Vanderbilt Lifeflight Airbus Helicopter Fatal, 11/8/25

A lot of operations that keep the front seat and controls will put a medic there. Sometimes it's driven by CG requirements. And plenty of pilots have the "here's what you do if I keel over" mindset and provide them with enough training to attempt a decent landing.
So how many single-pilot HEMS flights have crashed because of pilot incapacitation and how many single-pilot HEMS crashes have been averted in single-pilot flights with dual controls?

Nauga,
and his risk 'cube'
 
That's the name of the game, isn't it?
And they came very close to a no survivor accident.
No action would've ment three fatalities.
Can you name the operators with pilots that are teaching paramedics/nurses how to fly the helicopter?
I'd rather not, but they are successful operators with a very good safety record.

So how many single-pilot HEMS flights have crashed because of pilot incapacitation
At least one.

how many single-pilot HEMS crashes have been averted in single-pilot flights with dual controls?
Harder to find numbers on that, since such events probably end up not reported, or reported but without too much fanfare.
 
Can’t confirm that Vandy has a pilot incapacitation training program but I’ve heard rumors they do. Whether or not this paramedic went through that is unknown. It’s become pretty common training in the industry now. All started maybe 10 years ago when Airevac had a pilot in a B206 become partially incapacitated. Med crewmember crawled up on the litter and assisted the pilot for landing. After that, they developed a training program. We do it with the medcrew on initial hire and then annually. Without an AP it would be useless but all our aircraft have them now so at least it gives them a fighting chance. After the Vandy crash, a lot of them are coming up to me and are like “can we go over setting up the autopilot again?” ;)
 
Can’t confirm that Vandy has a pilot incapacitation training program but I’ve heard rumors they do. Whether or not this paramedic went through that is unknown. It’s become pretty common training in the industry now. All started maybe 10 years ago when Airevac had a pilot in a B206 become partially incapacitated. Med crewmember crawled up on the litter and assisted the pilot for landing. After that, they developed a training program. We do it with the medcrew on initial hire and then annually. Without an AP it would be useless but all our aircraft have them now so at least it gives them a fighting chance. After the Vandy crash, a lot of them are coming up to me and are like “can we go over setting up the autopilot again?” ;)

And that's the difference, setting up an autopilot vs "teaching" a non pilot crew member how to take over.
 
Harder to find numbers on that, since such events probably end up not reported, or reported but without too much fanfare.

Huh? Seriously?

Again, these are operators with a Part 135 certificate to maintain. Do you actually believe for a moment if one had an event of pilot incapacitation it would go unreported? Or even "reported without too much fanfare?'
 
And that's the difference, setting up an autopilot vs "teaching" a non pilot crew member how to take over.
Oh they’re taught how to take over as well. Our AP bumps offline at 44 KIAS so they’re gonna have to land it on their own at some point. SAS still stays engaged but it’ll be both cyclic and collective inputs from the medcrew to pull off a safe landing. Problem is, there’s no actuator to the pedals (same as Vandy) so once they get below ETL it’s gonna spin like a top and burn in. I always tell them “speed is life.” You get slow and you’re done.
 
This one did a pretty good job from the back seat, despite the lack of qualifications.
You don't make policy for black swan events. Is it more likely that a second set of controls will be necessary and used to save everyone or that it will get in the way. It seems the ratio is heavily tilted to the latter.
 
Oh they’re taught how to take over as well. Our AP bumps offline at 44 KIAS so they’re gonna have to land it on their own at some point. SAS still stays engaged but it’ll be both cyclic and collective inputs from the medcrew to pull off a safe landing. Problem is, there’s no actuator to the pedals (same as Vandy) so once they get below ETL it’s gonna spin like a top and burn in. I always tell them “speed is life.” You get slow and you’re done.

OK, that's not teaching them how to fly. It is teaching them that below 44 kts to push down to a hard landing, and probably a run on if they are lucky. There has to be a differentiation between teaching "how to fly" versus a survival escape.

Back when the Air Evac incident happened there was a lot of discussion because med crews were telling people they were being trained to "fly" the helicopter. This had to get defined and a formal training program introduced which you are seeing today.

I realize we are splitting hairs a bit, but without that an escape maneuver becomes full on training with an expected out come of a run on landing on centerline perfect approach. Then next we see training in other areas as well. At Air Evac they were reminded "sure, you can do whatever training you feel necessary, but you will need to document it and have the TM approved for such an event". Let that sink in for a moment.
 
