camts blog

Commission on Accreditation of Medical Transport Systems

Safety Alert Bulletin

In the 1980s, helicopter medical transport services were just beginning to develop. By 1990, the year CAMTS incorporated, there were approximately 200 services across the U.S. compared to over 1200 helicopters operating today. In those early days, groups like ASHBEAMS (now AAMS), NFNA (now ASTNA) and NFPA (now IAFCCP) were just evolving and starting to develop guidelines for patient care during transport that included operational issues not found in other areas of medical transport. As CAMTS developed, we studied the accidents and incidents to create standards that would address the practices that were common to the NTSB’s probable causes of HEMS accidents.

Today, we have a whole new generation of medical and aviation professionals who have the advantage of time-tested standards and of technology that was not found 30 plus years ago such as NVGs, satellite tracking, glass cockpits, simulators, improved weather reporting, etc.

But, with this new generation of pilots and medical crews, we are seeing some of the same unsafe practices that lead to accidents in the 1980s. This may be because they are not aware of the dangers that caused so many accidents in the past. 

So… LET’S GET BACK TO BASICS!

HELICOPTER SHOPPING IS DANGEROUS! Helicopter shopping is still happening and even more dangerous in this highly competitive era. It is one of the reasons the FAA has operational control regulations and there are standards that address helicopter shopping. If a flight is turned down for weather or unsafe conditions, it is important to inform any other providers considering the flight. It is also important to respect the decision in the interest of SAFETY.

Train to Proficiency! 

Training is critical to safety of flight. It is important to ensure all pilots are trained to proficiency on sophisticated technology (glass cockpit), night vision goggles, instrument flight procedures in the event of inadvertent weather, mountain flying or cold weather operations. Pilots should be trained to fly the specific aircraft assigned including enhanced technology. They should also be trained to the specific mission, location (including terrain and unique weather) and the instrument procedures required to get safely return from an encounter with reduced or no visibility.

Recognize Fatigue!
We know fatigue leads to errors that humans make more often when tired.  Not only are crews and patients are at risk when the pilot is fatigued but medical errors can be life ending. Pilots have duty time regulations, but it is difficult to regulate sleep habits on off-duty time. Medical crews are more frequently scheduled 24, 36, 48-hour shifts. Unless downtime is planned, emergency services must be available 24/7 so there is no guarantee how much sleep they will get. “Reducing fatigue-related accidents” was on the NTSB’s 2019-2020 Most Wanted List (see www.ntsb.gov).

Another safety recommendation on that list was “Eliminate Distractions”.

Avoid Distractions!

There are more distractions today than ever imagined. Cell phones may provide temptation to send a brief text when the crew’s full attention should be on assisting the pilot in looking for obstructions. Drones, laser and bird strikes are more and more prevalent and can be deadly. 

So, let’s get back to basics!

  • Take care of yourselves and each other.
  • Proper rest, diet and exercise
  • Don’t take short cuts.
  • Do the pre-flights, do the walk-arounds, use the checklists
  • Speak up – ask questions – if you see something- say something!
  • Stay Situationally Aware
  • Be alert – Stay alive!

NTSB’s Most Wanted List of transportation safety improvements for 2019-2020

Feb 06, 2019

The National Transportation Safety Board (NTSB) published its 2019-2020 Most Wanted List of Transportation Safety Improvements, during an event held February 4 at the National Press Club in Washington DC.

First issued in 1990, the NTSB Most Wanted List of Transportation Safety Improvements serves as the agency’s primary advocacy tool to help save lives, prevent injuries, and reduce property damage resulting from transportation accidents.

The top 10 items on the NTSB’s 2019-2020 Most Wanted List of Transportation Safety Improvements are:

  • Eliminate distractions
  • End alcohol and other drug impairment
  • Ensure the safe shipment of hazardous materials
  • Fully implement positive train control
  • Implement a comprehensive strategy to reduce speeding-related crashes
  • Improve the safety of Part 135 aircraft flight operations
  • Increase implementation of collision avoidance systems in all new highway vehicles
  • Reduce fatigue-related accidents
  • Require medical fitness screen for and treat obstructive sleep apnea
  • Strengthen occupant protection

 “The 2019-2020 Most Wanted List advocates for 46 specific safety recommendations that can and should be implemented during these next two years,” said NTSB Chairman Robert Sumwalt. “It also features broad, longstanding safety issues that still threaten the traveling public.

