# Kern Co HEMS crash



## SandpitMedic (Dec 11, 2015)

Early reports are all are feared dead. Sad to see yet another helicopter down.

No details have been released, but I'm going to say weather and night  operations will be the cause.

RIP all on board.

http://www.cnn.com/2015/12/11/us/medical-helicopter-crash/index.html


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## ViolynEMT (Dec 11, 2015)

4 dead. Pilot,  medic, nurse,  and patient.


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## SandpitMedic (Dec 11, 2015)

http://sacramento.cbslocal.com/2015/12/10/4-dead-after-medical-helicopter-crashes-in-kern-county/


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## gonefishing (Dec 11, 2015)

Rip god bless them.


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## Martyn (Dec 11, 2015)

http://www.abcactionnews.com/news/national/medical-helicopter-missing-near-kern-county


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## onrope (Dec 11, 2015)

RIP


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## onrope (Dec 11, 2015)

I had to double check the date, this happened 9 years to the date after the Mercy 2 crash in the Cajon Pass. From all accounts the weather played a factor in both of these crashes.


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## CentralCalEMT (Dec 11, 2015)

I was working last night when it all happened. I know the crew and they always put safety first. It was so surreal to hear them on the radio saying they were lifting off for the hospital, then being dispatched to search for them a short time later. RIP brothers.


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## ViolynEMT (Dec 11, 2015)

CodeBru1984 was on, too. They were dispatched and then cancelled. That's when they knew.


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## CANMAN (Dec 11, 2015)

First let me say RIP to the crew members. With the being said at some point in the aviation industry we have to take a long hard look at what we are doing. Every single time we put one into the ground no one is willing to ask the hard questions, and that's what plagues the industry, and why we will continue to kill crew members. Weather was a factor in this crash, and each time that comes out in a report we always try to preach about how safe so and so was, or how great of a pilot xyz was. If they were so great, or so safe they would have turned down the mission, landed short, performed an emergency landing somewhere, turned around and diverted back to sending facility etc. It's a helicopter, you can land almost anywhere, and these type of crashes are extremely sad however are also inexcusable. Over saturation in the HEMS industry has led to some companies investing in the cheapest aircraft, with non-industry standard safety systems, pushing weather & trying to edge other programs out of flights, and they still have a list of applicants out the door because everyone wants to wear a flight suit. There are many problems, and I could rant for days, but now is not the time or the place. Everyone and every program is prone to make mistakes, it's just so unfortunate that people are losing their lives at such a rapid rate, and all we do is light a candle, and remember them every year at AMTC or other conferences.....


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## CALEMT (Dec 11, 2015)

Weather most definitely played a part in the crash. The central valley is very foggy this time of year. Terrain doesn't really come into play as the route they were taking (Porterville-Bakersfield follows hwy 65) is flat land/ rolling hills. I agree with canman, nobody asks the hard questions when it comes to HEMS crashes. While watching the news a ntsb investigator suggested night vision for the pilots. While yes nvg's would work good on a clear night, I doubt they would be effective in foggy weather or in a low cloud ceiling. These crashes are always a tragedy and on the news the original crew on the bird was at a company Christmas party and the crew on the downed bird was a backup crew. It's sad but these crashes will continue until someone wises up and stops buying helicopters built by the lowest bidder. You can't put a price on someone's life.


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## CANMAN (Dec 11, 2015)

Agree CALEMT. You can provide every available safety feature known to man, however if poor decision making is the culprit all those safety items mean nothing. From the sounds of it fog was bad and it was also raining. It was a 10 minute flight time, so I don't care how sick, they could have gone by ground. My program does it all the time. NVG are an amazing tool, and could have helped identify a low ceiling/one that is getting progressively worse. People can argue single engine vs. twin all day long, the problem is IIMC (unplanned flight into clouds/fog) in a single is an absolute emergency and in a twin you might have been able to file a flight plan and go IFR with a trained pilot which may have prevented this incident. Will see what the prelim NTSB report shows.


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## chaz90 (Dec 11, 2015)

Before speculating, doesn't it make sense to mourn the losses of the crewmembers now and go over the causes after NTSB reports and other investigative facts are released? 

