Pilot Decision Making in Weather-Related Night Fatal Helicopter Emergency Medical Service Accidents

Technical Failures in Helicopters: Non-Powerplant-Related Accidents

Technical failures in helicopters are a main concern for helicopter safety. The prominence of mechanical failures differs for specific helicopter operations. This analysis used 151 General Aviation accident reports from the National Transportation Safety Board online database from an 11-year time period. The information in each report was collated, including the list of findings for each accident. Possible relations between causes and specific flight operations were analyzed by looking at significant differences between expected and actual values within the dataset of categorical data. It is found that the proportion of fatal accidents in this category of accidents is low (16.6%) compared with the percentage of fatal helicopter accidents in general, as well as those of specific helicopter operations. Instructional flights appear significantly more likely to be associated with maintenance-related causes. Causes related to fatigue of aircraft parts are more often associated with ferry and positional flights, as well as helicopters with turbo-shaft engines. Future research is recommended for these specific associations to further mitigate the number of accidents with non-powerplant failures.

Influencing factors of novice pilot SA based on DEMATEL-AISM method: From pilots' view

Pilot situation awareness (SA) regulates flight safety, and inexperience may impair novice pilot reliability in SA. This study aims to determine the key influencing factors of novice pilot SA and to analyze the interrelationship and interaction mechanism of the factors. We investigated 55 novice pilots trained at aviation schools and identified the influencing factor index system by the Delphi survey. The method of Decision Making Trial and Evaluation (DEMATEL) combined with Adversarial Interpretive Structure Modeling (AISM) was adopted. The results show that: (1) The influencing factor index system includes 18 factors, divided into four categories: individual factors, team factors, task and human-machine system factors, and cockpit environment factors. (2) Team communication, team cooperation, basic cognitive ability, interface design, occupational age and experience, and authority gradient are the six crucial influencing factors. The former three have the greatest association with other factors, while the latter three are most likely to affect other factors. (3) Team communication, basic cognitive ability, and interface design are root-cause factors, of which team communication is the most fundamental. (4) The results of DEMATEL and AISM are consistent, both disclosing team communication as the fundamental factor with the highest priority, and cockpit environmental factors as the direct influencing factors but most susceptible to other factors. The present study can be viewed as a conducive attempt to extract vital influencing factors of novice pilot SA, and to provide ergonomic insights for determining the priorities to improve novice pilot SA in training and aircraft design for flight safety.

Feasibility, Safety, and Technical Success of the Flying Intervention Team in Acute Ischemic Stroke

Background

Prompt endovascular care of patients with ischemic stroke due to large vessel occlusion (LVO) remains a major challenge in rural regions as primary stroke centers (PSC) usually cannot provide neuro-interventional services. Objective The core content of the Flying Intervention Team (FIT) project is to perform thrombectomy on-site at a local PSC after the neuro-interventionalist has been transported via helicopter to the target hospital. An important and so far unanswered question is whether mechanical thrombectomy can be performed as safely and successfully on-site as in a specialized comprehensive stroke center (CSC).

Methods

Comparison of 100 FIT thrombectomies on site in 14 different PSCs with 128 control thrombectomies at 1 CSC (79 drip-and-ship, 49 mothership) performed by a single interventionalist with respect to technical-procedural success parameters, procedural times, and complications.

Results

There were no significant differences between the two groups in terms of technical success (95.0% successful interventions in FIT group vs. 94.5% in control group, p = 0.60) and complications (3% major complications in FIT vs. 1.6% in control group, p = 0.47). Regarding time from onset to groin puncture, there was no difference between FIT and the entire control group (182 vs. 183 min, p = 0.28), but a trend in favor of FIT compared with the drip-and-ship control subgroup (182 vs. 210 min, p = 0.096).

Conclusions

Airborne neuro-interventional thrombectomy service is a feasible approach for rural regions. If performed by experienced neuro-interventionalists, technical success and complication rates are comparable to treatment in a specialized neuro-interventional department.

