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Oversight of Helicopter Medical Services by the Federal Government
Last Post 04 Apr 2013 10:55 AM by marcglang@aol.com. 27 Replies.
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Butch GraftonUser is Offline
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10 Apr 2009 02:01 AM QuoteQuote ReplyReply  
PHPA has been invited to testify before the Committee on Transportation and Infrastructure’s Subcommittee on Aviation regarding the Oversight of Helicopter Medical Services on 22 April 09 in Washington D.C.

If you have any suggestions, comments or opinions concerning the above topic please post them here.
larry
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10 Apr 2009 02:50 AM QuoteQuote ReplyReply  
The FAA needs Inspectors with real hands on experience to oversee HEMS, real world understanding of what we do. A good example of lack of understanding is A021, how does it increase safety.
Bryan
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10 Apr 2009 03:54 AM QuoteQuote ReplyReply  
When you look at the accidents over the years the primary issue is WX, most of the WX related accidents the temp and dew point temps were close.
So if we really want to fix the WX issue lets add 1000-1 to the unaided minimums when the Temp/Dew Point is within 6 and the winds are less than 10kts.
This may seem excessive to some people but when you look at the data it's an easy fix.
All of the changes to A021 is just documenting what I've been doing for years, but it doesn't address the real issue of flying in marginal WX.

See and Avoid.....

If it's 1000-3 and you're unaided over unpopulated terrain with lowering conditions and no illumination, how do you do it???
rotorjock
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10 Apr 2009 03:58 AM QuoteQuote ReplyReply  
I believe we're well on our way to being regulated to death.  We still need to police ourselves, and find a way to refuse flight requests that are too questionable to fly safely, but regulating instruments and equipment isn't the answer.  In fact, in many cases having too much information in the cockpit will only keep pilots from looking out and seeing what's really out there.  I agree that our helicpoters must be properly equipped and maintained, but we also need to know how to use it all efficiently, and be able to stay on the ground when the situation dictates.  We need to be able to think for ourselves without pressure.

Don't encourage the lawmakers and desk jockies to create more requirments and regulations for us.
AMC Line-Pilot
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10 Apr 2009 04:41 AM QuoteQuote ReplyReply  
Twin-engined helicopters should be a minimum standard for HEMS operations. Flying a helicopter with the patient shoe-horned into the co-pilot's slot is ridiculous! The patient care taking place en-route is too much of a distraction for the pilot—particularly at night. Ever drive down the freeway at night with the dome light on in your car? Well, it’s at least 10 times as distracting in the air. But, turn the lights off and now you're compromising patient care. It's time to demand cabin-class aircraft for HEMS.
naswingman
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10 Apr 2009 05:58 AM QuoteQuote ReplyReply  
Every EMS aircraft that flies at night should have as a minimum altitude hold. Look down at a radio or map and fly down into the ground. How many times does that have to happen?
Norm
Rotor_Driver
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10 Apr 2009 06:25 AM QuoteQuote ReplyReply  
I have always hated that the managers get a free ride!  We get all of the pilot error accidents with an occasional inadequate training/supervision thrown in.  If the pilot survives he will most likely lose his ability to fly for a time period, but nothing ever happens to the CP's or DO's who put that pilot in the position in the. first place.  One of the reasons I left EMS many years ago was the attitude of managment.  Make many waves about safe operations, or pressures to fly and the first comment that you will get is "if you can't do it, we will have to find someone else who can".  That type of attitude can not be allowed to continue!  There must be some sort of punishment for those types of managers.  I have long held the view that if inadequate training or supervision is found to be a contributing factor, the direct managers must pay some sort of penalty.  I would suggest something along the lines of 6-12 months of not being able to serve in a managment capacity for any certificate holder.  I realize that most push for more or better equipment, or 2 pilot crews and I am not opposed to that at all, but we can not expect managment to change their attitude unless they are held more accountable.
Duce
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10 Apr 2009 06:31 AM QuoteQuote ReplyReply  
My Company supposedly has fistfulls of money for NVG's but "The military has first call" In the meantime I'm flying with a 20 year old gps with no map and backup ships without searchlights.
Sean
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10 Apr 2009 06:47 AM QuoteQuote ReplyReply  
Without doubt, one of the major problems afflicting EMS is the continued practise of operators allowing the customers to have influence and control of pilot decision making. The majority of pilots in the majority of HEMS programs still feel that their decisions are subordinate to, and will be subject to, the oversight and critique of medical personnel and management, medical, aviation and business. The result of this is an insidious pressure that the pilot is aware of whenever he declines a flight. Although many operators espouse safety and that their pilots are not under any pressure to fly, the reality is that the pressure is there, although unspoken, and that the pilots are aware fully of it. An example of this that I have actually seen has been in community based programs that prominently display a big notice in the crew room, on the notice board, stating how many flights are need that month to make budget. As each flight is made during the month the number decreases, but toward the end of each month should a disparity between those required and those achieved remain, the medical crew and medical managements persistance and pressure towards accepting flights increases exponentially. The med crews are similarly aware that their continued employment is at risk if the program is not profitable and thus also exert this unspoken pressure on the pilot to take a flight. The pilot is aware that by declining he faces the possiblility of enquiry and discipline up to and including his removal from the program. It is rare that his own management will support him and do not, when their contract with the customer states that the customer has the ability to demand a pilots removal.