I understand that HEMS safety is a huge topic, but I don't want to get on the bandwagon of jumping to conclusions before anything concrete is released.


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## SeeNoMore (Dec 11, 2015)

Very sad. I agree that the immediate focus should be on mourning the crew and patient. As the conversation continues I think it's important to qualify statements like "they always put safety first". I don't know the crew in question and have no reason to believe they were anything but top notch at their job and about safety. But even then, we can't fall into the trap of overconfidence. I am in a program that is fairly conservative with weather decisions with pilots / crews who feel free to turn down jobs and even then you can either a) make a poor safety decision despite an overall pattern of good decision making  and / or b) encounter weather you just didn't expect.


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## CANMAN (Dec 12, 2015)

chaz90 said:


> Before speculating, doesn't it make sense to mourn the losses of the crewmembers now and go over the causes after NTSB reports and other investigative facts are released?
> 
> I understand that HEMS safety is a huge topic, but I don't want to get on the bandwagon of jumping to conclusions before anything concrete is released.



This is exactly my point. Everyone mourns the loss, and once everyone attends funerals and puts their black ribbons away they go back to business as usual and don't even pay attention to when an initial report, let alone the final report comes out. There's enough information out about this incident, to include the weather conditions, to understand what the situation likely was. That's exactly what investigators do.

SeeNoMore, you make some good points, however again at the end of the day instead of having "get thereitis" you land the damn aircraft. If you encounter weather which wasn't predicted then turn around and go back to where you came from/where the weather was good. And if the weather where you came from with the patient wasn't good then you shouldn't be flying..... If more people had this mindset and spoke up we would have a lot less dead coworkers. That is all from me.


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## CodeBru1984 (Dec 12, 2015)

ViolynEMT said:


> CodeBru1984 was on, too. They were dispatched and then cancelled. That's when they knew.


One of the units out of my station was dispatched, however my unit wasn't dispatched.


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## ViolynEMT (Dec 12, 2015)

CodeBru1984 said:


> One of the units out of my station was dispatched, however my unit wasn't dispatched.




Ooopsie.


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## Carlos Danger (Dec 13, 2015)

CANMAN said:


> Everyone mourns the loss, and once everyone attends funerals and puts their black ribbons away *they go back to business as usual and don't even pay attention to when an initial report, let alone the final report comes out. *There's enough information out about this incident, to include the weather conditions, to understand what the situation likely was.



CANMAN is 100% right. Now is the _only_ time to talk about this, because the reality is that this is the only time that people are actually paying any attention.

We are closing in on 20 years since I started in HEMS, and I can tell you that it is the same movie being played over and over again:

A HEMS crew makes a poor decision(s) and crashes as a direct result of their poor decision(s)
Everyone is shocked and in mourning.
No one is allowed to discuss it bluntly because "the NTSB report isn't even out yet", so "let's just honor them and mourn right now. Let's not speculate, mmmkay?"
Crew is described by everyone as heroic and highly skilled and dedicated, and no one even thinks about being critical of their decisions
FlightWeb gets blacked out, everyone changes their profile pic to the death wings, everyone goes to the memorials and talks about safety.
We say that we have new guardian angels now and that the crew was heroic and died doing what they loved, "so others may live", and other sappy, meaningless things to make us feel better about the senselessness of it.
A week later, websites go back to their normal color, profile pics get changed back, and everyone not personally impacted by the crash forgets about it
Months later the NTSB report comes out and confirms what everyone knew. Everyone pauses for a moment and makes some cursory statement about "safety first - we need to stop these tragedies", and then goes back to doing things the exact same way.
Rinse and repeat. Over and over and over.

So let's dispense with the political correctness this time, and have an honest discussion about what is happening in the HEMS industry. I think this is especially important for everyone who is interested in HEMS as a career, but it's also important for anyone in EMS or any other part of public safety.

