Aviation Safety

[SA_Medic]

After having a medevac / mercy flight from hell as described on my last blog I started thinking that maybe flight / aviation medicine might have to take a little bit of a back seat in my life again. Then last week, we had two aviation incidents. The first involved a Cessna that came down just after take off killing all (3) occupants. The next and latest was a Robinson 22 that came down killing the student with the instructor still in hospital. Then Today I discover the following picture in today's news paper.

PS: Eros Airport would also be the Airport where I take off from with any and all Medevac / Mercy flights....

[tniuqs]

You doing Med Evac in Robertsons ?

Lawn mower engines with rubber band drives ... yikes, cancel my travel plans.

cheers

[FireMedic65]

You doing Med Evac in Robertsons ?

Lawn mower engines with rubber band drives ... yikes, cancel my travel plans.

cheers

Nothing wrong with the R-22, aside from it being a 2 seater and would offer no where to a patient. Their power plant is also pretty efficient. Being that it is a piston engine, it has power more readily available. Of course, turbines have more power overall, there is nothing wrong with the R-22.

[tniuqs]

Nothing wrong with the R-22 aside from it being a 2 seater and would offer no where to a patient. Their power plant is also pretty efficient. Being that it is a piston engine, it has power more readily available. Of course, turbines have more power overall, there is nothing wrong with the R-22.

Well fill yer boots and the R 44 you can have as well, the blades are too light to develop inertia to auto rotate, a 400 lbs payload wtf? http://www.robinsonheli.com/r22specs.htm

http://www.ntsb.gov/publictn/1996/sir9603.pdf

If you look to the factors in this crash, in the FAA release and my own pronouncing of 2 dead (same situation) I will send flowers to your family.

The R22 is operated at close to its maximum gross weight (1,370 pounds) with two people on board and a full tank of fuel, resulting in operations routinely conducted near the upper limit of the helicopter's operating envelope. This condition requires that the helicopter be operated near the maximum design lift capability of the main rotor system. To gain the needed lift, the R22's main rotor blade angle-of-attack will on occasions be near the stall angle-of-attack during normal operations. According to RHC and a simulation study conducted by the Georgia Institute of Technology (Georgia Tech),11 large, abrupt control movements may produce main rotor blade stall and rapid decay of the rotor rpm.

I will take a jet box any day http://www.bellhelicopter.com/en/aircraft/commercial/bell206B-3.cfm look to safety records.

cheers

Edited November 23, 2009 by tniuqs

[fireflymedic]

and we thought it was bad in the US...it's bad, but I think you all definitely take the cake there. Please fly safe my friend.

[FireMedic65]

Well fill yer boots and the R 44 you can have as well, the blades are too light to develop inertia to auto rotate, a 400 lbs payload wtf? http://www.robinsonheli.com/r22specs.htm

http://www.ntsb.gov/publictn/1996/sir9603.pdf

If you look to the factors in this crash, in the FAA release and my own pronouncing of 2 dead (same situation) I will send flowers to your family.

I will take a jet box any day http://www.bellhelicopter.com/en/aircraft/commercial/bell206B-3.cfm look to safety records.

cheers

It's not a transporting helicopter. It's for training and touring. Just flaming.

[tniuqs]

It's not a transporting helicopter. It's for training and touring. Just flaming.

OK HUH ?

The R 22/44 are a poor excuse for a helo and they are classified light utility besides, sounds more like your going down in flames ? Very serious with a "few hours" in RW and FW myself, I will not get in one unless its sitting with ignition OFF!

The topic is Flight Safety and its lacking in more than one country but 4 deaths in a week on the famous Death Runway 19 in Windhoek .... I will drive from Cape Town will take my chances with the local "wild life" thanks for the heads up SA_medic

Just darn lucky SA_medic had great pilots in his Beech King Air(a great medivac machine btw) blowing a nose wheel on landing , well, besides the Sled problems then that sudden decompression thing (see Blog)

I know beers for the boys ... would ON MY COIN.

cheers

Then we have the TRAUMA TV show with Bell 212/ Twin Huey landing in school yards (unsupervised) single pilot, single "Wabbit" in da back, demonstrating clearly how NOT to it safely, then making TV heros out of fools that land on unaproved roof tops please, I mean PLEASE get real! Your loosing at lease 4 Medics a month these days in the US, I bet the stats in Nambia are better ....?

