O - CRAP! Fighting Complacency and Staying Alive

Perhaps the most difficult task for a flight crew is to maintain their sharp edge when flight after flight occurs without incident. The aircraft we operate are incredibly reliable; serious malfunctions, like engine failures, occur once in a lifetime - but they do occur.

The desirable state is to always be "ahead of the aircraft," so that no event or occurrence is unanticipated. This is tough to achieve at 3:00 AM when we are returning to our base in the country after dropping a patient at a metro hospital. Human nature dictates that we get excited for the exciting parts of a flight, and relax for the milk run to the house. If you have spent any time studying aircraft crashes, you know that the most common last words spoken by an aircrew are some variation of "OH CRAP."

A couple of nights ago, I woke up at 2:00 AM and began to think about the need to fight complacency and be prepared for whatever whenever. There have been some instances of engine failure in the aircraft in my company's fleet in the last few years, and more than one case of running out of fuel - this too causes a loss of power. These events have resulted in fatalities and destroyed aircraft.

Yes, a single engine helicopter can be safely landed after it's lone source of propulsion packs it in, but the infrequency of such failures, coupled with the sterile (read "safe") manner in which we prepare for these autorotative landings, results in a pilot and crew who are poorly prepared and "startled" by a real life failure.

 It is that startle-effect that we need to eliminate. In a perfect world, a bird coming through the windshield would be calmly announced over the interphone communication system, followed by a normal precautionary landing. I fear if that happened to me, the smell from the bird's guts would be mixed with the smell from my gut. But I try and stay ready - and I keep my visor down.

When I was learning to fly Chinooks, an aviation wizard named Howard Swaim taught me the practice of testing the warning-and-caution lights while flying en route (after announcing his intention of course). He would pick a light, like "engine oil pressure low" and have me discuss the emergency situation that this light's illumination would create. This rehearsal for a future contingency stood me in good stead as time went by. Indeed, much of a pilot's initial and recurrent training is designed to prepare her for a future human or system failure. The problem, as I alluded earlier, is that the training environment does not mimic the real world we operate in.

So what can we do?

Here's an idea. Brief your teams on practicing the Objective Continuous Risk Assessment Process (O-CRAP). This is what came to my mind at 2:00 AM - yes, I am a little strange. O-CRAP is nothing more than a verbal declaration prior to each phase of flight on the hazard or hazards assumed to be most likely. This doesn't mean that some other mishap or malfunction won't occur, but at least this alerts each team member into the mindset that something might go wrong. It activates a part of our brain that we use when walking through a dark forest at night, and provides a heightened sense of awareness.

I discussed this with my crew this morning, and asked the paramedic "what do you think is our greatest risk on take-off?" He replied "wire strike." Fair enough, that could happen, but what my nurse for today and I worry about in a single-engine aircraft is an engine failure during climb out with the collective raised and lot's of power applied. Losing an engine at that point would result in a rapid decrease in rotor rpm, and a rapid descent to who-knows-what kind of forced landing area.

It would be a lot different than pushing the collective down from level slow-cruise at one thousand feet above the threshold of a big beautiful runway - that's how we train for engine failures - because it's "safe" (but unrealistic).  Engines have an annoying tendency to quit at the worst places and times, and when we least expect it. As an instructor once said, "an autorotation is a training maneuver, a forced landing is an emergency.' If we subjected pilots to unannounced engine failures in the line-environment I suspect many pilots would develop different flight techniques, to include flying at higher altitudes. The Astar flight manual directs us to climb at 55 or 60 knots  (depending upon variant), with maximum continuous power applied - without stating why. The manufacturer doesn't want to highlight the risks of flying with one motor, but a thinking person can deduce that the sooner we get to altitude, which we can trade for time, airspeed, and rotor energy, the better. So - do you climb-out each and every time at the correct airspeed and the correct power setting to an altitude from which you are confident of reaching a forced-landing area? If not, perhaps you don't consider an engine failure to be a possibility - and they are rare. Or perhaps you just don't think about it.

