Flight Medical Provider™ | IBSC Test Prep

Flight and Surface Operations

• This module covers various aspects of effective crew resource management and risk mitigation
• Topics included are flight and ground operations, safe aircraft operations, and emergency procedures
• Landing zone preparation, fitness for duty criteria, communication/radio operations, night vision, goggle use, and troubleshooting will be discussed

Commission on Accreditation for Medical Transport Services (CAS)

• CAS accredits flight and ground programs
• CAS conducts surveys initially and every three years for re-accreditation
• Advanced certifications require maintaining a fourth of an inch of space between oneself and the flight suit
• Staffing requires four pilots for every aircraft operating 24/7
• Pilots need at least 2000 hours total, 1000 hours as pilot in command, and 100 night hours

Aviation Terminology

• Instrument Flight Rules (IFR) means flying based on instruments inside the cockpit due to low weather minimums
• Visual Flight Rules (VFR) means flying normally on a clear day without instruments
• Double IMC is inadvertent instrument meteorological conditions, going into IFR by mistake, when you should be under VFR

Federal Aviation Regulation (FAR) Part 135

• FAR Part 135 defines operating with a patient onboard as an air taxi
• Air taxi entails transporting the patient for compensation

Pilot in Command Authority

• The pilot in command (PIC) has ultimate authority and a maximum 14-hour duty day
• Shifts include a maximum eight hour of flight time
• Pilot can be on duty for 14 hours, but cannot fly for more than eight hours consecutively
• Regulations are strict, flying even a minute over 14 hours can result in severe penalties, including loss of license
• Pilots must stop flying after 13 hours and 59 minutes
• Passengers must be briefed anytime they are on board

Local vs Cross-Country Flying

• Pilots must know their local flying area and be well-defined geographically
• Anything outside first due service area must be defined as local or cross country area

Safety Belts

• Safety belts must be worn during all critical phases of flight, even at cruising altitude
• Pilots need to be aware, and announce any major shifts or altitude changes as severe injury may occur if out of belts

Equipment

• All equipment must be secured in an approved mount for takeoff, landing, and any movement of the aircraft.

Transporting Children

• The child must always be restrained during flight
• Multiply the patient's weight in pounds by the speed to calculate the force needed to restrain a child
• For a 25-pound patient flying at 35 mph, 875 pounds of restraint is needed
• The National Association of EMS (NAEMS) has a list of approved devices for commercial use
• When determining which transport device is needed, the height and weight limits must be considered

Ambulance Safety

• Always wear a safety belt in a moving ambulance
• New standards require being in a harness at all times
• Secure all equipment needed for patient care
• Newer ambulances are coming out with tower drawers to avoid leaving the seat to obtain the necessary equipment
• Prioritize safety for both the provider and the patient

Mission Acceptance

• Flight requests should not include patient information to avoid bias
• Dispatch requests should include limited information: coordinates, weight, and contact information
• Avoid using the word "mission" as it implies the request must be completed
• Opt to use "flight request" or "inter-facility transfer"

Go/No-Go Decisions

• It's "Forti go" instead of "Three to go, one to say no"
• Operational control centers (OCCs) have the final say on flight decisions, regardless of crew input
• If a crew member feels a flight is unsafe, voicing concerns is crucial, even if it's uncomfortable
• It only takes one person to stop a flight if unsafe

Preventing Normalization of Deviance

• Avoid pressure from management to take a flight
• Decisions should be based on safety, not profit
• Do not be coerced into unsafe flights
• Group think can lead to discomfort in speaking up
• It only takes only one person to change the culture

Visual Assessment

• If the aircraft is hugging the ceiling, or the cloud deck is low, it is not safe to fly with only VFR service
• An IFR program may be necessary in these condidtions

Risk Assessment

• With double IMC risk assessment tools, pilots must do a risk assessment before every flight
• Submit risk assessment to the OCC/operational control center for review
• Pilots include hours, location information, and experience in the area for better overall approval
• Assessments should be incorporated into practice, just like pilots

Emphasizing Preventative Action

• Mitigating an emergency in the middle of an emergency is avoided
• Take time to think about things to mitigate beforehand
• Prior to starting a flight, perform a risk assessment
• Risk assessment will avoid emergency and/or inadvertent situations

