Making EMS Flying Better- Part Two

In the mid-1990’s a new business model emerged in air medical flight operations. The helicopter operators, who for a decade-and-a-half had been hobbled by a competitive bid process that killed profitability, needed to improve their bottom lines. The hospital customers, looking to lower overhead costs, were anxious to save money on their aviation operations. This new way of doing business had the helicopter operators branching out to actually become ambulance companies- nurses, paramedics, and EMTs, previously supplied by the hospital, became employees of the helicopter operator. Billing the patients for the air ambulance service was taken on as well. Accordingly, the hospitals could reduce their staff and now the hospital only had to supply facilities to house the helicopter and crew.

In the early 2000’s the air ambulance subscription service saw growth. In this model the helicopter air ambulance company, operating independently of any medical customer, sold subscriptions to the general public that pre-paid for a helicopter air-ambulance transport should it ever be needed. By placing a large number of second-hand (therefore cheaper in cost) helicopters regionally with overlapping coverage, this became a profitable way to operate helicopters.
Regardless of the operational model used- legacy, turn-key, or subscription- it remained tough to turn a profit in the helicopter air ambulance market. Costs can very easily get out of hand and margins are always thin.

As the air ambulance business evolved there continued to be mishaps and crashes, some fatal. For the air crewmembers air ambulance flying continued to be high risk in spite of the industry’s efforts to mitigate that risk. The ‘go or no go’ decision before a flight was undertaken, once the sacred domain of only the pilot-in-command, was expanded to include the medical crew- everyone aboard had to agree that it was safe to depart for (and to continue) a flight. When that tactic proved to be only partially successful, the helicopter operators were required by the FAA to establish national dispatch centers with who the pilot would communicate several times each shift. (A collateral issue of ‘operational control’ a very specific definition born of Federal Aviation Regulations, also played a role in the establishment of these centers.)

Today air ambulance helicopters continue to crash far too frequently. Most of these aircraft are flown by a sole pilot and until the one-pilot model is abandoned the air medical safety record will not improve.

There are a few two-pilot air medical operations in existence in the U.S. and they have a better record than their single-pilot counterparts. Unfortunately, most two pilot operations opt to fill the copilot’s seat with a relatively inexperienced (and therefore low-cost) copilot. This is a false economy. Several years ago an air ambulance with two pilots aboard crashed and it could be argued a second pilot is apparently not a valid solution. But I think it is. The solution is for the air medical helicopter industry to adopt the operational model used in corporate aviation.

Corporate helicopters (and airplanes) are routinely crewed by two experienced pilots, both in their own right a qualified aircraft captain. Upon joining a corporate flight department a pilot attends an aircraft qualification course at Flight Safety International or CAE Simuflite. The two week initial training course includes a comprehensive review of aircraft systems and avionics followed by flight training performed in a full-motion simulator. The flight training includes VFR and IFR operations along with in-flight emergency procedures. Pilots train in both seats, i.e. as pilot-in-command and as second-in-command.

After completion of initial training corporate pilots return to school for recurrent training every six months. Recurrent training includes a two day review of aircraft systems and three or four simulator flights. In the simulator pilots review in-flight emergency procedures and accomplish an instrument flight review. (The reality is that most helicopter pilots who possess an instrument rating have very little experience flying in instrument conditions; this is a weakness that can be mitigated by simulator training and by flying with another instrument rated pilot on board.)
This method of training is expensive, no question about it, but large companies with in-house flight departments demand a high level of competency and expertise from their pilots. Undergoing high-quality formal training at one of these schools is one way of ensuring well-prepared pilots.

Some hospital customers currently require their pilots to attend courses at FSI or Simuflite. Flight Safety has obliged EMS customers by offering customized courses designed for EMS pilots. But the majority of EMS helicopters are flown by a single pilot who never attend one of these schools. The one pilot cockpit is air medical’s greatest flaw, in my opinion. Until the dual pilot cockpit becomes the industry standard for EMS operations the accident rate will remain unsatisfactory. Having two pilots up front will not eliminate accidents, to be sure, but one only needs to compare the safety record of corporate operations against that of air medical operations. I will stipulate the limited risks corporate helicopters are exposed to- one never observes a corporate aircraft landing on a road side next to a car accident at three a.m., for example.

