Introduction. OSI-HEMS Page 1 IHSS 2009, Montreal Ira Blumen, A Multi-Discipline Safety Research Project
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1 OSI-HEMS Page 1 A Multi-Discipline Safety Research Project. Used with permission Introduction U.S. HEMS safety research project Comprehensive review of HEMS accidents Root cause analysis > 140 HEMS accidents with final reports 1998 through 2009 Concrete recommendations that can Prevent HEMS accidents Reduce the impact of accidents that do occur
2 OSI-HEMS Page 2 Introduction HEMS Industry/Community research project and working group Represents disciplines within the air medical and aviation communities Not part of US JHSAT (US Joint Helicopter Safety Analysis Team) OSI-HEMS research group Several JHSAT colleagues are part of our group Utilizing a modified version of the US JHSAT spreadsheet Research Team >40 aviation and air medical professionals Representing Associations Air medical operators Manufacturers FAA Aviation training Aviation insurance
3 OSI-HEMS Page 3 Research Team Associations Air & Surface Transport Nurses Association (ASTNA) Air Medical Physician Association (AMPA) Air Medical Safety Advisory Committee (AMSAC) American Association for Respiratory Care (AARC) Association of Air Medical Services (AAMS) Commission on Accreditation of Medical Transport Services (CAMTS) Helicopter Association International (HAI) International Association of Flight Paramedics (IAFP) National Association of Air Medical Communication Specialists (NAACS) National EMS Pilots Association (NEMSPA) Research Team Helicopter operators Air Evac Lifeteam Air Methods Corporation CareFlite (Dallas/Fort Worth) EraMed Intermountain Life Flight Keystone Medflight Maryland State Police Aviation Med-Trans Corporation Metro Aviation Omniflight Helicopter, Inc PHI Air Medical Palm Beach County, Trauma Hawk
4 OSI-HEMS Page 4 Research Team Manufacturers American Eurocopter Bell Helicopter Turbomeca USA Federal Aviation Administration Aviation training (FlightSafety International) Aviation insurance (AirSure Limited) Timeline: January 2008: first group meeting : 13 meetings (~ every two months) September 2009: Initial reviews completed for 140 accidents Present initial raw data: IHSS and AMTC November 2009: begin weighted analysis and scoring
5 OSI-HEMS Page 5 Accident Analysis The Process U.S. HEMS Accidents and Fatal Accidents '00 '01 '02 '03 '04 '05 '06 '07 '08 '09* Total Accidents Fatal Accidents *Dedicated and dual-purpose through September 28, 2009
6 OSI-HEMS Page 6 Focus: HEMS accidents 144 dedicated HEMS 6 dual purpose 50 (of 149) fatal 47 HEMS 3 dual purpose
7 OSI-HEMS Page 7 Timeline of the Accident Events Actions Conditions What happened Contributing factors Problem Statements Standard Problem Statements (SPS) Modified and revised US JHSAT format 16 major categories (SPS Level 1) Over 70 sub-categories (SPS Level 2) Over 460 individual SPS Some overlap Modified US JHSAT format.....
8 OSI-HEMS Page 8 Problem Statements Added over 110 new Standard Problem Statements New Level 1 categories Medical crew Communications specialists Expanded Level 2 Categories (>40% increase) Equipment/safety management Safety program Performance of maintenance duties Inadequate procedures (communications) Mission risk environment Lack of real time data Confidence Level Factors Validity (V) Importance (I) Probability (P) Range: 1 to 5 1 = poor (just a guess on our part) 2 = weak 3 = average 4 = good 5 = excellent (absolutely sure)
9 OSI-HEMS Page 9 Interventions Intervention/Mitigation Strategies (IMS) Modified US JHSAT format 8 major categories (IMS Level 1) 42 sub-categories (IMS Level 2) > 425 specific interventions Some overlap Modified US JHSAT format.....
