Tuesday, November 17, 2015

Insufficient space available for the patient and equipment? Think twice about stuffing that bag...

I got a call from a friend at a program in the northwest... He wanted to talk about cabin size and storage/securing of equipment.  He flies a twin, and thinks twins are better not because of twin-engine reliability and redundancy, but because they have a bigger cabin with more storage compartments.

Then today I read this,..

         While loading a patient into the aircraft, a D oxygen cylinder was
        left between (the patient's) legs and secured with a seatbelt. In flight, the
        patient became agitated, causing the oxygen tank to dislodge and break
        through the nose cone of the aircraft.
        All crews have been educated to properly secure oxygen tanks in the
        aircraft and to not leave them between patient’s legs.

Any one of us who has flown patients in single-engine aircraft knows that finding a place for all the equipment can be a challenge. A BH-206 or AS-350 cabin simply does not have enough cabinets or drawers to accommodate the "stuff" that we have to take with us on flights. The EC-130 cabin is cavernous, but even here there is a dearth of cabinets and drawers.

Some cabins are bigger than others, with lots of cabinets and drawers. Even in this large cabin, items are clipped to a wall ring or seat strap - and depending on strength of restraint - could fly loose in a violent acceleration or deceleration.  

Like Gunny Highway, we end up improvising, adapting, and overcoming the limitations imposed on us by the folks who select the aircraft we work in. This equates to stuffing functionally-grouped items into a bag or soft-sided case and "securing" these with a D-ring through a strap or handle. While some aircraft have a baggage compartment, this cannot be accessed in flight, so the things that might be required must be kept at hand in the cabin.

Like I said, it's a challenge. And there is a certainty about the items that are tucked, stuffed, or clipped - when things get "real" in flight, they are going to go everywhere - including outside the aircraft. In the picture on top, a bird coming through the windshield caused an over-pressurization of the cabin and the doors popped open slightly. Pieces of medical equipment were strewn across the countryside.

An inconvenient truth... "Those items that you think are secure in your cabin? They aren't." ( from the paramedic who was on that flight)

In retrospect I am fairly certain that an FAA inspector would determine that this medical cargo was not adequately secured. Consider the requirements when you fly on a commercial jet, like Delta.  You must put all items in the overhead bins or underneath the seat in front of you. If you look under the seat you will see a metal restraining bar placed there to keep the bag from becoming a missile-hazard in the event of a sudden-deceleration in either the vertical or longitudinal axis (a crash). No items can be allowed to block emergency egress - and the definition of what constitutes blockage is pretty exacting. You cannot hold a laptop in your hands for take-off and landing, and any item bigger than a tablet or phone must be stowed as described above. You are not allowed to put your laptop in the seat pocket in front of you. You are not allowed to secure items in an empty seat with a seat-belt either - but we do that in our single-engine HEMS aircraft regularly.

Now compare our operations to the part-121 carriers (the airlines). When a critical patient is on board and multiple interventions are occurring in flight, the aircraft looks like a combat-zone after landing. Perhaps it's the nature of the job. One thing is for certain, the appearance of the aircraft cabin on the way to the patient should meet the requirements for stowage and security. The best resource for determining this is going to be your maintenance personnel. They should be consulted as you make decisions about what will go where. Pictures of cabin layouts eliminate doubt and the chance for any questions, or fines, after the fact. In fairness to his license and your company's operating certificate, your Director of Maintenance should probably be the determining authority as to whether what you want to do complies with the rules or not. Take some pictures of your cabin when it's configured for a patient flight, email them to your base mechanic asking for verification that everything is okay, and print and save the email.

An anecdote...

Years ago I operated a BH-206 with a spiffy new medical interior. The stretcher system included a restraint-bag that was intended to go on the patient's feet and be secured with seat-belt straps and buckles. My medical crew took one look at this foot-bag and determined that it was going to be too much trouble - and would become blood-soaked and dirty. They removed it from the aircraft. After a few months my director of maintenance got wind of this and blew a gasket. He explained to me in very clear terms that every bit of the medical interior was required by supplemental-type-certificate and every flight we performed with a piece of equipment removed constituted a separate violation of the Federal Aviation Regulations... He then proceeded to self-disclose our screw up to our FAA principal operations inspector, and we learned from this. Your aircraft has medical equipment installed and medical cargo carried on board. There are strict rules for both categories.

Pilots - The fact that you could put stuff wherever you wanted in the military has no bearing on what happens in the civilian world. Civilians are expected to be treated with a higher degree of regard than soldiers. The medical crew are - in the eyes of the FAA - passengers. You are the responsible party for whatever happens on your aircraft. You are held to the highest standard against negligent behavior by the law. The fact that your base is a long way from HQ and the FSDO will not protect you should things go south, or you get a friendly visit from the men in ties. As a matter of fact, in their efforts to protect the certificate, your company's leadership will first say that they had no idea what your were doing. The fact that "we have been doing it forever" will not help when the FAA begins digging in the dirt,

Remember over-water flights in single engine aircraft? It was no big deal - right up until the minute it was...

In another incident, a pilot decided that the balloon pump could be fastened into the rear facing seat of a BK cabin, instead of using the "approved" straps and floor mounting location. Another upset director of maintenance... Although rare, there are certain instances where people have to get out of an aircraft cabin right-this-second - and anything in the way is a no-go.

This is serious business folks. The O2 bottle coming loose in the event described in the report above could equate to a hefty fine against the certificate holder levied by the FAA, and the pilot could lose his license. Just imagine that D-cylinder falling down through someone's roof while they were eating breakfast or writing a blog-post.

It's better to ensure that your method for storing and securing equipment meets the requirements of the regulations before a problem is noted, not after. A picture is worth a thousand words, and an email is forever...

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