Friday, October 31, 2014

A Powerful Message From Randy Mains...


After returning to my hotel room from the second round of meetings with the HAA action team in Denver yesterday, my phone rang - it was a number I didn't recognize.

"Hello this is Dan..."

"Hi Dan, this is Randy Mains, did I get you at a bad time?"

I had the time and we talked for an hour, sharing experiences, AMRM teaching ideas, and things we have seen in the classroom that didn't fit - like a student fixated on a smartphone while we are doing everything within the limits of heart and soul to keep them alive.

I have known about Randy for years, as he writes in several magazines, has published books, and has presented several times at the Air Medical Transport Conference. When NEMSPA president Kurt Williams and I met him this year in Nashville - it made the trip! Randy is absolutely committed to ending the loss of EMS helicopters and crews.

As am I.

It was an honor to speak with him again, and hear about his trip to produce a "Digital Safety Story." This is a great project and these stories impart wisdom. We can learn from someone else's pain and suffering - instead of our own.

Check out Randy's digital safety story here by clicking here.

Wednesday, October 29, 2014

Acting NTSB chief says automation affects professionalism...

Click here to read full story pointed out to us at nemspa.org

"How do we design this whole human-machine system to work better so we don’t lose the professionalism in the humans who are doing this?”

Tuesday, October 28, 2014

Lesson Learned

Blogger is not the place to post an album of pictures. Facebook works better for that. The NBAA pics are at helicopterems.com on facebook. Hope to see you there...tell us what you think.

Saturday, October 25, 2014

ATC Audio From Mid-Air Collision.

One of the hazardous attitudes we face is "invulnerability," or "it could never happen to me.

It could.

Watch out!

Click here for audio...warning...discretion advised.

Saturday, October 18, 2014

Lawsuit Filed in Fixed Wing Air Ambulance Mis-Fueling Crash

According to a report released by the National Transportation Safety Board last month, the twin-engine aircraft was refueled with 40 gallons of jet fuel instead of aviation gasoline before it took off from the Las Cruces airport on Aug. 27.

Read full story by clicking here...

Wednesday, October 15, 2014

Throw-Back-Thursday... The Smartest Person in the Helicopter...

The guy or gal flying the aircraft you are riding in may not have the best handle on what is going on with the aircraft, the environment, and the situation at any instant.

Don't believe me? Start reading  N. T. S. B. reports.

How could this be?

As we contemplate crashes, mishaps, and injuries, it is easy to fall into armchair mode and smugly ask ourselves "how the heck did they do that?" Monday-morning quarter-backing ignores the fact that the people who participated in the adverse event were in the arena.

As safety-expert, AMRM wizard, and former EMS pilot William Winn pointed out in his work on AMRM and situational awareness; we who fly operate in a naturalistic environment. So, what does that mean, "naturalistic environment?"

It means that flying an aircraft into uncertain weather at 2:00 AM with unlit towers in our path, birds everywhere, a patient whose condition is deteriorating, a headwind that wasn't forecast, and a fuel gauge racing to empty is much different than sitting on one's sun-porch and pontificating.

Here is a note on a famous "naturalistic environment."

On January 22nd 1991, during the Gulf War, an eight-man S.A.S. (Special Air Service - Britain's version of -  and the precursor of -  our Delta Force) team known as Bravo-Two-Zero were sent on a mission behind enemy lines. Their mission was to remain concealed near the main supply route in Western Iraq for 14 days. During this time they would be expected to sever Iraqi fibre-optic cables, and report on the movement of scud missile launchers. However, due to source limitations, they were given suboptimal equipment. They also received vague intelligence reports. This was apparent when they arrived at their drop off point to find it only about 200 meters from an Iraqi anti-aircraft stronghold. This had not been reported by Intelligence. Because this information was crucial to the success of the mission, the group attempted to contact their base via radio and inform them of the new situation. It was at this time that they realised that they had no contact with base. It was later discovered they had been given the wrong radio frequencies. The group then made the decision to sit out until a liaison arrived in 24 hours. Unfortunately, that was too long a wait. They were spotted by an Iraqi goat herder, and from then a malady of errors began its course. The team were separated. They were confronted with intermittent enemy contact, and were completely unsupported by the larger organisation. Over the next three days, three of the eight died, and four were captured. Only one man made his way back across the Syrian border. This planning error resulted in one of the most costly patrols in SAS history. 
(David, 1997) 

This event was described in a riveting book and movie, and points out how the best-laid plans can go to hell in a handbasket.

This happens to us too, in our helicopters, as we fly sick people from one place to another...

If you want to become more informed about how naturalistic environments affect decision-making, click here (paper by Dr. Taryn Elliot)

In a nutshell, what we have to do at 2:00 AM (or at anytime we are flying) is react to ever-changing conditions by an ongoing process of situation-assessment, pattern-recognition, situational-awareness, and decision-making. Each choice we make affects our future, and typically leads to other choices having to be made, to react to future changes in our situation. All this occurs in a rapidly-changing dynamic environment with various stressors - like fatigue, distractions, and a lack of resources like time.

