A Post From Blog-Contributor and Flight Nurse Josh Henke : You Can Say No!

This is an open letter to my peers, my cohort.
Open letters seem to the the soup of the day lately, so thats what I'm calling it,

Dear flight crews. You do not have to fly. Just because the badge on your chest denotes a Flight
nurse or Flight paramedic, this does not mean that you are tied to your aircraft. You are, at the end
of the day, a nurse and a paramedic. you can go by air, you can go by ground. You can go by
horse and buggy if that is the safest option (dear lord I want to do that just once), but you are not
tied to your aircraft.

Editors note - as depicted in Airbus Helicopter's excellent video, "That Others May Live," pilots, being humans, can get caught up in "driving forward, getting the job done, finishing the mission." We are susceptible to a sort of "mission intoxication," You may be the last line of defense against this. And it may mean you have to accept spending hours in a bus. That acceptance may save your life.

Back to Josh...

It reminds me of a saying from my wildfire days; “never fly unless you have to”. But the converse
also exists and should be held just as dearly; “you don’t have to fly.”

I read the NTSB preliminary report for the most recent fatal HEMS crash today. I took a few hours
to cool down, but I’m still many things about that accident. I'm sad. I’m appalled. I'm a little hot
under the collar, but mostly, I feel kind of guilty. I feel  that we may have let a group of our peers down. You might think I’m taking this a little personally, but let me explain.

I feel guilty because I get the impression that the flight crew didn't know, or didn't feel
comfortable saying no. How is this not a daily conversation between every flight crew member
on shift? How is this not a mantra; the very cornerstone of what we do? You can say no.

It seems hard, I get it. Especially you new people. You want to be a team player or maybe you
don't feel like you have the authority to say no. But i promise you, you can say no. And if you don’t think “no” is appropriate, try asking a question. If your pilot or partner can't give you a good answer, the next step is “no."

Lets try a scenario...

Nurse: "Hey pilot, that weather seems pretty low. I know I’m new here, but that just doesn't look
right.”

Pilot: “Its ok. i’ve done this a thousand times before. We’ll just climb up through the clouds, get
on top and be on our way.”

Nurse: “Don’t we need two engines and a lot more equipment to be able to do that safely?”

Pilot: “Seriously, it’s OK. were only 20 miles away. it'll be quick. Now hurry up, the weather is still
dropping and we need to go.”

Does this scenario make you comfortable?
The correct answer is this scenario should scare the hell out of you and make you double time it
to the ambulance to go by ground. You can say no.

If you think your company will fire you for saying no on scene or saying no to accepting a flight
then you need to find a new program. Anyone that is willing to sacrifice your life for a patients - or a paycheck) - and maybe both, does not deserve your time, your education, your skills or your loyalty.

You can say no.

But what about the pilot? I admit, its easy to look up to these guys. they've been zipping around
the skies for 5000+ hours. Probably longer than a lot of us have been alive and lots of them in
much more unforgiving arenas. That does not mean that you cannot question them if something
looks out of the norm. (Don’t yak their ear off for an entire flight questioning every decision, thats
a good way to get a grumpy pilot. Keep the big picture in mind.)

Pilots are people too, with a myriad of backgrounds. Some are comfortable flying at 300 ft all
night. Some come from a background with an entirely different mission focus. some are newer
than others. But at the end of the day, you are climbing in their aircraft, with them at the controls
and possibly a patient on board. If something doesn't look right, ask the question. If they can't
give you an educated, descriptive answer with a plan, its time to start thinking about no.

Lets try another example.

Nurse: “Hey pilot, were hovering kinda close to those mountains looking for this guy. i'm not
super comfortable with this.”

Pilot: “Nurse, i hear ya. I've got 5 disks away from the obstacle, the winds are calm. if
anything goes wrong i have a good escape route forward and left.  If you're still concerned, we
can abort, but i feel very comfortable in out present position.”

Nurse: “Ok, now that you explain it, I feel a lot better about it and our place for an emergency
should it arise. thanks”

That scenario? I feel pretty good about that, don’t you? If you're nervous, ask questions. If the answer isn't a good one, say no, or seek a better answer.

If the plan for for the flight goes against things you've been taught, say no.

You can say no.

Fly safely friends...

