was it on climb out? Was it in cruise flight?

One thing we do know however, is that at the first sign of problems with a flight control system, we should land - either as soon as possible or as soon as practicable, depending on the problem. Don't try and diagnose a flight control problem while flying. Land.

This pilot apparently was thinking about other things besides landing right now. It appears he was attempting to be a "team player" by requesting a technician to meet him at the airport. But what if he could have simply performed a precautionary landing at the first sign of trouble? When faced with a problem in flight, we will be better served by landing and sorting things out on the ground.
To include "how will maintenance find us?" Years after this event a pilot flew an Astar for 15 or 20 minutes with the red oil pressure light on. And then crashed.

When something is wrong - LAND. Better to over-react than under-react.
Maybe this pilot was worried about hovering with limited ability to control the tail rotor. And maybe that is why he headed to an airport. But if that was the case, shouldn't he have performed a run-on landing? Or a slow shallow approach? Or an autorotation? To the runway? Isn't that what we do when we lose tail rotor control? (depending on problem and rotorcraft EP...)
Maybe he didn't think his problem was a big deal. But then it was. It is unlikely that he took off with the hydraulic cutoff switch off, more likely that he was attempting to sort out a problem while flying. Instead of landing...

If you encounter a situation like this while flying; as soon as you get the aircraft to a state where you can control it, stop making changes to aircraft configuration and land. And if you have to run it on, do it. Don't hesitate to ask for help and execute the the most conservative response.
(while complying with the rotorcraft flight manual emergency procedure and company guidance...)

Disclaimer - This post is not intended to open old wounds or cause pain or discomfort to the families of those involved. The sole reason for these discussions is to learn, so that no one repeats this tragedy. If there is any good to come from a crash, it is that we learn how never to do that again. We also know that luck plays a part in any crew's life, and that on any given day it may be our turn to measure up - or not.

You can read more about this crash by clicking here.

Tuesday, April 25, 2017

Trust - But Verify!

Soviet–American relations. Suzanne Massie, a writer in Russia, met with President Ronald Reagan many times between 1984 and 1987. She taught him the Russian proverb, "Доверяй, но проверяй" {Doveryai, no proveryai} (trust, but verify) advising him that "The Russians like to talk in proverbs.

Image courtesy Belfast Telegraph
Pilot Dara Fitzpatrick and her crew were lost as a result of a crash. There are lessons for all of us in this event. And if you do some soul-searching, you will realize that what happened to them could also happen to us. Take care. May God bless their souls and comfort their families.

"Ireland's Air Accident Investigation Unit (AAIU) released its preliminary report on the crash which stated that the helicopter's Honeywell Enhanced Ground Proximity Warning System (EGPWS), which alerts pilots to imminent danger from terrain and obstacles, does not include either the terrain of Blackrock island or the lighthouse on the island."

That single statement points towards a human-factors accident. A human failure to act that resulted in needless deaths.

We can never rely completely on a sole-source of information as to our position, safe-altitude, or hazards ahead. In the interest of true situational-awareness we must continually verify one source of information with another. Heading, altitude, destination, route to be flown... As well we must never put our complete faith in an onboard system. These systems are "aids," but the human at the pilot's station is the final defense should a system fail to operate as intended. If ANY system suddenly begins to malfunction - for instance if an autopilot suddenly commands an unexpected hard turn at the end of a coupled-approach - the pilot must be ready for this. He or she must be instantly ready to override the system and take manual control.

We cannot get so focused on the task, the mission, or outside distractions that we place responsibility for our safety on technology. The U.S. Federal Aviation Administration has warned that we are "addicted" to technology. The worry is that our basic airmanship skills have degraded, that we are becoming "direct-to-and-go pilots."

Tomorrow, 4.26.17 marks 13 months without a fatal HEMS crash in America.

We can never let our guard down.

Image courtesy Belfast Telegraph.

Click here to read full story from the Belfast Telegraph

Wednesday, April 5, 2017

Flights On The Bubble

I have been thinking about Chad Hammond the last few days, Chad was a well-liked and well-respected helicopter air ambulance pilot who, along with his crew and patient, were the last souls to be killed in a HEMS/HAA crash, as of this writing. The anniversary of their deaths was March 26th. As that date drew near, I wondered if we - collectively - could go a full year without killing anyone. And I hoped. I have come to know Chad's widow Natalin over the year since his death, and pondered his loss, and hers, at length. The NTSB report on this crash is not yet complete, so any discussion of cause is pure speculation. But I see similarities in this event and others, and I think it's worth a discussion between you and your HEMS team mates. It may well turn out that all assumptions about what happened to Chad and his team and patient are wrong. About the other events, there is no question.

As an Air Medical Resource Management instructor, I look for patterns and attempt to point these out when I find them - so that you might recognize a pattern as well. So that you might realize an accident chain is being welded together. So that you will not be the subject of a story like this.

And this morning I thought about HEMS flights on the bubble.

