Saturday, December 28, 2013


Jeanne just called. I am at home, sitting in front of a warm fire, watching two dogs watch me  for signs of a walk.  I am working up to it.
She has already done a flight this morning, taking a patient to St. Joe's in Savannah. Two nice things happened along her way.
First, she got to stop in and see our friend Laura. Laura is an older lady, mother of my friends Julius and Lawrence. She fell recently and broke her femur. This put her in-hospital for rehab - and we are keeping up with her progress. It is good to frequently visit people we care about who find themselves in the hospital. Much of institutional health-care is de-humanizing; it's important to provide a living, breathing, talking physical reminder to everyone involved that the patient is indeed a human, who is loved, and valued, and important. This matters, and improves the level of care, and the outcome.

So Jeanne was able to run up to the fourth floor and poke her head in the room for a quick hello. In uniform.
I asked Laura recently if she was being treated like the VIP that she is. She said, "oh yes - I graduated from here." I knew that Laura was a nurse, but I didn't know about her education at St. Joseph's when they taught nurses there. Laura spent her entire working life as a nurse, and was involved in the first-ever open-heart surgery in the city of Savannah. At the time this was cutting edge (pun intended). Laura has opened her home to me and my family for the last few years for each big holiday. She treats me like family. Her kindness and humility inspire me to be a better human. To do better at looking out for the people I work and play and live with.

  1. 1.
    fill (someone) with the urge or ability to do or feel something, esp. to do something creative.
    "his passion for romantic literature inspired him to begin writing"

  2. 2.
    breathe in (air); inhale.

Sometimes, when life get's sideways with us, it is good to consider the second meaning of that word - inspire. This is the meaning that paramedics, who own-the-airway, spend a lot of time focusing on - but it's good for us all to remember to breath - take a deep breath and relax - when things go wrong.

But I digress.
Winston Churchill said, "we make a living by what we get...but we make a life by what we give." People like Laura, and Jeanne give - freely, continuously, without reserve. And their lives are enriched for the giving.

As Jeanne was walking out of the hospital towards her helicopter, a huge man stood by. She wondered why until she got up close and recognized him from a decade and a half ago. He was at one time her medical-technician-assistant - her "tech." He went on to nursing school, then to Certified-Registered-Nurse-Anesthetist training. He lives near Atlanta now and is here for his dad who is also a patient at the Joe.

The giant thanked Jeanne for the way she treated him all those years ago. He told her, looking straight into her eyes, "I am the nurse I am today, because of you."



Let us be...

(Please share with your friends and co-workers...)

Saturday, December 21, 2013

A Request for Feedback...

We enjoy blogging, and hope that some of what we blog about may entertain, inform, and even help prevent an accident. We can check the stats and see from whence the page-views come (Russia? really?), but we don't know much about who is checking in with us.

If you have a moment, please post a comment listing how you got here, what you do, where you live, and if you work with a HEMS program; the name of the program. We don't need to know your name, unless you care to share it. Also, if there is any topic you would like to discuss, let's hear it. If you are aware of any great businesses related to our business, we would like to hear about them too. We may just expose their greatness...

safe flights...

Helo Porn (or why I am a proponent of CRM)

                                Photo Credit:  Benjamin  Hunter. click on picture to enlarge...

The crew on this helicopter work well together. This is because they do everything as one. They eat together, they sleep together (in the same room, or in the cabin of the aircraft). They drive together, they drink together, they go to strip clubs together, they puke together. They are brothers from different mothers. They know each other as they know themselves. After every flight, they sit in a room and ask hard questions of themselves, in order to get better, stronger, faster, more capable...

 The bonds they forge are for life.

If you want to be part of a truly excellent HEMS program, set about building bonds like this where you work. Be a rain-maker!

Monday, December 16, 2013

An Essay on S-A...

I think the pilot was simply creeped out. 

He was the pilot flying, and was responsible for control inputs during the leg from from Brazil to France on the evening of June 1st, 2009. He would shortly be the proximate cause of his Airbus A-330 descending, under full power, into the Atlantic Ocean. All 216 passengers and 12 crew members would die because of a simple breakdown in crew communication, coodination, and situational awareness. This would not be the first time these human factors would lead to the loss of an aircraft - nor the last. If you are a HEMS crew member understand that I write this to prevent you from having to share their fate. I mean no disrespect to those who lost their lives, instead I would like use what we can learn to prevent future mishaps.