Don't put yourself in a position where the last words you say are "O -CRAP." Try and stay ahead of your aircraft and ready for whatever life throws at you. Verbalize your assessment of the proximate threat or most likely hazard for each phase of flight, and ask your teammates for their input too. And I hope you don't wake up at 2:00 AM for no good reason.

It Could Never Happen To Me... The Hazardous Attitude Known as "Invulnerability"

When I stand in front of a room full of Helicopter Emergency Medical Services (HEMS) professionals and conduct a class on Air Medical Resource Management, I don't read from a script. We attempt to cover the same points in each class; but the manner, words, and phrases often differ depending on the vibe. It's hard to illuminate a topic - often associated with "safety" - in a way that keeps these bright, busy, type-A individuals in the game. They expect value for their time. I often wonder if there is some way I can express a thought, or an emotion, that will keep these friendly faces alive. I have found that it helps to discuss something other than Helicopter EMS - for hazards abound in every aviation endeavor. One particular hazard worth mention is the attitude we call "invulnerability," the mindset that a fatal crash could never happen to me . So let me tell you about a young man I never met, although I wish I had. He was - by any measure - a great American, a great guy, and a fantastic aviator. He must have been a source of immeasurable pride and joy and sorrow to his mother and father.

I have spent so much time thinking about Lt. Commander Kevin Davis, and his last few moments alive, that I feel as if I know him, and I hope he doesn't mind me trying to derive some use, some benefit, from his tragic death. I watched him die, and it affected me.

Kevin Davis attended Embry Riddle Aeronautical University, earning a Bachelor of Science degree in Aeronautical Science with honors in 1996. We graduated from the same University in the same year. He completed primary flight training at NAS Corpus Christi, Texas, and transferred to NAS Meridian, Mississippi, for intermediate and advanced flight training. While there, he flew the T-2C Buckeye and TA-4J Skyhawk, and received his wings of gold in June 1999. I had just retired from the Army and begun flying EMS helicopters.  Kevin reported to Fighter Squadron 101 (VF-101) at NAS Oceana, Virginia, for training in the F-14 Tomcat and was the “Top Stick” in his class. I doubt that this was his first brush with being the best. His parents raised him right, and created the kind of young man that anyone would emulate, and admire. In December of 2004, Kevin graduated from the United States Navy Fighter Weapons School (TOPGUN) as an adversary pilot. Here again, he was standing out above the crowd, as the opposing-force pilots are  handpicked - the best - in order to adequately prepare students for combat. Kevin joined the Blue Angels in September 2005. His role at first was to be the voice of the Blues, and to fly members of the media and celebrity-guests in the interests of creating a positive image of  the United States Navy. Thanks to YouTube, we can join Kevin on the job. I want you to listen very carefully to Lt. Commander Davis as he subjects the aircraft to high-G maneuvers. A "G" is equivalent to one times the force of gravity. Fighter-jet aircraft can maneuver such that the force of gravity can be multiplied greatly. Listen to Kevin's voice and his breathing....you may hear him grunting in a turn. Also listen to his instructions to his passenger, Steve, a reporter for the Atlanta Journal Constitution.

http://www.youtube.com/watch?v=h2gxYR3-eDk

Now, watch a famous person - a man who knows a thing or two about going fast - getting the ride of his life in a jet. During these maneuvers they will  exceed 7 Gs.

http://www.youtube.com/watch?v=eda2LTRA1UU&playnext=1&list=PLB43786AEEC4255D3&feature=results_video

G forces are a large consideration during high speed maneuvers, because during positive G multiples, blood is pulled from the brain and begins to pool in the lower extremities. This leads to a gradual loss of ability, on all levels. Vision tunnels - as if one were looking down a progressively narrower tube with black around the edges. Pull hard enough and vision goes to a dot, then blackness followed by unconsciousness. The last thing to go, and the first thing to return, is awareness.  GLOC stands for G induced loss of consciousness. Gray-out refers to partial loss of ability to fly. Fighter pilots combat GLOC and gray-out with special leggings called G-Suits, which might be compared in function to MAST trousers. G-Suits are automatically inflated by aircraft systems during high G maneuvers and serve to prevent O2 rich blood from leaving the brain.

