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EMS Helo Regs May Help

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You may recall an iconic photo that circulated a few years, a low-angle aerial shot depicting a freeway choked with traffic at a dead standstill. At the front of that bottleneck was a small fleet of emergency vehicles circled wagon-like around an EMS helo, strobes flashing, rotor spinning.

The viewer couldn't help but perceive the scene as an airborne angel of mercy snatching yet another life back from the mortal abyss. From the picture alone, you'd have no way of knowing that the trip to the trauma center—if it was even needed—might be nearly as risky as the car trip that precipitated the scene in the first place. If that's a bit of an exaggeration, the fact that the airborne EMS industry has a less than-stellar-safety record certainly isn't.

The FAA finally got busy and this week and announced new proposed regulations intended to reduce the risk of EMS crashes. Specifically, helos will be required to have H-TAWS and radar altimeters and pilots will have to be instrument rated and thus better equipped to survive a VFR-into-IMC encounter. Moreover, EMS operations will have to conduct their operations under FAR Part 135, not Part 91.

That's all good stuff and probably minimal. I'm actually a little surprised that these requirements aren't already in place. I'm skeptical that it will do much to improve the accident rate, however. And as far as for-hire flights go, the EMS rate is awful. Accurate rate data is hard to come by, but the GAO estimated that in 2008, the EMS fatal rate was 1.8/100,000 hours of flight. That's worse than GA's rate of 1.3, which is itself unenviable. If the scheduled airlines had a rate like that, they'd kill hundreds of people a year. To be fair, the better way of assessing EMS risk might be on a per operation rather than a per hour rate, but that data doesn't seem to exist.

Although I'm generally skeptical of this level of regulation moving the accident rate much, it actually might have some effect if 135 regs reduce the number of missions. The accident rate is poor in part because of the very nature of the operations EMS helos do. They fly into unknown landing zones night and day and even a mile of vis is just poor weather. They fly at low altitude, often without benefit of the instrument flight plans that help keep airline travel safe and many landings are at urban LZs, not airports. But the larger issue is that they are probably overemployed, used in circumstances where ground transport might have been a little slower, but would have been less expensive and safer. They are often used when the patient isn't critical enough to require rapid transport.

In a July 2006 article in Air and Space magazine, Dr. Bryan Bledsoe related the experience of a 63-year-0ld heart patient ordered to another hospital via EMS. No one questioned the use of the helo, but the patient never made it to the other hospital. The aircraft crashed enroute due to a known faulty altimeter, according to the NTSB. The crew was too badly injured to help the man and he strangled to death on a restraining strap.

Bledsoe reported that research data has revealed that patients rarely benefit from the rapid transportation that EMS provides and given the considerable crash risk, they may actual suffer from it. There are at least 800 EMS helos in the U.S.—more in the Phoenix area alone than in all of Canada. Why? Bledsoe says its because the air ambulance industry pushed federal regulators to increase Medicare payments for EMS operations and, accordingly, the industry expanded. So, perversely, just as EMS was helping to run up the deficit it was exposing patients who probably didn't need the service in the first place to more risk.

As all of us well know, this is the way government and private industry work together in this country, occasionally to the detriment of the sorry, beleaguered taxpayer. I'm all for things that increase employment in aviation and sell more aircraft, but I refuse to be a stooge and accept the notion that if it flies, it must be good. As in all things, I'd argue for responsible use rather than building a fleet on the government gravy train.

That's not to say there's no need for EMS. The vital services it provides have saved many lives, getting patients to the trauma center within that golden hour that so improves survival chances. If I were stranded on some mountain somewhere fading from a heart attack or an injury, I'd welcome that flap of EMS rotors. But on a rainy night on the interstate, I might be more inclined to ride the big red bus.

Comments (37)

I agree one hundred percent. this is way overused and wildly expensive but it seems cool mdixon md commercial/inst retired from the er

Posted by: martin dixon | October 11, 2010 6:33 AM    Report this comment

I agree with Paul for the most part on this issue. However as a Paramedic and a CFI I might be able to add to the conversation. I fully support the use of aviation in EMS and have seen many lives saved, in part because of it. However the way it is employed many times exposes Patients and crews to added risk. One thing that seems to be frequently overlooked in the decision for a scene flight is the proximity of a suitable airport. Many times a ground ambulance could be used to transport the patient just a few miles to a small local airport even a private strip and intercept with the helicopter there. Thus increasing safety for all by having an LZ that is clear and where the obstacles are at least well known and charted. However this detracts from the added rush many fire fighters, first responders, and indeed nearly all personnel on the scene get from the arrival of the helicopter.