Sumwalt issued a call to action during the February 4 event saying: “We at the NTSB can speak on these issues. We board members can testify by invitation to legislatures and to Congress, but we have no power of our own to act. We are counting on industry, advocates, and government to act on our recommendations. We are counting on the help of the broader safety community to implement these recommendations.”

There are 267 open NTSB safety recommendations associated with the 10 Most Wanted List items and the NTSB is focused on seeing 46 of those implemented within the next two years. The majority of these recommendations, roughly two-thirds of the 267, seek critical 
safety improvements by means other than regulation. Of the 46 safety recommendations the NTSB wants implemented in the next two years, 20 seek regulatory action to improve transportation safety.

SHARING THE AIRSPACE

There was a discussion at the 2018 HeliExpo and at the recent CAMTS Board meeting regarding hospital helipads and Unmanned Aircraft Systems (UAS).  The development of UAS technology in the private sector and the FAA’s limitation in developing airspace regulations to ensure that they will not interfere with air medical operations is an issue of concern, especially with the number of private and business UAS increasing every day.

The FAA has Operational Limitations (PART 107) for UAS that limit the altitude to 400 feet AGL and operations around Class B, C, D, and E airspace with ATC permission. There are also Flight Restrictions over Sporting events with a seating capacity of 30,000 or more (FDC NOTAM 4/3621) but there is no FAA separation rule governing operations around a hospital helipad.

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One of the reasons is that the FAA’s database on the location of hospital helipads is probably, by their own estimation, only 50% accurate. Since hospital helipads are considered private and therefore subject only to Advisory Circulars, many hospitals do not register the “Airport Master Record” – FAA Form 5010-3 – in the first place – when it is built.   Most also do not turn in a Notice for Construction, Alteration, and Deactivation of airports FAA Form 7480-1 when the helipad is moved, deconstructed or altered. We all know that hospitals add, change and rebuild frequently.  The FAA puts out the location of hospital helipads to the public – but this information only has a 50% chance to be correct.

CAMTS site surveyors visit hospital helipads that are either in the control of the air medical service or if an independent service bases its aircraft on a hospital helipad. In these cases, the site surveyors are asking to see the FAA Form 5010 or Form 7480 to determine if this is current and accurate.  This is one way to assist the FAA with correct information so that as new regulations catch up to an exploding UAS population, we can help to stipulate airspace around hospital helipads.  This is one way to help improve the safety and protection of our airspace as the UAS technology and popularity continue to expand.

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Lift-off Time Clarification

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There has been a lot of misinterpretation about CAMTS’ position on lift-off times. Recently, we were told that CAMTS requires a 5-7 minute lift-off from the time of the request. This is not true!

Medical transport services are measured against the Accreditation Standards. There is no such standard, and there never will be such a specific number. The only reference to lift-off is listed as part of the performance metrics in Accreditation Standard 02.01.07  5. under “Communications.” This is a metric that programs are collecting, tracking and trending as part of the Quality Management process. It is the program’s responsibility to determine a range of acceptable lift-off times based on their specific scope of practice.

There are many variables that could affect setting a realistic lift-off time:

  • complexity of the aircraft, start and checklists
  • immediate request versus request from a stand-by
  • two stage dispatch under operational control
  • weather checks, route checks
  • IFR flight plan
  • etc., etc.

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Therefore, an acceptable range is set based on the program’s profile. If a specific request falls outside of that range and tracking reveals a trend, there may be a need to change policy, process or training practices. This is the intent of quality management.

The use of specified lift-off times to put pressure on crews and to use as a competitive tool should not be the intent and is highly discouraged.

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New “Best Practices” 6th issue

In this our 6th issue of “Best Practices”, published in July 2017, we have selected policies and practices that were acknowledged as excellent examples, and we also focus on the areas that are typically cited as deficiencies. This publication is not meant to endorse or recommend any particular policy or service – it is merely to be used as a resource document.

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The Board of Directors acknowledges the excellent programs and practices exemplified in the materials provided with much appreciation to the medical transport services, FAA Part 135 Operators, private agencies as well as organizations for their enthusiasm in sharing these proprietary materials. Each document listed in the index is identified by its title and by the contributor whose logo and name may appear on the documents.

