So, perhaps EMS crews need to be constantly evaluated to make sure they don’t consistantly operate beyond the previous mentioned capabilities. Thus, management can play a major role in reducing the accident rate by reading and reviewing each flight to determine whether the crew was operating reasonably.

Hey Doc (Doodybutch) you’re right about many unnecessary flights and informed consent from the patient/family. But we save lives all across the country every day. It might be a small percent, but that life counts when it’s your loved one that is critically ill or injured. Let’s be cautious about scaling back resources that may be desperately needed “when seconds count.”

Nowhere else in aviation will you find find a lone pilot “down in the dirt”, landing at isolated sites, in the middle of the night, without current weather, lead in lights, PAPI, or any other enhancements. Then you get to add in the pressure, real or imagined, to save the patient, save the programs reputation, or to out perform a competing program.

NVG’s will greatly assist the cause of safety on those flights flown at night, less then 20%. The FAA themselves are unfimiliar with the NVG system. It seems difficult to find anyone within the FAA willing to sign their name to any NVG program. I have taken a FAA inspector on a typical day/VFR training scenario and only suceeded in scaring them. They never again offered to ride along. The inspector certainly wasn’t going to be foolish enough to risk his life again and ride at night. Until the FAA gets a few EMS veterans in their staff, and then does the unimaginable…listens to them, the carnage will continue. At present, the only entity really demanding any experience in the cockpit are the insurance companies. We have come a long way from the “two pilot, 24/365 day program”. We will kill more before it gets better.

Hospitals need helicopters EMS programs for the advertisement, not for efficient patient care. No self respecting hospitals will ever go to a national convention without a helicopter picture on their brochure. Hospitals, including their business offices, never complain when a helicopter brings a “cash cow” patient to their site. It’s all about the money…

In my opinion, the easiest, quickest fix is for the FAA to mandate two qualified and trained pilots on every flight. That scramble for pilots will significantly add to the pilots wages. The only way we got away from the old “two pilot’s and a helicopter” program was an FAA mandate. All the newest “gee whiz” equipment, all the big horsepower two engine systems, all the new tracking systems, etc, combined will not add as much to safety as two pilots working on the same scenario. It then takes two to make a fatal mistake.

Helicopter transportation is extremely expensive compared with ground ambulances. The typical transport I see has travelled less than 120 statute miles and the cost is $12,000 or more. Ground transportation typically costs less than 1/4 of this amount. The large majority are hospital-to-hospital transports, not from accident scenes. The cost often represents an extreme financial hardship to patients and families who are uninsured and they are seldom informed of the cost or alternatives prior to the transport.

The presumption is that transportation by helicopter is safer because the personnel are better trained and the patient is moved quickly and efficiently. In published studies, this has been very difficult to prove and only a small proportion of typical patient transports by helicopter involve unstable patients who would demonstrably benefit from a few minutes less transportation time. Obviously, there are real concerns that any improvement in medical outcomes using helicopters may be more than offset by the crashes.

In my opinion, most medical helicopter transports are unnecessary and they represent a poor expenditure of healthcare dollars. Most of these programs should be scaled back a lot. In large cities, for example, each hospital typically has their own helicopter or often multiple helicopters used to compete for patients. There is obviously pressure to use them all the time.

Families and patients should be informed of less expensive alternatives unless an extreme emergency exists. I think most would choose ground transportation if they were given informed consent of the benefits, expenses, and the potential for serious accidents.

HEMS PILOTS:

We have added features to eSectionals(tm) to make it easy to
comply with FAA A021. eSectionals(tm) now includes the FAA Obstacles
Database and the FAA Airports DataBase and the FAA Chart Bulletins.

First, you must know that Sectional Charts are NOT ACCURATE. If you
attempt to comply with A021, you cannot do it or you cannot properly
find the obstacles along your route. The reason is simple. The FAA
marks up Sectionals in such a manner so that items do not conflict
with other nearby items. This includes both the Airport and Obstacle
locations. Since eSectionals, via the FAA Airport and Obstacles Database,
displays their actual locations on the Sectional, when you draw a route,
eSectionals finds those locations and generates the report automatically.

The ONLY way you can use a paper Sectional to comply with A021 is to draw
your route and then span the route about 1/2 inch either side of the route
to find the obstacles. Do you have the time to do this while some accident
victim waits for your service?

We are also adding the National Elevation Database so that eSectionals
reports the highest terrain. We have to make this addition slowly since
the Elevation Database has to be ordered from the USGS and presently
takes about 8 weeks. Even so, we have added parts of the Elevation
Database for some selected HEMS bases.

If you wish to see how eSectionals works, download our HEMS User Guide
at http://www.vfrcopilot.com/site/downloads/HEMS_UserGuide.PDF.

For more information, call Fred Stevens (VP Sales) or Kevin Carbone (CEO)
at ED/iT Aviation Products Division, (800) 987-3282.

Write a check for a new MRI machine and the whole hospital gets news coverage, more business and they can see it everyday. Write a check for aircraft systems enhancement, safety or training programs and (assuming they work) nothing happens.

Underbid a contract for a hospitals Lifeflight program and everybody from the hospital administrator to the janitorial staff see it as a way to save money. They simply are incapable of comparing that with the often decades long litigation chain associated with an accident. It is very easy to cause an individual hospital or even a county wide hospital system to go into bankruptcy over an accident. If the operators and the hospitals can’t or won’t develop a safe and workable system, the public and the legislators will. Costs will only go up.

The only way to decrease the accident rate is to fund multi-pilot, day/night full IFR, GPS, NVG, SVS, FLIR, autopilot supported aircraft that have the lifting power and range to do the mission anywhere on the planet.

Clue: Look at what it takes to safely fly the North Sea oil patch, or the Coast Guard in Alaska, 24 hours a day, 365 days a year. It takes big complex machines operated by well qualified, fairly compensated crews, that are trained, supported and monitored by professional organizations who’s interest is safe reliable operations NOT the annual budget. Safety is not cheap, but it is cheaper than the alternative.