pic
Friday, November 18, 2016
Friday, November 11, 2016
Flashback Friday: ICE ICE Baby!
In some parts of the country, it's almost that time of year for ice on and in the aircraft. a couple of years ago, we in HEMS crashed a machine due to liquid water (rain) getting into the skyward facing engine air inlet - which was covered by a particulate (dirt) barrier.
As temps dropped throughout the night, the liquid turned to ice. The crew launched on a flight, and the ice underneath the filter broke loose and got sucked into the turbine a short time after takeoff. The ice destroyed the engine and the aircraft did not autorotate successfully.
A warm hangar would have helped...
A special notice about this is here...
While installing inlet covers is a pain, if a hangar is not available, and it is going to rain on your aircraft as the temperatures drop, it may be something to consider. We at this base are going to have to go out and run the aircraft each cold morning to defrost the blades, or suffer a delay upon activation for a ground run and visual check of the rotor blades. If there is frost on the cars in the parking lot, there is frost on the blades...
safe flights...
As temps dropped throughout the night, the liquid turned to ice. The crew launched on a flight, and the ice underneath the filter broke loose and got sucked into the turbine a short time after takeoff. The ice destroyed the engine and the aircraft did not autorotate successfully.
A warm hangar would have helped...
A special notice about this is here...
While installing inlet covers is a pain, if a hangar is not available, and it is going to rain on your aircraft as the temperatures drop, it may be something to consider. We at this base are going to have to go out and run the aircraft each cold morning to defrost the blades, or suffer a delay upon activation for a ground run and visual check of the rotor blades. If there is frost on the cars in the parking lot, there is frost on the blades...
safe flights...
Tuesday, October 25, 2016
For the love of flight...
Disclaimer: This isn't a story about HEMS. Yes it's a HEMS blog, but sometimes our minds wander.
If you are a HEMS pilot, or crewmember, it's late enough in the day that your chores are done. You may have done a flight, had lunch, enjoyed your safety nap, started CTS or AVSTAR and said...
Not today!
Rejoice! We have something that will make you smile.
No helicopters were harmed in the making of this film...
Maybe next year someone will show up with a wing that spins...
If you are a HEMS pilot, or crewmember, it's late enough in the day that your chores are done. You may have done a flight, had lunch, enjoyed your safety nap, started CTS or AVSTAR and said...
Not today!
Rejoice! We have something that will make you smile.
No helicopters were harmed in the making of this film...
Maybe next year someone will show up with a wing that spins...
Tuesday, September 6, 2016
From our Facebook page... Whose business is it anyway?
One of the two "business ends" of HEMS. That's what makes HEMS so interesting. And challenging.
HEMS is half healthcare and half aviation. So are we an aviation industry that adds a healthcare component as we fly people? Or are we a healthcare industry hiring a helicopter to shorten timelines?
Yes. We are both.
We need each end of that flying ICU to operate at peak efficiency. And to do that we have to work together. Straight up.
Pilots. Please don't interpret questions from your crew as threats to your position. Please ask yourself, is there some way I could handle this better? If they have a weather app on their smartphone, use it, and them, as another resource. Don't get angry when a crew member is looking at weather. Hundreds of us have killed hundreds of them. In weather. You may know that you are better than the folks that crashed. So did they, as they walked out to their helicopter for the last time... Patience and humility.
Please.
Clinicians. Please understand all of the information that your pilot is processing and acting upon, even as they sit there quietly and wiggle sticks. They weight of their responsibility is heavy, and pressure changes behavior. Patience and humility.
Please.
Leadership. Do not let a sore fester in your program. The infection WILL spread.
Do your job.
Please.
All. Please communicate clearly and calmly. Try to discharge your emotions when searching for information. Say what you mean to say...
It's a matter of life and death that we do this correctly.
HelicopterEMS.com
Monday, August 8, 2016
Reputation Unsullied...
Have you heard the news?
Clint is directing another movie. and it's going to be a good one; a must-see for any aviation professional. Mr. Eastwood has set about the task of telling the story of an un-remarkable man, who performed a remarkable feat on a beautiful clear morning in New York City.
Just about enough time has passed since Chester "Sully" Sullenberger and his co-pilot Jeff Skiles successfully negotiated a dual-engine failure and performed a flawless "dead-stick" landing into the Hudson River. We can discover the wonder all over again.
Here's the remarkable thing about Sully. Until the day he lost both engines, his life was - well - unremarkable. But when his measure was taken, he measured up. A random event allowed him to demonstrate his skill, his coolness under pressure, his ability to use CRM effectively.
Sully did have some things going for him. First, his employer allowed him to train regularly for loss of power and forced landing situations. He sat in a classroom and studied airline crashes. His company paid for the overtime to allow the pilots to be fully prepared for the worst case. Since his adventure turned him into a celebrity, he has used his platform to warn of a general deterioration in pilot training. He says "we need to respect the profession."
