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Critical Care Transfer In Bell 407


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#1 KingAirNLA

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Posted 01 November 2011 - 09:50 PM

Looking for information from personnel and/or programs that are currently using the Bell 407 for adult critical care transfer. Our fixed wing program is in the early stages of HEMS development and this is the aircraft that has been proposed by the employer. Staff have concerns regarding space issues for required equipment and patient care enroute. Feel free to PM me if you wish.
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#2 Jwade

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Posted 02 November 2011 - 12:21 AM

Looking for information from personnel and/or programs that are currently using the Bell 407 for adult critical care transfer. Our fixed wing program is in the early stages of HEMS development and this is the aircraft that has been proposed by the employer. Staff have concerns regarding space issues for required equipment and patient care enroute. Feel free to PM me if you wish.



Have any of your staff actually flown in a helicopter before?

Does any of your leadership have any experience flying in helicopters?

Just curious, as I have seen more than a couple of FW programs get in way over their heads trying to add a rotor program by just winging it with no education and a prayer....


The 407 is a very suitable aircraft for HEMS. I have flown in this aircraft and there is nothing that cannot be done by a standard HEMS crew. Now, If you are talking extremely high end critical care, like ECMO then you might want to reconsider. However, your standard ICU train wreck on a vent, multiple drips, chest tubes or even balloon pumps will be no issue as long as the crews have the ability to use some common sense and critical thinking skills BEFORE they get in the helicopter with the patient....In my experience, a bad flight is usually the DIRECT result of poor planning prior to leaving the referral facility.........

I did some consulting work for a FW program who added a Rotor last year, so hit me up offline if you have more questions.

JW
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John Wade MBA, CCEMT-P, FP-C, RN

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#3 KingAirNLA

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Posted 02 November 2011 - 02:55 AM

JW,

Thank-you for your reply.

Our Mgmt and most of staff have experience working on RW aircraft. Our concern is that the 407 does not meet our mission profile.
The majority of the calls that we would use the 407 for would be responding to small clinics/primary care centers for fresh critical patients. Average flight time would be around 1hr one way with the shortest possible trip being 30min after the Pt is on-board. Given the nature of the calls and our mandate to "bring critical care to the Pt", staff are concerned that the 407 does not allow space for adequate assessment and interventions enroute.
Another concern is the aviation environment that we work in. We live in the middle of the North Atlantic so flight conditiions are bad at best with high winds and rapidly changing unpredictable weather patterns.
All of my RW experience has been on MUCH larger IFR, dual engine, dual pilot aircraft (S92, Super Puma) doing offshore work. So, personally, I am having difficulty envisioning providing ongoing critical care in the 407.

Feel free to PM or e-mail me with any helpful information.

Regards,
DD
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#4 Macgyver

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Posted 02 November 2011 - 08:58 PM

Looking for information from personnel and/or programs that are currently using the Bell 407 for adult critical care transfer. Our fixed wing program is in the early stages of HEMS development and this is the aircraft that has been proposed by the employer. Staff have concerns regarding space issues for required equipment and patient care enroute. Feel free to PM me if you wish.


One word. Don't. Especially as you won't have access to HTAWS or NVG or even decent weather reporting stations in a maritime/cold climate. The 407 has it's niche, VFR, day only, and most of all - cheap: Single pilot, single engine, minimal avionics, scene "scoop and swoop"

You don't need a "scene machine" for short hops in an area where it can easily autorotate, you need a Critical care Transfer capable machine with twin engines and the range/lift to take 3 med crew/pilot/overweight pt for 100-150 miles. Where you're at a single light RW is totally inadequate. Ditto a light twin if you expect 250#+ pt or 3 person med crews.

You need a light medium or medium twin. Smallest suitable (range, lift and volume) would be a 902. EC-135 cabin is likely too tight and big pts/3rd med crew make it problematic. And since no NVG is likely in your neck of the woods the addition HTAWS and IFR current/proficent pilots. Better would be an EC-145. The S-76/412/AW-139 would be nice but really would be overkill. On Board weather RADAR would also be a huge safety multipier - the sat uplink type won't be very useful in your area again due to the lack of infrastructure to collect reliable data/observations in the many local microclimates.
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Ken BHSc, RN, REMT-P

#5 Macgyver

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Posted 02 November 2011 - 08:59 PM

In my experience, a bad flight is usually the DIRECT result of poor planning prior to leaving the referral facility.........


WORD.
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Ken BHSc, RN, REMT-P

#6 BackcountryMedic

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Posted 02 November 2011 - 11:24 PM

Especially as you won't have access to HTAWS or NVG or even decent weather reporting stations in a maritime/cold climate.


