UK Air Ambulance night flights
Air Pig - this bit
Quote:
After 2015, the cost will rise as we all know that the service is being 'privatised' to a private contractor.
And this bit
Quote:
£5000 per rotor hour, which is bound to rise, also have these costs been written into the new contract, knowing the NHS/MoD I would bet a beer or two they haven't
Not facts (maybe your £5000 is correct) just your opinion.
Quote:
After 2015, the cost will rise as we all know that the service is being 'privatised' to a private contractor.
And this bit
Quote:
£5000 per rotor hour, which is bound to rise, also have these costs been written into the new contract, knowing the NHS/MoD I would bet a beer or two they haven't
Not facts (maybe your £5000 is correct) just your opinion.
Yes I remember the use of PFI/PPI in the NHS, costs far more than an asset paid from central funding rather than over a period of 30 to 35years, look at Voyager or new build hospitals and schools.
Last edited by air pig; 28th May 2013 at 21:18.
Not really - in the case I'm talking about they are sending out a car/helicopter (depending on practicality/timings) to arrive on scene within <20 mins, with a specialist registrar/consultant level doctor with extensive A&E experience, and a paramedic, who can provide a much more comprehensive trauma response than the best equipped ambulance service cover. Taking A&E to the patient, with the ability to perform selected roadside operations, administer anaesthetics, induce comas, take the patient quickly to the most suitable trauma/major-trauma hospital, bypass the A&E doctor when reaching the hospital (having made these diagnosis themselves). Which for the selected trauma parients to whom Control deem time-critical/severe enough is a good service, paid for by charitable donation.
A doctor no matter how good does not have x ray eyes maybe a portable ultrasound only as now carried by HEMS London. Initial management is directed to securing an airway if required by endotracheal intubation or in certain cases a surgical airway and then ensuring adequate respiratory function, if necessary using bi-lateral thoracostomies for thoracic trauma. Spinal stabilisation and fluid replacement being either I/V or I/O routes. This all takes time and is eating up the 'golden hour' of improved potential survival.
An instance, unknown person who is unconscious and fitting, what is the cause, trauma drug overdose brain haemorrhage or emboli or epilepsy, all are possible and the doctor would have to treat what they see for the patients safety, definitive diagnosis is up to the trauma team following handover and further investigation. The above could require surgery, a trip to a cath lab, thrombolytic therapy, detoxification or sedation and further drug therapy. Difficult to diagnose at the roadside.
An instance, unknown person who is unconscious and fitting, what is the cause, trauma drug overdose brain haemorrhage or emboli or epilepsy, all are possible and the doctor would have to treat what they see for the patients safety, definitive diagnosis is up to the trauma team following handover and further investigation. The above could require surgery, a trip to a cath lab, thrombolytic therapy, detoxification or sedation and further drug therapy. Difficult to diagnose at the roadside.
I am afraid this doctor v paramedic is irrelevant
At night many services have a precare practitioner - often a consultant anaesthetist, not an A and E trainee. The helicopter doesnt alter this and indeed as many PCPs are on call from home the helicopter may have only a paramedic as there are no 'spare' trainees - their numbers are fixed. There is no time saving at the hospital either.
But this is not the point. The quality of medical care will not change by putting rotors on the vehicle. The issue is £300 goes to £1500 for no identified medical benefit.
At night many services have a precare practitioner - often a consultant anaesthetist, not an A and E trainee. The helicopter doesnt alter this and indeed as many PCPs are on call from home the helicopter may have only a paramedic as there are no 'spare' trainees - their numbers are fixed. There is no time saving at the hospital either.
But this is not the point. The quality of medical care will not change by putting rotors on the vehicle. The issue is £300 goes to £1500 for no identified medical benefit.
Not really - in the case I'm talking about they are sending out a car/helicopter (depending on practicality/timings) to arrive on scene within <20 mins, with a specialist registrar/consultant level doctor with extensive A&E experience, and a paramedic, who can provide a much more comprehensive trauma response than the best equipped ambulance service cover. Taking A&E to the patient, with the ability to perform selected roadside operations, administer anaesthetics, induce comas, take the patient quickly to the most suitable trauma/major-trauma hospital, bypass the A&E doctor when reaching the hospital (having made these diagnosis themselves). Which for the selected trauma parients to whom Control deem time-critical/severe enough is a good service, paid for by charitable donation.