Sully and his peers admired another pilot - Al Haynes - who had to land a jet he could not control. Sully views Haynes' ability to save so many of his passengers and crew as a triumph of individual preparation and flawless teamwork. True, Sully had experience flying gliders during his time at the Air Force Academy. But perhaps the main thing in his favor that morning was his mindset. His attitude.
When a flock of birds flew into his path and fragged both motors, he was not startled. He didn't waste a second thinking "this can't be happening to me." He made a quick decision on how to resolve his problem.
ATC offered several landing options. Sully said, "We're going into the river..."
Aviation is so safe today that it's easy for us to relax and take it for granted. Turbines are so reliable that we can become complacent and disregard the thought of losing power at the worst possible moment. But turbines do fail.
The pilot of this helicopter was faced with a "Sully Situation." He had just taken off, in a manner consistent with his training and experience. He didn't have the benefit of a long runway that would allow him to stay out the avoid-area of his aircraft's height-velocity diagram. When single-engine helicopter pilots depart hospital helipads, which are often pinnacles or confined areas. they tend to make an altitude over airspeed departure. We go right into the coffin-corner of the dead-man's curve. We initially climb vertically. That way, if the engine quits we can go back to the spot from whence we departed. Or perhaps to an adjacent parking lot. It's a calculated risk-decision. Mind you, it's not a one-size fits all situation. Every takeoff and landing area is different, and each requires forethought and planning. A little bit of "what-if."
But how many of us actually think about the engine failing each and every time we take off? Do we announce. as part of our take-off briefing, "and our forced landing areas will be...?"
When our engine quits, will we show the right stuff? Will we be like the gent flying the helicopter above? Yes, that man bent the skids. That's what the book says will happen at that combination of altitude and airspeed. But way more importantly that pilot saved himself and his crew. He is the skilled and capable helicopter pilot who can forever-more be referred to as the Chester "Sully" Sullenberger of Helicopter EMS.
What about us? When it's our turn, will we be as good as the gent above?
Or will we be just another dead pilot and crew?
It's up to us to fly right.
Clint is directing another movie. and it's going to be a good one; a must-see for any aviation professional. Mr. Eastwood has set about the task of telling the story of an un-remarkable man, who performed a remarkable feat on a beautiful clear morning in New York City.
Just about enough time has passed since Chester "Sully" Sullenberger and his co-pilot Jeff Skiles successfully negotiated a dual-engine failure and performed a flawless "dead-stick" landing into the Hudson River. We can discover the wonder all over again.
Here's the remarkable thing about Sully. Until the day he lost both engines, his life was - well - unremarkable. But when his measure was taken, he measured up. A random event allowed him to demonstrate his skill, his coolness under pressure, his ability to use CRM effectively.
Sully did have some things going for him. First, his employer allowed him to train regularly for loss of power and forced landing situations. He sat in a classroom and studied airline crashes. His company paid for the overtime to allow the pilots to be fully prepared for the worst case. Since his adventure turned him into a celebrity, he has used his platform to warn of a general deterioration in pilot training. He says "we need to respect the profession."
Sully and his peers admired another pilot - Al Haynes - who had to land a jet he could not control. Sully views Haynes' ability to save so many of his passengers and crew as a triumph of individual preparation and flawless teamwork. True, Sully had experience flying gliders during his time at the Air Force Academy. But perhaps the main thing in his favor that morning was his mindset. His attitude.
When a flock of birds flew into his path and fragged both motors, he was not startled. He didn't waste a second thinking "this can't be happening to me." He made a quick decision on how to resolve his problem.
ATC offered several landing options. Sully said, "We're going into the river..."
Aviation is so safe today that it's easy for us to relax and take it for granted. Turbines are so reliable that we can become complacent and disregard the thought of losing power at the worst possible moment. But turbines do fail.
 |
| Image courtesy John Thompson |
"witnesses said the helicopter reached about 80 to 100 feet when it suddenly plummeted to the ground in a cloud of blue smoke."
But how many of us actually think about the engine failing each and every time we take off? Do we announce. as part of our take-off briefing, "and our forced landing areas will be...?"
When our engine quits, will we show the right stuff? Will we be like the gent flying the helicopter above? Yes, that man bent the skids. That's what the book says will happen at that combination of altitude and airspeed. But way more importantly that pilot saved himself and his crew. He is the skilled and capable helicopter pilot who can forever-more be referred to as the Chester "Sully" Sullenberger of Helicopter EMS.
What about us? When it's our turn, will we be as good as the gent above?
Or will we be just another dead pilot and crew?
It's up to us to fly right.
Tuesday, July 26, 2016
AMRM 101.... Managing fatigue
OH MY GOD!
"The nurse was restocking the drug bag after landing. The crew had just completed a patient transfer from a rural facility to a major metropolitan hospital. He knew what supplies had been used, or at least he knew what supplies were supposed to be used, and as he inventoried the drugs, one that was supposed to be consumed wasn't. Worse, one that was not supposed to be gone was. The patient had been given the wrong medication. He immediately went inside his base and called the receiving hospital. "Hello, I just flew in Mr. Doe. I am afraid we may have made a mistake with his meds..."