Blue Angel pilots don't wear G suits.

This because their demonstrations require them to fly within a foot or so of each other. Such precision flying requires very fine hand movements. To facilitate this, Blues run their seats forward, which raises their upper legs. They rest their forearms on their legs and make control inputs by moving their hands at the wrist. A G suit might inflate and cause an inadvertent control input with disastrous results. So Blues use other techniques. They do a lot of squats, and develop muscular torsos, and when flying hard they clench their leg muscles and grunt-breath. Grunting raises blood pressure and keeps blood in the brain. They do this without conscious thought, it's a secondary task.

Side Bar: Primary versus Secondary Tasks

When pilots begin flight training, the most basic tasks -  like hovering, or making a normal approach to a landing - demand full concentration and effort. Ask a new student pilot a question while she is performing a maneuver,and she may be unable to answer. Manipulating flight controls to make an aircraft respond correctly takes a multitude of fine-motor skills, precision muscle movement, and constant correction and adjustment. In the beginning, it's hard.  As time passes and experience comes, tasks that were once difficult become progressively easier. Muscle memory and pattern recognition combine to permit pilots to relegate what were once primary tasks to secondary status. We can perform these secondary tasks without conscious thought. And this is a good thing - it allows us to do more than one thing at once, a vital skill for any pilot. We have to fly, think ahead, tune and talk on radios, and pay attention to what is going on around us - all at once. If we could not multi-task, we would need several crew members to do what one or two can do. Unfortunately, this ability to discriminate without awareness - what you are doing when you drive your car across town and realize after the fact that you remember nothing about the trip - can get us into trouble.

When we are distracted, or anxious, or under great stress, that task that we have relegated to secondary status may not be performed to standard. A helicopter pilot who is upset upon hearing that the fuel cap may not be on the aircraft - and may instead be laying on the parking apron at the airport just departed - may be so distracted during his approach to a large field for a check of the fuel tank - that he crashes the aircraft. This actually happened.

On the day that Kevin died, he was performing for the first time as a member of the demonstration team. His mom and dad were on hand. Under bright blue skies at Beaufort Marine Corps Air Station, Kevin and his team mates put on a dazzling performance of skill. Paramedic Les Langdale and I were there with the helicopter from Charleston. We had no nurse with us, and anticipated a pleasant day, friendly people, and good PR. As the show wound down, the signature "gotcha" flyby took place, in which the crowd's attention is drawn to one side of the airfield while a lone jet sneaks up from behind at almost supersonic speed and startles the novice Blues fan. These last minutes of flying left the aircraft spread around the horizon, and as an afterthought, they were joining up several miles away in order to return and land. Kevin was flying in the opposite direction to the other aircraft, and made a call to the team-leader, something like, "boss, I am out of position, I will be with you shortly." It was at this point that a minor oversight, a single lapse of attention, and the fact that Kevin could fly his jet without thinking about it, all combined to take his life. Kevin was "here" and wanted to be "there" and going in the opposite direction. So he moved the stick. And it would appear that he failed to "take a deep breath and clench those legs." A seven G maneuver, one that he could talk through with Dale Earnhardt Jr. on board, brought him down...

https://www.youtube.com/watch?feature=endscreen&v=vpniTVq4R38&NR=1

This occurred while Les and I were preparing to leave. I turned on the radio and asked the tower if they needed help. The tower advised us to proceed 300 degrees for three miles. A lone Blue orbited overhead. We flew over a small pond surrounded by people all pointing into the middle. I thought to myself, Good God, he's gone into the water. That was not the case. While some parts of the jet splashed down, other parts went smoking through roof peaks, lay here and there along a one lane road, and were embedded in a stand of pine trees. Les suggested we fly up his inbound path to search for a parachute, so we did, with no joy. Les said, "I think he rode it in so he wouldn't hit a house." The report says he had it nose-up, rolling wings level, in full after-burner, and may have been trying to save the jet. During the crash sequence, his seat ejected spontaneously and he was killed by the impact. He didn't kill anyone on the ground. A blessing.

