Friday, August 29, 2014

Welcome Poland! Thanks for Stopping By...


United States

Monday, August 25, 2014

Lest We Forget..."Airworthy" Means No Warning Lights...No Hidden Faults....If It's Broken Write It up.


The pilot called the operator's mechanic on duty that night, who arrived at the aircraft with some tools but no maintenance manuals or spare parts. The mechanic checked for oil leaks, did not find any evidence of an oil leak, and did not smell any burnt oil. the mechanic turned on the battery switch, starting the electrical power but leaving the engines turned off. The transmission oil-pressure warning light illuminated, but this was appropriate because, with the engines off, no oil pressure was generated. The mechanic then disconnected the oil-pressure switch, and the warning light turned off, which indicated the light was connected to the oil-pressure switch and was not being illuminated by a short circuit. The mechanic knew that when only the gearbox oil-pressure warning light illuminated, the problem was usually a faulty oil-pressure switch, which would be replaced. The mechanic did not have the tools and parts to change the switch with him. He rotated the main rotor and did not feel any unusual vibrations or hear any unusual sounds. The mechanic and the pilot decided that because the gearbox was newly overhauled and had minimal use, the problem was a faulty oil-pressure switch. They decided that the pilot would run the engines for a few minutes on the ground and then hover just off the ground. If no other warning lights illuminated, and if the pilot felt comfortable flying the helicopter, he would fly the helicopter back to the hospital for further maintenance. The pilot asked the mechanic to leave the oil-pressure warning light disconnected so he would not be distracted from observing the oil-temperature warning light if it came on. The pilot ran the helicopter on the ground, hovered for a few minutes, and then flew away. About one minute into the flight, the main rotor gearbox suffered a catastrophic failure. The helicopter crashed, and the piot was killed. Accident investigators testified that the crash was caused by the lack of cooling lubrication on the gears of the main rotor gearbox. 

Read more about this crash by clicking here...

One pressure we are subject to is the urge to refrain from writing up a discrepancy with our aircraft, and continue flight operations knowing something is wrong; perhaps because we fear that a backup is not available, we will lose flight volume, and perhaps lose our job. Or maybe we just want to get home. Sometimes peers or supervisors will even attempt to prevent us from documenting discrepancies.

Step back and look at the big picture... You can get another job. You can't get another life.

Monday, August 18, 2014

Eagle Med Crash...Lone survivor tells his story....

"The call came in around 5:30 that morning...

Billy Wynne  image courtesy news9.com

Click here for full story...

"No One Rings A Bell" A story about crashing....

Edited 8/21, 11/08

The striking thing is how meticulous they are. The soldiers in their perfect dress-green uniforms are deliberate and precise as they fold the flag. They are not rushed, and seem unaffected by the quiet sobbing from the front row of mourners. I don't know how they do it - how they keep their composure in the face of so much grief and heart-break. They completed the task and handed the flag, folded into a perfect tight-fitting triangle, to the mother.

The widow was not there. Earlier, when the main entrance door of the chapel was pulled open for her, and she looked down the long carpeted aisle at the wooden box with her husband's body in it, she screamed, sobbed, and collapsed to the floor before anyone could catch her. She moaned "no no no" as she was lifted to her feet and carried outside. She couldn't do it. With a new child, and the prospect of living out her days without her soul-mate, she had hit her wall. The crowd outside, still waiting to get inside, parted like the sea and made a clear path for her to be helped to a limo. Just then, a formation of helicopters from several air ambulance companies flew across the parking lot at low level, and the church-bell began to ring.

Like the dozens of ambulances, fire-trucks, and law-enforcement vehicles, the helicopters with their crews were here to pay their respects. The thundering vibrations from their rotors went straight to the heart, and that was when the tears started. Tears that had never stopped.

It was such a tragedy. There were so many unanswered questions. "Why?" "How?" What happened?" It would only be later when we would ask "what can we do to make sure this never happens again?" Sadly, after crash upon crash, we cannot seem to come up with that answer and see the steps through.

Instead we bury friends. There is a tacit acceptance that some number of us will be killed each year.

Because the dead are usually strangers.

But not always.

This is what happened....

The call came in at 3:48 in the morning. The pilot rolled out of his bed. He had been watching a show about sharks on Discovery, and dozing off. He stepped over to his weather computer and looked at the ceiling and visibility at the reporting-stations surrounding his base. The numbers were all good, as was the forecast. He noted that the temperature and dew point were converging with each hourly report, but that happened regularly in his area. He accepted the flight and went to knock on the crew's doors.

When they took off, the ceiling was lower than he expected. On climb out, they passed through a thin layer of fog or low scud that reflected the white landing light back into the cabin and shut down their night-vision-goggles for an instant. After a few seconds of silence the medic asked, "should we call the com-center to abort?"  As the question was asked of no one in particular it was answered with more silence - then the pilot said, "ah...no I think we will be okay."

They got about a mile from their base and the medic looked out to the front. He knew that he would normally be able to see the flashing lights on the top of a nearby bridge from here, and he couldn't. This was different. "Hey, I can't see the bridge, what do you guys think?" The nurse was new - so much turnover lately - and she put her faith in the pilot. The pilot wasn't yet too worried. Sure the weather was worse than he had expected, but he only had to go 15 miles and then come back. He would be back in bed before things went to crap.

They flew on.

They left the built-up area of the city just as the ceiling was dropping.  It was still legal, but it was getting harder to see what lay in front of them. Out the windshield the forest was a green and black blanket through the goggles. It was hard to determine the visibility with so little to look at. The pilot began to descend and slow down without thinking about it - it was a natural reaction to the environment. He wasn't familiar with NEMSPA's enroute decision point, and didn't have a hard-and-fast abort-criteria. He hoped for the best; in 20 years of flying things had always worked out for him and he figured they would this time as well.

The medic was beginning to have a bad feeling in his stomach. He didn't want to sound afraid, or as if he didn't trust the pilot - and their base had only done 7 flights with the end of the month approaching. He put his finger on the talk-button on his com-cord, but did not press it...

The forest floor began to dissolve in the haze. The pilot slowed down some more and pushed the collective down to descend. The weather was now below minimums and he was making up his mind to turn around when the earth disappeared. He looked up under his goggles and couldn't see anything. He switched on his landing light and the brilliant reflection from thick cloud blinded him. "SHIT! Guys, we are in the clouds. I gotta do the procedure..."

He had already been halfway flying on his instruments, but he didn't have a full and deliberate scan going yet. He came inside with his eyeballs, pulled power and began to climb. He was already down to 70 knots, so he decided to leave his airspeed alone. He called off the IIMC steps from rote memory, with a slight quaver in his voice. He had screwed up, and was going to have to complete a report. This wasn't going to look good.