I don't disagree with most of your statement, except regarding HTAWS or NVG. Is that a Canadian rule? I don't know the rules up there, but there are HTAWS and NVG packages for the 407.

If you're stuck using a Bell product due to provincial rules, why not go with the 412?
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#7 Mike Mims

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Posted 02 November 2011 - 11:30 PM

I don't disagree with most of your statement, except regarding HTAWS or NVG. Is that a Canadian rule? I don't know the rules up there, but there are HTAWS and NVG packages for the 407.

If you're stuck using a Bell product due to provincial rules, why not go with the 412?

Bell is no longer going to support the 222/230, 412 and eventually the 430.
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Mike Mims

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University of Mississippi Medical Center


#8 Macgyver

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Posted 03 November 2011 - 04:53 AM

I don't disagree with most of your statement, except regarding HTAWS or NVG. Is that a Canadian rule? I don't know the rules up there, but there are HTAWS and NVG packages for the 407.

If you're stuck using a Bell product due to provincial rules, why not go with the 412?


No provincial rules on Bell - even in Quebec where they are made - just economics. The only "rules" are by the provincial health boards when they set out their RFP's for MEDEVAC contracts - usually (like 95% of the time) specifing twin turbine, dual pilot, IFR capable. "AD-HOC" providers (ie call us for a short notice charter for a medical flight and if we have a ship available we'll come and pick your team up) have no rules and in BC there are a couple of Longrangers that are occasionally used. But all DEDICATED Canadian HEMS ships are medium twins with IFR and a two pilot crew.

And no fatal crashes in 33 years.

Only STARS in Alberta has been approved for commercial (non police/military etc) NVG in Canada. HTAWS in most of the versions out there relies on a database - which in the area the OP is in is scant to non-existant - hence the need for onboard weather RADAR that can look ahead/down.

Seems hard to justify (to me at least) going with a 407 or 350B3 for RW when you are using brand new King-Air 350's for FW...
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Ken BHSc, RN, REMT-P

#9 Macgyver

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Posted 05 November 2011 - 11:15 PM

IIMC video = why IFR capable equipment and proficient crews are so important to us. And this was for fixed wing - I think the number of seconds for RW pilots is far less...

http://www.aopa.org/...178seconds.html

Those Gov. officials making these "buddy buddy" contract decisions need to go for a flight in marginal VFR AFTER watching this video - then think again about using a cheap VFR only single vs an IFR capable twin...
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Ken BHSc, RN, REMT-P

#10 USDalum97

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Posted 07 November 2011 - 04:04 AM

One word. Don't. Especially as you won't have access to HTAWS or NVG or even decent weather reporting stations in a maritime/cold climate. The 407 has it's niche, VFR, day only, and most of all - cheap: Single pilot, single engine, minimal avionics, scene "scoop and swoop"

You don't need a "scene machine" for short hops in an area where it can easily autorotate, you need a Critical care Transfer capable machine with twin engines and the range/lift to take 3 med crew/pilot/overweight pt for 100-150 miles. Where you're at a single light RW is totally inadequate. Ditto a light twin if you expect 250#+ pt or 3 person med crews.

You need a light medium or medium twin. Smallest suitable (range, lift and volume) would be a 902. EC-135 cabin is likely too tight and big pts/3rd med crew make it problematic. And since no NVG is likely in your neck of the woods the addition HTAWS and IFR current/proficent pilots. Better would be an EC-145. The S-76/412/AW-139 would be nice but really would be overkill. On Board weather RADAR would also be a huge safety multipier - the sat uplink type won't be very useful in your area again due to the lack of infrastructure to collect reliable data/observations in the many local microclimates.


Sorry Macguver, going to have to disagree. We've been in a 407 for a few years now. We were in a 222 before this. We currently have NVG (3 sets of goggles), HTAWS, Storm Scope, XM Weather, Dual Garmin 430's, Sat tracking, and TCAS. Is that every tool available? No. Could it be better? Yes. However, your assessment of the aviation capabilities is a bit off. Also, Iíve never had a patient ask how many engines there were and having a single engine never changed my patient care ("you need a Critical care Transfer capable machine with twin engines").

We can easily fit 3 crewmembers. We do it all the time when training or we can take a family member for pediatric pt's. We have taken patients well over 400#'s (the gurney weight limit is 500). I've never turned down a patient due to size. We have LZ's as high as about 8500 feet (not that we regularly lift 400+ pound patients from there), but we don't have much issues at altitude. Also, I know of at least one children's team that has a 407 and fits the isolette just fine with their crew.

As for distance, our max is about 200 miles and we do it without issue.