CNN Reports:

The crash at 4:00 PM ET Saturday, during a precision-flying team demonstration, injured eight people on the ground and damaged eight structures. None of the injuries is life threatening. CNN is reporting that the jet clipped the top of a pine tree during a sharp turn at the end of the team's aerial exhibition. The crash sent a plume of smoke into the sky, which the five other jets in the formation then circled.

While I was in Concord NC recently, presenting this as a case study, I got to this point in the presentation and observed a young women in the back of the room with tears sliding down her cheek. It hit me. We should not take this  lightly. It was a tragedy and a huge loss for Kevin's family, our country, and all of us who fly.  Perhaps we can keep Kevin in mind as we go about our flying duties, and remember.

The next time you are feeling invincible, bullet-proof, and like God's gift to aviation, remember Kevin Davis. Remember that if the best of the best, a superbly skilled, highly trained, disciplined and dedicated aviation professional can have a momentary lapse and lose his life, well then, anyone can... Don't let this happen to you.

The full investigation report is here:

http://extras.blufftontoday.com/BlueAngelsJAGReport.pdf

We Live in Interesting Times

It's an interesting time to be in this business, what with the changes to operating models, reimbursement, and strategies for success. If you read the quarterly reports for publicly-held HEMS companies, you can see that they are doing better with the community-based operations than they are with the hospital-based programs. They also have several irons in the fire, so the comings and goings of a single contract may be more about what one regional fellow is or is not doing. Having said that, a relationship with a receiving hospital is still key, especially with regard to interfacility transports. While the closest available aircraft "should" be the one getting scene flights, a patient getting sent to a tertiary-care facility involves a discussion between physicians, and some give-and-take. If I am a doctor in rural America, and I am on the phone with a doctor at a metro hospital, what I really want is to be freed of responsibility for the patient in question. What happens at the rural hospital is more about providing billable services prior to sending a patient, so it's a balancing act for rural staff; "Let's send this guy to CT and check him out...Oh heck, he needs to go to (insert your metro hospital's name here)..." What the patient really needed from the outset was to go to to a trauma center, but someone has to pay for the country hospital to be there. Many is the time I have been waiting for a rural facility to finish messing around with a patient who they will not help while all the arrangements are made and the "wallet biopsy" is completed. Sticking with the CT thing, the one from the rural facility will not be good enough for the trauma center folks - they will take another one, and the patient or his insurance company will pay twice. Those scanners are expensive you know... Sometimes Rural Hospital Inc. waits a little to long and the victim circles the drain, then you see a real interest in us getting the patient the hell outta there, before he codes on them. OOPS. It really is all about the money. You would be amazed how often a really sick man or women - or child - is driven by ground AWAY from the hospital that could fix them, to be subjected to rural health care for a couple of hours, and to ultimately be flown to real health care and doctors who will do the hard things. Some day the regulators will figure all this out and protocol will be immediate transport to the most appropriate facility... Here's a tip for you. If you crash in the country, and can talk, tell the first responders you have no insurance and very little money. If you can speak Spanish, all the better - you will be flown to a trauma center directly, as you aren't a source of revenue to the local facility, and trauma centers take everyone. (They often train young surgeons, so they need tore-up folks for practice.) You will have a better chance at staying alive and getting out of the hospital sooner by passing no-go and not paying two thousand dollars. So back to the receiving hospital and the doctor on the phone. She says, "sure, I can take your patient, and I will send my helicopter." The trick is to be "that" helicopter. And while hospitals used to pay for a helicopter out front, now days the money might be going the other way - legal or not. As this is a relatively new development, some management folks might not have cottoned to it yet, and contracts will be lost. It'll all work out in the long run...

Using Assertiveness to Ensure Smooth Sailing

I listened to a discussion about the roles and responsibilities of ship's captains. The Titanic and her captain, Edward J. Smith, were presented as an example of "doing the right thing."  After studying CRM and AMRM for years, I think he did a terribly wrong thing, but he had help.