Josh...

Josh with a former patient, now a lifetime friend. We can and do accomplish this job safely,
but it takes all of us, working together. HelicopterEMS.com

Captains Couragous...

                                    "Then captains courageous, whom death could not daunt..."

AMRM Training Solutions was chosen for a presentation on Air Medical Resource Management at Northwest MedStar's (NWM) recent safety-day symposium in Spokane, Washington. 

The first plan was for a two-hour AMRM session, then as the situation developed, this was reduced to one hour. I wondered at the change of plans, but - if the customer wants it, and is paying for it - I will make it work, and work well.

This is AMRM Training Solutions after all... 

The change in speaking arrangements occurred as a result of a friendship that developed between a NWM leadership team-member and a United States Navy, "Naval Special Warfare" Captain 
(O-6) retired. 

A SEAL. 

The NWM team-leader is himself a retired Navy diver, and medic, and these two men have a shared bond of service. It is only natural that such an example of leadership and dedication as a career SEAL commander would be invited to speak to a high-speed organization - like Northwest MedStar. As it turned out they got not one SEAL, but two!

I arrived in Spokane the day prior to the symposium, and was treated to a fine evening of good food and camaraderie at Spokane's exclusive Davenport Hotel. I got to share experiences and memories of military service with the other speakers, and also members of the NWM leadership team - many of whom have a military background. 

Another life, with another great team...

It is always a pleasure to rub shoulders with American military professionals. And good for the soul. 

As described here...

I imagine you are familiar with the Navy's elite special operators, The SEALs. Did you also know about the Special Warfare Combatant Craft crewmen? (prounounced "Swicks") 

They too make waves. Indeed, the Naval Special Warfare team is comprised of thousands of folks, some of whom fly (and parachute, and swim, and patrol), and some of whom support operations from a quiet dark room with monitors and computers. Some fly, some shoot, some support. All are special. 

Does this resonate?

Yes, it made perfect sense to invite two SEALs to speak to a team of incredibly motivated, highly trained, dedicated and determined healthcare professionals. And it was an inspiring hour, listening to Captains Dave and Rob talk about becoming a SEAL, and what happens after. One bit that went straight to heart was Dave's discussion of "earning your Trident every day." 

Their overall message was: "Good leadership and good teamwork equal good safety."

Dave and Rob are retired from military service now, like me, and every day they wake up determined to earn the Trident that they were awarded all those years ago. Rob and Dave are ambassadors for the United States Navy, and for the SEALs, They know people are looking at them all the time, forming opinions of the organizations they represent from what they as individuals do. 

It's like that with us, we who operate, work in, and support  EMS helicopters. We are HEMS. Every day. On duty and off. 

Our seal of honor is the set of wings we wear on our chest. 

If you are interested in learning more about Captain Robert Monroe and Captain David Pittelkow; and the various services they offer to industry -  including risk mitigation/security consultation and training, and team-building/motivational speaking contact them at 

rmonro870@att.net

david.pittelkow@gmail.com

These two gentlemen created a safety-symposium experience for Northwest MedStar that made a real impact on this retired soldier-pilot and AMRM instructor. They will visit your flight program and do the same for you!

Rob, Dan, and Dave. Traditions of service...

Fly The Disk...

After 30 years of flying; instructing helicopter pilots, and being instructed by them, I can't remember where I first heard this line, "Fly the disk." 

I have been thinking about it lately though, considering how appropriate it is for all of us to remember that we must fly, better yet,  we must "be" the rotor disk.

Of course you know the "disk" is the spinning rotor system above our heads. When you are flying, it is life. The speed at which it turns is important. The attitude at which is travels through the air is important too.

Years ago, a check airman recounted a story about flying a Bolkow BO-105 cross-country with oilfield workers on board. A large long-legged fellow was sitting behind the pilot, with big heavy boots on. They were a few hundred feet up when the passenger shifted his feet forward and dropped his boot on top of the collective. It went down to the stop.

The aircraft tucked nose-down. The rotor system went from the normal thrusting state into an abnormal state, in which on-rushing air was passing through the entire disk from top to bottom - not through the action of the moving rotor blades, but in spite of them. This pilot initially had absolutely no control of his rotor disk, and the situation was grim. The trees were right there in front of the windscreen. They were all yelling.

