Tuesday, November 24, 2015

Case Study... Winter weather crash...

It is a good thing to learn caution from the misfortunes of others.
— Publilius Syrus

"It was a cold night in the dead of winter when Billy Wynne lifted off the helipad responding to a cardiac arrest call in the neighboring city of Watonga. Billy called his wife and told her he loved her. She was pregnant with their second child. It was February 22nd, 2013. Sitting next to Billy was 41 year-old nurse Chris Denning. In front of Chris was veteran pilot Mark Montgomery. In 60 seconds, both of these men would be dead.

The EagleMed had just reached its cruising altitude of 500 feet when the helicopter began to shake violently. It became instantly apparent this was not turbulence when the pilot began muttering, “don’t do this…don’t do this to me now.”

Preliminary reports on the crash would indicate that the helicopter hadn’t flown in three days. At the top of the helicopter, where the engine is mounted, ice had accumulated at the base of the air intake which feeds air into the engine. Once the helicopter leveled out, the air intake began receiving air at full capacity. The speed of the aircraft created so much wind velocity it jarred the ice obstruction loose and sent it hurtling directly into the engine.

The engine died immediately. The helicopter began to fall.
It would take 10 seconds for the helicopter to impact the ground. In those precious seconds, the pilot searched for a place to land the helicopter. They spotted a tiny street below, only a quarter mile long, but it was lit on both sides.

Billy remembers the nurse, Chris, patting the pilot on the back saying, “You got this, Mark, you got this.” Billy recalled the look on Mark’s face: “Mark knew he was about to die.”

Billy remembered something Mark had told him about helicopters. No airborne machines are really made to crash, but helicopters definitely aren’t. The engine mount sits on top of the helicopter. The (fuel tank), full of jet fuel, rests below the helicopter in the belly."

Text copied from the Chive. Discuss this event with your flight team. What factors played into this crash - make a list.  What could have been done differently? Could this happen to your flight team at your base?

Thursday, November 19, 2015

Training Quality Concerns...

We found this on a forum that pilots use to vent their dissatisfaction. There is a lot of chaff on the forum. And a fair amount of wheat. Read on and share...

What do you think about this? 

How would you rate your training?

"About 6 years ago my program decided to stop supporting an IFR program.  We kept the airframe, lost the training.  The training was just meeting the minimums anyway, and barely kept anyone competent enough to fly SPIFR.   I was sad to see it go, but we didn't make any money off of it.  It was supposed to be for safety, but I was still in an IFR twin, so, hard to complain.  I get it, business is business.  
Then about 4 years ago, we lost the twin and went into an ASTAR.  Flying around at night over hazardous terrain, houses, mountains, etc...  IIMC without an autopilot and no instrument training.   I have plenty of time in singles, so I was convinced I could maintain safety by lowering my weather minimums, and flying higher at night, choosing my flight path over more favorable terrain etc..  It made my job a little more difficult, but I still considered it safe.  I feel I was able to mitigate the risk.
Then about 3 years ago my employer decided it was "too dangerous" to train me to do autorotations.   I haven't doen an auto in 3 years, I go back to training to practice my power recoveries and my first auto is litterally the worst of my entire career.  I overshoot my spot by 100 feet, and I flair way too high.  The instructor is tickled with my performance and deems it "a really good auto".  This guy must see some crap if my worst auto ever is considered good. 
Training is supposed to last 5 days.  2 travel days and 3 training days.  I show up and get my "ground" done in about an hour.  The trainer puts on as much gas as he can fit and we do the entire training and checkride in one flight.  That is it for the year.  
Every year I am worse than the year before.  Every year they take away more redundancy, and skimp on the training.  
I'm done.  I can no longer justifiy the risk.  Being sent out there with no hope if anything goes wrong.  No training, and no redundancy.  Sad state of affairs.  
I took a job over seas.  I will miss being home, but I would rather be alive and I am not ready to stop flying yet.
Stay safe guys and don't accept the risk they expect you to so they can make money.  
I just got back from training"

Tuesday, November 17, 2015

Insufficient space available for the patient and equipment? Think twice about stuffing that bag...

I got a call from a friend at a program in the northwest... He wanted to talk about cabin size and storage/securing of equipment.  He flies a twin, and thinks twins are better not because of twin-engine reliability and redundancy, but because they have a bigger cabin with more storage compartments.

Then today I read this,..

         While loading a patient into the aircraft, a D oxygen cylinder was
        left between (the patient's) legs and secured with a seatbelt. In flight, the
        patient became agitated, causing the oxygen tank to dislodge and break
        through the nose cone of the aircraft.
        All crews have been educated to properly secure oxygen tanks in the
        aircraft and to not leave them between patient’s legs.

Any one of us who has flown patients in single-engine aircraft knows that finding a place for all the equipment can be a challenge. A BH-206 or AS-350 cabin simply does not have enough cabinets or drawers to accommodate the "stuff" that we have to take with us on flights. The EC-130 cabin is cavernous, but even here there is a dearth of cabinets and drawers.

