Association of Air Medical
Services
and
CORE Industry
Safety Committees
Position Statements
Published by
Association of Air Medical Services
526 King Street
Suite 415
Alexandria, VA 22314-3143
(703) 836-8732 phone
(703) 836-8920 fax
www. aarns org
2003 Edition
Copyright © 2000
Association of Air Medical Services &
CORE Industry Safety Committee
Safety Position Paper 2000
Association of Air Medical Services
and
CORE Industry
Safety Committees
Position Statements
Table of Contents
Safety within an Air Medical Program
2
Improving Safety through the Establishment of a Safety Based Culture
4
Appropriate Flight Crew Scheduling and Provision for Adequate Rest
7
Improved Flight Safety through Crew Member Interaction (CRM)
with Pilot in Command
10
Personal Protective Equipment for Flight Crew Members
13
Flight Crew Refusal to Participate in a flight as a Result of Concern
for Personal Safety
19
Special Programs designed to Improve the Flight Team Members’
Physical and Mental Well Being
21
The Role of the Communications Center in Enhancing Air Medical Safety
23
Safety Consideration for the Combative or Potentially Combative Patient
26
Loading and Unloading of Patients with the Aircraft Rotors Turning
28
Aircraft Emergencies
29
Weapons of Mass Effect
30
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Association of Air Medical Services &
CORE Industry Safety Committee
Safety Position Paper 2000
SAFETY WITHIN AN AIR MEDICAL PROGRAM
Problem Statement:
Air medical accidents continue to occur despite efforts to improve safety within the air medical
industry.
Significance:
The use of helicopters and fixed wing aircraft to transport patients is a recognized part of the
health care system in the US as well as several countries around the globe.
EMS helicopters are twice as likely to be involved in a reportable crash and four times as likely
to involve fatalities as were all helicopters operated under FAR Part I 35.
Helicopters and airplanes used in EMS require extensive modification to accommodate the
medical equipment on board the aircraft for patient care. In case of an aircraft accident, these
modifications may contribute to occupant injury and death.
As an industry, we must continue to pursue opportunities to minimize the risks associated with
air medical transport for our pilots, crewmembers and patients.
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Association of Air Medical Services &
CORE Industry Safety Committee
Safety Position Paper 2000
Bibliography
1. Dodd, R. (1992). Factors Related to Occupant Crash Survival in Emergency Medical Service
Helicopters. Dissertation John Hopkins University/Aviation Science and Technology.
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Association of Air Medical Services &
CORE Industry Safety Committee
Safety Position Paper 2000
IMPROVING SAFETY THROUGH THE ESTABLISHMENT OF A SAFETY-BASED
CULTURE
Background:
A safety-based culture is defined by everyone feeling a responsibility for safety and pursues
safety improvement opportunities on a daily basis (1). A safety-based culture provides the
framework for the safety program for any air medical service.
Recommendations:
Paradigm Shifts for a Safety-Based Culture
“In order to exceed current levels in safety excellence and reach the goal of a safety-based
culture, there needs to be changes in behavior, attitudes and perception a true paradigm shift
for total safety. These shifts require new principles, approaches and procedures and will result
in different behaviors and attitudes among the entire team, from top management to hourly staff.
An added benefit will be a sense of empowerment and consequently, support throughout the
entire culture”(l).
—
The ten changes are:
From Government Regulations to Corporate Responsibility
From Failure Oriented to Achievement Oriented
From Outcome Focused to Behavior Focused
From Top-Down Control to Bottom-Up Involvement
From individualism to Team Work
From a Piecemeal to a Systems Approach
From a Fault-finding to Fact-finding
From Reactive to Proactive
From Quick Fix to Continuous Improvement
From Priority to Value (2).
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Association of Air Medical Services
& CORE Industry Safety Committee
Safety Position Paper 2000
As an outgrowth of a safety-based culture, human factors associated with air medical transport
need be a day-to-day focus for all members of the air medical transport team and support staff.
Initial and annual training in the various aspects of human factors should be required of all team
members (administration, pilots, mechanics, communications and medical crews).
Creating A Safety Committee:
A Safety Committee is a part of every air medical program and can contribute to the
development of a safety-based culture. The air medical program’s safety committee, when
applicable, must be a partnership between the aviation operator and the program/hospital.
