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Sunday, March 1, 2009

Helicopters Versus Healthcare

Close on the heels of the National Transportation Safety Board hearings on EMS Helicopters and the accidents they suffer, I can't help considering the unmentioned role that EMS helicopters play in our national healthcare effort - that of a "force multiplier." I don't believe anyone, at anytime, mentioned the extent to which helicopters act as a "crutch" to our deficient healthcare system.

Healthcare in rural America is in bad shape. Physicians and others, who possess the rational desire to maximize profit from their labor, often seek affiliation with or proximity to major health care facilities, as that is where large groups of better-paying patients can be found. The best doctors understandably want to work in the best hospitals.

Rural hospitals have limited facilities, limited availability of various medical specialties, and -most importantly - limited budgets. When acute (read - really sick!) patients present to rural hospitals, the staff on hand often decide to shift responsibility for that patient's care to a major metropolitan hospital. The reasons for this are varied, and sometimes have nothing to do with the patients best interest.

Sidebar: While the largest hospital in Florence, SC frequently receives helicopters for the purpose of transporting patients OUT, they strongly resist any helicopter service bringing patients IN. I find it fascinating that the same group of doctors who resist overtly and covertly the establishment of any helicopter service that will increase the size of the hospital's service area - since most of that population is poor and uninsured - embrace the same helicopters and crews when they land to take a patient away! This hospital recently gave up level-two trauma center status to "stem the flow". They have also excoriated a fine helicopter service in the press.

The movement of acute patients presents several challenges. First, the patients condition is often such that a lengthy transport by ground vehicle will greatly increase the risk of death or increased acuity - with corresponding increases in length of hospital stay at the receiving facility. Second, rural cities and counties have limited ambulance resources. Sending a patient to the big city might tie up one of a counties two or three available trucks for several hours. Repeat this scenario and eventually we end up with more patients spending more time in the rural facility.

This is where the helicopter comes in. Helicopter transport greatly reduces the out-of-hospital time, with the logical conclusion that there is a decrease in the risk of death during transport. I have to mention as well that helicopters, by and large - are staffed with both a paramedic and a critical-care-nurse. Taking nothing away from paramedics, nurses can and do offer skills and capabilities not available in the typical pre-hospital care setting. Very rarely do nurses staff ground ambulances (Duke University comes to mind as an excellent resource where they do). Transporting a patient by helicopter also means the ambulance does not need to leave a rural area (unprotected)for extended periods of time.

Thursday, February 12, 2009

Helicopter GPS approaches to hospitals

When a company, hospital, etc. wants to create an approach using GPS technology, they hire a contractor (STI comes to mind). The contractor "terps" the procedure by evaluating the terrain and obstacles and coming up with a slight variation on a cookie-cutter approach. The FAA does not flight-check these approaches as they do the ones at your local airport, with their aircraft and folks. I am referring to approaches to hospital helipads, often "point-in-space" approaches with a short VFR transition to the landing area. They terminate the approach at a PIS vice the helipad to get a lower MDA and a higher probability of breaking out.

Since towers spring up almost overnight, and buildings get built too, there is a need to periodically verify that the altitudes published in the procedure continue to offer safe obstacle clearance. For this to occur, the owner of the approach (or some other interested party) must provide an aircraft to fly an FAA rep. over each of the approach paths/segments. I got tasked to do this in Ohio a few years ago with Mr. Tom Bruchs (I hope I spelled that correctly as he is a heck of a guy). It was a good experience - if you get the chance, do it.

Per Mr. Bruchs, you don't need an IFR capable aircraft, or even an IFR certified GPS - but you do need a GPS that works. Having all the waypoints in a database does make things go faster.
You don't actually fly the approach as published - instead you fly slow at lower altitudes along the legs and note all obstacles (they are easier to spot from low altitude).

So, as you are motoring along, you spot a tower. You hover right up next to it, you listen to the nearest available ASOS or AWOS for a current altimeter setting, you verify the location from your GPS, you note the altitude with your aircraft hovering immediately next to top of the obstruction, and the FAA rep writes all this down on his data sheets.

They take the derived altitude of the obstacle, add (I think) 50 feet for altimeter error, add the appropriate altitude "cushion" for whatever leg of the approach you are on (the cushion gets thinner the closer you are to the FAF) and come up with the appropriate altitudes to publish for the approach. If nothing has changed, the approach as published is approved for use for another time period (1 year?). If there is a new obstacle, then a new text/graphic procedure must be printed.

If the approach you want to use has not been checked within the required time period, you are not authorized to fly the approach.

