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Egress simulator
FLIGHT CREW TRAINING
Egress Simulator by Barney Green
A policeman pursues a fugitive up a dark alley. In another section of the city, a fireman enters a burning building to rescue victims trapped within. Each man then finds himself trapped by unforeseen conditions and circumstances. Nothing in their training curriculum, guidelines, or previous experience tells them what to do to save themselves, but they do it through assessing situations and taking action based on individual judgement. Afterward, each may reflect, "No two situations are the same. Training program solutions cannot possibly cover the countless number of different circumstances and conditions we have to face. It's something like making a parachute jump that has to be perfect the first time, and for each jump thereafter. Training can do so little to prepare us for so many different scenarios." Such thoughts might cross the minds of EMS helicopter flight crews. "In flight, potential emergency landing sites change every few seconds. With 28
so many variables facing us, what good is the Post Accident Training when it can cover only a small fraction of the possible actual conditions? What we need is s o m e practical experience without having to go through an actual emergency to get it." Members of the Care Flite, Inc. program operating with the Bronson Methodist Hospital in Kalamazoo, MI, held such concerns and decided to do more than just talk about it. This led to their building a plywood simulator of the cabin of their Bell 412 helicopter, dubbed the Egress Simulator, and using it as a part of their Post Accident Plan training.
Unique simulations "We have a real active safety committee, and we try to come up with unique ideas for simulations to be used in training," said Kathy Nichols, program flight nurse. "Last year, we had a video tape of some simulations of an accident and the evacuation and survival. We had the whole mock situation where
we filmed communications specialists getting the call, then our aircraft going down, and there was a fire. Each person watching the video tape was given a pad and pencil and asked to write down comments. "The simulated accident went so well that we decided to do something more realistic. We needed to train to do things in the helicopter in the event of an emergency, and to train to get ourselves and the patient out. Randy Mellinger, one of our communications specialists, came up with the initial idea to build a 412 mockup, and Art Standford, one of our pilots, helped him with the design. Randy is a carpenter by avocation, and he bought the plywood, 2 X 4s, and paint. He then drew up plans to scale, and they nailed the thing together. It has a bench seat rather than the individual seats, with seat belts but no shoulder harness. It has the same approximate inside dimensions as the real 412. The interior was sanded and painted to keep splinters out of our backsides." Hospital Aviation ° July 1989
FLIGHT CREW TRAINING
After the simulator was completed, it had to be mounted to simulate a hard landing with the fight skid buckling. Mellinger and pilot John Campos came up with a sawhorse type foundation for the left side, and a newly acquired floor jack for the right, "broken skid," side. The sudden release of the jack dropped the right side down, tilting the cabin about 30 degrees. A "simulated" tree blocked exit from the right, necessitating both crew and patient removal from the upper left side. P l e x i g l a s s w i n d o w s w e r e mounted in place with Velcro and literally had to be kicked out before anyone could get out. "Our simulator was built in late April with about 50 hours labor and some $300 reimbursed to Randy out of the miscellaneous fund," said Nancy Radcliff, Program Director. "We've had one drill so far, with about 36 people trained. All the flight nurses, all the pilots, and agood percentage of the physicians were there. Teams were assigned at random because the participants do not work with the same team every day. 'Wv-henone team had completed the training, another would go through until all had the experience. We will normally do this on an annual basis, but we're going through it again in the near future for the neonatal and pediatric teams. They don't fly as often as the regular crews, but still need the experience for when they do fly. Sometimes, when we are returning from a scene pickup and we need some extra hands on board, we bring one of the ground crew EMTs back with us, so they will be getting this training too." With the pilot, medical crew and patient all strapped in, the pilot began the training maneuver by simulating some malfunction that would necessitate an emergency landing. "Then he would drop the jack, and we would feel the jolt and be thrown to the low side," said Nichols. "Smoke was then fed in by the fire d e p a r t m e n t ' s s m o k e machine, and we were blindfolded and the hangar lights turned off to simulate darkness. We couldn't see, so we 30
had to feel to shut off oxygen and switches, and to check ourselves and the patient. We had three scenarios for each team. In the first, the pilot was not injured, and he would come back to the left side window and do what he could to help us and the patient out. In the second, the pilot was injured, completely out of it, and we had to do the whole egress without him. The third was with the EMT or other third rider unconscious, and we had to get him out as well as the patient." The hospital fire department loaned their 150 pound dummy to be used as the patient. The crews hadn't realized how difficult it would be getting a 150 pound "rag doll" patient up that incline and out the window. One person had to kick out the window, climb out, then pull from the outside while others pushed from the inside. And the "patient" had to be strapped to a litter to even get the job done at all.
