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Case #41 A Discussion Rate Topic: -----

#1 User is offline   Mike MacKinnon 

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Posted 04 July 2008 - 11:05 AM

All

In light of the recent tragedies and the back to back accidents of the last month I want to take this month to discuss the pressing issues in HEMS.

We always talk about federal regulation and the bigger picture for how to solve some of these issues, however, most people never get involved on that level. So for this discussion lets keep it to what an individual can do and see where we end up?

So, what can YOU do to avoid being in an accident like what has happened recently?

If you feel your company has weak safety practices what is the BEST course of action for YOU to take?

If you have issue with a pilot in some way, what can YOU do? What if you notice a trend of not using the radio on every take off & landing? What should YOU do?

Have you ever had a "near miss" and what did YOu do/say after the event?

Please add to he questions and add your own story. This can only be helpful.
Mike MacKinnon MSN CRNA
WWW.NURSE-ANESTHESIA.ORG

"What gets us into trouble is not what we don't know
It's what we know for sure that just ain't so" - Mark Twain
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#2 User is offline   Mike MacKinnon 

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Posted 06 July 2008 - 05:35 AM

hmm

suppose it would have helped had i set this visible eh? sheesh.
Mike MacKinnon MSN CRNA
WWW.NURSE-ANESTHESIA.ORG

"What gets us into trouble is not what we don't know
It's what we know for sure that just ain't so" - Mark Twain
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#3 User is offline   HELOSRCOOL 

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Posted 06 July 2008 - 01:57 PM

Safety, I am told, is now a culture. I don't know about that, but I can see it as a religion. Common sense usually leads the way in safe practice. What it boils down to is vigilance. If you wear eye protection on every call, you'll never have to worry about those 2-5 in your career you might have an exposure. Always wearing your PPE and being vigilant and aware of your environment will go a long way towards keeping you safe.

I am not say that this is always easy. Face shields don't always look cool and that last ten times I loaded the aircraft without gloves I didn't get my fingers squished. It is not hard to slip into an attitude of carelessness and let vigilance and preparedness go by the wayside, either for looks or laziness.

I have had a near miss with a small cessna at an outlying airport without radar control. The pilot failed to announce his presence and when he called final was approx 200 ft off the starboard side at our altitiude. Our pilot took evasive measures and the end of the flight went without incident. After the flight, as we did not perform a post-flight debrief at that time, we talked with the PIC about the incident. He was reluctant to file a safety report or report of near miss. The flight crew hounded him until he documented the incident and we educated the rest of our crew and reinforced our VIGILANCE.

Documenting the near miss events in our practice is what helps other avoid injury and death. Blame and finger pointing scare people from this worthy practice. Waiting for bad things to happen and then writing about it after the catastrophe do nothing for safety. Just as in medicine PREVENTION is more effective than cure.

Stay safe, thru VIGILANCE, PREVENTION and PPE
Bill
CCEMT-P, Flight Paramedic
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#4 User is offline   cbaker4481 

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Posted 06 July 2008 - 02:13 PM

View PostHELOSRCOOL, on Jul 6 2008, 08:57 AM, said:

Documenting the near miss events in our practice is what helps other avoid injury and death. Blame and finger pointing scare people from this worthy practice. Waiting for bad things to happen and then writing about it after the catastrophe do nothing for safety. Just as in medicine PREVENTION is more effective than cure.

Stay safe, thru VIGILANCE, PREVENTION and PPE

You hit part of the issue on the head. No one wants to admit there are near misses. They feel they will be beaten up for filing a report. It is no different than the nurse in the hospital that has a near miss and does not want to report. We have a program in our area that has had several occurances that were wittnessed, and one that actually made the news, yet never a report. We also have administrators who berate and beat up crews for reporting. Until we all realize that we need to work together and we need to learn from others mistakes, we will never get it together. I do not think any less of a program for a near miss, I actually have more respect for them that they would share so that we can all learn.
At our state AAMS committee, we pull and read all of the Concern postings and talk about trends and what we are all doing to mitigate such occurances. That is the kind of discussion that needs to happen in every state.
Safety is a culture and it is a culture that starts at the top of any program. I know it is a pain when you are in a hurry or have a bad patient, but the few seconds it takes to do thing right is what makes a difference. I also know that a lot of people hate when their program administration comes down on them for not wearing their gloves or not putting down their eye protection. The administrators can not possibly understand what we are going through that they would yell at us for something that silly. This is a program where the administrators DO understand and do care. If they did not beat mundane safety practices into your head, then they truly would not care.
Next time your Chief Flight Nurse or PD yells at you for forgetting one of these silly practices, give them a kiss and tell them thank you for caring and trying to keep you safe!
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#5 User is offline   shock360j 

