Hoisted On My Own Petard...

It's one thing to know what's right...

          It's another thing to say what's right...

                       But it's another thing entirely to fly right...

                                                This is the main thing...

I was flying at two thousand feet from a metropolitan-area hospital back to my base at a small hospital in the country. It was a beautiful day and all was well with the world. During a break in the conversation, and after a few seconds of silence, my paramedic asked, "hey Dan, where would we go if the motor quit right now?" 

And I put him up to it...

Here's the back story;  after a friend flew a helicopter into a storm and killed his crew, I volunteered to present AMRM training for my company. I studied crashes in all segments of rotor and fixed wing flying, looking for the "why," and how to avoid repeating the mistakes. What I found was that crashes usually happen because of mistakes that can be identified and prevented. The mistakes are right there for us to discuss; the folks who made them paid a terrible price. Read, do not repeat.

Working as a relief pilot allowed me to go around to different bases and focus on human factors during shift briefings. I look at some young man or woman and wonder - is there something I could say here today that will save their lives?

I was moved from a BK-117, to an EC -135, then to an Astar. Single engine aircraft are reliable, but engines do fail. From observing many of my peers, and myself, I realized that many of us pilots fly our helicopters as if the engine will never quit. We don't often fly "defensively." We hop into the machine, load coordinates, and push "direct-to." And we usually fly an altitude out of habit, without much thought to what we are flying over. 

An anecdote: I was filling in at Stuart, Florida. As we prepared to cross over a river in an Astar, I climbed steadily to 1500 feet, and altitude that I judged would let me reach a shoreline in the event the motor quit. One of my paramedics joked to his partner,"okay Brett, your job is to look out for airliners." I didn't get the joke. I asked, "what are you talking about?" He explained that I was flying much higher over the river than the other pilots did. I asked, "how high do they fly?" 

"Oh, about 500 feet..."

That aircraft had no floats...

Pilot's flying at 500 feet over water aren't thinking about the motor quitting. I understand that some jobs in single-engine helicopters require operating at airspeeds and altitudes such that an engine failure is going to hurt. And I know that engines are reliable.

But I wonder why we accept risk needlessly.

In truth, most of us single-engine pilots aren't given much chance to become proficient at autorotations.  Maybe we should stack the deck in our favor with...

Altitude.

Salient points in this video are made at 3:22 and 6:02. "Today's the day..."

The over water issue became a big thing a couple of years after that crew and I had that discussion. Nowdays, no one is flying a single without floats at low altitudes that won't allow us to reach shore should the motor quit.

This is a tour Astar. It lost power in flight with tourists on board. There was a
place to land, a narrow strip of beach, between rocky wooded terrain and water
and everything worked well. Kudos to this pilot for being ready. Not all are.

The FAA thinks that we are operating our single engine helicopters - at any time - such that an engine failure can be safely terminated with an autorotation. That's why they let us fly patients at night in a single.

Code of Federal Regulations, Part 91, explains that our altitude should allow a landing without undue hazard to persons or property on the surface. What about the persons and property on board the helicopter? Shouldn't we be concerned about them too? The fact that the weather minimums will allow you fly at very low altitudes doesn't mean you must. Your personal minimums can account for the fact that your motor might quit and you might have to land right now. If the weather won't allow you to fly at an altitude at which you are confident of a safe landing, maybe you should not go...

 We should fly defensively.

So, back to my team member and his question. I ask teams to "inquire, advocate, and assert" during my shift briefings. And one of my often-recommended questions for a team to ask a pilot is, "hey, if the motor quits right now, where are we going?

So Wes asked the question of me, at two thousand feet on a beautiful day. I looked down and saw nothing but a broad green carpet of 50 foot pine trees, with no clear spots that I could hope to reach in the event of a power-failure. See, my "direct-to" course took me over terrain which would not be kind to an autorotating pilot and crew, and I was just following the GPS.

He had me.

Maybe we should give more thought to our route (is there a place to land?) and altitude (can I reach that place?) And maybe you crew members should get more involved in discussions about this. After all, if your motor goes bang in the night and drops you into hostile terrain with no place to land - it will suck.

The question for you single-engine pilots is; after losing power from your one motor, are you going to be just another dead pilot, or are you going to be the Chester "Sully" Sullenberger of Helicopter EMS? You know what Sully had going for him when all his engines quit?

Altitude.

May your engine never quit - and may you be ready when it does...

Engines do fail. If  the oil-pressurre light comes on, it's best to stop flying.

                                                                                                  edited, January 29th 2017, tightening.

Professionalism 101...

I came across a bit recently on a helicopter forum,

"Yes I am an Air-Evac pilot so I know you hate me before I even vent about the Vanderbilts "RudeNess" but I think everyone will agree.  

