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Saturday, October 1, 2005

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Commercializing SAR

I am a helicopter rescue swimmer and a flight emergency medical technician for Croce Rossa Italiana (the Italian Red Cross). I serve on its National Aeronautical Committee, advising on helicopter search and rescue and emergency medical service (HEMS). Croce Rossa is a nationwide, primary EMS provider. A few of its EMTs, medics and helicopter rescue swimmers serve as reserve officers on military aircraft (especially with the coast guard, air force and customs police).

I write in response to the recent letters on commercialization of SAR services ("Commercialize SAR?" March 2005, page 7; "Commercialized SAR," June 2005, page 7). This is obviously a hot topic. With the right arguments, I hope I will help to focus on the core of the problem. Turning government SAR operations (maritime, mountain or aeronautical) over to civilian operators is apparently not an issue here in the Italy--even with its miles of shore and mountains--because cost-vs.-benefits calculations of starting this kind of operation is not favorable to private contractors. The number of true SAR operations are low nationwide and, at the moment, no one is battling in an open fashion to gain a slice of this market. But behind the curtains something is moving.

While the military is shifting and focusing to a combat SAR concept of operations, the civilian industry is battling to gain ground on SAR operations, without changing its name. Here, HEMS is a high-profit industry (but with high accident rates). It is pushing machines and crews to perform like heroes rather than professionals. We see doctors and paramedics being hoisted on mountains or ships with horrible operational risk management ratios. The HEMS industry is, in fact, now recruiting technical rescuers (sea and mountain) and pushing regulators to lower SAR flight standards and, consequently, raise the number of missions that can be performed by hospital-based helicopters, using lower dust-off time (compared to state helos) to win market shares. Third- and fourth-generation helicopters help on this road, but HEMS accidents are high in Italy.

I do not want to blame totally SAR commercialization projects, but I think that air department managements must really weigh the cost, benefits and risks. Worldwide, some SAR services are completely demilitarized (like the Royal Australian Air Force, which started using all civilian SAR in the late 1990s), but they still respond to a high-volume of calls in special environments (like surf rescue or high-mountain expedition medevacs).

Leaving statistics and costs to managers, I think we must start to evaluate the real core of the problem. Military crews are equipped, trained and paid to perform "mission first" flights in very hostile weather and remote areas. Civilian services conduct "safety first" flights. In this perspective, we can expect a high increase in accidents and incidents and in aborted rescue missions. But do we really want our doctor and nurse (or an ex-military technician) performing a hoist in a hurricane, or do we want to leave that job to a military specialist on active duty?

Marco Filippi
Italian Red Cross
Committee on SAR & HEMS
Helicopter Rescue Swimmer/Advanced EMT
Livorno, Italy

Mr. Filippi also serves as a SAR crewmember with the Italian coast guard in Luni and with its customs service in Rome.

More VH-71 Name Suggestions

It's obvious--The Commander.

Ritu Sahni, M.D., MPH
Assistant Professor of Emergency Medicine
Medical Director, Emergency Communications Center
Oregon Health & Science University
Medical Director, All-Terrain Rescue,
Education and Consulting
Portland, Ore.

What could be a better name then Big Bird?

Jim Barnard
Rotorcraft-Rated Commercial Pilot
Ventura, Calif.

Procedural Weaknesses

I enjoyed reading Tim McAdams' piece, "Preparing for Confined Area Ops" (Safety Watch, July 2005, page 62). But I was startled to notice a couple of procedural weaknesses, corrected within mainstream industry standards many times over, that were implied by his very well-written description of the BK117 accident. In that crash, an EMS departure was interrupted by a blade strike to a building structure.

Tim reports the surviving paramedic admitted to having been busy "programming the GPS" during the initial departure segment, at "20 ft. above the helipad." Most EMS programs have very specific philosophies and strategies in place with regard to crew coordination, especially during critical departure phases. Fiddling around with navigation equipment (or anything else inside the cabin) is generally considered exceedingly ill advised.

Optimum departure procedures will have all eyes on board assisting the pilot with scanning and monitoring the "big picture" environment, with thumbs on intercom buttons, ready to call any perceived hazards to the gross physical movement of the aircraft. GPS manipulation, as a matter of fact, should never consume the attention of anyone on board during departure segments. The GPS should, like all nav tools, be used to confirm and fine-tune nav strategies during en-route phases, when there is plenty of uncrowded time and immediate physical safety margins are much more generous.

Tim also referred to hazards associated with pilots alternating overnight work shifts, and attendant circadian-rhythm adjustment difficulties. "All-nighter" schedules are never "natural" to crewmembers, who inevitably live conventional, diurnal lives otherwise. Most programs have recognized that they must encourage team members to deliberately undertake correct rest before starting a night-rotation sequence. (Our program has found that scheduling pilots for three consecutive days of 12-hr. shifts, followed by a 24-hr. rest period and three consecutive night shifts breaks the monotony of a six-day "hitch", and maximizes encouragement of adequate rest prior to the first overnight.)

Robert K. Terrell
ATP, SK-61 (U.S. Coast Guard HH-3F)
Lead Pilot/Safety Director
Rescue Air 1/LifeFlight
Atlanta

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