By Paul Mazurek
Last month I discussed the recommendations of the National Transportation Safety Board (NTSB) following its extremely high-profile hearing on helicopter emergency medical services (HEMS). Nineteen recommendations were issued related to HEMS safety, 10 of which were directed to the Federal Aviation Administration FAA and included1:
1. Developing criteria for scenario-based HEMS pilot training. Such training would include inadvertent instrument flying in adverse weather conditions as well as hazards unique to HEMS operations.
2. Requiring periodic FAA-approved scenario-based simulator training.
3. Requiring HEMS operators to implement a safety management system (SMS) program.
4. Requiring HEMS operators to install flight data recording devices and establish a structured flight data monitoring program. Such a program would review all available data sources and help identify deviations from established norms and procedures as well as other potential safety issues.
5. Requiring HEMS operators to implement an annual reporting system with respect to total hours flown, revenue flight hours flown, revenue miles flown, patient transports completed, and number of departures.
6. Permitting HEMS operators to utilize an Aviation Digital Data Service Weather Tool for weather tracking (http://adds.aviationweather.gov/).
7. Conducting a systematic evaluation and issue a report on the requirements necessary for a viable low-altitude airspace infrastructure that can accommodate safe HEMS operations.
8. Initiating and developing infrastructure based upon the previous stated recommendation in item (7).
9. Requiring HEMS operators to install night vision imaging systems and require pilots to be trained in their use during night operations.
10. Requiring EMS helicopters to be equipped with autopilots, and that the pilots are trained to use the autopilot if a second pilot is not available.
Of particular interest to this month’s continued discussion of HEMS safety is the implementation of a safety management system (SMS). A couple of basic questions that many medical crew members attached to HEMS teams have are “what is it?” and “how will it help?”
What is a Safety Management System?
According to Helicopter Association International’s Safety Management System training, a safety management system (SMS) is “a coordinated set of processes designed to provide an organized and practical method for controlling risks and hazards.” It consists of programs and activities that will allow the HEMS operator to maintain control over primary safety factors. The beauty of this system is that it is designed by the operator and is mission- and goal-specific2.
There are 12 fundamental attributes to the safety management system (SMS), which include2:
1. Management Plan: This defines how the individual operator will manage its safety effort. The plan and system has to fit the individual program’s objectives and provides the matrix on how best to accomplish them.
2. Safety Promotion: This is getting every individual in the organization to embrace an established safety culture. It is truly a safety culture when everyone projects a commitment to safety in everything that is done within the group.
3. Safety Policy: This defines what is important to the program and the parameters that are to be set.
4. Information Management: Is the organized management of documents and data necessary to make safe, informed decisions. It involves maintaining up to date reference materials and the organized recording of data that will alert the organization to potentially hazardous trends that need to be adjusted or investigated.
5. Hazard Identification and Risk Management: The process in which potentially dangerous situations are recognized and subsequently addressed before they become part of an accident.
6. Occurrence and Hazard Reporting: The development of a non-punitive system for reporting and review.
7. Occurrence and Investigation Analysis: The determination of factors that led to an event. Analyzing the findings and adding these findings to program records to prevent future occurrences.
8. Oversight: Making sure the overall program is not the genesis of unintended consequences. Observation of operations and use of this information to evaluate performance. A dynamic process that allows the program to answer the question “are things better or worse?”
9. Safety Management Training: Training to an established standard and measuring set objectives.
10. Management of Change: Identification of changes within the operations and account for them with modified control measures.
11. Emergency Preparedness and Response: The hardest part of SMS. The overall plan for identifying those “worst case scenarios” and establishing a plan of action in order to effectively respond and act.
12. Performance Measurement: Answering three basic questions:
a) Are we safer?
b) Has the overall number of incidents declined?
c) Is the system working?
How will a SMS Help?
As so eloquently put in HAI’s training module and as quoted by Albert Einstien, “Insanity is doing the same thing over and over again and expecting different results.” The number of EMS helicopter accidents is not on the decline and the same accidents keep happening over and over. A SMS is a standardized method to keep such incidents from happening in the first place and if they do happen, to keep them from happening again. It is not budget constraining or limiting and can be tailored to fit the needs of any HEMS operator. If the benefits are not intuitive to the reader, I invite you to go to the Helicopter Association International Web site (www.rotor.com) and after looking at their training materials on SMS, they will be. To help develop a SMS of your own, you can download the SMS Toolkit free of charge from the International Helicopter Safety Team’s (IHST) website at www.IHST.org.
References
1. National Transportation Safety Board. Public Meeting of September 1, 2009: Four Safety Recommendation Letters Concerning Helicopter Emergency Medical Services. www.ntsb.gov. Accessed 21 September 2009.
2. Helicopter Association International. Developing a Safety Management System. www.rotor.com. Accessed 27 October 2009.
