Annual AircraftSafety Training

PURPOSE-Mission Statement Rural EMS Crew Members must work with

Medevac crews to ensure that all aspects of Medevac flights are safe and efficient. In order to function as a team, EMS personnel must have an awareness of how to operate safely on the airport tarmac and how to employ Medevac lifting devices. In addition, EMS crew members must understand what is expected of them should an incident require them to operate around or out of a helicopter. Annual familiarization with these elements of flight operations are essential.

OUTLINE

DEFINITIONSMEDEVAC CREW – Medically trained staff assigned

to provide clinical care during a Medevac flight.FLIGHT CREW – Employees of the air carrier who

operate/fly the aircraft.AIRCREW – Any person employed professionally to

work on board an aircraft.AIRCRAFT CAPTAIN (flies in the left seat) – The

senior pilot charged with safe operation of the aircraft.

FIRST OFFICER (flies in the right seat) – A junior pilot who operates aircraft systems under command of the AIRCRAFT CAPTAIN.

MEDEVAC OPERATIONSAmbulance Parking

Ambulance Movements

Ambulance Repositioning

Patient Packaging

Load / Unload Procedure

Ambulance Parking

The presence of vehicles on the airfield can present a hazard to aircraft and flight crews. Whenever possible:

- Park outside the airfield gates until the aircraft and propellers have stopped moving.

- Turn off strobes and flashing lights while airplanes are landing or taxiing.

Ambulance MovementsImmediately before moving onto the airfield,

turn on the vehicle’s rotating lights or flashing hazard lights.

Drive slowly and directly to the aircraft. Remain alert for other air traffic on the tarmac.

Avoid backing-up whenever possible. If you are forced to back-up, employ a guide to prevent contact with any aircraft or airfield structures.

Ambulance Repositioning Backing up around an airplane is generally an unnecessary

risk – usually the ambulance can be positioned close enough without using reverse:

Approach from the side once the propellers have stopped.

Park a safe distance from the wing so that the doors do not strike the airframe.

Once the patient has been loaded/unloaded, turn away from the wing and depart.

Patient Packaging When preparing a patient for Medevac, they are generally placed

on the #9 Stretcher by the Medevac Crew at the Health Centre. If asked to package the patient for Medevac, remember the following guidelines:

- Position the #9 on the ambulance cot.- Top strap under the head of the #9 stretcher.- Inflate the Therm-a-rest halfway.- Place the Therm-a-rest on the # 9.- Do not tape the Therm-a-rest or LifeBlanket.- Place the LifeBlanket on the Therm-a-rest.- Cover the LifeBlanket with a blue bed liner or a light sheet.- Position the patient and cover with blankets as required.- Attach all seat belts before transport.

Patient Load/UnloadThe load/unload procedure is a cooperative crew

procedure that requires clear communication and careful coordination:

- The pilots will move the patient to/from the door inside the aircraft.

- The Medevac crewmembers will direct the lift of the # 9 stretcher to/from the Lifeport Sled.

- Only one person should count to coordinate the lift.

- If you are unsure of the load/unload procedure, ask the Medevac crew to explain the plan.

AIRFRAME FAMILIARIZATION This orientation focuses on the dedicated

Medevac airplanes and commonly used alternative airframes. The aircraft covered will include:- The King Air 200/300,- The King Air 350,- The Twin Otter,- The A-Star helicopter, - The Bell 206 helicopter, and- The Bell 205/212 helicopters.

The Alkan Fleet

Our current air carrier is Alkan Air. They

have a fleet that consists of nine distinct airframes. For the most part Medevac operations are conducted on the King Air 200/300 and 350 series aircraft.

The King Air 200 - Exterior

The King Air 200 - Cabin

The King Air 350 - Exterior

The King Air 350 - Cabin

ALTERNATIVE AIRFRAMES When standard Medevac aircraft can not

address the specific needs of an unusual Medevac, the Emergency Response Communications Officer and the Alkan Dispatcher will coordinate the use of an alternative airframe.

Whenever YEMS personnel are required load an unfamiliar aircraft the Medevac crew or Aircraft Captain must brief the loading procedure for that airframe.