The FAA and the NTSB have identified fatigue as a silent partner in most of the fatal accidents we suffer in HEMS. In recognition of this fact, the study and discussion of fatigue has been included in the list of required topics for Air Medical Resource Management and Crew Resource Management training. As it turns out, fatigue can be factored into many of the mistakes and mishaps we experience. If your mouse is tired, you don't need a better mouse trap.
From advisory circular 00-64...
(3) Fatigue Countermeasures. The term “fatigue” has been used to describe many
different experiences: sleepiness, physical tiredness, inability to focus mentally, time on duty,
types and number of missions, prolonged stress, and other factors. The effects of fatigue, which
concern the operational community, are those that affect crew member alertness and
performance. This type of fatigue stems primarily from sleep loss, circadian rhythm disruption,
lack of fitness, inadequate food and fluid intake, and the interaction of these physiological
variables.
From CFR part 135...
§ 135.330 Crew resource management training.
(a) Each certificate holder must have an approved crew resource management training program that includes initial and recurrent training. The training program must include at least the following:...
(6) Effects of fatigue on performance, avoidance strategies and countermeasures;
The flight paramedic finished his good-byes and climbed into his truck for the hour-long ride home. It had been a long and a good shift, with a pilot and nurse he enjoyed working with. The three of them seemed to click together as a team, and they had completed four flights! The workload and activity had helped him feel okay through out the day and night, although he did struggle a bit completing the last of the charts. Charting had kept him from resting, and he had considered the need to close his eyes for a bit. But his base needed every flight, and he had willingly done his part to make the flights happen. He was a member of a team, and the team needed him.
He departed the secondary road and eased onto the interstate highway for the long, boring ride to the city. As he rode along, cruise control set and cool air flowing, he began to feel drowsy. "Thank goodness this didn't happen last night" he thought to himself, and sat up straight in his seat. He turned on the radio, and set the volume up higher than normal. He stretched his neck and head left, then right. He took a deep breath and flexed his hands. "Come on dude. You can do this. Wake up!"
Ten minutes later he was struggling to stay awake. He was too comfortable, and too relaxed. He thought, "twenty more minutes and I am home." He checked his side and rear mirrors, no traffic. Just him and a long ribbon of smooth concrete. His eyes drooped. His breathing and heart rate slowed. He was no longer concerned. His eyes drifted shut and a peaceful, wonderful sleep came upon him.
The white Ford pickup truck drifted from it's lane. It veered increasingly right, rumbled across the wake-up strips, and dove into the drainage ditch. At this juncture, the stage was set. Nothing was going to change the outcome...
HE WOKE UP! "OH CRAP." The front-end of the truck plowed into the ditch, and mud, water and weeds flew up across the hood and windshield. And then he was in the trees...
One of the realities of modern life is that we try to squeeze more out of every resource available. Any unused margin of capability is viewed as a wasted opportunity to increase personal or professional gain. When our schedule is maxed out, it's easy to forego a good night's sleep.
We cram more requirements into a given time-period. We accept more demands on ourselves. We expect more from others. And thanks to "the social normalization of deviance," we take this abnormal and unhealthy situation in stride without much thought.
The problem with this lifestyle? This business ethos? This way of living and working?
Well, we are still human. We must contend with human factors. Humans don't work well when tired...
Managing fatigue requires commitment from both employee and employer....
As managers of the human resource that is "us" we have a moral and ethical obligation to pay due diligence to our own personal fatigue state. As HEMS team members, we operate in an extremely high-consequence world. Society and gravity hold us to a high standard when it comes to any negligence or lack of preparation for our duties.
Let's consider 24-hour shifts for medical flight team members. After initial resistance, the Commission on Accreditation of Medical Transport Systems (CAMTS) got on board with 24-hour shifts, with stipulations.
In case you have forgotten, here's what CAMTS standards have to say about 24 hour shifts.
01.07.00 STAFFING
The service must have written operational policies to address each of the areas listed below:
01.07.01 Scheduling and individual work schedules demonstrate strategies to minimize duty-time fatigue,
length of shift, number of shifts per week and day-to-night rotation. (See References for circadian rhythm,
Fatigue Risk Management System (FRMS) and other fatigue studies.)
1. On-site shifts scheduled for a period to exceed 24 hours are not acceptable under most circumstances.
The following criteria must be met for shifts scheduled more than 12 hours.
a. Medical personnel are not required to routinely perform any duties beyond those associated
with the transport service. (emphasis added)
b. Medical personnel are provided with access to and permission for uninterrupted rest after
daily medical personnel duties are met.
MANAGEMENT AND STAFFING
1
1.11
camts.org Commission on Accreditation of Medical Transport Systems
10th Edition Accreditation Standards
c. The physical base of operations includes an appropriate place for uninterrupted rest.
d. Medical personnel must have the right to call “time out” and be granted a reasonable rest
period if the team member (or fellow team member) determines that he or she is unfit or unsafe
to continue duty, no matter what the shift length. There must be no adverse personnel
action or undue pressure to continue in this circumstance.
e. Management must monitor transport volumes and personnel’s use of a “time out” policy.