There are many reasons that crew members fail to communicate effectively in flight. In the case of the very recent crash of an Asiana Airlines Boeing 777, investigators point to culture, or power-distance, which is the amount of deference paid to superiors by subordinates. There is usually someone on board an aircraft that is about to crash who knows a problem exists, but they don't speak up.

The fail to assert led to the worst air crash in the history of the world; the destruction of two Boeing 747 aircraft, and the loss of 583 lives. Read about it by clicking here...

A crew member practicing:                                                          

Inquiry - the act of seeking information to create understanding

Advocacy - the act of pleading a cause or course of action

Assertiveness - the act of speaking up for what you think is right.

can prevent a crash, but because no one rings a bell when a crash is avoided, the larger HEMS community doesn't know.

The Air France pilot had the aircraft set up to fly automatically through an area of persistent bad weather known as the inter-tropical convergence zone. In flight, a pitot-tube was blocked by freezing rain, and the aircraft's computers lost the airspeed input and changed modes.

The fly-by-wire flight control system switched from "normal law" to "alternate law" affecting how much a given movement of a side-stick controller will move a control surface, but the pilot flying didn't know this. He lost situational-awareness. That aircraft is so complex, and can have so many things happening at once with systems, that the pilot doesn't understand what is happening or why.

This pilot got creeped out; he had just flown through a patch of rough weather and an atmospheric phenomenon that created an unfamiliar smell in the cockpit.

Then he  did two things wrong. First, he reflexively pulled his side-stick all the way back. When we get scared in an aircraft, one of our instinctive responses is to climb. His excessive control-input made the aircraft climb, and slow down. and then descend.

As he saw that the aircraft was descending, he kept this full-aft stick input applied. He wanted to go UP, not down.  His second and more important failure was that he failed to announce what he thought was happening and what he was doing about it.  This failure robbed the other pilot on the flight deck of situational-awareness. The second pilot didn't know that the stick was all the way back or nose-up, and they were stalling the wings. They fell into the ocean with engines screaming, in a level attitude. The designers never imagined that a pilot would hold the stick all the way back, all the way to the water, without anyone else noticing.

The take-away on S-A...

1. Anytime you sense anything "different" about your aircraft, sound the alarm! "Hey we have a new sound, shimmy, vibration, smell..." 

2. Then, announce what you think the problem might be. An electrical fire? Loss of oil pressure on engine number two? Loss of hydraulic-boost? A blocked fuel pump inlet or the strong odor of fuel? Take your best guess.

3. Announce what your are doing about this new sensation. If you are adjusting a flight control, switching a switch, turning a knob, speeding up, slowing down, climbing, descending, whatever... Announce your actions!

The other pilot could see that they were descending, but as that aircraft is fly-by-wire versus fly-by-cable, and there is no linkage between the two side-stick controllers.  The other pilot was denied the information that would have been provided by an old-fashioned between-the-legs control wheel being pulled backwards into his gut.

You can read about this crash by clicking here...

You can watch a video about this crash here...

                                         Photo courtesy Shawn Griffin, former USAF Combat
                                         Camaraman, current USAF and civilian flight nurse

Crew coordination is each of us knowing what the others are doing, when, and why. I was on a flight with a new crew member in a Bell 206.  He elected to get ahead of the game by placing a blood-pressure cuff on a patient's arm while still in the ambulance. They took the patient outside of the ambulance to move him from the EMS stretcher onto our aircraft stretcher. The other crew member observed a blood pressure cuff on the patient's arm and assumed it belonged to EMS. He took it off and handed it away. When we were all in the aircraft, the medic said to the nurse, "damn, I put a cuff on this guy, I wonder what happened to it."

Crew coordination depends on practice and communication - before, during, and after a flight. Rehearsals in the aircraft, full-crew simulator training, table-top scenarios, "rock-drills," and of course post-flight after-action-review all contribute to good crew-coordination.

Using periods of time when the work load is light to prepare for high work load times is part of Air Medical Resource Management.

Cross-training, or understanding what other members of the team do, and why, helps with maintaining situational-awareness. I practiced an instrument approach recently, with a relatively new flight nurse sitting directly behind me in our Astar. He was able to see over my shoulder. I explained everything I was doing. He asked what indications I was looking for on the instrument displays. I mentioned the common mistake of having the display set up to show GPS information when intending to use information from the Instrument Landing System (ILS), and handed him my approach plate to look at while we flew. Is he going to be responsible for how I fly approaches?  No. But the more he understands about what I am doing the better.

