Tuesday, November 25, 2014


Since the installation of Appareo video and data recorders in EMS helicopters, there have been three separate incidents - two of them fatal helicopter crashes - in which a pilot continued flight into bad weather, became disoriented, and allowed the aircraft to enter unusual attitudes.

He then reached forward and caged the attitude indicator.


Let's consider what is happening  The pilot elects to fly under visual flight rules into reduced ceiling or visibility. He either thinks that he is up to the task of instrument flight, or he hopes that things won't get worse and will get better shortly. Things don't get better and the pilot loses ground reference entirely. He is in the goo and cannot tell which way is up or down by looking out the window

Although he may have some experience flying on instruments, he is not proficient; and he loses control of the aircraft, allowing it to get into an unusual attitude. This often occurs during a turn back to where things were better.

By now his vestibular and proprioceptive systems are lying to him, At some point he realizes he has gone too far, and fear kicks in. It's tragic that he wasn't more afraid sooner.

He looks at his attitude indicator, and doesn't believe it. It is tilted over on it's side, and pitched up or down, and it just can't be right. He doesn't "feel" like he is turning and diving.

So he takes his hand and re-cages the gauge. 

Several seconds later (at 2318:40), with the helicopter at high pitch and roll angles, the
pilot pulled a knob on the instrument panel to cage the attitude indicator (which sets it to display
a level flight attitude). Caging an attitude indicator is meant to be performed only when an
aircraft is in a level flight attitude, such as on the ground or in straight-and-level, unaccelerated
flight. As an experienced pilot and mechanic, he would have understood the conditions under
which the attitude indicator could be safely caged. Therefore, the NTSB concludes that the
pilot’s action to cage the attitude indicator outside those conditions under which it could be
safely caged indicates that he distrusted the information he was seeing. (Possible reasons for this
distrust are discussed in section 2.6.) By caging the attitude indicator while the helicopter was at
high pitch and roll angles, the pilot caused the instrument to provide erroneous attitude
indications that would be difficult to ignore in a high-stress situation

Click here for full report...

The attitude indicator, if caged while upside down, will indicate right side up. If you have just caged the attitude indicator in the picture above, with your aircraft upside down, it is still upside down!

God forbid, if you are a crew member and I have taken you into the clouds, and you see me reaching for that knob - tell me THAT WON'T WORK.

The attitude indicators on early aircraft failed often. The were considered a "secondary" instrument, less reliable than the altimeter, vertical speed indicator, heading indicator, and turn indicator. Pilots are required to demonstrate the ability to fly "partial panel" with a cover over the attitude indicator during instrument proficiency checks - but VFR EMS  helicopter pilots - even though an instrument "rating" is required, do not have to take an instrument check ride. We must only demonstrate the ability to recover from an unusual attitude and shoot a single approach.

This is not enough to prepare a visual pilot for instrument conditions.

(edit: 10/02/17 Here is an excerpt from an accident report involving a pilot, patient, and medical team that crashed after encountering fog at treetop level immediately after takeoff from an interstate highway accident scene.
"The pilot's...training records indicate that he completed initial new hire ground and flight
training between April 15 and April 20, 2003. During initial flight training, he received 6.6
hours of flight training in a Bell 407 of which 1.6 hours were at night and 0.2 hour was
simulated instrument flight. He completed recurrent training in a Bell 407 on August 28,
2003, receiving 1.3 hours of flight instruction of which 0.2 hour was simulated instrument
flight. He next completed recurrent training in a Bell 407 on April 19, 2004, receiving 1.2
hours flight instruction of which 0.3 hour was simulated instrument flight. On April 27, 2004,
he satisfactorily completed the required 12-month 14 CFR 135.293 competency check and the
14 CFR 135.299 line check in a Bell 407 lasting 0.9 hour."

This training experience is typical for a VFR HEMS pilot. This pilot had zero actual instrument time. He was not ready to fly in fog or cloud and his last decision before he killed himself and his crew was to attempt to get under it. As his record shows, the instrument training provided to a VFR HEMS pilot in a VFR helicopter is extremely limited.)

So we better stop or divert before we get there - in the clouds, or snow, or heavy rain,. Stop because we aren't prepared, we aren't proficient, we aren't ready.