From personal experience over 17 years flying HEMS; I can tell you that management is pretty good at "monitoring transport volumes," but not so good at offering "a time out policy."
If your company requires a crew member to notify two or three levels of management before calling a time out, then you don't really have a time-out policy. You have something written in a book that says you have a policy, but your real policy is that your employees get their butts in that helicopter, no matter how tired they may be. If you tout your company's CAMTS certification, but don't adhere to the standards in good faith, then your company is CAMTS certified in name only.
Hidden factors of 24 hour shifts...
"The aircraft was in cruise flight when the nurse asked, "are you sure the weather is good enough for us to do this flight?" As this was the second time the question had been raised, the pilot determined that something was up. Something that had nothing to do with weather. He said, "guys, I checked the weather. It's way good. But if you don't want to go, tell me and I will turn around.
Silence...
What this pilot didn't know was that the nurse in question was tired. She desperately needed sleep. But because she was the proximate cause of her own fatigue she couldn't ask for a rest. Since she only worked on the helicopter every fourth day, she took advantage of her free time and took another job in a local hospital. The demands of two full-time jobs - and her personal life - left her without enough time to rest. She anticipated catching up on sleep at work, But when the work load was steady throughout a 24-hour shift and she didn't get a chance to nap she came up short. And snappy.
Fatigue effects mood, performance, and judgement. (Dr. Mark Rosekind)
Humans are subject to two circadian (circa - around, dian - day) lows in each 24 hour day. These occur, roughly, between 2 AM and 4 AM, and then again between 2 PM and 4 PM. It is during these hours that we have the most difficulty with our mood, performance, and judgement. If we are well rested we can work through these circadian lows. If we are fatigued, then we have two impediments to overcome. And things go wrong.
Policy and schedule should allow crews to rest during circadian-low periods, unless a patient-flight is at stake. This is when our bodies need to rest, and when our performance is most degraded.
It's true, safety-naps increase safety.
Crews working an extended shift should take advantage of any rest-opportunity during these low periods. Turn off the TV, shut down facebook (or this blog), and close your eyes.
We as individuals have an obligation to do our part by showing up for work rested and ready. The company should not need a policy that you do not work another job for 8 or 10 hours before reporting for work. You should know this yourself. You are going to be flying a helicopter or taking care of sick people who trust you with their lives. Don't violate this trust.
If I am making you angry without cause, I apologize. If I am making you angry because you recognize yourself in these anecdotes, get angry, then fix the problem.
If you are scheduled to work a 24 hour shift tomorrow, then today should be protected, when it comes to work-load, stress-inducing activity, diet, and drinking. Do drink water. Alcohol? Not so much, if any.
Sidebar: After I volunteered to serve in the 160th Special Operations Aviation Regiment, I was sent to SERE (Survival, evasion, resistance, and escape) school. As part of SERE, I was captured and held in a prison camp. I was made to stay awake for three days. As part of the torture regimen I was forced to drink liter upon liter of water. What I didn't know then, but I do know now, is that drinking so many liters of water helped my body cope with the demands placed upon it. If you are subject to a fatigue-causing scenario, drink water until you can't take any more. If you are using caffeine to mitigate fatigue, fair enough, but follow it with water...
"Without adequate hydration, bodies can experience more muscle soreness, the need for longer recovery times and less desire to push oneself – in short, dehydration can make you feel less motivated to achieve at any activity. As little as 3 percent or more loss of body weight due to dehydration can cause as much as a 10 percent drop in performance level. One study of athletes found after limiting fluids for 15 hours, 92 percent felt tired, had lapses in memory and difficulty concentrating." text courtesy truelemon.com
Finally, lets consider the role of the company-leadership in controlling fatigue for employees working 24-hour shifts. Let's go back to the CAMTS stipulation that crews shall not be required to perform any duty beyond those associated with medical transport - flying sick people and charting medical treatment.
Dear supervisor, leader, manager,
If you require your flight team, during a 24 hour shift, to perform ancillary duties not directly related to the care and transport of sick people, such as public-relations visits, teaching classes, or EMS nights-out... then you are NOT in compliance with the CAMTS standards.
And you are a contributing factor in the medical-errors made by your employees. You are a contributing factor when your employee falls asleep on the drive home after working a 24 hour shift. You are a contributing factor in your employee's degradation of mood, performance and judgement.
You have every right to ask your people to come to work ready, rested and able. And you have a responsibility to avoid subjecting them to any extra fatigue or stress.
You owe it to them and the souls they care for...
"The nurse was restocking the drug bag after landing. The crew had just completed a patient transfer from a rural facility to a major metropolitan hospital. He knew what supplies had been used, or at least he knew what supplies were supposed to be used, and as he inventoried the drugs, one that was supposed to be consumed wasn't. Worse, one that was not supposed to be gone was. The patient had been given the wrong medication. He immediately went inside his base and called the receiving hospital. "Hello, I just flew in Mr. Doe. I am afraid we may have made a mistake with his meds..."