This frequently leads to poor decision making by the pilot, fortunately not always with a bad outcome, even though he has accepted a flight that he may otherwise have declined. However, the downside to that is that, over time, he continues to accept flights or becomes known in the program as "the guy that gets it done" and this puts pressure to fly on not only himself, but other pilots in the program who are seen as not "team players" and are thus concerned about their own continued employment.

This should be brought up and exposed. Customers should be removed from the decision making process and contracts between an operator and customer that contain those clauses should be amended to read that the customers removal ability should be limited to cause only, not for their opinions of the professional decisions the pilots makes.
Lead Pilot
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10 Apr 2009 07:34 AM QuoteQuote ReplyReply  
I wish we could have some discussion about the real villian in HEMS: AWOS / ASOS. I routinely fly 150+ mile flight legs with two or less AWOS sites enroute and unless it's severe clear, the reports provided by these systems are ridiculously inaccurate. I fly in five states and the system doesn't improve from one to another. The launch and "go see" method is the only option. Without some "reliable" weather reporting system or human meteorologists placed in key locations; weather issues are going to continue to drive aborts and accidents. If you trust the AWOS lies, fly NVGs and see the truth!
Kate
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10 Apr 2009 08:16 AM QuoteQuote ReplyReply  
I liked what I read in the other forum on the issues we face, and how they were prioritized (eg. critical, important). I ask that the testimony include highlighting the issues that are no cost to the industry to fix(eg. "hard" liftoff times, which encourage taking shortcuts in flight planning and start-up), and are common practices for the sake of remaining competitive. If an issue has been highlighted, it doesn't cost the industry anything to fix the issue, and nobody loses their competitive edge because everyone is supposed to follow the fix, it should be a no-brainer - as long as the regulators are aware there is no actual cost. Another example of a risk we take to be competitive is keeping the helicopter running - as far as I've been able to figure we only do it because our competitor does it, and the first responders/hospital staff falsely believe it saves time. It has the potential to save a couple minutes, or it can add time to the launch if the med crew struggles with getting the patient loaded and can't communicate very well over the noise. It's a useless risk based on ignorance.

The other thing I ask in the testimony is to express appreciation in requesting input from the industry - I ask you to do this to encourage them to make regulations that are grounded in reality. I've heard there's one particular individual in the group receiving the testimony whose opinions are respected amongst them because he's a helicopter pilot - unfortunately, his time was all special operations in the Air Force, and he may not quite have the big picture understanding of our industry that they think he has.

One last suggestion: maybe PHPA could join forces with NEMSPA. If the two offer a united front on the issues, I would think your words would carry that much more weight.
Really fed up!
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10 Apr 2009 09:54 AM QuoteQuote ReplyReply  

Thanks for the opportunity to respond.  

