Aviation News Item: 02569

1st Feb 2009

Source: verticalmag.com

Editor's note: From February 3 to 6, Vertical will be providing online coverage of National Transportation Safety Board hearings on the air medical industry in Washington, D.C. In advance of that event, air medical safety consultant Matt Johnson has written about some key changes he'd like to see in helicopter EMS operations. Our goal is to spark productive dialogue about the problems in the industry and how to address them - feel free to weigh in on the topic in our online forums, http://www.verticalmag.com/forums/.

Multiple times every day, an air medical helicopter crew is called upon to do the extraordinary and perform flawlessly with never a question being asked. Far too often, however, these crews are accepting needless risks imposed upon them by others simply because no one asks (or answers) the tough questions. I feel it's time that we as an industry start asking those tough questions.

Now more than ever, we need to see critical steps taken using a practical, common-sense approach to improving the safety record of the air medical industry. At the time of this writing, with 2008 coming to an end, the air medical industry had suffered an astonishing seven accidents resulting in an alarming 28 fatalities. As we all know, this is what is commonly referred to as the "air medical problem" - which the industry accepts by refusing to make the changes necessary to solve it. Without each operator adopting a true culture of continuous improvement, the industry will no longer be allowed to regulate itself, but will be forced to rely upon ever-increasing government oversight.

On any given day, in one of our favorite industry periodicals or Internet news blogs, we can read about a new or innovative "approach" to solving the air medical problem. Some of the proffered solutions have a great deal of merit, while others fall well short of the minimum standards of practicality, let alone sustainability. Much as they did after 9/11, overnight "experts" seem to be popping up in droves. While I risk the possibility of being categorized into this same group, by publishing my opinions, ideas and suggestions for all to see, at the very least I will be able to sleep well at night. Will anyone listen? Will my suggestions and those of others in the industry actually be heard? Or will they fall upon the deaf ears of the powers that be? Time will tell if anyone - including the FAA - is listening.

There are several key actions that, if implemented by industry management, would be a strong first step in establishing the mindset of continual improvement that is required to advance the safety of the industry. The fundamental question here is two-fold. First, with lives at stake, what overwhelming factor is prohibiting the implementation of the simple, reasonable actions needed to reduce the air medical industry's accident rate? I think we all know the answer to that one. The next question is: if those same people who are inhibiting the industry's progress were making decisions that involved their own lives, would those decisions be the same? I suggest not.

In other words, with profit being the overriding factor, industry management has made a cost-benefit analysis and decided to accept a certain loss ratio. To me, that is unacceptable. With lives at stake, it is imperative to at least consider the following simple, relatively low-cost ideas, which, if implemented, would save lives, now and in the future.

Leadership Within Air Medical Operations
True, genuine leadership and leadership skills play hand-in-hand with safety and its associated culture. With poor leadership, there can be no safety culture.

Are leaders in air medical organizations passionate about safety, or are they paying lip service to the "safety philosophy"? With the advent of Safety Management Systems (SMS), more and more upper management personnel are committing - on paper - to making safety a top priority. But words are cheap. Anyone can say they will do something.

It's time for leaders at all air medical companies to start putting some bite into their bark. Telling everyone to "be safe" and "think safe" just doesn't cut it. Company officials need to commit to action to protect the lives of their patients and crews. Sadly, too many upper-management desk jockeys are more concerned with revenue generation, company expansion and safety talk than those actions that should be mandated by their organizations' safety culture.

The stigmatism often associated with "go/no-go" decisions can easily be attributed to poor management and leadership. Removing the revenue burden and not putting a pilot in fear of reprisal for turning down a flight makes logical sense. Yet we commonly hear of pilots having to explain themselves - and some even being ridiculed and belittled - for not taking flights due to weather or other justifiable reasons.

These men and women are tasked with flying aircraft each worth millions of dollars, and companies don't blink an eye about letting them fly. Let a pilot turn down a flight for any reason, however, and he or she will be in the spotlight. This stigma should not only be avoided, it should be abolished completely. Pilots should legally - by regulation and contract - be free of reprisal for turning down a flight for any reason. If companies won't do it, the FAA needs to step up to the plate and see that this issue is regulated and enforced.

Leaders within organizations must stop thinking of safety as simply a "feel-good" or "check-the-box" exercise. Not long ago, one air medical CEO was quoted as saying: "Accidents, unfortunately, are a part of air medical." The unfortunate part is that as long as this is the prevailing mindset in the industry, the accident rate won't change.

Air Medical Resource Management (AMRM) Training
Air Medical Resource Management (AMRM) training is, without a doubt, critical for air medical safety. Working cohesively as a team in the air medical environment is a must. Breakdowns in communication and the overall decision-making process have contributed to many air medical accidents and incidents.

AMRM is defined in an FAA Advisory Circular and is therefore "advisory" in nature. Why is something so important only advisory, and not mandated by regulation? The empirical data of our company alone suggests that AMRM is a very beneficial tool that can help save lives. Out of nearly 500 air medical crewmembers trained on AMRM concepts during the period studied, 99.4 percent of all attendees said they would incorporate AMRM training into their everyday duties. Additionally, 98.4 percent of all who received AMRM training said they would recommend the training to others in the air medical industry.