Replacing the current fleet of one-pilot helicopters will be very costly, running into hundreds of millions of dollars. Doubling the number of EMS pilots will be expensive and training them will cost tens of millions of dollars. Two-pilot helicopters, typically twin-engine and larger than their single-pilot counterparts, will require additional maintenance. Larger helicopters have the space on their instrument panels for more sophisticated avionics such as weather radar and terrain awareness systems.

Two pilot operation represents a paradigm shift for the air medical industry. Many EMS operations in existence today would close due to the increased cost of operations. But until the single-pilot EMS helicopter concept in use today is abandoned the air medical accident rate will remain unacceptable. Single pilot IFR operations don’t go far enough, in my opinion, but SPIFR is a step in the right direction.

So is there any room at all for single pilot operations? I suppose there could be if weather minimums are increased and consideration given to the proximity of weather information to the intended route of flight. For example if day-local and cross-country minima were set at 2,000ft & 5sm and 3,000ft & 5sm, respectively, and at night 3,000ft & 6sm and 5,000ft & 10sm. For off- airport operations a weather report would only be valid if within 10 miles of the route of flight, perhaps. I acknowledge these are severe limitations, but too many air medical helicopters crash in bad weather! Even with a two pilot crew the absence of valid weather reports for off-airport operations presents heightened risk.

Until the air medical industry adopts the two-pilot IFR concept, those who operate (or cause to be operated) air medical helicopters are tacitly acknowledging that the current fatality rate is acceptable. EMS remains one of the few commercial aviation activities with one pilot alone in the cockpit; I don’t understand why, but this needs to change.

Making Helicopter EMS Better. Part One.

Helicopter air ambulances continue to suffer accidents with monotonous regularity in spite of the industry’s best efforts to get that number to zero. The helicopter operators, the customers, the FAA, and the NTSB are all looking hard at what can be done to get the risk out of air medical operations. In mid-2009 the NTSB published 19 recommendations focused on the Board’s analysis of accident/incident data. 14 recommendations were made to federal alphabet agencies (the FAA, CMS-Center for Medicare and Medicaid Services, and the FICEMS- Federal Interagency Committee on EMS) and 5 to the community of helicopter operators. It is important to note that the NTSB has no authority to force any of these agencies or the operators to adopt those recommendations.

Early in my aviation career I was employed in the helicopter air taxi business and remained so for nearly 15 years. Helicopter EMS became our biggest market, in fact we eventually divested the company of all non-EMS operations. We began with one air medical base in 1982 and added more every year; a sister company was doing the same, we in the East and they in the Midwest. Eventually the two companies became one and shortly thereafter we acquired a competitor of equal size and grew to number two nationally in terms of the number of EMS bases, aircraft, pilots, and technicians. Over those years I served in all of the operations positions- Chief Pilot, Director of Operations, and VP/General Manager. The point here being that my experience allows me to offer meaningful comments on the air medical business, even after an absence of a decade and a half.

During that period of rapid growth we had crashes, too. During my years with the company we suffered a total of 4 accidents with 10 fatalities. Interestingly, none of these were related to weather conditions, which seem to be a leading cause of accidents especially when combined with flying in the dark. One of our aircraft went down due to fuel starvation, another had an in-flight fire*, and the third and fourth were involved in CFIT (controlled flight into terrain) episodes. In one CFIT event the pilot made a high-speed steep turn at an impossibly low altitude, and the main rotor came in contact with the ground. In the second case the aircraft contacted the ground at cruise speed in an area of gradually rising terrain.

(*Suspected but never proven conclusively. The crash occurred at the end of an unsuccessful autorotation at night.)