Sometimes we don't speak up because we are new, and don't want to say something dumb. In the name of every brand-new crew member who has been killed in a helicopter crash, you must set that thought behind you.  There is no such thing as a dumb question in an aircraft.

One of the Asiana pilots stated that he was preparing to speak up about his airplane's slow speed during descent for landing. The auto-throttles weren't set correctly, and the technology had gotten ahead of the pilots. That pilot decided that it would go against the cultural norm to question the command-pilot's actions. And they crashed.

Your organization's culture must be one that encourages frank, open, and honest discussion about things that concern your safety - or the safety of anyone in your organization. You speaking up may fix my misunderstanding about something that's happening to us in flight.  You may save our lives. You are not a passenger - you are a crew member.

As members of a crew, we coordinate our actions in the aircraft. We don't do anything without announcing it. We touch no switch without confirming which one we want, and announcing our actions. Failing to do this led to a crash of Marlin Air's jet carrying the University of Michigan's transplant team.

Read about this crash by clicking here...

Maintaining situational awareness requires managing the resources available to avoid demanding more from anyone on board or on the ground than they can provide. Separating and fixing responsibility goes a long way to preventing crashes like the loss of an Eastern Airlines jet in the Everglades in 1972 and an EC-145 in the water near Fort Myers FL in 2009. These crashes bear shocking similarities in the loss of situational-awareness while the person flying became distracted by attending to a duty not related to FLYING THE AIRCRAFT. In both crashes, the pilot thought the autopilot was flying the aircraft, and in both cases it wasn't doing what they thought it was.

Imagine if the flying pilot had said, "Hey guys, I am going to focus on flying the aircraft. Can you help my by working on..."

Our brains dislike being "adrift." We like to latch on to a sense of reality (right or wrong) and can easily get led down the wrong path by "expectation bias"  We can have everything all wrong, while thinking we have it all right. Complacency contributes to this, as does failing to use every resource available to confirm what is really happening.

In the helicopter, the one that went into the water, the pilot was trying to call EMS with no luck, and had the autopilot set. When she reduced power to descend to her selected altitude of 500 feet, she inadvertently set the collective too low to maintain the minimum autopilot speed. The helicopter descended to the water while the one person on board who could have been flying wasn't. The crew in back noticed water in the air outside and took it to be rain. It was sea spray. They didn't have situational awareness...

Thursday, December 12, 2013

Throwback Thursday... A day in the life.

A car bursts into flames on I-95. Four people are burned trying to remove a child from the vehicle. Colleton County EMS puts out a call for helicopters.

The former Meducare Air and the former CareForce helicopters (now LifeNet 7 and LifeNet 1, part of the LifeNet South Carolina statewide system) respond from Charleston and Columbia South Carolina, respectively. Not pictured, but also responding is the LifeStar 1 helicopter from Savannah GA. This program is also now part of  the LifeNet system, retaining the LifeStar name due to the associated history and goodwill.  

EMS prepares multiple patients for transport to the Dr. Joseph M. Still Burn Center in Augusta GA.

Paramedic Susan Lindemoen loads a patient into the Bell 230 with help from Colleton County Fire and Rescue personnel. Bell only made 38 model 230s, and soon transitioned to the 4 bladed rotor system on the Bell 430. 

The 230 departs, with her two massive blades thumping the atmosphere into submission. This is the rotor system that sets off car alarms on final approach.

This event is a precursor and rehearsal for the larger HEMS response to the sugar plant explosion and fire that will send every helicopter in the region to Savannah, and then on to the burn center...

All photos courtesy Barry McRoy, Chief, Colleton County Fire Rescue

Saturday, December 7, 2013

Another Fuelish Mistake... UPDATE 4/17/14

You gotta love humans. We never stop being creative. Or lazy.

I was enjoying a change-of-shift discussion this morning with my friend StuD, and I mentioned that I had looked over the entire list of pilots who work for our company. There are a bunch. I brought up a name from our past and he exclaimed - in the negative sense - his opinion of this fellow.

Stu told me a story that I had heard before, but forgotten. Life is like that,  when a mis-step happens to someone else it's not nearly as meaningful as when it happens to you. Perhaps that's why we are not so good at learning from other peoples mistakes - we prefer to make them ourselves and learn the hard way.

One morning, back-in-the-day, Stu was pre-flighting our old Bell 230 and checking out the base fuel system. His shift was following the other fellow in the story, who can remain Nameless. Nameless had developed a habit during refueling the aircraft, which seems kind of neat on the surface, but isn't. He would stick the fuel nozzle into the hole in the side of the helicopter

then use the grounding clamp for the fuel nozzle, which is supposed to be fastened to the airframe to prevent a static spark, to hold the valve lever in the open position. Aviation fueling systems do not have the "catch" on the lever like the one at your local gas station - for a reason.

