Category Archives: Safety

Understanding Air Ambulance Flights that use Hoist Services

When a person is stuck in a challenging environment, nothing else is as effective as air ambulance flights that make use of hoists. Their presence not only ensures quick rescue but also saves a lot of time and effort when compared to a ground rescue, although they too have not been without hoist fatalities. However, that is a risk that the brave rescuers sometimes take. Here are some of the advantages, limitations, and risks associated with air ambulance flights that make use of hoists.

What Limits the Air Ambulance Flights?

  • If the winds are moving at a speed greater than 20 miles per hour, if the visibility is poor or the weather is simply harsh, air ambulance flights may not undertake a rescue mission.
  • There is a weight limit that comes with hoist operations and if the combined weight of the patient as well as the equipment exceeds 450 pounds, the mission might be abandoned.
  • Hoist operations are never undertaken during night hours
  • Conducting a hoist operation over water is tough and can be quite limiting.

The Factors taken into Consideration by Air Ambulance Flights

  • The nearest location where the aircraft can be fueled
  • Availability of landing area
  • The location of the nearest command post
  • All information related to the patient such as the weight, age, people along with the patient, etc
  • Availability of a backup plan in case the mission cannot be carried out

The Different Types of Hoists Used by Air Ambulance Flights

  • Rescuer Backpack: This contains hoist equipment that’s best suited for rescue along with some emergency medical equipment in anticipation of the injury.
  • Bauman Bag: This equipment is used in winters when the injured patient needs to be kept warm. The bag is a splinter that fits automatically around the patient keeping him or her warm.
  • Rescue Net: Here, the patient is placed prone in a rescue net which is then hooked to the hoist.
  • Seat Harness: This is used primarily to rescue uninjured patients or to rescue those who have very minor injuries that do not pose any threat to life. Here, the harness is simply placed around the patient and hooked up to be hoisted away.

Carrying out hoist rescue missions requires special approval by FAA which is granted only after a rigorous certification process.

Aircraft flying high in the city

Medical Flights and RVSM

RVSM is an abbreviation that stands for Reduced Vertical Separation Minimum. RVSM-approved medical flights must be fitted with certain gadgets such as autopilot and certified altimeter. These medical flights are allowed to fly 29,000 feet above the sea level.

RVSM allows aircrafts to fly maintaining reduced vertical distance between each other; thus, paving way for more medical flights to share airspace simultaneously and safely. While this may seem quite technical for a layman, there are other distinct advantages of flying above 29,000 feet. It brings speed, comfort and safety. Let’s discuss the importance of RVSM, especially with long-distance medical flights.

Safety of Medical Flights and RVSM

Safety is always the primary concern when you choose an air ambulance. Medical flights coursing at lower altitudes are more susceptible to turbulence. Such turbulences can cause unnecessary anxiety in the patient which is not advisable when the condition of the patient is critical or the patient is already anxious about his or her health.

Speed of Medical Flights and RVSM

Time is always of essence when choosing an air ambulance. Medical flights flying at higher altitudes fly quicker and burn lesser fuel. This means that the air ambulance does not have to stop frequently for fueling. Circling the airport, landing, fueling and resuming flight can be quite time consuming and RVSM approved medical flights avoid/ reduce such hassles greatly.

Comfort of Medical Flights and RVSM

The reduced chances of turbulence, when flying at higher altitudes, make travel comfortable for the patient. The difference in comfort level is not too great but for a patient who has a fragile health condition, the small difference can mean a lot. There is also the peace of mind that comes along when you know that the aircraft carrying you will take lesser time.

Cost is always a consideration when choosing medical flights. The fact that a RVSM approved aircraft burns less fuel could translate into lesser costs for you.

A neonate being transferred from ground ambulance to air ambulance

Fixed-Wing Air Medical Transport Precautions

When you accompany a patient to a fixed wing air medical transport vehicle, you would be accompanied by qualified professionals belonging to both ground ambulance and air ambulance. However, knowing certain protocols can always come handy, and ensure a safe and swift transfer of the patient to the air medical transport vehicle.

