Understanding the Role of HEMS in Emergency Care and Working to Reduce Accidents, Costs, and Transport Time Project Number: MQF IQP 2814 An Interactive Qualifying Project submitted to the Faculty of the WORCESTER POLYTECHNIC INSTITUTE in partial fulfillment of the requirements for the By ______________ _____________ ______________ Aaron Durkee Sydney Padula Jeffrey Paquette Submission Date – March 29, 2012 Professor M. S. Fofana, Advisor Mechanical Engineering Department Abstract This paper comprises of three overarching objectives: to understand the helicopter emergency medical system (HEMS), to identify problems related to their use and operation, and to propose solutions to these identified problems. The areas of research consist of HEMS standards, monetary allocation associated with the HEMS program, landing areas and dispatch times, and factors that contribute to fatal and nonfatal helicopter crashes. The identified problems associated with helicopter costs are related to the high cost of obtaining and operating a helicopter under the EMS function, which is restrictive to both the program’s use and expansion. Proposed solutions to the expenses include itemized cost-saving opportunities as well as potential future technologies that the program would benefit from adapting. Problems associated with helicopter landing zones and transport times are a lack of safe, documented landing points and inefficiencies regarding helicopter dispatch. Proposed solutions include a portable landing zone kit for deployment at the accident site to allow for safe landing and takeoff by the helicopter. Lastly, the problems associated with helicopter safety and crashes include human error, mechanical malfunction, and environmental effects. Solutions include providing additional weather information and isolating the piloting area from the medical compartment and creating codes similar to the ground ambulance crews to isolate the pilot’s interaction with the stresses induced by trauma treatment. i Table of Contents Abstract i List of Figures iii List of Tables iv List of Equations v Acknowledgements vi Chapter 1. Helicopter Emergency Medical Service and Life Saving Practices 1 1.1 Introduction 1 Chapter 2. Understanding HEMS and Patient Centric Quality Care 3 Section 2.1 Uses and Costs 3 Section 2.1.1 Prerequisites for Aerial Ambulance Use 3 Section 2.1.2 Procedures and Regulations 9 Section 2.1.3 Costs 14 Section 2.2 Transport 21 Section 2.2.1 Procedures and Regulations 21 Section 2.2.2 Hospital Affiliation 27 Section 2.2.3 Transport Time 30 Section 2.3 Accidents and Incidents 33 Section 2.3.1 Human Error as a Major Consideration 33 Section 2.3.2 Mechanical Malfunction as a Major Consideration 43 Section 2.3.3 Environment and Surroundings as a Major Consideration 54 Chapter 3. Reducing Accidents, Costs, and Transport Time in HEMS 60 Section 3.1 Cost Reductions and Areas of Further Research 60 Section 3.1.1 Altering Current Costs 60 Section 3.1.2 Electric Powered Helicopter 64 Section 3.2 Reducing Transport Times 69 Section 3.2.1 Increasing Designated Landing Zone Sites 69 Section 3.2.2 Improving Transportation Time 72 Section 3.3 Decreasing Likelihood of Accidents and Incidents 74 Section 3.3.1 Identified Problems 74 Section 3.3.2 Possible Solutions 78 Section 3.3.3 Proposed Viable Options 80 Chapter 4. Conclusion 82 References 86 Appendices 90 Appendix I Typical HEMS Equipment List 90 Appendix II Takeoff, Flyover, and Approach Profiles 92 Appendix III HEMS Operational Costs Worksheet 94 ii List of Figures Figure 1 - Sample Landing Site .................................................................................................................. 23 Figure 2 - Safe and Unsafe Areas Around a Helicopter Blade ................................................................... 26 Figure 3 - HEMS Operations in Massachusetts .......................................................................................... 27 Figure 5 - HEMS Bases in the United Kingdom ........................................................................................ 29 Figure 6 – US HEMS Accidents and Incidents 1987 – 2000 [Blumen] ..................................................... 34 Figure 7 - Human Error Factors in HEMS Accidents 1987 - 2000 [Blumen] ............................................ 34 Figure 8 - Total Flight Hours vs. Number of Accidents [Blumen] ............................................................. 38 Figure 9 - Incidents and Accidents with Pilot Error [Blumen] ................................................................... 39 Figure 10 - CFIT vs. Environmental Conditions [Bouquet] ....................................................................... 41 Figure 11 - Probable Cause of Maintenance Related HEMS Accidents [Blumen] .................................... 