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Post icon  Posted 06 July 2008 - 02:48 PM

Self preservation is the key to survival. The issue has been beaten to death, but personal responsibility CANNOT be overlooked. Everyone wants to turn to there program for help, what are YOU doing to put yourself in the position to be safe? Everyone who works in this industry has done so because they placed themselves in a position to succeed, and in doing so beat out alot of other applicants to obtain their respective flight crew positions. Safety cannot and should not be looked upon any differently.

What does my company do for me? I will tell you-fly only twin engine NEWER airframes that havent been pushed to the limits for the past 30 years and are still flying around; SPIFR, NVG's, TAWS, required safety briefs with ALL crew members. Open discussion between flight crew and pilots, 3 to go one to say no, no second-guessing a flight turn down, ect.

What do I do? CONSITENTLY practice sterile cockpit when necessary, eyes out during takeoff/landing, when in cruise flight actually looking around instead of daydreaming/texting/playing games on the cell phone; when a patient is onboard, unless they require a critical intervention, I acutally take the time to have intermittent eyes out then as well. I read the CONCERN network, attempt to understand what happened, and use that information to prevent a similar mistake from happening to myself. (We must not forget the past or we are doomed to repeat it!!!).

Filing reports on any near miss is important. Remember the old George Carlin Joke? A near miss isnt a near miss, its a near hit. A collision is a near miss!!! I keep that in the back of my head, and thinking that 'wow we almost crashed' instead of 'wow we missed' puts a different spin on things, and may cause you to react aftwards differently (IE file a near miss report, ect).

My 2c, for what its worth...

Fly safe, and as Jerry says, "take care of yourselves and each other"
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#6 User is offline   Mike MacKinnon 

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Posted 06 July 2008 - 02:49 PM

The question is, is that a pilot culture problem or an HEMS culture problem. Truly I would say its the former not the latter as was shown in this situation.


View Postcbaker4481, on Jul 6 2008, 10:13 AM, said:

You hit part of the issue on the head. No one wants to admit there are near misses. They feel they will be beaten up for filing a report. It is no different than the nurse in the hospital that has a near miss and does not want to report. We have a program in our area that has had several occurances that were wittnessed, and one that actually made the news, yet never a report. We also have administrators who berate and beat up crews for reporting. Until we all realize that we need to work together and we need to learn from others mistakes, we will never get it together. I do not think any less of a program for a near miss, I actually have more respect for them that they would share so that we can all learn.
At our state AAMS committee, we pull and read all of the Concern postings and talk about trends and what we are all doing to mitigate such occurances. That is the kind of discussion that needs to happen in every state.
Safety is a culture and it is a culture that starts at the top of any program. I know it is a pain when you are in a hurry or have a bad patient, but the few seconds it takes to do thing right is what makes a difference. I also know that a lot of people hate when their program administration comes down on them for not wearing their gloves or not putting down their eye protection. The administrators can not possibly understand what we are going through that they would yell at us for something that silly. This is a program where the administrators DO understand and do care. If they did not beat mundane safety practices into your head, then they truly would not care.
Next time your Chief Flight Nurse or PD yells at you for forgetting one of these silly practices, give them a kiss and tell them thank you for caring and trying to keep you safe!

Mike MacKinnon MSN CRNA
WWW.NURSE-ANESTHESIA.ORG

"What gets us into trouble is not what we don't know
It's what we know for sure that just ain't so" - Mark Twain
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#7 User is offline   shock360j 

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Posted 06 July 2008 - 02:51 PM

I forgot to add a response to the above post by cbaker4481. I cannot agree more with your statement that constant hounding by your superiors proves that they care. In his last lecture, professor Randy Pausch points out that if you are doing something wrong and no one corrects you, that is a bad place to be. When people correct you, they care. If you mess up and no one points it out, it probably means they have stopped caring!!!
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#8 User is offline   jjones1418 

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Posted 07 July 2008 - 04:40 PM

View Postshock360j, on Jul 6 2008, 10:51 AM, said:

I forgot to add a response to the above post by cbaker4481. I cannot agree more with your statement that constant hounding by your superiors proves that they care. In his last lecture, professor Randy Pausch points out that if you are doing something wrong and no one corrects you, that is a bad place to be. When people correct you, they care. If you mess up and no one points it out, it probably means they have stopped caring!!!


