On Machoism...

I have always thought of (and discussed) machoism from a certain perspective. But it has different personas. Here is a comment from a post I wrote on a facebook string.

One of our problems is that we are assumed to have the experience for all the different environments we operate in, or perhaps it's left to "tribal knowledge" (a check-airman's actual words during a message exchange on this topic a couple years back) to prepare us. Landing on, in, and among high-rise buildings is akin to mountain flying. No one in HEMS addresses wind or turbulence limits - it's up to the pilot. And if "all the other guys do it" then I should be able to do it too, right? I now realize that this attitude (I can do it if they can do it) is another form of the hazardous attitude "Machoism."

While attempting a landing at the Medical University of South Carolina's helipad on top of a parking garage, downwind of an airfoil shaped tower (The Ashley River Tower), I realized that the vortices off the building were putting me at the limits of aircraft control.

Image courtesy Vertical Magazine

The thought went through my mind...all the other guys would be able to do this...

I decided that what I was doing and thinking was stupid. It was self-induced pressure to live up to an image. I aborted the approach and went to an airport. The patient went by ground.

Sometimes old pilots try to be bold pilots...

In The Thick Of It...

It's fun to blog about HEMS. It's deeply satisfying to be in a room with flight teams discussing AMRM. I enjoy traveling and serving EMS pilots as a volunteer-member of NEMSPA's board. But nothing compares to actually doing the job of a HEMS pilot. It doesn't pay much, but it's emotionally rewarding.  It keeps me honest and filled with humility and respect for those with whom I serve.

Over the years there have been some remarkable flights. Flights in which great work led to good outcomes, and camaraderie, and laughs.

Once upon a time...

We are flying a woman from a rural hospital who has suffered an acute M.I. (heart attack). This lady needs to go to a cath-lab and get checked out right now. Or she is going to die. We rumble along in the darkness at two thousand feet with many miles to go, and it happens...

"Crap, she's in V-Fib!" My  nurse for the night, "Steve" (not his real name) exclaims...

The medic on board, "Terry" (not his real name) says, "Okay! I am starting CPR, get  ready to shock her."

What follows is a non-stop determined effort to keep this woman alive. Her heart is giving up - failing, but Terry won't have it. He talks to her, and us. "Come on lady, don't give up on us. You are going to make it!" The CPR alternates with repeated drug therapies and multiple shock events.

"Charging! Clear!" I take my hands off the controls. She jerks on the cot next to me. Compressions resume.

 I radio the com-center, "the guys are busy and can't talk now, the patient's in arrest, we are going to need help at the pad."

"Roger. Help at the pad"

I want to be helpful too, but I have to remember that my job is to fly the helicopter. "Calm down, do the job, ignore this drama."

Easier said than done...

We HEMS pilots can't let the impending death of a patient distract us, or cause us to do something different - or stupid. We have to fly the helicopter with the action inches away.

Not long ago, I heard an industry-leader state that we pilots should keep medical personnel "out of the cockpit." The problem with that idea is that our cabins are so small that not only are crew-members in the cockpit, so is the patient, and the cockpit is where the CPR happens!

Sidebar: For the record, I philosophically disagree with keeping crew-members out of the aviation side of HEMS - at arms length so to speak. But I understand that not everyone sees things as I do, and I understand why. That's a post for another day...

Terry is bent over at the waist, pushing on her chest. "Come on lady! Come on!" her heart runs through bouts of V-Fib, asystole, and occasionally short periods of  normal sinus rhythm, and still he works. Terry is burning up, sweating, breathing hard, CPR is hard work.

He says, "Guys, I'm sorry but I gotta fart!"  Steve and I answer at once, go ahead go ahead... 

Whatever it takes...

The fart is potent and floods through the cabin. I pull the vent knob and open my window. Whoa! It breaks the tension and we all burst out laughing.

Steve says, "Hey! she's got a rhythm!" She maintained that rhythm through the landing and being rolled to the cath lab.

She lived...

AOPA Petitions the FAA for Increased Training Credit : Flight Training Devices.

This is a timely topic for us in HEMS, as the new training rules called for in the  HEMS rule (public law) will involve the increased use of flight simulators and flight training devices. Indeed, one of the questions put to the action team I serve on for NEMSPA was "how can the FAA incentivize the use of flight simulators?"

Click here to read the AOPA letter to the FAA.

US Federal Aviation Administration (FAA)

Flight Training Devices (FTD)

FAA FTD Level 4 - Similar to a Cockpit Procedures Trainer (CPT), but for helicopters only. This level does not require an aerodynamic model, but accurate systems modeling is required.

FAA FTD Level 5 - Aerodynamic programming and systems modeling is required, but it may represent a family of aircraft rather than only one specific model.

FAA FTD Level 6 - Aircraft-model-specific aerodynamic programming, control feel, and physical cockpit are required.

FAA FTD Level 7 - Model specific, helicopter only. All applicable aerodynamics, flight controls, and systems must be modeled. A vibration system must be supplied. This is the first level to require a visual system. (added, no motion...)