The FAA and the NTSB have identified fatigue as a silent partner in most of the fatal accidents we suffer in HEMS. In recognition of this fact, the study and discussion of fatigue has been included in the list of required topics for Air Medical Resource Management and Crew Resource Management training. As it turns out, fatigue can be factored into many of the mistakes and mishaps we experience. If your mouse is tired, you don't need a better mouse trap.
From advisory circular 00-64...
(3) Fatigue Countermeasures. The term “fatigue” has been used to describe many
different experiences: sleepiness, physical tiredness, inability to focus mentally, time on duty,
types and number of missions, prolonged stress, and other factors. The effects of fatigue, which
concern the operational community, are those that affect crew member alertness and
performance. This type of fatigue stems primarily from sleep loss, circadian rhythm disruption,
lack of fitness, inadequate food and fluid intake, and the interaction of these physiological
variables.
From CFR part 135...
§ 135.330 Crew resource management training.
(a) Each certificate holder must have an approved crew resource management training program that includes initial and recurrent training. The training program must include at least the following:...
(6) Effects of fatigue on performance, avoidance strategies and countermeasures;
The flight paramedic finished his good-byes and climbed into his truck for the hour-long ride home. It had been a long and a good shift, with a pilot and nurse he enjoyed working with. The three of them seemed to click together as a team, and they had completed four flights! The workload and activity had helped him feel okay through out the day and night, although he did struggle a bit completing the last of the charts. Charting had kept him from resting, and he had considered the need to close his eyes for a bit. But his base needed every flight, and he had willingly done his part to make the flights happen. He was a member of a team, and the team needed him.
He departed the secondary road and eased onto the interstate highway for the long, boring ride to the city. As he rode along, cruise control set and cool air flowing, he began to feel drowsy. "Thank goodness this didn't happen last night" he thought to himself, and sat up straight in his seat. He turned on the radio, and set the volume up higher than normal. He stretched his neck and head left, then right. He took a deep breath and flexed his hands. "Come on dude. You can do this. Wake up!"
Ten minutes later he was struggling to stay awake. He was too comfortable, and too relaxed. He thought, "twenty more minutes and I am home." He checked his side and rear mirrors, no traffic. Just him and a long ribbon of smooth concrete. His eyes drooped. His breathing and heart rate slowed. He was no longer concerned. His eyes drifted shut and a peaceful, wonderful sleep came upon him.
The white Ford pickup truck drifted from it's lane. It veered increasingly right, rumbled across the wake-up strips, and dove into the drainage ditch. At this juncture, the stage was set. Nothing was going to change the outcome...
HE WOKE UP! "OH CRAP." The front-end of the truck plowed into the ditch, and mud, water and weeds flew up across the hood and windshield. And then he was in the trees...
One of the realities of modern life is that we try to squeeze more out of every resource available. Any unused margin of capability is viewed as a wasted opportunity to increase personal or professional gain. When our schedule is maxed out, it's easy to forego a good night's sleep.
We cram more requirements into a given time-period. We accept more demands on ourselves. We expect more from others. And thanks to "the social normalization of deviance," we take this abnormal and unhealthy situation in stride without much thought.
The problem with this lifestyle? This business ethos? This way of living and working?
Well, we are still human. We must contend with human factors. Humans don't work well when tired...
 |
| If you are a supervisor, and you don't think fatigue in your employees means anything to you, study this chart. You may see it again someday in a court room... |
Managing fatigue requires commitment from both employee and employer....
As managers of the human resource that is "us" we have a moral and ethical obligation to pay due diligence to our own personal fatigue state. As HEMS team members, we operate in an extremely high-consequence world. Society and gravity hold us to a high standard when it comes to any negligence or lack of preparation for our duties.
Let's consider 24-hour shifts for medical flight team members. After initial resistance, the Commission on Accreditation of Medical Transport Systems (CAMTS) got on board with 24-hour shifts, with stipulations.
In case you have forgotten, here's what CAMTS standards have to say about 24 hour shifts.
01.07.00 STAFFING
The service must have written operational policies to address each of the areas listed below:
01.07.01 Scheduling and individual work schedules demonstrate strategies to minimize duty-time fatigue,
length of shift, number of shifts per week and day-to-night rotation. (See References for circadian rhythm,
Fatigue Risk Management System (FRMS) and other fatigue studies.)
1. On-site shifts scheduled for a period to exceed 24 hours are not acceptable under most circumstances.
The following criteria must be met for shifts scheduled more than 12 hours.
a. Medical personnel are not required to routinely perform any duties beyond those associated
with the transport service. (emphasis added)
b. Medical personnel are provided with access to and permission for uninterrupted rest after
daily medical personnel duties are met.
MANAGEMENT AND STAFFING
1
1.11
camts.org Commission on Accreditation of Medical Transport Systems
10th Edition Accreditation Standards
c. The physical base of operations includes an appropriate place for uninterrupted rest.
d. Medical personnel must have the right to call “time out” and be granted a reasonable rest
period if the team member (or fellow team member) determines that he or she is unfit or unsafe
to continue duty, no matter what the shift length. There must be no adverse personnel
action or undue pressure to continue in this circumstance.
e. Management must monitor transport volumes and personnel’s use of a “time out” policy.