Let me get this right. You're telling me that a helicopter can respond <20 mins. It can also carry a pilot (possibly 2), crewperson, paramedic and doctor/consultant.
You're telling me that team can perform roadside operations in the open air come rain or shine, day or night. They can then convey the survivor to hospital and bypass the receiving trauma team, pop them on a trolley and whisk them down to the CAT scanner circumventing the A and E team????
What films do you watch?
In reality it is far far far away from this perfect scenario.
There are NO stats indicating a night time demand for HEMS/AA to the extent that a helicopter is the best response vehicle. Stats can be 'massaged' to suggest the helo might 'improve' things so they meet PR targets but that is about all.
Homonculus is quite right, the cost is a quantum leap on traditional night time responses and entirely uncalled for. BUT......the forces of Marketing, H and S, public ignorance, helicopter service provider lobbying will prevail and the UK will see a proliferation of night support.....the public will willingly contribute too as they see it as a straight forward extension of day ops (which it isn't). Until they are properly educated in this area, their soft underbelly will continue to be exploited to the max.
[It's strange isn't it - if the government decreed there to be a "rescue and recovery" tax of say £40/yr, the public would kickoff. Shake a tin, hold a raffle, organise a charity run and people will willingly chip in a lot more than this over the year].
Air pig
what exactly do you think will be different under UKSAR? The aircraft and crews will already have been paid for and the DfT will, if required, be recompensed by the NHS for providing something (hospital transfer) that is not covered by the core contract ( and it is only your supposition that it isn't).
Any financial transfer will be between govt depts and not directly with the contractor - remember DfT are are responsible for providing UKSAR and they pay the bills. Frankly no different to transfer of funds between MoD and NHS at present.
The £5000 is correct, and you can bet the MoD costs will be a bare minimum profit margin, remember the crews and aircraft are already a paid for asset and civil operations are paid as 'aid to the civil power'. So a percentage is from the MoD budget supporting civil AA operations as flight crew pay engineering and command and control are paid from the defence budget.
Any financial transfer will be between govt depts and not directly with the contractor - remember DfT are are responsible for providing UKSAR and they pay the bills. Frankly no different to transfer of funds between MoD and NHS at present.
So many facets to this discussion..... there literally could be several threads 
First: I am an outsider. Not involved in the UK AA or SAR scene. And not much time to get across the whole discussion, however, I thought since we have some from the US contributing, I might throw a different perspective in. I fully appreciate that what I say may not be reflected in the reality that you guys face in the UK, as I am sure you will understand that some of your "truths" do not apply in my environment.
The thread was initially (and is entitled) about night flights, so I will start with that.
First Big call: Night EMS flights can be flown as safely, or very nearly as safely as day flights. "Can be" is the phrase, not "are currently", because it depends on which part of the world and where you look for trends.
So we turn to homonculus (are you going to tell us all what the name means and why the spelling?) and his/her constant argument in this and other threads that there is no benefit medically to AA flights. I disagree with this,because UK AA flights are not the only types of AA, and stating that AA flights don't show benefit is to capture all types of AA flights around the world. We use doctors on our AA flights as do most of Europe but not so with the typical Anglo and American models. So I accept that when you say "AA Flights" you are arguing about a slightly different animal from the alternative perspectives such as the one I am proposing here.
I know a lengthy argument about peer reviewed empirical evidence will ensue: however, I believe that the HIRT (Head Injury Retrieval Trial) in Sydney proved that Per Protocol and Treatment Received level evidence clearly indicated a demonstrable benefit, even if Intention To Treat was inconclusive due to contamination by the change to standard care during the trial. So we can go around and around on this and still hold different views at the end.
From my perspective, lets just assume that AA flights do help people, even if there can be disagreement on the empirical evidence at hand. Lets put it more bluntly: your child is trapped by compression and unconscious. Would you prefer (regardless of evidence of benefit):
a. Volunteer medical responder.
b. Ambulance Officer.
c. Paramedic Officer and Ambulance Officer.
d. AA arrives: Emergency/Anesthetic Consultant and Paramedic and 2nd Paramedic and Ambulance Officer.