Posted by: Travis Rader | October 11, 2010 7:20 AM    Report this comment

I've flown medevac's in canada and part of the reason that we have very few ems helo's here has to do with the great distances between towns and cities we used metro's for medivac's and there are government citations here and we would average at least 20 medivac fights a day and that's in a province (state) with just over a million people

Posted by: Ted H | October 11, 2010 10:59 AM    Report this comment

I worked as a physician in the California State Prison system. We were constantly pressured by the local ER staff to transfer inmates to the regional medical center (RMC) by helcopter, even tho the helicopter could not land at the hospital. The time savings was at most 15 minutes (in a 90 minute transport) and the cost was enormous. The total time from transport decision to arrival at the RMC was often greater than ground transport.

That much is fact. My opinion is that the local ER Doctors worried about lawsuits by inmates and thought helicopter transport would let them say they "did everything possible." We cannot prevent all bad outcomes no matter what we do, but our legal system does not accept that. Thus helicopters (and C-sections, PSA tests, CAT scans etc) get overused. -- Mike Perry

Posted by: D. M. Perry | October 11, 2010 12:24 PM    Report this comment

Paul, are you even rated in helicopters ? Why do you spend so much time writing about things that you know as much about as does the average NYC cab driver ? Why don't you just stick to things within your realm of actual experience ?

Posted by: RANDOLPH PALMA | October 11, 2010 10:21 PM    Report this comment

I'm writing as an informed tax payer and potential patient. I'm eminently qualified as both. And I can analyze accident and risk data as well as the next guy. Being helicopter rated is irrelevant.

Posted by: Paul Bertorelli | October 12, 2010 5:30 AM    Report this comment

Paul, quite frankly you really do not know what you are talking about, it's simple to recite a few stats and paste some FAA rhetoric. Being a helicopter pilot in itself alone might not be relevant, but being a helicopter pilot with 20 years of industry experience and 10 flying EMS, is quite relevent. No other individual is more knowledgeable about safety. As an experienced professional I can't help but giggle at most people's perception. Take some notes: The FAA's purpose is to PROMOTE aviation safety. If the FAA is serious about HEMS safety they will do the following: Require the use of NVG's for all night operations. For all night flights, require the aircraft and pilot be IFR capable, not IFR capable not on an IFR flight plan. Require scenario based training, and enhance training programs. Require an operable TCAS be installed and in use at all times. Increase hiring minumums from 2000 to 3000 hours for pilots. Promote legislation that requires reimbursement rates reflect the type of aircraft being used. Furthermore...... Companies will be required to meet these aircraft and pilot standards within 2 years of date xx/xx/xx. Some companies will fail. Some will downsize. Some will prevail. Some coompanies will struggle. In the end, the results will be evident. A safer product offered to the innocent public when they have a bad day. Now... this won't happen because of one thing.. THE FAA IS THERE TO PROMOTE AVIATION. Let's not confuse that reality.

Posted by: Steven Johnston | October 12, 2010 3:55 PM    Report this comment

If you think helicopters are dangerous, try chasing accidents with a horse and buggy. That is what you will have if you increase the involvement of the FAA in the EMS’s business. These new regulations are unnecessary The FAA is so terribly incompetent that when the EMT has to comply with part 135 regulations operations will slow to a crawl you may as well have a horse and buggy. I have a 125 certificate, in 2007 I tried to put two airplanes on the certificate. After three month and $50,000.00 I gave up. Abolish the FAA-------Wait! NO! Abolish the DOT. We do not need them to regulate aviation. Let a combination of the National Business Aviation and the Airline Transport Association along with AOPA regulate the industry. Underwriters’ Laboratory works well for manufacturing. Steven the way that the FAA wants to "PROMOTE aviation safety " is to ground all aircraft. Their theroy is if it no one is flying no one can have an accident. Look what they have done to Gen Aviation. My god you can have a TWAS on a GPS for less than $2000.00

