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EMS Rules

By Ed MacDonald - Actually “we” probably do…or at least one or two of us need a little firmer guidance from the FAA and/or our operator.  When I started flying patients in dire need about forty-one years ago we had very few restrictions.  Of course, it was a combat zone and we were very young and bold. Many years later after losing far too many friends who bravely pushed into the jaws of death, even in peacetime, it is clear to me that one doesn’t become “old and bold” unless we restrict ourselves and exercise restraint and good judgment on every single flight, no matter how critical.  It has also become clear to me that a few of our peers need adult supervision from time to time.

One of the inherent traits of many helicopter pilots is that we generally have personalities that actually empowered us very early in our careers to jump into a machine with multiple whirring parts all held together by a few engineering concepts, bolts and rivets and drag it airborne after a little training.  Somewhere along the line this took a little courage and perhaps simple faith.  As Dr. Robert Helmreich wrote several years ago, “Although we recognized the existence of and some of the manifestations of the professional culture of pilots early in our investigations of flight crew behavior and attitudes, we did not immediately understand its potency as an influence on safety. In retrospect, the roots of a strong professional culture are clear—early aviation was an extremely dangerous undertaking, for those in combat, carrying the mail, or stunt flying for awed audiences. To commit to such a hare-brained endeavor required a strong sense of personal invulnerability and efficacy. The respect and envy engendered among generations of adolescents also fostered pride in being one of “the few”, to borrow Churchill’s description of Spitfire pilots during the Battle of Britain. This image of personal disregard for danger and invulnerability reached its zenith with the early astronauts (all chosen from the ranks of test pilots) and was immortalized by Tom Wolfe in The Right Stuff (1979).’
 
EMS RulesMany of us went into aviation because it was exciting, meaningful, challenging and it was a career that would give us our identity or at least fortify our self image.  It was stimulating work and it made us proud, especially in the emergency medical service side of helicopter aviation.  Our smiles went from ear to ear when we got our solo wings and each subsequent rating.  Often our bravado and self confidence served us well especially on that first solo or jumping into a new and very challenging job or aircraft transition. “Brave” was an invaluable necessity for those of us who had the opportunity to fly into combat either in the current mountainous desert environment or past steamy jungles and rice paddies. Brave and headstrong, however, aren’t always the most helpful of traits in the world of a helicopter air ambulance pilot.   Years ago, in the early days of stateside emergency medical service piloting, just following that helicopter intense conflict in Southeast Asia, many of us began flying patients in a more peaceful yet demanding environment with the same strong work ethic and bravado imbued in us by the stressful combat environment.  There were no real weather minimums and little sense of the risks associated with pilot fatigue and duty time.  The result was an incredibly high EMS accident rate that resulted in the first significant rules from the FAA attempting to mitigate the tragic and senseless accidents the industry was experiencing in the early to mid 1980’s.

Upon my return from Viet Nam, I was an aircraft commander for a Military Assistance to Safety and Traffic unit in 1971.EMS Rules   All of our pilots were brave combat veterans and we took the culture of taking risks to save lives right into the civilian EMS world.  The risk and results were somewhat similar to those experienced by the Medevac (DUSTOFF) crews in Viet Nam minus the bullets and things that went boom.  It seemed that far too often we would lose another crew to a weather related accident on a life-saving mission.  Burying friends and comrades got real old fast.  Often it was night with marginal weather and on the way to or from a life saving mission.  Somehow we needed to get the attention of the few pilots who were so motivated to save lives and push into the jaws of danger beyond reason. They gave purple hearts and air medals for such behavior during war but was it appropriate in this new environment?  We were all motivated by the rescuer mentality and “white knight” syndrome.  It just seemed like it was what we were all about. 

When we have looked at EMS helicopter accidents over the years we have continued to come up with the very same probable causes again and again.  We continue to see human factors such as poor “decision making” and “loss of situational awareness” surface in NTSB accident reports time and time again.  These are truly preventable accident causes that could have been avoided by simply parking the aircraft or turning around well before the weather or dark night created a situation that even a great pilot couldn’t get out of.  Even with the rules that existed at the time, we still found pilots pushing below weather minimums or into pitch black situations that created perfect high risk conditions.  We hope that the new regulations coupled with enhanced operational control, satellite flight following, flight data recorders, and air medical resource management will reign in the very few “bold” or pressured pilots looking for an accident. 

So, in the mid eighties, the first significant rules affecting EMS pilots came along with more restrictive weather minimums for Part 135 flight and actual flight and duty time limits.  Pilots had been working very long shifts over many days of the month and this addressed fatigue factors found in those early accidents.  Weather minimums at least slowed down a little of the white knights among us. Accident rates went down after the first round of regulations from the FAA.  Numerous recommended practices and more restrictive rules followed over the years but many more tragic accidents occurred over the subsequent years where pilots continued to push even when they were actually below published VFR minimums, especially at night. The FAA changed the A021 a few years ago to tighten up weather minimums and flight planning requirements as well. Two major NTSB EMS accident studies in 2006 and 2009 suggested that the FAA actually tighten up the rules even more and become more aggressive in their monitoring and enforcement within the industry.  Up until this year, most of the FAA involvement in the air ambulance industry was through advisory circulars and notices with a little more bumped up monitoring.   “Advice” and rules carry much different weight and affect. 

EMS RulesThe new regulations, or at least the Notice of Proposed Rule Making (NPRM) generally reflect the advisory circulars that have come out over the last several years and have incorporated many of the NTSB recommendations.   Noticeably absent from the NPRM were any mandates for Night Vision Devices.   This and several other shortcomings were strongly brought to the FAA’s attention in the NPRM process by industry groups.  Input from many interested parties can be found at http://www.regulations.gov. You may find the NPRM input under the tab labeled "Read Comments"--pick select all in the first window then put in "FAA- 2010-0982" in the second window if you want to review them.

Most of us in the helicopter ambulance avocation are very conservative and the new FAA Regulations and Ops Specs will probably have little effect on our own sound decision making and personal minimums.  Most of us are mature and experienced enough to reject pressure from the business managers and peers and make our go-no-go decisions based on our own lessons learned over the years.  Unfortunately, if you look over the tragic accidents our industry has experienced over the years, we can see that there have been just a few of us who continued to push into deteriorating weather conditions (more often at night) and flew a perfectly good aircraft into the side of a hill no matter what the “rules” were.  The new rules will probably have no effect on the conservative among us but for the “few” overly bold or pressured risk takers in our profession it might be a wake-up call.

Ed MacDonald is the former lead pilot for PHI Air Medical.  In his twenty-one year Part 135 career he served as a EMS and offshore line pilot, lead pilot, base manager, Chief Pilot, and Air Medical Safety Manager.  He is currently Chairman of the Air Medical Safety Advisory Council (AMSAC), Co-Chair of the AAMS Safety Committee and Past President and current Safety Representative for the National EMS Pilots Association (NEMSPA).  Ed has 8800 rotor wing flight hours with over six thousand hours as an U.S. Army Aero medical Evacuation Officer and Part 135 EMS helicopter pilot over a forty-year flying career
 

Posted in: Safety

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