Recommended Practice (Final) September 1, 2004 RP2-Discourage user of Launch Times as Competitive Tool   In April 2000, the FAA came to the air medical community, via the Association of Air Medical Services, and asked us what we were going to do about rising EMS accident rates in recent years. AAMS responded by organizing a summit meeting of key players from industry, programs, professional organizations, hospitals, pilots, and crewmembers interested in participating. There were several important actions that came from that summit. One of the key actions was the formation of the Air Medical Safety Advisory Committee (AMSAC). We had seen the need for Part 135 operators, professional organizations, government, and industry representatives to meet regularly to discuss critical safety issues and propose solutions. Part 135 operators wanted and needed to be involved since they are directly responsible for the aviation operations in the community. This group was based on the Helicopter Safety Advisory Committee (HSAC). The HSAC, formed by Gulf of Mexico helicopter operators, had successfully tackled critical safety issues and built an effective organization for collectively dealing with common operational challenges in that setting. It was felt that such an organization in the air medical community would be able to speak with a unified voice across real or perceived competitive borders and propose joint solutions to safety concerns. Part 135 Operators, AAMS, NEMSPA, ASTNA, FAA, NASA, insurance and industry representatives have been regular attendees at these productive forums. The AMSAC is alive and well and meeting at least twice a year.   The AMSAC is evolving into an effective forum for discussing and acting upon the air medical community’s safety concerns. Such “meaty” issues as flight and duty time, mechanic duty time, minimum flight time standards, fatigue countermeasures, Air Medical Resource Management (formerly CRM), industry data collection, accident/incident reporting, sharing critical maintenance information, pilot and crew member duty day, competition and more. When a consensus has been reached on an issue, the AMSAC will propose a recommended practice for the air medical community to follow. This recommendation will also be presented to the National EMS Operators Executive Forum, also formed as a result of the 2000 Summit, for “buy in” and action at the CEO level. The AMSAC may also propose to CAMTS that some of these recommended practices be incorporated into the accreditation process. Part 135 EMS Operators and others are encouraged and welcome to join.   A major concern of the AMSAC is the effect of competition on programs. Competition creates pressures on a safety culture and can push pilots and crewmembers into unsafe or marginal decision-making. The AMSAC is concerned about competition’s undue pressures on response and/or lift off times. All of the AMSAC members view this issue with serious concern. The continuing, and in some areas, mounting pressure to decrease EMS Helicopter response times by compressing liftoff times is viewed as an increasing safety hazard.   As an air medical community, we realize the value that healthy competition provides. It helps us all remain on the cutting edge and provide the best service possible. There are many areas where the competition is healthy; we do not believe that lift off is one of those areas.   The fact that crews feel that their lift off times affect the overall perception of their job performance imparts extra stress in this critical phase of the flight. A five-minute lift off requirement is three hundred seconds from notification to airborne. If the average single-engine aircraft requires one hundred and eighty seconds for start and all appropriate systems to be ready for take off and the aircrew took sixty seconds to reach the aircraft and strap in, there are sixty seconds of free time left for any other preflight requirements to be accomplished. This might be an unrealistic objective.   The fact that our customers believe that lift off times is an appropriate arena for competition may be our own fault. As providers of aviation services, we may not have made a clear enough case for the complexity involved in launching an aircraft. It is not turn the key, hit the siren, lights, and go, and it will never be that simple. There is certainly a reasonable body of anecdotal evidence at each vendor of the costs incurred by going fast rather than going smart. Aircraft have been damaged, ground equipment has been damaged, and personnel have been injured.   We believe that this “hurry-up” mindset needs to be changed, an appropriate standard needs to be established at each program level and maintained and that we need buy in from AAMS and CAMTS and the rest of the industry. In our opinion this can be done but like many safety improvements, it must be sold because it cannot be driven to the industry as a whole.   If a program wishes to develop an appropriate standard that can be quantified for CQI reasons, we recommend that a “real life” procedure be used to determine this standard: Discuss the process with the program site manager and/or Part 135 Chief Pilot. Locate all crewmembers and pilot(s) in the location(s) where they are allowed to be during their shift. This could be in the ICU, the ED, the cafeteria, or quarters. Time their response times, at a fast walk, from the flight request to alert tones-- to actual launch from various locations at different times of the day or night. In this timed process, each crewmember and pilot must perform ALL of the required steps and safety actions that they MUST do. This includes, but is not limited to, all preflight actions, weather check, ATC actions, walk around, aircraft and equipment checks, and all aircraft or crew check list actions. Repeat this procedure with several pilot and crew configurations and come up with a “standard”. This standard can be the “ideal day or night” standard will not account for adverse weather, ATC delays, equipment issues and other predictable or unseen delays. We recommend that programs focus on a timely and performance based response criteria rather than an arbitrary time figure. It should be emphasized to the pilots and flight crews that these critical steps are not to be omitted on a real call. If a preflight or launch task is critical, it is always critical—not just during trial runs. Realistic standards also re-emphasize and re-enforce a program’s safety culture.   We are not aware of any data that indicates saving one or two minutes improves mortality and morbidity statistics for patients flown by EMS helicopter crews. There is far too much information that indicates taking off with shore power attached or a rotor blade tied down is bad for our well-being and costly.   The AMSAC welcomes the entire air medical community’s input on this or other safety issues. Comments or concerns can be made directly on the AMSAC web site (http://www.amsac.org)     Recommended Practices are published under the direction of the Air Medical Safety Advisory Council (AMSAC). RPs are a medium for discussion of aviation and medical operational safety pertinent to the Air Medical Community. RPs are not intended to replace corporate judgment, Federal Aviation Regulations, Company Operations Manuals, or Organizational SOPs. Suggestions for subject matter are cordially invited.   back