Well I was at Vanderbilt a few days ago and had to orbit the heli pad for about ten mins while another helicopter off loaded their patient.    The inside was wide open and still they would not let us land there.  Our patient was post CPR and tanking on us and Vanderbilt said  "DO NOT LAND ON THE INSIDE PAD"   its private.  Ok I understand that but they were so very rude about it over the radio.  

Well when we landed one of the Vanderbilt managers came up to me and said very LOUDLY to me.....   "THE INSIDE PAD IS PRIVATE FOR THEIR OWN HELICOPTERS AND THEY DIDNT CARE WHAT CONDITION OUR PATIENT WAS IN" and "THAT IF I DIDNT LIKE IT I COULD JUST TAKE OUR PATIENTS ELSE WHERE"   That is exactly the way she said it.     And when the medical crew came up the same Vanderbilt Manager repeated her self again to them.   

All I can say is that Vanderbilt needs to police their own..

Its no wonder Vanderbilt has the reputation thay have.   

I am sure this will get deleted because Vanderbilt HATES this forum.   

The truth hurts..........

I am sure many will agree with the problems that have had with Vanderbilt..."

Friend - there are winners and losers in every company. If you have a problem with a person, it probably has more to do them than the company. Your best defense and offense is nothing short of absolute courtesy and professionalism. Smile. Offer assistance. Be cheerful.
Be an ambassador for your company, and the person your parents would be proud of.

Vanderbilt  flight nurse Kevin High wrote in an industry publication years ago. He anticipated some of the issues that would arise as the HEMS market became over-saturated and competitive pressures heated things up. Kevin wisely counselled that we should all take a deep breath and remember that we are now - and should ever strive to be - professionals. We fly sick people for a living. It's an honorable profession. 

Don't let someone strip you of your professionalism or the dignity of caring for other human beings.

At the worker-bee level, those of us who occupy the aluminum office may not understand all the hidden agendas at play in HEMS and the hospitals. Unfortunately, HEMS attracts it's fair share of scoundrels and miscreants.

There's a ton of money washing around in the healthcare tub; and money makes people behave badly. Contracts come and go, new competitors pop-up, influence is bought and sold, people and companies strive for dominance...

Let someone else worry about that stuff. If you focus on being the best pilot, nurse, paramedic, comspec or technician, everything else will take care of itself. Do not fear what the future might bring. If you are excellent, your future is secure. HEMS is a very small world. Reputation is everything.

Think forward a few years. The way you are now will matter to you then. A hospice nurse told me once that not one of her patients ever said "I wish I had made more money." The thirty or forty odd years of service you provide will end much more quickly than you might believe, and the way you have conducted yourself across that span will be very important to you. Think of being decent now as an investment in your future self-satisfaction.

Managers get wrapped up in turf wars, struggles for market share, and quests for power. They get paid for this, that is their job and they no longer have to get into a helicopter at 3:00 am.

Let them worry about their worries, you mind the wonderful human resource that is you.  Remember that we crews are much more alike than we are different, no matter who we work for. We rarely get to pick the helicopter we crew, the equipment we carry, or the market we serve. "We are just glad to have a job." (Dutch Martin, retired HEMS pilot).

It is foolish to take an adversarial position with teams from another company, and trust me when I tell you that the senior leadership of your company are cordial when dealing with competitors. After all, mergers and acquisitions can make your competitor today your coworker tomorrow.

From personal experience, twice... When there is blood on the ground and we gather to show respect, all those "differences" become trivial. Believe it or not, competing crews refusing to talk to each other contributed to a fatal mid-air between two EMS helicopters.

If you want to land at a hospital, and they say no, don't get upset. If there is a delay, ask how long. If it is too long, divert. Go to another available hospital pad or airport. Call for an ambulance. That's what you would do if there was bad weather on top of the initial destination. Just roll with it and record everything. As long as you are behaving according to what's best for safety, patient, and company - in that order - you can face anything or anybody.

That's all we as crews can do. We can't force the owner of a  private helipad to let us land. And if we can't and the patient dies, it will be for someone else to sort out.

At the end of the day, all we can do is seek to maintain our perspective and our status as a...

Professional.

HelicopterEMS.com

Three Will Say Go...

I find out on facebook - usually.

A helicopter crashes. A crew member or two or three whom I have worked with announces that they are departing HEMS to return to the hospital, or to return to school, or perhaps to leave heath-care altogether.  Cited reasons are schedule, or time with family, or a better job beckons... I miss them when they leave, but I understand the forces at play.

These departures occur in the aftermath of a fatal crash. Crashes get people thinking, considering risks and options. And some folks decide that the risks of flying sick people outweigh the benefits. The companies aren't much help with this - not in my experience. The mindset of management seems to be, "hey, if you don't want this job, don't let the door hit you on the way out. There is a line of people waiting for your job." Perhaps there is a half-day "safety stand-down" in which management and speakers discuss events, and then we are expected to saddle-up and get back on the horse.