I started in HEMS in 1999. Back then most HEMS was provided by hospital-based programs that made little money on them, and some community based ones which tended to be non-profit and thus also made little money. There may have been some programs that made money on HEMS transports, but for the most part it just wasn't profitable and really was viewed as a service to the community, not unlike a volunteer ambulance service that exists in an area where no paid services are available. Most areas had only one HEMS program available so there was little competition between programs.

Fast forward to late 2002, when CMS authorized a nearly 500% increase in reimbursement rates for HEMS transports. That changed _everything _about the industry. Seemingly overnight, established programs doubled or tripled the number of helicopters in their fleet. "Community based" programs were popping up in rural areas everywhere. The number of medical helicopters available in the US went from something like 350 in the early 2000's to over 1000 in 2010. Less experienced pilots, paramedics, and nurses - who never would have been hired before the expansion - were now finding HEMS jobs without much trouble. Average patient acuity seemed to go way down in many places, as patients were being "flown" routinely who no one would ever have thought about calling a helicopter for before 2002. Thanks to a convoluted interpretation of the Airline Deregulation Act of 1978, states had very little control over the HEMS industry. That's how the industry came to look like it does today.

About the accidents. Here is the thing: we know _exactly _what causes a large majority of HEMS crashes....it is not some mystery that is yet to be solved. Anyone who asks "why does this happening" is simply not paying attention. Probably 90% or more of civilian HEMS crashes in the US follow a nearly a nearly identical pattern: the crew takes off at night (when vis already sucks) in weather that they shouldn't be flying in, figuring that they'll be fine (and _usually_ we are). But this time they don't handle the poor visibility as well as they hoped they'd be able to, and it kills them. Thats all. If you want to analyze these things to the nth degree you can read all the minute details in the NTSB reports, but "they crashed because they couldn't see where they were going because visibility was poor" accurately summarizes almost all of those reports.

These crews (and I mean in general terms - not singling out anyone) made a careless choice that they knew they shouldn't make, and they suffered the consequences that they knew they might suffer. It's not that different than getting in your ambulance and driving the whole way to a call well over the speed limit and barely even slowing down for intersections. That's not a perfect analogy but I think you get the point. It's not heroic or selfless - it's careless.

Why do smart, well-trained people keep making the same mistakes that they've seen kill other people? The answer to that question isn't _quite_ as cut-and-dry as the last one, but we have a pretty good idea how it works. There's a whole Human Factors / Crew Resource Management industry built around this and HEMS crews spend lots of time in classes and reading articles about this very topic.

The folks who teach CRM and make money off it make it complicated, but the main ingredients to this crap sandwich are *overconfidence* and *feeling pressured to fly,* seasoned with plenty of *that won't happen to me*. You know the weather is marginal or worse and you know that you really shouldn't take off. However, you've flown this route before, you think you can avoid the worst of the low vis, and if worse comes to worse, you know you are well trained in how to handle an inadvertent IMC. That's the overconfidence part. The pressure to fly part is more insidious and even less apparent, but just as much of a factor, if not more so. It comes both from the fact that most HEMS programs are corporate, for-profit businesses that have to do a certain amount of transports just to stay in business. Each base is generally competing for transports with other HEMS programs, or even with other bases within the same program. There are only so many transports to go around, so the reality is that you can only turn down your slice of the pie so many times before everyone else eats it. Of course everyone says "I never feel pressured to fly" and "I don't factor that stuff into my decisions at all", but it is very naive to think that your bases transport numbers aren't in the back of everyone's mind pretty much all the time.

Programs have no incentive to do what _really _needs to be done in order to stop this from happening, because those things mean fewer transports, and thus less profit. I mean sure, they'll provide the crews with NVG's and make them attend CRM every year, and they'll tell the crews that they'll never question a weather turn-down and that they don't want to crews to ever feel pressured. And those are good things, but they aren't sufficient. The programs will do those things and then turn around and hire minimally experienced pilots to staff helicopters at a new base right in the backyard of an existing program, and they'll market to the local EMS agencies about how important "The Golden Hour" and "Critical Care In the Air" is to patient outcomes. That the HEMS industry refuses to take the steps necessary to curb unnecessary transports is actually pretty sick, given the obvious ramifications.