I’d like to think somehow we could have avoided these horrible mishaps. I spent a lot of time after each one looking at the conditions and circumstances preceding it- I wasn’t alone- everyone in the company did the same. Each of us within our particular aviation disciplines looked for ways to make improvements to flight safety and then took the steps we thought appropriate. In my area pilot training continually improved- more hours, night training, instrument training, and scenario-based training. Pilot selection became more rigorous. An EMS manual, a specialized guide for our pilots intended to supplement our General Operations Manual was introduced.

In response to our efforts, not just our company but for the EMS business overall, the accident rate did improve in the late 1980s and early 1990s. I left the business in 1993 and safety statistics were trending upward for air medical programs. At the time there were approximately 180 hospital bases and 250 helicopters nationwide (all operators). For a couple of years those numbers remained constant but the end was coming for the established business model in which a hospital contracted with a helicopter operator to supply an on-site helicopter, pilots, and a technician. The hospital then crewed the back end of the helicopter with its own doctors, nurses, or paramedics/EMTs and sent the patient a bill for the air ambulance care and transport. It was worth it since the potential profit to be made from a gravely ill or injured patient could run into six figures. But by now that market segment had matured- hospitals wanted to reduce their financial committment and the associated risk. Helicopter operators wanted bigger profits in a market segment where for too long competition made it hard to make any money.

To Be Continued.

The Lear Fan Business Turboprop

Even non-pilots have heard of or know what a Lear Jet is, but you’ve got to be an aviation buff to know about the Lear Fan. The Lear Fan, also known as the LearAvia 2100, was the final airplane project of business aviation pioneer Bill Lear. This aircraft was one of the two all-composite airplanes designed starting in the late 1970’s. The Lear Fan, along with Beechcraft’s Starship was notable because they had fiberglass skin on the fuselage- not aluminum- as well as other non-metal components throughout. The goal was to make the airplanes lighter and as such more fuel efficient and faster. Both airplanes were developed independently and in addition to the use of composite materials each was powered by aft propulsion. Both were two engine turbo-props with the propellers in the rear.

What set the Lear Fan apart from its’ rival as well as from any other airplane was its use of two engines to feed a combining gearbox that in turn drove a single propeller. The Starship had two aft mounted engines and two propellers set conventionally on each wing. The Lear Fan’s engines were mounted on the sides of the aft fuselage, much like any typical business jet, with a single propeller mounted at the end of the tail cone. Lear’s intent was to offer the benefit of two engines but at a lower cost and with better performance. The Lear Fan had the added safety of a second engine but with one propeller and less weight it would be faster in the air and cheaper to operate.

The ground breaking technology of this plane, apart from the use of non-conventional materials was that combining gearbox. The eventual refusal of the Federal Aviation Administration to approve this gearbox led to the end of the Lear Fan. Because of the airplane’s dependence on the single gearbox and with no available on-board backup system, should it fail in flight Lear fan then became a glider. So the Feds chose not to award the airplane its Type Certificate. Apparently it’s okay for helicopters to use two (or three) engines to feed a single gearbox and in turn a single main rotor, but airplanes are not the same as helicopters in the eyes of some federal engineers.

The airplane did fly- Lear’s engineering worked well. Three Lear Fans were built as test beds and technology demonstrators. But without a license to produce the airplane it died a regrettable death. Two of the three Lear Fans still exist- the one above is in the Seattle Air Museum and the second in the Dallas aviation museum at Love Field. If you have an opportunity to visit either place seek out the Lear Fan and take a moment to appreciate the work of one of the great aviation pioneers.

Incidentally, Beechcraft’s Starship was eventually certified and (I think) fifty or so manufactured. But the plane was a commercial flop because of its weight- it was heavier than ever intended- and its subsequent lackluster performance. In 2008 Beech attempted to buy back as many of the Starships as it could and broke them up for scrap.