I discuss Captain Smith and the Titanic during presentations on the pressures we face in HEMS. From the accident report, " Mr. Ismay (the owners representative) occasionally accompanied his ships on their maiden voyages, and the Titanic was one of them. During the voyage, Ismay talked with chief engineer Joseph Bell and/or captain Edward Smith about a possible test of speed if time permitted..."

I believe what happened was Mr. Ismay pressured Captain Smith to run full speed all the way (including at night) in order to set a record or at least make a splash in the media. The ship's construction was over-budget and took longer than expected, and the owners were anxious to prove the ship was a winner.

This is a classic case of pressure from management to get a result that may not be consistent with safety. In our case, an excessive emphasis on flight volume might well lead pilots to accept a flight when they shouldn't. Sometimes the pressure comes from within the person, with no help from anyone else. It has happened in HEMS more than once.

Captain Smith had a reputation as being "quietly flamboyant" and "a millionaire's captain" and may have suffered from machoism, ie. needing to live up to his image of himself. Consider all the experienced crew walking her decks who must have known that running at speed in the darkness in those waters was folly.

In Captain Smith's day, no subordinates dared question the decisions made by the captain. This was a hold-over custom from the Royal Navy, where the captain was imbued with absolute authority.

That same custom carried over into the beginnings of aviation, right up until a lone KLM Captain caused the deaths of  583 people. That investigation revealed that his co-pilot was worried that something was amiss, but he lacked "assertiveness." And then there were all those dead people. And two 747s destroyed.

We have suffered hundreds of dead people in HEMS as well. As did the airlines, we figured something had to change. Tonight, we expect crew members to voice concerns, using a specific format:

1. You are going to speak up. Use the name of the person you are speaking to.
2. Give voice to your concern. You own it. While we may discuss it later, and it may come to light that your concern was baseless - right now it is valid  - and right now we are going to change the way events are unfolding. It's better to be alive and wrong than dead and wrong.
3.  State the risks involved. Obviously,  a crash and loss of life come to mind. Or perhaps a midnight swim in cold water.
4.  Offer a suggested course of action. Is there a way we can still help the patient without putting ourselves at undue risk? Remember, there will be another patient tomorrow, and we need to be here to help them too.
5. You are part of a team, and you have to work together tomorrow. Honestly and calmly ask for affirmation or "buy-in." Try to avoid letting assertion become aggression, but meet aggression calmly and resolutely. No matter whether you are new, inexperienced, or significantly subordinate to the other parties; when that time comes do not hesitate to flip the "can't continue switch."  And don't think for one instant that job concerns outweigh safety concerns. You can get another job. Another life? Not so much.

Hopefully, today, a crewmember in a "Titanic" situation would say, "Captain Smith, I am very concerned about our speed and the dark conditions. We can't see an iceberg in front of us until we are on top of it. Hitting an iceberg could seriously damage the ship and perhaps injure our passengers or crew. This could damage your reputation and make you infamous. I recommend we reduce speed to one that will allow us to maneuver clear of an iceberg in our path...

Captain, don't you agree that safety is the best policy; sir?"

CNN reports a "medical' helicopter crash in OK City

Initial reports indicate two fatalities, one survivor. More to follow.

Pushing Back...

I witnessed a special moment in the evolution of the helicopter emergency medical services (HEMS) industry recently. This occurred during a safety stand down and group meeting/training session involving several aircraft and crews affiliated with a major HEMS provider. The stand down was precipitated by three HEMS mishaps in a recent period, two of which were experienced by the company in question. In two of the three crashes, people were killed, in the third the aircraft suffered significant damage after suffering engine failure and landing hard – there were injuries.

This meeting offered a rare chance to have so many people involved in HEMS in one room, from the newest clinicians and pilots to the guys calling the shots from the head shed. HEMS has changed much in the 13 years I have been around it. When I started flying sick people to hospitals in 1999, most EMS helicopters were operated by a few vendor companies, who employed pilots and mechanics working at a hospital. The clinical staff; nurses, paramedics, respiratory specialists, and on some aircraft – physicians, were affiliated with or employed by the hospital.

