Final NTSB Mediva from 2016

[Mike Smith]

This is a long sad read. This crash is of particular interest to me because I have a family member who was a flight nurse with this outfit. Luckily he was was not on duty this night

https://app.ntsb.gov/pdfgenerator/R...ID=20160326X80544&AKey=1&RType=Final&IType=FA

 

[weilke]

I am amazed how often the mismatch between the two common formats to transmit coordinates contributes to accidents and search snafus. By now, anyone involved in SAR should be aware of the issue and make sure that any coordinates are transmitted along with a message of what format they are in.

 

[midwestpa24]

In spite of the coordinate error (which I still can't figure out why we have two different formats, pick one!), the fact that the pilot didn't do his own checking on weather conditions, continued the flight into low weather conditions, and decided to take off again into low weather conditions is astounding. I also find it interesting that he is busy texting while sitting on scene still turning.

I think a bigger issue that I have seen personally as a responder, is what I would call overuse of medical helicopters. It is highly encouraged by the operators to take every patient they can to justify and amortize the operational expenses, even though many times the patients are not critical enough to really justify the helo ride, or the time saved enroute is minimal compared to traditional ambulance service. Often times there is a 15-30 minute delay in transport by the time the helo is dispatched, lands, assumes medical care for the patient and loads, and is airborne again. 30 minutes can put the normal ambulance quite a way down the road, not to mention more patient care is possibly typically in an ambulance just because there is more room and more equipment to use. Most of your services using a Bell 206/407 or AS350 are purely transport, because the patient litter takes up so much space and the medic has no room to move.

 

[Mike Smith]

I guess one of the things I see in this is the accident chain, the comedy of errors and hazardous attitudes. One thing I can’t wrap my head around is, the pilot had a ton of instrument time and to auger it in so soon after take off, I wonder “what” happened to him.

 

[midwestpa24]

I guess one of the things I see in this is the accident chain, the comedy of errors and hazardous attitudes. One thing I can’t wrap my head around is, the pilot had a ton of instrument time and to auger it in so soon after take off, I wonder “what” happened to him.

Given that I have never done it, I wonder what flying IMC at night with night vision goggles on is like. What does the instrumentation look like through the NVG?

 

[dtuuri]

One thing I can’t wrap my head around is, the pilot had a ton of instrument time and to auger it in so soon after take off, I wonder “what” happened to him.

Me too. Too much experience to simply write this off as an amateur pilot's blunder. One thing though, they should take all those texting devices away.

 

[weilke]

I think a bigger issue that I have seen personally as a responder, is what I would call overuse of medical helicopters. It is highly encouraged by the operators to take every patient they can to justify and amortize the operational expenses, even though many times the patients are not critical enough to really justify the helo ride, or the time saved enroute is minimal compared to traditional ambulance service. Often times there is a 15-30 minute delay in transport by the time the helo is dispatched, lands, assumes medical care for the patient and loads, and is airborne again. 30 minutes can put the normal ambulance quite a way down the road, not to mention more patient care is possibly typically in an ambulance just because there is more room and more equipment to use. Most of your services using a Bell 206/407 or AS350 are purely transport, because the patient litter takes up so much space and the medic has no room to move.

This crash happened an hour after dispatch of the helo iow 1:10 after a scene EMS or fire provider called for it. Unless this was a 45min extrication, this patient was sitting in place on a cot for 45min. They could have been far down the road in that amount of time (or met up with a IFR transport at a ILS equipped airport).

Yup, system is broken.

 

[Mike Smith]

Given that I have never done it, I wonder what flying IMC at night with night vision goggles on is like. What does the instrumentation look like through the NVG?

I have no experience with NVG’s at all and very little IMC, but it would seem to me that it might require some training and experience.

 

[Mike Smith]

This crash happened an hour after dispatch of the helo iow 1:10 after a scene EMS or fire provider called for it. Unless this was a 45min extrication, this patient was sitting in place on a cot for 45min. They could have been far down the road in that amount of time (or met up with a IFR transport at a ILS equipped airport).

Yup, system is broken.

The helo probably would have saved half an hour or so had it worked out, again, assuming that they could have left by ground earlier. It’s @ 85nm from accident site to the hospital. It is very rural and maybe half of that trip would have been on 2 lane rural roads. Also there was ground fog covering much of the area.