From personal experience over 17 years flying HEMS; I can tell you that management is pretty good at "monitoring transport volumes," but not so good at offering "a time out policy."
If your company requires a crew member to notify two or three levels of management before calling a time out, then you don't really have a time-out policy. You have something written in a book that says you have a policy, but your real policy is that your employees get their butts in that helicopter, no matter how tired they may be. If you tout your company's CAMTS certification, but don't adhere to the standards in good faith, then your company is CAMTS certified in name only.
Hidden factors of 24 hour shifts...
"The aircraft was in cruise flight when the nurse asked, "are you sure the weather is good enough for us to do this flight?" As this was the second time the question had been raised, the pilot determined that something was up. Something that had nothing to do with weather. He said, "guys, I checked the weather. It's way good. But if you don't want to go, tell me and I will turn around.
Silence...
What this pilot didn't know was that the nurse in question was tired. She desperately needed sleep. But because she was the proximate cause of her own fatigue she couldn't ask for a rest. Since she only worked on the helicopter every fourth day, she took advantage of her free time and took another job in a local hospital. The demands of two full-time jobs - and her personal life - left her without enough time to rest. She anticipated catching up on sleep at work, But when the work load was steady throughout a 24-hour shift and she didn't get a chance to nap she came up short. And snappy.
Fatigue effects mood, performance, and judgement. (Dr. Mark Rosekind)
Humans are subject to two circadian (circa - around, dian - day) lows in each 24 hour day. These occur, roughly, between 2 AM and 4 AM, and then again between 2 PM and 4 PM. It is during these hours that we have the most difficulty with our mood, performance, and judgement. If we are well rested we can work through these circadian lows. If we are fatigued, then we have two impediments to overcome. And things go wrong.
Policy and schedule should allow crews to rest during circadian-low periods, unless a patient-flight is at stake. This is when our bodies need to rest, and when our performance is most degraded.
It's true, safety-naps increase safety.
Crews working an extended shift should take advantage of any rest-opportunity during these low periods. Turn off the TV, shut down facebook (or this blog), and close your eyes.
We as individuals have an obligation to do our part by showing up for work rested and ready. The company should not need a policy that you do not work another job for 8 or 10 hours before reporting for work. You should know this yourself. You are going to be flying a helicopter or taking care of sick people who trust you with their lives. Don't violate this trust.
If I am making you angry without cause, I apologize. If I am making you angry because you recognize yourself in these anecdotes, get angry, then fix the problem.
If you are scheduled to work a 24 hour shift tomorrow, then today should be protected, when it comes to work-load, stress-inducing activity, diet, and drinking. Do drink water. Alcohol? Not so much, if any.
Sidebar: After I volunteered to serve in the 160th Special Operations Aviation Regiment, I was sent to SERE (Survival, evasion, resistance, and escape) school. As part of SERE, I was captured and held in a prison camp. I was made to stay awake for three days. As part of the torture regimen I was forced to drink liter upon liter of water. What I didn't know then, but I do know now, is that drinking so many liters of water helped my body cope with the demands placed upon it. If you are subject to a fatigue-causing scenario, drink water until you can't take any more. If you are using caffeine to mitigate fatigue, fair enough, but follow it with water...
"Without adequate hydration, bodies can experience more muscle soreness, the need for longer recovery times and less desire to push oneself – in short, dehydration can make you feel less motivated to achieve at any activity. As little as 3 percent or more loss of body weight due to dehydration can cause as much as a 10 percent drop in performance level. One study of athletes found after limiting fluids for 15 hours, 92 percent felt tired, had lapses in memory and difficulty concentrating." text courtesy truelemon.com
Finally, lets consider the role of the company-leadership in controlling fatigue for employees working 24-hour shifts. Let's go back to the CAMTS stipulation that crews shall not be required to perform any duty beyond those associated with medical transport - flying sick people and charting medical treatment.
Dear supervisor, leader, manager,
If you require your flight team, during a 24 hour shift, to perform ancillary duties not directly related to the care and transport of sick people, such as public-relations visits, teaching classes, or EMS nights-out... then you are NOT in compliance with the CAMTS standards.
And you are a contributing factor in the medical-errors made by your employees. You are a contributing factor when your employee falls asleep on the drive home after working a 24 hour shift. You are a contributing factor in your employee's degradation of mood, performance and judgement.
You are either part of a problem, or part of a solution...
You have every right to ask your people to come to work ready, rested and able. And you have a responsibility to avoid subjecting them to any extra fatigue or stress.
You owe it to them and the souls they care for...
 |
| Our world is more litigious than ever before. Take care. |
Friday, June 24, 2016
Pals...
Miles and I talked for an hour a couple of nights ago. These conversations that occur between those of us who serve on NEMSPA's board are rewarding and enjoyable. I have them with Rex Alexander, and Kurt Williams, and Miles Dunagan.