The Safety Committee should be aware of industry trends for safety enhancement including
professional organizations’ efforts to address safety standards for their membership. The Safety
Committee should be empowered to develop policies and make recommendations for safety
enhancement to include but not be limited to:
Develop and communicate a Safety Mission Statement
Create an Education and Training Process
Develop Evaluation Procedures
Contribute to a Performance Feedback Mechanism
Continuous Quality Improvement as it Pertains to Safety
Association Position:
The Air Medical Program leadership has a responsibility to develop a safety-focused culture by
identifying and implementing the essential elements of a safety culture and by developing and
empowering a safety committee.
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Association of Air Medical Services
& CORE Industry Safety Committee
Safety Position Paper 2000
References
1.
Dickinson, L. (1998). Creating a Safety Based Culture. AAMS Medical Transport
Leadership Institute, Topic 110.
2.
Dodd, R. (1992). Factors Related to Occupant Crash Survival in Emergency Medical
Service Helicopters. Dissertation John Hopkins University/Aviation Science and
Technology.
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APPROPRIATE FLIGHT CREW SCHEDULING AND PROVISION FOR
ADEQUATE
REST
Background
Many fatigue countermeasures have been proposed. To date, only one approach improved
work schedule systems has proven to provide positive long-term effects. Improved work
schedule systems recognize that cultural, social, individual, and chrono-biological factors must
all be considered in the design of a scheduling system. Such a system requires cooperation and
active participation between workers and the organization(s) (1). Chrono-biologists have shown
that in order to maximize performance, shifts should be changed infrequently, in a forwardrotating direction (i.e. from day to evening to night), with days off scheduled so as to allow
maximum transition between shifts (2).
—
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The National Transportation Safety Board (NTSB) has published a safety study that clearly
documents a relationship between performance levels and adequate rest. Alertness, fine motor
skills, and judgment deteriorate significantly when adequate rest is not obtained (3). (Adequate
fluids and nutrition are also required for optimal performance) (4). Prior to the institution in the
mid-80’s of Federal Aviation Administration (FAA) regulations mandating pilots receive a
minimum of eight to ten (8-1 0) hours of uninterrupted rest within a 24-hour period, the air
medical transport industry suffered its worst year ever with regard to EMS incidents/crashes.
Most of the accidents involved fatalities (5). After the minimum rest statutes were implemented,
the accident rate declined sharply. While these Federal Aviation Regulation (FAR) requirements
under Part I 35 apply only to pilots and not to other air medical transport crewmembers, it is
common sense that safety will be enhanced if every single member of the transport team is
adequately rested. To provide for maximum safety and job performance, non-pilot
crewmembers should receive a minimum of eight hours uninterrupted rest within every 24-hour
period during peak transport seasons and six hours interrupted rest during slow transport
seasons. These 24-hour periods include on-call time as well as actual on-duty time.
According to the National EMS Pilots Association Safety Guidelines, fatigue cannot always be
self-determined, and in most cases it may not be apparent until serious errors are made (6).
Therefore, in order to demonstrate a paradigm shift of being ‘proactive rather than reactive’,
scheduling must allow for no less than these minimums of rest periods.
“. . .
. . .“
Recommendation
The Association of Air Medical Services recommends that all flight programs recognize that
fatigue compromises safe decision-making. Programs must realize the importance of
adequate rest and enforce procedures, which through a proactive stance promotes
appropriate scheduling.
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Association Position:
A written policy should be established so that fatigued personnel can be removed from
service, and/or back-up personnel identified to assume flight duty should a crew member
become excessively fatigued or otherwise unable to perform optimally at any time.
Association ofAir Medical Services
& CORE Industry Safety
Committee
Safety Position Paper
2000
References
1.
Tepas, DI. and Monk, TM. (1987)Workschedules. In: HandbookofHuman Factors, G.
Salvendy, (Ed.). New York: John Wiley & Sons.
2.
National Flight Nurses Association Position Statement: “Improving safety in the airmedical helicopterenvironmenf’. Issue 1, 1998.
3.
National Transportation Safety Board, Dodd R.S. : Safety Study, commercial emergency
medical services helicopter operations. U. S. Department of Commerce, National
Technical Information Service. January, 1988, Report #NTSB/SS-8801.
4.
Rayman R.B.: Passenger safety, health, and comfort: a review. Aviation Space &
Environment Medicine. 1997; 68 (5) 432-40.
5.
North, Michelle. Rocky Mountain Helicopters Online. White Papers: EMS crew
interactive roles; pilot and flight nurse. 1997.
6.