Are you familiar with this phrase, "on the bubble?" It normally refers to a team or team member who is right on the edge of not making the cut. It is often used in the context of a sport.  But it has another meaning. According to the Urban Dictionary "on the bubble" can be defined as...

At risk. In peril. Most often used to describe someone or something that may be cut from scope or removed from the group.

So the context I am considering is a flight that a HEMS pilot and crew are considering that is "just good enough to go"  The weather minimums that we VFR HEMS pilots use are pretty loose. Here they are.

So you can see that if we have night vision imaging systems or an approved helicopter terrain avoidance and warning system, our route is non-mountainous, and our destination is within our "local flying area," (as much as fifty nautical miles away from the base) the weather can be as low as 3 statute miles of visibility and 800 feet of clearance between earth and clouds for a night flight. Now, most flight teams understand that those numbers aren't used to start a flight, they are used to terminate one, but invariably some volume-conscious manager will push, or an over-zealous flight team will blast off hoping for the best.  Perhaps the pilot is seeing a trend of improvement and assumes the trend will continue. Never mind the fact that when we consider weather categorically, 800 and 3 is considered IFR, or instrument flight rules weather.

IFR = 500-1000′ and/or 1-3 miles

I imagine helicopter operators pushed for such low numbers and were given them by the regulators because some of the things we can do with a helicopter involve flights very close to the takeoff point, or flights at a very low speed, such as hovering over a grove of fruit trees to keep them from freezing on a cold winter's night, moving timber down a hill to a river, or hovering along next to a high tension power line. And of course, a helicopter can stop just about anywhere, even though many of us pilots have died because of a shocking reluctance to use this capability.

So let's consider the pilot who checks weather, and finds it "legal" and convinces the crew that all is well. As they proceed to the patient pickup point, things aren't great, but they are good enough to get by.

We are now flying "on the bubble."

We land on a scene or at a hospital pad, and the waiting game starts. Here is where we can get ourselves into trouble. We arrive on the bubble and while we wait it pops.

JALAPA -- Three times before dawn Tuesday, calls went out to emergency medical helicopters: A woman with a broken leg needed help along I-26 in Newberry County. 

Air rescue units from two Columbia hospitals and another in Greenville said it was too foggy to fly.

(added: One helicopter, "CareForce" from Richland Hospital in Columbia, launched and then aborted for weather.) 

A fourth call went to Spartanburg, where Regional One pilot Bob Giard checked the radar, decided the weather looked clear and took off with two crew members. 

The crew never reported problems with the weather en route to the site. But minutes after picking up the patient, their helicopter crashed in woods near the Palmetto Trail, about 1,000 yards from an I-26 rest area, authorities said. 

Giard, 41, flight paramedic David Bacon, 31, nurse Glenda Frazier Tessnear, 42, and an unidentified female patient died.  (text courtesy Associated Press)

Here is a bit from the NTSB on this crash.

"A single-engine emergency medical services (EMS) helicopter was destroyed after impacting trees in a national forest about 0532 eastern daylight time. Night visual meteorological conditions with mist and light fog prevailed in the area of the accident site. The flight crew was contacted about 0452 to determine if they could accept the mission. The pilot performed a weather check and accepted the mission about 0455. He departed about 0502. The helicopter arrived at the accident scene and landed on the interstate highway near a rest stop about 0523. The helicopter departed the scene about 10 minutes later, flying toward the national forest located north of the interstate. A witness reported that the helicopter made no abrupt maneuvers and that the engine "didn't sound like it was missing, sputtering, or any other kind of power loss." He reported that the helicopter was straight and level then it "pitched forward to go forward." He reported the helicopter was "flying level" as it descended into the trees. He reported that the helicopter's searchlight was on and that fog and mist were visible at treetop level. Postaccident inspection of the helicopter revealed no preexisting anomalies that could be associated with a pre-impact condition. Download of the engine's electronic control unit nonvolatile memory indicated that the engine was operating at 98 percent Ng when it impacted the trees. Three other EMS helicopter operators had turned down the mission, including one who had attempted it but had to return because of fog conditions. However, the accident pilot was not informed that other pilots had declined the mission because of fog."

Now maybe you are thinking that "about 10 minutes" isn't long enough for weather to go from just above minimums to well below them, but I assure you, saturated air can go from muggy to foggy very quickly. Giving this crew the benefit of the doubt, and assuming they weren't breaking the law on the way to the patient, one must surmise that conditions deteriorated while they sat on the ground at the scene. And sadly, they decided they had to go anyway.

When I was doing AMRM for Omniflight, I was privy to event reports in which pilots described adverse flight scenarios they had lived through. I used these redacted reports for classroom discussions so that we might learn from someone else's "thrilling" moments. In one such event report a pilot recounted a night flight to a patient in which he noticed the weather deteriorating and decided to abort and return to base. The requestor, a ground-based ambulance crew, asked if the aircraft and crew might stop somewhere mid-trip for a linkup and patient transfer. So after doing a 180, this pilot landed and waited for the ambulance to show up. And as he and his crew waited they observed the weather getting worse and worse. Finally, he had had enough and he set about departing for his base. But just as they came up to a high hover, the ambulance pulled into the parking lot!