If you saw the video on Enroute Decision Point, you have seen Miles. If you haven't seen it, here it is...
We talked about serving as NEMSPA's president. We decided that he would be a better, more logical choice than me. He is still an active HEMS pilot. And he looks good on camera. I'm just an old has-been blogger.
Of course, NEMSPA's board has to vote, but I don't see anyone fighting Miles for the task of working daily on behalf of people who largely have little idea or concern that such work is occurring. For free.
During our chat, we had a "rest of the story" moment. I think we started out by talking about inviting Natalin Hammond to AMTC. Natalin's husband Chad was the pilot of the aircraft that crashed in Alabama recently. She contacted me and we have become friends. I think having her at the NEMSPA booth and in my presentation on nextgen AMRM for HEMS will be good for her, and good for HEMS. I think many of us believe that crashes only happen to someone else, and they are abstract events. When you speak with Natalin, it becomes real.
Sometime during our talk about Chad, we started talking about another crash. One that I am too familiar with. Miles is connected as well. I asked him to write about it.
Here is what Miles wrote...
Pals
I remember the day as yesterday. It was February 16th, 2001. I had accepted a position flying for Dale Earnhardt and it was moving day. We were leaving a good job along with friends and family to embark on what was sure to be a real adventure. Everything we owned was packed in a U-Haul van. My wife at the time and our two kids, Jessica 6 and Tully 4 months, were in the minivan and we were ready to head east. We said our goodbyes, wiped away tears, and that’s when it happened. Bob stepped forward, took the keys to the moving van from my hand and pointed to the minivan. Bob said “get in there with your family, I’m driving the moving van. You’re going to make this trip right beside your family.” I looked at him and said, "Bob, Memphis to Mooresville NC is a 12-hour drive." He just grinned and said, "well, I’ll see ya there."
What can I say, but that was Bob Giard.
That was not the first time Bob would come to my rescue, and it wouldn’t be the last. Two days later, Dale Earnhardt was gone. For 4 days, Bob didn’t leave my side.
I knew him for several years. The scenario played out countless times. Let’s say you’re having a crummy day. Your ticked off, feeling sorry for yourself, The whole 9 yards. Then you look up to see that big red Dodge truck pull up and your head drops. I would think to myself “crap its Bob." I would do this because I knew that without fail, in short order, I would be forgetting about what ever petty problem I was dragging with me and I would be laughing until my side hurt. You can’t help but love a guy like that. Those kind of friendships are rare.
I remember another time, very vividly, some 3 years later. It was the evening of July 12th, 2004. I had left flying in the Carolinas to return to my old job in Memphis. I locked the door to my office at Dewitt Spain Airport after my evening jog and was walking to my motorcycle for the ride home. That’s when I heard my land-line start ringing. The dilemma, put everything down unlock the door, and maybe answer before whoever is on the other end hangs up. Well, I answered. It was Bob! He had just reported for duty at Regional One in Spartanburg SC. It was a night shift. We discussed that Shelby, the kids and I would be coming to see him two days from then to check out his new Harley, on our way to Emeril Isle NC for vacation. After about 15 minutes, Bob assured me that he would be putting on his P.J’s. The weather forecast was for crummy weather, so it would be a good night to sleep. We said our goodbyes, and that was it.
The next morning, I’m riding into work and for some odd reason, I have half a dozen missed calls. I pull my bike to the side of Hwy 51, and Joe Obremski, a mutual friend and EMS pilot, tells me the news. Regional One is down. No survivors. There all gone.
Unfortunately, I lost touch with Bob’s family. People go on with their lives. I did as well. I have not visited South Carolina since Bob’s funeral.
Now, fast forward to two weeks ago. I receive a text that someone from South Carolina was looking for me. My ex-wife shared that someone wanted to talk about Bob. They had some questions. So, I made contact with them, Cecil and Roger Wilkie. These brothers wondered if Bob was a military veteran, which he is not, and also wondered when his birthday was. You see Roger came across Bobs Grave marker and discovered that 12 years later, it still had the temporary grave marker. The temporary marker did not even include Bobs birthday. Roger would like to get Bob the marker he feels he deserves, and I feel I have a duty to help. After discussing this, we are going to try to have it completed by AMTC which is in Charlotte the last week of September. I will make the hour drive to visit my friends final resting place and hopefully see his grave marker.
Miles Dunagan
10 year EMS pilot,
NEMSPA Board of Directors.
Miles, when you drive down to Bob's grave, I am going with you. He deserves that. He deserves a decent memorial. He tried, and failed, and paid with his life. He could have been me.
If you read the report about Bob's crash, it resembles many others. It involves a good guy who is trying to do the right thing by helping someone, and things went terribly wrong. We involved with NEMSPA believe we can stop these events, but it will take training, and commitment. And it will take all of us working together.
Bob Giard's memorial is going to cost around $1500. If you are interested in helping us pay for it, you can make a donation marked "Bob's memorial" through NEMSPA. Bill Winn will make sure the money comes to us. We will post the list of donors, unless you ask us not to include your name.