The Twin Otter - Exterior

The Twin Otter - Cabin

April 7, 2023

The A-Star helicopter has a left-mounted stretcher that can be put in place by the pilot on request. Some of these stretchers have padding and may be used to elevate the head of the patient. They may also be used to secure the Ferno # 9 Stretcher and/or a back board.

http://www.aero.pub.ro/wp-content/themes/aero.pub.ro/uploads/JANE_S_ALL_THE_WORLD_S_AIRCRAFT/JANE_S_AIRCRAFT_UPGRADES/jau_0552.htm

AS-350 (A-Star)

April 7, 2023

Bell 206 (Jet Ranger or Long Ranger)The Jet Ranger and Long Ranger both have stretcher mounts that can be attached to the seats on the left side of the aircraft. Most 206 stretchers are unpadded and can not elevate the head or be used to provide SMR. However, this assembly can secure the # 9 Stretcher or a backboard.

http://www.colacambulance.com/HEMS%202.htm

Bell 205/212 The Bell 205 and 212 are much larger helicopters more commonly employed locally during Wildland Fire Season. The # 9 stretcher, backboard or rolling stock cot (i.e., the Ferno 35P) can be secured to the floor in a number of configurations allowing attendants to sit/operate on both sides of the patient.

http://www.airambulancetechnology.com/he_bell%20205.htm

That the pilot knows what you will need to carry the patient appropriately.

Discuss the options for positioning a stretcher-bound patient before you leave the Helipad and make sure you have all

the necessary equipment

Do not assume:

STANDARD FLIGHT OPERATIONS

Pre-Flight BriefingsAny personnel unfamiliar with operations on a particular

aircraft should request a pre-flight briefing from one of the pilots. The mandatory elements of a pre-flight briefing are:

Seatbelt Operation – Take Off/LandingMain Door – Open/CloseEmergency Exit OperationEmergency Egress ProcedureFire Extinguisher Location (2)Emergency Locator Transmitter LocationCabin Security RequirementsLocation of Survival Equipment

SeatbeltsSeatbelts must be worn:

Whenever the aircraft is moving on the ramp, taxiway or runway.

Whenever the aircraft is taking off or landing.

During periods of turbulence.

Whenever ordered by the AIRCRAFT CAPTAIN.

Cabin Security In the event of sudden turbulence or a hard

landing, items that have not been secured will become missiles. The forces associated with such events will increase the kinetic potential of these items many times, causing damage and trauma to everything in the cabin.

All items must be secured for flight using the nets and belts supplied.

Loading CargoGenerally cargo will be loaded before the patient.

Equipment must be loaded in the cabin or tail compartments under the pilot’s direction.

Ensure that weight is evenly distributed laterally and fore / aft.

If there is a mixed load of cargo and passengers,

the cargo must be loaded so all exits are accessible to passengers.

Upon LandingNever undo your seat belt or attempt to exit any

aircraft until the landing gear is on the ground, all motion has stopped, and the pilot has indicated his/her approval.

Obtain a signal or verbal instruction from the pilot before opening doors or exiting the aircraft.

If it is not possible for the pilot to shut the propellers/rotors down discuss the procedure for leaving the aircraft while the propellers/rotors are still turning.

Patient Load / Unload1. Load/Secure all equipment and personal effects.2. Pilots will ready the sled and ramp system.3. Medevac attendants will position the stretcher

carrying the patient at the base of the steps.4. When the lift team is ready, the Medevac team will

coordinate the lift.5. The patient will be moved onto the ramp and secured.6. The flight crew will slide the patient into position and

will secure the Lifeport Sled.7. The flight crew will fold/secure the ramp and replace

the door cables. The First Officer will secure the door for flight.

The cabin of a helicopter is both cramped and noisy – a difficult place to provide patient care.

Noise, unregulated air temperature, altitude and vibration will adversely affect patient condition unless the attendant anticipates and prepares for this environment.

Helicopter Operations

1 vs 2 attendants?Positioning of equipment.

Initiation of intravenous access?Extra batteries, oxygen and blankets.

Positioning of patient to optimize access.Need for airway protection and

ventilation?

Heli-Ops Considerations

Internal LoadingFlammable or dangerous goods (Oxygen and

some medications such as Entonox) should be stored outside the crew cabin when not in use.

Heavy items such as defibrillators should be carried as close to the center of the cabin as possible.

Ensure cabin cargo is secured to prevent shifting during flight.

Never obstruct flight controls.

Cargo in the Tail BoomSecure light or potentially hazardous items in the

tail boom as directed by the pilot.

Unload the tail boom before the forward compartments to ensure Centre of Gravity is maintained.

If unloading items while the rotors are turning, maintain control of doors and any light articles that may be drawn into the rotors.

