At first glance, many readers might think general aviation is as far removed from helicopter emergency medical services (HEMS) operations as east is from west. However, there are more similarities than meets the eye, especially when it comes to safety.
Let’s have a look at what we, as general aviation IFR pilots, have in common with the HEMS branch of aviation and, more importantly, what we can learn from them. They had a rocky start (the first HEMS operation was in 1972) in terms of safety, but have made remarkable gains over time.
What We Share
Like general aviation, HEMS historically had a poor safety record with a comparable accident rate. In fact, one Johns Hopkins researcher calculated that a HEMS pilot flying 20 hours per week, over the course of 20 years, had a 37-percent chance of being involved in a fatal accident—not something that their family would want to know.
Perhaps this is not surprising considering the hazardous off-airport environment (perhaps a car accident on a freeway encumbered with surrounding obstacles) that these aircraft have to negotiate, not to mention the lack of instrument approaches. Moreover, many operations are often during periods of inclement weather—historically a leading cause of HEMS accidents.
A second similarity shared by both groups of aviators was that (at least until last year with the advent of modified FARs) HEMS pilots could (if not carrying a patient) depart under Part 91 rules, much as we do for a general aviation IFR flight.
A third commonality is the real potential for get-there-itis—with a twist. For the general aviation IFR pilot it might be a business meeting, or a long-planned family reunion, whereas a HEMS pilot, knowing of a trauma case involving a child, might feel a compelling pressure to complete the flight. The perception to accomplish the mission is there for both groups.
Finally, fatigue has been a big problem for both the HEMS industry and general aviation. IFR flight can be demanding—add in a missed approach, a change in runway necessitating reprogramming the avionics and/or digging around for a different chart, and things can get out-of-hand. We need our mental awareness performing at peak efficiency. Until last year, like general aviation, there were no rest requirements imposed on HEMS operators.
Improved Safety For HEMS
There does happen to be one big difference between general aviation and HEMS safety. While the accident rate for the former has stubbornly remained unchanged, the HEMS industry has seen a 70-percent decrease in accidents over the last 15 years—that’s impressive.
Remarkably, this dramatic improvement in safety has come in the absence of new regulations (the updated FARs for HEMS were only implemented in 2014) and therefore reflects effective self-policing by the industry. Those pilots are doing something right for sure. What can we learn as instrument pilots?
What has changed in the industry that might have contributed to their reduced accident rate? For starters, one of their frequent cause of accidents was inadvertent flight into IMC—77-percent of which were fatal. This should sound familiar, as the same problem continues to plague general aviation—including instrument-rated pilots. Just because a pilot holds an IFR-ticket doesn’t mean they are current and/or proficient. All too often instrument rated pilots fly into unexpected IMC. However, these types of accidents have decreased over time for HEMS pilots.
The industry has undertaken several steps that may have resulted in fewer of these kinds of mishaps. In the early days of the service, most HEMS pilots were IFR-rated, but there was little requirement for those flyers to be current/proficient—as a result, scud-running was popular.
This point was emphasized to the industry early on in a compelling study using a full-motion helicopter simulator that demonstrated the obvious—rusty instrument pilots lost control more often in unplanned IMC than their proficient counterparts.
In addition, the non-current pilots entered these weather conditions at lower altitudes than their more proficient brethren—running the risk of impact with ground obstacles. Sound familiar? The industry took heed and many an operator, on their own initiative, required their pilots undertake regular training on getting out of inadvertent IMC.
Risk Assessment
Along similar lines across the industry, preflight risk assessment matrices were implemented. Depending on the level of risk, mission authorization required approval by a senior pilot, the chief pilot, or director of operations.
Sure, the general aviation IFR pilot has access to something similar—the AOPA Flight Risk Evaluator and a comparable (albeit more perfunctory) construct by the FAA (see the FAA Risk Management Handbook FAA-H-8083-2). There’s also the PAVE/IMSAFE advocated by the FAA.
But, how many pilots use these tools? Perhaps not as many as should. There’s no one checking as to whether a pilot has done a self-assessment. As an alternative, consider discussing an upcoming flight with a senior flight instructor or perhaps a FAAST team member. It’s even more relevant if that person is familiar with your flight history and perhaps has even flown with you recently.
Fatigue Assessment
Current self-evaluation tools for the general aviation pilot are still deficient in fatigue assessment. One of the questions posed is the amount of sleep that the pilot had the prior night—using a cut-off of eight hours. That’s a good start, but for the pilot who has built up a sleep-deficit over the period leading up to the flight, one night of restful sleep is unlikely to do the trick. The fatigue issue has been addressed across the HEMS industry via mandating rest periods for their pilots.
As there’s no such comparable rule for general aviation pilots, one option for us is the use of personal sleep monitors (collectively known as actigraphs), which a pilot could use in the days leading up to a flight.
There’s a range of commercially available products out there with odd-sounding names presumably generated by imaginative marketing departments—PEAK, The Fitbit Surge, Jawbone Up, Misfit Shine, and ActiGraph—to name a few. The peculiar names might reflect the fact that these devices are primarily for exercise—sleep assessment is ancillary.
There are numerous products that can be viewed on the web to help you track your sleep. Personal sleep monitors represent less expensive alternatives than the gold standard for sleep assessment—a “polysomnograph” conducted in a sleep clinic. Actigraphs, which contain accelerometers, are typically worn on the wrist and function by monitoring arm movement. Note that these devices define sleep based on lack of movement. Therein lies a potential problem—a person lying motionless will be tracked as sleeping so the length of sleep given by the device could represent an over-estimate.
Get-There-Itis
The pressure to complete a flight that sometimes ends in an accident is nothing new to general aviation. The same applies to the HEMS industry where pilots in the past could push themselves, resulting the same effect in degraded weather.
In addition to implementing the risk assessment matrix described above, the HEMS industry now typically does not reveal the criticality of the mission to the crew. Because there is no equivalent for the general aviation IFR pilot, there needs to be some way of addressing this problem.
If the trip is that urgent, consider forgoing the use of general aviation. Remember you aren’t flying a transport-category aircraft with the corresponding level of redundancy, and more than likely there’s only one, not two, persons up front. Alternatively, have a rental car or an airline ticket as backup. A rental car can be cancelled and some airlines will allow you to “bank your air fare” should you determine that conditions allow for your personal air transportation.
Wrapping It Up
The improvement in HEMS safety, especially in the realm of operation in IMC, has been remarkable. Even more impressive is that these changes were brought about in the absence of federal regulations.
As IFR rated pilots, it would serve us well to learn from an industry that, by its own design, has made dramatic inroads in their operational safety. Examine your thought process in light of these examples.
Douglas Boyd, Ph.D. is a Professor at The University of Texas, and a Commercial, SMEL and instrument rated pilot.
This article originally appeared in the March 2013 issue of IFR Refresher magazine.
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