Getting to the Air Medical Transport Vehicle

First and foremost, the ground ambulance needs to wait for the aircraft to shut down its engines completely before approaching it. Even when the ambulance approaches the air medical transport vehicle, it has to stop at least 25 feet away. All flashing lights must be switched off and only the headlights must be used in case of poor visibility.

You must wait for the crew to arrive to the ground ambulance to take the patient away. Switch off the ground ambulance immediately after reaching the destination to avoid the exhaust fumes getting into the aircraft. Keep in mind that the aircraft might be pressurized to a certain degree and the exhaust fumes can be quite a disturbance.

Taking the Patient to the Air Medical Transport Vehicle

Walking in front of the wing of the airplane is a strict no. Also, refrain from opening the doors of the air ambulance. Assist in loading the patient only if help is requested. If the help is sought, do not stay inside the air medical transport vehicle unnecessarily after loading the patient, unless you are travelling along. Never hesitate to ask what you must and must not do once inside and when travelling with the patient.

Before Exiting the Airport

It is wise to leave the airport only after the air medical transport vehicle takes off. Inform the crew of any issues such as debris or animals in the vicinity that might hinder takeoff. Even when the ground ambulance moves away from the aircraft, the flashing lights must be switched off.

Finally, have all your questions relating to the medical travel answered before the transfer. Your questions at the last moment can unnecessarily waste valuable time.

Picture of Sikorsky S-76 chopper

Airambulance and Your Safety – Know a Little About the Choppers

It is remarkable to know that airambulance services or Helicopter Emergency Medical Services ferry over 400,000 people safely each year in the US. Most of these rescues are usually conducted in tough weather conditions and poor visibility. Landing is another concern as pilots have to land the airambulance in unfamiliar terrains.

The fact remains that airambulance services today are increasingly turning commercial and safety is sometimes put on the backburner. The FAA has been extremely active in regulating the airambulance market in recent times, laying down new rules for safety. In this realm, we look at certain facts. However, a good chopper can cut the risks to a huge extent. Here, we discuss a few of those briefly.

The Various Airambulance Choppers and their Capabilities

There are several airambulance helicopters that are used in emergency situations these days. As a person who might potentially be in need of these at some point, you must know a little about the popular helicopters out there.

Bell 206: The cost varies from $800 thousand to $3 million. It is a single engine airambulance that can host only one pilot. It has only limited weather capability. It also has limits when it comes to carrying load such as fuel and medical equipment.

Eurocopter EC135: The cost varies from $4 million to $6 million. It sports a twin engine and can host 2 pilots simultaneously. It has excellent weather capability and can run on autopilot. It can fly for longer distances. This airambulance can carry equipments such as balloon pumps and ventilators.

Sikorsky S76: The cost of this chopper varies between $7 and $12 million. It is a twin engine helicopter that can host two pilots at a time. It has instrument weather capability and can also run on autopilot. It has specialty transport capabilities such as onboard pediatric care. This airambulance has the highest distance range.

Considering the fact that helicopter airambulance operations accounted for the second highest commercial accidents in 2014 as reported by FAA, it becomes vital that you know a bit about these helicopters.

Healthcare Standards in Medical Flight Services and the US Law

Megan Gilbreath was a resident of Abilene, Texas. She was an 18-year-old student who was involved in a motor vehicle accident involving her pickup. She had a rollover accident where she sustained a head injury and a broken leg. A medical flight was quick to respond and she was all set to be transported to the nearest medical facility.

However, one major error was committed. The EMT that belonged to the medical flight service had intubated her wrongly. The tube that was supposed to carry oxygen was inserted into the esophagus instead of her windpipe. As a result she was declared brain dead by the time the medical flight took her to the treating facility. All the while oxygen was being pumped to her stomach instead of her lungs.

Are You Safe on a Medical Flight with Mere FAA Regulations?

It must be noted that FAA is a regulating body for flights of all types and not just medical flights. This means the medical flight service providers don’t really have regulations that govern them when it comes to ensuring adequate medical care on the flight. FAA only has the say when it comes to medical flight safety when flying. It concerns itself with issues such as crew safety in bad weather conditions and medical flight during bad visibility at night.

