NOTE: Recurrent training is recommended for all maintenance personnel.
e. Cockpit Resource Management (CRM). Regardless of the type of operations conducted (Instrument Flight Rules (IFR) or Visual Flight Rules (VFR), a training program should be established for CRM and the use of checklists. CRM procedures should include the utilization of all flightcrew resources, including medical personnel assigned duties, for all operations, including emergencies. Pilots should be trained in "challenge and response" method of checklist usage. First officers, when assigned, should be trained to assist the pilot as directed. when two pilots are assigned to a particular EMS transport, cockpit procedures should be developed for emergency situations where one pilot is designated to fly the aircraft while the second pilot tends to the emergency.
f. Judgement and Decisions. The decisionmaking process should have input from all elements involved in an EMS operation. Aeromedical directors, helicopter operators, flightcrew, medical personnel, and ground crew contribute to this process. The degree of input from each of these elements will depend upon the type and complexity of each mission.
should be familiar with appropriate FAR and FAA guidelines related to safe operations. Management personnel should participate in the certificate holder's training program to gain knowledge concerning EMS/H operations.
(2) An essential element in flight operations is the timely decision to conduct a particular flight or continue a flight as planned. To familiar with helicopter operations pertaining to the mission being planned.
(3) All personnel assigned to EMS/H should be trained in the operational aspects of each type of helicopter being used. Training should include, but is not limited to, the range of each helicopter versus number of crewmembers/passengers carried, equipment installed versus carry-on equipment, weather capabilities, safety around helicopters, and safety in landing areas.
(4) The certificate holder should be thoroughly familiar with the operational characteristics of each helicopter and the qualifications of each flight crewmember.
(5) Pilot judgement may be defined as: The mental process by which the pilot recognizes, analyzes, and evaluates information regarding himself/herself, the aircraft, and the external environment. Good pilot judgement can be developed as part of a flightcrew training program.
Pamphlet DOT/FAA/PM-86-45, Aeronautical Decision Making for Helicopter Pilots, is recommended to improve aeronautical decisionmaking. The pamphlet covers the concepts of judgement and decisionmaking and is designed to be reviewed under the supervision of a flight instructor.
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(6) A decision whether or not to conduct a flight, or to continue a flight as planned, is required by regulation to be made by the pilot in command. This decision should be based on the information received from other elements involved and on his/her judgment as an experienced pilot. The decision should not be based solely on the condition of the patient.
(7) The final step is the decision to conduct the flight in a safe and timely manner.
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CHAPTER 3. OPERATIONS
7. GENERAL. This chapter outlines recommendations regarding the conduct of FAR Part 135 EMS operations with helicopters.
a. EMS/H Flight Following. In order to ensure a safe, orderly execution of an EMS/H mission, each operating site should have a flight following system. Several factors including the potential 24-hour demands of EMS/H missions, surrounding terrain, and variable weather conditions, affect the safety of EMS flight operations. The following is provided to help ensure safe mission accomplishment:
(1) The certificate holder should have flight following procedures to include the notification of the communications center of specific aircraft departure times and estimated time of arrival.
(2) Flight following and/or communications should be maintained with the helicopter during each mission. These intervals should not exceed 15 minutes in flight and 45 minutes while on the ground.
(3) A communications system is established to ensure that medical personnel and crewmembers can communicate with the hospital and ground personnel at the patient transport site.
(4) A qualified, trained individual is designated as a communications specialist to receive and coordinate flight requests for EMS/H operations.
(5) An intercommunications system is available for communications between medical personnel and the flightcrew.
b. Weather Minimums. Each EMS/H flight following location should establish a local flying area and a cross-country flying area. VFR weather minimums should be specified for day and night local, and day and night cross country. VFR minimums should be no less than in table 1 which follows.
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Table 1. Uncontrolled Airspace
CONDITIONS CEILING VISIBILITY Day local 500 ft 1 mile Day cross country 1000 ft 1 mile Night local 800 ft 2 mile Night cross country 1000 ft 3 mile NOTE: For operations in controlled airspace, refer to FAR Sections
91.155 and 91.157.
(1) Each EMS/H certificate holder should develop a system of obtaining weather information prior to releasing any flight.
c. Landing Sites.
(1) Criteria should be established to ensure each airport/approved helicopter landing site has been evaluated by qualified personnel and the heliport or landing site meets the guidance contained in AC 150/5390-2, Heliport Design. The site evaluation should include the following:
(i) Identification and/or removal of obstructions.
(ii) Assessment of area lighting.
(iii) Notation of helicopter ingress/egress limitations.
A system should be established to familiarize pilots with all heliports serviced by the hospital/certificate holder. A method considered acceptable would be photographs, drawings, and other descriptive means to identify the helistop or heliport and any obstructions.
d. Flight controls. The flight controls of a helicopter should not be left unattended by crewmembers while the rotor is turning.