WHEN will governments get there shit together and impliment safety regulations:

Speed and Time in Prehospital Trauma Care

By Bryan Bledsoe

Related Article:

Research challenges link between quick EMS response and survival chances

Related content sponsored by:

One of the most fundamental tenets of EMS has been the attempt to get the patient to the hospital as quickly as possible. This concept was bolstered by R. Adams Cowley with his "Golden Hour" scheme. The trauma folks soon developed catchy phrases like "load and go" and "scoop and run." But, several recent studies have shown that total out-of-hospital time has little or no impact on most subsequent patient outcomes and mortality.

In a soon-to-be-published study in Annals of Emergency Medicine, Newgard and colleagues looked at outcomes of prehospital trauma patients and correlated these with various out-of-hospital time intervals. The study included a total of 3,565 trauma patients transported by 146 EMS agencies to 51 Level I and II trauma hospitals in 10 sites across North America from December 1, 2005, through March 31, 2007. The inclusion criteria were a systolic blood pressure less than or equal to 90 mm Hg, respiratory rate less than 10 or greater than 29 breaths/min, a Glasgow Coma Scale score less than or equal to 12, or the need for an advanced airway intervention.

They looked at various defined prehospital time intervals (activation interval, response interval, on-scene interval, transport interval, and total EMS interval). The study concluded, "Among injured patients with physiologic abnormality prospectively sampled from a diverse group of sites and EMS systems across North America, there was no association between EMS intervals and mortality."1 This was the largest study with the greatest validity on this topic conducted thus far.

Several other studies have come to the same conclusion. In a Denver study, which included all types of EMS response, Dr. Peter Pons and colleagues found that a paramedic response time less than eight minutes was not associated with improved survival to hospital discharge after controlling for several important confounders, including level of illness severity. However, a survival benefit was identified when the response time was within four minutes for patients with intermediate or high risk of mortality. They concluded that adherence to an eight-minute response time guideline in most patients who access out-of-hospital emergency services was not supported by the results of the study.2

In a study of 1,877 prehospital trauma patents, six percent (116) did not survive. The following parameters were found to be predictors of mortality: CUPS (critical, unstable, potentially unstable, stable) status, patient age, Injury Severity Score (ISS), and Revised Trauma Score (RTS). The total out-of-hospital time was the only variable NOT found to be a significant predictor of mortality.3 A Norwegian study found that longer prehospital scene times by medical helicopter crews were not associated with worsened outcomes.4

Now, I am not naïve enough to say that we should not make every possible effort to minimize out-of-hospital time. But, we should not do so at the peril of the providers and the public. All of the pseudoscientific response time standards and rapid deployment schemes (e.g., system status management) do little to improve patient outcomes (other than customer satisfaction) and torture employees in the process. Helicopter EMS (HEMS) is almost totally based upon the perceived need for speed and decreased out-of-hospital times. But, will they react to evolving evidence that seems to show that out-of-hospital times have little or no impact on patient outcomes and negates the main reason for their existence? The whole HEMS industry is out of control and all EMS providers share the blame for the problem and overuse. The needs of the patient have given way to the need to make a profit. Ground EMS personnel and physicians must start limiting use of this expensive and dangerous technology to patients who really stand to derive benefit (which are actually few and far between). Is a patient's life really worth a helicopter pin for your cap, a coffee cup, or a pizza dinner?