Posted by: Dale Roark | October 12, 2010 4:57 PM    Report this comment

And read the NPRM carefully... it's not just EMS. Now all 135/91 operators will need radar altimeters..so who's going to pay for all this..Owner operator not the FAA. If you have a problem with one segment of rotorcraft ops, then fine deal with that group..here goes the broad brush approach again. If the ships VFR only like most..(other than some EMS) do you really need the radar altimeter to tell there is a ridgeline ahead. Remember it's VFR. The ship doesn't fail the pilot..the pilot fails the ship.

Posted by: Dan Lipko | October 12, 2010 6:06 PM    Report this comment

I am a 34 year Paramedic and an Instument rated pilot. I have flown with the local air rescue helicopter on several occasions. We have two air rescue services locally. One - the one I flew with has had an immaculate record in the close to thirty years they have been flying. Their pilots are top notch and their go-no go decisions are conservative. These services while obviously complying with the FAA also have to self assess and fly within a very safe standard - the same as any pilot should. They have to take the pressure to fly (either for the sake of the patient or for finacial reasons) out of the equation.

Posted by: TOM LAGERMANN | October 12, 2010 7:30 PM    Report this comment

What Paul fails to realize is that most of these "improvements" were put in place more than a year ago through changes to A021 and Operations Specifications. I know I'm a current EMS pilot who has to follow them.

For the most part this NPRM just codifies the changes already made. That means the FAA is now going through the process they should have gone through over a year ago but circumvented.

Oh yes one part of these sweeping regulations which we have been complying with for more that 3 years under current regulations is now everyone will need to do a manifest with these changes not just twin engine aircraft. The lack of a manifest or W&B calculations written on a piece of paper for later inspection has never crashed a helicopter or saved one from crashing.

I feel much safer. NOT

Posted by: Bruce Fenstermacher | October 13, 2010 8:48 AM    Report this comment

I've gleaned this list from several friends and my own observations. I started flying in '68, started flying SAR in '85, started flying EMS in '01. I’m still practicing.

Posted by: MICHAEL MUETZEL | October 13, 2010 3:32 PM    Report this comment

First off, if this NPRM is necessary for passenger (patient) safety, why not use the same process that is used in the airline industry – with certificated dispatchers? Oh, they’re only for fixed-wing? The NPRM says each helo EMS company should be able to build an entire training and qualification process for itself? ARE YOU KIDDING ME? Last time I checked, FAA issued ATP certificates for both fixed and rotary wing. FAA, do your job, establish a PTS and certification process for helo dispatchers.

Second, why does the dispatch center requirement only apply to operators of more than ten aircraft? Of course I know it's a $ problem, but isn't human life more important than $? Smaller operators could contract all the dispatcher (oops, excuse me, operations control specialist) jobs to a services company employing certificated dispatchers – even if they had to use fixed-wing dispatchers with mission-specific training because – see “first off” above.

Posted by: MICHAEL MUETZEL | October 13, 2010 3:32 PM    Report this comment

Third, the whole idea of a risk assessment form is silly. There was a glimmer of hope in the NPRM, "documenting the certificate holder’s MANAGEMENT personnel’s approval of the decision to accept a flight when the risks are elevated." Then they proved they don't have a clue about this by writing, "This would be particularly effective where the risk is not so great that it is clear that the flight should be refused, but rather when it is at a level where a pilot may be unsure about the flight’s safety, and the pilot may feel personal pressure to perform the flight and perhaps save a life despite the identified risks." ARE THEY NUTS? This is just another air taxi business; saving lives is God's job, not ours. Any professional aviator who calls management personnel to consult with them WHEN UNSURE ABOUT THE FLIGHT'S SAFETY is an idiot! That is the DEFINITION of a flight that MUST be refused!

Fourth, at least they’ll have comfy cozy operations control specialists. They’ll have tighter crew rest regulations than the pilots! “…maximum of 10 consecutive hours of duty” when the pilots are sked up to 14 hours! And ops control specialist duty time INCLUDES preflight prep, unlike the pilots, who do their prep after the shift starts and woe be unto you for slow takeoff time due to preflighting the aircraft or briefing the crew – or passengers – or whatever they are this week.