Len told me that he pushed and pulled on the collective and moved the cyclic through all the quadrants trying to get the rotor disk tilted correctly, with the leading edge up. At the last second, just before impact, he did it. Air went back up through the rotor from bottom to top - autorotative state. And then he increased collective - normal thrusting state - and climbed away.

Scary...

During my last annual training I was flying with a sharp, charismatic young check-airman named Micah. I had told him that I was worried about my autorotation skills and needed practice, and he was having me perform autorotations to a runway. I did a couple of decent maneuvers, got over-confident, then botched one up. I lowered the collective, entered autorotation, then looked at my airspeed. It was fast. I looked at my rotor RPM, it was too high. Then I got nervous and wanted to slow everything down to figure out what was wrong and how to fix it. I began to pull backward on the cyclic.

Micah (like all good instructors) was ahead of me, and had his hand behind the cyclic to prevent this. He said, "don't pull back, you will overspeed the rotor system." If I pulled back on the cyclic, I would tilt the disk toward the rear, nose up, and the onrushing air would increase the already high rotor RPM. I was distracted by indications, I wasn't flying the disk. Note to self: Think about the rotor disk first. Everything else is secondary.

I discussed this topic with a friend who is both a pilot and a writer... She says...

This reminds me of my very first time teaching autorotations as a very low-time flight instructor in the R22. My student (who was exceptionally talented, and remains a great friend) was already a rated airplane pilot, and I had been gravely warned about airplane pilots' tendencies to instinctively push the cyclic forward following an engine failure. So, fearing for our lives, I had sternly warned him, DO NOT PUSH THE CYCLIC FORWARD. 

When the time came for him to roll off the throttle and enter his first autorotation, he dutifully pulled the cyclic back — way back! As I watched the rotor tach needle speed toward the red line, all I had the presence of mind to say was "Nonononononononononono!!!" (Which he still gives me a hard time about.) Fortunately, no harm was done, to either us or the aircraft. :)

In HAI's excellent video on autorotations, "Autorotations: Reality Exposed - Revised" available at

https://www.youtube.com/watch?v=YOl2YEH6wFU an NTSB investigator is shown presenting two autorotation scenarios (with video). In one, after loss of power the pilot lowers the collective and applies aft cyclic. This changes the rotor disk from the normal thrusting state to the autorotative state. They land safely. Next the video shows loss of power, reduction of collective, but no application of aft cyclic. As described above, the aircraft tucks nose down - it crashes in a few seconds.

Luckily, it was a simulator. The event being discussed however happened in a real helicopter, and it didn't crash because the pilot was texting. It crashed because the pilot forgot that we helicopter pilots have to, first and foremost,

Fly the disk.

Do you remember the Air France jet that crashed into the South Atlantic a few years ago? The investigation revealed that the pilots either never had, or had lost basic piloting skills.  Basic stick and rudder "air sense." They were so accustomed to being "systems operators" - a requisite skill in such a technologically advanced aircraft as the AIRBUS jet they were operating - that they were unable to cope with the loss of airspeed sensors and autoflight systems.

Our helicopters too are becoming marvels of modern technology. Autopilots are now so light and inexpensive that they are coming to the light-singles that many of us fly. Engine governors, fuel controls, and FADECS have removed the need for us to manage power with a collective twist-grip. The act of flying is easier than ever before. We are becoming less like pilots and more like systems operators. Autopilots will further divorce us from the need, and the skills, to manipulate the flight controls.

An anecdote : PHI Airmedical's chief pilot and I were talking about a Bell 230 that we both had experience with. He had delivered it to his pilots on a hospital contract, and at first none of them were comfortable with operating the autopilot. He recounted that they were reluctant to trust it, and preferred the hands-on approach. He left and came back to the base six months later. They had worn the paint off of the autopilot buttons.

No matter how sophisticated and automated our helicopters become, the time will come when we will be faced with a challenge, a failure, a malfunction. And our lives will depend on our ability to...

Fly the disk...

Alouette in Action : Alpine Rescue - Episode 1 - Angels of Mont Blanc

Helicopter meets Superbowl. Here's to a great game!

Guthrie One - 25 years later - A Situational Awareness Case Study. What would you do differently tonight?