Farewell to the Corporate Flight Department

As the U.S. economy continues its struggle to recover one of the shoes that is going to be sucked off and lost forever in the quicksand is the corporate flight department as we’ve known it. The actions of three gutless auto company CEOs, in response to a question from a hypocritical member of the U.S. Congress has forever changed the landscape of business aviation. After slinking back to Detroit and closing their own company flight operations they spawned a virus that grew into an epidemic. Each day another company with a private aircraft is trying to run away from it- or hide it – as quickly as possible. Not wanting to be perceived by the share holders as wasteful and extravagant corporations are shuttering their flight departments, some after decades of service. Private aircraft owners, not wanting to be judged by the public as moneyed arrogant twits jetting from one private resort to another while burning up precious fossil fuel, they are selling their airplanes- or parking them until the resale value recovers.

We are witnessing the death of the corporate flight department.

The prototypical company flight operation has an airplane, sometimes several, along with a staff of pilots to fly them, technicians to service them, maybe a flight attendant, and perhaps a scheduler or two. These folks are employees of the company and they work extremely hard to ensure the highest degree of safety and convenience for their passengers. Those passengers are employees too, for by and large these airplanes are not approved for hire by the general public; they fly only for company business. The business rents a hangar or perhaps builds its own at the nearby airport. Some company airplanes never leave U.S. airspace while others fly around the world.

Smart executives know the value of a company plane. They know the efficiencies and of the opportunities gained. The brightest of them aren’t intimidated when the naysayers point and shout at the corporate jet. They know a plane is the best implement in the company tool box.

When the Board of Directors decides to shed the in-house flight department the justifications can be many but more often than not the goal is to change perception. They can say, “We respect our investors and their money- we got rid of the company flight department and now everyone from the CEO on down flies commercially!” Just for good measure they'll add those commercial flights will be made on a discount carrier. The truth is that those executives are unlikely to ever sit in a seat on Southwest Airlines. It is also true there is no longer a company flight department; the hangar is closed and the employees are laid off. But the airplane may or may not go away.

If an aircraft is leased it often can’t be turned in without accepting severe financial penalties. If it’s an owned asset it may be hard to sell, as is in today’s flooded market. And really, all the Board ever wanted to do was to be able to tell the shareholders that the costly and unpopular flight department is gone. Did anyone seriously think the CEO and his mahogany-row associates were going to fly anywhere on those cattle-car airlines? And so the company airplane is turned over to a management company that specializes in operating business jets. The management company employs the pilots and technicians; it keeps the plane in its hangar; it puts in the fuel and vacuums the carpet. Once a month it sends its client a simple bill for services rendered and everyone is happy.

Some companies close their flight department and get rid of the airplane, too. But because the need for executive transport still exists they charter airplanes or become a fractional owner of a shared aircraft. They too can truthfully state that they have no corporate flight department.

To be sure there are advantages to this hands-off approach to corporate flying. It’s much easier to manage (just send in a check when the bill comes); the pilots and flight attendant are merely contract employees (“Can we replace our usual cabin attendant with a better looking one?"); sometimes the company plane earns a little revenue when it’s chartered out. There doesn’t seem to be much of a downside for the corporation, does there? Now which is actually more expensive- the in-house operation or the out-sourced one? It depends....I’m sure the determination varies with the company’s accounting practices. So for these reasons the traditional corporate flight department is now on the endangered species list. The trend will continue until equilibrium is achieved.

Why will some companies keep their own flight departments in spite of this fad to switch? I think because it’s an issue of control, i.e. the “our airplanes, our employees” attitude. Smart executives know too that rarely does anyone care as much about the passengers and airplanes as much as an employee does- it’s hard for a contract employee to sincerely care very much- after all he or she is just a hired hand. Regarding the management company, you are their most important customer until the contract is signed and their attention is directed to the next potential client.

The demise of the corporate flight department is a sad thing but this segment of the aviation industry has fundamentally changed forever, I’m afraid.

