Helicopter Safety for EMS Personnel
The helicopter is becoming a frequently used tool by the Emergency Medical Service (EMS). Soon, even the most remote fire department or EMS agency will be in close proximity to a helicopter, which can be used in a variety of ways.
Because safety is always the top priority on the fireground or emergency scene, it is imperative that ground emergency personnel learn the rules of survival when working around helicopters. They must know how to protect themselves, bystanders, and patients. In addition, EMS personnel must be trained and knowledgeable in order to use helicopters to their maximum advantage. So, here is a discussion on basic helicopter “ground rules.”
Remember that helicopters vary greatly depending on manufacturer, model, etc. The helicopter at your emergency scene may be military or civilian. It may be permanently equipped for its current job—EMS, for example—or it may be a multi-purpose craft that handles many roles. If this is the case, you may have to load the EMS equipment before you load the patient.
The crew may vary in content and training. There may be a physician, a nurse, a paramedic, a physician’s assistant, or any combination of the above. There may be one pilot or two. A member of your ground crew may be requested to ride in the helicopter enroute to the hospital—or it may be out of the quesiton. The craft may be able to carry only one patient, or it may carry several. Because of all these variables, you should be familiar with the services available in your district and try to maintain open and regular dialogues with them.
Weight on board
Helicopters also have a great deal in common. Because the amount of weight carried on a helicopter is critical, the crews tend to be wiry but small types. In fact, some males are experiencing “reverse discrimination” because their female counterparts are lighter and therefore more acceptable in aircraft operations.
In addition, every item of equipment is weighed and evaluated for importance before it is carried on board. There are some items that ground EMS personnel take for granted, such as an extra splint or pillow that can be tucked away in their vehicle. However, these things cannot be carried on the helicopter unless there is a demonstrated need for them.
Ascent and descent
Once airborne, helicopters are extremely safe vehicles, and the agencies that operate them try their best to preserve an excellent safety record. Surprisingly, even if the engine fails while in the air, the helicopter can still glide to a fairly smooth landing by “autorotation.” This is when the helicopter descends at an angle of approximately 45°.
In practice, landings without engine power are barely distinguishable from conventional landings. This holds true only if the craft is operating above 500 feet of altitude, so that the pilot has room and time to do the necessary maneuvers. The most dangerous area for a helicopter is when it is flying under 500 feet.
Although a helicopter can land and take off vertically, and hover, this puts the maximum stress on the engine and craft, and so pilots prefer to land and take off at about a 45° angle. Therefore, the ideal landing zone is longer than it is wide. The most dangerous thing a helicopter can do is to land or take off vertically, or to hover under 500 feet in altitude.
Helicopters develop a large downdraft from their overhead rotors. This is important for a variety of reasons. The downdraft will kick up dust and stones, and will sandblast the paint off the side of your apparatus if you get too close. It will blow sheets off of stretchers or rubbish off the ground.
Remember that the air being blown down from the blades is pushed sideways by the ground and then returned to the upper side of the blades. This means that something that gets blown away will momentarily be propelled back down through the blades where it may snag or do structural damage.
Beware of the “ground effect.” Be sure that hats, sheets, etc., are well secured. This same “ground effect” helps the helicopter take off until it is moving forward through the air (pilots call this “translation”), but it can also cause severe damage to people and objects that get in the way.
Helicopters always draw a crowd. Whenever a chopper lands, the immediate urge is to rush forward and open the doors—even while the blades are still turning—in order to help the occupants disembark. This makes crowd control a necessity. Only persons trained in helicopter operations should approach the vehicle.
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While some systems routinely do “hot” unloading or loading— with the blades still turning—it is a dangerous procedure and should be done only when the time factor outweighs the risk involved. Again, you should learn the procedures of your local services and follow them.
What about those overhead blades? They are overhead and no threat to safety, right? Wrong. On flat and level ground, the blades are a comfortable distance over your head. But, the pilot may land on the shoulder of a highway— several feet below the level of the roadway or next to a knoll. Out at the perimeter of the blades’ radius they may only be waist high.
Another situation in which you should exercise caution is when the helicopter is sitting on the ground preparing to take off with the blades turning rapidly or at what the pilots call “flight idle.” The centrifugal force keeps the blades in a level plane of rotation. But, as the pilot shuts the engine down and the centrifugal force decreases, the blades become much more unstable, and a sudden breeze can tip them over as low as waist level.