PAVE Acronym

• PAVE is a risk assessment tool focusing on:
  • Pilot
  • Aircraft
  • Environment
  • External pressures
• The tool addresses weather conditions for the entire trip, the time of day, and crew experience

Flight Following and Operational Control

• There are flight following and operational control safety standards that factor into accreditation
• Should have a position check for flight every 15 minutes and for ground every 45 minutes, which technology via GPS has improved

Route Planning

• If detouring off a flight path or stopping for fuel:
  • Dispatch center must be notified, as they track the flight versus the plan
  • Can lead to logistical issues

Post-Accident Planning and Emergency Procedures

• Communicate last known location as a safety protocol requirement
• Implement A-P-A-I-P (post-accident incident plan)

Emergency Protocol

• A-P-A-I-P plans are essential, because they follow a set of guidelines to maintain and activate an emergency and notify everybody
• A-P-A-I-P gets initiated when contact with the dispatch center or operational control center are lost and it they can't acquire GPS signal
• Protocol includes looking at last known location/altitude, or how fast the aircraft was flying
• "Pips per ca standards have to be practiced at least once quarterly:"
• Crews pick up on terminology and experiences

Aircraft Walk-Around

• When doing a walk around on your aircraft, ensure that you aren't just looking for the obvious things
• The point is to follow details and processes so nothing falls off or gets left open

Livestock on Runway

• Active assessment is required
• A go-around and low pass may be required to assure the location is safe

FAA Minimums

• VFR weather minimums during the day:
  • One mile visibility at 500 feet ceilings
• VFR weather minimums at night:
  • Three miles of visibility with 500 feet
• The specific program minimums should be learned to make safe decisions for the flight

Double IMC protocol

• Double IMC is an emergency, but it's not a reason to panic as there are established procedures
• The pilot plans for this in briefings
• Pilot duties, in this case, includes climb, squawk, and contact air traffic control for vectors for better weather
• The biggest risk for pilots in this conditions, is their instinct to manipulate the aircraft, wanting to move from weather instead of climbing
• Contact TC, get vectors, and know how to input squawk codes

ATC and Gyroscope

• If the pilot is focused on the aircraft and immediate/better weather, know how to contact air traffic control
• Brown should be on the bottom on the gyroscope
• Watch altitude and airspeed
• Ascend if descending

Normalization of Deviance

• Taking safety shortcuts because it has never been an issue before
• It causes disasters or problems
• Maximizing safety and not normalizing things will prevent problems

Visor Protocol

• During flight, visors should be down, regardless of whether it is sunglasses, the visor, or the clear visor.

Aircraft vs EMS Safety

• Aircraft maintenance is heavily regulated, documented, and taken seriously.
• Ground transport should have these standards as well
• Ground EMS units should have walk arounds for their ground trucks

Action Required

• If a hard landing occurs on the aircraft, one should not hop in another aircraft in 10 minutes
• Protocol must be as serious as air transport

United Flight 173 Landing Gear Malfunction

• The flight crew is flying from New York to Portland
• There was landing gear malfunction
• The pilot, too worried about talking to the air traffic control, forgot to check fuel levels
• The copilot did not speak until six seconds before the black box data was reported, which showed this was due to a cultural deference to rank and a failure in resource management
• They had no fuel, causing the crash

Culture Deference Impacts

• Calling out what seems like a small vibration in comparison to a malfunction is key
• No matter, it is all fixable if we say it

Proper Conduct

• Ask questions from the get go, no matter the medical or environmental status
• You have to be ventilating
• Be part of the crew source management

Setting Goals Together

• Agree on any near term objectives (left to right)
• Level hierarchies so everyone can voice their opinion
• You can have a say and voice your concers, without stepping onto the pilot's toes

Securing Site

• Ask ground contact to describe the landing zone and ensure it is at least a hundred by a hundred
• This creates mutual trust between pilot, contact, and patient

Being Aware for Flight

• In terms of bad weather, it should still be secured, as everyone will work together to ensure a successful flight

Safety Measures

• Make sure both lights on as it is also okay to use on the vehicle per CA standards
• Must have road hazards and mechanical failure

Critical Phases of Flight

• Critical phases of flight occur any time the aircraft is in motion
• Examples: Take off, landing, refueling, taxiing, and traveling through busy airspace, or when talking to government entity etc.