Anyone NOT choose d? There will be some for the sake of argument on pprune, but really.... I think we would all like d, even in the face of "no peer reviewed evidence".
I would hasten to add that doctors (where trained appropriately) are the key to this proposition. I agree with homonculus and TC, that sending a paramedic only on an AA flight is definately beneficial in terms of getting a pre hospital expert (paramedic) to the scene faste, but it is still a bit "akin to attaching rotors to an ambulance" and upping the costs consequently, and I agree with homonculus, the benefits of this would generally come down to the speed of the scoop and run as no higher level of care will be provided. I am NOT saying that the befit of speed is not tangible as per the inference from homonculus. I think getting a paramedic there more quickly and conveying the patient to hospital more quickly is a great benefit. But if having the paramedic is needed, lets add the doctor (not replace the paramedic). Now, we have an asset that, although expensive, can bring a higher level of clinical care, not just the pre-hospital expertise faster.
Now speed. TC says:
L
What I am about to say may not work in the UK, and may not be safe or applicable. But please accept that it can be done (and has been done) safely elsewhere. During the HIRT (Head Injury Retrieval Trial) in Sydney, NSW, the team was able to respond well within those times, day AND night, and for over 6 years. Typically, they were first on scene in a majority of cases (including even the CBD of Sydney) and recorded an average lift off time of 6 minutes from the phone call. That is, 6 minutes from START of the phone call of the victim, not from the end of the phone call from co-ordination to the helicopter crew.
As consultant level doctors and the highest level of paramedic training in NSW (this differs throughout the world), they could and did perform a variety of roadside "operations". In the open air. In the rain. At night. And their times at triage in casualty before CT, etc, are demonstrably less, depending on the semantics of the trial outcomes I referred to above. No-one bypasses the receiving trauma or A and E teams, and I think I can excise that from the quote: but I am talking about when a trauma team of significant experience and seniority walks in with a trauma patient, sometimes a team that is equivalent or more experienced than the team at the hospital.... you must accept that that creates a different dynamic at the triage, and a dynamic that will always favour the patient. Imagine if the head of that trauma centre walked in accompanied by the highest level of pre hospital expertise (paramedic) with the casualty because the head of the trauma centre was the doctor on the helicopter. Would that help? A little bit??
So, I accept that my view is based on (and limited by) my experiences - again, I do not know how this translates into the UK environment, but for us, AA flilghts are capable of being the "golden hour" level of care in many cases, can fly safely at night, and can respond quicker than ground resources even in heavily covered areas, but can respond with a higher level of care than that provided by ground alone. They SUPPLEMENT ground capabilities, they DO NOT replace. And, when they cannot fly, no worries, there is still an extremely efficient ground response that can deal with the problems or scoop and run as per normal.
The above concentrates on pre hospital, however we also perform a significant number of inter hospital flights as well. On one operation of ours, we fly approx 850 hours of inter hospitals per annum, 60% of which is night.
Does the UK system of paramedic or police office/medic system (without redesign) support the notion of AA flights at night in the UK? Not from the discussion above, but if you do want the benefits and you do want the capability to provide those benefits safely by night, there are other ways to do AA that are worth considering. Some of these would and facilitate the safety and the benefits of AA flights experienced elsewhere in the world.
in my opinion
First: I am an outsider. Not involved in the UK AA or SAR scene. And not much time to get across the whole discussion, however, I thought since we have some from the US contributing, I might throw a different perspective in. I fully appreciate that what I say may not be reflected in the reality that you guys face in the UK, as I am sure you will understand that some of your "truths" do not apply in my environment.
The thread was initially (and is entitled) about night flights, so I will start with that.
First Big call: Night EMS flights can be flown as safely, or very nearly as safely as day flights. "Can be" is the phrase, not "are currently", because it depends on which part of the world and where you look for trends.