And three of us have proved it by putting their hand on a knob.

This pilot made the mistake - and lived to tell the tale. Click here.

Disclosure: During my last check ride with my company, I was forced to demonstrate partial panel flying, with a cover over the AI. This is the first time in twenty five years or so that I had to do this. It is very good training and something we should all do regularly. You do not need an attitude indicator to fly on instruments. Practice, practice, practice.

VFR EMS pilots should be required to take an instrument proficiency check at least once a year. A real check ride, not one approach.

Crews - do not let your VFR  pilot take you into instrument conditions. Please. You can prevent a fatal crash. If you know of team members who are not as familiar with what is happening here - such as pediatric or neo-nate team members, or perfusionists - people who don't fly as often and don't hear about events like this,  please call them and discuss this. You may save their lives.

Speak up!

Monday, November 24, 2014

Quick and Dirty: Posterior Hip Dislocation

Here’s a quick 5 minute video full of tips on diagnosing and managing this injury. Click here to view video.

Material from Dr. McGonigal's "The Trauma Professional's Blog" posted with permission.

Action Team Trip...Dinner With Friends...

We just returned from Dallas after attending  the third set of "action team" (FAA term) meetings to advise a working group that will advise an aviation-rule-making committee on new rules for Helicopter Air Ambulance (FAA term) pilots training. Still with me? It is a real eye-opener getting to see how rules get made, and pretty cool being here for the National EMS Pilot's Association representing the guys and gals on the front line. And straight-up I have to say that there is a lot of good "face-time" with chiefs and directors of operations (and Terry Palmer who directs training for Metro and is an Omniflight graduate!) I volunteered for this duty and have given up about a week of my time, but it has been a learning experience. Pilots - I recommend you join NEMSPA, get involved, volunteer to take on a project, and have fun with it. To a man (and women) every person on this team is totally decent, respectful, and (I believe) appreciative that us pilots want to be better trained, more professional...
More safe.
Last night at dinner, Kevin (Bell instructor) and Dennis (Air Methods DO) got into a discussion about 206s and engine failures. Apparently in 80% of the engine failures in a 206, the engine would relight if given the chance. So a technique is - if the motor quits - to mash on the start button with the throttle WIDE OPEN. At 60 knots the airflow will prevent an overtemp - and honestly if there is an overtemp followed by a safe landing - who cares.
Dennis told us that - after losing a friend to an engine failure fighting fires, he would, when dropping water, just hold the start button on during his final run-in. This momentarily fails the generator (with a light) but ensures that if the engine would restart it does.
I think conversations like this (and there were lots more!) are a big reason pilot training should be in a group environment, with time to interact, socialize, tell stories, and...

Monday, November 17, 2014

CRM (AMRM) Fundamentals (posted on the JH original Forum)

Feel free to commit this to memory and also have it laminated for your wallet...

*Eight Multi-Crew Coordination Procedures Applicable to All Flight Operations*

1. If you do something, announce it

2. If you need/want something done, ask for it

3. When you hear a statement or question, acknowledge it

4. Announce changes to aircraft flight path, configuration, or condition

5. Question unannounced changes to the aircraft's flight path, configuration, or condition

6. If another crewmember does not perform as expected, prompt him

7. Listen to inputs and judge information, not the source

8. If you suspect a problem exists, talk about it and eliminate doubt

Picture credit: Brady Palmer
From a 'hooker...

Thursday, November 13, 2014

2009 Washington Post Special-Report on HEMS : In Five Years, Much Has Changed, Yet Much Remains the Same...

This report provides an interesting retrospective on our industry. Many of  the numbers have changed, and now most of us do fly with NVGs and radar altimeters. Yet many of the issues raised in this in-depth report continue to factor into our crash-rate today.

What began almost four decades ago as a way to save lives is now one of the most dangerous jobs in America -- deadlier than logging, mining or police work -- with 113 deaths for every 100,000 employees, The Post found. Only working on a fishing boat is riskier. 

October 2014 Crash, One of Three In Just Over a Year...

To Read This Multi-part Story Click Here...

Monday, November 10, 2014

Safety Through Helicopter Simulators...

