Publication

JAN.-MAR. 2015
SafetyMatters
America’s Medical Transportation Safety Newsletter
A quarterly, collaborative publication
from MedFlight and HealthNet
Aeromedical Services
Association of
Air Medical Services
Welcome AAMS Members!
SafetyMatters is published collaboratively on a
quarterly basis by MedFlight, based in Columbus,
Ohio, and HealthNet Aeromedical Services, based in
Charleston, West Virginia.
These not-for-profit programs operate the nation’s
only jointly sponsored air medical helicopter base
and have fully integrated the safety programs of their
respective systems.
SafetyMatters is just one example of the MedFlight/
HealthNet Aeromedical Services partnership.
THIS ISSUE INCLUDES:
• Considerations for Selecting
and Using Aviation Life Support
Equipment (ALSE)
• The Dreaded Ground Trip
Considerations for
Selecting and Using Aviation Life
Support Equipment (ALSE)
Dudley Crosson, PhD
Delta P, Inc.
Introduction
This is the second part of a 2-part paper on Aviation Life Support Equipment (ALSE). Hopefully you had
a chance to read the first one that focused on helmets. As a continuation, let me share the introductory
remarks from the previous paper.
Wearing the proper flight gear during flight is critical for the safety of crewmembers. While it can be
argued that the absolute necessity of wearing a helmet, flight suit, proper boots and gloves all of the
time is unnecessary, it is for that one time (that hopefully never happens to anyone) when the aircraft
unexpectedly goes down. That is when all of this equipment’s value may come into play. Essentially it is
insurance, as are your automobile seat belts. Crash investigators often hear from crash survivors that they
are able to speak to us singularly because they were wearing their ALSE. The FAA does not mandate use,
but for survivability in numerous cases, this is not an option, it is an imperative and should be considered
an industry standard.
This paper focuses on flight suits, underwear, gloves and boots.
Flight Suits
It would be safe to say that flight suits are probably the most visible of items along with the crewmembers’
helmets. It is unique and if a helmet in not being worn at the time, such as around the hangar, it is the one
piece of ALSE that indicates the person is a crewmember. The proper use of one, however, seems to be
lost on some people. It is absolutely critical that the flight suit fit properly. Far too often flight suits are too
Continued next page >
• Air Ambulance Accidents 2014
• Providing Safe Medical
Transportation Solutions
Considerations for Selecting and Using Aviation
Life Support Equipment (ALSE) Continued
tight; they are meant to be loose fitting. This
is based on the "Thermos Bottle Principle’". In
other words, it is based on layers of material
and air. The flight suit makes up the outer
layer, then there must be a layer of air. The
next layer of material will be the underwear
(to be discussed next), then another layer of
air. This layering is what protects the individual
from the thermal attack. Remember, flight
suits are NOT meant to fight the fires, merely
to protect the crewmember for a short period
of time in order to quickly egress the aircraft.
First, let us consider the material. In talking
with several individuals in the air ambulance
community, it is apparent there is a great
deal of confusion as to the types of material
available and what needs to be worn. As a
top-level review, we will take a look at what is
available.
Traditional Synthetic Fiber
These are the man-made fibers that have
been produced over the years to improve on
naturally-occurring animal and plant fibers.
Before synthetic fibers were developed, fibers were made from plants that
were called cellulose fibers.
Synthetic fibers are made from synthesized polymers or small molecules.
The compounds that are used to make these fibers come from raw materials
such as petroleum-based chemicals or petrochemicals. Just from this it
becomes obvious why these types of fibers should not be used for flight
suits. Differing chemical compounds will be used to produce different types
of fibers.
Examples of synthetic fibers would be nylon, rayon, polyester and spandex.
A major disadvantage of these fibers is their low melting temperature. As the
product melts, it sticks to the body. Think of it as shrink wrap…it melts and
adheres to the body. This is not the material one wants to wear in a postcrash fire.
Natural Fiber
From an aviation perspective, natural fibers are normally animal hair, cotton,
leather and/or silk.
Animal hair is essentially fiber or wool taken from animals or hairy mammals,
e.g., sheep's wool, goat hair (cashmere, mohair), alpaca hair, horse hair, etc.
Cotton is a fiber that grows in a boll, or protective capsule, around the
seeds of cotton. The fiber is almost pure cellulose.
Leather is a durable and flexible material created by the tanning of animal
rawhide and skin, often cattle hide.
Silk fiber is produced through secretions from glands of insects during the
preparation of cocoons.
The main characteristic with these, as related to protection, is they will burn
for a short time, but will not melt.
Aramid Fiber
While aramid fiber is also synthetic, it was developed specifically to be fire
resistant (FR). By far, the most common is Nomex®. This material will not melt
or sustain a flame. While Nomex is the most common, it is not the only FR
material that can be used.
