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Thu Oct 16 12:55:13 BST 2008

On Thu, Oct 16, 2008 at 7:23 AM, Lorick Fox, PA-C <Lorick at lorick.org> wrote:

> I have read only portions of this discussion.
> However, it appears that the discussion has focused on whether or not these
> resources are being used appropriately.
>

> That is not the primary issue - it is a valid issue, but NOT the primary
> one.
>

Technically, it is the primary issue at least from the medical side of the
argument (which is the obvious focus of this list and others)  and it is a
contributing factor to use NTSB parlance because the lack of oversight on
this issue drives many services to push for more flights even when the
weather conditions make all but a questionable few general aviation planes
and many Part 135 aircraft stay safely on the ground.

Also given the lack of the desire of the FAA to do anything but make
limp-wristed recommendations makes the use of dispatch criteria one of the
few manners of recourse given that air medical operations have backed up
into a corner- formed by the FAR and other regulations that states have yet
to find a way to do an end run around- like some sort of tomcat and hiss and
swat at anyone who tries to improve safety when it even hints that they
might not continue to turn a tidy profit at the cost of lives.

The issue is: Why are there crashes at a rate > usual rotary operations.

More or less the same probable reasons that commercial cargo operators tend
to have a higher crash rate than other sectors of commercial aviation (Part
121 being the primary example): lack of oversight, the fact that at some
companies the corporate office might say it's the pilot's absolute decision
to fly or not but pilots are quietly reminded that they can be rather easily
replaced if they don't fly and the resulting flights into bad weather, etc.

> There are many aeromedical agencies with ZERO accidents over decades.

This is true and their operations need to be used as examples of how to do
it.

>
>
> The problem is crashes (actually dead air crews and patients - airplanes
> are expendable), not the patient who happens to be in the helicopter.
>

Very true, but if the crash is avoidable by not flying the patient who does
not need and will not benefit from it then the concerns about excessive use
are part of the problem.  It's not the only one, but it is a major part of
the problem.

Other issues include (but are obviously not limited to):
-Crew fatigue
-Lack of proper equipment and training
-Marginal to questionable maintenance practices to keep helicopters
available for revenue generating flights

>
> IF the number of crashes/operation were the same for (1) aeromedical vs.
> other rotary and (2) all agencies, then the appropriateness of operations
> would be primary.
> They are not.
>

Actually would it not make sense that if one aspect of the aviation
community has a dismal safety record that questioning whether they should be
flying in the first place would a good idea?  If they don't fly, they can't
crash.

My questions are
(1) are pilot's being pressured to fly (or continue a flight), by job
security concerns, peer pressure or by concern for the patient?  (N.B.
Pilots should be blinded to patient condition at all times.)

You'll never prove  that first point unless you find a pilot willing to wear
a wire, but everyone in the commercial aviation community knows it happens
at almost any operation where profits are concern #1.

>
> (2) are there effective risk management programs in effect regarding flight
> operations?  This is NOT a question of "is this flight necessary?", it IS:
> "Can this flight be conducted safely?"
>

Actually it should be a question of both.  If you have a patient with
bilaterally gangrenous feet, do you only address one of them?

>
> (3) is there a post flight safety review program to hold pilots responsible
> for their operational decisions, even if "they get away with it"?
>

My guess is if one does exist in many of the more crash prone operations
(Air Evac Lifeteam for example), that it is kind of like the panel in
Maryland.  It's simply there so when a crash does occur, the administration
can point and go "Hey! Look, we had nothing to do with the fact that our
helicopter crashed....we tried to avoid it."  They (AirEvac Lifeteam) have
done more or less the same thing with it's maintenance program, but given
that two helicopters in a row experienced what can best be described
as compressor stalls during normal operations cause me thinks that there may
be something rotten in Denmark.

>
> Sorry, but as a pilot and former FAA Aviation Safety Counselor (SLC FSDO),
> I thought I would add by 2 cents.
>

Glad to have your input Lorick.  Feel free to chime in any time on list or
off.

> --
> Stephen L. Richey, CRT
> Aviation Injury Research Project Leader
> Saginaw Valley State University
> Work E-mail: slrichey at svsu.edu
> Home Office Phone: 248-366-4452
>
> "It is the characteristic excellence of the strong man that he can bring
> momentous issues to the fore and make a decision about them. The weak are
> always forced to decide between alternatives they have not chosen
> themselves."- Dietrich Bonhoeffer
>

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