Full Flight Simulators (FFS)

FAA FFS Level A - A motion system is required with at least three degrees of freedom. Airplanes only

FAA FFS Level B - Requires three axis motion and a higher-fidelity aerodynamic model than does Level A. The lowest level of helicopter flight simulator.

FAA FFS Level C - Requires a motion platform with all six degrees of freedom. Also lower transport delay (latency) over levels A & B. The visual system must have an outside-world horizontal field of view of at least 75 degrees for each pilot.

FAA FFS Level D - The highest level of FFS qualification currently available. Requirements are for Level C with additions. The motion platform must have all six degrees of freedom, and the visual system must have an outside-world horizontal field of view of at least 150 degrees, with a Collimated (distant focus) display. Realistic sounds in the cockpit are required, as well as a number of special motion and visual effects.
( Courtesy Wikipedia)

Can we perform single-pilot IFR in a single-engine helicopter?

We are returning from the Industry/Government conference in Alexandria, VA. We will have a post about the comments made in a day or so - but as a teaser - a serious and well-fashioned proposal was made to again conduct SE SPIFR.

Engine reliability was discussed, single pitot-static systems, and lightweight inexpensive autopilot systems - which will be appearing in our VFR aircraft in the near future.

HAI is involved in this debate, and more action is expected at Heli Expo, click here for info.

What do think about this?

The FAA Will Permit Drones for Journalism, Starting With CNN

Click here for full story from CNN...

AG Pilot Harassed by UAV

Click here for full story...

OSHA Orders Fired Pilot to be Reinstated, Citing Whistle-Blower Statutes...

Faced one night with a trip over mountainous terrain in a medical transport helicopter with a faulty emergency locator transmitter, a pilot refused to fly the unsafe aircraft and was later terminated in retaliation for doing so. An investigation by the U.S. Department of Labor's Occupational Safety and Health Administration followed. As a result, Air Methods Corp. was ordered to reinstate the pilot, pay $158,000 in back wages and $8,500 in damages, and remove disciplinary information from the employee's personnel record. In addition, the company must provide whistleblower rights information to all employees.

Click here for full story...

Never Quit Flying... A Video About a Catastrophic Failure...

Click here to view.

First AIRBUS EC130-T2 Placed Into HEMS Service...

Many of the flight instruments have been replaced with all-in-one digital technology. These include synthetic vision technology, on-screen satellite weather, GPS and real-time digital tracking of the helicopter for dispatch, night-vision, and traffic and terrain alert systems.

Click here for full story...

Air Ambulances Lack Oversight on Medical Care... The Bend Bulletin

Courtesy Marklan Hawryluk/The Bend Bulletin...

Want to know how we got to where we are in HEMS?

Click here for the full and informative story...

Is Mechanism of Injury a Valid Reason to Fly a Patient?

“It’s sort of the perfect storm,” said Dr. Michael Abernethy, chief flight surgeon for University of Wisconsin Health’s Med Flight. “It’s great money, it’s unregulated and there’s really no utilization criteria.” (quoted in The Bulletin, Bend Oregon)

If your system does not support viewing this video clip, access it by clicking here...

When we fly a patient who walks out of the hospital hours after arrival, some question the appropriateness of the flight. Then again, there are injuries which cannot be detected in the field, which might prove serious or fatal after some time has elapsed.

In some cases, staff at receiving facilities give helicopter crews a hard time.  "Why did you fly this patient?" asks the overworked and fatigued resident. Few if any cases allow a crew to decide that a patient does not need to be flown after arriving on scene. If first responders call, the patient will fly...


What do you think? Do you have any stories about flights that ended up being appropriate after all?

Here is one anecdote...

Some years ago I flew a mechanism of injury patient who was alert, oriented, and telling us not to make such a fuss over her, she was "fine".

We were only minutes into the flight when she decompensated, she became unresponsive and her belly began to show evidence of internal bleeding.

We were on our way to the "closest trauma center" in Camden, NJ, and upon arrival were unable to land as the pad was occupied by the State Police helicopter, shut down and unmanned delivering a patient the facility.

My crew made the decision to "cross state lines" (if you operate in the Philly area, you will understand that statement) to take her to our trauma center in West Philly (all of a 2-3 minute furthther flight).

We landed at our facility before the helicopter at the original destination had cleared the pad, in fact as I recall, the patient was in the OR, exanguination protocols in effect, by the time the other pad was clear.

Moral of this true story, unless you have a CT scanner available in your A/C or ground unit, perhaps mechanism of injury is not such a bad thing.

For all the naysayers, if this one life was saved for certain by that criteria, how many others have been as well?

MED-TRANS Selected As Provider For Mississippi Air Ambulance District

Residents will not be billed for transport..

Read full story...click here.

What Will Cheap Oil Mean For Us In HEMS?