10 OSI-HEMS Page 10 Interventions Added over 150 interventions Expanded Level 2 Categories (>40% increase) Investigation Aircraft components Post incident survivability Infrastructure - Communications Infrastructure Ground support Regulatory Regulations/standards Safety management Capital Investment (added) Safety management Risk Assessment Safety Culture SOP Mission Specific SOP Ops Maintenance IMS Scoring Factors Effectiveness (E) Feasibility (F) Range: 1 to 5 1 = poor (poorly effective or utilized) 2 = weak 3 = average 4 = good 5 = excellent (absolutely effective / 100% utilized)
11 OSI-HEMS Page 11 Accident Analysis Initial Results: Standard Problem Statements (SPS) Standard Problem Statements: Level 1 Pilot Judgment & Actions Safety Management Pilot Situation Awareness Data Issues Ground Duties Maintenance Medical Crew Mission Risk Post-crash Survival Communications Part/system Failure Infrastructure Regulatory CommSpecs Safety Systems and Equipment Personnel - Non Crew
12 OSI-HEMS Page 12 Top SPS Level 2s Human Factors - Pilot's Decision Inadequate information in report External Environment Awareness Mission/Flight Planning Safety Program Visibility/Weather Flight Profile Procedure Implementation Landing Procedures Management (Safety Management) Human Factors - Pilot/Aircraft Interface Lack of real-time data Performance of MX Duties MX Procedures/Management Part/system Failure - Aircraft Pilot (Safety Management) Top 10 Specific Standard Problem Statements Information missing/incomplete in report (76-100) Aircraft position and hazards (51-75) Disregarded cues that should have led to termination of current course of action or maneuver [Human Factors Pilot Decision Making] (51-75) Failed to recognize cues to terminate current course of action or maneuver [External Environment Awareness] (51-75) Lack of real-time data available (51-75) Pilot misjudged own limitations/capabilities (41-50)
13 OSI-HEMS Page 13 Top 10 Specific Standard Problem Statements Range: Pilot decision making Risk Management inadequate Inadequate and/or untimely intervention by medical crew member Diverted attention, distraction (tie) Management policies/oversight inadequate (tie) Accident Analysis Initial Results: Intervention / Mitigation Strategories (IMS)
14 OSI-HEMS Page 14 Intervention Strategy: Level 1 Training/Instructional Safety Management Data/Information Systems and Equipment Maintenance Infrastructure Regulatory No recommendation Top 10 IMS: Level 2 Safety Training Basic Training Risk Assessment/Management Advanced Maneuver Training Recorder Safety culture Mission specific Investigation SOP - Ops Mgt Situational Awareness Enhancers
15 OSI-HEMS Page 15 Top 10 Specific Interventions AMRM training and utilization (Range: ) Improve quality and depth of NTSB investigation and reporting (76-101) Install data recording devices (51-75) Simulator Training - Advanced Maneuvers (26-50) Training emphasis for maintaining awareness of cues critical to safe flight (26-50) Install cockpit recording devices (audio) (26-50) Top 10 Specific Interventions Establish/Comply with programs to encourage culture of conservative safety decisions (26-50) Establish/Comply with procedures or risk assessment program to eliminate culture of non-compliance (26-50) Ground Hazard Awareness/Proximity Training (26-50) Emergency Procedures Training (26-50, tie) Establish/Improve Company Risk Management Program (26-50, tie)
16 OSI-HEMS Page 16 The End Product Recommendations Based upon Anticipated benefits Lives that could be saved Accidents that could be prevented Cost Effectiveness Feasibility
17 OSI-HEMS Page 17 LACED Scoring Lives that may be saved Accidents that may be prevented Cost Effectiveness Doable (Feasibility) Example: LACED Scoring Factor Score Lives Saved 1 Accidents Prevented 5 Cost 3 Effectiveness 3 Doable (feasible) 4 Total 16
18 OSI-HEMS Page 18 LACED Score.... Determine a LACED Score for the various intervention Allow a direct quantitative comparison between recommended interventions In conclusion..... Evaluate a lot of data Identify the problems specific to HEMS Identify interventions that will help the HEMS community Make recommendations that will make a difference Justify our recommendations Provide a mechanism for evaluation and comparison
19 OSI-HEMS Page 19 Grant Support and Funding MedEvac Foundation International (formerly Foundation for Air-Medical Research and Education) Flight Safety Foundation American Eurocopter Vision Zero Safety Award Air Medical Physician Association Air Methods Corporation PHI Air Medical Metro Aviation Omniflight Helicopter Corporation Turbomeca USA Flight Safety International Air Medical Memorial Wings Sikorsky Aircraft Corporation Thank you
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