So we turn to homonculus (are you going to tell us all what the name means and why the spelling?) and his/her constant argument in this and other threads that there is no benefit medically to AA flights. I disagree with this,because UK AA flights are not the only types of AA, and stating that AA flights don't show benefit is to capture all types of AA flights around the world. We use doctors on our AA flights as do most of Europe but not so with the typical Anglo and American models. So I accept that when you say "AA Flights" you are arguing about a slightly different animal from the alternative perspectives such as the one I am proposing here.
I know a lengthy argument about peer reviewed empirical evidence will ensue: however, I believe that the HIRT (Head Injury Retrieval Trial) in Sydney proved that Per Protocol and Treatment Received level evidence clearly indicated a demonstrable benefit, even if Intention To Treat was inconclusive due to contamination by the change to standard care during the trial. So we can go around and around on this and still hold different views at the end.
From my perspective, lets just assume that AA flights do help people, even if there can be disagreement on the empirical evidence at hand. Lets put it more bluntly: your child is trapped by compression and unconscious. Would you prefer (regardless of evidence of benefit):
a. Volunteer medical responder.
b. Ambulance Officer.
c. Paramedic Officer and Ambulance Officer.
d. AA arrives: Emergency/Anesthetic Consultant and Paramedic and 2nd Paramedic and Ambulance Officer.
Anyone NOT choose d? There will be some for the sake of argument on pprune, but really.... I think we would all like d, even in the face of "no peer reviewed evidence".
I would hasten to add that doctors (where trained appropriately) are the key to this proposition. I agree with homonculus and TC, that sending a paramedic only on an AA flight is definately beneficial in terms of getting a pre hospital expert (paramedic) to the scene faste, but it is still a bit "akin to attaching rotors to an ambulance" and upping the costs consequently, and I agree with homonculus, the benefits of this would generally come down to the speed of the scoop and run as no higher level of care will be provided. I am NOT saying that the befit of speed is not tangible as per the inference from homonculus. I think getting a paramedic there more quickly and conveying the patient to hospital more quickly is a great benefit. But if having the paramedic is needed, lets add the doctor (not replace the paramedic). Now, we have an asset that, although expensive, can bring a higher level of clinical care, not just the pre-hospital expertise faster.
Now speed. TC says:
L
et me get this right. You're telling me that a helicopter can respond <20 mins. It can also carry a pilot (possibly 2), crewperson, paramedic and doctor/consultant.
You're telling me that team can perform roadside operations in the open air come rain or shine, day or night. They can then convey the survivor to hospital and bypass the receiving trauma team, pop them on a trolley and whisk them down to the CAT scanner circumventing the A and E team????
You're telling me that team can perform roadside operations in the open air come rain or shine, day or night. They can then convey the survivor to hospital and bypass the receiving trauma team, pop them on a trolley and whisk them down to the CAT scanner circumventing the A and E team????
As consultant level doctors and the highest level of paramedic training in NSW (this differs throughout the world), they could and did perform a variety of roadside "operations". In the open air. In the rain. At night. And their times at triage in casualty before CT, etc, are demonstrably less, depending on the semantics of the trial outcomes I referred to above. No-one bypasses the receiving trauma or A and E teams, and I think I can excise that from the quote: but I am talking about when a trauma team of significant experience and seniority walks in with a trauma patient, sometimes a team that is equivalent or more experienced than the team at the hospital.... you must accept that that creates a different dynamic at the triage, and a dynamic that will always favour the patient. Imagine if the head of that trauma centre walked in accompanied by the highest level of pre hospital expertise (paramedic) with the casualty because the head of the trauma centre was the doctor on the helicopter. Would that help? A little bit??
So, I accept that my view is based on (and limited by) my experiences - again, I do not know how this translates into the UK environment, but for us, AA flilghts are capable of being the "golden hour" level of care in many cases, can fly safely at night, and can respond quicker than ground resources even in heavily covered areas, but can respond with a higher level of care than that provided by ground alone. They SUPPLEMENT ground capabilities, they DO NOT replace. And, when they cannot fly, no worries, there is still an extremely efficient ground response that can deal with the problems or scoop and run as per normal.
The above concentrates on pre hospital, however we also perform a significant number of inter hospital flights as well. On one operation of ours, we fly approx 850 hours of inter hospitals per annum, 60% of which is night.