Certainly we can all accept the fact that it is best to have FR material for
our flight equipment. This means that the material is totally or almost totally
unburnable.
Nomex is the standard partly because of longevity and partly because it is
the most fire resistant (FR) fabric. It is a very tough fabric, lasts a long time, and
was developed by DuPont®. The big disadvantages of Nomex are that it fades
in UV light, doesn’t breathe, and doesn’t wick moisture as well as people
would like. Nomex is inherently fire resistant and is a relatively chemically-inert
fabric. Because it is relatively inert, it doesn’t dye well. The dye coats the
fiber more than it reacts chemically with the fiber. Nomex products are sold by
several companies.
The one new fabric that is making inroads into the FR clothing business is
modacrylic. The military uses modacrylic for its two-piece flight suit and for
some ground crew clothing. It is comfortable, breathable, wicks moisture,
and is nearly as fire resistant as Nomex. Modacrylic also does not fade in UV
light. DuPont claims superior fire resistance for Nomex, but it appears the
difference is not significant. TenCate, SSM Industries, and Springfield all make
modacrylic fabrics.
Now that we have established the need for the flight suit, the materials to
use, and the concept of how it protects, let us look at how it should be worn.
The idea of the flight suit is to provide maximum coverage in order to provide
maximum protection. So remember, long sleeve with sleeves down, and the
collar up in order to protect the neck. Think of it this way…whatever is not
covered could be at risk for being exposed to the flame. Along with this, there
should be no metal on the flight suit. This could not only puncture the suit and
injure the wearer on impact, but could melt and compromise the integrity of
the flight suit.
Undergarments/Socks
It is not wise to go commando! Undergarments should always be worn.
Earlier we discussed various materials. In this case, any of the natural fibers
or FR materials are acceptable. A good place to look for FR underwear is on
a NASCAR website. Everything the drivers wear is FR. One can also check
military clothing sights and look for Fire Resistant Operational Gear (FROG).
Due to the Improvised Explosive Devices in the Middle East, the United States
Marine Corps has gone all FR clothing in the field.
The main thing to remember when dressing is to ensure the shirt is tucked
into the pants. Never should there be any elastic material touching the skin.
In the case of bras, it is advisable to wear jogging bras since they provide
material over the elastic.
Gloves
In the case of gloves, it is essentially the same as the flight suit. Most
individuals use Nomex gloves, but
NASCAR websites provide a wide
selection.
When
wearing
gloves,
remember to tuck them in under the
flight sleeve, and Velcro® the sleeve. Again, it is all about coverage.
Boots
The function of the boots is to provide stability and protection of the feet
and ankles both during normal operations and egressing a burning aircraft.
Boots generate some interesting discussions. There are areas that everyone
Continued next page >
Considerations for Selecting and Using Aviation
Life Support Equipment (ALSE) Continued
agrees on, but there are a couple that can be contentious. For example, do
they need to be all leather (remember natural fibers)? The answer is, what is
the company policy? There are boots available that are flight approved that
are a combination of leather and FR material, the largest selection of tested/
approved boots are manufactured by Belleville.
Once we decide on the material of the boot, the next area of contention
is the use of a zipper. At this time, there are NO flight-approved boots with
zippers. This is due to the fact that none have ever been tested. The U.S.
military provides all testing, and they do not allow zippers. Would they be
adequate? The argument suggests that, like the flight suit, the boots are not
meant to fight fires, merely to rapidly egress. It is understood that the zippers
would eventually melt, but would they not last long enough to egress the
aircraft? The bottom line is, if the company requires flight-approved boots,
then zippers are not an option.
Beyond these points, most people agree on
the characteristics for boots. The main ones are:
• Boots should be at least 8” high and have a
good overlap by the flight suit
• Have a strong FR retention system (yes, the
laces should be FR)
• Need to be laced to top for support
Summary
Hopefully after reading this
paper there is a better understanding of the need for wearing
proper ALSE. Perhaps this has
raised questions…it is certainly
encouraged to research the products. But when considering flight
gear:
Flight Suits
• Always worn
• FR material
• Sleeves down
• Collar up
• No metal on flight suit
Underwear
• Always worn
• Natural fibers or FR material
• Shirt always tucked in (never
expose skin to the elastic
material)
Gloves
• Always worn
• FR material
• Tucked in under the flight suit
Boots
• Always worn
• Flight-approved
About the Author
Dudley Crosson is an Aeromedical
Safety Officer (AmSO) and the
Principal of Delta P, Inc. The focus of
Delta P is to increase the operational
efficiency and safety of the aircrew
and others participating in air operations in order to ensure "mission
completion" by providing aeromedical
consultation and identifying and
countering aeromedical threats facing
today's crewmembers. Dr. Crosson’s
PhD is in physiology and has
successfully completed the ERAU’s
Aviation Safety Management program
and the U.S. Navy’s Aviation Safety
Officer School. He is a member of
the CAMTS Aviation Safety Advisory
Board and the Aerospace Medical
Association’s
(AsMA)
Aviation
Safety Committee. Along with Delta
P he is the Aeromedical Liaison
for the Airborne Law Enforcement
Association and an Affiliate Professor
at the University of Hawaii-Hilo.