Then a couple of events happened that changed the industry into what it looks like today. First, Health Care Finance Administration (HCFA) reforms went into effect increasing the government payment for HEMS patient transports. Private insurance company payments are influenced by what the government reimburses along the lines of a rising tide lifting all boats. Second, and with inexplicable timing, hospitals began to opt out of paying for a helicopter to bring people in.

This may be related to the drying up of funds for trauma care. Perhaps hospitals wanted to reduce the size of their catchment area for indigent, uninsured, or underinsured patients. When the vendors were faced with the prospect of losing contracts, they created a new operating model, the community-based HEMS operation. The vendors hired the clinical staff away from the hospitals, and set up shop out in the areas surrounding the big cities. Where-as the checks previously came from the hospitals, and to a large extent were guaranteed regardless of whether or not any patients were transported, under the new operating model, the vendors turned into health-care companies and billed for services rendered themselves.

This turned out to be extremely lucrative, and all this easy money drew participants into the marketplace. There are still hospital-based and funded flight programs, but the numbers are dwindling as more health care executives grasp the reality of the situation – they control the hospital, and patients have to go there. In practice, the receiving facility determines how the patient will arrive notwithstanding the EMTALA stipulation that the referring or “sending” physician makes this determination. Within the limits of the law, a hospital might even receive a subsidy for facilities. This funnels the money for inter-facility (hospital to hospital) transports to whatever helicopter operator the hospital has a relationship with – as many wise people have stated, it really is all about the relationship.

The goal for helicopter companies today is to be “that” helicopter. With a hospital relationship established, a HEMS company is in a stronger position to market the other types of service provided; accident-scene response flights and specialty care services such as Intra-Aortic Balloon Pump transports and Pediatric or NeoNate team trips. While the two models described, hospital based and community based HEMS are not the only models in existence -hybrid and consortium are two other examples - they constitute the lion’s share of HEMS services today. In the new paradigm, helicopter companies seek first to fly as many patients as possible. The number of uninsured and non-paying patients does affect profitability, and some areas of the country are less lucrative than others, but rarely does payer-mix come into the discussion.

Under the old way of doing business, with a check coming from a hospital every month, the imperative was to minimize risk. The best way to minimize the risks of flight are to remain on the ground. Interaction between HEMS and the marketplace used to consist of utilization reviews (did this patient actually need to be flown?) and safety-related training on helicopter operations; often conducted by the flight crews themselves. Times have changed. In the effort to increase demand for service, fly more people, and generate more revenue; a new category of HEMS professional has been created. The Business Development Manager (BDM) is now the point of contact between the company and the customers. He or she typically has a medical or business background, and is for all purposes a salesman.

Whereas the objective was previously to fly patients who actually needed the level of care and speed of transport afforded by HEMS, today the BDM will ask the customer to fly anyone and everyone.  HEMS and the healthcare industry have their dirty little secrets just like any other endeavor. The BDMs are very aggressive in their efforts to increase the demand for HEMS flights, and to improve the service whenever and wherever possible. They are out there hearing the comments from the hospitals and EMS first responders in the field.

One common complaint is that “it takes too long for the helicopter to arrive.” So we try to reduce this time by asking everyone to be ready to go on a moment’s notice, and to move as quickly as possible once alerted. This is fine, to a point. One bone of contention is the lift-off time limit. Most operators expect the crew to move to the aircraft and depart within ten minutes. In some cases the goal is eight, or even five minutes. Often this is implied rather than written, because past experience has taught that hurrying and helicopters don’t go well together. We have a rational business objective hard-up against a bit of conventional wisdom.