Why wouldn't they be able to have NVG's where the OP is? That confused me ("And since no NVG is likely in your neck of the woods the addition HTAWS and IFR current/proficient pilots").


To the OP, the 407 does just fine. It is reliable, efficient and very workable platform for any EMS not requiring IFR.

I third JWADE on the preparation. I took a patient not long ago that had 3 chest tubes, a vent and 6 drips on an hour long flight. A little prep work made it go just fine.
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#11 Macgyver

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Posted 09 November 2011 - 05:52 AM

As for distance, our max is about 200 miles and we do it without issue.

Why wouldn't they be able to have NVG's where the OP is? That confused me ("And since no NVG is likely in your neck of the woods the addition HTAWS and IFR current/proficient pilots").


Many pts in the Canadian Arctic are 100-150 kg. Many crew members are 80-120kg. Labor laws there prohibit weight based hiring. There are VERY few places to land and refuel so your planning has to account for the greater distances between available fuel. Not like in the lower 48 where you can land almost anywhere and have a fuel truck meet you - there are very few roads and all comunities are extremely isolated. All this and the heavier winter clothing and required survival equipment add up to a higher base weight thus reduced range.

See a few posts earlier - this is in Labrador in Northern Canada. There are simply NO civilian operations using NVG west of Alberta. And highly unlikely to be any soon - especially a very small private operator with a single charter 407. Even if they wanted to it would take 2 or 3 years to put in place with Transport Canada etc involved. XM weather not available there AFAIK - unless things hove improved a LOT lately. Even if it is, it is weather from several hundred miles away at major airports. Many places have no AWOS even. There are just too many local climate variations due to the coastal outline (think seriously high cliffs/fjords and communities buits in the lee of land features). HTAWS that rely on a database inneffective since so remote many areas not current.

This scenario is not a 407 ordered from Air Methods or another medical interior fitter. It is a charter aircraft with the OEM litter kit thrown in - and med crew/bags etc.

Would you fly 200 miles over the North Atlantic (you know - where the icebergs that sank the Titanic were birthed) with a 400# pt in a 407 - in a cold maritime climate with temps below freezing more than 6 months a year (think VERY narrow dew point spreads and risk of icing) and nowhere else to land except ditching? Oh yeah - at present the operator has no survival suits or water egress capability/training. Even getting helmets for the crew will be a fight.

Just because it CAN be done doesn't mean it SHOULD. Especially when other options exist and the tiome savings are less than 5-10% of the total bed-bed time. Including the option of remaining with the existing BE-350 fleet.

Not trying to flame you - but until you have flown under the Canadian regs and in the Arctic - you don't know what you don't know. It is NOWHERE NEAR a similar situation as anywhere in the US - parts of mainland costal Alaska excluded. And I have had pts refuse top board single engine aircraft. Especially in marginal weather. Don't forget - the North (Canada and US) have a HUGELY higher proportion of aviation familiar people as they use it FAR more often just to get around - and many have survived incidents/crashes or known co-workers or village members who have died.
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Ken BHSc, RN, REMT-P

#12 Macgyver

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Posted 09 November 2011 - 06:05 AM

CAVEAT: I am not refering to the use of a properly set up dedicated HEMS 407 in more built up areas in the south where emergency landing are surviveable - but a marginally equipped aircraft in areas where even once safely landed it will be 6 hrs to 3-4 days before ANY help arrives and in MUCH more hostile conditions than even North Dakota/Minnesota. Two engines allows continuation of the flight long enough to reach an area where a safe landing can be made without risking everyones life. One engine gives you enough time to look for the least bad place to crash.

ANd the best reason - a VFR ship in a predominantly IMC environment is not a wise choice. Even if it is otherwise a capable aircraft when suitably set up.
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Ken BHSc, RN, REMT-P

#13 KingAirNLA

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Posted 10 November 2011 - 03:37 AM

Thank-you everyone for your responses.
As Macgyver as stated so clearly, we live in a very different aviation environment. In the picture on my profile that is an iceberg off our wing tip! Our primary concern at this point in the game is addressing saftey concerns for crew and patients before this expansion goes any further.
I welcome any more thoughts or suggestions you may have.
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#14 Thinking

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Posted 12 November 2011 - 08:25 PM

I'll have to agree with Ken on this. Newfoundland and Labrador are not places to be doing HEMS in a single engine machine. I've spent a large portion of my career in less than ideal environments, (Nunavut for 2 years and Northern Ontario for 6) where conditions are similar to where you are, and IMO, an IFR capable medium twin with 2 engines and 2 pilots is a must. One engine is never enough when flying over areas that remote. Also if you are doing critical care, the space offered in a larger airframe is nice to have. IMO either an S76 or an AW139 would be more suitable.
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