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Stephen Richey stephen.richey at gmail.com
Mon Dec 29 07:37:38 GMT 2014

The fixed wing we operated in was in and out of some very heavy traffic due
to all the cargo jets at our base.  It's not that bad of a mix.

I can't argue about terrain in your part of the world.  We have it good
because even in the hilly southern part of Indiana, you generally have
airport within easy transport distance of any town big enough to have a
hospital.  Almost all of them have at least a GPS/RNAV approach as do the
majority of public airports in the US.

I think the military helo comparison is a potentially dangerous one because
the skills, training and proficiency standards of those pilots are so much
higher than some for profit HEMS outfit.  It leads to a mindset, if not
tempered by knowledge of the subject as in your case, to the idea that
civilian operators are comparable.  A few are but most are not if for no
reason other than relying on single pilot operations in marginal VMC or IMC
(night operations in rural areas even on crystal clear nights should just
as a precaution be treated as IMC due to the frequency of the black hole
effect; this goes for fixed wing as well but it's a bigger problem in
medical helicopters) in aircraft that often are not equipped with full
autopilot systems.

There's a time, place and way use any tool as you said.  Unfortunately, the
aeromedical industry seems resistant to doing what seems necessary to
achieve high operational efficacy with sacrificing ten to fifty crew
members and patients annually.  Fortunately, the FAA finally seems to be
getting the message that the NTSB has been screaming at them for ten years
or so and is mandating improvements in training and equipment.  Time will
tell if it has significant implications for safety or whether loopholes
will be found to allow business as usual to continue.  I am optimistic
about it.  I'm ready to see comparable safety between the two sections of
aeromedical transport in this country.
On Dec 28, 2014 10:44 PM, "Charles Krin" <cskrin2 at hughes.net> wrote:

> Stephen:
> I agree that for distances further than the unrefueled operational
> radius of the helo, fixed wing should be considered as primary... many
> of the facilities I worked at did NOT have an airstrip of over 3000 feet
> within 30 miles, and even those that did had *at best* a Visual Approach
> Slope Indicator (VASI) system. Add in the additional transfer/transport
> time from even the smaller 'downtown' air port to the receiving
> hospital...and the near 'door to door' of a helo flight can cut
> significant time off- one memorable trip from Ft Sill Indian Hospital to
> Parkland Dallas ended up with us having to land at Love Field for some
> reason, and wait for ground transport- I seem to recall that for some
> reason, the Parkland helopad was occupied and could not accommodate our
> Huey... since our patient was a 400 pound alcoholic GI bleeder...that
> was NOT a comfortable wait for *either of us*-
> In the early 1980s, our Hueys could leave Ft Sill, make a pick up at any
> hospital within 80 miles or so and get to Oklahoma City or Wichita Falls
> generally before a ground ambulance could go direct from the little
> hospital into the city...at least partially because there frequently was
> no 'good way' to get from the small hospital to OKC or WF. Additionally,
> because of common weather patterns, even after civilian air ambulances
> started springing up in OKC, Tulsa and WF, we would frequently get the
> call, because we could sneak around a weather front and follow said
> weather into the City...while the city units would have to punch through
> the weather- it also helped that we were equipped and staffed to fly
> dual pilot night IFR and could handle light icing, something that the
> smaller JetRangers and AStars of the day were not.
> I have some friends who work with an ambulance service in Northern
> Louisiana- this outfit has both fixed and rotor wings, and the most
> common use of the fixed wings is to take cancer patients from the
> Monroe/Ruston catchment areas into Houston for care.
> (While aircraft flying with "Lifeguard," "DUSTOFF," or "MEDEVAC" call
> signs have relative priority over any other aircraft in the sky *except*
> balloons and unpowered gliders, past practical experience has indicated
> to me that it's not really smart to try to insert a KingAir or smaller
> aircraft; or any rotorwing craft into a busy traffic pattern full of
> 'heavies' short of a truly emergent patient!)
> without drawing the ire of Dr. Mattox (with whom I have locked horns
> with in the past on this matter), there is a time and a place for every
> form of transport, from a blanket drag to a LearJet or Gulfstream....and
> consideration of the distance, patient, weather and available staff all
> need to be considered to provide the best and most appropriate transport
> for any given patient.
> ck
> On 12/28/2014 18:45, Stephen Richey wrote:
> > True but honestly, in that setting, call for a fixed wing turboprop
> rather
> > than a helicopter.  If the patient is stable you can wait a little while
> > longer for a less risky mode of transportation (especially at night or in
> > marginal weather).
> > On Dec 28, 2014 7:42 PM, "Charles Krin" <cskrin2 at hughes.net> wrote:
> >
> >> Stephen:
> >>
> >> having worked in many rural EDs over the years, I'll point out that many
> >> of those service districts are not equipped or staffed to 'lose' a
> >> critical care truck for 6 to 8 hours at a time... and in many cases, the
> >> only 'mutual aid' group that could help would be the regional Air
> >> Ambulance service. (It used to be the Military Assistance to Safety and
> >> Traffic program using (mostly) Army DUSTOFF assets...but after civilian
> >> helo medical services spread out, and especially after 2001, military
> >> helos are rarely available for civilian transfers.)
> >>
> >> As an NR EMT-A/91B2F flight medic in the early 1980s, I cared for more
> >> than a few patients this sick or sicker as we hauled them out of North
> >> Central Texas and most of Southern and Western Oklahoma.
> >>
> >> ck
> >>
> >> On 12/28/2014 16:07, Stephen Richey wrote:
> >>> All of the above.  If he's stable and it's less than four hours away by
> >>> ground, why fly them?  A ground ambulance crew is just as able to
> >> transfer
> >>> such a case unless you're going really far.
> >>> On Dec 28, 2014 4:14 PM, "Charles Krin" <cskrin2 at hughes.net> wrote:
> >>>
> >>>> 1: how high and how far? (fixed vs rotor, for ex)
> >>>>
> >>>> 2: any other medical problems? (no breathing problems? Glasgow 14 or
> >>>> better?)
> >>>>
> >>>> ck
> >>>>
> >>>> On 12/28/2014 09:35, Robert Smith wrote:
> >>>>> Does anyone have a thought on the possible problems of medivac for a
> 78
> >>>> yr old guy with a closed (presumed) skull fx and small stable
> epidural?
> >>>>> --
> >>
> --
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