Does the UK system of paramedic or police office/medic system (without redesign) support the notion of AA flights at night in the UK? Not from the discussion above, but if you do want the benefits and you do want the capability to provide those benefits safely by night, there are other ways to do AA that are worth considering. Some of these would and facilitate the safety and the benefits of AA flights experienced elsewhere in the world.
in my opinion
Helmet fire
I thoroughly enjoyed your post. For the avoidance of doubt I confirm I am talking about air ambulance work in England and Wales using the current model. I am not saying HEMS has no benefit even in the UK, merely that we need to identify who to attend and with what and why.
I certainly am not talking about the US where I spend many happy years flying some worthwhile missions albeit with antiquated equipment. Nor am I criticising in particular Australia who have very impressive set ups in metro areas and vital services in rural areas.
As to Homonculus, Google Penfields Homonculus and you will understand
I thoroughly enjoyed your post. For the avoidance of doubt I confirm I am talking about air ambulance work in England and Wales using the current model. I am not saying HEMS has no benefit even in the UK, merely that we need to identify who to attend and with what and why.
I certainly am not talking about the US where I spend many happy years flying some worthwhile missions albeit with antiquated equipment. Nor am I criticising in particular Australia who have very impressive set ups in metro areas and vital services in rural areas.
As to Homonculus, Google Penfields Homonculus and you will understand
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HEMS by night
In principle I agree it isn't a terrible idea and could offer something.
But out of curiosity, please excuse the ignorance, how often would the aircrew in question get to practice flying into unknown sites by night on NVG or mortal?
In the military it is probably the one skill you practice the most on a regular basis. So my next question is who will pay for the currency training?
Just wondered as an outsider considering if the grass is greener...
But out of curiosity, please excuse the ignorance, how often would the aircrew in question get to practice flying into unknown sites by night on NVG or mortal?
In the military it is probably the one skill you practice the most on a regular basis. So my next question is who will pay for the currency training?
Just wondered as an outsider considering if the grass is greener...
Purveyor of Egg Liqueur to Lucifer
Ricorigs;
When you say that the military regularly practise NVG/Mortal flights into unknown landing sites, would they be the same sites that would have been day recce'd just a few hours before?
In reference to the currency training for landing in unknown sites, can you please remind us what the military currencies for that activity are and in which column would it go in the old logbook?
But out of curiosity, please excuse the ignorance, how often would the aircrew in question get to practice flying into unknown sites by night on NVG or mortal?
In the military it is probably the one skill you practice the most on a regular basis. So my next question is who will pay for the currency training?
In the military it is probably the one skill you practice the most on a regular basis. So my next question is who will pay for the currency training?
When you say that the military regularly practise NVG/Mortal flights into unknown landing sites, would they be the same sites that would have been day recce'd just a few hours before?
In reference to the currency training for landing in unknown sites, can you please remind us what the military currencies for that activity are and in which column would it go in the old logbook?
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Silso,
Fair point my bad england. I was referring to night flying in general not the unrecce'd sites being regularly practiced. Consider my bad typing hands slapped.
But on the unknown sites bit, it depends where you are and which service you are in whether they are recce'd by day first. The Navy/Marines are a bit more up for it than the RAF and Army to go in blind. Plus sometimes you can't recce everything within the last 7 days and it isn't exactly realistic training to go to a recce'd site all the time.
Which is all well and good on a plain somewhere. But in the middle of a city center, solo pilot NVG or mortal that would be pretty taxing. I don't know if the rest of the crew help out on this in a HEMs aircraft.
That's why I just wondered how often the guys would practice it..
Fair point my bad england. I was referring to night flying in general not the unrecce'd sites being regularly practiced. Consider my bad typing hands slapped.
But on the unknown sites bit, it depends where you are and which service you are in whether they are recce'd by day first. The Navy/Marines are a bit more up for it than the RAF and Army to go in blind. Plus sometimes you can't recce everything within the last 7 days and it isn't exactly realistic training to go to a recce'd site all the time.
Which is all well and good on a plain somewhere. But in the middle of a city center, solo pilot NVG or mortal that would be pretty taxing. I don't know if the rest of the crew help out on this in a HEMs aircraft.
That's why I just wondered how often the guys would practice it..