As they passed through a thousand feet off the ground, he made an attempt to call air traffic control on the radio. His call went out on the com-center frequency. They came back with, "sir check your radio - you are on flight-com." "Crap - wrong radio," he thought, and moved his hand to the selector. He put it on radio-one and made the call again. Approach answered, except it wasn't approach. It was the tower, now 10 miles to his rear. Tower responded and advised him to change to approach frequency.

"Holy crap" he thought. A sense of foreboding came over him. This was proving to be harder than he remembered. He had tons of cloud-flying experience - but none in a few years. He did one approach each year for his check-ride and that always went well, so he had considered himself ready. And he would be if things would work right. He said, "guys I am going to start a turn back." "Okay" came the response.

He put  the aircraft into a standard-rate turn to the right, still climbing, and as things settled down he leaned over to change the frequency on the radio. This required him to put his head down for a few seconds. It took him two tries to roll in the frequency - why was everything so hard to do? He pressed the flip-button to move the frequency into the active-field and looked up to the instruments.

"HOLY SHI...!" As his head came up in the turn, he accelerated the fluid in the three semi-circular canals in his inner ear in different directions. He had an overpowering sense that the aircraft was rolling, pitching, and yawing, all at once. He tried to look at his instruments but his eyeballs were jerking laterally in his head. He had a sudden urge to throw up.

It would not last long.

The radar track that the NTSB put together showed that during the last few seconds of this crew's life, their aircraft went through wild gyrations in altitude, heading, and airspeed. As high as 4000 feet, as slow as 40 knots; as fast as 140 knots and as low as the surface. There was no voice recorder onboard, so no one knew what the crew experienced or said near the end. It must have been a terrible last few breaths.

The addition of Appareo devices tells the real story. 

When the aircraft fell out of the bottom of the clouds, the medic was confused. The picture was upside down and tilted crazily. He was trying to make sense of this, and the fact that what was up was rushing at him so fast. It looked like they were climbing - but that was the forest above them.  He never put it together. The pilot did, at the last second, but it was too late to do anything.

This picture is an actual helicopter crash site near Palatka, Florida.
Like the crew in this story, they kept going in spite of the weather.

Editors note:  I don't know about you, but I hate stories like this. They are told repeatedly; each year we agonize over this type of event. We could reduce, or even eliminate our accident rate by spending more time and money on the three "Ts," training, technology and temperament.  At least we might have a crash-free year. But we don't spend the time, we don't spend the money, and we continue to destroy aircraft and kill people.

We do have one inexpensive relief-mechanism though. It involves studying ourselves; how we work together, how we communicate, and how we can help each other. It also involves three key concepts: Inquiry, Advocacy, and Assertion. We call this Air Medical Resource Management training or "AMRM." It is derived from the CRM (Crew Resource Management) training that was developed by the airlines.

And now we will change our story a bit.

The nurse was new. She wanted to let go of her concern, relax, and trust the pilot. But her recent AMRM training was still fresh in her mind. The instructor had hammered home certain points during the day; and he had looked at her so often--the new girl--that she had almost thought he was picking on her.

He was. Every time he taught new crew, he thought about the woman who died in a helicopter in Newberry, South Carolina on one of her first flights. And another one in Georgetown, and dozens more. The instructor drove the fact that she might be the last line of defense into her head. And as she heard the medic say, "Hey, I can't see the bridge, what do you guys think?" she remembered how the instructor had made her sit in front of the class and role-play her way through a scenario that began as this flight was beginning, and ended badly. She had learned some things that day.

"Okay," she said. Is it normal to see the bridge from here?"  "Dan, is it?" (inquiry)

"Well yeah, I guess so, but it's not too bad out here," he replied.

"Okay, I know I am new--so I am going to lean toward being conservative. Please bear with me." (advocacy)

Dan thought to himself, "crap, the woman is brand new and already being a pain. I can see how this is going to work out." He said, "I think we are good. I would like to continue for a bit."

The nurse remembered this from class as well--time to be assertive. She said, "Dan! (step one, say the person's name), "I am really uncomfortable with this. It's my first flight at night and already we are doing something different" (step two, state the owned emotion). "It sounds like the weather is worse than normal" (step three, state the problem). I think we should turn around and go back. Maybe the weather will improve in a bit and we can try again" (step four, offer a solution ).

"I know I am new, but is that okay with you Dan?" (Step five; you are a team, look for agreement or buy-in.)

The pilot thought about it for a second. "Okay, screw it, let's go back."

He would be looking at sharks again in just a few minutes...

Nobody rings a bell when you don't crash

If you are a HEMS pilot and don't agree with the flight crew questioning your decisions, well, I get it. Sometimes I don't like it either.  I respectfully ask you to put yourself in their seats, however. You may be absolutely convinced of your ability to deal with any situation. But often enough HEMS pilots fall short, and like it or not you are a member of that group and viewed as such.

The best way to understand what your crews go through would be for you to climb in back some night in marginal weather with another pilot flying: With no access to controls and no control of what's happening. It can be disconcerting. I know that some people make trouble. I have been run-off from a job by a nurse who was a trouble-maker. We, however, must try and keep to the high road. It's not easy, but it's something we can do with humility and perseverance.

I salute you and hope you enjoy safe flights.

Sunday, August 17, 2014

Improving your ability to make the right choice..."Cognition and Decision Making Under Stress..."

Don’t train and prepare until you get it right. Train and prepare until you can’t get it wrong.”

After watching this 45 minute presentation, I am thrilled to have such great insights provided by a person who has all the bona fides we could ever ask for. Military special operator (shooter-able to heal or kill with steel), current flight-team member, future doctor...

Grab a cup of coffee, sit back, relax, and soak it in... It's good stuff for HEMS.

Click here to see Mike's presentation on YouTube via Greater Sydney HEMS

Friday, August 15, 2014

You do that...We do this...A HEMS Fairy Tale...

You drive down the interstate and something goes terribly wrong...

Photo courtesy Barry McRoy

First Responders quickly begin to rescue you.

Photo courtesy Barry McRoy

Your carriage has arrived...
Photo courtesy Barry McRoy

Bringing the Flight Nurse who will keep you well until you reach definitive care...

Photo Courtesy Barry McRoy,  Flight Nurse J.Foulds
You live happily ever after.

The end...

Site update

You can tell your friends (please do) that another way to find us is by heading over to helicopterems.com. That is our domain and will redirect to helicopterems.blogspot.com.
Want to see your HEMS story on the blog? Leave a comment and if it resonates we will make it a post.

Thursday, August 14, 2014

A TBT repost... Our Cup of Good-Will...

This is the kind of story that goes viral. It smacks of greedy helicopter companies sticking it to people at their worst and weakest point of life, and if the word gets out that this is the way our industry is, that good will I was mentioning earlier will be...Gone!