National EMS Pilots Association Safety Guidelines. In: National Flight Nurses
Association Position Statement: “Improving safety in the air-medical helicopter
environment’~ Issue 1. 1998.
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Association of Air Medical
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Safety Position Paper
2000
Bibliography
Cauthorne CV., Fedorowicz, R.J.: EMS Helicopter Pilots and TheirWork Schedules: an
Analysis. Hospital Aviation I 986; March: 1 8-24.
Collett H.M.: Air Medical Accident Rates. JournalofAirMedical Transport 1991; 10 (2): 14-15.
Dodd, R.S. : EMS Helicopter Safety Revisited. Hospital Aviation I 989; 1 : 6-8.
Martin, T. : Adverse Effects of Rotating Schedules on the Circadian Rhythms of Air Medical
Crews. Air MedicaiJournal. April—June, 1995: 83-86.
NFNA. Performance Standards, Safety Recommendations. Standards of Flight Nursing
Practice, 2ed., 1995. P. 67.
Preston, N.: Air Medical Helicopter Accident Rates. Journal of Air Medical Transport. 1992;
11(2): 14
-
16.
10
Wright, D.: Safety Management vs. Picking Leaves. Journal of Air Medical Transport. 1991; 10
(9): 11-2.
Wright, D.: An Analysis of Shift Work and Emergency Medical Service Helicopter Pilot
Performance:
Unpublished Manuscript, 1984.
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Association ofAir Medical Services
& CORE Industry Safety
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Safety Position Paper
2000
IMPROVED FLIGHT SAFETY THROUGH CREW MEMBER INTERACTION
(CRM)
WITH PILOT IN COMMAND
Background:
11
The paradigm shift from individualism to teamwork requires an “entire-crew-oriented” approach
to creating and maintaining a safe environment for air medical transport. In Practice Standards
for Flight Nursing, the standards of professional performance for flight nurses are: ‘safe
transport of the client and others during transport, as well as, (participating) in the safety ofthe
aircraft and all others aboard the aircraft (1). It is well recognized that all air medical
crewmembers, in cooperative efforts with the pilot in command, play an important role in
assuring a safe aviation environment. Subsequently, Crew Resource Management (CRM) must
be a CORE VALUE (rather than a mere priority) of EVERY air medical program.
After the unacceptable accident rate (of a high as 13.4 accidents per 100,000 hours most
resulting in fatalities) of the early 80’s, the air medical industry attempted every possible course
of action to reduce this high rate. Notably, the highest percentage of accidents were a result of
some human factor or error, and it was determined that, somehow, there had to be developed
interaction between all crewmembers and the pilot. The medical aircrew is a team and must
work together helping each other to do the best job possible for the team rather than working
separately as an individual (2).
—
Recommendations:
It is believed that effective teamwork and communication between crewmembers will ‘save more
lives than Nomex or helmets’ (3). This communication should include pre-mission and/or shift
briefings, pre-flight checklists, post-mission briefings, and minimum requirement of annual
safety training, to include education and practice of appropriate actions during an aircraft
emergency (4). Data identified in the usually more formal and written post-mission briefings
should serve as a basis for identifying potential problems and monitoring trends. This
information should include feedback from all crewmembers involved in the particular mission,
(including dispatch personnel), and should not be used as a punitive measure.
According to results of two surveys conducted by the National Flight Nurses Association, 32% of
respondents in 1988 and 60% ofthel998 respondents practiced CRM in their programs, while
62% in 1988 and 71 % in I 998 had written policies addressing such (5). If doing all in our power
to ensure a safe aviaUon environment is truly a core value, we understand that pilots are no
longer solely responsible for creating this safe environment, and therefore, these statistics must
become 100% industry-wide!
Association Position:
.
.
•
All air medical team members should receive training in Crew Resource Management
initially upon hire and at least annually thereafter.
A policy and practice of conducting pre-mission and/or shift briefings, pre-flight checklists,
post-mission briefings with documentation for trending purposes must be in place and
tailored to fit each program’s specific needs.
A minimum requirement of annual safety training, to include education and practice of
appropriate actions during an aircraft emergency should also be in place.
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Association ofAir Medical Services
& CORE Industry Safety
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Safety Position Paper
2000
References
I
.
National Flight Nurses Association. Performance Standards, Safety Recommendations.
Standards ofFlight Nursing Practice, 2 ed., 1995. P. 67.
2.
North, Michelle. Rocky Mountain Helicopters Online. White Papers: EMS crew
Interactive roles:
pilot and flight nurse. I 997.