A learning experience "It was absolutely fascinating, we had a g r e a t time," said Radcliff. "People learned things they had never known before. W h e n the s m o k e poured in, it was a very, very fearful thing, to be at an angle, you're tipped, there's screaming, and somebody says, 'I think there's a fire,' and you have to decide what you're going to do when you can't see. "We had discussions throughout the whole four hours of training. Most of it was on survival. There was a part on how bad your patient is, and whether or not there's a fire, whether or not it is likely to explode. And, whether or not you are going to get out and save yourself, or save your patient with it. In spite of all the confusion and fear, everyone did their job." Fred Koenig, EMS M a r k e t i n g Manager for Bell Helicopter Textron, was observing during the entire four hours of the training session. "I was both impressed and pleased by what I saw in this training," he said. "More than anything, I was struck by the comments that came out of the debriefings. I've be~n in some helicopter acci-
dents myself, and I picked up on these things right away. Only someone who had experienced these things or had been stimulated to think about them would ask those types of questions. So from that standpoint, it got the people thinking. "The simulator was cocked on its side and apparently a liquid bag had ruptured and vomit or something covered the floor. They had a difficult time with traction in trying to get the litter up that incline. This was something totally unexpected. That was an important point no one had previously thought about, how difficultit would be to lift an inert patient from a sitting position and with a slippery floor. Then, there were discussions on getting out first, getting the patient out, how dark it was, etc. A lot of little comments like that came out. It was really a worthwhile experience." "I think the main outcome of the entire exercise was the crew members in the back realizing they need to be aware of where they are at all times inside the aircraft, and have in mind which way they need to go," said pilot Campos. "All of them did real well in getting themselves and the patient out of the machine. It was a very educational exercise for non-aviation trained people." This little exercise did not cover even a small fraction of what could possibly happen in a real emergency situation. But, each participant felt the jolt, the confusion, the smoke and darkness, and the fear, even in simulation. Yet, each one kept his/her wits and carried out the particular assignments, and they learned to expect the unexpected. If an emergency landing should be necessary and it results in damage to the helicopter and/or injury to its pass e n g e r s , t h e y s h o u l d be b e t t e r equipped to handle it. No doubt they will be frightened, but even frightened, they will likely be able to act without panic, and like the fireman and the policeman, be able to assess and react properly to the special circumstances in existence at the time. [] Hospital Aviation • July 1989
Egress Simulator by Barney Green
A policeman pursues a fugitive up a dark alley. In another section of the city, a fireman enters a burning building to rescue victims trapped within. Each man then finds himself trapped by unforeseen conditions and circumstances. Nothing in their training curriculum, guidelines, or previous experience tells them what to do to save themselves, but they do it through assessing situations and taking action based on individual judgement. Afterward, each may reflect, "No two situations are the same. Training program solutions cannot possibly cover the countless number of different circumstances and conditions we have to face. It's something like making a parachute jump that has to be perfect the first time, and for each jump thereafter. Training can do so little to prepare us for so many different scenarios." Such thoughts might cross the minds of EMS helicopter flight crews. "In flight, potential emergency landing sites change every few seconds. With 28
so many variables facing us, what good is the Post Accident Training when it can cover only a small fraction of the possible actual conditions? What we need is s o m e practical experience without having to go through an actual emergency to get it." Members of the Care Flite, Inc. program operating with the Bronson Methodist Hospital in Kalamazoo, MI, held such concerns and decided to do more than just talk about it. This led to their building a plywood simulator of the cabin of their Bell 412 helicopter, dubbed the Egress Simulator, and using it as a part of their Post Accident Plan training.