The NTSB has prepared a video on the use of simulators to prevent crashes. I wish I was not as familiar with the crashes discussed, but this is a small industry and I know them all too well. Pay special attention to the point that our current auto-rotation training does not prepare us for a forced landing/engine failure sequence. Mental rehearsal and proper mindset are going to be key if our one motor quits.

To view this excellent video covering simulators and actual crashes click here...

NTSB: 'Inadequate safety management' contributed to fatal trooper helicopter crash

Photo Courtesy of Stephen Nowers

The deadly crash of Alaska State Trooper Helo 1 near Talkeetna in 2013 was tied to state Department of Public Safety policies that encouraged pilot Mel Nading to take dangerous risks, the National Transportation Safety Board has concluded.

Click here for full story..

Click here to link to crash sequence video...

Saturday, November 8, 2014

Unsung Heroes... Redux

With the advent of community-based operations, the aviation-services-vendors have become their own worst customers, demanding things that, in the past, would not have flown. And the mechanics have suffered.

Bobby Mordenti showed up at the hangar today, looking no worse for the wear. Amazing, considering what happened to him a few weeks ago. He was standing on a ladder, waxing the tail boom of  his aircraft, and fell. The ladder made a racket - thank-goodness - and the firefighter-medics here at the base went to see what was going on. One of them began treatment and the other came running inside to get more stuff and call for help. Bobby was out-cold on the concrete, with a plate-sized circle of blood coming from the split in his head.


Bobby has been a "wrench" for longer than some of his pilots have been alive. When speaking with him, a sense of camaraderie develops quickly. Hangar talking is good stuff - a pilot who asks questions and listens can learn something. Decades ago, Bobby sailed his boat to Charleston, South Carolina for a job as the mechanic for an EMS helicopter there; the Medical University of South Carolina's MeducareAir. When he was getting tied up at the dock, a kid working at the marina named Jess Perry helped him. They struck up a friendship, and Jess ended up going to Embry-Riddle and getting his Airframe and Powerplant certificate.

Jess was in Savannah maintaining a BK-117 when I showed up in 2000, after fleeing a Pennsylvania winter. We worked together four years. For years after I left, I would call and ask his advice about this or that happening with a helicopter, and he never complained or griped - he just kept giving up the gouge.  Jess spent twenty or so years himself as the LifeStar-Savannah mechanic, and did a wonderful job keeping a great ship in the air.

Jess now lives a "normal" life working for Gulfstream. I can't say that I blame him. A HEMS mechanic's life is grinding. They are on-call 24 hours a day, with perhaps one or two weekends off a month; by that I mean away from the base with the pager turned off. For the privilege of having a day off, they are usually responsible to cover another mechanic's base so that guy or gal can have a day off - it reminds me of the old HEMS pilot's "Chinese Vacation." If the helicopter gods are angry, and both ships break, there is hell to pay.

Image courtesy John Mulder, WARDOG

I don't know how they do it, these "knuckle-busting" trouble-shooting quiet-professionals. They have to get the aircraft exactly right every time or else, in the face of constant pressure for more in-service time. Now days scheduled-maintenance has to be performed during the hours when flight requests are least likely - this is when most humans are sleeping - and this mid-night labor often occurs out in the open on an exposed helipad; by flashlight. And guys still sign up to do it. When vendors had hospitals as customers, this wasn't how things were done. Maintenance was understood to be part of aviation, and it was done as required and when required - rarely in the middle of the night by a single mechanic out in the open. What kind of signal do we send to mechanics about their value to the organization when we treat them with so little regard? When we make a job so distasteful that the best and brightest, like Jess Perry, leave the workspace, what does that leave us with? How deep into the labor pool will we have to dip before we scrape the bottom?

With the advent of community-based operations, the aviation-services-vendors have become their own worst customers, demanding things that, in the past, would not have flown. And the mechanics have suffered.

I wonder why we don't make more of a fuss about the guys (and gals?) who keep our butts alive by providing us safe aircraft to fly. We have our professional organizations, and they recognize the Nurse or Medic or Pilot "of the year" but never have I seen a mechanic's face in a trade publication being honored for the huge part they play in a successful HEMS enterprise. Maybe it's time for AMMA. The Air Medical Mechanics Association... What the hell? All the other groups have their alphabet clubs.