3.
AAMS & CORE Industry Safety Committee Members at 1998 Air Medical Transport
Conference, Safety Committee Meeting. Albuquerque, New Mexico; October, 1998.
4.
National Flight Nurses Association Position Statement: “Improving safety in the airmedical helicopterenvironment” Issue 1. 1998.
5.
National Flight Nurses Association Safety Survey. In: Position Statement; “Improving
safety in the air-medical helicopter environmenf’: Appendix B, 1998.
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Association of Air Medical
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2000
Bibliography
CAMTS. Commission on Accreditation of Medical Transport Systems. Accreditation Standards,
3rd ed., 1997.
Collett HM: Air medical accident rates. Journal ofAir Medical Transport, 1991; 10 (2): 14-15.
Dickinson, L. (1998). Creating a Safety Based Culture. AAMS Medical Transport Leadership
Institute, Topic 110.
Dodd, R.S.: EMS helicopter safety revisited. Hospital Aviation 1989; 1: 6-7.
Preston, N: Air medical helicopter accidents rates. Journal of Air MedicalTransport. 1992; 11(2): 14-16.
Wright, A. E., Campos, J. A., Gorder, T.: The effect of an in-flight, emergency training program
on crew confidence. Air Medical Journal, 1994; 13 (4): 127-31.
Wright D: Safety management vs. picking leaves. Journal of Air Medical Transport. 1991; 10(9): 11-2.
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Association of Air Medical
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Safety Position Paper
2000
PERSONAL PROTECTIVE EQUIPMENT FOR FLIGHT CREW
MEMBERS
Background:
A systems approach to safety requires recognition that each and every aspect of creating and/or
maintaining the safest environment possible must be explored. Certainly, personal protective
gear for flight crew members is an important piece of that “puzzle”. But there are other aspects
of HEMS operations that likely play a far more important role in the overall safety picture than
what crew members wear (1). The focus of safety should be on prevention of the injury and/or
fatality-causing incident. Those preventive measures begin with appropriate aircraft selection,
configuration, maintenance, etc. and continue along a chain of events, which occur long before
the crew members don whatever personal protective equipment is chosen or required for them.
,
15
Appropriate crewmember training, effective Crew Resource Management (CRM), and improved
crew awareness are at least as important as what personal protective gear is worn. Perhaps the
most important protective “gear” of all is the “putting on” of an attitude of personal commitment
and responsibility to safety.
Until the staggering rise in fatal helicopter crashes in 1 986, most civilian EMS programs
required little or no personal protective gear for their crewmembers. Even after it was
documented that many of these crashes may well have been survivable had “additional safety
equipment” been utilized, the HEMS industry as a whole has not come to agreement on what
minimum protective gear should be required (2). Nearly all of the statistical data obtained thus
far has come from military, rather than civilian, investigations. While it can be argues that there
are some differences in military missions when compared to civilian ones, a helicopter crash is a
helicopter crash, regardless of whether it occurs during civilian or military operations (3).
Recommendations:
The National Transportation Safety Board began an investigation into the growing number of
EMS helicopter incidents/crashes, with the completion of the comprehensive study in 1 988.
Resulting from this study, safety-improving recommendations were made and presented to both
the FAA and the Association ofAir Medical Services (AAMS) as Class-Il, Priority Action
recommendations. Specifically related to individual crewmember protective gear was the
following recommendation. “Encourage members who operate emergency medical service
(EMS) programs to provide medical personnel who routinely fly EMS helicopter missions with
protective clothing and equipment to reduce the chance of injury and death in survivable
accidents. This clothing and equipment should include protective helmets, flame and heat
resistant flight suits and protective footwear”(4). The NTSB recommendations were supported
and adopted by AAMS four years later when the I 992 Safety Congress published the position
that “flight programs doing scene work have head protection, Nomex uniforms, and boots with
steel toes and shanks.” Further, the Safety Congress recommended, “all EMS helicopter
personnel wear helmets for head protection” (5). Extensive studies completed by military
research teams, largely comprised of U. S. Army operations data, indicate that of accidents in
U.S. Army helicopters, 24% of all injuries sustained were to the head and face, and nearly 25%
of these were fatal injuries. Further, data presented in the U. S. Army’s Aircraft Crash Survival
Design Guide TR 79-22B indicates that spinal injuries resulting from vertical direction impact
and head injuries caused by unrestrained contact with the environment are the major cases of
both severe injury and disability in rotorcraft accidents (6).