Who Regulates the Medical Flight when it Comes to Standard of Care?

The Airline Deregulation Act of 1978 that paved way for using air ambulances during medical emergencies had one major flaw. It exempted the medical flight service providers when it came to “routes, prices, and services.” This loophole allows the medical flight service providers to have their own standards when it comes to services.

This however does not mean that all air ambulance service providers cut costs when it comes to standard of care. Most medical flight operators maintain high standards of medical care. However, in the highly competitive air ambulance sector, it is possible that there are medical flight service providers who cut corners through not-so-well trained or inadequately trained medical staff.

The Airline Deregulation Act of 1978 does have a provision where the states can regulate the medical aspect of air ambulances; the only condition is that such regulation should not impact the economics of operating a medical flight “significantly.” In essence, there is scope and hope for regulations in this regard.

The Latest on Air Ambulance Transport Rules by FAA

The Federal Aviation Administration had laid down its groundbreaking safety rules for choppers in February of 2014, popularly known as the HAA (helicopter air ambulance) rule. It mandated that the choppers involved in emergency transport of the patient would have to meet requirements like:

  • Inclusion of certain specific safety instruments
  • Improved training and testing
  • Establishment of control systems for air ambulance transport vehicles

These were only a few requirements that were laid down. Although the initial deadline to meet these requirements was April 22 of last year, it was then extended by a year owing to the difficulties of the air ambulance transport companies to comply with them at such short notice. Most air ambulance transport companies have already complied with the first set of rules, although there is some anxiety in the air ambulance transport industry as the deadline nears.

The Air Ambulance Transport Sector will have to Meet More Deadlines

Although the air ambulance transport companies will have to comply with several of the rules laid down this year, there are some for which the sector still has time. Here’s a breakdown.

Compliance by April 2016: Setting up of operations control center.

Compliance by April 2017:

  • Installation of radio altimeters
  • Incorporation of warning systems and terrain indicators for choppers
  • Meeting qualification criteria for PIC instruments

Compliance by April 2018: Complying with mandated systems to monitor flight data.

Guidance is awaited by the Air Ambulance Transport Industry

The sources in the air ambulance transport industry revealed that it is not possible to comply with certain mandates unless there are clear guidelines by the FAA. Compliance with most of the rules will cost the air ambulance transport operators huge dollars, so obviously, they want to get it right and keep the expenses to a minimum.

For the pilots, crew and the people travelling in air ambulance transport vehicles, the rules will bring in more safety and efficiency. In general, the rules have been well accepted by the air ambulance transport industry so far.

Air Ambulance Transport – A Dangerous Profession

Wanting to help the needy by being part of air ambulance transport is no doubt a noble intent. However, the profession is fraught with several dangers and is counted among the most dangerous professions in the world. People who aspire to join air ambulance transport sector must give due consideration to certain aspects of the sector. Apart from the fact that air ambulance transport services cater to people in war torn areas, natural disasters and global epidemics such as the recent Ebola threat, there are other factors too that must be considered. Here, we highlight a few of those.

Air Ambulance Transport Crews are More at Risk than Patients

One simple reason is the fact that more than one crew member accompanies a patient usually. The second reason could be that the crew usually has to make more flights, one to pick the patient, one to drop and another trip to return to the air base. All this while the crew, with the inadequate safety standards, is exposed to more danger.

There is also a sense of urgency that surrounds most air ambulance transport trips. For instance, if a patient has had a heart attack, the first priority is always to transport the patient to the nearest medical facility within the first hour.

Some air ambulance transport industry experts have also raised concerns about the competition that exists between air ambulance transport companies to make the maximum number of flights. Such a “race” naturally puts the air ambulance transport safety in the backseat.

Stricter Rules for Air Ambulance Transport in the US are on the Way

The need of the hour, therefore, is stricter regulations. American air ambulance transport sector can take a leaf out of the Canada which has stricter regulations. For instance, it is mandated that at least two pilots must be present in every air ambulance trip. That said, the FAA has now proposed new safety rules, which will be implemented by 2015. The regulations have come into place after many postponements and delays. On the positive side, however, we hope that the new rules make air ambulance transport safer for the crews.