A year ago, Jeanne (wife, friend, flight nurse) and I went on a Cool Jazz Cruise for a week. We had a great time going to the big shows each night, hanging with cool people, and soaking up the tropical vibe. The best part of the ride took place the night before we stopped in Key West. We went to the early evening show in which Marcus Miller did things with a bass guitar that were mind and eardrum blowing, and were then walking back toward our stateroom. We passed by a small, almost empty piano bar and I suggested we stop in for a drink. The room was dark, and the ships piano player was tickling the ivories. I stood there for a minute and as my eyes adjusted I noticed Jonathan Butler - one of the featured musicians on board - sitting at a table with his family. "Hey Jeanne, that's Jonathan Butler. Let's sit at the piano for minute..."

I sat down and exchanged pleasantries with the piano player, an older fellow with a slightly tired grin and a vast talent, and ordered drinks. After a few minutes, in this dark little nearly-empty space, J.B. got up from his table and walked over to the piano.

"Holy Shit, he's gonna play..."

The house player gave up his seat at the piano and then Rick Braun, walked in with his horn in his hand. He and J.B. started talking and smiling. Then the fellow who had chartered the boat, the entire boat with 2000 passengers, came in and sat down. Then a couple more performers bellied up to the piano, and the cruise host... Someone said, "close the doors."

Now I don't know what your favorite music is, but imagine if you had the chance to sit in a dark little bar with the people who make it, and listen to them talk, and play for each other. We sat there quietly, and soaked it up - obviously not part of this group - and loving every minute of it.

Then it happened. Someone from across the piano didn't recognize us and asked "what do you do?"

I sipped my Jameson, put down the glass, and said "I take sick people to the hospital in helicopters." 

"Wow." "Cool man." "That must be really something..."  We were made to feel welcome, and J.B. played Jeanne a love song for her birthday. J.B. and Rick Braun tore into a couple of songs, and then the others took turns performing a song or two, and it was a really good time... A once in a lifetime kind of thing. Jeanne and I were welcomed because of what we do. She takes care of sick people and I fly. 

Society - today - looks up to us, literally and figuratively. We enjoy significant good-will and support from the communities we serve, and will continue to do so unless we lose our way and get out of touch with the "service" aspect of our endeavors.

I know that operating a HEMs business is challenging. The risks are significant. The amount of capital required is staggering. There is no guarantee of success. The old joke about making a small fortune -by starting with a big one and buying a helicopter - has played itself out time and again. It is understandable, indeed rational, that as business people in the business of transporting ill and injured persons for profit, we should attempt to maximize our profits, and perform as many transports as possible.

We don't check for insurance before flying someone, and some people don't pay anything - that money is lost. We also don't get paid for airborne-standby flights that get cancelled, or other community-services we provide, but obviously, there is money to be made because the number of EMS helicopters has quadrupled in just over a decade.

Occasionally, profit-motive can run over caring and compassion like a squirrel in the road and leave the caring aspect a little flat.

An anecdote:  A rural hospital employee suffered a stroke and was transported by helicopter to definitive care at a stroke-center. She recovered, and got a bill approaching $20,000 for a 15 minute flight. She was contacted by the transport service's billing department and the discussion went like this:

"Well ma'am, your insurance has authorized payment of $5000.00 for this transport which leaves you with a balance of $15,000.00. How do you intend to pay this?"

"Sir, I don't have $15,000.00 to pay this bill. I work in a country hospital and don't make much. I can come up with another $5,000 and hope that can be acceptable to settle my bill."

"No ma'am that will not settle your account. Do you thing you might get your church to have a fund-raiser? Or perhaps you could have your husband come out of retirement and get another job..."

This actually happened. The thing that makes it so indefensible is that if this patient had been a Medicare beneficiary, whatever Medicare paid would have amounted to 80% of the total allowable charge (much less than the straight-billed rate), and this woman's obligation would been only 20% of that allowable amountAnd the company would have been satisfied. But she wasn't old enough to be under Medicare, or poor enough to be under Medicaid,  and she was stuck by balance-billing.

This is the kind of story that goes viral. It smacks of greedy helicopter companies sticking it to people at their worst and weakest point of life, and if the word gets out that this is the way our industry is, that good-will I was mentioning earlier will be...


Perhaps the Government should dictate that the most money a person with no healthcare insurance can be required to pay is equal to what the provider would accept under Medicare rules...The self-pay amounts are jacked up today to provide for greater write-offs against profits, thereby reducing tax liability. But the patient's credit, and perhaps life, is still ruined. And frequently, in the case of air medical transport, that patient has no idea what's going on, or even if air transport is really required. 

Courtesy AP
If the companies don't cotton to the fact that one aw-shit wipes out a thousand atta-boys, and use some common sense regarding business development and utilization-review, the friendly folks in government are going to be flooded with irate emails and phone calls and in addition to not getting paid there will be hell to pay. 

May wiser heads prevail.        

So that our cup of good-will never runs empty...

Wednesday, August 13, 2014

There is Something to be Learned Here... Again! Cowl Strike Redux...

You have to find it

Another cowl strike... and this one bears a similar factor from a previous cowl strike that I discussed and posted pictures of. you can read that previous post by clicking here...

Here is a redacted bit of an event report. It is a current event.  Who did it, where it happened, etc. is much less important than NOT DOING IT AGAIN...

While slowing to land on top of the hospital rooftop pad, the flight
medic riding in the passenger compartment stated  "That wasn't me," and
said he had heard a noise.
The pilot nor the flight nurse on board had
heard it.
The pilot landed the helicopter on the rooftop pad, unloaded the
patient and crew and then proceeded to the hospital hanger to refuel
and return the helicopter to a mission ready status.

Further investigation revealed a hole approximately 20 wide by 8
   high on the number 2, (Right Side), hydraulics cover/cowling. It was
determined that a dzus fastener on the forward portion of the
hydraulics cover either failed or was not fully fastened and loosened
to a point where it allowed the hydraulics cover to flap freely and
come in contact with the turning rotor blades.
All 4 rotor blades had minor scratches and the hydraulics cover was
replaced altogether. No other damages occurred.

There is much to be thankful for here. First of all and most importantly, no one got hurt. Second, the aircraft was not destroyed. Make no mistake though, this is going to be costly. When the manufacturer is consulted about the "scratches" on the blades (and the operator most certainly will consult, they will not assume the liability for operating equipment with any known damage such as this) the manufacturer is going to direct replacement of all "scratched" blades. They make money by selling blades you know, and they are wickedly expensive.  I wouldn't be surprised if they call it a sudden-stoppage event and also direct replacement of rotor hub and transmission. I wish I didn't know about things like this but from personal experience I do.

Sidebar: Operator to manufacturer phone call... "Hey we had this little event happen and we need to know what to do."  "Well, just do this, do that, buff it out and drive on."  "Hey great! Can you send us that in writing?"   "Ohhhh, if you want it in writing, well then you need to replace etc. etc. etc." No one takes a chance when it's in writing...

So, what are the lessons to be learned...

1. Do a thorough walk around before each and every flight. Don't just confirm that the latches are latched.

One of them is open - you have to find it.