Moving away from a helicopter If you must leave the helicopter while the rotors

are still moving: Gather equipment and walk clear of the rotor arc

in clear view of the pilot. Crouch down in a group until the aircraft has flown away.

Remember to make a plan for ongoing communication and pick-up BEFORE

the pilot flies away.

If you can’t leave the rotor arc:If it is unsafe for you to move outside the rotor arc,

crouch in view of the pilot to the front of the aircraft until the helicopter has lifted off and flown

away.

NEVER walk upslope away from a helicopter whose rotors are still turning.

NON STANDARD OPERATIONS

Extreme Cold Weather Operations

Bariatric Medevacs

Remote Site Medevacs

Cold Weather Operations When temperatures drop below -30 degrees Celsius, it

may not be possible for the pilots to shut the aircraft down at a remote location. In these instances only the left side engine will be shut down to allow boarding and deplaning.

In such circumstances, the AIRCRAFT CAPTAIN or a member of the Medevac crew will clearly instruct the EMS Crew Members on the procedures to be followed.

Cold Weather Operations In extreme cases, the aircraft will have to remain

flying while the MEDEVAC CREW is at the health centre – use of airport transfers during cold weather operation is encouraged if patient condition permits.

Bariatric MedevacsThe standard flight equipment used by YEMS can be used to transport patients safely only if they weigh less than 350 lbs./160 kg.

If a patient who exceeds this safe operating weight must be transported, alternative aircraft and equipment will have to be employed.

Typically, it will take additional time to organize and carry out a Bariatric Medevac.

Remote Site MedevacsIn the event that YEMS is asked to retrieve a patient from a remote site, it is likely that an alternative aircraft will be brought into service.

Remember, YEMS is NOT a rescue service. Ensure that you work safely and within the scope of your training.

The Emergency Response Communications Officer (ERCO)may assist with any Remote Site Medevac Request:Contact them at 1 867 667 3333

PROHIBITED OPERATIONS

Hover Entrance / Exit

Helicopter Refueling

Hot Refueling

Hover Entrance and Hover Exit are the practices of entering or leaving a helicopter while the skids are not touching the ground.

Hover Entrance / Exit

Hover Entrance/Exitare specialty operations requiring specific

training and safety procedures.

There is no operational requirement for YEMS personnel to ever be involved in

hover entrance/exit operations.

RefuelingRefueling will be carried out by the pilots or flight

engineers. YEMS staff will NOT refuel aircraft.. Hot fueling is at the discretion of the pilot. YEMS

staff and patients WILL NOT be on board during refueling.

NO SMOKING

AT OR NEAR

FUELING SITES

EMERGENCY OPERATIONSDitching

Crash Positions

Emergency Egress

Aircrew Survival

In-Flight Code

Ditching In the event that the aircraft must make a landing on

unprepared terrain, the AIRCRAFT CAPTAIN will instruct AIRCREW and passengers that they must prepare for ditching:- All items in the cabin must be secured.- The patient backrest must be lowered to the bottom setting. - Shoulder straps (if available) engaged.

Once the cabin is secure, AIRCREW will advise the FLIGHT CREW that the cabin has been prepared before attaching their seatbelts and assuming the crash position.

Crash Positions

Emergency Egress Following a hard landing or ditching, wait until all

motion has stopped before releasing seatbelts and moving about the cabin. Make contact with the flight crew immediately and follow their instructions. If flight crew are not able to assist with the egress, the priorities will be to:- Activate the appropriate exit.- Suppress active flame using the fire extinguisher. -Facilitate the extrication of all injured or ill.- Facilitate the egress of all crew.- Retrieve the survival equipment if safe to do so.- Move to a safe location and adopt survival tasks.

Overwing Egress

Aircrew Survival Tasks (prioritized)1. First Aid2. Fire (for warmth and signaling)3. Shelter4. Signals5. Water6. Food7. Communications

In-Flight Code Having a patient lose vital signs en route significantly

changes the nature of a Medevac. The FLIGHT CREW must be kept in the picture as the situation evolves. Whenever possible, the Flight Crew should be advised:

- Before delivering defibrillation;- When requiring diversion to an alternative destination;- If an additional set of hands is required for CPR.

CONCLUSION The key to conducting smooth, efficient flight

operations is communication and cooperation between all FLIGHT CREW, MEDEVAC and EMS CREW members.

If ever you are unsure of what is expected of you, ask the Aircraft Captain or a Medevac crew member to explain.

QUESTIONS?

THANK YOU