Editors note: Please know that we don't intend to open old wounds or cause hurt by examining HEMS crashes. We want to derive something positive from tragedy;  if it's possible to do so. And that benefit? The knowledge to prevent another crash. If we don't learn from history we will be condemned to repeat it. For those for whom this pain is still fresh, you have our heartfelt sympathy. We are weary of loss - as you are...

Click on image to enlarge

NTSB Identification: NYC91FA067

The docket is stored on NTSB microfiche number 43142.

Accident occurred Saturday, January 26, 1991 in SONESTOWN, PA

Probable Cause Approval Date: 04/30/1992

Aircraft: MBB BK 117 B-1, registration: N891GM

Injuries: 4 Fatal.

NTSB investigators either traveled in support of this investigation or conducted a significant amount of investigative work without any travel, and used data obtained from various sources to prepare this aircraft accident report.

THE MEDIVAC HELICOPTER WAS RETURNING TO SAYRE AFTER TRANSPORTING A PATIENT TO DANVILLE. RECORDED RADAR DATA AND DATA OBTAINED FROM THE HELICOPTER'S LORAN-C MEMORY INDICATES THAT THE FLIGHT WAS FOLLOWING A DIRECT COURSE FROM THE GEISINGER MEDICAL CENTER AT DANVILLE TO THE ROBERT PACKER HOSPITAL AT SAYRE. THE ACFT'S HSI WAS SET TO DISPLAY LORAN COURSE INFORMATION. THE CLOSEST POINT OF THE COURSE TO THE CREST OF NORTH MOUNTAIN WAS APRX 3/4 MILE TO THE WEST. THE PILOT HAD ADVISED WILLIAMSPORT ATCT TRANSITTING THEIR CONTROL ZONE AT 2,500 FT. IMPACT OCCURRED AT 2,440 FT MSL. THE CREST OF THE RIDGE IS 2,520 FT MSL WITH 40-FT HIGH TREES. A WITNESS WHO LIVES IN A CABIN ON THE MOUNTAIN 200 YARDS FROM THE ACCIDENT SITE STATED THAT IT WAS SNOWING VERY HARD WHEN HE ARRIVED AT THE CABIN AROUND 1930.

The National Transportation Safety Board determines the probable cause(s) of this accident as follows:

• THE PILOT'S INADEQUATE PREFLIGHT PLANNING TO ASSURE THAT THE INTENDED COURSE AND ALTITUDE PROVIDED ADEQUATE TERRAIN CLEARANCE. CONTRIBUTING FACTOR(S) WAS: THE DARK NIGHT, SNOW AND MOUNTAINOUS TERRAIn

Guthie Air conducts a mock patient drill.

Jack...

Jack would tell us that this is life and life is worth living; live it to the fullest," said former Guthrie pilot, Stan Rose, in remembering his friend. "I still feel bad, but I want to thank you, Jack, for a great example of how to live a life.

Jack Goodwin was employed by Keystone Helicopter Services and had been with Guthrie One since the program began in 1989. A 10-year veteran of helicopter flying, Jack had been an EMS pilot since 1987. At the time of his death, he was a member of the Pennsylvania Air National Guard Unit in Phillipsburg, PA. He served in the U.S. Army Military Police at Fort Gordon, Georgia and also flew in Korea. He attended Penn State University and graduated from the U.S. Aviation Program at Fort Rucker, Alabama in 1981.

On a return flight from Robert Packer Hospital in Sayre, PA to Geisinger Medical Center, in Danville, PA, the helicopter Jack was flying crashed on North Mountain during a snow storm. All those aboard lost their lives including 35-year-old Jack Goodwin. The unfortunate accident happened on January 26, 1991.

A Kingston, PA native, Jack lived in Sayre with his wife, Louise, and two children, Mara and Colleen. Jack will be remembered for being an unbridled free spirit and for his thirst for life. (National EMS Memorial Service)



Deb...

"She always faced challenges and met them head on," said flight nurse, Jack Strollo of his colleague. "Deb was not afraid to die because she was not afraid to live. If everyone was a little bit less afraid to live, then the footprints that Deb has so deeply planted in our hearts will never fade away."