The pilot should owe the crew a prize (pizza?) if they can catch him or her leaving a "dzus" or any other type of latch, catch, cap, or cowl undone. All crewmembers should be taught how all forms of latch work, and what they look like open, closed, and in-between.

2. Emphasis added... DON'T IGNORE A STRANGE SOUND. If a crewmember says, "hey I heard something (or smelled something or saw something) different you must stop and investigate... complacency makes us overlook warning signs and continue, at our peril...

The one chance to obtain Situational Awareness is often lost because we are tired and something small arises. It's like a whisper that something is wrong. If your aircraft does something different stop and figure it out. This same type of mistake, when someone noticed something and it was not acted on, has led to many damaging events... like the one in my previous post in which a crewmember heard a "ticking' sound but they took off anyway.

"There are no new causes of accidents...it's new people making the same mistakes..."

safe flights

And now for your safety briefing topic...LASERs...

Laser pointed at flying helicopter... click here for story...

Tuesday, August 12, 2014

For Mike...

Thank you for being here. I know your presence means the world to Karen and the kids. We have two ways to deal with our loss as we contemplate Mike's life - we can feel sorry for ourselves for what we have lost, or we can rejoice in what we were given by the incredible blessing of knowing Michael Francis Sharp.

Eating his cooking. Drinking his coffee, Laughing at his jokes and stories (there were tons), having a beer with him at parties, and occasionally getting to fly with him (you clinicians got to fly with him all the time, us pilots - not so often). It was truly a pleasure. I don't remember him ever saying an unkind word about anyone. Ever. Karen - Mike had a thing for you for years before he finally won you. His time with you was wonderful and made him very happy.  Just look at the pictures.

When I started to write the first web-log post about Mike, I had some difficulty deciding which "tense" to use - as in present tense or past tense. Mike was alive when I wrote about him, so it didn't feel right to talk about him as if he wasn't. I had to scratch out "Mike Sharp was..." and replace it with "Mike Sharp is." I am still having trouble with this - as his effect on me - on all of us, was so great. He is larger than life. We will reflect him throughout our lives.

When I was moved from Fort Bragg to  Hunter Army Airfield in 1989, and was just getting settled in, Mike Sharp was winding down a long and distinguished career as an Army Aviator. He taught pilots to fly, and then taught them to fly in the clouds on instruments. He was a consummate Army Aviator, and received his share of awards and decorations. He lived through a war that enjoyed little public support. He was not treated like a hero, but all the same he did his job as an American Soldier. People like Mike demonstrate to the rest of us how to behave. How to live our lives. How to treat others. He did that for me when I arrived at LifeStar in 2000. He was kind and compassionate to both the patients he flew, and the crewmembers he worked with.

Ten years ago, I left LifeStar and began living a nomadic work-life. I am now a travelling relief pilot. A couple of years ago, I picked up a day shift at LifeStar. When I showed up to relieve him, Mike and I were talking near the aircraft and we got toned out for a flight. I hadn't yet signed in or received a flight release, so he said, "let's go together." I had the distinct pleasure of flying with someone I really enjoy being around. I got to  watch a master at work. We went to our scene, picked up our trauma patient, and flew to Memorial. After landing we stood on the roof in the breeze - shooting it. It was wonderful. I am grateful for that flight. And that talk. It was our last flight together. I hope Mike's last flight was nearly as wonderful for him as was his last flight with me.

Now I would like to ask you all for a favor. There is a big hole in Karen's life right now. I would like to ask each person here to make it a point to make a human connection with her at least once each week for the next year. Something more than "liking" a post on Facebook. A personal note, a call, or a visit. This might take discipline and forethought on my part. But we can do it.

Karen. I recommend you get another horse. One than needs a lot of love. Because if you have demonstrated anything in the last few years, it is that you have love to share. And just as an idea you might name this horse "Francis." That name will work whether it's a boy or a girl. 

Mike started with LifeStar in 1990 and just stopped recently.  He was there a long, long, time; a quarter of a century. For 1/4th of all those years, or put another way, for approximately fifty three thousand  hours during that time period, if you were a victim of trauma, or disease, or burned in our area of the state beyond the range of an ambulance, you were going to be served by Mike Sharp and the LifeStar Helicopter.

We in society need our institutions. We need our universities with their football teams. We need our military. We need our hospitals, our police forces, our fire departments, and yes we need our EMS helicopters. Our institutions provide structure and order to our lives. They control chaos and uncertainty. They provide comfort and peace of mind. We need our institutions...

The funny thing is, institutions are really nothing more than people. It's not the big brick building - it's the people inside that give us the institutions that we need. And frequently, it's a very small group of people within an institution that ensure it's existence. It's the guy or gal with their hands on the controls, leading the way by example, lighting the path. It's the man or woman who steps forward and grasps hold of the guidon - the flag - and holds it up overhead for all to see, and then shoves it into the dirt and says something like...

"Houston, Tranquility Base Here. The Eagle Has Landed." 

Or in our case, "Base; LifeStar One with three on board, two hours of fuel, 20 minutes to the scene."

Yes, we need our institutions, and when you consider the institution that we know as LifeStar, the institution that has been taking care of sick people, old and young, rich and poor, important and nobody for almost 30 years, you need to realize that Mike Sharp was that institution.

No, scratch that.  "Mike Sharp is that institution..."

"Mike Sharp is."

Thank you.

Autopsy Cites Intubation As Cause of Cyclist's Death

A preliminary autopsy Monday revealed that a Little Rock cyclist died Saturday after a crash on a mountain bike trail because of problems with placing a breathing tube in her airway, the Washington County coroner said.
Laura Wooldridge, 39, of Little Rock, died after suffering facial lacerations and head and neck trauma on a cross-country mountain bike trail at Lake Leatherwood near Eureka Springs. Wooldridge, who friends described as an experienced mountain biker, was "pre-riding" the trail in preparation for competition Sunday as part of the Fat Tire Festival, an annual two-day mountain biking festival that began in 1999.
Washington County Coroner Roger Morris said Wooldridge was transported to Washington Regional Medical Center in Fayetteville. She was pronounced dead a few minutes after arriving there at 11:24 a.m.
An autopsy was performed at the state medical examiner's office Monday in Little Rock. Morris said the preliminary autopsy gave the official cause of death as esophageal intubation, which may have made breathing difficult or impossible, with complicating neck and face trauma.
Intubation is the placing of a tube down an airway to assist breathing. Esophagael intubation happens when the tube is incorrectly placed in the esophagus, which leads to the stomach rather than the lungs.
Morris said that Wooldridge had cartilage damage and fractures in her neck and upper chest that prevented emergency personnel from properly inserting a breathing tube into her trachea.
"It's putting in the breathing tube, the breathing apparatus, to help them breathe. But due to the injuries, they were having a hard time placing it," he said.
Tom Dransfield, assistant fire chief and paramedic with the Eureka Springs Fire Department, said that Wooldridge was speaking when his team stabilized her at the festival. He said that Air Evac, a medical evacuation service based in O'Fallon, Mo., responded to a request to evacuate Wooldridge for further treatment.
Information for this article was contributed by Scott Carroll of the Arkansas Democrat-Gazette.
Metro on 07/22/2014
Print Headline: Autopsy cites intubation as cause of cyclist’s death

Sunday, August 10, 2014

I Like Mike... Update 8/11 Gone but never forgotten.

