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Tightening helicopter supervision
OPINION
from the NTSB
Tightening Helicopter Supervision T he National Transportation Safety Board (NTSB) h a s recently recommended t h a t the Federal Aviation Administration (FAA) establish new procedures governing the certification of emergency medical helicopter operations, the training of EMS crews, the crashworthiness of EMS helicopter interiors, and specifically, the effects of EMS pilot scheduling. The NTSB also noted problems with m a n y hospital-based EMS program managements, calling t h e m a "hybrid combination of two m a n a g e m e n t structures which provide few advantages and m a n y potential problems:' The board's recommendations are contained in a study titled "Commercial Emergency Medical Services (EMS) Helicopter Operations:' The study covers NTSB's experience in investigating 59 EMS helicopter accidents, 18 of which were fatal, from 1978 to 1986, and is based on field surveys conducted by a n u m b e r of EMS programs around the country. NTSB's statistics show t h a t from 1980 through 1985 commercial EMS helicopters had nearly twice the accident rate of non-scheduled helicopter air taxis (12.34 accidents per 100,000 flight hours vs. 6.69), and 11/2 times the 7.35 accident rate experience by all turbinepowered helicopters during the same period. The fatal accident rate (5.40) was about 31/2times t h a t of non-schedule helicopter air taxis (1.60) and of all turbine-powered helicopters (1.53). NTSB noted t h a t this might be "because EMS helicopters routinely operate in poor weather and at night, land and take off from unimproved landing areas, and depart on missions with little advance notice:' The industry grew from 43 EMS helicopter programs in 1981 to an estimated 155 by mid-1987. Ninety percent of the hospitals with EMS programs use commercial helicopters; 10 percent use public helicopters. During 1986, approximately 95,000 people in medical need were transported by commercial EMS helicopters in the United States; in 1987, this figure was expected to exceed 100,000. The study shows t h a t the most common element of commercial EMS heli-
This "Opinion" was prepared by the Safety Information Division of the National Transportation Safety Board. Send personal commentaries relating to the aeromedical industry to: A M J Opinion, % Jems Publishing Co., P.O. Box 1026, Solana Beach, CA 92075.
30 MAY/JUNE 1988 ~M$
copter accidents is h u m a n error. Of the 59 total accidents reviewed for the study, approximately 70 percent involved h u m a n error. The leading factor in fatal EMS helicopter accidents was the weather, with 61 percent of the 18 fatal accidents occurring in reduced visibility, so the board recommended t h a t the FAA increase the daytime VFR restrictions for EMS helicopter operations to at least one mile visibility, rather t h a n the current 1/2-mile t h a t applies to all helicopter services, because the standard is not adequate for the speeds at which EMS helicopters tend to operate. An additional problem noted is t h a t policies on observance of EMS programs' VFR weather m i n i m u m s are not always clear. (Some pilots believe the mandatory m i n i m u m s are merely advisory and may disregard them.) While noting t h a t the FAA's instrument flight rules (IFR) system is not designed optimally for helicopters, the board said t h a t the safety advantages offered by IFR-EMS helicopters flown by proficient pilots are great enough t h a t EMS programs should seriously consider obtaining this capability. The influence of fatigue should not be discounted. The high-stress environment in which EMS pilots operate predisposes t h e m to acute and chronic fatigue, which could affect pilot judgment. In addition, pilots are frequently subjected to intense pressure to complete their mission. This pressure can be both self-imposed or externally imposed by m a n a g e m e n t in competing with other programs less careful about weather minimums. Most hospital-based programs have two m a n a g e m e n t structures -- the hospital t h a t contracts the service and the Part 135 operator t h a t leases the helicopters and pilots to the hospital. These m a n a g e m e n t structures "occasionally have objectives which conflict and t h u s adversely impact s a f e t y . . . Effective communication between the two m a n a g e m e n t structures is required to determine program safety priorities:' Formation of a safety committee composed of both m a n a g e m e n t entities and staff t h a t meet every month helps. The NTSB also found t h a t "pilots and m a n a g e m e n t have sometimes conflicting interests t h a t can exacerbate the conflict between the hospital and operator m a n a g e m e n t objectives:' For example, pilots are required to make judgments t h a t directly influence the safety of every EMS flight, yet if they make a judgment t h a t displeases the hospital program administrator (such as cancel-