Two things:

1:  HEMS operating companies' practice of binding HEMS pilots and medical crewmembers during summer heat in a spun glass flight suit (aka Nomex - i.e. it will NOT afford the pass-through of body heat for dissipation) with collar up, high top leather boots with cotton socks, and a helmet, all that restrict the disipation of excess body heat, is nothing short  of anti-OSHA, complete negligence, complete amateur behavior, and short sighted.  Nomex and helmets are NOT holy grails!!!!  The so-called standards outfits we have in the US are nothing short of NOT doing their homework!!!  We have got to put our brains in to this industry (what little the helicopter industry has), not blind faith in standards organizations that possess even lesser intellect (and we all know which one I am referring to).  The operating companies of the HEMS industry are deferring their responsibilities to organizations that are medical centric, not aviation centric - aviation is the problem and can NOT be driven by medicine or medically centric standards organizations.

2:  Infrastructure?  About time the US decided helicopters are a viable form of transportation deserving of the respect and attention afforded fixed wing aircraft.  This is a subject that is soooooo...........ancient the FAA and Congress should permanently bow their head in shame.

Thanks again.

 

flyright
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10 Apr 2009 11:07 AM QuoteQuote ReplyReply  
Regarding the new A021 rules:  I don't know what FAA bureaucrat decided that this was something that needed to be implemented at the speed of light, but the spectacle of EMS pilots at my base scrambling to use a computer program to  set up preplanned routes with MSAs a day before the rules went into effect was ridiculous.  First, the FAA should have gotten some serious feedback from pilots on the issue first, and second, there was no reason to rush things in such a manner.  It really makes you wonder whether the people regulating our industry on the government side have the minimum requirement of common sense.  Regarding equipment, every operator should be required to be fully NVG equipped by a certain date (my large company will be complete within the next month or so, so availability can't be that much of an issue), and should be required to replace all single-engine, non IFR-capable aircraft on a similar schedule.  Companies such as the one sprouting bases all over the country by doing the EMS job on the cheap by flying obsolete, underpowered 206s (they're just the most extreme example) should be required to change or surrender their business to those who will.
Dirt Doc
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11 Apr 2009 06:36 AM QuoteQuote ReplyReply  

Let's cut to the chase and look at the bigger picture. There's a dead elephant in the middle of this issue. Everyone can smell it but no one wants to acknowledge it. That elephant has a name and it smells like MONEY. In fact, too much money, and the quest for it is the source or our evils. What the committees need to focus on is the puzzle created by the money trail, and disect each piece of the puzzle to see how it affects not just safety in the HEMS world but its impact on the long term status of the national budget and a national health care system that's not filled with waste and abuse as it is currently. Then someone needs to have the "huevos" to take the bull by the horns and turn the entire system upside down. This problem goes way beyond the issues that we line pilots throw out, even though THEY'RE ALL valid. (Personally I think the committees need to hear more directly from the troops, not so much the CEO's or unions if they really want to know what life is like in the trenches.)

This industry needs to become a SERVICE just like Fire and Police. Then allow it to have really qualified vendors if necessary. It's really no different. Then, we the tax payers, can keep the hedgefunds, Wall Street and the Warren Buffets from standing in line with their "Medicare dollar" hands out. I guarantee this industries safety record would improve tremendously and so would the publics health care. This industry is all about health care, RIGHT?

You know you have a problem: when an organizations annual goal is to expand to X number of bases each year with no thought of where they'll find QUALIFIED pilots, paramedics, mechanics or appropriate airframes. You know you have a problem when: minimum qualifying standards for employees are decreasing as  staffing requirements are going up in an industry of diminishing manpower. The industry is substituting quantity for quality. You know you have a problem: when hospitals  are encouraged to "chopper shop" because P.R. and competition for Medicare/Insurance payments have put an aircraft on every corner. You know you have a problem: when even FAA regulations have allowed you to operate in unsafe conditions (If we're going to have more or changed regulations let's put more thought into it first). You know you have a problem: when unnecessary Medicare payments are bleeding the nation dry. The list is endless yet somehow some one always manages to point the finger at the lowly line pilot. I guess the buck just naturally stops here along with the RPM.