Update 8/11: Karen writes  "My beloved friend, soulmate, husband left on god's train at 12:04 pm; i'm beside words for this sadness;"

Godspeed Mike Sharp...

This is almost too painful to write. I have been avoiding doing this because some things in life are too close - too raw - too painful. We all know where we are going, but we don't like to be beat over the head with it.

In 2000, when I moved from Pennsylvania back to Savannah for my dream job - piloting the LifeStar helicopter out of Memorial Hospital, the first guy I spent time with was Mike Sharp aka "senior."

This was in the days of helicopters with two front seats, when a "new" pilot would gain initial operating experience in a new area by doubling up with a pilot who had been there a while. This training continued until the new guy (me) was "cut loose" after all the crew members gave a thumbs up. (Perhaps we would have less crashes if we revisited this custom)

Mike is easy to fly with, tells a lot of jokes, and has a booming laugh that explodes after each one.

 He comes from a different era - the Viet Nam generation. This was when guys got shot down often. Many of these pilots had multiple helicopters shot out from underneath them. They started HEMS.

Mike is the kind of guy that can do stuff. It was nothing unusual to report for work at LifeStar and have a piece of car - like the automatic transmission - being rebuilt by Mike. Once upon a time he decided to build a model of the LifeStar helicopter. He took the images from the flight manual and maintenance books to a blueprint shop, had them blown up, and then bought a huge block of foam. He pasted the oversized images to to the foam, and using a hot-wire cut the rough shape of the helicopter into the foam. They kept at it, trimming and sanding until they had it right. No one taught him to do this, he just figured it out himself. He is like that - able to figure things out.

When the model was done 20 or so years ago, they put it on a float in the Savannah St. Patrick's day parade. They won a prize, and were then told they could not enter it any more as it was obviously professionally made at great cost and had an unfair advantage. It has been a model of the green and white ship, the orange-spotted wiggler, and now wears the livery of the current owning company. But Mike made it.

One day, during the war when he was stationed in Savannah and training pilots, he was rolling across the marsh towards Wilmington Island in a Huey. The motor quit.

"No big deal" he says as he is telling me the story. "I auto'ed into the marsh grass with zero ground run and stood on the roof waiting for help. The aircraft was slung out in a few hours and was back in service the next day.

Mike is a man's man. (and a bit of a ladies man as well, that's how he caught lovely Karen) He can fly the heck out of a BK. Or at least he could.

Not long ago, Mike was working on something in his shop, got dizzy and weak, and dropped to a knee. He knew right then he was done flying. For ever...

The doc found a thing in his head called a glioblastoma. It is cancer and it takes people down quickly.

Karen advises that Mike is about ready to leave us. I thought about waiting to write this until after. But screw it. I love him and if he is still awake alert and oriented I want him to know that. He was here when I got here and he showed me the way. I imagine he will do the same thing at the next stop...

fly safe all you angels out there...

Thursday, August 7, 2014

Drones in the News...

Franklin Co., VA – The crew of Carilion Clinic Life-Guard says there is concern in the air medical service community regarding the use of unmanned aircraft, commonly called drones, over accident scenes.
Click here for full story...

Do You See Me?

 The helicopter pilot stated that he "immediately" queried on CTAF whether the airplane crew had him in sight. The pilot heard a "double click" on the CTAF frequency, which he interpreted as acknowledgement by the airplane crew that they had him in sight.

NTSB Identification: WPR14LA313A
Nonscheduled 14 CFR Part 135: Air Taxi & Commuter
Accident occurred Friday, July 25, 2014 in Boulder City, NV
Aircraft: EUROCOPTER EC 130 B4, registration: N154GC
Injuries: 9 Uninjured.

This is preliminary information, subject to change, and may contain errors. Any errors in this report will be corrected when the final report has been completed. NTSB investigators may not have traveled in support of this investigation and used data provided by various sources to prepare this aircraft accident report.

On July 25, 2014, about 1643 Pacific daylight time, a landing Eurocopter/Airbus EC-130, N154GC, and a taxiing DeHavilland DHC-6, N190GC collided at Boulder City airport (BVU) Boulder City, Nevada. Neither the two pilots on board the airplane, nor the pilot and six passengers aboard the helicopter, were injured. The helicopter, operated by Papillon Airways Inc. (dba Papillon Grand Canyon Helicopters dba Grand Canyon Helicopters) as an aerial sightseeing flight, sustained substantial damage. That flight was being conducted under the provisions of Title 14 Code of Federal Regulations Part 135. The airplane, operated by Grand Canyon Airlines, was beginning a repositioning flight, and was being operated under the provisions of Title 14 Code of Federal Regulations Part 91. Day visual meteorological conditions prevailed.

According to the EC-130 pilot, he was inbound from the south, and planned to land on the airport location designated as "Spot 2," which was a dedicated helicopter arrival and departure location. He followed the company-designated arrival procedure, in which the helicopter flew a descending pattern first north along the centerline of taxiway A, and then west along the centerline of taxiway D to Spot 2. Spot 2 was a 50-foot painted square situated on the airport ramp. Taxiway D was 40 feet wide, was oriented approximately east-west, and comprised the southern perimeter of the same ramp. The center of Spot 2 was located about 50 feet north of the centerline of taxiway D. Since BVU was not equipped with an operating air traffic control tower, the pilot communicated his positions and intentions via radio transmissions on the BVU common traffic advisory frequency (CTAF).

The helicopter pilot first saw the airplane when the helicopter was making the left turn from north to west near the junction of taxiways A and D. At that time, the airplane was moving south, towards taxiway D, along a taxi line just east of Spot 1, on ramp about 600 feet east of Spot 2. The airplane crew announced their intentions on CTAF to taxi to runway 15 via taxiway D. The helicopter pilot reported that the last time he saw the airplane prior to the accident was as the helicopter overflew the intersection of taxiway D and the taxi line just east of Spot 1. At that time, the airplane was turning westbound onto taxiway D. The helicopter pilot realized the potential for conflict, since the two were now both traveling westbound along taxiway D. The helicopter pilot stated that he "immediately" queried on CTAF whether the airplane crew had him in sight. The pilot heard a "double click" on the CTAF frequency, which he interpreted as acknowledgement by the airplane crew that they had him in sight. Based on this information, the pilot was convinced that the airplane was behind him and that its flight crew had him in sight.