Some cabins are bigger than others, with lots of cabinets and drawers. Even in this large cabin, items are clipped to a wall ring or seat strap - and depending on strength of restraint - could fly loose in a violent acceleration or deceleration.  

Like Gunny Highway, we end up improvising, adapting, and overcoming the limitations imposed on us by the folks who select the aircraft we work in. This equates to stuffing functionally-grouped items into a bag or soft-sided case and "securing" these with a D-ring through a strap or handle. While some aircraft have a baggage compartment, this cannot be accessed in flight, so the things that might be required must be kept at hand in the cabin.

Like I said, it's a challenge. And there is a certainty about the items that are tucked, stuffed, or clipped - when things get "real" in flight, they are going to go everywhere - including outside the aircraft. In the picture on top, a bird coming through the windshield caused an over-pressurization of the cabin and the doors popped open slightly. Pieces of medical equipment were strewn across the countryside.

An inconvenient truth... "Those items that you think are secure in your cabin? They aren't." ( from the paramedic who was on that flight)

In retrospect I am fairly certain that an FAA inspector would determine that this medical cargo was not adequately secured. Consider the requirements when you fly on a commercial jet, like Delta.  You must put all items in the overhead bins or underneath the seat in front of you. If you look under the seat you will see a metal restraining bar placed there to keep the bag from becoming a missile-hazard in the event of a sudden-deceleration in either the vertical or longitudinal axis (a crash). No items can be allowed to block emergency egress - and the definition of what constitutes blockage is pretty exacting. You cannot hold a laptop in your hands for take-off and landing, and any item bigger than a tablet or phone must be stowed as described above. You are not allowed to put your laptop in the seat pocket in front of you. You are not allowed to secure items in an empty seat with a seat-belt either - but we do that in our single-engine HEMS aircraft regularly.

Now compare our operations to the part-121 carriers (the airlines). When a critical patient is on board and multiple interventions are occurring in flight, the aircraft looks like a combat-zone after landing. Perhaps it's the nature of the job. One thing is for certain, the appearance of the aircraft cabin on the way to the patient should meet the requirements for stowage and security. The best resource for determining this is going to be your maintenance personnel. They should be consulted as you make decisions about what will go where. Pictures of cabin layouts eliminate doubt and the chance for any questions, or fines, after the fact. In fairness to his license and your company's operating certificate, your Director of Maintenance should probably be the determining authority as to whether what you want to do complies with the rules or not. Take some pictures of your cabin when it's configured for a patient flight, email them to your base mechanic asking for verification that everything is okay, and print and save the email.

An anecdote...

Years ago I operated a BH-206 with a spiffy new medical interior. The stretcher system included a restraint-bag that was intended to go on the patient's feet and be secured with seat-belt straps and buckles. My medical crew took one look at this foot-bag and determined that it was going to be too much trouble - and would become blood-soaked and dirty. They removed it from the aircraft. After a few months my director of maintenance got wind of this and blew a gasket. He explained to me in very clear terms that every bit of the medical interior was required by supplemental-type-certificate and every flight we performed with a piece of equipment removed constituted a separate violation of the Federal Aviation Regulations... He then proceeded to self-disclose our screw up to our FAA principal operations inspector, and we learned from this. Your aircraft has medical equipment installed and medical cargo carried on board. There are strict rules for both categories.

Pilots - The fact that you could put stuff wherever you wanted in the military has no bearing on what happens in the civilian world. Civilians are expected to be treated with a higher degree of regard than soldiers. The medical crew are - in the eyes of the FAA - passengers. You are the responsible party for whatever happens on your aircraft. You are held to the highest standard against negligent behavior by the law. The fact that your base is a long way from HQ and the FSDO will not protect you should things go south, or you get a friendly visit from the men in ties. As a matter of fact, in their efforts to protect the certificate, your company's leadership will first say that they had no idea what your were doing. The fact that "we have been doing it forever" will not help when the FAA begins digging in the dirt,

Remember over-water flights in single engine aircraft? It was no big deal - right up until the minute it was...

In another incident, a pilot decided that the balloon pump could be fastened into the rear facing seat of a BK cabin, instead of using the "approved" straps and floor mounting location. Another upset director of maintenance... Although rare, there are certain instances where people have to get out of an aircraft cabin right-this-second - and anything in the way is a no-go.

This is serious business folks. The O2 bottle coming loose in the event described in the report above could equate to a hefty fine against the certificate holder levied by the FAA, and the pilot could lose his license. Just imagine that D-cylinder falling down through someone's roof while they were eating breakfast or writing a blog-post.

It's better to ensure that your method for storing and securing equipment meets the requirements of the regulations before a problem is noted, not after. A picture is worth a thousand words, and an email is forever...

Friday, November 13, 2015

Meeting Ira...

Dr. Ira Blumen with the University of Chicago Aeromedical Network Dauphin.