Posted by: MICHAEL MUETZEL | October 13, 2010 3:33 PM    Report this comment

Fifth, this nugget: “Each certificate holder must designate a local flying area for each base of operations.” There are numerous locations where using reduced visibility minimums is dangerous. Others where it is impractical, some where it’s impossible. Don’t mandate local flying areas. Make the PT135 Air Ambulance certificate applicant prove their safety in practice before allowing them to establish a local flying area with lower minimums.

Sixth, I flew for years with a helo 135 operator who PROHIBITED night or IMC flight and pulled the gauges and lights out of the aircraft so his pilots wouldn't cheat. It was VERY effective at preventing night or IIMC accidents, but with this new rule, that's not an option. Stupid.

Oh, and no more hover practice for Part 91 new guys when the field is W0X0F. Not only did they come up with stupid new rules, they won’t keep the ones that make sense! Your mileage may vary.

Posted by: MICHAEL MUETZEL | October 13, 2010 3:33 PM    Report this comment

Lastly, I think the informed tax payers and potential patients, eminently qualified as both, who analyzed accident and risk data as well as the next guy and issued this NPRM missed the point. Being helicopter rated is obviously irrelevant, since many of the people who came up with these jokes ARE helo rated. Actually surviving the job while fighting off the avalanche of irrelevant paperwork IS relevant. Ask the people who do it how they stay alive, don't ask the people who left the field for the crystal palace and the head shed because - well, draw your own conclusion why. I have.

Posted by: MICHAEL MUETZEL | October 13, 2010 3:41 PM    Report this comment

All good points from the helo crowd, none of which seem to address the issue of overemployment of the services, driving costs up and increasing risks to no one's benefit.

That is the larger point, not how careful or expert an individual pilot is. I don't know if the regs help or not. But if they push back on the government gravy train, that's a start.

See Bledsoe's piece and the GAO study, which offers good data. There are others.

As for refusing flight, a fatal rate of 1.8 is pretty bad and that would suggest some of these crews aren't refusing the missions. Or maybe they're just unlucky.

Posted by: Paul Bertorelli | October 13, 2010 6:10 PM    Report this comment

This second link is the GAO study.

http://www.aci-na.org/static/entransit/gao_air_ambulance_safety.pdf

Both explore the idea of Part 135-type regulations to improve safety. The NTSB rightly raises the question of competitive pressure impacting judgment calls on mission dispatch and that is largely my point. Data to prove EMS patient outcomes are better than ground transport is hard to come by. Bledsoe suggests it may actually be worse.

We all know one thing. It's way the hell more expensive and in some cost models, Medicare pays half. The for-profit EMS ops will want than money....

Last, the EMS industry comment on the GAO study:

I should have posted this before:

http://www.ntsb.gov/events/Hearing-HEMS/HEMS_Summary.pdf

It's the link to the NTSB study on EMS safety and the potential economic effects, which is what this is really about.

http://emsflightcrew.com/content/aams-responds-gao-report-changes-air-ambulance-services?page=36

Posted by: Paul Bertorelli | October 13, 2010 7:06 PM    Report this comment

One other link:

http://journals.lww.com/jtrauma/Abstract/2002/03000/Impact_of_Discontinuing_a_Hospital_Based_Air.12.aspx

This a short-term study showing that elimination of the hospital air ambulance had no impact on mortality or patient stays. Short study; small sample.

Point being, there's significant debate on whether EMS is really effective for as much as it costs.

Posted by: Paul Bertorelli | October 13, 2010 7:10 PM    Report this comment

The EMS industry has changed a great deal in the last ten years. Once upon a time you would call a helicopter to not only transport a patient more rapidly, but to also get a crew that had more life saving capability than most ground ambulances. This is no longer the case in many places, in most places I would guess, and it is not in the EMS system I helped build and still run for the past 15 years. The more interesting point though is the speed of transport of the patient to the bed of an Emergency Room. After we examined a couple years of our own calls we realized it actually took longer in most cases to fly the patient rather than to go by ground. When you add the time to call, the time to start and launch, flight to the scene, time at the scene and transfer of care, loading the patient, flight to the hospital, and the often too-long trip from the pad to the ER bed. The only time the helicopter is faster is if it is on scene when a patient is freed from entrapment and the flight crew doesn't delay by treating a great deal on scene. We do still use helicopters occasionally, but only when our patient is trapped. I have no beef with air ambulances. I have many friends that work on them, and I had the unfortunate need for one myself one morning about nine years ago, but Brian Bledsoe is right. It is overused. Greatly overused.

