Kern Co HEMS crash

[Carlos Danger]

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.

 

[Carlos Danger]

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

I completely understand.

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.

 

[NomadicMedic]

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

I was 24 in 1999.

I was 29. F you all.

 

[CANMAN]

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

 

[CANMAN]

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?

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.

 

[Scott33]

Thank you for an excellent post Remi.

 

[FiremanMike]

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.

(snip snip, post was too long and won't let me submit)

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.

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

 

[CANMAN]

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

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.

 

[FiremanMike]

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.