 The pilot said he performed a "high recon" of ...the... helipad and called out his intentions to land. He performed the pre-landing checklists, and started the approach to the helipad from the northwest at an altitude of 700 feet above ground level (agl). Both of the hospital's lighted windsocks were "limp" but were positioned so they were pointing toward the northwest. The pilot, who had landed at this helipad on numerous occasions, said the approach was normal until he got closer to the helipad. He said he felt fast "about 12-15 knots" and a "little high," so he decided to abort the approach. At this point, with about ¼ to ½ -inch of left anti-torque pedal applied, he added power, "tipped the nose over to get airspeed," and "pulled collective." The pilot said that as soon as he brought the collective up, the helicopter entered a rapid right turn. He described the turn as "violent" and that it was the fastest he had ever "spun" in a helicopter. The pilot told the crew to hold on and that he was "going to try and fly out of it." The pilot said he tried hard to get control of the helicopter by applying cyclic and initially "some" left anti-torque pedal "but nothing happened." The pilot said he added more, but not full left anti-torque pedal as the helicopter continued to spin and he was still unable to regain control. He also said the engine had plenty of power and was operating fine. The pilot recalled the helicopter spinning at least five times before impacting the ground. The pilot said the helicopter landed inverted and quickly filled up with smoke. He unbuckled his seatbelt assembly, took off his helmet, punched out the windshield and exited the burning helicopter.

On it's surface, this event started with a decision to abort the approach because it didn't feel right. Although the official cause has not been determined, one possible scenario is a downwind approach, followed by vortices from the main rotor disk interfering with the tail rotor and creating loss of tail rotor effectiveness. The downwind landing would have felt wrong because the speed across the ground would have been faster than normal, and faster than the speed through the air. Being pushed forward by a tail wind would steepen the approach angle and make one feel a "little high" on approach.

At night, it is hard to determine wind direction in flight. And easy to get it wrong.

"It would be expected that the more experience a person had, the more successful they would be at decision-making. However this has been found to be incorrect. It seems that decision error can be attributed to any of: individual, organisational, or social factors." (Dr. Elliot)

It's no wonder that things go wrong. Indeed, it's a wonder that things don't go wrong more often. The standard operating model in HEMS is a single-pilot, single-engine aircraft with modest capabilities, and "crew-members" who are not really recognized as such by the FAA or - frequently - the pilots flying the aircraft. Vernacular statements like, "self-loading baggage," "climb-in, strap-in, and shut-up," and "you take care of the sick people and I will fly the aircraft," reveal the state of things in our industry.

And this contributes to fatal crashes.

Although we don't usually don't have a copilot in our helicopters, we do have at least two smart people on board who can be developed into resources able to help us make choices that don't kill us.

We can discuss what we think is going on, with our medical crew, and ask them what they think. We can also ask them to point out things, like flags blowing in the wind, smoke coming from smoke stacks, or wind effects on bodies of water. As an instrument pilot, I used to brief crews on approaches, and if I said, "now what was that decision altitude again?" they would announce it.

In short, I treat my crew like pilots in training, and explain as much and as often as possible.  They begin to think like pilots. I haven't crashed yet.

Sometimes a layman comes up with the answer that saves the day. We can't shut anyone out, or alienate anyone to the point that they sit back and shut up and watch us make a mistake. Although my medical crew members are - perhaps - busy taking care of a patient, they are certainly NOT mired down with flying the aircraft. They may see something I don't, or become aware of something I am not, like a new ticking sound or a new vibration, or a new smell...

Note to crew: It's very hard to only crash a part of a helicopter. Never give up on the situation, even if your pilot doesn't play well with others.

I sat in the jump-seat of a C-5 Galaxy once, on a flight from Japan to Korea. As we got ready to take-off, the PIC stopped the aircraft (all 380,000 pounds of it), turned around, and stated to the entire body present, "okay, so what we are going to do is..." After describing his understanding of the future, he made sure that's what we all had in mind too - even me, an army warrant officer helicopter pilot. He wanted to develop a "shared-mental-model," and offer a chance for anyone to detect a plot-flaw.



Your Team Is Called to Fly a Patient With Ebola... What Do You Say?

Click here for story from National Nurse United

The Way We Would All Like to Be Thought Of...

A post on facebook came from Native Air in Carlsbad,

Well we are all sad around NA 29 today. This is our last shift with Matt G. Montgomery! He will be transferring back to Nebraska. While we are all sad at the loss of our team member, we know that he will do great things at his new base. This is an exciting day for him and his family. You will be greatly missed around here. Thank you for all your hard work and positive attitude every day! Good luck on your new adventure and lets get through your last shift here with a bang!

Well, minus the bang part...

Thanks for all you do Matt. This note says a lot about how you have done your job.

Fair Skies and Following Winds...

Frequently Asked Questions about... MedEvac Transport

We estimate that there are nearly 400,000 rotor wing transports annually, with an additional 150,000 patients flown by fixed wing aircraft each year. (US only)

Welcome, from wherever you are...

Recent visitors hail from...

United States





What brought you?

What about HEMS interests you?

