First You Dream...

Recently we got into a philosophical discussion about what a rational mission-based HEMS structure would look like: as opposed to today's structure, which is partly market-based and partly based on struggles for market dominance.

"Who pays and does it cost the same for each airframe or is it funded differently?  Then the next question is about fees; or should it be a tax supported system.  I will say that a tax-supported system is something that I distrust. It would eventually look like the VA running our medevac community which would be more flawed than what we have now."

Jonathan Godfrey, Flight Nurse, Industry Expert, Co-Founder Survivor's Network for the Air Medical Community

I envision IFR twins at the metro hospitals, VFR or limited-IFR singles distributed evenly across the area, and at least one tilt-rotor per larger state, based near the geographic center, ready to respond to pad or runway, and able to leap vast distances with a single fuel load. As much as I favor free markets and respect the benefits of competition, I feel that naked ambition, greed, and fear-driven marketing strategies lead to waste and inefficiency.

 "I believe that it is one of the Scandinavian countries that has provider bid on contracts for areas of operation. This seems like a pretty sound plan to me. I agree with Jonathan we do not want US HEMS to become the "VA" however If we set up a system where companies have to bid on contracts it enables some quality control and sensible deployment of resources. Unlike today where it is a free for all." Sam Matta, Flight Nurse, Combat Veteran, Co-Founder East Coast Helicopter Organization (ECHO).

The IFR twins, with their larger cabins, are better suited to transporting pediatric and neo-nate teams from the hospital to the kids, and then everyone back to definitive care.

"Couldn't it work like other public service utilities? Or like the public/private partnerships the fire service employs in many locations? It seems that the pure open market we have now creates a competitive situation that is also bad for safety."  Dr. Cathy Jaynes, Former director of research at The Center For Medical Transport Research. Former College Campus Chair at the University of Phoenix, Former Assistant Professor at The University of Colorado - Denver, Former Chief Flight Nurse at SkyMed.

The IFR twins can move adults when the weather grounds the singles out in the countryside. The singles can move patients in good weather, and are less costly to operate.

When Rocky Mountain Helicopters began to lose lucrative hospital contracts, they came up with the idea of the "Community Based" EMS helicopter, in which all staff work for the aviation provider. Thus was born LifeNet. This step got the helicopters away from the hospital, and put them out in the country where the patients are. Air Evac Lifeteam developed this model further, and experienced explosive growth. AEL provides rapid access to definitive care for millions of Americans. AEL looks for support from the communities they serve, and originated the idea of selling subscriptions. These subscriptions shield those transported from rapidly rising bills, now estimated to be in the range of $50,000 per flight. A subscriber is not liable for any costs beyond what his or her insurance company pays.

HEMS is, today, largely a fair-weather resource. In the advent of low ceilings and visibility, the vast majority of EMS helicopters are grounded. This is a tremendous weakness in the HEMS system, and the technology exists to overcome it. Today.

Tiered reimbursement, in which government payments would be adjusted to account for the costs of providing the transport, would help drive the industry towards - if not all-weather, at least adverse-weather capability. Instrument-flight-capable twin engine helicopters are much more expensive to operate, but beyond the increased safety and chance to capture more flight opportunities, there is no financial incentive to operate these more expensive machines. The ultimate capability to transport the ill and injured could be realized by use of a tilt-rotor. The tilt-rotor can operate around or above weather that will ground all the pure-helos. And it can best move patients interstate.

"Once you fly on a tiltrotor you realize that it cannot be compared to any helicopter. Its a turboprop that hovers while the helicopter is a helicopter with its limitations. God bless the tiltrotor. ....it has its place in EMS" Skip Robinson, Helicopter Industry Observer, Photographer, Author. 

Dr. Ira Blumen with the UCAN  Dauphin. Dr. Blumen led the

"Opportunities for Safety Improvement in Helicopter EMS" project.

Thanks to the knowledge and hard work of

people like Dr. Blumen, we have hope for a bright future for HEMS.

As Congress, the General Accounting Office, and the states come to grips with the issues facing HEMS and the health-care system; an understanding of where we are, how we got here, and where we might go in the future of HEMS will be key to sound decisions.

"(All this) sounds better than the race to the bottom we are in now but me thinks you're a dreamer." Tim Lilley, Pilot, 10 year HEMS veteran, MSM. 

 "Dreaming is critical! 😉"
Dr. Cathy Jaynes

Accident Review... Knowing when to say "enough."

14 CFR Part 91: General Aviation
Accident occurred Friday, March 06, 2015 in St Louis, MO
Probable Cause Approval Date: 06/22/2016
Aircraft: Airbus Helicopters (Eurocopte EC-130-B4, registration: N356AM
Injuries: 1 Fatal.
NTSB investigators either traveled in support of this investigation or conducted a significant amount of investigative work without any travel, and used data obtained from various sources to prepare this aircraft accident report.

The emergency medical service (EMS) helicopter was landing on a privately owned elevated heliport to pick up two medical crewmembers. The medical crewmembers had been dropped off with a patient on a preceding flight. During the preceding flight, the nurse thought about telling the pilot to abort the landing on the heliport because there was a lot of rolling and yawing, and he was having a hard time landing the helicopter. After the landing, the nurse and another medical crewmember stated that the pilot did not want to depart the heliport, but the medical crewmembers told the pilot that there may be potential arrivals of other EMS helicopters. The pilot chose to depart the heliport and obtained fuel at the operator's base of operations. For the return flight to pick up the two medical crewmembers, the wind had increased, and the helicopter approached the heliport in high-wind conditions and with a right, quartering tailwind. Also, the wind along with the surrounding buildings likely created a turbulent airflow/windshear environment in which the helicopter was operating as it approached for landing. The helicopter's operation in a high-power, low-airspeed condition in high-wind conditions, including a right quartering tailwind, likely resulted in a loss of control due to settling with power.

A security video showed the helicopter on a northerly flightpath descending at about a 45-degree angle before impacting the ground and coming to rest on an approximate northerly heading. The pilot sustained fatal injuries due to the subsequent fuel tank fire/explosion, which otherwise would have been a survivable accident.

A postaccident safety evaluation of the heliport showed that the final approach and takeoff area/safety area were obstructed by permanent and semi-permanent objects that pose a serious hazard to helicopter operations. These obstructions limited the available approach paths to the heliport, which precludes, at times, approaches and landings with a headwind. The helipad is privately owned; therefore, it is not subject to Federal Aviation Administration (FAA) certification or regulation.

A review of the helicopter's flight manual revealed that there were no wind speed/azimuth limitations or suggested information available to pilots to base the performance capabilities of the make and model helicopter in their flight planning/decision-making process. Examination of the helicopter revealed no anomalies that would have precluded normal operation and showed engine power at the time of impact.


The National Transportation Safety Board determines the probable cause(s) of this accident as follows:
The pilot's decision to land during unfavorable wind conditions, which resulted in a loss of control due to settling with power. Contributing to the accident were the lack of an adequate approach path due to numerous obstructions and the lack of available guidance regarding the helicopter's performance capabilities in the right quartering tailwind condition.

Born in Flight...

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...

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...

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

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.

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."

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.