A Visit to the Royal Gorge

Scanning the rack full of travel brochures in the lobby of my Colorado Springs hotel the one catching my eyes was for the nearby Royal Gorge. From the description I wasn’t exactly sure what to expect at the Royal Gorge- there was a suspension bridge across a deep chasm, that much was clear but what else was there to see? Was it a near a town? Was it just another one of those spectacular highway bridges across a canyon so common in the great American West? And what made this gorge “royal”? My copilot and I had the day free, we had a rental car, and it was a sunny summer day so curiosity and wanderlust got the better of us. Off we headed towards Cañon City and the Royal Gorge.

An hour later we left the main highway for the winding road that led to the Royal Gorge Park (so, it was a park!). After securing the car we walked toward the entrance, catching a glimpse of the towers of the suspension bridge- but wait, weren’t we going to drive across that bridge? Was it an unused bridge on a now obsolete highway? What kind of a place was Royal Gorge Park? The mystery deepened as we walked on. Reaching the entrance and spotting a ticket booth it finally dawned on us- the Royal Gorge was a tourist trap! We’d been hoodwinked by slick advertising! The suspension bridge that had loomed large in the brochure is actually only a foot bridge! (But what a footbridge- read on.)

Deciding we’d traveled too far to go back to COS unfulfilled we opted to pay the $20 entrance fee and see what this place was about. Well it turns out the Royal Gorge Park actually is nothing more than a tourist attraction and it’s been in operation since 1929 when the bridge was erected. After spending a day roaming we found the place well-run, clean, and refreshingly unpretentious with impressive sights- not at all cheap and tinny as we’d half expected upon arrival. The bridge, it turns out, actually is a foot bridge spanning a narrow thousand-foot deep gorge cut by the Arkansas River. Only eighteen feet wide and twelve-hundred feet long the bridge itself is a work of art and engineering.

While the structure is all steel the deck is all wood, specifically individual thick fir planks about eight inches wide and three inches thick. I mention this because across the span of the bridge there are small gaps between the boards, meaning one can look down and see the floor of the gorge below! For people like me who are afraid of heights (don’t snicker- most pilots have a fear of heights), a walk across this bridge is therefore a leap of faith. I was sure at any moment the plank I was standing on would snap in half or I would slip through one of those monster-sized gaps and fall to my death! Irrational thinking, I agree, but no more so than being certain if I leaned against the bridge handrail it, too, would collapse from my weight and well, a plunge to my death would follow.

At one end of the bridge is an incline railway that takes riders to the bottom of the Royal Gorge. The gorge itself is relatively narrow with shear walls from bottom to top and the railway inclines at forty-five degrees. It’s a five minute ride to reach the bottom of the thousand foot deep cut. There one gets a close up view of the Arkansas River and if the timing is good you’ll see the sight-seeing train roll through. The train is another area attraction and probably worth the time and expense should you ever visit the Royal Gorge Park. You may also see some river rafters floating by on the river’s white water.

Transiting the bridge there’s a small theater, a music venue, a petting zoo, an overlook, and a Sky Coaster on the opposite side. The coaster is one of those cable-and-sling affairs allowing riders to swing out and over the gorge- you can’t be faint-of-heart for this thrill ride. (No doubt if I rode on it the cables would snap and throw me to the bottom of the canyon and to an instant death.) We attended a short presentation about the area and the park at the theater. The area itself is not especially significant historically but the presentation was informative.

A cable car traverses the gorge as well but opted to walk back across the bridge. A quick stop at the lodge for souvenirs- I buy whiskey glasses from the places I visit for my son- and we were done for the day. We agreed that our day spent at the Royal Gorge had been a good one, worth our time and the expense. It was $20 very well spent. The value of visiting is in the spectacular scenery and if you go Pike’s Peak is not too far away. The bridge, funicular, and cable car do give you access to this beautiful spot and views that will stay with you for a long time.

Many years ago when I was a Chief Warrant Officer and helicopter pilot in the Army I and a fellow officer made a memorable weekend trip in an Army UH-1H Huey. The flight was special to us because there was no direct military mission involved- it was a sanctioned personal trip. A flight of this type was infrequent but not unusual back when I was on active duty and similar flights still occur in today’s military. Aviation units budget for a fixed number of flying hours by quarter each fiscal year and strive to fly off all of those hours. If those hours are not used then the next year’s budget is reduced accordingly, so the Operations Officers get creative with their flight schedules, especially toward the end of the year.