Why do the med crews put up with it? Cuz flight suits. Cuz they don't know any better, cuz they don't pay attention. Cuz everyone thinks they are special and different. "Well, _our_ program isn't like that" thinks every flight nurse and flight paramedic who reads a critical appraisal such as this. "_Our_ management really does put safety first. _We_ really do have a huge impact on the outcomes of the patients we fly, so it's important that we get to every transport that we possibly can. We're different than all those other programs". Because _we_ are an exception, because _that will never happen here_, so we have permission to not really take this stuff that seriously. I mean sure, it's serious, and we'll pay attention to it, but it doesn't _really_ apply to us, because we are different.

Let's not kid ourselves. The reality is that we aren't saving lives any more on helicopters than we are on ground ambulances. We're just spending a hell of a lot more money and looking cooler in the process. Yes, the patients are sicker, but the difference is not as great as you might imagine, nor is our ability to really doing anything about it. At the end of the day, all we are really doing is looking cool, having fun, making a lot of money for the corporations who own the programs that we work for, by flying people who could usually go by ground much more cost-effectively and perhaps even much more safely.

The bottom line is that we all really need to stop viewing these crashes as some romantic, selfless sacrifice that we all hate, but that has to happen occasionally in order to save lives. It isn't that at all - it's actually senseless and even purposeless. We aren't heroes - we are just workers. We didn't _sacrifice_ ourselves when we crashed and died - we screwed up, plain and simple. We aren't dedicated and selfless, we are stupid and egotistical.

That last part might sound a little harsh, but maybe part of the reason we keep making the same mistakes is because we refuse to call a spade a spade.


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## chaz90 (Dec 13, 2015)

Touché. I was reluctant to want to get into this when it is so fresh for these crewmembers and their families, but you're right in saying this is the only time we listen and pay attention. 

What's your suggestion then? Increased regulation to cut down on the number of aircraft? You mention the hiring of minimally experienced pilots as a problem, but I imagine more stringent hiring requirements really have to be company driven on an individual level. Does some of it start at the hospitals and EDs themselves? If the doc requesting a transfer recognizes that an extra hour transport time isn't going to be detrimental to this patient, maybe they can start arranging a ground CCT instead. 

Most importantly, how do you cut down on the poor weather flights crews are taking? Part of it is obviously lip service, but with the decisions in the crew's hands and company insistence that there is no pressure to fly it seems like they're at least attempting to do the right thing. It sounds like it's the general culture and logical fallacies that make crews take flights when they shouldn't in most cases. 

I'll admit, I've never been involved in HEMS so I'm not 100% certain how the process works. I know the crews have the ultimate say in "fly/no fly," but is there anyone above them that can issue a guaranteed "no fly" due to weather? I'm imagining an independent regional (and hugely unpopular) aviation/meteorology expert who is not employed by the HEMS programs themselves and can issue a blanket "flying is allowed or is not allowed on this route at this time" every time an aeromedical transport is requested. Maybe they can consult with the crews regarding their equipment and opinions on the flight. The crew could override a "flying is allowed" recommendation and choose not to go, but they would be bound by the "no fly" ruling. This would prevent competing companies from jumping the transfer in borderline weather because they really want the transport or future contracts as well. Is there any feasibility to a program like that or am I totally off base?


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## CALEMT (Dec 13, 2015)

Remi said:


> I started in HEMS in 1999.



Wanna feel old? In 1999 I was 5 years old. 

Mimicking chaz, remi hit the nail square on the head with his post.


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## Carlos Danger (Dec 13, 2015)

CALEMT said:


> Wanna feel old? In 1999 I was 5 years old.



Nice. I don't really need any help feeling old, though.

I was 24 in 1999.


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## Carlos Danger (Dec 13, 2015)

chaz90 said:


> I was reluctant to want to get into this when it is so fresh for these crewmembers and their families,



I completely understand. 



chaz90 said:


> What's your suggestion then? *Increased regulation to cut down on the number of aircraft?* You mention the hiring of minimally experienced pilots as a problem, but I imagine more stringent hiring requirements really have to be company driven on an individual level. Does some of it start at the hospitals and EDs themselves? If the doc requesting a transfer recognizes that an extra hour transport time isn't going to be detrimental to this patient, maybe they can start arranging a ground CCT instead.