So they are doing this training and hiding it from the FAA? Seriously?
Stop jumping to conclusions so hard, you'll injure yourself. I just don't want to name them.
Do you actually believe for a moment if one had an event of pilot incapacitation it would go unreported? Or even "reported without too much fanfare?
What would make it reportable per the rules if the landing is successful?

And that's the difference, setting up an autopilot vs "teaching" a non pilot crew member how to take over.
As Velocity173 already explained, most autopilots will drop around 40-50kts.
Are you aware of the capabilities and limitations of a typical helicopter autopilot?
What I've seen taught for the non-pilots is to stay above ETL and attempt a running landing.
 
Stop jumping to conclusions so hard, you'll injure yourself. I just don't want to name them.
Right.
What would make it reportable per the rules if the landing is successful?

Want to discuss the various self reporting programs that a Part 135 operates under?
As Velocity173 already explained, most autopilots will drop around 40-50kts.
Are you aware of the capabilities and limitations of a typical helicopter autopilot?

Yea, since I am a helicopter pilot and have done the training. What about you?

What I've seen taught for the non-pilots is to stay above ETL and attempt a running landing.

So what position are you in that you have observed this training? And what is your background in Part 135 HEMS operations?
 
A lot of operations that keep the front seat and controls will put a medic there. Sometimes it's driven by CG requirements.
The problem with that is how to do you stay within CG when the medic gets in the back with the added patient?

At least one.
Harder to find numbers on that, since such events probably end up not reported, or reported but without too much fanfare.
You'll find its a statistical anomaly on those numbers when compared to flight hours flown. The offshore industry did several studies on this in the 80s to see if there were viable mitigative steps using non-crew members to assist. The end result the oil companies opted to address the problem on the human side and required more medical requirements, age limits in the cockpit, etc. to reduce any potential pilot incapacitation issues. Regardless, all those types of events must be reported by rule so very doubtful they were not reported.
 
Man, that autoland feature that Buffalo River King Air had installed would have been great for an event like this.

I think Garmin and Leonardo have options for that.

I’m not usually for regulated safety, but for SP helos in commercial use, it seems like a no brainer. Costly for sure, but still beats being along for the ride after the pilot steps out.
 
Man, that autoland feature that Buffalo River King Air had installed would have been great for an event like this.

I think Garmin and Leonardo have options for that.

I’m not usually for regulated safety, but for SP helos in commercial use, it seems like a no brainer. Costly for sure, but still beats being along for the ride after the pilot steps out.

What about single pilot SE operations in Alaska? Should they be mandated to operate 2 pilot or install an autopilot that would exceed the cost of the airplane?
 
49CFR part 830.5.

Nauga,
coded

It goes farther than that depending on which reporting program the operator is using under Part 135.

This is why training failures, unscheduled landings, aborted take offs and other items must be disclosed to the Certificate Management Team.
 
What would make it reportable per the rules if the landing is successful?
I think this question is covered on most FAA written tests I've taken. I know for sure that it was on my latest commercial and CFI tests.

§ 830.5 Immediate notification.
The operator of any civil aircraft, or any public aircraft not operated by the Armed Forces or an intelligence agency of the United States, or any foreign aircraft shall immediately, and by the most expeditious means available, notify the nearest National Transportation Safety Board (NTSB) office, 1 when:

(a) An aircraft accident or any of the following listed serious incidents occur:

. . .

(2) Inability of any required flight crewmember to perform normal flight duties as a result of injury or illness;
 
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What about single pilot SE operations in Alaska? Should they be mandated to operate 2 pilot or install an autopilot that would exceed the cost of the airplane?

Cost of any aircraft in revenue service is a red herring however as I mentioned in my OP, I’m not usually in favor of regulated safety because there’s always a cut line and that results in different levels of safety for pax, even solely within Part 121 or Part 135 and the pax usually don’t have enough knowledge (or motivation) to make an informed choice.

Where HEMS (and fixed wing evac for that matter) is different is the pax (patient) usually doesn’t have a choice whether they’re getting the ride or not and many times may not have the ability to even consent to the ride.

In that scenario, it becomes a moral choice of what level of safety is “good enough” for the patient.
 
Where HEMS (and fixed wing evac for that matter) is different is the pax (patient) usually doesn’t have a choice whether they’re getting the ride or not and many times may not have the ability to even consent to the ride.
For those patients, the choice is often get on the helicopter or die.
 
Want to discuss the various self reporting programs that a Part 135 operates under?
Sure. How much of that is public records?
Yea, since I am a helicopter pilot and have done the training.
Plenty of helicopters don't have autopilots. Your previous statement was not aligned with knowledge of a typical heli AFCS.