Some of us don't climb back up.

That's too bad. We lose capable, compassionate caregivers every time someone flies a helicopter into the earth. They don't come right out and say why. They just go away quietly. They represent the "other" cost of a crash. Consider the costs to recruit and train a flight nurse. And then orient her or him to health-care during flight-operations. Six weeks as a third crew member? Not uncommon. The most precious assets in HEMS are wearing flight suits, and some of them will leave after this last crash in California.

I attended Krista Haugen's presentation on what survivor's go through during the recent AMTC.  She also discussed how programs should prepare for and respond to crashes. It was the last class, the last hour of the last day of the conference, and the room was full. Krista was the co-founder of the Survivor's Network for the Air Medical Community. She lived through a crash and it affected her. Sometimes we need to talk things out, with someone who has been there. That's what the network does, they offer someone to talk to.

Click there to visit their facebook page...

Long ago, a friend took my helicopter and crew in Honduras and crashed. The guy sitting in my seat died along with everyone else on board. I experienced emotional aftershocks, and physiological effects. Two months later, after the Army un-grounded the Chinook fleet, I climbed into a pilot's seat and my legs began to jump and hop on the pedals. My voice was okay, and I knew what I had to do, but for the life of me I could not stop my legs from jumping. The instructor in the other seat said, "don't worry, it will pass."

I tell you this too friend. If you are upset about this last crash - or any of the others we have suffered, that is okay and normal. Different people will respond in different ways. Some may cry, some may laugh, some may scoff, Many will say it's because of this or that factor. And some fools will look you in the eye and tell you that crashing is part of flying and if you can't deal with it too bad.

Crashing helicopters is not part of flying. We CAN stop crashing helicopters. And you are part of the answer. I won't tell you not to go if you feel you must, but consider that your replacement will be some young person with stars in her eyes, someone who won't have your depth of experience, someone who won't understand - as you do - how important it is for a crew member to know when to say...

STOP.

Pilots, please consider easing up a bit for the next few weeks. Consider what is going through your crew's minds. If one of them asks about the weather, that is a sign. An extra dose of conservatism may let them work through some things that are bothering them. This is especially true if you are working with people you don't know well. You may have "flown in much worse weather than this" and you may be sure of your skills and a good outcome. But please remember, the crew is your first concern - not the patient. You may not like them, you may not like this, but it's true. Your job is to protect the crew. And this includes being mindful of their feelings.

Respectfully,

HelcopterEMS.com

Bullets in the Gun

Our friend Josh Henke wrote this when he was a flight nurse with CALSTAR. He switched programs and coasts, but he is still as passionate about patients and safety as ever. We hope he is well.

“Nobody would ever go out if they thought they weren't going to come home.”

That seems like an easy sentiment, right? Just as easy as “nobody would point a gun to their
head if they thought it was going to go off.”
This seems like simple logic to a lot of us. Something that complacency and confidence has
fostered in our minds. The “it would never be me” mentality. Or the, “just 5 minutes farther and
well see what the weather looks like then.”

We all do it, have done it and unfortunately will do it in the future. (despite the warnings from
other more experienced, “luckier” crews from the past.) We have all at one time or another put
the gun to our head, without checking it, hoping it doesn't go off. And in that I mean, we’ve all
climbed into an aircraft feeling a bit unsure. Maybe feeling a bit “exploratory” IE: “lets just go up,
fly around and see if we can get in there.

The simple logic in this is, how often are we not checking the gun. How often are we NOT
making sure the gun isn't loaded. What are the little things we can do to make sure that gun is
empty before we leave the safety of the ground?

I'll use a recent example of mine in which i feel like a “checked the chamber” before we left.
“Medic engine 21, medic engine 22, battalion 514, medic 36, medic 39, medic 41 Medevac 10:
respond for a vehicle over the curb at JFK elementary. Multiple victims with reports of victims
still under the vehicle.”

“Shoot……..this is going to be interesting”

And so we checked the weather, even though the school was only 2.5 miles away from our
base. We tuned our radios to the county frequency so we could keep tabs on the tenor of the
call and be in touch with the battalion chief and have a heads up on the LZ plan, etc. While we
listen to the county frequency, we get bits and pieces of patient information too, such as “victim
appears to be a young male, trapped under the vehicle with agonal respirations”
As the pilot walks out, i ask my partner in the aircraft to turn his radio off as the piloting getting
in. He gives me a quizzical look, but complies. “thank god” i think.