Purveyor of Egg Liqueur to Lucifer
But on the unknown sites bit, it depends where you are and which service you are in whether they are recce'd by day first. The Navy/Marines are a bit more up for it than the RAF and Army to go in blind. Plus sometimes you can't recce everything within the last 7 days and it isn't exactly realistic training to go to a recce'd site all the time.
Then again, if the site is recced by someone else (OC night?), surely that realism is still there, all you have given the site is a clearance that goes as far as; 'There shouldn't be any gotchas in here'.
But in the middle of a city center, solo pilot NVG or mortal that would be pretty taxing.
To the HEMS chaps & chapesses, any idea how many elevated pads are night cleared?
So little of world wide HEMS is data driven or data based.
Granted, it might be the revenue from heart and trauma procedures that is the measure but the almighty dollar is the base upon which decisions are made.
SASless
I presume you refer to the US where most HEMS are loss making projects funded by hospitals to pull in very profitable major surgery. That works well but in the UK we have socialised medicine. There is no profit. A large operation such as a heart transplant is a big COST or loss for the hospital not a profit. Hospitals do not get paid for treating patients, they have to pay the costs themselves or via the CCG
SilsoeSid
There is no problem with return to base or return to hangar at night and London HEMS have done the latter. This dubious project is about flying to trauma sites at night, and not just city centres where in Essex you might be able to manage with half a dozen recycled sites per city - although why you would do so is beyond me as you would have to task land transportation to collect the crew and then a land ambulance to transfer the patient and after all that nonsense you could have the patient in the operating theatre much sooner and cheaper and safer in a land vehicle.
No this is about going to night trauma which is often down country lanes with little ambient lighting, trees, livestock, inclines, farm implements and cables and wires. You have to land within say 50 metres as there is no spare personnel to transfer you to the patient and you will have to manhandle the patient plus stretcher plus monitoring plus oxygen to the aircraft so no hills, mud or cow pats please. I would be interested to know how the military would approach it.
I presume you refer to the US where most HEMS are loss making projects funded by hospitals to pull in very profitable major surgery. That works well but in the UK we have socialised medicine. There is no profit. A large operation such as a heart transplant is a big COST or loss for the hospital not a profit. Hospitals do not get paid for treating patients, they have to pay the costs themselves or via the CCG
SilsoeSid
There is no problem with return to base or return to hangar at night and London HEMS have done the latter. This dubious project is about flying to trauma sites at night, and not just city centres where in Essex you might be able to manage with half a dozen recycled sites per city - although why you would do so is beyond me as you would have to task land transportation to collect the crew and then a land ambulance to transfer the patient and after all that nonsense you could have the patient in the operating theatre much sooner and cheaper and safer in a land vehicle.
No this is about going to night trauma which is often down country lanes with little ambient lighting, trees, livestock, inclines, farm implements and cables and wires. You have to land within say 50 metres as there is no spare personnel to transfer you to the patient and you will have to manhandle the patient plus stretcher plus monitoring plus oxygen to the aircraft so no hills, mud or cow pats please. I would be interested to know how the military would approach it.
So I guess mitigation of Loss/cost....is not a consideration for charities?
Are you doing it just to be doing it...or to do as much "good" as possible with the funds extant?
It still gets back to cost v benefit does it not?
I once posed a question re the wisdom of IFR Ops....up in the wilds of Pennsylvania....where we would lift from the Hospital Pad...fly to a a rural Airport...meet an Ambulance with the Patient...transferred from a safe, warm, capable Medical Facility...transfer the Patient to the Helicopter...depart the Airport...transit to the Hospital...and make an IFR Approach to the Hospital Helipad with very high minimums due to the Hills surrounding the Heliport (then in the case of a Missed Approach)...transit to another Airport, transfer the Patient to yet another Ambulance....transport the Patient to the Hospital and transfer the Patient into Facility along with all the attendent check-in routines....to Yes....wait for the advanced medical treatment.
The Patient could have waited in the first Medical Facility with no undue stress until the weather improved and the flight could be made Hospital to Hospital in one go with just two transfers in the process.
I argued the "Do No Harm!" rule was being violated in the pursuit of proving our company was the first in doing routine IFR Ops.