The entire industry is built on insurance (mainly CMS) reimbursements. So I think the best and simplest way to fix the industry is for CMS to simply refuse to pay for flights that aren't clinically indicated. I'm not sure how they'd define that, but they already do it in other areas. I said as the boom was happening that it wouldn't last long, because third-party payors would not finance all these helicopters flying all of these patients, but I was wrong. For some reason they still do. It's inexplicable. 

The FAA has had hearings and has refused to intervene. Some say that's because AEL and AM together have enough political clout to force their will at the federal  level. Maybe thats the same reason CMS won't modify their payment schedule for HEMS.

Like the rest of EMS this should be a state issue, but states aren't allowed to regulate aviation operations to any extent. Some states (MD, NC) have gotten around that a little by regulating the EMS side of things (in NC, paramedics who work for a HEMS program have to be affiliated with a level-1 trauma center; this is meant to keep out the AEL and LifeNet bases), but that has been only partially effective and is becoming less so.

I don't know what the answer is.


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## NomadicMedic (Dec 13, 2015)

Remi said:


> Nice. I don't really need any help feeling old, though.
> 
> I was 24 in 1999.



I was 29. F you all.


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## CANMAN (Dec 13, 2015)

Bravo! Hell of a post, and hits the nail on the head. Actually going to print and toss it out as a topic of discussion at our P.M. flight brief tonight at work. Agree 100% with all points, having said that I feel safer at work then I do driving to work, or commuting to my 3 different jobs throughout the week in the area I live in. That is only because I did countless hours of research into my program, and others in the area, before applying to only my program. My top 3 most important factors were 1. Pilot requirements and on-going training 2. Airframe worthiness and safety systems 3. True just culture program not some BS lip service and a program in which the medical providers decision making is held at the same level of importance as the pilots. If we encountered a crap weather situation we couldn't counteract safely and we told the pilot to land on the capital beltway they would make it happen and we would continue on by ground. Our program isn't afraid to land short and finish the mission by ground, and we provide all the critical care ground services in poor weather and during the winter if we decline flights for the entire state due to lack of resources. I also highly believe non-for profit vs. for  profit has ALOT to do with this problem, and personally I would not fly for a single engine for profit outfit anywhere. I think the patient benefit vs. looking cool factor really depends on your service area and capabilites of the facilites in those areas. It blows my mind that people can work for places like EagleMed, AEL, etc, put aircraft into the ground on a yearly basis, then post in forums and online about how safe "their base and their pilots" are and how they are great companies to work for. In closing REMI I know your in a completely different profession now but you would be a great advocate and consultant for aviation safey if you ever decided to venture down that path.
Cheers


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## CANMAN (Dec 13, 2015)

chaz90 said:


> Touché. I was reluctant to want to get into this when it is so fresh for these crewmembers and their families, but you're right in saying this is the only time we listen and pay attention.
> 
> What's your suggestion then? Increased regulation to cut down on the number of aircraft? You mention the hiring of minimally experienced pilots as a problem, but I imagine more stringent hiring requirements really have to be company driven on an individual level. Does some of it start at the hospitals and EDs themselves? If the doc requesting a transfer recognizes that an extra hour transport time isn't going to be detrimental to this patient, maybe they can start arranging a ground CCT instead.
> 
> ...



Alot of the lip service programs will certainly put pressure on the pilots to take flights or pilot may lean on crew and try to justify why he/she believes it's workable. End of the day the choice is 100% up to the crew, and I say that not because that's every companies policy, but if you're flying in a program where you get any pressure in declining a flight, saying you want to land short, etc, then you need to doff flight suit and walk out the door quickly. I honestly think alot of people love flying, like the autonomy it can provide, the "coolness factor", and there may be limited options in the area they work or live in. So they stick with it, and hardfast common sense items easily become overlooked because they don't want to leave their job. 