We added a section in this edition called “Preparing for Accreditation” to assist new programs that are applying for accreditation. The process of applying for accreditation involves several steps, and the application materials may be time-consuming. However, services often acknowledge that they learned a lot about their programs by going through this application process, whether they achieve accreditation or not. Also, requesting materials prior to the site visit which are reviewed by the Executive Staff and site surveyors (more than 60 hours of review) results in a well-prepared, comprehensive audit.

Your copy of “Best Practices” 6th issue can be ordered on our website.

www.camts.org

CAMTS Awards Accreditation to Three Medical Transport Services

The Commission on Accreditation of Medical Transport Systems (CAMTS) proudly awarded accreditation to sixteen medical transport services at the CAMTS July board meeting in Weehawken, New Jersey.

Congratulations to the three new services as well as the services reaccrediting as follows:

New Accreditation

  •                 Sky Nurses, Delray Beach, FL
  •                 Memorial MedFlight, South Bend, IN
  •                 Medical Air Rescue, Rapid City, SD

Reaccreditations

  •                 Air Methods SouthEast Region, AL, FL, GA, SC
  •                 Air Methods Region 7, AR, IL,  MO
  •                 Children’s Medical Center, Dallas, TX
  •                 Life Force Air Medical, Chattanooga, TN
  •                 LifeEvac Virginia, Gasburg, VA
  •                 Med Flight Air Ambulance, Albuquerque, NM
  •                 Memorial Star Transport, Colorado Springs, CO
  •                 MONOC 1, Neptune, NJ
  •                 Nationwide Childrens, Columbus, OH
  •                 PHI Air Medical Kentucky, Lexington, KY
  •                 Sanford AirMed, Sioux Falls. SD
  •                 University of Iowa AirCare, Iowa City, IA
  •                 UMass Memorial Life Flight, Worcester, MA

 

The Board of Directors welcomed guest speaker Frédéric Bruder, Managing Director of ADAC Air Rescue in Germany as a lunchtime speaker during the Board meeting. Mr. Bruder provided a presentation on the ADAC service, the largest rotor wing air medical service in Germany.

 

Urgent Safety Notice – Lifeport Clip Decks

CAMTS has received several calls on this safety issue.  We have been made aware of incidents as a result of the LifePort Clip Decks.  We have been told that not all parties have received the following notice from LifePort.  Please heed this urgent warning!

Re: LifePort, Inc.’s Clip Decks – All Models/Part Numbers

It has recently come to our attention that Life port’s Clip Deck may be subject to misues in the field.  Our records show that you purchased, received through an intermediary, or may be in possession of a Life port Clip Deck.  Accordingly, this is to inform you that Life Port’s Clip Deck is designed and to be used for the purposes of non-vehicular ground transfers only.

LifePort’s Clip Deck is not designed, approved and should not be used, under any circumstances, to secure or retain an AeroSled during ground vehicle travel of any kind, including ambulance travel.  LifePort’s Clip Deck is not, and has never been, intended to be used in ambulances or any type of ground vehicles, under any circumstances.  Any such usage will expose all persons using the equipment, including but not limited to patients, passengers and medical professionals, to possible injury or death and therefore should be ceased immediately.

Please immediately contact LifePort’s Customer Service Department at 360 225-1212 or via email at customerservice@lifeport.com to arrange for shipment of warning placards for affixation on all Clip Decks consistent with the above.  LifePort will provide all placards free of cost, including affixation instructions.

Sincerely

Patrick Ogle

Customer Service Manager

LifePort

The following was received from a CAMTS accredited program:

On 6-5-17, while traveling in a ground ambulance, the LifePort sled came out of its base when going around a curve.  This is the third occurrence of a sled coming out of the base at our program.   When the second occurred in 2010, we took a harder look at the pins and receptacle holes they go into.  We found two design flaws:  1) the metal where the pin went into was made of a softer metal, aluminum, versus steel like the one in our aircraft base 2) the hole is drilled on the edge of a bevel, facilitating its wear.  When we contacted Lifeport at that time with our findings and looking for help, they offered no solutions nor assistance.  We fixed the problem ourselves with our mechanic replacing the receiving metal receptacles with steel ones in all our stretchers as are in our aircraft base.