So, whenever you are near a helicopter and the blades are turning, walk in a crouch. Never approach the aircraft unless you are accompanied by a flight crew member. Make eye contact with the pilot and wait until he signals you to approach. Flight crews are automatically safety conscious and will appreciate it if you are too.
Look at the skids the helicopter sits on. Skids with a low profile make it easier to load patients. But it also means that the rotor blades are closer to the ground. Higher skids raise the blades, but make loading and unloading more difficult. Do not allow tall objects like intravenous (IV) poles, radio antennas, etc., to get under the rotor blades.
Because the helicopter has skids, not pontoons or other flotation devices, it is not equipped for water rescue or for flying over open water. This is usually a trade off by the operator. Although pontoons adapt the helicopter to water rescues, they add weight and slow the top speed considerably.
Despite what you may see on television, emergency crews do not routinely rappel from ropes out of a helicopter, nor are they pulled aboard by ropes. Only larger helicopters that are equipped with a hoist are intended for this purpose. Even then there is a considerable risk involved because the load is not centered in the aircraft.
If you are involved in a vertical rescue situation with a helicopter that is equipped with a winch or hoist, you should know this: There is an emergency cutting device built into the hoist that can instantly sever the cable if the aircraft is in danger, and the crew will not hesitate to sacrifice the patient or rescuer to save themselves or the aircraft. It goes with the territory.
Watch out for the tail rotor.
This is important. Let’s say it again.
Watch out for the tail rotor.
This is the most dangerous area of the helicopter. The tail rotor is fixed on the rear of the aircraft in a vertical position. It counteracts the rotation force of the big overhead rotors. Without the tail rotor the helicopter would spin in the opposite direction from the overhead rotor blades. The tail rotor may be mounted on either side of the tail boom and usually comes down about shoulder high.
When it is rotating, the tail rotor is nearly invisible and very easy to walk into with the noise and sensory impact of the overhead rotor to distract you. Because the tail rotor is the cause of most helicopter accidents, the crew tends to be very cautious about the rear of the aircraft.
Never, ever go near the tail while the engine is running. Even if the engine is not running, only the pilot and mechanic belong near the tail of the aircraft. They should be the only ones to ever even touch the tail rotor. It is delicately balanced and susceptible to nicks or other damage. There is usually a cargo compartment located inside the tail boom, but you should also leave that to the flight crew.
Don’t go past a line across the far end of the most rearward doors of the patient/passenger area. When you approach the helicopter, exaggerate your route to stay close to the front of the aircraft. Try to maintain eye contact with the pilot, or make sure you are accompanied by a crew member.
You can’t be “too safe.” No one will think less of you for following good safety practices around the helicopter. In fact, it will register as a mark of competency.
One helicopter model, the MBB BO 105, has a rear facing door into which the patient is loaded on a conventional wheeled ambulance stretcher. This obviously puts the rescuers and crew in the area of danger near the tail rotor. Most of these helicopters have raised skids that put the tail rotor out of reach, but don’t depend on it.
Again, you should communicate with the helicopter agencies in your area and preplan. Find out about their loading procedures, etc. They will probably be more than happy to do a demonstration or training session for your group.
Helicopter models vary in their methods of loading patients. Some choppers carry the patient feet first alongside the pilot and attendants. Some load the patient across the aircraft behind the pilot with a rear facing seat for the crew. Some accept a conventional wheeled ambulance stretcher, while many need to reload the patient onto their own stretcher.
All helicopters will accept an immobilized patient on a spine board that is 16 X 72 inches. Most choppers can handle a spine board that is 18 inches wide. But if your spine boards are 20 or 24 inches wide, or more than 72 inches long, they may not fit into the helicopter’s patient compartment.
Again, prior planning and practice are a must. Some helicopter services will even distribute free spine boards to the EMS teams in their areas. Ask your helicopter service about it.
When you are in an airborne helicopter, it is often difficult to locate people and places on the ground. Street signs and house numbers are illegible. It is also difficult to tell the difference between a hospital building, a National Guard armory, and an apartment building.
Hospital roofs should have a big red cross painted on them for identification, but they don’t. This problem is compounded at night. Another problem is that most hospitals have one or two radio and television antenna towers on their roofs. This presents an obstacle course for the pilot.