I love my job, and like my program, however nothing is paramount to my safety and going home at the end of shift. If that means my voice isn't heard one shift and I have to take a stand against a pilot, management, CEO, etc and potentially walk off and find another job then that is something I am 100% ok with. I would wager a bet that most provider's in the air medical industry wouldn't back up that kinda talk, and some pay with their lives.


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## Scott33 (Dec 14, 2015)

Thank you for an excellent post Remi.


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## FiremanMike (Dec 21, 2015)

Remi said:


> CANMAN is 100% right. Now is the _only_ time to talk about this, because the reality is that this is the only time that people are actually paying any attention.
> 
> We are closing in on 20 years since I started in HEMS, and I can tell you that it is the same movie being played over and over again:
> 
> ...



I was linked this thread off of another site and haven't logged in here in quite some time.  I wanted to log in and say that I tend to disagree with Remi (or perhaps just his approach), but I agree with the bulk of this post and find it mirrors my short (2 year) experience in HEMS.

At the end of the day, it's got nothing to do with twin engine vs single, a Bell 206 vs EC145, or a community for profit vs hospital non profit.  The crashes all follow the same general M.O., highly motivated type-a personalities that come from risk taking, high adrenaline backgrounds and love flying.  Bad decisions are made, deaths happen, and then we rush to blame the company, the airframe, the patient acuity, or whatever other non related factor that doesn't really matter.  As long as helicopters are made and operated by humans, human error will happen.

So what do I think will improve the accident rate?

1.  Stop scene flights - pre-establish appropriate landing zones that pilots can familiarize themselves with if they work in the area
2.  Stop night flying unless in an IFR ship and only to and from IFR pads, hospitals will need to invest in getting their pad IFR rated or stop flying at night
3.  More local education to providers - studies have shown that if your drive time is less than 45 minutes, you're better off driving.  Less flying = less crashing


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## CANMAN (Dec 22, 2015)

FiremanMike said:


> I was linked this thread off of another site and haven't logged in here in quite some time.  I wanted to log in and say that I tend to disagree with Remi (or perhaps just his approach), but I agree with the bulk of this post and find it mirrors my short (2 year) experience in HEMS.
> 
> At the end of the day, it's got nothing to do with twin engine vs single, a Bell 206 vs EC145, or a community for profit vs hospital non profit.  The crashes all follow the same general M.O., highly motivated type-a personalities that come from risk taking, high adrenaline backgrounds and love flying.  Bad decisions are made, deaths happen, and then we rush to blame the company, the airframe, the patient acuity, or whatever other non related factor that doesn't really matter.  As long as helicopters are made and operated by humans, human error will happen.
> 
> ...



1. I think that's pretty over-kill. I don't know where you're flying but establishing enough pre-determined LZ's in certain parts of the county and states just isn't practical. Most of these accidents in HEMS aren't landing or taking off from scene LZ's, most are in forward flight and collision with terrain in crap weather. Scene calls at remote LZ's can absolutely be done safely providing you have good crew communication and NVG's for all team members. Orbit until you are comfortable with the LZ, don't be afraid to call for a wave-off/go around if needed, and worst case demand the LZ be setup in another area if not suitable. To say we shouldn't land in an open farm field without hazards doesn't seem to me like something which would decrease crashes. The patient's that typically benefit at all from the service we provide are the patient's that live 2 or 3 hours away from a trauma center so I disagree and don't think only landing at pre-fabricated LZ's would work. 

2. Do I agree every HEMS program should be in an IFR capable airframe with well trained IFR rated pilots, absolutely. With the being said GPS approaches into hospital pads aren't cheap, and many hospitals will not spend the money to make that happen. In a perfect world that would be great, but again I think unrealistic. If the weather is IFR and the hospital doesn't have an approach you just turn the flight down and reset for the next mission. Simple as that.

3. Agree totally with #3.


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## FiremanMike (Dec 22, 2015)

I was really just spitballing.  I was thinking that if there were only certain landing zones would mean that there would only be a finite number of paths to and from said landing zones and CFITs may decrease in frequency because pilots would be more intimately familiar with the flight plan.


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