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Association of Air Medical
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2000
It is obvious from the statistical review of injury patterns and percentages that flight helmets
provide much needed protection to flight crew members. Helmets specifically designed for use
in rotor wing aircraft provide additional protection to hearing, and allow for improved
communication during operations. The face shields on these helmets also provides visual
protection, and may very well prevent a crash in the case of a bird strike or other potentially
sight-threatening event encountered during flight (7). However, helmets must be fitted to each
individual appropriately, worn according to manufacturer guidelines, and then properly
maintained to ensure adequate protective performance. These factors make helmet purchase
and/or upkeep a financial commitment, and are, even under ideal circumstances, no substitute
for the basics of crash-attenuating seats, clear head-strike zones, and full safety-belt protection,
including shoulder harnesses (8).
The widespread use of crash-resistance fuel cells has significantly decreased the incidence of
post-crash fires. Currently available statistics indicate this incidence in survivable air-medical
accidents to be less than 25%, although the potential exists in every serious crash (9).
Therefore, the recommendation for crew members’ wearing of flame-retardant (Nomex) clothing
is a logical added protection in those occurrences. (For a complete discussion of the appropriate
feature of such clothing, minimum recommended flammability and heat-transfer characteristics,
and guidelines for proper wearing of Nomex garments, please refer to the National Flight
Nurses Association Position Statements: Flight Nurse Safety In The Pdr Medical Environment,
Revised January, 1998) (10). However, in orderto achieve maximum protection, such clothing
must be specifically laundered, worn within certain air gap and layering guidelines, and used in
conjunction with only natural-fiber undergarments. (i.e. cotton, wool) (1 1) It must also be kept in
mind that maximum protection from thermal injury is provided only with the use of Nomex gloves
and outerwear/coats (12).
While the debate regarding the use of helmets and Nomex rages on, the one certainly is that the
greater the amount of appropriate protective gear utilized in the operations of air medical
transport, the lesser the risk of injury. Such personal protective gear is costly to obtain and
maintain. However, programs wishing to provide continuous improvement rather than a “quick
fix” in this area will take a serous look at the best use of these frequently limited funds, and
training and maintenance will not suffer because of “some helmet of nomex obsession.” (13)
Adequate personal protective gear for crew members should not be limited to clothing and
headwear. Survival equipment (and training in its effective use) is also included in a plan to
provide maximum protection. Since the ability to summon help, or to survive until help arrives,
may very well be the crew members’ best protection against life-threatening injury, each
member should have a small survival “pack” within easy access inside the cabin of the aircraft
(14). This pack can be small in size and contain only minimum equipment for signaling,
attracting attention, and maintaining body temperature.
Lastly, pilots and other crew members should be in good enough physical shape to safety do
the lifting and carrying that are required in their jobs. The physical ability to extricate oneself
from an aircraft after an incident/crash should also be considered when setting guidelines for
minimum personal protective “gear”(l 5).
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Association ofAir Medical
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Association Position:
•
•
The Association of Air medical Services and the CORE Industry Safety Committee believes
that safety can be enhanced through use of personal protective equipment and safety
equipment training. Programs should evaluate the benefits of helmets, fire-retardant clothing
and survival equipment training and use.
Minimally, all air medical crews should routinely wear hearing protection when working in or
around an aircraft with engines in operation.
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2000
References
1.
Flight Med Archive; Tuesday, 09 March 1999
2.
Schneider, Andrew. The Pittsburgh Press. “Nation’s Medevac Crews Want Safety
Changes to Increase Survival” November 1, 1987.
3.
4.
5.
National Transportation Safety Board, Bureau of Safety Program. Safety
Study: Commercial Emergency Medical Service Helicopter Operations,
NTSB/SS-88/01, Washington, D.C. January 28, 1988.
6.
Aviation Safety Institute: Analysis of 84 Aeromedical Helicopter Accidents and Incidents
for the Period 1975-1986; December 3, 1986.
7.
National Transportation Safety Board, Dodd, R.S. : Safety Study: Commercial
Emergency Medical Service Helicopter Operations. U.S. Department of Commerce,
National Technical Information Service. January, 1 988; Report #NTSB/SS-88/01.
8.
National Transportation Safety Board, Bureau of Safety Program. Safety Study:
Commercial Emergency Medical Service Helicopter Operations, NTSB/SS-8801
Washington, D.C. January 28, 1988.
19
,
9.