To make the location and landing process easier, surround your landing zone with emergency vehicles and leave the rotating roof lights on. Even if the chopper is landing at a hospital helipad there should be fire apparatus present and fire police on the scene to control bystanders.
At night, don’t shine spotlights or flashlights up toward the chopper as it makes its final approach because it will blind the pilot. Keep the lights low across the landing zone and out of the pilot’s eyes. Keep the press under control. Do not allow them to pop flashbulbs at the helicopter as it descends. The pilot loses his night vision for several minutes each time a flashbulb goes off in his eyes.
A landing zone must be at least 70 X 100 feet, although 100 X 100 feet is better—especially at night. Look for overhead obstructions, especially power lines and wires. Surprisingly, there are many hospital helipads that are constructed next to high-voltage power lines.
You may be able to communicate from the ground with the approaching helicopter. Many helicopter services are equipped with a programmable radio that can match any FM frequency in the public safety bands—even the state police or highway patrol—as long as they know the frequency in advance. Again, preplanning is the key. The helicopter also probably has an electric siren and public address system similar to the one on your emergency vehicle. They may use these to give commands before landing.
Here are some things you should know about patient care in a helicopter. IV fluid containers for ringers lactate, etc., must be in a flexible bag so a pressure bag can be wrapped around them. This is because of the helicopter’s limited headroom and the changing atmospheric pressure as the aircraft ascends or descends.
If you start an IV from a rigid bottle or container this will cause a delay because the helicopter crew will have to change it to a bag. The inflation pressure of the cuff on an endotracheal tube or in the medical anti-shock trousers (MAST) must be watched closely if the helicopter makes significant changes in altitude (more than about 3,000 feet) en route to the hospital.
There are many hidden expenses involved with helicopter operation. Here are some of them: A hospital that operates a helicopter must build two helipads: one for their own helicopter and one for other helicopters that may fly in from other hospitals.
Because a helicopter must be taken out of service for maintenance after every 100 hours, a back-up helicopter must be available. The pilot must get 8 hours of sleep every 24 hours, necessitating the availability of back-up pilots.
Heat or air conditioning is necessary to maintain the helicopter’s interior temperatures within specified limits. This protects delicate navigational equipment and fluids and medications from damage by extreme heat or cold. So, there may be either a portable air conditioner or a portable heater connected to the interior of the helicopter while it is sitting on the helipad. A mechanic is usually available at all times.
To reduce turnaround time, many helicopter services duplicate all their equipment, such as stretchers, medications, resuscitation equipment, etc. This is done so that the helicopter can be quickly restocked after each flight as soon as the patient has exited the aircraft.
Because helicopters are specialized vehicles and expensive to operate, they should be used only for the appropriate patients. The helicopter is an important part of a regional trauma system. It is an ideal way to quickly transport a patient who has suffered severe multi-system trauma from an outlying area into a major hospital trauma center within the “golden hour.”
In today’s world, more and more people live in the suburbs, while hospitals are usually located in the cities. The helicopter provides a quick response time between these suburban areas and the hospitals by eliminating the problem of traffic jams on super highways.
HELICOPTER CREW PROCEDURES
We all know that severe trauma patients stand the best chance of a complete recovery if they are removed quickly from the incident scene. Helicopter crews tend to be fanatics about this. They call it the 10-minute rule. They tend to move quickly at the scene to the point of appearing brusque. This is partly because they probably have a supervisor who is responsible for quality control and who scrutinizes their call reports for ground time.
So, if they appear to do “jerk and run” don’t take it personally. It is the nature of their business. When you call for a helicopter, their dispatcher may ask some surprising questions, such as how much the patient weighs. This is so they can cut down on their ground time and do their drug calculations in flight before arriving at the scene.
You should remember that safety is paramount. Maintaining the safety of the patient, crew, public, and aircraft is the business of all concerned and cannot be overstressed.
One of the pilots who I fly with goes so far as to remove the fuel tank cap and stick his finger inside after each refueling. He does this to make sure that the aircraft contains the proper fuel and also to make sure he eliminates any possibility of error.
This dedication to complete thoroughness and safety is the best attitude to have when you are involved in a helicopter rescue operation.
1MAST garments are worn by victims while they are in the helicopter en route to the hospital. They are inflatable pants, which help pump extra blood from the patient’s lower extremities into the heart and lungs.