National EMS Pilot's Association Air Net

Seat Belts Save Lives by Richard J. Fedorowicz

FAR PART 91-14 [2 ]z : "No pilot may takeoff or land a U.S. registered civil aircraft unless the pilot in command of that aircraft insures that each person Qn board has been notified to fasten his seat belt."

[3 ] : "During takeoff and landing of U.S. registered civil aircraft each person on board that aircraft must occupy a seat or berth with a safety belt properly secured about him."-

Would you believe that more than one program pilot has informed me that not only have they experienced difficulty in getting a medical crew member to fasten their seat belts on takeoff and final approach with a patient onboard, but that they (the pilot) were reluctant to pursue the matter because their vendor did not want "problems" with the program staff!!

Pardon me if I seem incredulous?! If this is really happening, I would think we could immediately discount the vendor 's wishes simply because he is not going to be in the same crash sequence as the pilot and crew.

The fact that nearly all of our EMS helicopters are operating at or near maximum gross weight conditions, are flying into and out of small hastily prepared landing zones, at times requiring steep approaches and maximum performance takeoffs, and under numerous environmental conditions, should cause alarm gongs to go off in the crew's collective heads! Sure these turbine engines are reliable, but would you want to bet your life on them?

An unofficial analysis of Hospital based helicopter accidents from 1972 to 1984 by "Hospital Aviation" indicated that 44 % of the accidents occurred during the landing phase resulting in 22 % of the fatalities, 56 % of the injuries, and 50% of the damage. I really don' t know how many helicopters these statistics are applied to, but I do know that I don' t want to be one of them, nor do I want you to be one of them. I don ' t know how many fatalities or injuries were attributable to improperly fastened seat belts either, nor do I want you or me to become a member of this exclusive club, particularly since this type of fatality or injury is entirely avoidable!?

The problem seems to be that crew members feel that, in some instances, it is impossible to adequately care for the patient while s trapped securely to the seat. For the most part this is due to space limitations and interior design configuration of the helicopter. In a few instances the problem is due to body confirmation (read obesity) of the medical crew member, and in many cases the

complaints involve crew members who are performing CPR in flight. Whenever CPR is in progress the pilot knows that he has a critical situation on his hands and, consequently, is susceptible to letting basic safety requirements slide a little. He tends to justify his actions under the rather broad heading of "extraordinary circumstances require extraordinary actions." This is hogwash?? Medical crew members should never be uns t rapped from their seats. The belts should be long enough to allow the crew member to reach the patient without unfastening the buckle. Obviously, a loose seat belt is no better than one that has been removed. The only difference is that having it a round you makes it easier to find and eliminates the step of having to push the buckles together. Now all you have to do is to t ighten it prior to takeoff and landing. If your problem is one of obesity then you should go on a diet, and you should do this for more reasons than just being able to keep a seat belt around you?

The next problem is the patient. This will require a coordinated effort between the pilot and the crew members. The pilot 's requirements are quite clear and ill fact are governed by Federal law. He must insure that each person on board has a seat belt proper ly fastened about him during takeoff and landing. The crew must care for the patient, so the problem is now one of timing. It takes about 10 to 15 seconds to accelerate a helicopter into a "safe flight envelope," and about the same amount of time to pass through that envelope for a landing.

What is the nature of the patient 's care that would prohibit you from taking care of your own personal safety during this time period? My unders tanding is that the American Heart Association recommends that CPR not be ceased for more than 15 seconds, and t further unders tand that you have an option of hyper-venti lat ing the patient prior to ceasing CPR for that amount of timel Now I don ' t speak "me4ic-alese" so that is a subject for discussion between the pilot and medical crew when you decide the seat belt issue. In any event, if you cannot comply with the law, then the pilot has no business either taking off or landing.

One should never delude one's self into believing that an accident cannot happen to him. There are a number of survivors of helicopter crashes who, in hindsight, now wish that they had taken those few extra seconds to properly secure their seat belts. Let's not become a "statistic" because of a simple failure to communicate!

PHI Leads the Way by Tom Einhorn

After attending the NBAA show in New Orleans in September, NEMSPA representatives visited Air Care at West Jefferson General Hospital in Marrero and talked with three of their pilots. The program has one IFR Bell 222 based at the hospital for 24 hour service capabilities. Briefly, these were some of our findings: • The aircraft was well equipped and, as

per the pilots we spoke with, maintenance was excellent.

• Facilities for the pilots, provided by the hospital, were quite good. This included sleeping areas, lounge and kitchen.

• Instrument training was accomplished in the Bell 222 at the pilot 's convenience.

• The most impressive feature, though, was the staffing. A total of six pilots were provided for the program with relief pilots as necessary. The pilots work twelve hour shifts,

seven days on and seven days off. Pilots did not rotate between days and nights. Instead, day operations were conducted with a single pilot and all missions at night were flown with two pilots. This unique approach was reflected in the attitude of pilots. Pilots made all the decisions regarding flight safety and weather with absolutely no pressure to overextend themselves. All felt that they had an excellent working relationship with the flight nurses and ground crews. User agencies had all been pre-briefed about aircraft safety and landing requirements. The pilots indicated that these guidelines and procedures were adhered to religiously.

Finally, and perhaps most refreshing, were the pilots' attitudes about their employer, Petroleum Helicopters, Inc. They were proud of the fact that PHI was concerned enough about safety to allow for no short cuts in this area. One pilot explained that PHI encouraged, listened and reacted to pilot input. He also pointed out that PHI not only met minimum FAA requirements, especially those subject to interpretation, but in many cases far exceeded those requirements providing an additional margin of safety. "PHI has the attitude that if we can't do it safely, then we won't do i t ."

Our hats off to Petroleum Helicopters, Inc. for their commitment to safety and to the pilots at West Jefferson Hospital for a most professional approach.

12 HOSPITAL AVIATION, DECEMBER 1985.