The current clip deck involved in the incident 6-5-17 was received six months ago with our new isolette.   We knew we should replace the receiving metal parts and had begun the process but unfortunately it was not high priority as the prior clip decks had been used for ~ 10 years before the incidents occurred.  Apparently, an even inferior metal is being used in current production for the degradation seen in the images to have occurred so rapidly.    The hole is no longer round, but oblong and by its being in the bevel, you can see in image looking top down, this allows for a more rapid loss of integrity.

Our program has yet to receive the attached Lifeport notice.  We know of at least 2 others that have not received this notice; we are all current customers.    We learned of the warning via AAMS Critical Care Ground Special Interest Group who had a member receive this notice. 

Lifeport clipdeck - new from top_edited

 

Inadvertent Instrument Meteorological Condition (IIMC) training

In keeping with CAMT’s values of continuously improving accreditation standards to improve patient care and safety of transport, the next revision to the CAMTS Standards will encourage additional helicopter Instrument Flight Rules (IFR) training requirements.  The draft of the recommendation, to be incorporated into the 11th Edition of the CAMTS Standards, will require quarterly Inadvertent Instrument Meteorological Condition (IIMC) training and demonstration of the pilot’s ability to safely maneuver the helicopter into visual meteorological conditions (VMC) following an inadvertent encounter with IMC and completion of an IFR approach.

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For instrument proficiency training in non-IFR-certified rotorcraft, the pilot should perform such maneuvers as are appropriate to the rotorcraft’s installed equipment, the certificate holder’s operations specifications, and the operating environment.

A recent analysis of fatal accidents over a five- year period, conducted by the U.S. Helicopter Safety Team, revealed that the Helicopter Air Ambulance industry had the second most fatal accidents, second only to Personal/Private operations.  Fifty-two percent (52%) of these accidents involved:

  • Inflight Loss of Control
  • Inadvertent IMC
  • Low Altitude Operations

Increasing IFR training requirements is an attempt to reduce the historical accident rate in our industry while focusing on data driven causal factors and is in keeping with the CAMTS mission to continuously improve transport safety.

This proposed future revision of the CAMTS Standards is being recommended by the CAMTS Aviation & Safety Advisory Committee, comprised of industry safety experts including non-CAMTS Board members. Final verbiage for the 11th Edition of the CAMTS Standards will be approved by the CAMTS Board of Directors prior to incorporation.

 

AIR EMS awarded Conditional Accreditation

 

The Commission on Accreditation of Medical Transport Systems (CAMTS) awarded Conditional Accreditation to Air EMS today for fixed wing and medical escort services.  Air EMS is the first to be awarded this accreditation and is supported by two very experienced FAA Part 135 operators who are able to provide aircraft for both national and international transports.

Conditional Accreditation was created to verify that a new service (in business for at least 4 months but less than 1 year) is able to demonstrate that policies, practices and training of aviation, surface and medical staff under a dedicated medical director meet accreditation standards based on the mission and scope of service as advertised. The aircraft and/or surface vehicle and medical equipment must also meet compliance with the standards and all legal regulations must be satisfied.

A service receiving Conditional Accreditation is permitted to advertise as conditionally accredited and will receive a letter of conditional status which can be provided to regulators and to contracting agencies that require accreditation. There is no minimal number of transports required but staff must be hired and trained and the medical director must have developed protocols. Although new programs may not have a mature Quality, Utilization and Safety Management System, those systems must be developed and organized according to the criteria in the standards.

The program may submit a PIF for full accreditation at its one-year anniversary or when the Conditional Accreditation expires.

CAMTS feels strongly that this process will provide a robust review for a new medical transport service that regulators and contracting agencies can support rather than requiring accreditation as soon as an aviation company decides to transport patients without proper preparation.

PIF Process – online format

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Dear CAMTS Accredited Services:

We are in the process of moving the entire PIF process to an online format – including attachments and all forms. We are anticipating it to be ready by January 1, 2017. In preparation for the new process and in recognizing the need to streamline the reaccreditation process, we need your help to identify the areas of completing the reaccreditation process that seem especially labor intensive with little benefit.

We are holding a Town Hall Meeting on September 25 from 2-4 at the Charlotte Westin Hotel in the Queens Room to meet with those who want to express their suggestions about the accreditation process and discuss where we have seen some inconsistencies. All are invited to attend even if you have completed this survey. Many of our Board members will be present to speak with you individually or as a group. The following survey will provide us with a starting place for those discussions.

Please complete this survey and return by September 9, 2016

StartSurvey_Button          SURVEY

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