Sightseeing Accidents with Helicopters and Fixed-Wing Aircraft

BACKGROUND: Sightseeing operations are characterized by the presence of passengers as well as favorable light and weather conditions. They include both fixed-wing aircraft and helicopters, an aspect that allows for a comparison of these two types of aircraft in similar operations.METHODS: A total of 95 accident reports from 2008 until 2018 were extracted from the NTSB online database, with each mentioning commercial sightseeing as their operation.RESULTS: Out of a total of 95 accidents, 16 were fatal with a total of 58 people suffering fatal injuries. On average 3.625 people died in each fatal accident. There were significantly more accidents in Alaska and Hawaii than expected. There were significantly more accidents caused by the maintenance crew in helicopters than in airplanes, but significantly more pilot-related accidents in fixed-wing aircraft compared to helicopters. Despite favorable light and weather conditions, 37 accidents reported the environment as a contributing factor to the accident.CONCLUSION: Sightseeing accidents show a pronounced difference between helicopters and airplane accidents that point to different approaches when improving safety in either category. Although night and instrument meteorological conditions are largely absent in the dataset, wind conditions and unsuitable terrain are frequently mentioned. The experience of the pilots and the specific geography of the sightseeing area are likely to affect operational safety the most. The specific dangers of unsuitable terrain affect both helicopters and fixed-wing operations and may be assuaged by specific training or briefings.de Voogt AJ, Hummel Hohl C, Kalagher H. Sightseeing accidents with helicopters and fixed-wing aircraft. Aerosp Med Hum Perform. 2022; 93(6):532–535.

Fatality and Operational Specificity of Helicopter Accidents on the Ground

INTRODUCTION: Accidents with aircraft standing are more likely with helicopters than fixed-wing aircraft due to the common presence of off-airport landings and the possibility of the rotor system to strike objects in its immediate surroundings.METHODS: A total of 115 accidents involving helicopters characterized as standing as a broad phase of flight were selected from the NTSB online database for the period 1998 until 2018.RESULTS: Accidents reporting fatal (8.7) or serious injuries (7.8) were significantly less likely to occur when the aircraft was substantially damaged (84.3) or destroyed (5.2). The majority of the cases occurred after off-airport landings (57.4), which were reported significantly more often in Alaska (N= 15). A main rotor strike with an individual was at the basis of each of the 10 fatal accidents in the dataset and in 8 of these cases the cause of the accident was attributed to the victim. None of the accidents occurred in instrument meteorological conditions, but, in particular, high winds and gusts proved a main cause of accident (18.3).CONCLUSION: Pilot, passengers, and crew endangered themselves when they were outside the aircraft while the rotors were still turning. Helicopter operating manuals should highlight the limitations and dangers for wind and wind gusts not only during takeoff and flight, but specifically when standing.de Voogt AJ, Hummel C, Kalagher H. Fatality and operational specificity of helicopter accidents on the ground. Aerosp Med Hum Perform. 2021; 92(7):593596.

Prehospital Stressors: A Cross-sectional Study of Norwegian Helicopter Emergency Medical Physicians

OBJECTIVE

Personnel working in helicopter emergency medical services (HEMS) and search and rescue (SAR) are exposed to environmental stressors, which may impair performance. The aim of this survey was to study the extent HEMS and SAR physicians report the influence of specific danger-based and non-danger-based stressors.

METHODS

The study was performed as a cross-sectional, anonymous, Web-based (Questback AS, Bogstadveien 54, 0366 Oslo, Norway) survey of Norwegian HEMS and SAR physicians between December 2, 2019, and February 25, 2020.

RESULTS

Of the recipients, 119 (79.3%) responded. In helicopter operations, 33.6% (n = 40) reported involvement in a minor accident and 44.5% (n = 53) a near accident. In the rapid response car, 26.1% (n = 31) reported near accidents, whereas 26.9% (32) reported this in an ambulance. Of physicians, 20.2% (n = 24) received verbal abuse or threats during the last 12 months. When on call, 50.4% (n = 60) of physicians reported sometimes or often being influenced by fatigue.