ing a flight due to weather), it could be used against their employer when the contract is up for renegotiation. The board examined the FAA's role in the establishment and regulation of EMS programs, and found t h a t although the FAA requires Part 135 operators (including EMS helicopter operators) to notify the agency when opening a new base, this is not always done. Additionally, the FAA requires t h a t a designated FAA representative conduct an inspection at each Part 135 location at least once a year. These inspections are missed occasionally, due to the rapid growth of the industry and the uncertainty about where new programs are located. The NTSB said t h a t it believes the FAA should provide specific guidance to its principal operations inspectors on m i n i m u m t r a i n i n g for EMS helicopter pilots, including weather briefing procedures and interpretation, performance characteristics of EMS helicopters, and pilot responsibilities in regard to landing zone security and pilot/crew member coordination. The FAA should also require demonstrated skill in basic control of the helicopter by reference to ins t r u m e n t s and proper procedures to be followed when i n s t r u m e n t meteorological conditions are encountered inadvertently. The crashworthiness of EMS helicopter interiors may not be considered when configuring the helicopter for EMS programs, the NTSB found. There are no industry standards for the placem e n t and securing of medical equipment, which often comes loose in an accident or poses hazards for occupants merely by its location in the cabin. Some of the equipment used is for use in ground ambulances, not helicopters. The board recommended t h a t the FAA develop m i n i m u m EMS helicopter equipment installation and performance standards, t h a t it require the installation of shoulder harnesses for all medical crew members and passengers, and t h a t it require all flying personnel aboard EMS helicopters to wear protective clothing. The NTSB issued 10 safety recommendations to the FAA and four each to ASHBEAMS and the Helicopter Association International. The board also recommended t h a t NASA, in cooperation with the FAA, study the effects of EMS pilot workload, shift lengths, and circadian r h y t h m disruptions on performance. This research should be used in evaluating the effectiveness of the current flight/duty time regulations in providing EMS pilots adequate rest.
from the NTSB
Tightening Helicopter Supervision T he National Transportation Safety Board (NTSB) h a s recently recommended t h a t the Federal Aviation Administration (FAA) establish new procedures governing the certification of emergency medical helicopter operations, the training of EMS crews, the crashworthiness of EMS helicopter interiors, and specifically, the effects of EMS pilot scheduling. The NTSB also noted problems with m a n y hospital-based EMS program managements, calling t h e m a "hybrid combination of two m a n a g e m e n t structures which provide few advantages and m a n y potential problems:' The board's recommendations are contained in a study titled "Commercial Emergency Medical Services (EMS) Helicopter Operations:' The study covers NTSB's experience in investigating 59 EMS helicopter accidents, 18 of which were fatal, from 1978 to 1986, and is based on field surveys conducted by a n u m b e r of EMS programs around the country. NTSB's statistics show t h a t from 1980 through 1985 commercial EMS helicopters had nearly twice the accident rate of non-scheduled helicopter air taxis (12.34 accidents per 100,000 flight hours vs. 6.69), and 11/2 times the 7.35 accident rate experience by all turbinepowered helicopters during the same period. The fatal accident rate (5.40) was about 31/2times t h a t of non-schedule helicopter air taxis (1.60) and of all turbine-powered helicopters (1.53). NTSB noted t h a t this might be "because EMS helicopters routinely operate in poor weather and at night, land and take off from unimproved landing areas, and depart on missions with little advance notice:' The industry grew from 43 EMS helicopter programs in 1981 to an estimated 155 by mid-1987. Ninety percent of the hospitals with EMS programs use commercial helicopters; 10 percent use public helicopters. During 1986, approximately 95,000 people in medical need were transported by commercial EMS helicopters in the United States; in 1987, this figure was expected to exceed 100,000. The study shows t h a t the most common element of commercial EMS heli-
This "Opinion" was prepared by the Safety Information Division of the National Transportation Safety Board. Send personal commentaries relating to the aeromedical industry to: A M J Opinion, % Jems Publishing Co., P.O. Box 1026, Solana Beach, CA 92075.