The helicopter pilot therefore continued his descent along the centerline of taxiway D towards Spot 2. About 8 to 10 seconds later, as the helicopter came almost abeam of Spot 2, the pilot began a right pedal turn to traverse to and set down on Spot 2. At the commencement of that pedal turn, the pilot simultaneously spotted the wings and nose of the airplane through his chin windows, and felt an" impact." He stopped the turn and descent, transitioned to Spot 2, descended, and landed on the ramp.

The flight crew of the airplane was unaware that there had been a collision, and they continued with their taxi-out and departure from BVU. The airplane was recalled to BVU by company personnel once they learned of the collision. The airplane was equipped with a cockpit voice recorder (CVR). Subsequent to the company's attempt to obtain a non-NTSB sanctioned readout of the CVR, the device was obtained by the NTSB, and sent to the NTSB recorders laboratory in Washington, DC for readout.

The helicopter pilot had recently been hired by Papillon, and the accident occurred on his first day "flying the line" for the operator. The captain of the airplane began his duty day at 0507 that morning, and the collision occurred during his sixth flight of the day.

The 1656 automated weather observation at Henderson Executive airport (HND) Las Vegas Nevada, located about 13 miles west of BVU, included winds from 240 degrees at 15 knots, gusts to 19 knots, visibility 10 miles, clear skies, temperature 40 degrees C, dew point 9 degrees C, and an altimeter setting of 29.86 inches of mercury.

A commenter writes: All you sky god's on here commenting like you haven't made a mistake.
I remember flying in the canyon with only a 1000 hours. I wonder how many times I landed and if a plane was under me I wouldn't have known. I wonder how many times the variables could have lined up during that moment my attention was some where else.
This guy is either incredibly unlucky, or incompetent. We don't know which it is. But if you have been flying long enough, your butt has been saved by nothing but pure dumb luck more than once, and you know it.
I have made some pretty bad decisions during my career. I do my best to learn from them and not make them twice. Some of those decision I made during the early portion of my career could have been really bad.
None of us are perfect. Every time we fly we take a risk, so let's stop picking this guy apart, learn what we can, and hopefully the next time a guy in another aircraft calls you in sight you don't trust him. That is what I am learning from this guy's mistake. Oh yeah, and look before you leap. (OR LAND)

Sunday, August 3, 2014

It's still hurts when you get stuck... A reposting of Bill Winn's "Life At The Sharp End."

A pilot who might otherwise feel conflicted at the point of an important in-flight decision will be much more likely to opt for safety when his Chief Pilot, Director of Operations, and Program Director all stand shoulder-to-shoulder and tell him, “There is no excuse for flying in conditions that are below the minimums established for this program. You are expected to divert or abort when possible, or land and call for help if you cannot maintain minimums.” 

Editor's note:  In 2010, when I was selected to be Omniflight's AMRM training coordinator, I did some research and quickly came across work by William T. (Bill) Winn. I studied his seminal work;  A Safe ride to a Soft Bed, a safety primer for air medical crewmembers, as an introductory textbook on  Air Medical Resource Management. I knew instinctively that if I ever got to meet him, I would like him and enjoy learning from him. I did meet Bill at the last Air Medical Transport Conference, after listening to him speak. I am fortunate  now to communicate with him regularly as part of my volunteer-support of the National EMS Pilot's Association (NEMSPA). Bill works with NEMSPA on behalf of all of us in HEMS, everyday, and we are all in his debt.

This article is four years old, but as the sad events of the last year have made clear, we still have lessons to learn; from the CEO to the brand new crew member...