We have to remember the Patient's best interests in all this we do and propose to do.
Are you doing it just to be doing it...or to do as much "good" as possible with the funds extant?
It still gets back to cost v benefit does it not?
I once posed a question re the wisdom of IFR Ops....up in the wilds of Pennsylvania....where we would lift from the Hospital Pad...fly to a a rural Airport...meet an Ambulance with the Patient...transferred from a safe, warm, capable Medical Facility...transfer the Patient to the Helicopter...depart the Airport...transit to the Hospital...and make an IFR Approach to the Hospital Helipad with very high minimums due to the Hills surrounding the Heliport (then in the case of a Missed Approach)...transit to another Airport, transfer the Patient to yet another Ambulance....transport the Patient to the Hospital and transfer the Patient into Facility along with all the attendent check-in routines....to Yes....wait for the advanced medical treatment.
The Patient could have waited in the first Medical Facility with no undue stress until the weather improved and the flight could be made Hospital to Hospital in one go with just two transfers in the process.
I argued the "Do No Harm!" rule was being violated in the pursuit of proving our company was the first in doing routine IFR Ops.
We have to remember the Patient's best interests in all this we do and propose to do.
ricorig
so which ones aren't operating iaw the JHC flying order book?
But on the unknown sites bit, it depends where you are and which service you are in whether they are recce'd by day first. The Navy/Marines are a bit more up for it than the RAF and Army to go in blind.
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Good post Helmet Fire. Although this thread is concerned with UK AA flights it is useful to remind people that night AA flights have been operating successfully in Australia for well over 30 years now.
Having experience flying AA night flights in Australia and UK for me the main differences were attitude and currency. You have a (comparitively) very pro-aviation CASA in Australia which helps enormously and the prevailing attitude is that flown properly with correct rules and aids there is little risk with night AA flights.
Australian AA flights are (as HF said) up to 60% of all tasks and when flying 850 hours per annum that is a lot of night flying including off-airport landings. The equates to very current aircrew in night operations and night currency training flights tend to get in the way of real night tasks. However training is still important and regularly flown. UK AA flights fly much less than this and a tiny amount of night flying so night AA is seen by many as a very difficult and hazardous.
There have been night AA accidents in Australia in the past but these have been with VFR single-engine machines operated by organisations with poor CRM and flown by pilots who were uncurrent and/or lacking in decision making skills.
Australian HEMS are (mostly) single-pilot IFR machines of the Bell412/AW139 size. The Australian model means that it is possible to fly with a crew of pilot, crewman, rescue crewman (all using NVG) doctor and paramedic and carry two stretcher casualties. The UK model tends to utilise smaller machines of the EC135/MD900 class with pilot and 2 paramedics.
The two countries are very different in many respects but Australia has shown that night AA tasks can be performed just as easily as day tasks with the right aircraft, crew combination, night vision equipment, currency, rules, regulations and attitude.
Having experience flying AA night flights in Australia and UK for me the main differences were attitude and currency. You have a (comparitively) very pro-aviation CASA in Australia which helps enormously and the prevailing attitude is that flown properly with correct rules and aids there is little risk with night AA flights.
Australian AA flights are (as HF said) up to 60% of all tasks and when flying 850 hours per annum that is a lot of night flying including off-airport landings. The equates to very current aircrew in night operations and night currency training flights tend to get in the way of real night tasks. However training is still important and regularly flown. UK AA flights fly much less than this and a tiny amount of night flying so night AA is seen by many as a very difficult and hazardous.
There have been night AA accidents in Australia in the past but these have been with VFR single-engine machines operated by organisations with poor CRM and flown by pilots who were uncurrent and/or lacking in decision making skills.
Australian HEMS are (mostly) single-pilot IFR machines of the Bell412/AW139 size. The Australian model means that it is possible to fly with a crew of pilot, crewman, rescue crewman (all using NVG) doctor and paramedic and carry two stretcher casualties. The UK model tends to utilise smaller machines of the EC135/MD900 class with pilot and 2 paramedics.
The two countries are very different in many respects but Australia has shown that night AA tasks can be performed just as easily as day tasks with the right aircraft, crew combination, night vision equipment, currency, rules, regulations and attitude.