Yet, for many in the industry, AMRM training is either lacking or nonexistent - and the former can do more harm to an organization than the latter, if it gives management a false sense of security. AMRM training should include real-life scenarios where there is no absolute black or white, only shades of gray. Live crew interaction is a must! One recent comment revealed that at one organization, "new hires get one lousy hour of AMRM lecture and then are told they will learn what they need in the field." Some crews get web-based AMRM training programs and scenarios.

This is a poor substitute. This isn't Aircraft Systems 101. Real-life scenarios need to be discussed in an open forum where "what ifs" can also be addressed. Each person has a different communication technique and this can only be addressed in face-to-face discussions. Effective crew coordination can only be achieved when communication lines are real, open and candid.

Landing Zone Standardization, Training and Certification
Landing Zones (LZs) are like fingerprints: no two are the same. Too often, crews tasked with establishing LZs have little if any training in this critical task. Those who have had training generally received a cursory briefing from a local air medical provider or watched a short training film on LZ procedures. Also, we commonly see public safety personnel in the middle of an LZ set up with personnel from neighboring jurisdictions. How were they trained? Is everyone playing to the same sheet of music?

This state of affairs has led to landing zone "horror stories," like the one about the fireman who ran as fast as he could toward the helicopter and nearly ripped the door off trying to get the stretcher out. Or the one about the physician who was almost arrested after interfering and creating a serious hazard to landing zone operations. Unfortunately, such stories are far too common.

The men and women flying EMS helicopters are professionals; they shouldn't be hearing statements over the radio like "I think you can make it." It's simple: why not establish a national standard for LZs, with regional training and certification for public safety organizations to back it up? Ensuring public safety personnel are adequately trained is win-win for everyone involved, from the ground and air medical crews to - most importantly - the patient who is in need of critical medical attention.

With the economy in its current state and fuel prices unsteady, think about how much it costs to fire up that EC 135 or BK117 for 10 or 12 landing zone PRs (public relations flights) per year. Sure, PRs are fun and have their place (pilots get to answer those standard questions like "how fast and how high does it go?"). But are these PRs providing adequate training from a safety perspective? Not exactly: LZ incidents are occurring at an alarming rate.

I propose a cutting-edge, first-of-its-kind LZ training program divided into two distinct levels. The first level would be "initial awareness training" that would be for any and all public and private sector personnel who might find themselves at a landing zone. The second level would be a more advanced program for personnel who are tasked with coordinating LZs, and would encompass an actual certification to a national standard. Our pilots and crews are professionals, trained and well-versed in a critical set of skills - why shouldn't the people on the ground have a solid foundation on LZ safety fundamentals to complement the professional skills of the people who land there?

Mandatory Aircraft Equipment and Pilot Training
Absolutely, positively and without a doubt, technologies like Traffic Alert and Collision Avoidance Systems (TCAS), Helicopter Terrain Awareness and Warning Systems (HTWAS), Automatic Flight Control Systems (AFCS) and night vision goggles (NVGs) are needed in the air medical industry.

Several lives might have been saved this year had TCAS or HTWAS been mandated in air medical helicopters. Pilots are routinely being asked to fly in areas where common sense would dictate this equipment. And if an air medical program operates at night its pilots should have NVGs available - period.

Why single-engine, single-crew, unstabilized helicopters fly at night in mountainous terrain or regions of unpredictable weather is beyond comprehension. Air medical companies are far too focused on revenue and company growth. As long as executives are concentrating on where they will open their next base - and not on the equipment their men and women need to safely do their jobs - lives will continue to be lost senselessly.

It's worth noting, however, that none of this equipment is of value if crews are not properly trained on it. Training cannot be one-size-fits-all, sink-or-swim. Compare the usual five hours of training that a new hire at an air medical company receives to the extensive training given to the private owner of one of the new Very Light Jets. A VLJ owner is required to complete an intense training program, including simulator exercises, over a 10-day-period, then is graded on his or her ability to fly single-pilot. Shouldn't our air medical pilots receive at least as thorough of training?

Anonymous Safety Reporting Systems
Why do air medical operators not have an anonymous, third-party safety reporting system? The concept has worked successfully in schools, businesses and other industries for years. Employees and management alike, in all industries, are at times hesitant in speaking up. Providing a route of communication that is free of the fear of reprisal allows issues of true merit to come to light.

Why not even go so far as an FAA regulation mandating reporting systems, with provisions to oversee operators and follow up on issues deemed a threat to air medical safety? It would be nothing more than much-needed accountability - similar to the Sarbanes-Oxley Act, which, among other provisions, protects "whistleblowers" in publicly held companies from reprisal.

Summary
To see any appreciable improvement in the air medical safety problem, we must start at the top. The powers that be must step forward, make a commitment that extends beyond paper, and stick to it. If changes aren't made soon, you can bet that a lot of current business practices will come to a very loud, screeching halt when government powers step in. The men and women in the air medical industry deserve the best equipment and training available. Anything less should be criminal. As we kick off this New Year, let us not forget those crewmembers who lost their lives in 2008. I give my sincerest condolences and prayers to all of the family members and colleagues who shared in this great loss.

Matt Johnson is the founder and CEO of Eagle Eye Solutions, LLC, which provides safety solutions for personnel in the air medical industry, including Air Medical Resource Management Training. He can be reached at matt@EagleEyeSolutionsLLC.com.

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