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...

The Details Matter...Even When We Are Tired

I had the pleasure of speaking with the Director of Flight Operation of a very large EMS helicopter company. We were discussing crashes. I mentioned that I had read a pilot's report to the NTSB stating that he had felt like his approach was fast and steep, as might occur if one was landing with the wind or "downwind" prior to initiating a go-around. As the pilot applied power to climb and accelerate, the aircraft began an uncommanded yaw that turned into several rotations in the yaw axis, loss of control, and a crash. People were killed.

The D.O. stated that this has happened more than once.  Pilot's preparing to land at 2:00 am don't perform as well as they might at 10:00 am, and this is made apparent by studying HEMS crashes and hospital security-camera feeds.

All pilots know that they should go through a deliberate set of steps prior to landing. A before-landing-check should be verbalized, a statement of the planned path in (and out) should be made with an announcement of any hazards observed. If you only have one motor, the forced landing location(s) should be announced so that you and all others on board know where you are going when the engine quits.

Sidebar: If your pilot has not announced a visible hazard, like a tower or wires or a vehicle - she might not see it. You must announce it.

And - very importantly - the pilot should announce his or her opinion of where the wind is coming from and how it might affect the helicopter. Often when we land there is no wind sock on scene. So we must determine the wind direction and velocity through other means. If I state where I think the wind is coming from, and you disagree, now is the time to speak up.

Unfortunately for us, when we are out in the wee hours, we don't perform as well as we do during the day when fresh and rested. It's a proven fact. Read the NTSB reports.  Our mood, performance, and judgement are degraded.

And that's why we tend to crash more in the middle of the night. When tired we just do the minimum to get by; to get the aircraft, crew and patient to the destination.

We can miss the details.

If we are landing, and you see smoke from a stack flowing in the
same direction we are flying, call a go-around. Landing downwind
leads to vortex-ring-state and loss of tail-rotor effectiveness

For this reason, at night is when established procedures, protocols, checklists and company best-practices must be adhered to. Like performing a high recon, like knowing where the wind is from, Like getting the aircraft slowed down per company policy. Like flying the correct angle.

Note that if I am falling short on any of these items, the only persons who can point this out to me are you two or three crew members flying with me. There is no second pilot to catch my mistake.This means you have to know how things are supposed to look and feel, and speak up if something is off. I am a damned good pilot. And I haven't crashed.

Yet.

This makes me just like your pilot.

As a human being, I am subject to make a mistake, like a guy in Texas did. He initiated a go-around, aborting his approach because it didn't feel right. And it led to a crash.  In another event - on video - another guy did the same exact thing and got into the yawing spin. That helicopter went around about 45 times, yes forty-five times, before the pilot initiated a climb in desperation. He got some altitude , reduced power, and let the helicopter fall off to one side. The aircraft weather-vaned, stopped spinning, and he was able to fly out of it.

"Well pardon the crap in my pants..."

So, perhaps we should focus on getting it right the first time in - especially at night. Some aircraft are more susceptible to loss of tail-rotor effectiveness than others, but they are all subject to vortex-ring state, and hitting things. In any helicopter, a small decrease in rotor RPM - such as might occur during a massive power increase when aborting an approach and starting a climb - will equate to a much greater loss of tail-rotor/fan RPM and authority. In a BK the ratio is 8 to 1 TR to MR.  And when that tail rotor stops being effective we will push more pedal until it either is effective or it stalls.

Note: In the first event referred to here, the pilot reported that he did NOT apply FULL pedal against the yawing spin. We should be ready to apply full pedal to control the aircraft. This has never happened to me, but experts say full pedal will arrest the yawing motion. Both pilots reported that "the cyclic stopped working." This led the DO to surmise that the aircraft, when spinning rapidly - on the order of 360 degrees per second - can get out of sync/phase with cyclic inputs. If the nose is down, and the pilot inputs aft cyclic, the delay in cyclic effect means that the aircraft has spun to the point that the input is reversed. This is something to consider, and more reason to avoid letting the yaw get away from us. Apply full pedal against yaw as required...

Crews can assist with determining wind direction. Look fo flags in the wind, smoke from stacks, groundspeed versus airspeed comparisons, and wind correction headings inbound to the destination. All these serve to tell us the wind direction and speed. Wind can change near the ground, and we have to be ready for this, and ready to call a go-around.

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...

Some Thoughts for Today. What is The Role of Culture?

Air Medical Resource Management Operates at the Intersection of Psychology (what's going on between my ears) and Culture (what's going on in my organization) ... William T. Winn

By Dan Foulds

I am going through my AMRM presentation slides today, making some changes and preparing for classes next Monday and Tuesday. I decided this was worth sharing and hope you agree. If you have any thoughts let's hear 'em. And "war stories?" We love stories.

As a medical crewmember, communications specialist, mechanic, or member of hospital security, at times we hesitate to speak up, to ask a question. We don't want to appear dumb, we worry about appearing to lack trust. We worry about being perceived as a trouble-maker and perhaps losing our job.

As pilot, we may hesitate to speak up for fear of showing weakness.

This hesitation is especially prevalent in new crew-members. The nurse who died in a crash in Newberry SC was new. The nurse who died in Georgetown SC was new. 