What about you?
I know nothin'!
1769098979034.png
So what position are you in that you have observed this training? And what is your background in Part 135 HEMS operations?
See above.
 
49CFR part 830.5.
Thanks - you made me re-read the reg and saw it.

how many single-pilot HEMS crashes have been averted in single-pilot flights with dual controls?


Searching the NTSB database for heli part 135 accidents that involved incapacitation provides six results (one questionable).

One of them had no injuries because the flight nurse took over and landed.

Another one had the the front passenger attempt to control the helicopter using the pilot's controls, managing enough to end up in a survivable ditching for the two passengers.

So, two out of five had a potentially better outcome due to a passenger attempting to take control.
 
Sure. How much of that is public records?

What does that have to do with anything? Theses are reporting programs between the operator and the FAA. You have alluded that operators don’t report to the FAA. Keep twisting.


Plenty of helicopters don't have autopilots. Your previous statement was not aligned with knowledge of a typical heli AFCS.

Huh? So which helicopters are you qualified in?

I know nothin'!
View attachment 149152

See above.

Obviously
 
Yes, many of the patients are so critical they don't make it off. I actually met a Vanderbilt flight crew a few years ago that had transported a six-month old baby from a regional hospital to Vanderbilt. It was around her third birthday. The nurse recounted taking the girl from her mom for the flight, and how moving the goodbye was. She said they always let parents take their time in such situations because it's often the last time they'll see their child alive. What these people do is amazing.
 
Yes, many of the patients are so critical they don't make it off...
Which is why having a single point of failure around the most critical component for flight deserves consideration.

I seem to recall data somewhere that nearly half of patients die in a HEMS crash while crew fatalities were significantly lower. That could be related to the fact the patient is already in a bad way, but a crash doesn’t help their condition either.
 
What does that have to do with anything?
Look at the context of the conversation, and what nauga asked. The general public can look at the NTSB database, not at what the 135 reports to the FAA. I (incorrectly) read the rule as not requiring reporting to the NTSB. Thus drew the conclusion that there might not be a good enough amount of data there to conclude the pros/cons.
You have alluded that operators don’t report to the FAA.
No, that was your assumption. Yes, my statement left room for interpretation, but you chose to go there.

You alluded to the training being just autopilot operation training, when the AP will go offline at 40-50 kts. The only AP mode the passenger needs to know is SAS or ATT (if available) and how the trim system works.
"Smashing it down" from 50 kts will not go too well. Now, a gentle decel to 30 at a low rate of descent will allow for a much better outcome.

So which helicopters are you qualified in?
None whatsoever.
 
Man, that autoland feature that Buffalo River King Air had installed would have been great for an event like this.

I think Garmin and Leonardo have options for that.

I’m not usually for regulated safety, but for SP helos in commercial use, it seems like a no brainer. Costly for sure, but still beats being along for the ride after the pilot steps out.
Can’t be having that stuff man. Next step will be taking me out of the loop. I’m not ready to retire yet!
 
Can’t be having that stuff man. Next step will be taking me out of the loop. I’m not ready to retire yet!

Your job is safe; somebody’s gotta feed the dog.

The alternative is two man crews which means you can’t retire until all those new jobs are filled anyways.
 
Which is why having a single point of failure around the most critical component for flight deserves consideration.
Unfortunately, the current slew of helicopters operating in EMS would not be capable of using such technology on several levels. Even with the addition of 2-axis autopilots and SAS systems on the legacy <6000lb fleet, there would still need to be a technology leap to get those in the autoland loop. As to the 2 crew option, the EMS side has generally moved away from that configuration for quite some time just has the move has been away from twin-engine to single engine ops.
 
You alluded to the training being just autopilot operation training, when the AP will go offline at 40-50 kts. The only AP mode the passenger needs to know is SAS or ATT (if available) and how the trim system works.

I was directly involved with the Air Evac B206L event when the pilot became incapacitated. I was also involved with the additional training involved with med crews and the training dept and the approvals required.

You are so far off base it's humorous.

"Smashing it down" from 50 kts will not go too well. Now, a gentle decel to 30 at a low rate of descent will allow for a much better outcome.

The purpose of the incapacitated pilot scenario is not to save the helicopter. The training is not looking for that smooth touchdown. At 30 the helicopter will begin yawing without pedal input. Touching down sideways will not end well and probably end up in a roll over.

None whatsoever.

That's obvious.
 
Wow!