Posted by: Tim Wolf | October 13, 2010 9:20 PM    Report this comment

I guess I misunderstood the point of the “EMS Helo Regs May Help” article. The title and content threw me off. Mr Bertorelli wrote, “The FAA finally got busy and this week and announced new proposed regulations intended to reduce the risk of EMS crashes” and “I'm skeptical that it will do much to improve the accident rate, however.” I thought the discussion was about the value of the NPRM to improve EMS helo safety. I missed “All good points from the helo crowd, none of which seem to address the issue of overemployment of the services, driving costs up and increasing risks to no one's benefit” and “Point being, there's significant debate on whether EMS is really effective for as much as it costs” and “the NTSB study on EMS safety and the potential economic effects, which is what this is really about.” Oh, they weren’t in the article? Well, well. When losing a debate, change the subject.

Posted by: MICHAEL MUETZEL | October 14, 2010 6:31 AM    Report this comment

I don’t dispute the efficacy of air transport versus ground transport. That’s not my job. Dr. Bledsoe has been a self-aggrandizing cherry-picker in past articles and testimony, but I don’t dispute the basic statistics. Improving those stats is my job. And my neck. Mr Bertorelli wrote, “NTSB rightly raises the question of competitive pressure impacting judgment calls on mission dispatch.” Adding an operational control specialist to the decision-making process to resolve questions “where a pilot may be unsure about the flight’s safety” is NOT the way to reduce that pressure. That is possibly the most egregious example of what is wrong with the NPRM.

Posted by: MICHAEL MUETZEL | October 14, 2010 6:31 AM    Report this comment

The FAA is trying to make the industry safer. I agree with Mr Bertorelli’s “I'm generally skeptical of this level of regulation moving the accident rate much” especially when the NPRM has so many window-dressing solutions that don’t address the underlying SAFETY problem. His observation “it actually might have some effect if 135 regs reduce the number of missions” is what I expect will happen. The number of missions will decline, and there will be an impact on safety. You’ll hear it. We all will. THUD CRASH SMASH.

Posted by: MICHAEL MUETZEL | October 14, 2010 6:32 AM    Report this comment

One way to improve anyone’s ability to do a difficult task well is to increase training and proficiency while mitigating risk. In the late 80’s the EMS industry had an in-depth assessment by the FAA, the right way. In the cockpit, not a conference room. FAA safety reps visited civilian and military helo units studying how the job was done. One flew with our military unit for a month. Verdict? Civilians crashed on missions because they didn’t do enough mission-specific initial training and no proficiency flights. The military crashed on training missions because we trained for stuff no sane person would do. What’s changed? Now the military does less off-the-wall training and crashes on actual missions.

Posted by: MICHAEL MUETZEL | October 14, 2010 6:32 AM    Report this comment

Decreasing flight volume without increasing training while increasing busywork is counterproductive. Implementing this NPRM will decrease flight volume because it will increase response time, thus reducing flight requests. But there is no provision requiring increased training or proficiency flying. The public will see diminished service without increased safety.

I pray my experience is wrong, because this NPRM smells like a PR-issued cr-p sandwich. Pass the mustard.

Posted by: MICHAEL MUETZEL | October 14, 2010 6:32 AM    Report this comment

In over twenty years as an ER doc, I don't think I ever saw a case where a helicopter, or even red lights and siren for that matter made a difference. I did see several very bad outcomes from red lights, sirens and helicopters however.

Posted by: martin dixon | October 14, 2010 6:33 AM    Report this comment

Dr Wolf, Dr Dixon, Mr Bertorelli, Mr Bledsoe, I read your documents as "park the EMS helos." While that might decrease total accidents, does that affect the accident RATE? Shouldn't we expect that from the NPRM?