 

[Zeldman]

I think a bigger issue that I have seen personally as a responder, is what I would call overuse of medical helicopters. It is highly encouraged by the operators to take every patient they can to justify and amortize the operational expenses, even though many times the patients are not critical enough to really justify the helo ride, or the time saved enroute is minimal compared to traditional ambulance service.

Lot of truth here. Probably a lot more that you realize.

Air ambulance companies can submit a claim to the insurance company for more money when using a helicopter, no matter if it is needed or not. Another problem is too many doctors think that a helicopter is the faster transport. Which it is for a facility to facility patient transfer 10 miles across a crowded city or for a swoop and scoop from the interstate back to the closest facility, but not for a 200 mile cross country where terrain has to be navigated around.

One of many examples of helicopter overuse here in town. There was an accident just outside of town on the interstate. A helicopter was called because one victim was super critical. Ok, a little slower.... a helicopter was called to pick up a victim because he was super critical. There was 3 ground units already on the scene when the decision was made to call the helicopter. Two other victims were taken by ground units, and made it to the hospital before the helicopter even arrived at the accident site. One of the ground unit medics made the decision. He is a manager in the ground unit company. The same company that owns the helicopter medevac company. Apparently time did not matter, but making profit did.

I wont even get into how indian health services are bilked... I mean billed for using a helicopter when it is not needed.

 

[midwestpa24]

Lot of truth here. Probably a lot more that you realize.

Air ambulance companies can submit a claim to the insurance company for more money when using a helicopter, no matter if it is needed or not. Another problem is too many doctors think that a helicopter is the faster transport. Which it is for a facility to facility patient transfer 10 miles across a crowded city or for a swoop and scoop from the interstate back to the closest facility, but not for a 200 mile cross country where terrain has to be navigated around.

One of many examples of helicopter overuse here in town. There was an accident just outside of town on the interstate. A helicopter was called because one victim was super critical. Ok, a little slower.... a helicopter was called to pick up a victim because he was super critical. There was 3 ground units already on the scene when the decision was made to call the helicopter. Two other victims were taken by ground units, and made it to the hospital before the helicopter even arrived at the accident site. One of the ground unit medics made the decision. He is a manager in the ground unit company. The same company that owns the helicopter medevac company. Apparently time did not matter, but making profit did.

I wont even get into how indian health services are bilked... I mean billed for using a helicopter when it is not needed.

Exactly what I have seen. We are a rural community, but only 10 miles from the nearest hospital/ED that has a based helicopter. However it is in the operations book that they auto-launch for any trauma case outside of the city limits. Once they land there is an expectation that they will get the transport. It is only a 15 minute drive to the ED most days, the helicopter flight only saves 5-10 minutes max, and that is once they are loaded and airborne. If there is a delay waiting for them to arrive, transfer, etc., the difference is even worse.

Imagine getting a $30,000 helicopter transport bill for a minor bump on the head from an MVA, or even a stable broken leg, instead of the $3,000 ambulance bill. I just read an article somewhere about a case just like that. The family was shocked to get the bill, that they didn't request, and the situation didn't require.

 

[weilke]

The helo probably would have saved half an hour or so had it worked out, again, assuming that they could have left by ground earlier. It’s @ 85nm from accident site to the hospital. It is very rural and maybe half of that trip would have been on 2 lane rural roads. Also there was ground fog covering much of the area.

If the decision tree includes 'Weather is too poor to drive, let's fly!', you probably should stop and re-evaluate the situation.

As overnight radiologist at a regional level II (soon level I) trauma center, I have a unique perspective on trauma care. Our HEMS does few scene flights, most major trauma comes our way after initial stabilization (chest tubes, lines, intubation) at a local hospital. From doing this for 7 years, I can say that for blunt force trauma, the 'golden hour' is bogus.

 

[Tarheelpilot]

Exactly what I have seen. We are a rural community, but only 10 miles from the nearest hospital/ED that has a based helicopter. However it is in the operations book that they auto-launch for any trauma case outside of the city limits. Once they land there is an expectation that they will get the transport. It is only a 15 minute drive to the ED most days, the helicopter flight only saves 5-10 minutes max, and that is once they are loaded and airborne. If there is a delay waiting for them to arrive, transfer, etc., the difference is even worse.

Imagine getting a $30,000 helicopter transport bill for a minor bump on the head from an MVA, or even a stable broken leg, instead of the $3,000 ambulance bill. I just read an article somewhere about a case just like that. The family was shocked to get the bill, that they didn't request, and the situation didn't require.