By William T. Winn - Anyone who has read Professor James Reason’s writings on human factors in accident causation is familiar with his well-known model of how causative factors can line up like the seemingly random holes in slices of Swiss cheese to result in a mishap or in a serious accident. Dr. Reason is professor of psychology at the University of Manchester, United Kingdom. He has published books on motion sickness, human factors in transportation accidents, absent-mindedness, human error, and on identifying and managing organizational risk factors.
helipic1In an analysis of the chain of events leading to any accident, the sequence inevitably leads to the individual whose action or inaction most directly results in the occurrence of the event. Professor Reason refers to this unfortunate individual as the “sharp-ender”, since he or she stands at the tip of an expanding sequence of actions and circumstances which lead to the final mishap. Traditionally, the sharp-enders receive credit for causing the accident. In the history of aviation accidents they have typically been pilots, aircraft mechanics, or air traffic controllers. In air medical transport operations, the medical crew members on board are close enough to the sharp end of the accident sequence to be considered “affiliate” sharp-enders.
During the past two and a half decades in the United States and elsewhere, those associated with commercial aviation operations have come to acknowledge a broad range of systemic factors that may affect the quality of a pilot’s decision making processes during flight. In particular, an interest in identifying the root causes of EMS helicopter accidents has prompted research to carefully review and analyze the information gathered by the NTSB in their investigations of those accidents.
A careful review of the accident dockets shows that the NTSB investigative procedures do not typically look very deep into the complex systems in which air medical helicopters operate. Due to the constraints imposed by very limited resources, and faced with the difficulties of processing any evidence other than that which is the easiest to gather and to interpret, the investigations tend to focus on the traditional sharp-enders and upon such tangibles as the weather and the physical evidence of the aircraft wreckage. Aircraft maintenance records and pilot logs and training records are examined and information from any available witnesses is carefully gathered and documented. But eyewitness accounts, even when they are accurate, can only shed more light on the terminal link in the accident chain. There remains a need to identify, classify, and mitigate each of the systemic factors that may have played a significant role in the preceding causal sequence. A formal classification of these factors is helpful because a carefully structured system of classification will facilitate the effective and economical development and implementation of a system of interventions to prevent future occurrences of similar accidents.
Review and analysis of NTSB accident investigation dockets by the Joint Helicopter Safety Advisory Team (JHSAT) and recommendations by the Joint Helicopter Safety Implementation Team (JHSIT) have laid an initial foundation for the identification and mitigation of the causes of helicopter accidents.
In addition, the current efforts of a research effort titled Opportunities for Improvement in Helicopter Emergency Medical Services (OSI-HEMS) are focusing specifically on the air medical helicopter accidents that have occurred in the United States from 1998 through 2009. This on-going project began in January 2008 under the direction of Dr, Ira Blumen of the University of Chicago Air Medical Network. His research group consists of approximately 40 professionals from the air medical transport industry, including pilots, medical crewmembers, air medical communications specialists and representatives from air medical operators and the FAA. Other interested parties from the nationwide air medical transport community have contributed their time and expertise on an occasional basis. The group uses a modified and expanded version of the JHSAT taxonomy. It is projected that a preliminary statistical analysis of the data generated will be presented at the Air Medical Transport Conference in Ft. Lauderdale, FL in October, 2010. It is likely that the findings and recommendations from this research effort will influence changes and improvements to the helicopter EMS industry for years to come.
The 4 Dimensions of Safe Air Medical Operations
A review of the causes of accidents and the recommendations for prevention that have been identified reveal that virtually all of the identified causal factors, as well as their associated interventions, fall into one or more of the following four broad categories.
  • Organizational Culture
  • Individual Psychology (the Sharp-enders)
  • Technology
  • Training
The first two categories pertain to the sources of pressures that may be brought to bear on air medical crew members and which may in some measure compel them to accept or to continue a flight under conditions of elevated risk and in circumstances where they are not comfortable with the conditions.
The culture of an organization may be defined as the set of rarely articulated, largelyhelipic2unconscious beliefs, values, norms, and fundamental assumptions that the organization makes about itself, the nature of people in general, and its environment. In effect, culture is the set of “unwritten rules” that govern “acceptable behavior” within and outside of the organization.
An organization’s safety culture consists of the team’s collective attitudes, awareness, philosophy, and behavior with respect to the importance of safety in day-to-day operations. Ideally, it is manifested through a generally held commitment that team members will not compromise safe practices when there is a conflict between being safe and just ‘getting the job done’. All organizations have both formal and informal cultural conditioners that influence the safety of their operations.
Formal Conditioners: GOMs, SOPs, SMS
The formal conditioners of an organization’s culture are found in the program’s published mission statement, in their General Operation Manual and other written policies, and in the documentation of their formal safety management system. In terms of the old expression, ‘Walk your Talk’, the formal elements of our cultures are the ‘Talk’. Actual day-to-day behavior is the ‘Walking’ part of the expression. In many ways, this behavior may be influenced more by certain informal cultural conditioners than by the formal ones.
Informal Cultural Conditioners
One of the greatest informal influences on culture is the manner in which executives and managers communicate their priorities to members of the flight team. Notwithstanding a clear emphasis on safety in the formal elements of the program, if the messages from managers place undue emphasis on flight volumes, liftoff response times, or “meeting the competition head-on”, then team members may feel pressure to push themselves to satisfy those perceived priorities.  Another informal cultural derives from an individual manager’s personal style of communicating and relating to other members of the organization. An excessively steep authority gradient between managers and staff may  hinder the two-way communication that is essential to safe operations.
In some business models of air medical provider organizations, the mixed-messages that are received from managers are due to the fact that they are required to report to and receive direction from higher level managers who have a limited appreciation of the risks inherent in flight operations. Decisions and policies that have an influence on aviation safety must be made at a level that understands and supports operational safety. Corporate fiscal or HR officers may not always give proper consideration to safety in their analysis of, and demands on, the flight program’s operations.
Pressure to get the job done may also be generated at the level of the individual flight crewmembers.  Pilots and medical crewmembers alike tend to be Type-A personalities who possess a high level of personal desire to perform in an exceptional manner.
We must also recognize that time pressures and a pre-disposition to get the job done are built in to the fabric of the air medical transport industry. Patients of all ages and descriptions with a critical need for rapid transportation rely on these providers to get them to the facility that can best relieve their suffering, or save their lives. Although virtually all flight programs tell their crewmembers that the circumstances of the patient are not to be considered in making aeronautical decisions, it is impossible for members of the transport team to ignore what the outcome for the patient might be if they fail to complete the transport.
Implications for training and management
From the above, it is a given that a flight program should have clear and unambiguous written policies that place considerations of safety at the forefront of all operations. In addition, this emphasis on safety and prudent decision-making needs to be reflected frequently in routine communications from managers.  To borrow a paragraph from a primer on air-medical safety, a pilot who might otherwise feel conflicted at the point of an important in-flight decision will be much more likely to opt for safety when …
…his Chief Pilot, Director of Operations, and Program Director all stand shoulder-to-shoulder and tell him, “There is no excuse for flying in conditions that are below the minimums established for this program. You are expected to divert or abort when possible, or land and call for help if you cannot maintain minimums.” And, of course, they’ve also told him, “The condition or situation of the patient has no bearing on aeronautical decisions.ii
This kind of message should be part of initial training for all new hires, and should be reiterated routinely during each team member’s annual recurrent training.
Individual competency
A high degree of experience and technical competency is expected of all team members in air-medical transport programs. Highly experienced and qualified pilots and medical crew will enjoy a greater measure of ‘cognitive reserve’ while performing their duties. This reserve permits an increased awareness of factors in the flight environment that might be significant to their personal safety. We refer to this as situational awareness, and reduction or loss of situational awareness is a major contributing factor in most human error accidents. It should therefore be part of a flight program’s safety management plan to provide regular training in all areas necessary to insure that crewmembers remain proficient at their technical skills. A review of NTSB accident investigation reports also reveals that pilot training should include emphasis on and frequent practice of the particular skills required by the specific flying environment where he operates. It is expected the final findings of the OSI-HEMS research project will provide a more detailed discussion of the training deficiencies that have contributed to accidents in the past.
Team Competency
In addition to training to insure individual proficiency, Air Medical Resource Management (AMRM) training is specifically designed to teach all members of the patient transport team how to work together to insure safer operations. The patient transport team includes those who are directly involved with flight activities: the pilot and medical crewmembers, as well as those who are indirectly involved: communications specialists, operational controllers, and maintenance technicians, when needed.