Unique simulations "We have a real active safety committee, and we try to come up with unique ideas for simulations to be used in training," said Kathy Nichols, program flight nurse. "Last year, we had a video tape of some simulations of an accident and the evacuation and survival. We had the whole mock situation where
we filmed communications specialists getting the call, then our aircraft going down, and there was a fire. Each person watching the video tape was given a pad and pencil and asked to write down comments. "The simulated accident went so well that we decided to do something more realistic. We needed to train to do things in the helicopter in the event of an emergency, and to train to get ourselves and the patient out. Randy Mellinger, one of our communications specialists, came up with the initial idea to build a 412 mockup, and Art Standford, one of our pilots, helped him with the design. Randy is a carpenter by avocation, and he bought the plywood, 2 X 4s, and paint. He then drew up plans to scale, and they nailed the thing together. It has a bench seat rather than the individual seats, with seat belts but no shoulder harness. It has the same approximate inside dimensions as the real 412. The interior was sanded and painted to keep splinters out of our backsides." Hospital Aviation ° July 1989
FLIGHT CREW TRAINING
After the simulator was completed, it had to be mounted to simulate a hard landing with the fight skid buckling. Mellinger and pilot John Campos came up with a sawhorse type foundation for the left side, and a newly acquired floor jack for the right, "broken skid," side. The sudden release of the jack dropped the right side down, tilting the cabin about 30 degrees. A "simulated" tree blocked exit from the right, necessitating both crew and patient removal from the upper left side. P l e x i g l a s s w i n d o w s w e r e mounted in place with Velcro and literally had to be kicked out before anyone could get out. "Our simulator was built in late April with about 50 hours labor and some $300 reimbursed to Randy out of the miscellaneous fund," said Nancy Radcliff, Program Director. "We've had one drill so far, with about 36 people trained. All the flight nurses, all the pilots, and agood percentage of the physicians were there. Teams were assigned at random because the participants do not work with the same team every day. 'Wv-henone team had completed the training, another would go through until all had the experience. We will normally do this on an annual basis, but we're going through it again in the near future for the neonatal and pediatric teams. They don't fly as often as the regular crews, but still need the experience for when they do fly. Sometimes, when we are returning from a scene pickup and we need some extra hands on board, we bring one of the ground crew EMTs back with us, so they will be getting this training too." With the pilot, medical crew and patient all strapped in, the pilot began the training maneuver by simulating some malfunction that would necessitate an emergency landing. "Then he would drop the jack, and we would feel the jolt and be thrown to the low side," said Nichols. "Smoke was then fed in by the fire d e p a r t m e n t ' s s m o k e machine, and we were blindfolded and the hangar lights turned off to simulate darkness. We couldn't see, so we 30
had to feel to shut off oxygen and switches, and to check ourselves and the patient. We had three scenarios for each team. In the first, the pilot was not injured, and he would come back to the left side window and do what he could to help us and the patient out. In the second, the pilot was injured, completely out of it, and we had to do the whole egress without him. The third was with the EMT or other third rider unconscious, and we had to get him out as well as the patient." The hospital fire department loaned their 150 pound dummy to be used as the patient. The crews hadn't realized how difficult it would be getting a 150 pound "rag doll" patient up that incline and out the window. One person had to kick out the window, climb out, then pull from the outside while others pushed from the inside. And the "patient" had to be strapped to a litter to even get the job done at all.
A learning experience "It was absolutely fascinating, we had a g r e a t time," said Radcliff. "People learned things they had never known before. W h e n the s m o k e poured in, it was a very, very fearful thing, to be at an angle, you're tipped, there's screaming, and somebody says, 'I think there's a fire,' and you have to decide what you're going to do when you can't see. "We had discussions throughout the whole four hours of training. Most of it was on survival. There was a part on how bad your patient is, and whether or not there's a fire, whether or not it is likely to explode. And, whether or not you are going to get out and save yourself, or save your patient with it. In spite of all the confusion and fear, everyone did their job." Fred Koenig, EMS M a r k e t i n g Manager for Bell Helicopter Textron, was observing during the entire four hours of the training session. "I was both impressed and pleased by what I saw in this training," he said. "More than anything, I was struck by the comments that came out of the debriefings. I've be~n in some helicopter acci-
dents myself, and I picked up on these things right away. Only someone who had experienced these things or had been stimulated to think about them would ask those types of questions. So from that standpoint, it got the people thinking. "The simulator was cocked on its side and apparently a liquid bag had ruptured and vomit or something covered the floor. They had a difficult time with traction in trying to get the litter up that incline. This was something totally unexpected. That was an important point no one had previously thought about, how difficultit would be to lift an inert patient from a sitting position and with a slippery floor. Then, there were discussions on getting out first, getting the patient out, how dark it was, etc. A lot of little comments like that came out. It was really a worthwhile experience." "I think the main outcome of the entire exercise was the crew members in the back realizing they need to be aware of where they are at all times inside the aircraft, and have in mind which way they need to go," said pilot Campos. "All of them did real well in getting themselves and the patient out of the machine. It was a very educational exercise for non-aviation trained people." This little exercise did not cover even a small fraction of what could possibly happen in a real emergency situation. But, each participant felt the jolt, the confusion, the smoke and darkness, and the fear, even in simulation. Yet, each one kept his/her wits and carried out the particular assignments, and they learned to expect the unexpected. If an emergency landing should be necessary and it results in damage to the helicopter and/or injury to its pass e n g e r s , t h e y s h o u l d be b e t t e r equipped to handle it. No doubt they will be frightened, but even frightened, they will likely be able to act without panic, and like the fireman and the policeman, be able to assess and react properly to the special circumstances in existence at the time. [] Hospital Aviation • July 1989