And so my colleague from one of the other aviation units on the base approached me to tell me he’d been assigned a Huey for the weekend and ordered to put at least twelve flying hours on it. He asked if I was interested in going along. The only restriction was to limit any fuel purchases to those from government contract suppliers. Of course I agreed to accompany him but asked what destination he had in mind. We were stationed in central western Louisiana and his folks lived in Arkansas- he wanted to visit them.

Best of all, his parent’s lived on a small ranch with room enough for us to land our helicopter. Come that sunny Saturday morning off we flew to Mountain Home. We arrived in the early afternoon after a quick stop for fuel- his father, a retired Air Force colonel, snapped this picture of us landing out in the pasture. For dinner his folks prepared a wonderful meal of shish kabobs cooked on the grill and in general treated us like the prodigal sons. Their home and property were beautiful and the setting bucolic. It was a wonderful and special visit for all of us. The next morning we were off and on our way back to Louisiana by a somewhat circuitous route- after all, we had to get twelve hours on to that airframe.

Feeling at Home in England

One of the wonderful benefits of professional flying is having some free time when traveling and the too-infrequent opportunity to be a bit of a tourist. Better yet are those serendipitous occasions when the stopover becomes much more than you’d have expected beforehand. Such was the case for me and my co-captain when we flew into London Southend Airport in the early spring of 2008. We’d been to Southend before but on this trip a hotel was booked for us in the nearby town of Rochford. Southend-on-Sea is east of London where the Thames feeds into the North Sea.

Rochford is a small town with a population of about 7,500. It’s proximity to the airport, once a fighter base during World War II, then subjected the town to frequent aerial bombardment. No bombs fell during our stay but we did have the opportunity to interact with a Spitfire before we left. Our hotel was the Maison Renouf, a newly opened boutique hotel near the center of town. After many a night spent in chain hotels a place like this with its 22 rooms, each with a unique floor plan and interior furnishings, is always a nice change. After dinner- “Bangers-and-Mash”- we decided to explore Rochford on foot and it didn’t take too long for us to find the King’s Head Inn.

It was late when we entered and the patrons were few, probably because it was mid-week. Not a large pub at all but made up of two small rooms, each with its own short bar, one half was vacant and dark. The building, we were told is 500 years old. In the occupied section, a fire blazed cheerfully in the small fire place. When we entered all heads turned to size us up- this is a place inhabited locals, after all, and well off any tourist track. Our accent gave us away when we ordered (I’d never had anyone refer to me as ‘Yank’ before that night) and soon we’d been introduced to everyone in the place. We made friends with the proprietor and his wife and had conversations with everyone in the pub. That particular night there was great concern expressed over the ever-growing British Nanny State, declining levels of personal responsibility, and the dilution of British culture under an influx of immigrants and declining birth rate of native Englanders.

British pubs have an unfortunate practice of closing the door at 11:00 p.m. each night. That night was no exception and promptly at eleven the door was locked. Happily, those of us still in the pub remained in the pub and continued to enjoy our drinks! In fact we enjoyed them for two more hours before returning to the hotel.

Following a good night’s sleep the two of us rode the train into downtown London to explore, but that’s a story for another day. In the evening we found ourselves back in the King’s Head but now awarded with the status of honorary local folk. We once again were invited for the after-hours session. Next morning, breakfasting at a small Rochford restaurant, the owner/manager stopped by our table to say she’d enjoyed meeting us in the King’s Head the night before last. We both agreed truly we’d achieved resident status in this delightful English village.

What about the Spitfire? At the King’s Head one of the ales on tap is Spitfire Kentish Ale, brewed for the Bottle of Britain. I’m not making this up- visit the website. It was quite delightful, I drank my fill, and I’ve got the logo bar glass and bar towel to prove it.