UNCOMPROMISING COMMITMENT TO SAFETY

WORLD CLASS PATIENT CARE

MARCH 2014
1
SAFE -vs- AIRWORTHY
Dwain McDonald
BAM, Beaumont TX (Ret.)
We had received a call to transfer a patient from the Port Arthur,TX. medical center to the medical center in
Houston. At approximately 0345 hrs. the patient was loaded on the aircraft. After my walk-around
inspection, I climbed in, strapped in and put on my helmet and prepared to start the aircraft. Before I could
start the aircraft the med crew announced the patient was coding and they were going to move him back to
the ER. As I was taking off my helmet I heard a bang and someone say Im sorry. I looked down and saw a
hole approximately 2 by 5 in the pilot chin bubble. The ER nurse had run the stretcher into the chin bubble.
I exited the aircraft and called the mechanic and explained what happened and the damage done to the
aircraft. I told the mechanic to start the procedure to get us a new chin bubble. I told him I would take the
aircraft back to our base which is about a 4 minute flight. This is where I went wrong. My definition of
airworthy means the aircraft is safe to fly. However airworthy according to the FARs means that the
damage has been written up in the logbook, properly serviced and signed off by maintenance and returned
to service. Also, a request for a one time flight must be made to the FAA if it needs to be repositioned for
repair. This incident is still under investigation by the FAA and I stand a chance of having my license
suspended for a period of time. Bottom line: If the aircraft sustains any damage whatsoever, no matter how
minor you may think it is, leave it where you had it parked and let maintenance do their job.
Are We There Yet?
After much research, comparing and contrasting, all
four companies came to the same conclusion:
Baldwin Aviation is the vendor we want to partner
with for safety reporting.

Expect changes to how we
report things starting in April.
First it will be safety reporting, next, the flight risk
assessment then other reports and forms. Every
employee will have visibility on the risks at their
base and across the company. If you havent
watched the Baldwin training videos on
Cornerstone, now would be a good time.

No Really, Are We There Yet?
Final stages of polishing the Safety Manual are
almost complete. Changes you will see from the
2014 Safety Initiatives

old way of doing things:

A formalized Just Culture
program, implemented
consistently across all four
companies

A Med-Trans Time-Out
Policy to provide all
employees with a tool to
prevent bad situations
from becoming worse.


Localizing the Safety Compass. Get our programs
involved to host a month of Safety Compass to share
their safety efforts.
UNCOMPROMISING COMMITMENT TO SAFETY
WORLD CLASS PATIENT CARE
MARCH 2014
2013 started off with the tragic accident in Mason City IA, but thankfully ended
peacefully. Tracking our top two recurring incidents, we have a near tie between bird
strikes (8) and leaving stuff on, attached to, or unsecure on Takeoff (7). Lets discuss
mitigation for these two types of events.
Bird Strikes
There isnt much we can do to prevent birds from
operating in our airspace. So mitigation is best
addressed by what we can do to ensure the safety of
everyone on board should one crash your party. A
bird strike through the windscreen can be a
catastrophic event, and aircraft control could be lost,
making recovery difficult or impossible given the
time you have to react. 92% of bird strikes occur in
the airspace we typically operate in (below 3500
AGL)

Mitigation strategy
1 Helmet visor down or glasses on during the day

2 Clear visor down at night unless NVGs are worn.

3 Scan 45 degrees either side of the nose in your
flight path, slightly above to slightly below flight
level

4 Dont rely on the birds instinct to dive as you
approach it, be prepared to perform
evasive action to avoid a collision

5 Quiz yourself periodically in flight:
What actions would I take and
where would I land if I lost my
engine(s)right now?

6 If the pilot needed my help, what
could I could I do to ensure a successful PL?


Pre-Flight Misses:
Urgency yes, rushing, no. There is no substitute for
attention to detail. Unfortunately, attention to
detail falls victim to rushing every time. In 2013,
we took off at least seven times with aircraft
unprepared for flight. Whether it was a door left
ajar, a seat belt hanging out of the aircraft or
needed equipment left on the pad or falling off in
flight.