Sterile Cockpit Standards

• Sterile cockpit must be enforced during all phases of flight
• Sterile cockpit means no casual conversation/distractions are permitted.
• Unless it involves something that could kill everybody on board
• It is okay to look for obstructions/issues

Laser Strike Consequences

• If there is any issue concerning safety, speak up immediately, even mid-flight
• As of 2021, laser strikes are up to 9,723
• High powered lasers, FAA, and a form, are tracked/have information available
• Report to FAA.
• If a pilot on MVGs gets a laser strike, it can cause blindness or vision deficiencies

Safe Landing Protocol

• Landing zones must be 100 x 100 feet
• Illumination sources should not be hazardous or obstructed and level
• Community LZ should participate in educating fire department
• Crews must make contact before landing to ensure the landing area is safe

Approach Tips

• Always approach an aircraft and look the pilot in the eye
• Pilot wil give a thumbs up or down
• If it is not a good time, there will be a light flash
• Know that the oil is circulating appropriately
• Get eye contact from the pilot, then approach

Tail Rotor Guard

• Do not walk back to the tires
• If anyone sees anyone walking, signal to make contact with the pilot
• If not, they have to give the pilot the signal to shut the engine off

Instructors landing at the nose

• Be sure to shut down!
• Make sure everything is clear before stopping the rotors
• You will want to stay away from the nose when rotors are slowing

Specific Air Frame Emergency Info

• Ask pilot for book in case of emergency
• Know where and how to contact

Landing Emergencies

• Immediate - water/trees. land immediately
• Soon as possible - first piece
• As soon as practicable - airport/established LZ, still have the other engine

Post Emergency Landing

• Must look on the nose out for anyone

Remembering Shut Down

• Break Throttle Fuel Battery Rotor Brake

Older Aircraft Info

• You should reference any discharge procedures

MVGs Enhancement

• Enhance situational and operational situations at night
• You need at least five hours

Visibility

• You often can't see LED lights
• Make sure to scan under your lights as you have situational awareness that you are not missing anything
• These are monochromatic and circular
• They can also increase fatigue in the neck

Equipment for Balance

• A lot of times, counterweights will help offset
• No Depth Perception
• Vision Decreases when Smoking

Survival Gear Standards

• survival gear should have: -CAEs, accredited    -Number of Occupants    -Coverage Air.

• The Vehicle used to transport Survival, Must be checked

• expiration Date & Replaced on schedule.

Emergency Locator Transmitter (ELT)

• The Emergency locator transmitter, has to be activated at level 4 Gravity(4G) force
• Located Aircraft, or anywhere it is being placed.  Be sure to know your special test at 406 megahertz. 121.5 mhz

Radio System

• There are very critical, due to your specific timing for certain circumstances
• VHF
• UNF -Those that Penetrate barrier

If in a Buliding

• if you are ever in a building, then their is a trunking system
• like a seve or 800 megatrz, search key
• if there is an error, turn it off

Simplex/Dublex

• Press F-3 key and be sure about what you re keying
• Only transmit; cant receive
• Talk back, but not at the same time
• Be able to have communications at the same time without iterference

Ambulances Standards

• They prevent shady companies
• Mained with safety and appropriate standards

Lights and Sirens Safety

• Some say good to use , others say not
• The standard says must be Equipped There must be 500 feet for visibility

General Rules

• You must, always be alert
• Always respond to any call
• Remember, know your frequencies and listen for state frequency to follow

Ambulance Requirements

• State EMS
• Radio, Med Con
• Hospitals and Agencies

Communication Is Key

• Safe compartmentalisation
• The most critical ones have inter-communication

No One Goes Without Safety

• Policy, to protect from the elements
• Should be a safe transport with great and proper procedure
• You Must have the right person -Must Not Risk, Some one safety to get one from somewhere

EMS Regulations

• They must have 2 years experience and be an EMT
• EMT Cert as Well
• The vehicle, should be properly maintained by a Mechanic

Exam Info

• Kill the engines, remove the throttle

Final Question

• Which is not pertinent to take a flight.
• What will you fly difr
• The acuity of the pat