Now, if you are still with me, you will remember that I mentioned that obstacles spring up almost overnight, and flight checks occur but once a year. A prudent person with these approaches in his or her operating area might want to do a "self-check" in VFR conditions on a more frequent basis - say quarterly or semi-annually. After all, as I am sure you know, just because something is legal doesn't mean it's safe or smart.

safe flights,

rf

Thursday, January 22, 2009

Can we learn from this?

hgn crash pilot fault NTSB

Author: wasthere Date: 1/22/2009 1:07:45 AM
SOUTH PADRE ISLAND - Federal aviation investigators have determined that weather conditions and the pilot's lack of recent instrument flying experience contributed to last year's medical helicopter crash that killed three.The National Transportation Safety Board's official cause of the Feb. 5, 2008, crash of the Valley AirCare helicopter states, "The pilot's failure to maintain aircraft control resulting (sic) in the helicopter impacting the water. Factors contributing to the accident were the pilot's inadvertent flight into instrument meteorological conditions, the low ceiling, dark night conditions and the pilot's lack of recent instrument flying experience."The report was released Jan. 15.Pilot Robert Goss, 55, flight nurse Raul Garcia, 38, and paramedic Michael Sanchez, 39, died when the Eurocopter AS350 crashed around 11 p.m. into the Laguna Madre about two miles west of the South Padre Island Convention Centre.They were en route from Valley Baptist Medical Center in Harlingen to the Island to pick up a 60-year-old woman complaining of chest pains and difficulty breathing. The woman was not on board the helicopter and was ultimately taken to the hospital by ambulance.The NTSB report states that a review of Goss' pilot experience "showed that his most recent actual instrument experience was in 1997 when he completed an instrument competency check in a single-engine airplane."The only instrument experience in a helicopter ... was two entries of simulated instrument time of .2 hours in September 2007 and .8 hours in December 2005," the report states.According to the report, the helicopter, equipped with a global positioning system, left the Valley Baptist Medical Center helipad around 8:40 p.m. It reported that it was at about 1,000 feet altitude when it was about four miles west of the landing zone on the Island.The National Weather Service said that a cold front moving into the area around the time of the crash produced winds of about 10 mph, with gusts to 25 mph. The weather service had issued a Marine Weather Statement earlier on the day of the crash, warning of possible sea fog with the arrival of the cold front.According to the NTSB report, the flight nurse transmitted the following radio recordings: "Uh, I got lights here ... Follow the uh lights out ... OK ... Follow the lights out ... We're in the clouds again. We're gonna abort. Transport patient by ground."Witnesses told NTSB investigators that they saw the helicopter's lights fall almost straight down, according to the report. The EMS personnel waiting at the landing zone on the Island saw the crash and called 9-1-1. Another witness, a resident of a nearby RV park, said she saw the helicopter's lights spiral downward and then heard the impact.According to the report, an examination of the helicopter's wreckage was consistent with damage from a "high-speed, port-side inverted impact with water."There was no evidence of mechanical problems with the aircraft's airframe, systems and engine, the report states.Sanchez's and Garcia's bodies were found shortly after the crash; Goss' body was found the next morning about 150 feet from the helicopter wreckage.The report states that the helicopter wreckage was found in 3 to 5 feet of water in the Laguna Madre. It was recovered by the U.S. Coast Guard and taken to the NTSB's Dallas office shortly after the accident.Goss was from Illinois where he flew a crop-duster plane, and worked in the Rio Grande Valley during the winter, Rene Perez, director of transport services for South Texas Emergency Care, said following the crash.Sanchez was from San Benito. Garcia, a native of Laredo, lived in Weslaco.The Garcia and Sanchez families have filed a wrongful death lawsuit against the helicopter's operator Metro Aviation Inc. and South Texas Emergency Care Foundation Inc.The families' attorney J. K. Ivey said Wednesday that the NTSB report "confirms the findings of our independent investigators, that it was pilot error.""We are alarmed and concerned by the pilot's lack of relevant flying experience," Ivey said.Valley AirCare declined to comment on the report. Metro Aviation, which owned the helicopter and hired the pilot, did not return a phone call requesting comment.


Here's what I think....

Is sounds like the PIC was trying to fly VMC in IMC. It also sounds like someone other than the pilot was telling/asking the pilot "to follow the lights".

I wasn't there, and I don't want to be disrespectful.

Just wondering though, does it really matter how much instrument experience you have if you wait too long to use it? As for me, if I scew up and push to hard and far in crappy weather, and find myself in the clouds or fog I am going to:

Commit - to flight by reference to instruments. I will make the decision, and that's it unless I fly into severe VMC.

Climb - Wings level, maintain heading, climb power, climb airspeed. During the transition, turns can equal spatial disorientation so no turning unless absolutely required.

Confess - to ATC and the crew. "Guys, I screwed up. We are in the clouds without a clearance. I am flying on instruments and I am going to call ATC as soon as I get situated." I will use any and every resource available to me, including the warm body sitting next to me if there is one.

I ain't proud to be admitting this, but this event actually did happen to me 10 years ago. I blew into the clear at 5000' with sweaty palms, a dry throat, and tachycardia going on. At that point I had been flying helicopters on instruments for 15 years.

The sudden, unwanted transition to IMC is no cakewalk, but it can certainly be survived with the right choices.

Wednesday, January 7, 2009

High Wind Heebyjeebies

So there I was - today, flying towards a rural hospital in winds gusting to 30+ on the surface and tossing us around in the BK. Frontal passage this am. Gotta love a BK in turbulence. Thanks to a hingeless rotor, the aircraft will occasionally jump sideways.