Deb Nole, 32, graduated from the Geisinger Medical Center School of Nursing and worked in the intensive care unit of Moses Taylor Hospital in Scranton before coming to Robert Packer Hospital. She began her career at Guthrie in 1986 as a nurse in the intensive care unit at Robert Packer Hospital. As soon as she heard of the plans for Guthrie One Helicopter and its flight program, she couldn't wait to climb on board.

Deborah J. Nole, a critical care flight nurse, lost her life when the helicopter she was riding crashed on return from transporting a patient from Robert Packer Hospital to Geisinger Medical Center in Pennsylvania. Deb was one of three crew members who lost their life aboard Flight #609. An estimated crowd of 2,000 filled the sanctuary for the memorial service for the crew. EMS personnel arrived in emergency vehicles from many of the areas the helicopter had visited during its first year and a half. Tributes were sent from as far away as California.


Deb Nole is survived by her father, Alexander Nole, and her fiance, Kevin Tomasello. (National EMS Memorial Service)



Mark...

"What I admired most was the way Mark dedicated his life to helping people and the professional way in which he did it. I'll miss his guidance and his assistance," said a co-worker, Tom Brandt, a flight nurse, of how Mr. Haussler influenced his career. When Mr. Brandt entered the flight service he said he had a "very clinical approach" to the work. His association with Mr. Haussler helped him to develop a "new pattern in emergency medical nursing," he said.

Mark Haussler, 26, was a Guthrie One flight paramedic. He joined the Guthrie family in 1987 as an EMS training coordinator. Mark graduated from Davenport College Center for the Study of Emergency Medical Services in Michigan with a degree in paramedic/EMS management. Long committed to EMS, Mark's career included serving as a volunteer firefighter with Athens Borough. He also served as regional training coordinator for the Bradford/Susquehanna Emergency Health Service Region and was a staff paramedic and supervisor with Bay State Ambulance Service of New England.


On a return flight from Robert Packer Hospital in Sayre, PA to Geisinger Medical Center, in Danville, PA, the helicopter crashed on North Mountain during a snow storm. All those aboard lost their lives including Mark Haussler. The unfortunate accident happened on January 26, 1991. Mark is survived by his wife, Kim. (National EMS Memorial Service)


Ed...

"He was a kind and gentle man and a super uncle," said nephew Walt Rogers as he remembered Ed Soper. "From the first time he saw Guthrie One, Ed had a dream to fly with the flight team. Other than his family, his life revolved around being good enough to get aboard that bird."

A dedicated EMS volunteer, Mr. Soper was a member of the H.O.P.S. Ambulance Service, served 10 years with the LeRaysville Fire Department and was an emergency communications dispatcher for Bradford and Sullivan counties. He lived on and operated a dairy farm in LeRaysville at the time of his death.

Mr. Soper was a flight observer aboard Guthrie One helicopter #609, on a patient transport from Robert Packer Hospital to Geisinger Medical Center, in Pennsylvania when it crashed, ending the lives of all aboard. An estimated crowd of 2,000 filled the sanctuary as family, colleagues and friends remembered the crew. Tributes and memorial donations were sent from other flight teams throughout the northeast, and as far away as California.


Mr. Soper is survived by his wife, Linda, and three children, Candace Lynn, Jeremy, and Adam Edward. (National EMS Memorial Service)

Training Imperatives...

Two AM. One hundred feet above the desert, one hundred knots. A darkness so complete that the goggles sparkle. There isn't enough ambient light for the tubes to intensify, so they make visual static. I am flying a Chinook, with a pilot next to me, another in my jump seat, and a mix of Army Special Forces and Air Force PJs riding in the back. On the ramp, I have two experienced crew members, and in each forward side window a young enlisted "gunner" sits ready. We are heading from KKMC to Rafha to sit "Fat Cow" standby, with tons of jet fuel to give to other helos, or tanks. Our internal tanks have a placard that plainly reads "Not crashworthy, not to be used in combat." But combat changes the rules.

I can barely keep my eyes open. The excitement and anxiety of going to war for the first time had kept all of us awake for most of the day prior. We are well south of the border between Saudi and Iraq, and although we know trouble may come later, not one of us anticipates trouble now. We have our position lights and anti-collision lights on, and are following a route flown repeatedly by Andy and his crew the night prior as they set radar reflectors for inbound airstrikes to use as a final position fix.