They are like bass players or drummers in a rock-star band. We couldn't do this business without them, but they toil in the background, unseen, unheard, and largely unappreciated. They receive polite applause, because it's obligatory. But they are never recognized for being the absolute rock-solid foundation upon which safe aviation operations stand. When Omniflight Helicopter's owners decided to do away with their own ability to fix helicopters - it spelled the end of the company.

Times are changing.

There is a new breed of mechanic coming along now, and they are too smart and too cool to stay in the shadows. One is a young fellow named John Janiszewski. John decided to highlight the fact that "wrenches" are indeed "rock stars" and created a company selling Aircraft Mechanic Shirts (and other cool stuff).

                                         Photo from http://www.aircraftmechanicshirts.com/
                                         Property of John Janiszewski

He creates shirts and other items that make clear how much we need a good mechanic to fly sick people - indeed to fly at all. On top of this, John is a working HEMS mechanic, maintaining a helicopter on the line. When you go to Johns online "store" be sure and check out his blog post about using social media to enhance your business. I did, and it makes perfect sense. He is a real guy, with a bunch of real good products, and you can actually speak with him.

For a neat little video about John and his company, click here!

That young man's going places. His ad is on this blog because I believe in him, his work, and his message.

Maybe - thanks to people like John - and his products - we can bring  bring  mechanics out of the background - to the front of the stage. Like the rock stars they are!

                               Photo courtesy of Mike Harrington. Flight Engineer, Crew Chief,
                               Helicopter Mechanic!

safe flights...

Sunday, November 2, 2014

Ever Wonder Where The Golden Hour Came From?

The BTLS course attributes the term to R Adams Cowley from the ShockTrauma Center in Baltimore. Unfortunately, no references are given. A biography of Cowley entitled Shock-Trauma names him the author of the term, basing it on dog research.

To read more from Dr. McGonigal's great trauma blog, click here.

Avoiding a Mid-Air with "Rough Air"

While riding in one of Delta's cramped cabins last week on the way to Denver, I listened as a flight attendant announced that we should wear our seat belts when seated in case we encounter...

"rough air."

I like this euphemism for turbulence. It sooths. Rough air isn't something to be overly concerned about. Turbulence is.

As we cruised along, with my shoulder, arm,  and leg in constant contact with a stranger sitting next to me on what Delta calls a seat, I looked out the window and thought to myself, "at least it's a beautiful day with a smooth ride."

Without warning the aircraft dropped with a violent motion. If I hadn't been strapped in, I would have come unseated. Nervous laughter filled the cabin, then a quiet waiting for the other shoe to drop.

A few minutes later, a pilot made a PA and explained that we had encountered the wake turbulence of an aircraft 8 miles ahead. Wow - 8 miles and it rocked our world - in a fully loaded passenger jet.

Imagine hitting that wake in your little helicopter.

I did that once myself. I was departing from the now-closed Caraway hospital in Birmingham, Alabama, which sits close to the airport and near the final approach course to one of the runways. I took off headed away from the airport and turned back toward the University of Alabama Hospital at Birmingham, which lies across that same final approach course. A jet had just landed at the airport, but as I hadn't seen him on his final I didn't give it much thought. He was down and no factor.

His wake was still there though, invisible, in front of me; in my mighty Bell 206 L-4. Under a cloudless blue sky in calm winds we flew right into an invisible hammer that slammed us. It was an Oh-crap! moment. And a lesson.

Pilots of all aircraft should visualize the location of the vortex trail behind larger aircraft and use proper vortex avoidance procedures to achieve safe operation.

Crew members can assist with situational awareness, by staying aware of other aircraft in the vicinity and visualizing a wake streaming along behind and perhaps below these aircraft. Ask questions about where that wake might be now, and where it might be going. In a busy moment, while talking to ATC and listening to an LZ briefing, and getting ready to land near an airport, a pilot might not be aware of a pending wake turbulence encounter. You can help with this. It's no different than looking for wires and towers.

Except you might be able to see them. You have to anticipate "rough air."

Too learn more about wake turbulence, click here...

Safe Flights...

Image courtesy AirLiners.net