Have any great pictures to share?

Sunday, October 12, 2014

Would You Hire Yourself Today?

While standing beside a lead-pilot as he worked on a schedule that was hopefully going to have me on it, I had an "out of body" experience earlier this year. It was one of those epiphanies.

I wish I had more of them.

I saw myself standing there, next to this manager, and wondered how - in his mind - I measured up.

Then I looked at myself from outside and took my own measure.
                                                                                                                                                                    We go through life individually doing our best. We want to take care of our families and make a living. We grind it out.   We have a talent that we sell for money. And the people who decide whether or not to select us for a job, project, or shift compare us to other members of the group when making that decision.

When I hear about people who don't get their way at work, and are angry, or upset, I wonder if they have thought to ask themselves - honestly - why this has happened. It's easy to blame outside factors for an adverse outcome, and much more difficult to look in the mirror and acknowledge that the reason I  was not favored is...


A friend told me about a paramedic who was shocked and disappointed that he was not going to be selected for a position, and I wondered aloud, "how on earth could he not have known?" This fellow complained constantly. He waited until the last minute to accomplish his assigned tasks - forcing regular reminders. He called in sick as soon as he had time accrued. He worked multiple jobs and was unhappy at all of them.

Maybe he thought that because he had been a flight medic for years he was entitled to cause problems. Sure, longevity matters, but only if it is coupled with consistently reliable, satisfactory performance. Twenty years on the job doesn't mean that one can stop doing it, and our supervisors compare us to our peers each and every day. Why is it then that when we don't measure up we get angry and resentful?

Once, a flight-nurse was a candidate who competed against people outside the company for a management position. She came to the interview unprepared, unkempt,  and with a negative demeanor. What was she thinking? And how little was her understanding of human nature? People expect you to come to an interview dressing and acting the part. The interviewers may make a joke about you being overdressed - but if you are under-dressed they will say nothing and think the worst.

As for us, we should strive to be the guy or gal who came to the interview, every day until our last with the firm. When you can no longer be that person, do yourself a favor; go find something else to do that challenges and rewards you. If you think the company is terrible, and you are confident that you aren't part of the problem, do yourself a favor. Move on. Life is too short and special to waste it being miserable.

When people have to make a decision about you, remember that they are going to run all the memories of your interactions through their mind. If you have been a source of frustration, anger, anxiety, or disappointment, you are going to get this in return.

We have to be at least as good as the outsider off the street... every day.

Or we may find ourselves on the street instead.

We have to pay attention to our personal "brand," and the details of our job, and our relationships at work.

This matters.

If you don't believe it you are in line for disappointment. HEMS is a small industry and reputation matters. You can do yourself incalculable damage if you don't monitor your own performance, and the sad thing is that in the end, you will pay the price.

There is no such thing as a "forever-job" anymore. Change and transition are constant. And during those transitions; from one owner to another, or one operating-model to another, some people get left behind.

Don't let it be you...


Friday, October 10, 2014

Sunday, October 5, 2014

Interim Guidance for Management of Patients with Known or Suspected Ebola

Emergency medical services (EMS) personnel, along with other emergency services staff, have a vital role in responding to requests for help, triaging patients, and providing emergency treatment to patients. Unlike patient care in the controlled environment of a hospital or other fixed medical facility, EMS patient care before getting to a hospital is provided in an uncontrolled environment. This setting is often confined to a very small space and frequently requires rapid medical decision-making and interventions with limited information. EMS personnel are frequently unable to determine the patient history before having to administer emergency care.

Announcing Your Forced Landing Area...

Thought for the day for HAA pilots. Call out your forced-landing area for all departures and arrivals as part of your briefing. If you don't have a suitable forced-landing area and intend to proceed, this is a risk-decision that should be announced to the crew. While engine failures are rare - they do occur. If you have one motor, and it quits, this forethought will be invaluable. If you have two motors and one quits on climb-out or short-final, the second motor will probably not have enough power to avoid a forced landing...

You can watch this video by clicking here...

Go Around... a digital safety story...

Thank you to Dr. Cathy Jaynes for sharing this story.

Saturday, October 4, 2014

Air Evac Lifeteam Helicopter Crashes in Texas, Patient Dead, Crew Burned

Wichita Falls Fire Chief Jon Reese said a helicopter carrying three crew members and one patient out of Waurika, Oklahoma crashed near the intersection of Ninth and Grace streets while trying to transport the patient to United Regional for life-threatening injuries around 1:56 a.m...(Times Record News, Wichita Falls)
Photo courtesy Times Record News...

Click here for full story...

Photo courtesy Times Record News...

If you do not see video click here to go to YouTube...

Friday, October 3, 2014

MedFlight of Ohio named "Program of the Year" by Association of Air Medical Services

Rod Crane, President and CEO of MedFlight of Ohio. Image courtesy MedFlight
COLUMBUS— MedFlight, who provides air and ground critical-care transportation across Ohio, was recently named ‘Program of the Year’ by the Association of Air Medical Services (AAMS) at the Air Medical Transport Conference in Nashville, TN...

Click here for full story...