Among the most important factors that count when it comes to medical flight risk assessment according to the Federal Aviation Safety Administration is having an accurate flight risk assessment tool. Such a tool enables the pilots to evaluate the flight risk well in advance and to make an informed decision whether to proceed with the medical flight rescue mission or not. An efficient tool enables the pilot and the flight team to develop a risk mitigation strategy that is effective enough. It includes everything from weather condition assessment to cabin preparation for the patient who will be onboarded. However, there are several other factors, too and often, it is an evolving situation that the risk assessment tool must factor in.
The Changing Medical Flight Risk Landscape
Pandemics, volatile political conditions, conflicts, sudden weather changes – the factors that result in increased medical flight risk are several. The tool must take into consideration all these factors. Of course, the tool must work on inputs received digitally as well as through manual human intervention. There are specialized disciplines when it comes to such assessments today. Not to forget the numerous safety organizations throughout the world. However, sometimes the safety standards of one country can conflict with another.
Medical Flights Across Borders
Crossing certain international borders is considered low risk. For instance, a medical flight company would not think twice before flying a patient between the United States and the United Kingdom. However, the considerations vary vastly when, for instance, when it is between a country like Sudan and the United States. Of course, not all medical flight companies undertake missions in countries that are considered volatile. Having said that there are private medical flight companies today that specialize in undertaking missions from high-conflict nations. It all boils down to the adequacy and the efficiency of the risk models, tools and human expertise that they employ.
According to one research medical flight services run by for-profit organizations had seen, on average, 7 to 8 crashes a year between 1998 and 2012. Of these mishaps, the biggest contributors were those organizations that ran the most medical flights. This raised serious concerns about the safety norms followed by the industry and several studies and investigations were performed simultaneously to make the skies safer for the crew and the patients. The result was some startling revelations. It was seen that the crew was pressured to make as many flights as possible in a day to maintain the profitability of the organizations that they worked for.
What Were the Medical Flight Services Doing?
It was seen that medical flight services were taking orders for new rescue missions even during an ongoing mission. This caused unnecessary operational chaos and instilled a sense of urgency among the crew members. Moreover, it was seen that ground ambulance paramedics were being hired by medical flight services too. This was causing a conflict of interest, wherein the possibility of the paramedics contacting their favored service providers was high. It was also found that some so-called rescues were actually unnecessary as they did not provide any advantage over the ground transportation.
New Safety Laws were Passed
The medical flight industry was subjected to intense scrutiny. Certain safeguards such as maximum permissible hours of work for crew members and laws concerning visibility were put in place. The aging aircrafts had to be replaced by new and safer ones. Upgrades with respect to technology were also made compulsory in certain areas. Better weather reporting and aids for in-flight decision-making were put in place. It can be stated, with confidence, today, that medical flight services are safer and more efficient. The industry and the patients that it serves have benefitted immensely from these developments.
The life of an air ambulance pilot is risky with weather conditions that transform without warning and the ongoing COVID-19 situation. However, it is not impossible to take precautions and prepare for them. Then, there are mindless pranks that are played by miscreants not fully comprehending the repercussions of their acts. One such act is shooting laser lights at air ambulance pilots. Recently, a Wiltshire air ambulance pilot was subject to one such prank that left him temporarily unable to see and the landing had to be aborted. Just imagine being pilot mid-air, in a situation where visibility is suddenly near-zero. Scary, isn’t it?
The Air Ambulance Pilot’s Family is Scared for His Life
The wife of the air ambulance pilot has appealed to people through a video that was posted on one of her social media channels. The woman breaks into tears as she appeals to people to refrain from shooting laser beams at pilots. The pilot is also a father of twin girls. His wife conveyed through her heart-wrenching video message that she loves her husband very much and hopes to see him walking his daughters down the aisle someday.
She Called to Ban Laser Lights
Laser lights can travel up to 50 miles. This humongous range brings almost all aerial vehicles within its range. It is hard to understand why such a tool must be put in the hands of the public. Laser lights are quite affordable and can be bought for as little as a few dollars. The woman has appealed to the government to pass rules that prohibit the sale of this item.
The pilot in question was on a training mission when the incident occurred. However, had it occurred during a live mission, it would have to be aborted putting the patient’s life at risk owing to delayed treatment.
If you are a patient who is in a medical serious condition and fighting for life, would you be okay with an air ambulance professional who is fatigued and has been working a shift of almost 24 hours? Would you perceive this condition to be grave for your life? Although air ambulance personnel these days are not expected to work abnormally long hours, this fact is something you should know about. In this context, one must note that 24-hour shifts were a practice, if not common practice, prior to 1997. We bring you a research conducted in this regard by the US National Library of Medicine National Institutes of Health, which is a part of National Center for Biotechnology Information, a US Government undertaking.
The Findings of the Report were Astounding and Contrary to Popular Belief
The primary objective of the research was to assess the psychomotor agility and skill performance of the air ambulance personnel when they worked 12-hour shifts versus 24-hour shifts. The data gathered pertaining to 24-hour shifts belongs to the pre-1997 era. The data collected was compared with times when the air ambulance industry was mandated to work for limited number of hours as against the time when shifts spanning 24 hours were not alien. Intubation – a critical task that is undertaken routinely – was used as a scale to measure the efficiency of the air ambulance professionals. Surprisingly enough, there was hardly a difference between ‘overworked’ professionals and the ones who worked reasonable hours.
How Do Air Ambulance Professional Manage to Work at Optimal Efficiencies?
The answer may lie in the fact that failure is not an option when lives are at stake. No matter what the level of fatigue, when people who are driven by passion and compassion are put in a situation where the outcome depends on how they perform, the chances are they will try their best and come out winners. The fact is also an ode to the dedication of the professionals belonging to the air ambulance industry.
It might seem that the aviation and air ambulance companies have little in common. While one deals in the mechanics of aviation machines, the other primarily deals with biology and chemistry of the human body. However, when one looks closely, it is easy to spot several similarities between the two. It is these similarities that the air ambulance companies must be aware of and must work on, to improve the safety of medical flights. The risks involved in both industries are very similar to each other. This is why REVA, which is an international fixed-wing air ambulance company, has published a white paper on ‘Just Culture’
What is ‘Just Culture’ and How Does it Apply to Air Ambulance Companies?
This is a highly relevant question. Although one rarely gets to hear about fatal crashes and safety flaws concerning air ambulance companies, such incidents are not unheard of. Apart from this, there are obviously going to be some near misses. The logic behind the ‘Just Culture’ is to treat mistakes as learning opportunities to avoid them completely in the future. REVA released a white paper on the topic recently.
According to Emma Roberts who is the company’s Safety Director, the white paper meant for air ambulance companies, lays down the steps involved in implementation of just culture and explains how this culture increases the degree of safety.
‘Just Culture’ Fosters Transparency in the Way Air Ambulance Companies Function
‘Just Culture’ makes reporting easier for staff who constantly put their lives on the line to protect and serve the needy patients. The culture ensures that these front-line warriors are not punished for the mishaps but are rather encouraged to report them so that apt solutions can be found. The result is improved safety of medical flights and better compliance with medical as well as aviation norms.
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.
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.
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.
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.
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.