Image courtesy BBC News

The effects of America's flood of oil are rippling out across the world. OPEC decided to continue production at current levels, effectively assuring a collapse of prices. We probably won't again see oil selling for less than $12 a barrel - as it did in 1999 when my entire new-hire class of  Gulf of Mexico pilots got laid off from Air Logistics. But the drop in prices is going to be big.


Click here for a story about trouble in the oil and gas industry...

Every change to the status quo brings winners and losers - and fear of belonging to the latter group is why so many fear change.

So, should we in HEMS be afraid?

That depends on what you do here. If you are an operator, your fuel costs have gone down and are going to go down further. The airlines are in the news because they are enjoying reduced fuel costs, and "keeping the money." We are airlines too. HEMS stands to benefit from cheap oil. History however is full of unexpected adverse outcomes. Every silver lining has a cloud.

If you are a HEMS pilot, cheap oil - resulting in less offshore oil and gas production - will mean more competition for a finite number of  HEMS pilot seats. When the wells are idle, there is no need for a helicopter to move workers to and from platforms. Offshore pilots are going to be looking for work, and filling open HEMS positions at entry-level wages. This will decrease pressure on HEMS operators to raise pay, so we can expect stagnation in wage-growth in the immediate future.

Overtime - or "workover"  opportunities will diminish, and relief pilots (like me) will be less important  (oh well, it was fun while it lasted!) Companies will be in a position to pick and choose from the available-pilot pool, and experience-minimums will increase. On the downside, there will be more people with no HEMS experience making the same mistakes new HEMS pilots have always made, and we will suffer more crashes due to stupidity. On the plus side,  people with questionable histories will be passed over in favor of spotless candidates.

And yes, operators do compare notes about pilots...PRIA notwithstanding. There are few secrets in HEMS.

There will likewise be an increase in the size of the available mechanic pool, and the same downward pressure on wages. Companies might even be able to properly staff bases with two mechanics working week-on week-off which would improve the mechanic's lot in life. So - perhaps for you "wrenches," less pay and a better quality of life.

Cheap oil will mean more people traveling and crashing cars, More spendable cash will mean more risky behaviors - smoking, drinking, speeding, falling off golf carts and 4-wheelers. Flight volume should increase. This will keep more bases in operation, and should be good for clinicians who aren't facing a mass-reduction in other health-care production. When I started flying HEMS there were about 300 helicopters in HEMS service, now there are about 1500. So lots of nurses, medics, and RTs get to scratch the flying itch.

So, is cheap oil good or bad for HEMS?

I guess it depends on your position and perspective...

Tell us what YOU think...

safe flights.

Tongue Piercings And Emergency Intubation (from The Trauma Professional's Blog by Dr. McGonigal)

Click here to learn more from the Trauma Professionals Blog...

Newest Cool Device : X-Stat Dressing (from the Trauma Professional's Blog)

You land at a scene for a shooting victim. You load him into your aircraft and a stream of blood sprays up and over the patient/pilot barrier and lands in a spotted pattern on the pilot's knee-board. He exclaims.

Gauze and pressure aren't stemming the flow, and you have a long flight back to a trauma center.

Perhaps this product would help...

We were pointed to this by Dr. McGonigal on his blog. Click here.

Read more at a PopSci article here...

Quick and Dirty: Posterior Hip Dislocation

Here’s a quick 5 minute video full of tips on diagnosing and managing this injury. Click here to view video.

Material from Dr. McGonigal's "The Trauma Professional's Blog" posted with permission.

Action Team Trip...Dinner With Friends...

We just returned from Dallas after attending  the third set of "action team" (FAA term) meetings to advise a working group that will advise an aviation-rule-making committee on new rules for Helicopter Air Ambulance (FAA term) pilots training. Still with me? It is a real eye-opener getting to see how rules get made, and pretty cool being here for the National EMS Pilot's Association representing the guys and gals on the front line. And straight-up I have to say that there is a lot of good "face-time" with chiefs and directors of operations (and Terry Palmer who directs training for Metro and is an Omniflight graduate!) I volunteered for this duty and have given up about a week of my time, but it has been a learning experience. Pilots - I recommend you join NEMSPA, get involved, volunteer to take on a project, and have fun with it. To a man (and women) every person on this team is totally decent, respectful, and (I believe) appreciative that us pilots want to be better trained, more professional...
More safe.
Last night at dinner, Kevin (Bell instructor) and Dennis (Air Methods DO) got into a discussion about 206s and engine failures. Apparently in 80% of the engine failures in a 206, the engine would relight if given the chance. So a technique is - if the motor quits - to mash on the start button with the throttle WIDE OPEN. At 60 knots the airflow will prevent an overtemp - and honestly if there is an overtemp followed by a safe landing - who cares.

Dennis told us that - after losing a friend to an engine failure fighting fires, he would, when dropping water, just hold the start button on during his final run-in. This momentarily fails the generator (with a light) but ensures that if the engine would restart it does.

I think conversations like this (and there were lots more!) are a big reason pilot training should be in a group environment, with time to interact, socialize, tell stories, and...

learn.