This is a very uncomfortable position to be in as a pilot. I have been there and done it wrong. I didn't want to disappoint the "customers," (the ambulance crew) and I didn't want to leave the patient in the lurch.

So as this pilot and his crew see the bus pull up, somebody decides to land and load in a hurry and hope for the best. The next few minutes were undoubtedly an experience that none of them will ever forget. The text in the event report went something like, "I took off and got into the clouds and could no longer see the ground. I lost control. The aircraft spun to the left and spun to the right, then I got on the instruments and regained control. I flew on to the receiving hospital." In actuality, there was a little bit more to it. I presented this case study at this pilot's base, not knowing who he was or where he worked, and after the class he confessed to me that it had been him. I now have the utmost admiration for this man's courage and candor, because he rightly assumed that his experience might be repeated. So he volunteered to tell his story in a video sponsored by Airbus Helicopters.

You can watch this video, titled "That Others May Live" here.  It is chock full of lessons, and it has undoubtedly saved some lives.

So now let's consider the most recent fatal crash. Here is a bit from the initial NTSB report,

"On March 26, 2016 about 0018 central daylight time, a Eurocopter AS 350 B2, N911GF, impacted trees and terrain near Enterprise, Alabama. The airline transport pilot, flight nurse, flight paramedic, and patient being transported, were fatally injured. The helicopter, registered to Haynes Life Flight LLC. and operated by Metro Aviation Inc. was substantially damaged. The flight was operated under the provisions of Title 14 Code of Federal Regulations Part 135, as a helicopter emergency medical services flight. Night instrument meteorological conditions (IMC) prevailed for the flight, which operated on a company visual flight rules (VFR) flight plan. The flight departed from a farm field near Goodman, Alabama about 0017, destined for Baptist Medical Center Heliport (AL11), Montgomery, Alabama.

According to the Coffee County Sherriff's Office, on March 25, 2016 at approximately 2309, a 911 called was received when a witness observed a motor vehicle accident on County Road 606 near Goodman, Alabama. Sheriff's deputies were dispatched along with Enterprise Rescue Squad. Deputies also contacted Haynes Life Flight dispatch, when it was discovered that the vehicle was overturned and that an unconscious victim was inside.

According to communications records, the call from the deputies was received by Haynes Life Flight Dispatch at 23:19:10. The pilot of "Life Flight 2," which was based at the Troy Regional Medical Center, Troy Alabama was notified at 23:20:38. The helicopter departed Troy at 23:26:57 and arrived at the landing zone (LZ) in a farm field adjacent to County Road 606 at 23:53:15.

According to witnesses, after touchdown, the pilot remained in the helicopter with the engine running. The flight paramedic and flight nurse exited the helicopter and entered the Enterprise Rescue Squad ambulance to help prepare the patient for transport. Once the patient was ready for transport, the flight nurse and flight paramedic along with several other emergency responders rolled the gurney approximately 70 yards through a grassy area to the helicopter and loaded the patient on-board. Once the patient had been loaded, the flight nurse and flight paramedic boarded, and at 00:16:45 the helicopter lifted off and turned north towards AL11.

Fog, mist, and reduced visibility existed at the LZ at the time of the helicopter's arrival. Witnesses also observed that these same conditions were still present when the helicopter lifted off approximately 23 minutes later. The helicopter climbed vertically into cloud layer that was approximately 150 feet above ground level and disappeared when it turned left in a northbound direction toward AL11. Review of the recorded weather at Enterprise Municipal Airport (EDN), Enterprise, Alabama, located 4 nautical miles east of the accident site, at 0015, included winds from 120 degrees at 4 knots, 3 statute miles visibility in drizzle, overcast clouds at 3oo feet, temperature 17 degrees C, dew point 17 degrees C, and an altimeter setting of 29.97 inches of mercury."

So, do you see a pattern? We get to the patient, and the weather gets worse, and for whatever reason we give it a shot. None of these pilots were bad people. They weren't dumb. They were respected and liked and loved. And they certainly didn't walk out to their aircraft thinking "tonight's the night." And yet they all took off into weather that was bad enough so that even a medical crew member walking back from the bus to the aircraft should have been able to look up and realize that a VFR aircraft was in for trouble.

So that's exactly what I will ask you medical crews to do. Be aware of the weather where you are. And be aware of how a pilot's mind works. He or she wants to get the job done. We want to help the patient and avoid disappointing anyone. But in our efforts to do this, in some cases, we cause disappointment beyond belief. YOU may be the person who says, "hey friend, while we have been here things have gotten worse. So I am making the call. We are going by ground." (If your program permits that option, if not maybe you should not go at all.)

Flights on the bubble put us at risk, in peril. I don't want you to be cut from the scope of our business, or removed from the group.

Safe Flights friends...