Civilian helicopter emergency medical services (HEMS) in Norway have a long tradition using a multi-crew concept of operations compromising a single pilot with a HEMS technical crew member (HCM). In recent years, the Norwegian service has improved its low level instrument flight rules (IFR) route network consisting of Required Navigation Performance (RNP) 0.3 for all phases of flight, standard instrument departures, transitions and Localizer Performance with Vertical Guidance (LPV) / Lateral Navigation (LNAV) approaches. The main reason for the IFR expansion is to increase safety by avoiding flights in marginal visual flight rules (VFR) and regularity when VFR, even at HEMS operating minima, is not an option. Today, HEMS in Norway has more IFR destinations than the national fixed-wing network. These improvements are possible both thanks to enhanced autopilot technology, and the training and competence of the crew.

Workload

An increased focus on instrument flying also raises the question whether the single pilot with an HCM crewing system in Norway is getting too complex. Will HCMs be able to cope with the increased workload related to their flight tasks in the cockpit? What implications can this have for their other work-related tasks, concerning both medical and rescue technical procedures? These are legitimate questions, as there is a balance as to how many different tasks a crew member can sufficiently handle. Another issue that contributes to the complexity of the operation is that the Norwegian Air Ambulance operates helicopters with different designs and layouts, such as the Airbus H135 T3H and H145 (D2 and D3), as well as the Leonardo AW139. All crew members serving on the AW139 are also qualified and proficient on the H145, serving as a backup for the AW139. The difference in autopilot and cockpit layout between these two manufacturers adds to the overall workload for both the pilots and HCMs.

There is a balance as to how many different tasks a crew member can sufficiently handle

Pilot incapacitation

One well-known hazard during single pilot operations is pilot incapacitation. Even though the probability of this hazard is extremely low, the consequences may be catastrophic as there are no redundant barriers when the pilot is unable to fly the helicopter. The logical step is how to manage this hazard in the best possible way.

Some single pilot operators have implemented emergency checklists for the medical passenger or flight assistant to mitigate this hazard and, recently, MedTrans published a checklist where a flight paramedic can use the autopilot to gain control of the helicopter and aid the incapacitated pilot.

Checklist

The safety ambition is that single pilot with HCM operations should have the equal level of safety as multi-pilot

The project incorporated measuring the workload and stress of the HCMs in a full flight simulator during instrument meteorological conditions

operations. This requires an organization that is willing to adapt and adjust the system to new demands, technology, rules, and other relevant issues. In 2020, a project was started in Norwegian Air Ambulance that intended to explore how the service could both mitigate the risks associated with pilot incapacitation and, while doing this, also improve the HCMs’ understanding of the helicopter’s autopilot technology. The latter may help the HCMs’ performance assisting the pilots in everyday HEMS flight tasks. The project incorporated measuring the workload and stress of the HCMs in a full flight simulator during instrument meteorological conditions (IMC). The authors developed an HCM emergency checklist using the autopilot to safely get the helicopter on the ground in both visual meteorological conditions (VMC) and IMC (Figures 1 and 2). The emergency checklist was validated in 2021 in a full flight simulator by testing HCMs in a single pilot incapacitation scenario. One control group operated without the newly developed checklist and one intervention group managed the emergency by using the new checklist. The results were convincing and showed that the HCMs who used the emergency checklist had significantly fewer human errors when compared with the control group. The stress level and workload also seemed to decrease with a standardized checklist.

Validation

After the preliminary validation of the checklist, the decision was made to train all the HCMs in using the emergency checklist for the H135 T3H and H145 during 2022. The training comprised a pre-study package with e-learning that included both theory and videos of the procedure, a theoretical session with an instructor, and a practical training session in a full flight simulator (Figure 3). When all the HCMs had completed the emergency checklist training for the Airbus helicopters, the next challenge is to adjust the checklist for the AW139. A draft was developed and is currently being tested in a full flight simulator with good results.

The checklist has been well accepted among both the pilots and HCMs, but one concern during the project was if this newly developed checklist would lead to the pilots and HCMs independently training on pilot incapacitation scenarios during regular HEMS duty. A statement has been issued by the flight operations manager that training on the emergency procedure is only allowed during organized training with an instructor.

Our experience indicates that HCMs are becoming more proficient and confident in their flight operational tasks

Our experience from implementing a standardized emergency checklist and training for the HCM is the concern that operations with a single pilot and an HCM may be too complex is not warranted. On the contrary, our experience indicates that HCMs are becoming more proficient and confident in their flight operational tasks.

Thanks to the dedicated organization and all the competent crew members for making this safety improvement possible.