30 MAY/JUNE 1988 ~M$
copter accidents is h u m a n error. Of the 59 total accidents reviewed for the study, approximately 70 percent involved h u m a n error. The leading factor in fatal EMS helicopter accidents was the weather, with 61 percent of the 18 fatal accidents occurring in reduced visibility, so the board recommended t h a t the FAA increase the daytime VFR restrictions for EMS helicopter operations to at least one mile visibility, rather t h a n the current 1/2-mile t h a t applies to all helicopter services, because the standard is not adequate for the speeds at which EMS helicopters tend to operate. An additional problem noted is t h a t policies on observance of EMS programs' VFR weather m i n i m u m s are not always clear. (Some pilots believe the mandatory m i n i m u m s are merely advisory and may disregard them.) While noting t h a t the FAA's instrument flight rules (IFR) system is not designed optimally for helicopters, the board said t h a t the safety advantages offered by IFR-EMS helicopters flown by proficient pilots are great enough t h a t EMS programs should seriously consider obtaining this capability. The influence of fatigue should not be discounted. The high-stress environment in which EMS pilots operate predisposes t h e m to acute and chronic fatigue, which could affect pilot judgment. In addition, pilots are frequently subjected to intense pressure to complete their mission. This pressure can be both self-imposed or externally imposed by m a n a g e m e n t in competing with other programs less careful about weather minimums. Most hospital-based programs have two m a n a g e m e n t structures -- the hospital t h a t contracts the service and the Part 135 operator t h a t leases the helicopters and pilots to the hospital. These m a n a g e m e n t structures "occasionally have objectives which conflict and t h u s adversely impact s a f e t y . . . Effective communication between the two m a n a g e m e n t structures is required to determine program safety priorities:' Formation of a safety committee composed of both m a n a g e m e n t entities and staff t h a t meet every month helps. The NTSB also found t h a t "pilots and m a n a g e m e n t have sometimes conflicting interests t h a t can exacerbate the conflict between the hospital and operator m a n a g e m e n t objectives:' For example, pilots are required to make judgments t h a t directly influence the safety of every EMS flight, yet if they make a judgment t h a t displeases the hospital program administrator (such as cancel-
ing a flight due to weather), it could be used against their employer when the contract is up for renegotiation. The board examined the FAA's role in the establishment and regulation of EMS programs, and found t h a t although the FAA requires Part 135 operators (including EMS helicopter operators) to notify the agency when opening a new base, this is not always done. Additionally, the FAA requires t h a t a designated FAA representative conduct an inspection at each Part 135 location at least once a year. These inspections are missed occasionally, due to the rapid growth of the industry and the uncertainty about where new programs are located. The NTSB said t h a t it believes the FAA should provide specific guidance to its principal operations inspectors on m i n i m u m t r a i n i n g for EMS helicopter pilots, including weather briefing procedures and interpretation, performance characteristics of EMS helicopters, and pilot responsibilities in regard to landing zone security and pilot/crew member coordination. The FAA should also require demonstrated skill in basic control of the helicopter by reference to ins t r u m e n t s and proper procedures to be followed when i n s t r u m e n t meteorological conditions are encountered inadvertently. The crashworthiness of EMS helicopter interiors may not be considered when configuring the helicopter for EMS programs, the NTSB found. There are no industry standards for the placem e n t and securing of medical equipment, which often comes loose in an accident or poses hazards for occupants merely by its location in the cabin. Some of the equipment used is for use in ground ambulances, not helicopters. The board recommended t h a t the FAA develop m i n i m u m EMS helicopter equipment installation and performance standards, t h a t it require the installation of shoulder harnesses for all medical crew members and passengers, and t h a t it require all flying personnel aboard EMS helicopters to wear protective clothing. The NTSB issued 10 safety recommendations to the FAA and four each to ASHBEAMS and the Helicopter Association International. The board also recommended t h a t NASA, in cooperation with the FAA, study the effects of EMS pilot workload, shift lengths, and circadian r h y t h m disruptions on performance. This research should be used in evaluating the effectiveness of the current flight/duty time regulations in providing EMS pilots adequate rest.