Dr. Crosson can be reached at:
772-359-3680
[email protected]
http://delta-p.com
The Dreaded
Ground Trip
By Jeff White, BA
Director of Safety
HealthNet Aeromedical Services
The Ground Risk Assessment Explained! In the past few years there has been much discussion across the country
about ground EMS safety and operations structure and where it is going.
With increased call volume, decreasing number of providers and Federal
reimbursement dropping, we are seeing changes that have begun to
significantly modify the structure we know. Our current thought process of the
“traditional” ground EMS model is changing by the month.
On a national level experts lament about how change should evolve and
work to identify the most economically feasible way to achieve this change.
The leading thought process of how this will all be accomplished was
published in an October 2013 article titled "The National Strategy for an EMS
Safety Culture." The article addresses everything from fitness, hiring exams to
shift schedules and risk assessments.
Air medical services are not completely immune to this issue. Many flight
programs maintain internal ground service, or contract with local agencies
to transport flight crews in times of inclement weather. The challenge then
becomes, how do we effectively manage the safety of a contract company?
How do we accurately assess the risk of a flight crew completing flight
missions, having the weather turn IFR and now have to complete missions
by ground? Within HealthNet Aeromedical Services we tackled these challenges headon. Admittedly, the trial run of this process did not work the way we had
intended. The initial assessment was a four question assessment that was
originally built for a strictly ground transport service completing interfacility
transfer missions. Quite honestly it was not an accurate representation of the
risk associated with a changing mission status (air to ground) and not really
meant for the geographic challenges that were faced in West Virginia. In conjunction with a colleague from Sanford Health in South Dakota the
Flight Team Ground Transport Risk Assessment was revised and reflects
a more accurate assessment and representation of risks associated with
transports in West Virginia and surrounding states.
The entire goal and purpose of the Ground Transport Risk Assessment is
not to say no to the transport, but to bring to the forefront any risks associated
with the transport. These risks are identified before the team responds,
allowing the team to mitigate them in advance. Flight Team Leaders are
there to help with this process by helping team members evaluate weather,
contact hospitals, make arrangements with the transporting agency, or
mitigate anything necessary to see that the transport is completed as safely
as possible. The new criterion consists of seven questions that are more suited to our
region. They also focus on specific situations of a crew on flight duty and
deteriorating weather impedes flight operations. Questions two through seven
are completed first and used to accept/mitigate risks for the trip followed by
question one when the transporting agency arrives. After completed the form
is submitted.
The following is the new criteria found on the HealthNet Aeromedical
Services Ground Transport Risk Assessment:
Question 1. Transport Team Fatigue. This question is to be answered once
contract transporting crew arrives, just prior to submitting the form. If the
crew score is either a three or five the Flight Team or Flight Team Leader may
Continued next page >
The Dreaded Ground Trip Continued
consider contacting the contract agency to request a less fatigued crew to
complete the transport or develop a safe mitigation plan.
Question 2. Severe Weather. This is for all seasons and as in the previous
form, there are several links to weather reporting and area traffic cameras to
obtain a real time assessment of weather in a particular area.
Question 3. Distance. This is the round trip transport distance calculated
from base or current location back to base.
Question 4. Time spent on transports during current shift. This question
pertains to time on previous ground transports or flights. How many hours
has the team spent in the truck/aircraft on transports? Time spent at base
does not apply here.
Question 5. Road Conditions. Road conditions for entire route. Looking
back at the weather section, the weather links have a route planner showing
weather for entire route and local traffic cameras provide real time information
on road conditions.
Question 6. Road Type. This takes into account two and four lane roads/
highways.
Question 7. Crew Fatigue. This question assesses the number of transports
completed in the current shift, as well as, how long after the current shift the
transport will extend an individual’s hours on duty.
If the assessments score between zero and thirty this is an acceptable
range. Any score over thirty requires Flight Team Leader approval. Comments
are documented in the comment section.
This has been a challenging road but we feel this is the right thing to do for
all team members involved. The national spotlight on this transport component
serves as a testament that everyone wants true continuity of care and a global
mindset of safety. This mindset focuses not only on the patient, but on those
providing the care as well.