CONCLUSION

This study shows that Norwegian HEMS and SAR physicians are exposed to several stressors of both a danger-based and non-danger-based nature, especially regarding accidents, threatening patient behavior, and fatigue. Very serious incidents appear to be seldom, and job satisfaction is high.

Future development of helicopter emergency medical services in Korea

This paper discusses the future development of air ambulance operations in Korea. Helicopter emergency medical services are a useful means of transporting critically ill patients to the right hospital, at the right time. It is an important element of the emergency medical system to treat acute diseases at the scene, or in transit. For more efficient operations of the emergency medical helicopters (air ambulances or the so-called ‘Doctor Helgi’ in Korea), various challenges are faced. These include, the expansion of air ambulance bases, proper placement of rendezvous points (landing point), increase of field transport requests, and the operation of night missions. First, it is necessary to reduce the disparity in the benefits of emergency medical care for critically ill patients through the expansion of helicopter bases. Second, through the advancement of joint operations of the pan-ministerial emergency medical helicopters, the time from dispatch to helicopter take-off should be minimized, and a quality improvement program for air transportation should be carried out. Third, it is necessary to increase the number of insufficient rendezvous points and ensure the safety of the helicopters during takeoff and landing, to activate field transportation. Finally, the safety of patients and medical staff should be secured through the systematic preparation of the air transport system for future night missions. To solve these tasks, an appropriate legal system for helicopter emergency medical service is required. Based on the improved system, it is expected that everyone will enjoy equal rights for health, regardless of the regions.

Prevalence and potential risk factors of flight-related neck, shoulder and low back pain among helicopter pilots and crewmembers: a questionnaire-based study

BACKGROUND

Flight-related neck, shoulder and low back pain are the most common musculoskeletal disorders among helicopter pilots and their crewmembers, thus becoming a growing concern. Information on the combined prevalence of these types of pain and related risks are scarce. The aim of this study was therefore to estimate pain prevalence and to evaluate potential risk factors for neck pain among helicopter pilots and crewmembers within the armed forces, the airborne police and airborne rescue organizations in Austria.

METHODS

Among a cohort of 104 helicopter pilots and 117 crewmembers (69.8% compliance), demographics, flying experience, use of Night Vision Goggles (NVG), helicopter type flown, prevalence and intensity of musculoskeletal symptoms (pain was defined as any reported pain experience, ache or discomfort) were collected by an online-based questionnaire.

RESULTS

For helicopter pilots the 12-month prevalence of neck pain was 67.3%, followed by low back (48.1%) and shoulder pain (43.3%). Among crewmembers, the 12-month pain prevalence were 45.3, 36.8 and 30.8% among the neck, lower back and shoulder, respectively. During this period, 41.8% of these helicopter pilots had experienced 8-30 pain days in the areas of neck (45.7%), shoulder (37.8%) and lower back (42.0%) whereas 47.8% of crewmembers self-reported 1-7 days of neck (54.7%), low back (44.2%) and shoulder (44.4%) pain in the previous year. The 3-month prevalence of neck pain was 64.4% followed by low back (42.3%) and shoulder pain (38.5%) for helicopter pilots. Among crewmembers, 41.9% suffered from neck, 29.9% from low back and 29.1% from shoulder pain the previous 3 months. Multivariate regression analysis revealed NVG use (OR 1.9, 95% CI, 1.06-3.50, p = 0.032), shoulder pain (OR 4.9, 95% CI, 2.48-9.55, p < 0.001) and low back pain (OR 2.3, 95% CI, 1.21-4.31, p = 0.011) to be significantly associated with neck pain.

CONCLUSIONS

The 12- and 3-month prevalence of neck, shoulder and low back is considerably high among both, helicopter pilots and crewmembers confirming the existence of this growing concern. The use of NVG devices, shoulder and low back pain in the previous 12 months represent independent risk factors for neck pain. These findings highlight the need for longitudinal studies.