Posted by: MICHAEL MUETZEL | October 14, 2010 7:41 AM    Report this comment

Dear Mr. United States Navy Retired...a request for you. Would you mind using your real name. That is all we ask of you in this forum and I don't think it's unreasonable. If you don't want to re-register, then please just sign with your real name.

Thanks.

Posted by: Paul Bertorelli | October 14, 2010 10:20 AM    Report this comment

>>Decreasing flight volume without increasing training while increasing busywork is counterproductive...there is no provision requiring increased training or proficiency flying.<<

Agree on the busywork. But why do you say there's no provision for increased training? 135 293 through 299 require minimal recurrency and line checks. The operators can make of this what they will, but it's pretty minimal. As a former 135 pilot, I know that some companies take training seriously, some not so much, Could be some HEMS are already exceeding this, but how about the industry as a while? As recently as 2008, there were at least a couple of LOC VFR-into-IMCs. That's a training/competency/judgement issue.

And yes, you do read me right: I say park some of the helos. The large number of them may cause competition for the flight dollar that impinges on safety and, in any case, their efficacy on outcomes is questionable. At some point in this country, if we are to confront unaffordable medical costs, we'll have to make decisions like that, no matter whose ox gets gored.

I still think HEMS has an important function. I just question whether it's used wisely systemically. If this regulation pushes marginal operators out and improves the safety of those who remain, so much the better.

I concede that this iteration of regs may not achieve the safety improvement. But if not, what will? More operators competing for the missions? Or should the legal profession solve the problem through tort?

Posted by: Paul Bertorelli | October 14, 2010 11:04 AM    Report this comment

As an EMS pilot, I note that there is some overuse. But once you get away from major metro areas, where trauma, cardiac, neuro and other facilities don't exist, helicopters are invaluable. I have yet to see a first responder who can accurately asses, or has the tools to accurately assess the extent of a patients injuries. Some flown patients go home, some are more seriously injured than the mechanism of injury indicated. Increasing hiring minimums does nothing for safety. Most EMS accidents involve very experienced pilots. I have had three night IIMC encounters when the TAFs, AF and METARS indicated 3000/5 or better. Even though my program is VFR, I try to maintain IFR currency. I believe that if you fly at night you must be IFR current and preferably proficient. Demonstrating an IIMC encounter under the hood during the day is not a proficiency check for the real thing at night. This makes sense in the Great Lakes, Mid Atlantic and Northeast but NVGs are more important in the desert southwest than IFR proficiency. The FAA rules don't take reqional factors into consideration, they are one size fits all rules.

Posted by: Stan S. | October 14, 2010 2:20 PM    Report this comment

I said there is no provision requiring increased training or proficiency flying. The NPRM won’t change that but it should. The status quo isn’t enough to operate safely in the EMS environment. Basis? The accident rate.

If we want to push out marginal operators and address systemic problems, make the NPRM apply to all, including public-use operators who currently work without any FAA oversight and fleets less than 10.

If this NPRM may not improve safety, why do it? More important, what will? Stan S.'s and Mr Johnston’s comments are a good start. We disagree slightly. Hours aren’t as important as documented training, and demonstrated performance level is vital. That should be in the NPRM along with quarterly line-oriented flight training OR monthly simulator LOFT. But FAA doesn’t do it to other 135 certificate holders, and doesn’t like it when Congress rams it down their throats.

The NTSB Hearing that Mr Bertorelli referenced said that the FAA doesn't consider HEMS to be different from any on-demand operator. They’re right on principle. But it is, and FAA operating specifications acknowledge that. If they intend to implement new opspecs to require better and more frequent training, great, say so in the NPRM.

The FAA and NTSB are not to blame for medical overuse, misuse, or costs. That’s Health and Human Services. I’ve didn’t mean to imply using any ambulance, ground or air, is superior to letting the patient walk to the ER.

Mickey Call

Posted by: MICHAEL MUETZEL | October 14, 2010 2:46 PM    Report this comment

The FAA says the NPRM is because patients might not participate in choosing helicopter transport or the operator. Medical professionals and others excoriate air ambulance companies for overuse of the assets. Emperor-has-no-clothes time.