My rationale? I know that my pilot has school age children and lives in the area. I'm not sure
what school they go to, but I know he lives in the area. He’s also a newer pilot to our base. But
my rational is this: i don’t want my pilot thinking that this might be his kid. Or any kid for that
matter. I don’t want him to rush his startup and miss something because he’s trying to go faster
for the sake of a child. (we all do it. when we hear its a kid, the hackles go up, concentration
gets focused, and we try to do things just a bit faster because, its a kid. An innocent.)
I wanted to take the bullet out of the gun so to speak. I wanted my pilot to startup and fly like he
was going to pick up his dry cleaning. Just like he does every time we fly. And i wanted him
thinking about nothing else.

We all go out and fly. And we all like to think that we are doing our job as safely as possible. But
are we really checking the gun? or are we just thinking about the standard list of safety items
that we always do? (weather, wind, duty time, etc.). Are we thinking outside the box when it
comes to leaving the ground?

We should because you know what, complacency and excitement are little bitches and they'll
sneak a bullet in that gun when you're not looking. so before you put the gun to your head, take
the 5 seconds, slow down, think and make sure that thing isn't loaded.
Please keep our neighbor flight program Sky Life and their families in your minds and prayers.
This is going to be a crappy Christmas for some of our family.

Fly safe, slow down, think.

Learning from our past... Life Flight Down...

At Last, Real Cat "A" Performance From A Twin Engine Helicopter at Gross Weight...

Jeff and I are riding over to his house near Penn State University for a visit. The years apart have vanished and we have taken up right where we left off, both eager to talk helicopters and HEMS. He tells me about his trip to AMTC in St. Louis  a few years back, paid for by Eurocopter (now AIRBUS Helicopters) so that he could stand next to Geisinger's new ship on display. He assures me he sold several aircraft on that trip, and was offered a sales job. That boy can talk - when the two of us both get going at once, cabin O2 levels drop.

Our conversation moves onto the newest variant of the BK, the AIRBUS H145T2. We discuss how it got certified. As you may know, the type certificate claims that an EC145 is really a BK-117C2. The company saved themselves a ton of money by saying that the 145 was simply a modified BK. Yes, sure, if you consider different engines, different fuselages, different engine monitoring systems, and different cockpit layouts simply "modifications" to an original. Now, with the addition of a fenestron the only thing about a H145 that resembles a BK is the rigid "blades bolted to the mast" rotor system. The French half of the marriage that made Eurocopter/AIRBUS got their way and added a fenestron, too bad they didn't add a starflex rotor system as well. The BK rotor system sucks, when in the clouds in turbulence.

Jeff says, "it's the first one with true Cat A capability." I hadn't thought much about Cat A lately, because here in America operators aren't required to comply with Category A takeoff requirements. We could, but we don't. It would reduce our payload and fuel range too much.

What is CAT "A"? Basically, it's a set of standards and procedures that result in a twin engine helicopter never being in a position from which a single engine failure will result in a crash. Most twin engine aircraft will not hover at maximum gross weight with one motor off-line, but Jeff assures me that the new 145 will. That is going to change how departures are made in this machine, I suspect.

Dare County Med Flight is the US launch customer for the H145T2
The addition of a fenestron makes the ship easy to identify.

If you want to read more about Category A standards, click here...

A category A takeoff looks different than a "normal" takeoff. As the pilot brings the aircraft up to a high hover, she backs up slightly, keeping the pad just departed from in view down below and slightly in front. Once at a "takeoff decision point" the ship is rotated and flown away. If a motor quits prior to rotation, we are going back to the pad. If a motor quits after rotation (pitching the nose down to accelerate) we will fly away on one motor. Likewise, on approaches the aircraft has enough power to land on one motor, without bending metal. When I got checked out in an EC-135, we practiced engine failures (using the FADEC's training mode) on approaches, and the 135 has near flyaway capability, but I am not sure it would meet true CAT A capability at max gross weight. The Bell 222s and 230s I flew years ago would have laughed at me if I mentioned CAT A. In those ships, the second engine would do no more than fly us to the scene of the crash. As happened here..



Luckily, motors don't quit very often. And we fly singles here every day. This is perhaps why, here in America,  Cat A capability isn't required. The airlines have a different deal. A twin engine airplane must have enough runway to accelerate to flying speed at which point the pilot makes a decision to abort or continue. There must be enough runway to stop safely from that decision point. They call this number of feet of runway required the "accelerate-stop distance." The aircraft must have enough power to fly away on one engine from that decision point. These requirements guarantee  the safety benefit of having two motors.

Here's hoping no one ever has to use the Cat A capabilities of the new H145T2. But it will be comforting to know that the capability is there, just in case.

How 'bout HIPAA? From The Trauma Professional's Blog - courtesy Dr. McGonigal

Bottom line: Trauma professionals do not have to deny patient information to others if they follow the rules. 

Are you Hip to HIPAA? from the trama professional's blog. Click here