What is the accreditation process for medical transport services?

Accreditation begins with an application form. The form indicates the service’s intentions to complete the process. The service then receives a Program Information Form (PIF). The PIF consists of a demographic section, a list of bases and a self-evaluation of the service, based on the CAMTS Standards. Response to the PIF self-study also requires attachments that include policies, education materials, quality management and safety processes. The PIF and attachments are submitted electronically within a year of applying for accreditation.

Once the PIF is complete and returned to the CAMTS office, it is reviewed by the CAMTS staff for completeness and sent to two Board members who will review contents for completeness and for additional questions that they document for the site surveyors. Site surveyors are then appointed, based on their experience and background related to the type of service (air/ground; fixed/rotor; critical care, ALS/BLS ground, etc.) they will visit.

The site visit is then scheduled at a time agreeable to both the service and site surveyors and at least 1 month prior to a Board of Directors meeting in order to be placed on the agenda for an accreditation decision. Once onsite the surveyors will conduct a series of interviews of personnel, look at training records, quality improvement programs, safety policies, etc. Their comments and observations are documented for the two Board members who present the program anonymously to the full Board. The programs are always presented by a six digit number – proper names and specific locations are not known by the full Board. If a Board member has a conflict of interest – he or she is excused while the program is presented and the Board deliberates.

Air Ambulance Safety by AMS

From 1972 through September, 2002, when HEMS safety research by Dr. Ira Blumen of the University of Chicago Aeromedical Network (UCAN) was completed, HEMS had flown approximately three million hours, transporting some two and three-quarter million patients.  In that time, there were 166 crashes involving HEMS, with 183 fatalities.  The UCAN study found that while the number of crashes each year has fluctuated, the number per 100,000 patients flown had dropped from 17.36 in 1980 to 5.5 in 2001.

The risk to patients, estimated over the years of the study, is reported as a fatality rate of 0.76/100,000 patients. Subsequent admission to a hospital carries with it a greater risk of death from complications or errors: various recent estimates range from 1.2/100,000 patents to 292/100,000 patients.

Nonetheless, any form of medical transport incurs inherent risk and in the past few years there have been increased numbers of accidents associated with the increased number of helicopters and transports. In an editorial comment in the UCAN study, a past president of the National EMS Pilot Association emphasizes that the causes of crashes haven’t changed over the years. The top three causes are “risk taking, pre-flight planning, and in-flight decisionmaking,” reflecting the unique pressure placed on crews by the condition of the patient and by the feelings of obligation to fly.

The air ambulance service community has taken significant steps, particularly in the area of aircrew resource management (a proven airline industry safety tool) to improve its safety for patients.  Some HEMS prograir ambulance service are replacing aircraft, hiring pilots to fly under Instrument Flight Rules (IFR), and employing new technologies such as night vision goggles (NVG’s) and terrain avoidance warning systems (TAWS), especially important when weather conditions abruptly change mid-mission.80 Transport medicine is among the most complex arenas of medicine, and is characterized by the need to provide immediate access to time-sensitive care for critically ill and injured patients at the same time that operations are conducted in hostile environmental conditions with limited planning time. As Justice Oliver Wendell Holmes once noted: “to be safe does not mean to be risk free.” Recognizing that risk cannot be completely eliminated, it is essential both for the public served, and the pilots, nurses, paramedics, physicians, and other health care providers who deliver care, that the practice environment be as safe as possible.

To that end, the Association of Air Medical Services has already initiated Vision Zero (http://aamsvisionzero.org/) and has joined the International Helicopter Safety Team (IHST, www.ihst.org), led by the American Helicopter Society (AHS), the Helicopter Association International (HAI), the Federal Aviation Administration (FAA), and Transport Canada to reduce helicopter accidents by 80% in the next ten years.

These initiatives seek more effective methods and approaches to avoiding errors in complex systems premised on the model that providers must work collaboratively, on a voluntary basis, with regulators to identify and accelerate the implementation of best practice standards. These efforts focus on developing and implementing strategies using cost benefit analysis and evidence based best practices related to safety in order to prioritize investment and financial plans to result in a goal of zero serious injuries or fatalities.