No dual flight controls?
Why should there be? It's a single pilot helicopter.
When responding to a question, is it necessary to be a jerk?

I mean, most of us here have probably never flown a helicopter before. And the helicopters we've seen have most likely all been dual controls. So it's a legitimate question.

As for it being a "single pilot helicopter", almost every non-airline airplane I've seen is a "single pilot airplane". Yet every single one had dual controls.
 
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When responding to a question, is it necessary to be a jerk?
iu
 
Your job is safe; somebody’s gotta feed the dog.

The alternative is two man crews which means you can’t retire until all those new jobs are filled anyways.
I’d definitely retire if we went to two pilots. No way I could stand sitting around for 12 hrs a day, 7 days in a row with the same pilot. We’d drive each other crazy. That and the fact the pilot not on the controls would be bored out of their minds. The flights are really low workload. Even the IFR guys, the AP is easy to setup for single pilot.
 
And the helicopters we've seen have most likely all been dual controls.
Actually, with a number of helicopter models dual controls are an option. So percentage-wise most light helicopters have no dual controls or even the provisions for them. Where they become standard equipment, in general, are in models that require 2 pilots if it has IFR capability. So no real comparison to airplanes.
 
Can’t be having that stuff man. Next step will be taking me out of the loop. I’m not ready to retire yet!
Maybe you should cross train on the medical side so you’re not the only single-task guy in the crew after the rest of them finish learning to fly it. :cool:

Nauga,
who can also pour coffee
 
I was directly involved with the Air Evac B206L event when the pilot became incapacitated.
Care to provide a link? Nothing with your description came up in CAROL.

The purpose of the incapacitated pilot scenario is not to save the helicopter. The training is not looking for that smooth touchdown.
You're not saving anyone by "dropping" it at 50kts, plus whatever vertical velocity you achieve with the drop. An impact at 30kts has one third of the energy compared to the 50kt one.

At 30 the helicopter will begin yawing without pedal input.
Depends on the helicopter.
Even assuming that it does yaw, since you've already trained that paramedic to use the cyclic and collective, is it that much more training to teach him/her what the pedals do?

Touching down sideways will not end well and probably end up in a roll over.
Digging into the ground with 50kts of forward velocity won't keep you upright, either.
 
Care to provide a link? Nothing with your description came up in CAROL

Not sure you would find it there as there was no damage and no injuries. While the pilot did suffer some incapacitation he was able on the landing to get it down with help. The paramedic initially engaged the autopilot and set it up for the emergency landing.

The helicopter was a B206L operated by Air Evac.

You're not saving anyone by "dropping" it at 50kts, plus whatever vertical velocity you achieve with the drop. An impact at 30kts has one third of the energy compared to the 50kt one.

You’re the one using the word “drop”. That was never implied.

Hit the ground sideways at 30 kts and the helicopter is rolling over. Ever seen a running helicopter roll over on a landing?

What you don’t seem to understand is how helicopter controls actually work. As the helicopter slows, collective must be added which in turn adds torque to the MR shaft. It takes pedal adjustment to compensate for that. If not added the helicopter will begin yawing.

Also, as the helicopter reaches about 25 kts, the helicopter comes out of translational lift requiring more power which in turn requires more pedal and of course cyclic input.

Now keep in mind the med crew is bending over the center console trying to manipulate the cyclic and collective.
Depends on the helicopter.
Even assuming that it does yaw, since you've already trained that paramedic to use the cyclic and collective, is it that much more training to teach him/her what the pedals do?

Ok, in a typical EMS configuration with no dual flight controls and a pilot in the seat, how would the nurse/paramedic reach the pedals?
 
So in the sim, Airevac came up with 50 kts for a touchdown speed. Now you can debate the pros & cons with that but 50 kts isn’t a bad start. I won’t go into the specifics of our policy but it doesn’t have any speed recommendations for touchdown. I tell my medcrew what I would do without conflicting with company policy. My recommendation is 60 kt approach, slowly decelerating to no less than 30 at touchdown. In a perfect world, they could they could stay above our AP restriction of 44 kts and set up the GPS for a straight in. Wish we had speed hold. That would eliminate the worry about a right yaw. In reality though, they really need to be ready to take over if they get below 44 kts.

All easier said than done. Just finding an appropriate landing area, setting up a proper speed, descent angle and FPM is going to be a daunting task in itself. So many variables involved that as pilots comes as second nature for us. For them it’s going to be information overload. Then of course if we have a patient on board it’s all a moot point. Unless it’s a pediatric, non of my medcrew is going to fit through the gap to access the controls anyway.
 
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