And if noone has seen this lecture, you need to watch it. It's well worth it! I have it on my iPod.

http://www.youtube.c...h?v=ji5_MqicxSo

I'll post to the safety issue later today.
Jason Jones, EMT-P
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#9 User is offline   coloradoclimb 

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Posted 09 July 2008 - 05:10 AM

So this will be my first post here on Flight Web. I have been reading the case presentations on this thread and love the challenge. That being said, I will move on to the question at hand. I am new to HEMS, and when I say new I mean I haven't even been on a flight yet. I will be starting in August with my orientation. I think I may have a unique oppotunity here. As a new person to this field I will be acutely aware of all the things going on around me, all the time. I won't be "seasoned" or used to any of it. Safety will be paramount for me. What I feel I can do is to never loose the level of diligence I will have for these first 12 months (or untill whatever point I feel like I'm comfortable). One thing that stuck out to me in my interview was this quote from the panel of interviewers in regards to safety... "Apathy kills". I feel thats pretty powerful and it give's me pause . I am very confident in who I've hired on with in regards to safety but I know I will need to be on my toe's for every shift for the rest of my career. I am not so naive to think that there will not come a point where I will question what I see, no matter what my initial impression of my new employer is. I'm sure most people in this profession are truly dedicated to safety but clearly, given recent events, there are some issues to work out. I won't postulate further on things I'm not familiar with yet, but as the annoying "new guy" I think that if I come across something that appears unsafe, I'll ask about it. Perhaps I'll be wrong and just don't have a full understanding of things. Or maybe it will be something that is off, and my "fresh eyes" caught it. Either way it'll be a learing leason for those involved. These types of environments can only be good.

Thanks for letting me throw in my $0.02.
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#10 User is offline   doz2240 

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Posted 12 July 2008 - 04:06 AM

In response to the last post, I feel you have some good traits as written in your post. I should point out a few things, You will be put into situations that will make you uncomfortable. A lot of flight programs talk safety in orientation, However, many fall short of these policies once flights are on the line. You need to use your gut instincts, just as I'm sure you've used on patients. I feel this is one of the most important thing we as clinicians can have. I can't tell you how many time my gut feelings have lead me down the right road. You will need to listen for that inner self telling you something isn't right, and have the confindence in speaking up. The response you get from the crew and company will truely tell you if the company will stand by there safety statement in orientation.

I have always been an aggressive paramedic. I never do anything note nessecary, but I will always treat my patients with the intent to have the best outcome. I never feel bad if I have to do a decompression, or a cardioversion etc. I realize that somethings we do treatment wise will hurt the patient as far as pain goes, but that never crosses my mind. I have meet many medics that won't do certain procedures because of the invasivness. My point is you need to have that same approach on safety. YOU are number 1... YOUR crew is next and your patient is 3rd. You can never get pulled into the thought of "my patient is going to die if we don't fly". Just keep using the same instincts that have gotten you this far in your career and you'll be fine.

Sorry for rambling, and hope you understand my point...
E. Bauer, CCEMTP, FP-C
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#11 User is offline   rovrkil 

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Posted 18 July 2008 - 12:11 AM

I have read the other posts and I do believe that in the end the NTSB/FAA with release a report that it was "pilot error".
The underlying issue is why?
If you have read the post over in the general discussion, which I don't recall who wrote, he lays it out there. Some don't agree and others do. I think it will take some balls to get things changed in the world of HEMS as we know it. Crews refusing flights that are of questionable merit and others "demanding to turn around" in weather that they aren't uncomfortable in.
As we all see on a daily basis, rules are bent to allow for a flight or to even land (if you read verbatum the rules for some of the larger companies, "one must have ground contact at an uncontrolled landing area"). Until ALL of the rules are followed, black and white no grey, we will continue to see this site blacked out.
I don't claim to know anything about flying, quite frankly I don't care to know, but know enough not to let my pilot do something stupid to kill me and I will piss him off when I say, "the LZ ain't big enough and you ain't landing here!"
To be relative to the most recent crash, the program that I work for has "respectfully requested" that aircraft coming into our city/town notify our dispatch center so that any other incoming aircraft are aware, and any aircraft landing at our hospital (or sister hospital 1 mile away) has to contact our dispatch. It unfortunately has to be worded that way because our comm center is not ATC, although they do "juggle aircraft" on a routine basis. We are trying to be proactive due to the business our rooftop pad is seeing.

My 2 cents, be safe!
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