Now, burn me at the stake if you want but before you strike that match give serious thought to what I've just said and I dare you to tell me I'm wrong. We're but a symptom to a life threatening disease 

josh
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11 Apr 2009 10:09 AM QuoteQuote ReplyReply  
I would like to second what Sean said about operators giving up their control to their customer.  Despite their testimony at the NTSB hearing, customers do have a huge influence in the operational control of that aircraft.  They decide when to fly it, where to fly it, how to fly it.  The pilot is merely doing a weather check.  Customers have almost complete control of what safety equipment is used in there program, what aircraft are to be used serving the public, when maintenance is to be scheduled.  They pay for pilot's salaries indirectly through the contract causing a very real employee-employer relationship that cannot be denied.  They contract with local governments to provide air ambulance service without the air carrier being involved.  Despite the air carrier denying they do not have time-motivated launches, the customer does and sometimes contracts with local governments to have an aircraft at the LZ within a specific time.

The problem in this industry is that customers are not really customers, they are air ambulance providers acting like certificate holders without a certificate!  Pilots are simply pitted between abiding by the air carrier whom they rarely see, or the customer whom they see daily and who's uniform they wear.
dustoff54
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11 Apr 2009 10:59 AM QuoteQuote ReplyReply  
1. Give me goggles.
2. Require all hospitals to have rotating beacons and lighted pads.
Give me something like the Garmin GMX200 (WX display, TCAS, etc.)
Daninbenson
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11 Apr 2009 12:38 PM QuoteQuote ReplyReply  
Don't let the regulations limit the use of HEMS. Please don't forget to stress the importance of HEMS flights not just for speed, but for advanced care. Having a helicopter on scene is more like bringing the emergency room to the patient! The patient then has the best chance of survival, even if their condition does not seem that threatened. By the time a patient begins to show symptoms, it may be too late.

First responders are not ER doctors and may not properly evaluate the patient. This evaluation is usually based on the mechanism of injury(as it should be) rather than the condition of the patient because of the inability of the first responders to identify potential life threatening injuries. This is usually due to a lack of equipment and the personel trained to use it.
 
I am an EMT and you can have an ambulance with BLS (Basic Life Support), ALS(Advanced Life Support) and then double that and you have HEMS. The level of care that can be given by flight crews is almost as much as being in the emergency room itself!  If there is any question at all then the patient should be flown- period! It is easy to sit back, in hindsight, and say that HEMS is over used, but if it is your loved one- you want nothing left to chance regardless of the cost!
Ex EMS
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12 Apr 2009 05:52 AM QuoteQuote ReplyReply  
Please get the hospital people out of the cockpit. I left EMS because of the "if you won't do it we'll find someone who will" attitude. I know they have read a lot of stuff about aviation, some of it written by other nurses,docs,medics, but that does not make them experts in the field. There is no reason for a nurse/medic to be tuning radios/looking up freq in the cockpit. If a pilot can't handle the workload he probably shouldn't be there.
That being said, we as pilots need to police our own. If you know of a weak pilot mentor him/her and bring them up to speed. If you know of a hot-shot fool,take him out at the knees. We don't need warm bodies in the A/C, we need pilots.
ems26
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12 Apr 2009 06:55 AM QuoteQuote ReplyReply  
I agree except for one thing...1 mile visibility is stupid to fly in at any time. 

Give me a low ceiling any time as long as I have unlimited visibility below it..

On the other hand, if there is restriction to visibility of any type, say 3,4,5 mile flight vis, and no ceiling at all, that's an accident waiting to happen.

To accomplish the HEMS mission, you need to consider that the patient is spending extra money, and further risk to his life without conscious approval, in order to get to a higher level of care, FASTER than the ambulance would get him there.

If you're out messing around in 3 miles vis, or even 5 miles, you're not flying at cruise speed unless you're nuts.  Esp. at night.   The difference between 2 miles or 5 miles vis is often times as quick as one look inside the cockpit and back outside, because haze/fog/clouds are seldom of a consistent density.

With all that being said, the recent changes to our wx minimums was a step in the right direction, however, too much emphasis is being placed on ceilings, and not enough focus on visibility and dew point spreads.   All this to protect us from the few cowboys out there that mess around in crappy weather.

And until a company comes out with an effective and AFFORDABLE blade deice system for civil helicopters, coupled with extended range fuel tanks and the power to lift them, IFR is not the answer, at least in any areas I've flown.   Not to mention that I would expect to be further compensated to maintain IFR proficiency over a VFR job.
EMS26
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12 Apr 2009 06:59 AM QuoteQuote ReplyReply  
I agree 100%
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