I worked fixed wing medivac. ... . About a year ago I was in a car accident and was injured. The ground crew was discussing calling a helicopter. I told them I would walk before I got on a helicopter. It was not necessary, not even a little bit.

 

[Mike Smith]

If the decision tree includes 'Weather is too poor to drive, let's fly!', you probably should stop and re-evaluate the situation.

I wasn’t defending the decision, I was just giving background cause this is in my neck of the woods.

As overnight radiologist at a regional level II (soon level I) trauma center, I have a unique perspective on trauma care. Our HEMS does few scene flights, most major trauma comes our way after initial stabilization (chest tubes, lines, intubation) at a local hospital. From doing this for 7 years, I can say that for blunt force trauma, the 'golden hour' is bogus.

 

[weilke]

I wasn’t defending the decision, I was just giving background cause this is in my neck of the woods.

I didn't think you were. This was more of a general commentary on the decision-making process.
I doubt they would have even gained 30 minutes. Google maps gives me 1:34 from Goodman,AL to Baptist medical center. And that's civilian driving subject to speed limits and traffic lights. As emergency vehicle you can shave off another 10-15min, with the scuzzy weather add in another 15 and it's back to 1:34. The time from dispatch to crash was 1:00. It would have still taken an AS350 about 35min to cover the 85nm flight. At best it was a wash.

Sometimes the best you can do for a trauma victim is to package them and hit the road. The other day we got a guy with a tension pneumothorax (dropped lung) from a hospital 2 hrs away. This was a no-fly day and they have only basic life support ambulances. He was a bit pale and hypotensive when made it to us but he turned out allright.

 

[Velocity173]

Given that I have never done it, I wonder what flying IMC at night with night vision goggles on is like. What does the instrumentation look like through the NVG?

You don’t look at the instruments through the NVGs. They’re focused to around 100-200 ft away which results to an “infinity” type setting. The panel is completely unreadable in that focus range so in the event of IMC, you either look under the NVGs or do what some do and just flip them up. Doesn’t do much to keep them down unless trying to sneak a peak through a thin obscuration.

 

[Mike Smith]

I wonder if the pilot has some visibility and has on his NVG’s and as he lifts off, at some point enters IMC, by force of habit goes eyes down, could spatial disorientation come on that fast?

 

[Velocity173]

I wonder if the pilot has some visibility and has on his NVG’s and as he lifts off, at some point enters IMC, by force of habit goes eyes down, could spatial disorientation come on that fast?

For this pilot, it came on pretty fast (start at 5:00). Not sure if he had NVGs on through all these gyrations. Could’ve easily ended up the same way of the Haynes Flight accident.

 

[Mike Smith]

Wow!

 

[flyingcheesehead]

If the decision tree includes 'Weather is too poor to drive, let's fly!', you probably should stop and re-evaluate the situation.

True, most of the time... But I have flown a trip that I was originally planning to drive, because freezing rain had passed through. The sky had cleared up but the roads (and all other surfaces!) were covered with 1/2 inch of ice. Flying was way safer.

 

[azure]

True, most of the time... But I have flown a trip that I was originally planning to drive, because freezing rain had passed through. The sky had cleared up but the roads (and all other surfaces!) were covered with 1/2 inch of ice. Flying was way safer.

Other surfaces? If that includes the ramp and taxiways... not sure I would have done it!

 

[455 Bravo Uniform]

For this pilot, it came on pretty fast (start at 5:00). Not sure if he had NVGs on through all these gyrations. Could’ve easily ended up the same way of the Haynes Flight accident.

Nice. Thanks for sharing. Don’t have to be a helicopter pilot to watch and learn somethings to apply to my own flying.

Interesting all around, but one thing that was an “aha!” moment was the chief pilot saying something to the effect of why do we feel the need to justify and explain why we scrubbed a flight, instead of why a flight is a go.

 

[flyingron]

I can't vouch for the situation here, but when I was a paramedic, we didn't make a capricious call for air evac. There were definite protocols that had to be followed when going somewhere other than to the closest hospital (by ground). Typically, it took multisystem trauma to get someone directed to the trauma center (and got the helicopter ride if such was available). Simple fractures won't cut it. It's not the helicopter system that's to blame if people are abusing it.

 

[Velocity173]

Nice. Thanks for sharing. Don’t have to be a helicopter pilot to watch and learn somethings to apply to my own flying.

Interesting all around, but one thing that was an “aha!” moment was the chief pilot saying something to the effect of why do we feel the need to justify and explain why we scrubbed a flight, instead of why a flight is a go.