So at this safety stand down, we get to the point in the proceedings where awards for performance are being handed out. The well-spoken, well-intentioned, and personable BDM announces an award for the base (there are several in the area) with the shortest average liftoff times for the past reporting period. At this point a voice from the back of the room booms “THAT IS A BAD IDEA!” Many of us present, mostly the pilots, understand his concern. Asking people to hurry – indeed incentivizing it – amounts to a moral hazard. Haste, coupled with lack of experience or too little attention to detail, has led to dozens of mishaps. Cowlings not latched, fuel caps not closed, shore-power cords not unplugged, baggage doors not closed, checklist items skipped; the list is long and the outcome is bad or fatal. Understanding the BDM’s objective, I proposed tracking the time it takes for the pilot and crew to arrive at the aircraft, noting the elapsed time between the acceptance of the flight and a “mission-ready” radio call. The decision was made to table that award and give it more thought, a smart move. Ironically, the same pilot who so assertively voiced his concern was subsequently recognized for having flown the most patients of any pilot in the room.

It’s nice to see conventional wisdom still has a place at the table.

Environmental Flight

A couple of decades ago, I was a B/3/160 pilot who got sent to Desert Storm. At the time I went over, I had a couple of thousand hours, and had a wide range of flight experience. I was also an NVG IP. I was pretty comfortable flying in any environment. Then I had my first flight across the desert at night with NVGs on. It was so dark that seeing the ground was barely possible at 100 feet, and impossible at 300 feet - the bottom of our normal profile (300 to 500 AGL). The guy I was flying with said - "welcome to the sandbox, we do it a little different here; 100 feet and 100 knots." Each time I let altitude increase, I would lose the ground, and then it was very very had to push the thrust control down to find it again. It was a new environment, and I needed training in it to be comfortable and more importantly, proficient. Recently I flew some HEMS shifts near the toe of the Appalachian's in Alabama. A guy at another base was turning flights down with good ceiling and visibility, so as the new guy in the area I called him to see what was up. He told me that the flights he was refusing were to his northeast, in the mountains, and the wind that day would make the turbulence worse than what he was comfortable with. Fair enough. I have been mountain trained (years ago), and have ferried aircraft across the mounains frequently, but this was a new environment, with new hazards and new things to think about. I mentioned environmental flight training, specific to mountains, to a company instructor. He replied that as experienced pilots, we "at this stage of our careers" are assumed to be experienced enough to get by in any environment. This begs the question of why I am forced to demonstrate proficiency at flying a traffic pattern once a year, but am assumed to have enough experience to prepare me for whatever else nature throws my way. Now we have had two mishaps in a short time span, in which cold temps and visible moisture were likely a factor. I can't help wondering if the parties involved were up to speed on flight in the cold weather environment. I myself was finishing up a ferry flight from PA to SC recently, and as I neared my destination, I noticed the OAT at 2 degrees and had a rain shower on top of the destination. I have flown SPIFR into ice, and it only takes once to have the short hairs on the back of the neck standing up when conditions are ripe. The regulatory distinction that allows VFR helicopters to fly to the point of "known" icing versus the IFR pilot's duty to avoid "forecast" icing is of little help, and may even hurt. Temps less than 4.4 C and visible moisture can result in icing in the windscreen, in the inlets, and on the main and tail rotor blades. This is an environmental flight issue, and a person who hasn't had training in that environment recently may not correlate the weather at hand to the hazards involved. The aforementioned instructor posited that local "tribal' knowlege would be sufficient and indeed desirable to a company-wide policy on environmental flight, and to wit, training on same. So now we are going to have a safety stand down. Perhaps we will talk about environmental flight. Sidebar: What is the turbulence penetration airspeed for the aircraft you fly? For the Astar, googling around will yield that the Brits publish 80 knots in their books. The RFM is no help, but does advise "slowing down". For some reason, it doesn't advise to what speed. Googling will also reveal that jack stall will not occur at collective travel less than 50%,. What is the maximum level of turbulence you should fly in? When was the last time you encountered severe turbulence? For that matter, do you remember the descriptions of turbulence levels, and do you know what aircraft these descriptions are based on? Is this company policy, personal policy, or medcrew policy. If you don't know, it might be time to discontinue beverage service and do some research. safe (environmental) flights rf