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Tuesday, September 1, 2009

Where the Light Is

By Terry Terrell

Current EMS helicopter operational safety statistics, as we know all too well, continue to echo the early 1980s, when medical transport activities grimly persevered to survive a high-risk professional infancy. In those early days, it was relatively easy to identify that helicopter operators were creating many of their own safety problems by trying to sell their product in an unfamiliar market arena, through sometimes-overstated promises and misplaced operational heroics.

Today’s safety issues are less identifiable, and seem to stem from a shotgun pattern of complex cause factors. A number of conferences and meetings have recently convened, aiming to improve EMS safety performance. Though an assortment of useful intelligence has been produced, many feel that some of the suggested remedies might be missing the mark slightly.

For instance, improvements to heavily emphasized "Operational Control" policies and discipline are not totally inappropriate, but adding artificial and often less-than-efficient layering of control authority does not fully achieve needed improvement in operational decision-making. Preflight errors do not seem to be the weakest part of the mission execution timeline; rather pilots typically make the worst decisions mid-mission. But tightening the operational control aspect of EMS is readily manageable, in conventionally quantifiable terms, so emphasis is allocated accordingly. This, unfortunately, sets up a situation similar to the man who looks for his lost keys under a streetlight. He knows that he couldn’t have lost his keys there, but that is where the light is, so the search — ignoring all weaknesses in logic — proceeds at full tilt with determined enthusiasm. In looking at some of the factors that have been confirmed as legitimately bearing on EMS helicopter safety issues, we find that:

  • Night flying is still more dangerous than day ops. Only 38 percent of all flights occur during hours of darkness, yet 52 percent of all accidents are recorded at night. For weather-related accidents, more than 85 percent occur at night.

  • Takeoffs and landings are intuitively suspected as the most dangerous flight mission phases, but it turns out that enroute segments are statistically worse. A high number of major accidents occur during enroute phases, often involving CFIT and eclipsing all risks encountered during departure segments, destination maneuvering, scene operations, etc.

  • Human errors and deficient personnel performance factors are identified in nearly 80 percent of all mishaps. Chief among these is faulty in-flight decision-making, the dominant example being a pilot deciding to continue into deteriorating weather under the perceived influence of mission pressure. Disregard for weather minimums before takeoff is far less of a problem than the temptation to press on during enroute phases when weather deteriorates. Consequently, IFR competency and currency, so that recovery from inadvertently encountered weather conditions can be quickly and reliably accomplished, is again invaluable to safe EMS ops, as is regular review of priorities between mission urgency and overall discipline.

  • Other factors contributing to high accident rates describe miscellaneous human errors, including failures in following proven standard operating procedures while under the pressure of the medical mission. Delaying remedial action necessary to correct poor decisions made earlier in the mission has been cited as specifically problematic. Misinterpreting environmental cues and pilot distraction from onboard medical activity have also been studied.

  • Finally, pressure, either overtly or implicitly, to initiate flight operations quickly is a continuing threat to safety, as it has been consistently in years past.

Technologies — such as night vision enhancement equipment, terrain warning systems, TCAS gear, etc. — are being examined within our industry as possible fixes for weaknesses in EMS operations. However, all of these equipment upgrades, though valuable, are ultimately just tools. Tools can only prove constructive when used with sound judgment and balanced perspective. These competent users can only join the EMS setting through prioritized pilot selection and training cultures within organizations, with an understanding that their most critical safety component will always be quality pilots capable of trusted leadership and good decision-making, able to resist the temptation to search for good operational performance only where the light is.

To beat these systems one must plan backward from the objective to the starting point.

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