The pad I am going to is a small fenced-in ground-level slab immediately downwind of a multi-story building. Pretty much one way in under current conditions. So I get slowed down and plan a steep approach to clear the pine trees on final, growing up close to the pad. Who designs these places anyway?

We intercept the approach angle, and start down. Nice and slow, power in, ready for the potholes.

At about 300 feet the aircraft stops descending. Huh?

Okay, reduce power, forward and down. Lose another 100 feet or so. Aircraft stops descending.

It won't go down. Push the collective further down. Aircraft stays put. Getting bounced around pretty good now. Hair starts standing up on back of neck. Okay, we are obviously in an updraft coming off the building - what happens when we drop below the updraft and out of the wind? Or worse, into a downdraft, and the collective is almost bottomed out. Turbine-lag? Rotor Droop? VRS? Will it stop?

A little voice inside says "do a go around". I listen. Ain't messed with no mountains or concrete canyons lately.

As luck would have it, there is a big flat airport two miles away. We go there instead.

I heard once that a superior pilot is one who avoids putting himself in a position where he has to demonstrate his superior skills. Sounds reasonable to me.

Friday, December 19, 2008

New to the BK-117?

Don't be low, slow, and in a right turn (to look at an LZ). Cross controlling the cyclic and pedals will lead you to running out of cyclic travel to the left rear quadrant. At least one BK has been crashed for this. Top (left) pedal will get you out of this conundrum.

Don't forget to turn on your transfer pumps. The supply tanks do not get fed any other way. If you have the instrument lights turned on, you won't see the caution segments. (Using the checklist helps with this). More than one BK has been crashed for this.

Don't get anywhere near VNE. The rigid rotor system can suffer RBS all at once and when the old girl snaps up it will scare the ever-living-crap out of you. Rotors have struck empennages for this. It could easily turn into loss of control. Cruise at 60% torque vice top-of-the-green-arc and reduce power to descend. Don't push her over on her nose.

Per an industry expert, the reduction in VNE to RBS margin may be due to erosion on the leading edge of the rotor blades.

Don't fly in moderate or worse turbulence unless you want to induce vomiting in all pax and maybe a little white-knuckle in yourself. Turbulence can also contribute to RBS. The BK is a horrible IFR platform. The POS autopilot has no redundancy and will quit in turbulence.

Any time you change aircraft (BK to BK), do a complete thorough preflight and runup using the checklist, and checking every single switch, gadget, function etc. Most pilots don't use checklists, so some anomolies go un-noticed or un-documented for long periods of time. No two aircraft are set up the same. It's not good when the overspeed protection system isn't hooked up and no pilots notice this for several months. (Checking this is a daily function)

Do not ever try to do a power check on a dolly.

Smarter guys than me can tell you more....

rf

Sunday, December 7, 2008

What does an EMS pilot do to kill time?

Some spend time on the "Just Helicopters" forum/message board.

After reading thru all the chaff this morning about who has the best jobs, I took literary license with an old airplane story and came up with....



A student pilot was soloing an R-22 in the practice area one fine morning, and heard a call on the radio....

"Flying Cloud tower, army copter 26386 is on final for runway 22, flying cloud." The youngster looked over toward the airport and observed a CH-47 Chinook on short final. He said to himself, wistfully, "Geez, I would love to fly one of those big complex bastards someday."

The Chinook pilot landed and taxied into the general aviation parking area. He planned on draining the local fuel tanks, and thought to himself that he had better be careful to avoid damaging any of the shiny little aircraft.

He noticed a trailer off to one side of the apron, with a flashy AirMedicalTransport sign. He then saw a brand new EC-145 with the Lifeflight logo shining brilliantly in the sun. This Chinook pilot thought to himself, "hmmm....someday.... someday I am going to get out of this smelly can of hydraulic fluid and fly something like that.

“What a great job that must be!”

The 145 pilot was in his room in the trailer, with the door closed so as to avoid any interaction with the flightnurse. He had had enough of the pushy bitch always asking questions. As if she actually knew anything about helicopters!

He was surfing the web, having just finished complaining about his lot-in-life on JustHelicopters. He noticed a link to a job offer, to fly for a power-company in Florida. He thought to himself, "Now that would be the life. Money....prestige.”

“I need to be flying corporate!"

The corporate job was available because its previous holder had been flying along one day, carrying 4 "suits" with huge egos and bad attitudes, and feeling sorry for himself. Halfway through his flight, he had decided - enough of this buttkissing job - screw the money. The execs didn't understand how hard he had worked to get himself into that seat. They didn’t care what he had done in the army, and were not impressed with his exceptional knowledge and skill. He thought back to the last time in his life that he had really felt pure joy in a helicopter. The realization came flooding through him like a beer being slammed.

It was when he was in training, caught up in the sheer pleasure of flight. That corporate S-76 pilot had decided then and there to give up his cushy gig and return to his roots. He would teach kids to fly R-22s, and maybe some of their joy would rub off on him.

Now he stood in the tower cab at the Flying Cloud airport, gazing through a pair of binoculars. He watched the tiny little helicopter go deliberately through its maneuvers. He was impressed and proud of his student – and himself.

Of course he was also penniless.