The customer isn't the toddler who fell in the pool after daddy passed out from heroin. Not the septuagenarian motorcyclist on the box van after the texting soccer mom rear-ended him at the stoplight. Not the cuckold who put four rounds in his wife then blew off half his face because his hand was shaking. The customer's the paramedic on her knees in the blood of the meth addict shot robbing 7-11. Or wondering if the virile youth with no visible injuries extracted from the t-boned vehicle that rolled three times falling off the cliff is REALLY all right.

And the PIC is asked, “point A to point B, continue to point C, weight XX lbs, can you do it?”

Protocols for treatment. The certificate holder and PIC don't decide if the patient should fly, the medical professionals in the jurisdiction make the rules and the first medical responder works within that conservative framework. The meatwagon doesn't have MRI and microsurgery and neurologist – heck, not even a nurse practitioner with 20 years ER experience. Tell me EVERY medical test that came back negative was a waste of money, NONE of them had ANY risk to the patient. My autistic nephew was “normal” before the vaccination. No risk? Life is choices. Not always your own.

Mickey Call

Posted by: MICHAEL MUETZEL | October 15, 2010 7:09 AM    Report this comment

Mickey Call's last paragraph is right on. I've NEVER made a decision whether a patient should fly based on medical need and I never will. You see I'm not trained or qualified to make that assessment despite holding an ATP Helicopter certificate. And I've NEVER read a FAR that discussed a passengers health and how that would relate to a flight. You see the FARs aren't suppose to regulate when a passengers health should dictate they fly. That is for the health professionals who request I make a safe flight.

If you want to have a meaningful discussion on when a patient should fly then you need to go to EMSweb or some other forum. Last I checked this is AVweb.

Once again I say. I've been flying under nearly all these rules for more than a year made mandatory by our companies OPS Specs. All other 135 EMS operators had the same changes made to their OPS Specs. Want to get an idea how well they are working take a look at the 2010 accident rate in EMS flights. It's nearly as bad as 2008, one of our worst years.

Posted by: Bruce Fenstermacher | October 15, 2010 1:06 PM    Report this comment

Want to get an idea how well they are working take a look at the 2010 accident rate in EMS flights. It's nearly as bad as 2008, one of our worst years.<<

So how would you fix this unsatisfactory accident rate?

Posted by: Paul Bertorelli | October 18, 2010 6:04 AM    Report this comment

Well at first blush it does seem to be an unsatisfactory accident rate. But the problem is and has been there is not enough information ie EMS flight hours to accidents to really compare. And then the industry is immediately compared to the airlines. What we do has nothing really in common with the airlines past the fact we are carrying soles on board. When the FAA and the out cry of the public figures that out maybe we will get meaningful regulations rather than knee jerk reaction. I'd like nothing more than to see a 0 accident rate and it is a goal, but is that really realistic?

continued next post

Posted by: Bruce Fenstermacher | October 18, 2010 8:49 AM    Report this comment

continued from last post

There is no magic bullet answer and no answer for every part of the country. Fancy HTWAS isn't it. Though some minimum level of equipment should be mandatory. Believe it or not not all EMS helicopter have a moving map GPS. Radar Altimeters could be a help but if not set won't do a thing. Accurate or even timely weather in a lot of places is not available. The ability to receive what ever wx is available through sources like XM would be a big plus to the pilot in making decisions. But lots of places there is just no weather. NVGs are not the total answer but a big piece of technology for night time operations.

Training training training. We do not get enough training. And the training has to be realistic. All to often what training we get is from trainers who may know how to fly IFR for example but have never flown IFR in the EMS environment or they've never actually used the avionics installed in the training aircraft. All to often the trainers are not familiar with the local weather or terrain and those special operating characteristics the pilot at that base works under and should be training for. Then of course we have to limit the training both in scope and practice because while we are training our base is out of service and that is not acceptable to management.

Posted by: Bruce Fenstermacher | October 18, 2010 8:50 AM    Report this comment

Mr Fenstermacher said, "Training training training. We do not get enough training. And the training has to be realistic... Then of course we have to limit the training both in scope and practice because while we are training our base is out of service and that is not acceptable to management."

Ditto.

Posted by: MICHAEL MUETZEL | October 18, 2010 7:14 PM    Report this comment

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