You don't get to be new here. You must ask and learn NOW.

Ridicule, intimidation, and sarcasm have no business in this business. Culture begins with senior leadership and ends with you.

The National EMS Pilot's Association has prepared a great cultural health assessment tool, CHAMPS. It only costs $500 to find out what your cultural "pulse and pressure" are, and you can compare your organization to others ( no identifying information is shared). You can also compare one part of your program to another part. Visit NEMSPA to learn more.

Corporate Culture: A Case of Monkey See, Monkey Do?

Written by Fred Nickols

Did you ever wonder how your company's culture – that set of beliefs, traditions, and behavioral norms that determines "the way things work around here" – came to be? Or why, when you try to change it, it seems so resistant? Well, here's a little story about a scientific experiment that shows how culture comes into being and why it is so resistant.

The experimenters began with a cage, a set of externally enforced boundaries. Inside the cage, they hung a banana on a string and placed a set of stairs under it. They then introduced five monkeys into the cage. Before long, one of the monkeys started to climb the stairs toward the banana. As soon as it touched the stairs the experimenters sprayed all the other monkeys with really cold water. When another monkey made an attempt to get the banana they again sprayed the other monkeys with cold water. After a while the monkeys prevented any of their group from going after the banana.

After the cultural prohibition against "going for the banana" had been established the experimenters put away the cold water. They took one of the original monkeys out of the cage and introduced a new one. Upon spotting the banana the new monkey went after it. To its surprise and dismay all of the other monkeys attacked it. After another attempt and attack the new monkey learned that if it tried to climb the stairs and get the banana it would be assaulted and so it stopped going after the banana. It had been acculturated, assimilated into the cage's "don't go for the banana" culture.

Next the experimenters removed another of the original five monkeys and replaced it with another new one. The second new monkey went to the stairs and predictably it was attacked. The first new monkey took part in this punishment with enthusiasm! Similarly a third original monkey was replaced with a new one, then a fourth, then the fifth.

Every time the newest monkey took to the stairs it was attacked by the other monkeys. Most of the monkeys that were beating it had no idea why they were not permitted to climb the stairs or why they were participating in the beating of the newest monkey. After all the original monkeys were replaced none of the remaining monkeys had ever been sprayed with cold water. Nevertheless, no monkey ever approached the stairs to try for the banana. Why not? Because as far as they knew: "That's the way it's always been done around here."

Is The Scene Safe?

The flight nurse looked out the back windows of the aircraft in disbelief. They had landed on a two lane road at an accident scene - in front of the aircraft a horrific car crash was being sorted out - behind them, the road was open. It was chaotic, and emergency vehicles were still inbound. As she glanced behind them, she observed a large vehicle bearing down on her. Too fast, too close. She yelled.

With feet to spare, the truck veered off the road and came to a stop beside the aircraft. The truck's driver had been unable to determine distance to the obstacle to his front - a running helicopter - because of the dozens of flashing lights and apparatus surrounding the scene. He was responding to a crash with his own lights and siren going, and had some adrenaline on board. It almost ended like this... ( the action starts about 1:45 in)

If the video is not supported on your device you can access it here.

The film above makes a good case for not having trucks driving next to a running helicopter on scene. If a picture is worth a thousand words, a film should be worth a few million (dollars - what that aircraft cost) How sad and ironic is it that you can survive for years operating "a collection of parts - flying in close formation - all supplied by the lowest bidder," and get whacked by a truck on the ground.

The hazards of  landing a helicopter at an accident scene are easily overlooked, especially after landing at a few hundred of them without incident. We take it for granted that everyone involved is trained, and knows what not to do - but every once in awhile this ends up not being the case.

I landed at a scene once in South Carolina. My crew asked me to stay running. As I watched them disappear into the back of the ambulance, the man they had designated as my "tail-rotor guard," wearing blue jeans with cigarette in hand, strolled up to my left front window and casually had a look at the cockpit. When asked to move away from the running helicopter, he stated that he knew what he needed to do.

Apparently not.


The situation is made more complex by the fact that we in HEMS depend on cordial relationships with first-responders for flight requests. If we don't get calls, we stop making house payments. We face competition in our service area, and we want them to call us, not the other program - so we walk a fine line between demanding a level of performance and accepting whatever-goes on scene. One thing you don't want to do is be the guy or gal who offends the volunteer-chief of the fire service setting up your scene; but you also don't want to kill a new probie - or have her kill you.

Clearly, the answer is communication and training. Someone from your flight program needs to visit every agency in your service area at least once a year to present a class on the good, bad, and ugly of scene operations. Someone needs to call and debrief each scene operation - what the military calls "after action review." If you are relegating this task to a business-development manager you are asking for trouble - they get paid to increase flight volume, not safety. Part of your training should be a review of actual accidents and incidents. There was a time when a director of operations I worked for didn't want us to speak about crashes with customers. As a person who has taught AMRM classes for several years and seen what works and what doesn't, there is nothing like a discussion of actual events - real people, real blood - to get someone's attention and buy-in for scene safety.

Click here for a story about the type of training that should be occurring everywhere.


Fly (and land) safely...





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