If you saw the video on Enroute Decision Point, you have seen Miles. If you haven't seen it, here it is...
We talked about serving as NEMSPA's president. We decided that he would be a better, more logical choice than me. He is still an active HEMS pilot. And he looks good on camera. I'm just an old has-been blogger.
Of course, NEMSPA's board has to vote, but I don't see anyone fighting Miles for the task of working daily on behalf of people who largely have little idea or concern that such work is occurring. For free.
During our chat, we had a "rest of the story" moment. I think we started out by talking about inviting Natalin Hammond to AMTC. Natalin's husband Chad was the pilot of the aircraft that crashed in Alabama recently. She contacted me and we have become friends. I think having her at the NEMSPA booth and in my presentation on nextgen AMRM for HEMS will be good for her, and good for HEMS. I think many of us believe that crashes only happen to someone else, and they are abstract events. When you speak with Natalin, it becomes real.
Sometime during our talk about Chad, we started talking about another crash. One that I am too familiar with. Miles is connected as well. I asked him to write about it.
Here is what Miles wrote...
Pals
I remember the day as yesterday. It was February 16th, 2001. I had accepted a position flying for Dale Earnhardt and it was moving day. We were leaving a good job along with friends and family to embark on what was sure to be a real adventure. Everything we owned was packed in a U-Haul van. My wife at the time and our two kids, Jessica 6 and Tully 4 months, were in the minivan and we were ready to head east. We said our goodbyes, wiped away tears, and that’s when it happened. Bob stepped forward, took the keys to the moving van from my hand and pointed to the minivan. Bob said “get in there with your family, I’m driving the moving van. You’re going to make this trip right beside your family.” I looked at him and said, "Bob, Memphis to Mooresville NC is a 12-hour drive." He just grinned and said, "well, I’ll see ya there."
What can I say, but that was Bob Giard.
That was not the first time Bob would come to my rescue, and it wouldn’t be the last. Two days later, Dale Earnhardt was gone. For 4 days, Bob didn’t leave my side.
I knew him for several years. The scenario played out countless times. Let’s say you’re having a crummy day. Your ticked off, feeling sorry for yourself, The whole 9 yards. Then you look up to see that big red Dodge truck pull up and your head drops. I would think to myself “crap its Bob." I would do this because I knew that without fail, in short order, I would be forgetting about what ever petty problem I was dragging with me and I would be laughing until my side hurt. You can’t help but love a guy like that. Those kind of friendships are rare.
I remember another time, very vividly, some 3 years later. It was the evening of July 12th, 2004. I had left flying in the Carolinas to return to my old job in Memphis. I locked the door to my office at Dewitt Spain Airport after my evening jog and was walking to my motorcycle for the ride home. That’s when I heard my land-line start ringing. The dilemma, put everything down unlock the door, and maybe answer before whoever is on the other end hangs up. Well, I answered. It was Bob! He had just reported for duty at Regional One in Spartanburg SC. It was a night shift. We discussed that Shelby, the kids and I would be coming to see him two days from then to check out his new Harley, on our way to Emeril Isle NC for vacation. After about 15 minutes, Bob assured me that he would be putting on his P.J’s. The weather forecast was for crummy weather, so it would be a good night to sleep. We said our goodbyes, and that was it.
The next morning, I’m riding into work and for some odd reason, I have half a dozen missed calls. I pull my bike to the side of Hwy 51, and Joe Obremski, a mutual friend and EMS pilot, tells me the news. Regional One is down. No survivors. There all gone.
Unfortunately, I lost touch with Bob’s family. People go on with their lives. I did as well. I have not visited South Carolina since Bob’s funeral.
Now, fast forward to two weeks ago. I receive a text that someone from South Carolina was looking for me. My ex-wife shared that someone wanted to talk about Bob. They had some questions. So, I made contact with them, Cecil and Roger Wilkie. These brothers wondered if Bob was a military veteran, which he is not, and also wondered when his birthday was. You see Roger came across Bobs Grave marker and discovered that 12 years later, it still had the temporary grave marker. The temporary marker did not even include Bobs birthday. Roger would like to get Bob the marker he feels he deserves, and I feel I have a duty to help. After discussing this, we are going to try to have it completed by AMTC which is in Charlotte the last week of September. I will make the hour drive to visit my friends final resting place and hopefully see his grave marker.
Miles Dunagan
10 year EMS pilot,
NEMSPA Board of Directors.
Miles, when you drive down to Bob's grave, I am going with you. He deserves that. He deserves a decent memorial. He tried, and failed, and paid with his life. He could have been me.
If you read the report about Bob's crash, it resembles many others. It involves a good guy who is trying to do the right thing by helping someone, and things went terribly wrong. We involved with NEMSPA believe we can stop these events, but it will take training, and commitment. And it will take all of us working together.
Bob Giard's memorial is going to cost around $1500. If you are interested in helping us pay for it, you can make a donation marked "Bob's memorial" through NEMSPA. Bill Winn will make sure the money comes to us. We will post the list of donors, unless you ask us not to include your name.
Subscribe to:
Posts (Atom)