What Pilots and Mechanics Should Know about Air Medical Operations

HELI-EXPO 2013, Las Vegas - On March 6, as part of the new HAI Rotor Safety Challenge at HELI-EXPO 2013, Dudley Smith of the Commission on Accreditation of Medical Transport Systems (CAMTS) spoke on “What Pilots and Mechanics Should Know about Air Medical Operations.”

Helicopter medical operations prior to the Vietnam War typically consisted of strapping a patient to the exterior of a helicopter and transporting him to a hospital as quickly as possible. In Vietnam, the service evolved to transporting the patient inside the helicopter, where a dedicated medical team would attend to him en route to the hospital.

This marriage of pilot/co pilot and medical team/patient brought with it not only operational considerations, but unique safety issues that continue to affect those aboard the helicopter and those who maintain the helicopter to this day.

Smith detailed four safety concerns those considering the Helicopter Emergency Medical Services (HEMS) mission profile might encounter:

Change in Mission Philosophy:
• HEMS teams operate 24 hours a day, in all seasons: “You never know when you’ll go”
• HEMS operations are maintenance-focused rather than mission-focused: careful planning is required to ensure adequate cover when taking an aircraft out of service for maintenance.

Change in Environment:
• The hospital: hospitals occupy large areas and are often under construction, with the presence of cranes, wires and other hazards. Tall buildings cause turbulence, and MRI machines create magnetic fields that can interfere with flight instrumentation
• Infection control: the safe handling of blood, bandages, gauzes etc. is vital to protect the crew from any infection a patient might have.

Change in Scene:
• HEMS crews are required to land wherever the incident may be: in a muddy field, in a private back yard, on a country lane, in areas close to wires and other hazards
• Landing zones are not always controllable; members of the public may be present, marking-flares can cause fires, a scene might involve an upturned hazmat truck with the situation exacerbated by rotor wash from the helicopter.

Change in Aircraft:
• HEMS aircraft carry unique equipment – oxygen supplies, IV bags, cardiac monitors, neonatal incubators, stretchers etc. These have to be regularly maintained. They also have to be stowed aboard the helicopter securely but in a way that keeps them easily accessible. HEMS pilots and medical crew need to stay in contact with the scene, the hospital, and with ATC. Thus, they typically carry more radios than aircraft of other mission profiles. These need to be kept in a constant state of readiness
• Blood can quickly and easily spread throughout the aircraft and seep into instrumentation and other components. Aircraft floors should be adequately sealed. As well as being a bio hazard, blood is corrosive. It is most effectively cleaned using chlorine, which is also corrosive. Other bodily fluids are also a factor. Smith says the rule of thumb is, “If it is wet and it’s not yours, don’t touch it!”

HEMS missions can be emotional; patients are in pain and often moaning. However, even when the patient is a child, the viability of the mission must still take precedent over the desire to accept the mission. A clear distinction must exist between the concerns of the pilot and the medical team. The only consideration the pilot should have is “can I fly safely from point A to point B?”

Smith cites the old adage, “Three to say go, one to say no” when deciding whether to accept a mission. Traditionally, it was the hospital that said “go” according to its own weather considerations. The FAA has since mandated a pilot, who monitors weather conditions from an Operational Control Center, to contribute to the “go/no go” equation for a Part 135 operator in his area.

Smith concluded with the thought that HEMS is unlike most other rotary-wing sectors. The pilot/nurse/paramedic team often works together all the time, forming deep bonds of mutual respect and camaraderie. While the safety considerations can be a challenge, the satisfaction of saving lives makes this mission profile a most rewarding career choice.