Association of Air Medical Services: Air Medical Safety Congress Proceedings and
Recommendations. Recommendation: Protective Clothing. 12.1-12.1, 1992.
10.
ASHBEAMS: Interim Safety Guidelines, developed in conjunction with NFNA, NFPA,
and HAl/EMS Committee. 1987.
11.
Shanahan, D. R., Shanahan, MO.: Injury in U. DS. Army Helicopter Crashes, October,
1979-September, 1985. J. Trauma 1989; 29 (4):415-423
12.
Analysis of U. S. Army HelicopterAccidents to Define Impact Injury Problems. Paper
published by NATO/AGARD Conference on ImpactAcceleration, June 1971.
I 3.
Crowley JS: Should Helicopter Frequent Flyers Wear Head Protection? A Study of
Helmet Effectiveness. J. 0cc. Med. 1991:33 (7):766-769.
14.
Reading, T.E., et al. SPH-4, U.S. Army Flight Helmet Performance 1972-1983, USAARL
Report No
85-1 I -31 November, 1984.
,
,
I 5.
Dodd, R. S. : The Cost-Effectiveness of Air Medical Helicopter Crash Survival
Enhancements. An Evaluation of the Cost, Benefits and Effectiveness of Injury
Prevention Interventions Air Medical Journal. 13 (7): 281-96, July, 1994.
16.
Coleman, J. W., Akif, 0. B., Laananen D, Simula, Inc.: Analysis of Rotorcraft Crash
Dynamics for Development of Improved Crashworthiness Design Criteria: Sponsored by
FAA Technical Center, Final Report June 1985:DOT/FAA/CT-85/11.
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& CORE Industry Safety Committee
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17.
Albright, J.D., Et al. The Testing ofThermal Protective Clothing in a Reproducible Fuel Fire
Environment, a Feasibility Study. USAARL Report No. 71-24: 1-15, June 1971.
References (cont.)
18.
Ripple, G. R.; Torrington, K. G.; Phillips, Y.Y.: Predictive Criteria For Burns From Brief
Thermal Exposures. J. 0cc. Med. 1990:32(3):215-219.
I 9.
National Flight Nurses Association Position Statement: “Improving Safety in the Air
Medical HelicopterEnvironment” Issue 1, 1998.
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20
20.
21
Know, F. S. Ill, et al: Engineering Test of Lightweight Underwear of the Winter Flight
Clothing Systems Thermal Protection. USAARL Report No 71-19: 1-31, June 1971.
.
Neilson G: Safety in a Flash. E.l.duPont de Nemours & Co., Wilmington, DE.
22.
Knox F S. Ill, et al: Bioassay ofThermal Protection Afforded by Candidate Flight Suit
Fabrics. Aviat Space Environ. Med. 50 (10): 1023-1030, 1979.
23.
Knox F. S. Ill, et al: Evaluation of Four Thermally Protective Fabrics Using the
USAARL Bioassay
Method, USAARL Report No. 78-9:1-19, June 1978.
24.
Ripple. G.R., Torrington, K. G. Phillips Y.Y.: Predictive Criteria For Burns From Brief
Thermal Exposures. J. 0cc. Med 1990; 32 (3) 215-219.
25.
Flight Med Archive: Tuesday, 09 March 1999.
26.
Presentation by crew member from team in one of the Carolinas had a crash just 100
yards from an interstate, but could not summon help. Left hanging upside-down in a tree
for numerous hours.
27.
Flight Med Archive: Tuesday, 09 March 1999.
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2000
Bibliography
Analysis of U. S. Army Helicopters Accidents to Define Impact Injury Problems. Paper published
by NATO/AGARD Conference on ImpactAcceleration, June 1971.
CAMTS. Commission on Accreditation of Medical Transport Systems. Accreditation Standards.
3rd edition, 1997.
Carolina Air Care Task Force. Program Safety Review of Carolina Air Care, The North Carolina
Memorial Hospital, Chapel Hill, NC, January 1987.
Collett, HM: Aeromedical Accident Trends. Hospital Aviation 6:2-6-7/
Collett HM: Air Medical Accident Rates. Journal ofAirMedical Transport 1991; 10(2): 14-15.
Crash Survival Design Guide. USAAVI.ARS. Technical report 67-22, U. S. Army Aviation
Material Lab. Fr. Eustis, Virginia, August, 1967, updated in 1971.