Perhaps EMS needs what the aviation industry calls a "stand down." We need to stop, catch our breath, and critically analyze the things that we do. Can any EMS system (except the casinos in Las Vegas) provide a response time of four minutes or less (the only response interval scientifically associated with improved patient survival? Are our artificial response time guidelines truly beneficial and sustainable? As I get older I find more and more things that I do because of ritual or misinformed beliefs. Changing these has made my life easier and safer. Think about it.

References

1. Newgard CD, Schmicker RH, Hedges JR. at al. Emergency Medical Services Intervals and Survival in Trauma: Assessment of the "Golden Hour" in a North American Prospective Cohort. Ann Emerg Med. 2009;(in press)

2. Pons PT, Haukoos JS, Bludworth W, Cribley T, Pons KA, Markovchick VJ. Paramedic response time: does it affect patient survival? Acad Emerg Med. 2005;12:594-600.

3. Lerner EB, Billittier AJ, Dorn JM, Wu WY. Is total out-of-hospital time a significant predictor of trauma patient mortality? Acad Emerg Med. 2003;10:949-54.

4. Ringburg AN, Spanjersberg WR, Frankema SP, Steyerberg EW, Patka P, Schipper IB. Helicopter emergency medical services (HEMS): impact on on-scene times. J Trauma. 2007;63:258-262.

Bryan E. Bledsoe, DO, FACEP, EMT-P is an emergency physician, paramedic and EMS educator. Dr. Bledsoe is the principal author of the Brady paramedic textbooks and others. He has more than 20 years publishing experience and has more than 900,000 books in print and has written more than 400 articles. He is a prolific writer, popular lecturer, and EMS researcher. Dr. Bledsoe is currently developing a distributive educational program for initial EMS education through the University of Nevada Las Vegas and online continuing education through Paramedic.com. Dr. Bledsoe maintains residences in Midlothian, Texas and Las Vegas, Nev. To contact Dr. Bledsoe, email bryan.bledsoe@ems1.com.

Copied without written permission but I doubt BEB would mine ... he IS doing his best.

[SA_Medic]

The thing that scares me most on this article would be that the mentioned runway is the main runway used by our medevac flights when taking off and landing for internal and cross border flights. The statistics involved being that 4 people died in one week in aviation related accidents would be even more scary, especially considering that there isn't all that much flying happening from that specific airport. It's mostly our medevac flights and then the sightseeing planes they use. Helicopters are actually a pretty new thing at Eros airport...I think I need to find another job or start refusing to fly

[Kiwiology]

HEMS is often the poor forgotten child by the regulators and the nature of it makes it kind of dangerous from the outset.

95% of my experience with the aviation regulators related to what is called scheduled operations or Part 121 which is what the airlines fly on; HEMS fly under what is called non-scheduled subpart ... off the top of my head it's 91 or 135 I'm unsure which, and they are a lot less stringent.

Airline pilots are heavily restricted on when, what and how they fly, for long long and under what conditions and the same does not apply to HEMS. Of course the NTSB knows this, the FAA probably does too, but the NTSB has no regulatory power whatsoever and the FAA could probably care less.

One of my classmates was a Westpac Rescue pilot and basically we run around single pilot visual flight rules (basically clear of clouds) in and out of places a fixed wing pilot probably wouldn't dream of going; into grass fields at night in and out of power lines, canyons doing winching operations etc. Some place i know in Canada for example run dual pilot IFR.

Truth be told I'd rather fly dustoff using a UH-1H Iriquous in Vietnam during Tet than run around doing HEMS

Edited November 24, 2009 by kiwimedic

[tniuqs]

'kiwimedic'

Some place i know in Canada for example run dual pilot IFR

Ahem: All that a dedicated and designated, only in very remote areas or woodland fires do we use "Local RW operators" typically a medium ... just like "da Wabbits" machine but I use more help in the back, I am not as good as him.

Truth be told I'd rather fly dustoff using a UH-1H Iriquous in Vietnam during Tet than run around doing HEMS

Think again and stop watching so many movies .... getting shot at is an entirely different game, personally I would rather fly in an R 22.

cheers