44 Figure 12 - Use of Protective Clothing by US HEMS Crews 1995-2000 [Veillette] ................................. 47 Figure 13 - Fenestron .................................................................................................................................. 50 Figure 14 - Helicopter Transmission Showing the Combiner Gear ............................................................ 50 Figure 15 - Parts Breakdown for BHT Model 206A/206B Showing Location of Tension-Torsion Strap – Component number 44. ....................................................................................................................... 51 Figure 16 - Tension-Torsion Strap .............................................................................................................. 52 Figure 17 - Transmission for Rear Rotor .................................................................................................... 53 Figure 18 - Severity of Injury All Accidents vs. Weather Related 1982 - 1998 [Blumen] ........................ 54 Figure 19 - Day vs. Night HEMS Accidents [Blumen] .............................................................................. 58 Figure 20 - Train crossing gates that may be adapted for use for road closures for helicopter landings. .. 70 Figure 21 - Concept bridge that included helicopter-landing pad. ............................................................. 71 Figure 21 - Helicopter interior showing opening between patient bay and cockpit. .................................. 79 iii List of Tables Table 1 - Common HEMS Helicopters and Characteristics 4 Table 2 – Dynamic Control System of Helicopter Emergency Medical Systems Operations 7 Table 3 - Common HEMS Helicopters and Costs I 15 Table 4 - Aviation Operations Cost Worksheet 15 Table 5 - Commons HEMS Helicopters and Costs II 18 Table 6 - Commons HEMS Helicopters and Costs III 19 Table 7 - Landing Site Markers 23 Table 8 - Obstacle Strikes in US HEMS Accidents and Incidents 1987 – 2000 [Veillette] 40 Table 9 – Pilot Experience Prior to Accident or Incident 42 Table 12 - Distribution of Injuries in Survivable Crashes [Blumen] 47 Table 14 - Pilot Experience Prior to Accident or Incident 77 Table 14 - Common emergency service response codes 80 Table 15 - Modified Emergency Response Codes 80 iv List of Equations Equation 1- Combustion Fuel Energy Capacity ......................................................................................... 65 Equation 2 - Combustion Engine Flight Time - Perfect Efficiency ............................................................ 66 Equation 3 - Battery Powered Flight Time ................................................................................................. 66 Equation 4 - Combustion Powered Fuel Costs Per Full Tank .................................................................... 67 Equation 5 - Battery Powered Power Costs ................................................................................................ 67 v Acknowledgements Most importantly, we would like to acknowledge professor, MIRAD Labs IQP advisor, and mentor Mustapha S. Fofana. His insight, knowledge, and understanding aided us greatly in the development of our work. We would also like to acknowledge Neil P. Blackington, the Deputy Superintendent of Fleet Services for Boston EMS. Neil was present for a preliminary presentation of our findings and provided useful information that further refined our search for information and aided us in discovering new solutions to improve current HEMS operations vi Chapter 1. Helicopter Emergency Medical Service and Life Saving Practices 1.1 Introduction Medical helicopters are currently much more expensive and less efficient than current ground transport systems. Helicopters are used in situations where time is of great importance to the care of the patient, long distances must be traveled, or when ground crews are unable to reach the patient. The drawbacks are great, however, and inhibit the widespread use of helicopters as medical transport devices. The costs associated with acquiring and maintaining a fleet are multi- million dollar expenditures, meaning that many hospitals are unable to afford their use. Many areas lack the infrastructure for aircraft to takeoff and land, and buildings built to support helicopters require special structural considerations for increased stresses. Many landing zones are uncharted and unknown to operators, making the current infrastructure inefficient. Helicopters also create additional stresses for operators and patients during flight. Based on the speed of the aircraft, they consume more fuel, create extraordinary noise, vibrate excessively, and have a very limited space to operate and