In 2014, lets not charge the hill until we are ready:
Crew in sync, aircraft prepared for flight,
Required equipment on board, nothing left behind,
everything secure.

Mitigation strategy
As our new policy states, after everything and everyone
else has boarded, one person is responsible for making
sure that nothing was left out, on, attached to the
aircraft, and panels and doors are secure.

There is no excuse for taking off before you and
your aircraft are ready to fly.

2
UNCOMPROMISING COMMITMENT TO SAFETY
WORLD CLASS PATIENT CARE
MARCH 2014
3
I ask this question to myself as much as my fellow
maintenance technicians. Is today the day that being
tired or preoccupied results in an accident or
incident?

Take a minute and think back on the mistakes youve
made in your career.how many where due to being
tired or preoccupied with another matter. I would
hazard a guess, more than half.











On December 7
th
2011 N37SH, a Eurocopter AS350-B2
crashed with tragic consequences, the loss of five lives
and the destruction of the aircraft. NTSB Aircraft
Accident Report PB2012-103890 dated January 29
th

2013 cited four areas in the cause of the accident:

Improper re-use of used self-locking hardware
Maintenance personnel fatigue
Lack of procedures outlining the maintenance tasks
Lack of human factors training by the company

The work environment for mechanics in the EMS field
is not conducive to a steady work schedule so
maintaining your aircraft can involve some fatigue. In
the accident investigation it was noted that the
maintenance personnel
had been called in early to work and presumed to be
tired which started the chain of events. So what can
we do to minimize the risk when called in?

First is to follow all procedures associated with the
task at hand, short cuts or procedures handed down
through generations are not worth the time saved if
an incident occurs.

Second have an extra pair of eyes check your work,
explain the task steps and verify all FOD and tools are
removed. If the second pair of eyes is tired, get a
third. In the Eurocopter accident, the Quality
Assurance mechanic was also tired and overlooked
the errors.

Third, review common maintenance task and standard
practices, standards may have changed.

Fourth, knowledge is power. Study Human Factors in
aviation maintenance and pay attention to what your
body is telling you, taking a break to refresh your mind
may be all it takes to break the chain of events.

The responsibility we hold as mechanics should not be
thought of lightly, the lives of all who fly in your tail
number currently and years to come rely on what we
do today. BE SAFE, AND KEEP THEM IN THE AIR.

IS TODAY THE DAY?
Eric M. Smyth
Lifeguard Base Mechanic
Cedar Rapids IA
UNCOMPROMISING COMMITMENT TO SAFETY
WORLD CLASS PATIENT CARE
MARCH 2014
4
HOW FAST CAN YOU DIAL 911?
How many pushes does it take on your cellphone to dial 911? And how long do you think it would take
to correctly input those selections in an emergency, with adrenaline dumping into your bloodstream?

Try this little exercise. Do 20 pushups as fast as you can, then immediately grab your cell phone, punch
in your security code, go to the dial pad and type in 911. How fast were you able to do it? If you cant
do 20 pushups, that is a separate issue that involves a gym membership.

If you have never been in a life or death situation, its easy from your
armchair to assume that you would be able to focus your attention
and deftly input the correct numbers in the correct sequence. That is a
bad assumption. When your mind perceives a mortal threat to your
safety, fight or flight physiology take over. The fight or flight response is
our body's primitive, automatic, inborn response that prepares the body
to "fight" or "flee" from perceived attack, harm or threat to our survival.
Symptoms include:




All symptoms that make dialing 911 from a cellphone more difficult. Smart phones are taking over as
the go-to device to keep us connected to our world. So why not use technology to compensate for
physical shortcomings? Why not employ your phone to increase your safety and security posture?

There are many apps available, three of which are shown below as representative examples. While
Safety Compass does not endorse any product, our crack team of researchers found all three to be
well designed and surprisingly simple to operate, even under the life and death stress ofpushups.
On-Watch 911 imsafe
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UNCOMPROMISING COMMITMENT TO SAFETY
WORLD CLASS PATIENT CARE
MARCH 2014