This is the first proactive step of many in the plan for HealthNet Aeromedical
Services and we hope to continue leading the way to provide quality patient
care in the safest manner possible.
Air Ambulance Accidents 2014
Date
04/09/2014
Location
Albuquerque,
NM
Type
AS 350B3
Injuries
3 minor
05/04/2014
Hamburg, NY
BK117A4
3 uninjured
06/23/2014
Texarkana, TX
AS 350B2
4 uninjured
07/17/2014
Newkirk, NM
A 109E
3 fatal
08/27/2014
Las Cruces,
NM
CE 421C
4 fatal
10/04/2014
Wichita Falls,
TX
Bell 206L1
2 fatal
2 serious
Synopsis
Video from a security camera mounted on the hospital
helipad revealed that the helicopter began to yaw in a
counterclockwise direction as it lifted off the helipad. The
helicopter completed several rotations before it impacted
the roof top and came to rest adjacent the helipad.
Aircraft was substantially damaged while in cruise flight, after
a cabin door partially separated from the helicopter and
struck the main rotor blades.
Aircraft was substantially damaged following an
autorotation.
Aircraft collided with a mesa. A post impact fire ensued and
the helicopter was destroyed.
Aircraft was destroyed after impacting terrain during initial
climb. A post-accident review of refueling records and
interviews with line service technicians showed that the
airplane had been misfuelled with 40 gallons of Jet A fuel
instead of the required 100LL aviation gasoline.
Aircraft was destroyed by post-impact fire after it impacted
terrain while on approach to the United Regional Hospital
helipad. The pilot recalled the helicopter spinning at least five
times before impacting the ground.
Thoughts and prayers go out to the family and friends of those who have perished in these accidents.
Providing
Safe Medical
Transportation
Solutions
By Colin Henry
Vice President of Safety
MedFlight
Medical transportation can be performed by air and ground and is usually
based on what is best for a particular patient. Sometimes this becomes a
challenge when there is inclement weather and the most appropriate mode
of transportation is not possible. When this occurs solid contingency plans
must be in place with processes to safeguard against undue threats that are
required to be effectively managed. Listed below are some examples:
1. A patient needs to be transported from hospital A to hospital B
by helicopter. The closest helicopter service is called but the pilot in
command turns this request down due to reports of weather conditions
that are hazardous or below his/her company’s weather minimums. The
communications specialist inquires if another base/service may be able to
complete this request coming from a different area. If the answer is “yes” that
base may be called and given that request but the pilot in command that
turned down the request must be in communication with the newly requested
pilot and be working as a team to work on producing the safest possible
outcome for the patient and the crew. If the answer is “no” then there may be
a possible ground solution.
2. One possible ground solution may require use of a vetted ambulance
service with the base’s medical crewmembers providing medical care. When
this occurs, we must have the relevant processes in place and use them to be
able to conduct this exercise safely. For example, is your driver in a state of
alertness for this trip? Is his/her fatigue assessed? Is the ground transport risk
assessed? Is the vehicle equipped to perform the relevant patient care? For
example, is the oxygen adequate for the trip?
3. Another possible ground solution involves use of the company’s
ambulances. This still requires crews that are well rested to be able to perform
the task at hand. The trip also must be assessed for risk during the entire
transport. You may complete a risk assessment when the trip begins, but has
anything changed since then?
As a part of the decision-making process, it doesn’t matter if the patient
is being transported by air or ground, we
must continuously assess the risk of the
transport and the fatigue of our crewmembers in order to provide that safe
transport solution. There will be times when
both air or/and ground trips may have to be
delayed or cancelled in the interest of the
crewmembers’ or patient's safety.
Safety Communication
Contact Information
1. VP of Safety, Colin Henry
866-745-2445, 614-734-8047 or [email protected]
2. VP of Risk, Linda Hines
614-734-8024 or [email protected]
3. Infection Control Officer, Karen Swecker
614-734-8044 or [email protected]
Intranet Website Resources:
• Safety Awareness Form – The link to the form is located under
the Safety section
• Unusual Occurrence Form – The link to the form is located
under the Forms section then under Administrative Forms
• MedDebrief System – The link is found under the quick links
on the intranet and is automatically activated after a medical
transport
1. Director of Safety, Jeff White
304-610-3666 or [email protected]
2. Air Methods Sr. Director of Technical Safety, Don Lambert
412-398-0087 or [email protected]
3. Infection Control Officer, Nick Cooper
304-653-4025 or [email protected]
Intranet Website Resources:
The link is found on HealthNet WorkPlace under
Flight Team/Communicators tab.
SafetyMatters
America’s Medical Transportation Safety Newsletter
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