Crashworthiness vs. Cost: A Study of Army Rotary Wing Aircraft Accidents in Period January
1970
through December 1 971 Paper presented at Aircraft Crashworthiness Symposium. University
of
Cincinnati, Ohio, 6-8 October, 1975.
.
Crowley J. S. Lucina, JR, Bruckart JE: Flight Helmets: How They Work and Why You Should
Wear One. Journal ofAir Medical Transport I 992; 1 1 (8): 1 9-23, 26.
Dodd, R.S.: EMS Helicopter Safety Revisited. HospitalAviation 1989; 1:6-8.
“General Accident Investigation”. In Aircraft Crashworthiness. Saczalski et al (editors),
University of Virginia Press (1975).
Harvey, D: Do the Pilots Have the Answers to EMS Safety? Rotor and Wing 15 December,
1980.
Helmet Design Criteria for Improved Crash Survival. USAAVLAHSTR 65-44, U. S. Army
Aviation Material Lab., Ft. Eustis, Virginia, 1966.
Oleske, D.M., Hahn, JJ. Leibold, M. Work-related Injuries to the Foot. (Data from an
occupational injury/illness surveillance system). J. 0cc Med. 1992,34(6): 650-655.
22
“Patterns of Injury in Fatal Aircraft Accidents” Aerospace Pathology, Reals and Mason (editors).
College ofAmerican Pathologists Foundation (1973), pp. 170-176.
,
Preston, N. Air Medical Helicopter Accident Rates. Journal of Air Medical Transport 1992 11(2):
14-16.
Shanahan, Jim. L.: Basilar Skull Fracture in U. S. Army Aircraft Accidents. Aviat. Space Environ.
Med. 54(7)628-631. 1083.
Wright, D.: Safety Management vs. Picking Leaves. Journal of Air Medical Transport 1991;
10(9) 11-2.
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Wright D.; Einhorn, T: The Final Authority: Hospital Aviation 5:10:36. October, 1986.
23
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FLIGHT CREW REFUSAL TO PARTICIPATE IN A FLIGHT AS A RESULT OF
CONCERN FOR PERSONAL SAFETY
Background:
According to the Federal Aviation Regulation 91 .3a, “The pilot in command of an aircraft is
directly responsible for, and is the final authority as to, the operation of that aircraft” (1). Within
the air medical transport industry, the pilot in command is responsible for his/her decision to
accept a flight request and to continue or terminate the flight. Nobody should not be allowed to
influence the pilot to accept or continue a flight when the PlC does not believe that continuing
the flight is the safe thing to do.
Recommendations:
24
The Association of Air Medical Services and the CORE Industry Safety Committee believe that
the personal safety of all flight team members would be enhanced if:
Each program leadership team demonstrated their commitment to these principles by
implementing a policy describing the flight team members’ responsibility to cancel a flight for
reason of concern for personal safety.
The policy would define acceptable reasons for refusal to participate. The policy would include a
reporting mechanism for such events.
The outcome of such refusal and reporting would include an action plan to prevent future
occurrences.
Association Position:
The medical team members have a responsibility to ensure their own safety as well as that of
the patient. For these reasons, the medical team members have the right and responsibility to
refuse to participate in a flight and to cancel a flight if there is concern for personal safety.
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Association of Air Medical
Services & CORE Industry Safety
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Safety Position Paper
2000
Reference
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1.
Section 91 .3a of Federal Aviation Regulations (FAR).
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Association ofAir Medical
Services & CORE Industry Safety
Committee
Safety Position Paper
2000
SPECIAL PROGRAMS DESIGNED TO IMPROVE THE FLIGHT TEAM
MEMBERS’
PHYSICAL AND MENTAL WELL BEING
Background:
The eight classic stresses of flight as described by the US Air Force (1 ) are discussed as part
of flight physiology, a required topic of study for aviators and flight team members. Mitchell (2)
describes emergency service stress as common to the rescue. Chronic stress or cumulative
stress may be overlooked and in the end, be more destructive than an acute stress reaction
because it is often unrecognized and thus not addressed. Excessive suppression of emotions
can lead to post Traumatic Stress Disorder (PTSD).
In addition, it is well described in the literature that improved physical fitness and physical well
being reduces the level of stress and decreases the likelihood of n individual being involved in
an accident.
Recommendations:
Each air medical transport program develops formalized physical fitness programs, stress
management programs and Critical Incident Stress Management interventions.
Program mangers should be knowledgeable regarding the signs and symptoms of stress and
factors leading to critical incident stress.