I attended two educational sessions presented by Dr. Ira Blumen while attending the recent Air Medical Transport Conference in Long Beach, California. I have heard Dr. Blumen's name mentioned over the years as an authority why HEMS helicopters crash. I confess to wondering why there aren't more helicopter pilots answering these questions - why are we asking doctors how to fix HEMS, why aren't we asking pilots?

After meeting him and gaining some insight into his work on our behalf, I realize that my thoughts were wrong-headed. Dr. Blumen, joined by a team of HEMS professionals from all over the country and representing multiple disciplines, set about the most comprehensive project yet to determine why we crash HEMS helos, and what we should do to stop crashing them.

Dr. Blumen's recommendations are evidence-based, and go beyond the National Transportation Safety Board's work. Indeed, the completed NTSB reports served as a point of departure for the team's investigations into every crash between 1998 and 2009, 140 separate investigations...

But the team didn't just read the NTSB final reports, they read the entire "docket" (the entire file of every bit of information relative to a crash). This represented a tremendous amount of work, performed by volunteers. NEMSPA was represented by Bill Winn - thanks Bill for this service.

What did they find? Sometimes the NTSB gets it wrong. The NTSB doesn't fully understand what we do in HEMS and how we do it.. They do good work with what they have - but Dr. Blumen's team dug deeper and gained further insights.

I located a pdf of an earlier powerpoint on Dr. Blumen's work. Click here to view.

The first of Ira's presentations recapped the team's research work, "The Opportunity for Safety Improvement in Helicopter EMS." The next was titled "The Wizard of Odds."  His second presentation was coincidentally scheduled to follow mine in the same room.

As I was spending time with my group, Ira was sitting on the floor behind the rows of chairs, laptop open, reviewing or tweaking his presentation I think. It reminded me of nights in the 160th, prepping and briefing missions - with work going on until the time-hack. I was struck by the fact that a mere-pilot was in the same room with an acknowledged industry expert. Ira and I both want the same thing - to prevent the next crash. The experience was collegial.

Are you a pilot? There should be more pilot's speaking at AMTC. Why not you? You can increase your knowledge - for the surest way to learn more about anything is to teach a class on it - and you can elevate all of us pilots in the eyes of our partners in HEMS. Presenters get a free pass to the conference and a free room-night in the show hotels. AMTC is in Charlotte next year and you can submit a presentation idea through early December...

So, about those odds...

Ira dispelled some myths. Do you think that flying on the backside of the clock - at night - is significantly more dangerous? I did. It's not. I have been putting out the information gleaned from various sources, and it turns out those sources are frequently wrong. We all know the joke about things on the internet, but it turns out things being published in the media are wrong too.

Even the FAA get's things wrong. In their fact sheet to accompany the new HAA rules, they note that there are approximately 1515 (ems) helicopters being operated in the United States. This isn't what Dr. Blumen found, his number was closer to 900.

Flying HEMS is not 6,000 per cent more dangerous than other types of flying as was published in the media. For the patient, the HEMS flight is the least risky part of the health-care experience. When they go into the hospital, that's when things get "real." In 2008 flying HEMS may have been the second most dangerous occupation behind commercial fishing. Not so anymore. We have made real safety improvements in HEMS - the numbers don't lie. The 40% probability of being killed in HEMS over a 20 year career as was noted in a medical publication is simply wrong.

We still have a way to go and both Ira and I think that AMRM is the answer. It's number one on his list of "fixes."

Dr. Ira Blumen is very gracious, and funny, and wickedly smart. He has been in movies and TV shows. His program, UCAN, uses flying doctors. So he has been there and done what we do. He is our friend, and we are lucky to have him in HEMS. I look forward to sitting in more of his presentations, and hopefully you will be there with me.

Wednesday, November 11, 2015

The Fifth Law of Trauma : Pediatric... From Dr. McGonigal's Trauma Professional's Blog

Dr. McGonigal writes...

I knew there was a fifth law! Any time I give a pediatric talk, I mention it. This one applies to anyone who takes care of children, and is particularly important to EMS / prehospital providers and emergency physicians.

On occasion, medics are called to a home to treat a child in extremis, or occasionally in arrest. Similarly, extremely sick children are often brought to the ED by parents or other caregivers.

Here’s the fifth law:

A previously healthy child who is in arrest, or nearly so, is a victim of child abuse until proven otherwise.

Bottom line: It’s so easy to go down the sepsis path with sick kids, especially those who can’t talk yet. But healthy children tend to stay healthy, and don’t easily get sick to the point of physiologic collapse. If you encounter one as a prehospital provider, glance around at the environment, and evaluate the caregivers. In the ED, ask pointed questions about the circumstances and do a full body examination. What you hear and what you see may drastically alter how you evaluate the patient and may save their life.

To read more from Dr. McGonigal, click here... (used with permission)

Thursday, November 5, 2015

A video produced by the FAA Safety Team in Orlando, Florida. A good primer for anyone interested in learning more about CRM and it's offshoot, Air Medical Resource Management...

Monday, November 2, 2015

Congratulations Randy, your 45 year career is an inspiration. Best wishes for a long and happy retirement...