From the ramp, Mig's voice, "BREAK LEFT BREAK LEFT MISSILE MISSILE MISSILE." I hear this, understand what I have heard, and do absolutely nothing. I hold what I got, frozen in disbelief. Across from me, Russ says "I have the controls," and he begins a gentle turn up and left. We are four thousand pounds over max gross weight in a self-propelled fuel-air explosive and we aren't going to do much hooking and jinking.  From the jump-seat Don commands, "break phase and break plane, you gotta break phase and break plane!" Don has been to the Marine Corps' WTI course. I have not.

A brilliant flash turns night into stark daylight, and I know I am a dead man flying. My goggles shut down, I look up under them and see the desert floor below us, shadows lengthening as the source of light falls. It isn't a rocket killing us, its a flare (from us?). At that instant, both pilots and one of the two gunners (the one who hadn't launched the flare) realized that we had flare launchers and we all started pushing our flare buttons. Luckily, there is a time delay in the system, or we would have salvoed the canisters. We lumber through some turns, climbs, descents, and Don says, "you need to land and let the guys in back kill these dudes." As no one else had any better ideas, and the "missile" calls kept coming, Russ lands the helicopter; hard and fast. A massive cracking sound resonates through the airframe, and it bounces nose-up and rolls right. We crunch the right rear gear into the rocky floor. Now we can't land here.
God Bless those Lycomings. They screamed at the torture, but pulled us away.

Notice anything missing? 

We lived through this experience, twenty five years ago now. I have had tons of time to reflect on things that went right and things we did wrong. It was our first time, and we were all new at getting shot at. For years, we thought they were shooting SA-7s at us; those unseen men in the desert. Later wars have indicated that they probably had RPGs, still deadly at close range, but nothing like the SA-7. The crew on the ramp could only see the flaring, streaking objects. We in front couldn't see anything. Rich Dewald probably saved everyone when he said, in an angry tone of voice, "okay everybody calm down, they aren't anywhere near us anymore."

If only we had had combat training... If only we could have been subjected to that scenario before encountering it "for real."

Just over a year ago, the National EMS pilot's association was invited to participate in a rule-making advisory group for new HEMS training rules. NEMSPA sent me.
I was again, "new" and wish I could go back and get a do-over. I did push for more training, better prep for IIMC and engine failures, and even asked for autos to the ground. (Shot down on that one...)

Here's what I should have said...

Training should take into account what we have to do, and what might happen to us while we are doing it. Training should be evidence-based . What is killing us, and how do we stop it? Training should be designed not simply to expose us to new situations that we may have never encountered before, but also to reinforce proper behavior. It should be conducted to the point that when faced with an in-extremis situation, the response will be automatic, conditioned, without thought or hesitation. I think the SF guys called these "battle drills." They trained under fire, so that when they came under fire they would act instinctively.

There are times we need to do this as well. A forced-landing after an engine failure in a single engine helicopter is top of my list. Pilots in training should be subjected to multiple forced landing scenarios during training and evaluations. This could be started in simulators. They exist - today. We should be using them now, not when it's convenient. No pilot should be flying the line who hasn't demonstrated the ability to cope with a loss of power during every phase of flight. There should be some type of confirmation in the actual aircraft, for example...

While in the aircraft, in a downwind at an airport, the instructor will announce "you have an engine failure." The rated-student-pilot will successfully adjust cyclic and collective to enter an autorotational flight profile, will complete a 180 degree turn into the wind, and will position the aircraft such that a successful landing could be completed. The success of the maneuver must never be in doubt and the RSP must be the obvious master of the aircraft. If not able to reduce engine power, discussion of the maneuver will include what an actual loss of power will sound and feel like.

The topic that kept coming up during the meetings was the cost of training. No one wants to be subjected to higher training costs. But consider what one crash costs, in terms of negative publicity, employees who leave out of fear for their personal safety, and of course the loss of human life and destruction of aircraft.

With five fatal HEMS crashes last year, it is obvious that we have room for improvement in the manner in which we prepare pilots and crews to conduct HEMS. We can either fix our problems ourselves, or someone  else will do it for us.

HelicopterEMS.com