Original incident report from the CONCERN Network

At approximately 16:28 hrs CDT, on 12 January 2018, an Air Evac Lifeteam flight crew was transporting a patient from a scene flight when the pilot suffered a medical emergency that impaired his ability to operate the aircraft. The pilot had engaged the stability augmentation system and autopilot systems (HeliSAS) after departure from the scene and moments later stopped responding to the medical crew over the ICS. 

After several attempts to elicit a response from the pilot, the flight paramedic accessed the cockpit and assisted the pilot, who landed the aircraft safely in a rice field while the flight nurse contacted the company’s operations control center. The flight paramedic and nurse performed an emergency shutdown of the aircraft and removed the pilot. Additional resources were dispatched to transport the patient and the pilot to appropriate medical facilities.

Action taken

Following the incident, Air Evac Lifeteam is now developing revised cockpit orientation and HeliSAS autopilot familiarisation training for medical crew members, and additional procedural guidance for use by company operations control specialists during in-flight emergencies is being developed.

a thorough review of this event was conducted and additional training has been developed and tested in our in-house simulators that increases the medical crew members’ awareness and understanding of the Autopilot/Stability Augmentation System (SAS) platform

Tom Baldwin, the company’s Director of Safety, explained in more detail the training that crew members will undergo: “All company medical crew members receive both initial and recurrent training relevant to their duties on and around the aircraft. This training covers a series of modules that includes in-flight emergency procedures, Air Medical Resource Management (AMRM), aircraft performance and limitations, fuelling operations, survival training, and hot and cold climate operations.” He then went on to share more information about what the company has done to take action following the incident in January: “In accordance with our SMS, a thorough review of this event was conducted and additional training has been developed and tested in our in-house simulators that increases the medical crew members’ awareness and understanding of the Autopilot/Stability Augmentation System (SAS) platform.

Working in conjunction with our operations control center, this training allows a medical crew member to quickly determine the status of the Autopilot/SAS and establish an approach to the closest airport if necessary.”

Industry opinion

AirMed&Rescue spoke to Stacy Fiscus, NRP, CCP-C, FP-C, MTSP-C, who currently works on an air ambulance helicopter in Haiti, about her experience as a flight medic with regards to how much she knows about the aircraft on which she flies. “Personally,” she said, “I’ve been given very little training in regard to operating a helicopter other than how to perform an emergency shutdown while it is on the ground.” While this may be the industry standard, there are exceptions. “There are some public service programmes that allow for the medical crew members to have more advanced aviation training, which allows them to land the aircraft on a set of dual controls in the event of an emergency or act as a pseudo second-in-command as far as navigation and radios go. Once, I even visited a programme that offered pilot training to its medics, but this is rare,” she added.

Baldwin of Air Evac Lifeteam is not aware of any US operators that offer to train their medical crews as pilots.

However, in a single engine, single pilot helicopter not configured for dual operations, such training would be moot anyway, as the medical crew member would likely not be able to just slip into the pilot’s seat. Fiscus points out: “If, due to the incapacitation of the pilot, the helicopter became unstable it would be that much harder, if not impossible, to even get a hand on the cyclic and collective, let alone the pedals.”

Training is always a good thing; but for now, staying in our own lanes and mastering our own trades while learning to bring it all together as a team is one of the most important things we can do

Are medics better off just doing what they should do, then, instead of trying to fly the helicopter? Maybe. They could try to treat the pilot, getting them into a state of health whereby they are able to safely land the helicopter, and then the medics can perform an emergency shutdown. Fiscus said: “Training is always a good thing; but for now, staying in our own lanes and mastering our own trades while learning to bring it all together as a team is one of the most important things we can do

Fiscus also noted a trend towards better aviation terminology knowledge and education efforts, related to other safety movements. She added: “I think medical crews are asking more questions of their pilots and pilots are taking an active role in ensuring they understand their responsibilities in the aircraft. Stateside, associations like NEMSPA and AAMS are ensuring there is more aviation-related safety training at national conferences and available online to anyone interested. So, while training on the rare instance of operating an aircraft for an incapacitated pilot may not be occurring, I think safety training and general aviation awareness has increased exponentially.”

A prime example of flight and medical crews working together in an emergency was exemplified by another CONCERN Network report early this year, in which a US-based medevac company reported that a paramedic assisted a pilot in reviewing the aircraft emergency checklist when the #2 Engine Chip Light illuminated; the pilot landed the aircraft without an issue, but the paramedic did state that it was difficult to locate the emergency procedure in the checklist. The operator, in its ‘after-action items’ report, noted: “The pilot handing a clinical team member the aircraft checklist is probably a foreign process. In an emergency, we know we should use all resources when necessary. We are exploring and discussing future education for team members regarding the use of checklists as well as other situational awareness items in the aircraft. The entire process worked very well with all involved, as did the communication among disciplines – great AMRM. This is a testament to processes, training, and education.”

Safety first

There is little doubt – thankfully – that flying in an air ambulance has become safer in the last decade. It’s a risky business, but through a combination of regulation and independent industry efforts, the number of crashes involving air ambulances has dropped significantly. This shouldn’t mean, though, that there should be any kind of complacency. Education of the flight medics about the workings of the helicopters on which they are placed could save their own lives, and those of the pilots and patients onboard. A little bit of knowledge can go a long way.

Keeping an eye on pilot health

For US part 135 air medical operations the Federal Aviation Administration requires an annual class II flight physical. Tom Baldwin told AirMed&Rescue: “In addition, all of our employees are given the opportunity to undergo a biometric screening annually. If they do so, they increase their short-term disability coverage from 50 to 70 per cent. This screening includes a variety of medical tests. While the company does not have access to the results of these screenings, the employees do, and may choose to follow up with their personal doctors to correct potential health issues.”