Yeah, depends on company climate. My company would never question my weather decision making in scrubbing a flight. I’ve got maybe a 6 or 7 other friends in the business, and I’d be willing to bet they have no company pressure as well.

Now, you might have yourself a “rescue ranger” who goes out in weather they shouldn’t be in and internal drive / pride prevents them from “tapping out.” Those guys are getting rare these days. Most cases it’s the opposite. Plenty of EMS pilots who know they can use weather as an excuse because they don’t want to get their lazy a$$ out of bed at 3 AM and do their job...I won’t go on a rant on that though.

In the OP example, it’s quite clear that 1) they shouldn’t have departed 2) should’ve aborted after conditions deteriorated (you can see fog a long ways out under NVGs), 3) OCC should have been all over the weather and at the very least, questioned the pilot’s plan (happened to me just a few days ago) 4) should’ve concentrated on the flight instead of being on smart phones. Also curious as to this Sentry Aviation Weather as an approved weather source??? Based on the pic, doesn’t look like a useful weather decision making tool anyway.

Sad deal though and unfortunately another hard learning experience for the rest of us. I’m sure I’ll hear more about it in CRM training this year.

 

[flyingcheesehead]

Other surfaces? If that includes the ramp and taxiways... not sure I would have done it!

I was flying from a class C whose smallest runway was 5800x150, all concrete grooved, and very well maintained in inclement weather as it's an alternate for ORD for many airlines. IIRC, the destination itself hadn't gotten the freezing rain, but the roadway most of the way there had.

On a separate occasion, I have landed on a runway with nearly nil traction, and I'd still take that over driving on it any day. Flight controls are useful down to very low speeds, at which point even poor traction can still allow you to steer OK. The best part is that you can land in a crab if there's a crosswind!

 

[EdFred]

You just have to do your run up while moving because the brakes won't hold. T/O and landing on ice is no big deal, you just use the rudder to keep the ground track what you need it to be. With a crosswind it's kinda weird to crab on the takeoff ro-....skid.

The problem is when the ice is patchy. Then it gets..........fun.

 

[Zeldman]

Yeah, depends on company climate. My company would never question my weather decision making in scrubbing a flight. I’ve got maybe a 6 or 7 other friends in the business, and I’d be willing to bet they have no company pressure as well.

I was never questioned on making weather decisions, except a few times by the doctor that was trying to get rid of.... I mean trying to get a patient transferred.

I have only worked for 3 medevac companies, but in all three companies anyone of the flight team could call off a flight. Personally I never had a medic call a flight. There were times when they questioned me, and I made sure they understood what we would encounter in the flight as well made sure everyone could question me at anytime.

At one company there was a medic that was terrified of flying. Any little bump in the air and she would start to panic and almost hyperventilate. Unless we had a patient that kept her busy, then she was Ok. She finally resigned from the flying part, she never could get used to flying.

 

[Zeldman]

Other surfaces? If that includes the ramp and taxiways... not sure I would have done it!

I have done a lot of ice covered surfaces. The wheels might not have traction, but directional control was done with air flow over the control surfaces, engine power and use of differential power in the twin.

I landed on a frozen over runway with a significant cross wind. I landed in a crab and kept directional control with the engine and rudder. Taxiing was done the same way, as well as the take off. It really doesn't take much to get used to that. Should be even simpler for someone that has a sail boat.

I once watched a 727 land on an ice covered runway. The wind was strong enough to move that plane around after it parked. Then I took off in a C-207.

But if you don't feel comfortable on ice, no problem.... don't do it..!!

 

[azure]

You just have to do your run up while moving because the brakes won't hold. T/O and landing on ice is no big deal, you just use the rudder to keep the ground track what you need it to be. With a crosswind it's kinda weird to crab on the takeoff ro-....skid.

The problem is when the ice is patchy. Then it gets..........fun.

TO and landing isn't what I worry about so much as taxiing to the runway, especially if there are any slopes on the taxiways leading from the ramp as there are here. It was bad enough here this winter that the FBO was moving planes by tug to the hold short line.

 

[EdFred]

TO and landing isn't what I worry about so much as taxiing to the runway, especially if there are any slopes on the taxiways leading from the ramp as there are here. It was bad enough here this winter that the FBO was moving planes by tug to the hold short line.

Ah, I've always been on pretty flat airports when operating on ice - you know how southern Michigan is that way. I can see sloped taxiways being interesting to navigate depending on wind and all that. If the airports would just salt the movement areas....