Air Medical Programs should have policies and procedures in place identifying the resources
available for air medical crews to access CISD, or other psychological counseling following a
critical event. Policies should support the flight team member’s ability to take themselves out of
service until the stress response can be mitigated.
CISM should be part of every flight team member’s basic curriculum of study.
Association Position:
The Association of Air medical Services and the CORE Industry Safety Committee believes that
safety can be enhanced through improved flight team members’ performance and job
satisfaction.
• Air medical programs should have a policy and procedure addressing a crewmembers
access to Critical Incident Stress Management (CISM). If the psychological impact of the
event poses the risk of impairing safe decision making, the crewmember should be removed
from duty.
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Association of Air Medical
Services & CORE Industry Safety
Committee
Safety Position Paper
2000
References
1.
United States Air Force of Aerospace Medicine: Flight nurse handouts, June 1995.
2.
Mitchell, J., Bray, G. (1990), Emergency Services Stress, guidelines for preserving the
health and careers of emergency services personnel. Englewood Cliffs, NJ: Prentice
Hall.
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Association ofAir Medical
Services & CORE Industry Safety
Committee
Safety Position Paper
2000
THE ROLE OF THE COMMUNICATIONS CENTER IN ENHANCING AIR
MEDICAL
SAFETY
Background:
Several areas of the communication specialists’ duties and responsibilities have a direct role in
enhancing safety.
Recommendations:
The following have a direct role in enhancing safety and outlines items that communication
centers should put into place.
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Training: Training must include all program specific policies and procedures, job expectations,
standards, and duties and responsibilities. A formal training program should be developed and
followed to ensure that all new hires are given consistent information. Specific items that must
be covered in orientation are:
Post Accident/Incident Planning
Flight Following (Related to FAR 135 requirements)
Weather
Map Reading
Landing Zone Preparation
Navigational Aids
Stress Management
Radio Skills
Additional Training: It is recommended that all communication specialists take.
The National Association of Air Medical Communication Specialists Training Class. This all
inclusive class is the most comprehensive training tool available for new staff.
16 hours of Continuing Education Units (CEU’s) should be completed each calendar year by all
communication specialists. These CEU’s should include job specific areas and training.
Post Accident Incident Drills. Biannual PAIP drills should be conducted and debriefed with all
program members for performance improvement and lessons learned.
Commission on Accreditation of Medical Transport Systems (CAMTS). It is recommended that
all air medical communication centers adopt the CAMTS standards for communication centers.
This will help ensure a quality communication center is in place.
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Association of Air Medical
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Safety Position Paper
2000
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Procedures: The following procedures must be developed and readily available in the
communication center:
Post Accident Incident Plan (Which Includes)
Precautionary Landing due to Patient Condition
Precautionary Landing due to Weather or Mechanical Conditions
Missing or Overdue Aircraft
MayDay
Post Accident/Incident
Lost Communications
Equipment Failure Procedures. This procedure must include trouble- shooting procedures for
each piece of equipment, emergency procedures for working without the particular item, and the
procedure for getting the equipment repaired.
Flight Following. The flight following procedure must be in writing and should require the
communication specialist to physically plot the aircraft’s flight progress on an area map. If other
systems are used to monitor and track flight progress, these too must be of demonstrated
proficiency.
Schedules: Communication Specialist’s should be scheduled on the console for a maximum of
12 hours per day. Unlike pilots and flight crew members, the communication specialist cannot
sleep during duty time. On rare occasions 16-hour shifts are acceptable for coverage of sick
call. A minimum of 8 hours between shifts for rest is also highly recommended.
Breaks: Staff should be given beaks away from the console. lfthe program’s staffing consists
ofjust one communication specialist, the relief person should be equally trained. Breaks should
always be delayed when the aircraft is in the air. Meals should be allowed at the console if an
unpaid lunch break is the policy.
Equipment and Resources: The following equipment and resources must be present in the
communication center.
Audio Recorder with auto playback capabilities.
2-way~adio system.
Service area maps.
Emergency Phone Lists
Post Accident/Incident Plan Manual.
List of all serviced hospitals including landing site information and telephone numbers
Committee Participation: A communication specialist should be included on the Safety and
Quality committees.
Communication Center Layout: Some things to consider when building or remodeling the
communication center:
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Restrooms should be located in close proximity to the communication center.
Carpeting should be used on the floor to absorb sound and reduce slipping.
Ergonomic seating and console designs should be used to reduce discomfort and personal
injury.
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