Then Nameless would walk across the helipad to the fuel-system cabinet and switch on the pump. He would watch the counter for the correct number of gallons to be pumped into the aircraft, turn the pump off, then put everything away. Now this is an easy method of dispensing fuel, and saves much walking back and forth to check the fuel counter. It also eliminates the need to actually hold onto the lever while dispensing fuel.

Hey, we love automation; right?

There is no telling how many times Nameless performed his modified aircraft refueling, without incident, but one evening, he got distracted during the process. Maybe it was late and he was tired, or maybe he was talking to the new flight nurse - and something slipped his mind. Whatever - in any case Nameless forgot one little piece of his personal refueling-method before closing the fuel cabinet and heading back to bed.

The next morning, Stu opens the cabinet door and begins to check the system, checklist in hand. He needs to drain fuel from the filter vessel, to look for contaminants, so he switches on the pump, while standing directly in front of the wound up hose sitting on it's reel - nozzle pointed out.

Well, Nameless had forgotten to remove the clamp from the fuel lever, and it was stuck in the full flow position. Stu took a shower.

And never forgot.

Neither should we.

Safe Flights...

Friday, December 6, 2013

Maryland State Police Helicopter Program Costs Continue to Climb...

Updated: Thursday, December 5 2013, 02:22 PM EST On Wednesday Maryland State Police won approval of an emergency request for money to keep aging medevacs flying, despite a brand-new fleet of AW-139s. The State Board of Public Works approved roughly $500,000 to overhaul the engine of an older Dauphin Medevac helicopter which has been in service since 1990.  This is the third time this year that State Police have sought emergency funds to keep older choppers in service. State taxpayers paid roughly $130 million dollars to purchase ten new AW-139s - helicopters that preliminary plans indicated would be in service this year. However, several accidents and an unanticipated Federal Aviation Administration (FAA) ruling have delayed the rollout. One of the new AW-139s may have been damaged by a stray bullet on one if its rotor blades. Another AW-139 was waylaid when a technician broke a blade while trying to balance the rotor. In late September one of the state medevac helicopters hit the tarmac without its landing gear deployed. In September the state approved $600,000 to fund the hiring of ten additional pilots to fly the AW-139s after the state lost a behind-the-scenes battle with the FAA to fly with just one per aircraft. The decision to purchase 12 of the larger, more technologically advanced helicopters was controversial when it was made in 2008. The requisition forced the state to borrow $133 million instead of choosing cheaper alternatives such as privatizing the fleet or refurbishing existing helicopters. 

Read More at: http://foxbaltimore.com/news/features/top-stories/stories/price-tag-transition-new-medevac-helicopters-continues-grow-23816.shtml#.UqJCgNJDvTp

New 'Copter for Kids in Ohio

                                Photo Courtesy Nationwide Hospital

Transport at Nationwide Children's Hospital has expanded services to now include a fully-dedicated helicopter (named Monarch 1) to serve critically-ill patients. And fast. Their new helicopter, Monarch 1, will allow their neonatal and pediatric transport team to initiate critical care services more quickly.

The helicopter is an addition to the existing ground-based and air transport options offered by Nationwide Children's Hospital and MedFlight, their current partner for helicopter transport. The helicopter will be based at The Ohio State University Airport and is equipped with state-of-the-art critical care equipment. This includes IFR technology allowing the helicopter to fly in low visibility and a combination of nitric oxide therapies and High Frequency Ventilation (HFV) for patients in need of respiratory care.

Monarch 1 is the only Ohio transport helicopter that offers this kind of respiratory care for neonatal patients. And with Nationwide Children's Hospital being home to one of the largest neonatal networks in the U.S., with about 30 percent of all neonatal admissions requiring at least a one-hour drive, the helicopter will be a dedicated, specialized resource.

"Minutes count when it comes to transporting critically ill infants," said Edward Shepherd, MD, section chief of Neonatology at Nationwide Children's Hospital. "The addition of this EC145 helicopter allows them to better serve their patient families while increasing the access to the neonatal and pediatric specialty care."

The helicopter also offers a large cabin with the potential to allow a parent or guardian to ride on-board during the transport of their child as well as additional staff to ensure patient safety while in flight. The helicopter will focus on transfers between hospitals and will not land at accident scenes.