Training program structure
A description of the substance of a complete AMRM training program for members of an air medical transport program is beyond the scope of this article. Ultimately, it is up to each program to develop and administer that training and to continuously assess and update the substance of it to insure the competency of both individuals and teams. Each of the other three dimensions of safe operations: the cultural, psychological, and technological, must be addressed in the substance of the training.
In their book Beyond Aviation Human Factors, Maurino, et al make plain the need to look above and beyond the sharp end of the accident sequence to identify and control the broader organizational or systemic factors which influence the safe conduct of air-medical operations. Even so, it is still important to attempt to understand what may have been going on between a pilot’s ears as he and all on board approached the point of impact with the terrain.
Tolerance of risk
One issue that has to be addressed is the individual level of risk tolerance possessed by both pilots and medical crewmembers. In the presence of time pressures, organizational pressures, and a high level of personal motivation, how much risk can, or should, a crew accept?
There are no risk-free air medical flights. That is a reality that all accept. A crewmember’s level of risk tolerance is conditioned largely by his individual personality and by his previous experiences. The majority of rotor-wing pilots in air-medical transport received their initial training and gained their early experience as pilots in the military. In that environment a pilot’s perceived worth, as well as his next promotion, depended to some degree on his readiness to accomplish the mission, or die trying. We don’t need to argue the appropriateness of that philosophy in the arena of national defense, but none would find it acceptable for the air medical transport industry.
There are probably very few pilots, if any, in the industry who would admit to regularly and intentionally ‘pushing the envelope’ to complete a patient transport. Still, 6 or 8 (or 28) years of accepting high levels of risk will have an effect on a person’s decision making, unless it is actively mitigated by more proximate influences. That is why clear policies and strong statements from management, like the one cited above, are so important for every flight program.
And, although some pilots may take offense to this statement, the medical crewmembers need to play an active role in acting as a damper in cases where a pilot is taking a flight beyond the limits established by policy, or regulations, or common sense. While the need for such interventions by crewmembers would rare, crewmembers should be trained and enabled to speak up if a pilot should opt to disregard the rules and push the limits. With very few exceptions, air medical pilots are responsible and mature men and women who demonstrate exceptional aeronautical decision-making each time they fly. But the records show that even well trained and highly experienced pilots can get into trouble when too many causative factors are present and lined up in just the wrong way.
Nor are we pilots the only ones who may be too accepting of risk. In the 2003 fatal accident that cost my program the lives of a pilot and a paramedic, there has been some interesting speculation about the dynamics of that specific crew. The accident occurred during conditions of darkness and fog; conditions that have prevailed in too many fatal helicopter accidents. The pilot was ex-Army, trained for combat operations. The medic was a full-time professional firefighter, and the flight nurse, the only survivor, was an avid backpacker and back-country enthusiast. It’s impossible to know, but some have speculated that had the testosterone on board been diluted by even one of our female nurses, the outcome might have been different. The women in my program are all highly motivated professionals, but as a group they are more conservative with respect to risk taking and they are quicker to speak up when they feel that something is not as it should be. In short, they are more naturally disposed to act in accordance with the principles of Air Medical Resource Management.
Assessing risk tolerance
In an FAA study of pilots and risk it was determined that a pilot’s perception of risk during actual flight was as important as his individual tolerance of risk. In fact, these two dimensions, perception and tolerance, appear to be separate constructs that exist independently, notwithstanding the fact that there are correlations between them. Moreover, it was determined that of these two dimensions of risk, it is risk perception that lends itself more easily to mitigation through training. It seems that it is much easier to improve a pilot’s ability to recognize and appreciate significant in-flight hazards than to change the personality factors that affect willingness to accept risk.
Implications for training and management
Just as for the other dimensions of safe operations, training can accomplish much to mitigate potential problems due to the influence of individual psychology. At the most basic level, this might be done by simply putting the topic on the table for clarification and discussion among all crewmembers. This would be one place to stress the importance of erring on the side of safety whenever there is serious doubt as to the safety of a course of action. It might also be the time to clarify the consequences of exceeding any statutory limits established for flight operations. It is a given in aviation that a pilot may temporarily act in variance to a rule in order to deal with an emergency. But the license to violate the rules is provided so that a pilot can extricate his aircraft and the occupants from an emergency, and not so that he can get them into one.
Everything discussed in this article to this point has been for the purpose of considering how to mitigate human error. We all need to recognize that it is not possible to eliminate errors. We also need to acknowledge that we make dozens of errors every day. We catch most ofhelipic3them immediately and make quick corrections. Many of the ones that we don’t catch may still go unnoticed because they are inconsequential. This is true whether the task at hand is cooking dinner, driving your car, or flying a helicopter. Our concern is for those errors that may lead to a tragic accident if they are not either avoided or immediately trapped and corrected.
A significant number of such errors are the result of inadequate situation awareness. Even under ideal conditions humans may misinterpret or simply fail to perceive critical situational cues in the surrounding environment. A helicopter in flight is not an ideal environment. Even with a healthy safety culture in place and a crew that is trained and committed to AMRM principles, a momentary distraction or lapse of attention can result in critical cues going unnoticed. At night cues are even more difficult to discern due to the reduced ability of the pilot to see. A pilot with 20/20 daytime vision, experiences 20/200 vision on a dark night. That’s legally blind by anybody’s definition.
The use of technology to fill in the gaps in a pilot’s situation awareness seems like a natural fit for some of the current problems in air-medical operations. The devices that best lend themselves to the needs of air-medical transport are night vision goggles, terrain alert and awareness warning systems, traffic alert and collision avoidance systems, and perhaps some kind of cockpit monitoring and cockpit voice recording system. The industry has resisted this technology in the past for three reasons: cost, weight, and effectiveness.
From a strictly business point of view, a capital expenditure is generally justified only when it results in increased revenue which exceeds the costs. While it might easily be argued that the costs of even a single serious accident far exceed the expense of new technology, some managers and financial officers are still having problems connecting those dots.
Nearly all air-medical helicopters frequently operate near the limits of their gross weight capabilities. In years past, the hardware we are considering here was designed for larger fixed wing aircraft. The weight and bulk of such systems could compromise our ability to add a large patient to the flight manifest. The newest generation of these devices promises to be a much better fit for medical transport helicopters.
In addition, most of the current devices were designed for aircraft that flew higher and faster than is typical of medical helicopters. If those devices were used in medical helicopters as initially designed, they would produce a large number of false traffic or terrain alerts. Any system which provides frequent false alerts will soon be ignored or simply switched off by the operator. In order to be effective, the technology has been redesigned to accommodate flight profiles characteristic of HEMS operations.
Implications for training
If new technology is not deployed properly, it has the potential of causing the very accidents that it is intended to prevent. In the first months of flying with night vision goggles, the U.S. Army experienced a series of accidents, major and minor, that were the result of pilots not fully understanding the limitations, as well as the capabilities of the devices. The technology under consideration for use in the air-medical transport industry will also carry the cost of thorough initial and recurrent training for all operators.
There is no denying that this technology will be an added cost and training burden upon operators; but this burden should be viewed in its proper perspective. A backpack containing food, water, and first-aid supplies is certainly a burden to a hiker. But, no prudent back-packer would start up the trail without one.
These considerations of organizational culture, training, individual psychology, and technology are intended to serve as a general guide for self-examination and re-evaluation of how we train, how we manage, and how we conduct our operations in order to accomplish our goals in the air-medical industry.

Mitroff, I.I., Pauchand, T., Finney, M., and Pearson, C. (1990) Do some organizations cause their own crises? The cultural profiles of crisis-prone vs. crisis-prepared organizations. Industrial Crisis Quarterly, 3: 269-283. Quoted in Maurino, et al, Beyond Aviation Human Factors.

Winn, William T., A Safe ride to a Soft Bed, a safety primer for air medical crewmembers. Last accessed at www.williamwinn.com on Feb 28, 2010

Hunter, David R., (September 2002) Risk Perception and Risk Tolerance in Aircraft Pilots. Office of Aerospace Medicine, Washington, DC. Federal Aviation Administration.
William Winn served as a helicopter pilot and instructor pilot in the US Army for 27 years and began flying as a HEMS pilot when he retired from the Army in 1996. After a health problem forced him out of the cockpit in 2005, and with Bachelors and Masters degrees in Education to draw on, he turned his efforts to the development of materials to teach HEMS safety. He is currently the Safety Officer for Intermountain Life Flight in Salt Lake City, Utah. He is a member of the HEMS safety improvement research group working under the direction of Dr. Ira Blumen of the University of Chicago Air medical Network. Bill also serves as the General Manager for the National EMS Pilots Association.