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Flight Time and Rest Requirements. Each operator will maintain a record that distinctly shows the difference of flight time, rest time, and off-duty or unassigned time, in accordance with FAR Part 135. It should be noted that in addition to FAR Section 135.263, there are two basic flight and duty time FAR sections applicable to EMS operations.
(1) FAR Section 135.267, Flight time limitations and rest requirements: Unscheduled one-and two-pilot crews, allows the flight crewmember to conduct any flight or other duties as assigned such as training, testing, routine transport missions, etc., while on duty/assignment. For an assignment conducted under this section, flight crewmembers must receive rest in accordance with FAR Section 135.267 (at least 10 consecutive hours of rest during the 24-hour period that precedes the planned completion of the assignment).
NOTE: FAR Sections 135.267 or 135.271 should be identified in the company training program and operations specifications and specify which FAR the operator has chosen to comply with for his/her particular operation.
from the requirements of flights conducted under FAR Section 135.267. During operations in accordance with FAR Section 135.271, provisions must be made for 8 consecutive hours of rest during any 24 consecutive hour period. If the flight crewmember does not receive the required rest period, that pilot must be relieved of the assignment. The certificate holder should establish a recordkeeping mechanism to show that only bona fide emergency flights are conducted during these FAR Section 135.271 assignments. While a flight crewmember is assigned to HEMES under FAR Section 135.271, he/she may not be assigned to any other duties.
(3) For programs providing 24-hour consecutive EMS/H coverage, it is recommended that no less than four pilots per aircraft be assigned. EMS/H programs with high activity levels or those with unusual circumstances may require higher pilot-to-aircraft ratio. Sufficient staffing levels should be established to promote operational safety standards.
(4) Each certificate holder should provide relief for each person performing maintenance from duty for a period of at least 24 consecutive hours during any 7 consecutive days, or the equivalent thereof, within any 1 calendar month. The requirement of the certificate holder should be the same for contractor/vendor maintenance.
f. Weight and Balance. Each operator should develop a control system for weight and balance that shows the aircraft will be properly loaded and will not exceed limitations during flight. A control system may include the following:
(1) A loading schedule, composed of graphs and tables based on pertinent data for use in loading that particular aircraft in a rapid manner for EMS/H operations, should be prepared.
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An index type weight and balance program using average load weights may be established in accordance with AC 120-27A, as revised.
index-type weight and balance is used, the manual should contain the procedures for using, managing, and updating.
(3) These programs should include assorted aircraft occupant and equipment configurations (1.e., one or two pilots, two medical personnel, two patients, large carry-on equipment, balloon pumps, fuel in the most critical center of gravity location, etc.).
g. Procedures for Flight Into Instrument Meteorological Conditions (IMC). An operational procedure for inadvertent flight into IMC should be developed for inclusion in the certificate holder's operations manual. The procedures should address the applicable FAR pertaining to IFR including operations in an ATC radar environment as well as inadvertent IMC in isolated areas or a non-radar environment.
NOTE: This procedure should in no way be construed as authorizing or condoning actual IFR flights without meeting all IFR requirements.
The FAR Part 135 certificate holder/operator might choose to request the use of a discreet transponder code from the local ATC facility for use when conducting EMS/H operations in that area. This would provide positive identification during an EMS/H operation at all times. This procedure may be established with a Letter of Agreement between the operator and its local ATC facility.
h. Night Experience. The pilot in command must meet the requirements of FAR Part 61 and should complete a company night training program before conducting any night operations. Procedures for maintaining night currency in EMS/H operations should be developed and specified in the company training program. Such night training should be tailored to the operations of a certificate holder considering the experience level of EMS pilots, the area of operations and the management and safety policy for that operator.
1. EMS/H Heliports. Because of the operating environment (night, weather, and emergencies), EMS operations require a high degree of safety.
FAR Part 135 EMS/H operations should only be conducted from heliports that meet the criteria established in AC 150/5390-2. For operations over congested areas, ingress/egress routes to EMS/H heliports may have to be identified for compliance with FAR Section 91.119.
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CHAPTER 4. SAFETY
8. GENERAL. The commitment to safety must start at the top of an organization. The single most important element of a successful safety program is the commitment of senior management. Safety cannot be dictated - it must be practiced. Managers must display a prudent safe attitude by being involved in safety training. The following safety program recommendations are unique to EMS/H operations:
a. Safety Program. The safety program should be developed considering coordination, when necessary, with organizations that may be essential to the safe completion of an EMS/H mission. The operator may coordinate with one or more of the following organizations: ATC, hospitals, police and fire departments, and search and rescue organizations. An operator might hold briefing sessions with another organization prior to undertaking a specific EMS mission addressing topics concerning the aircraft operations.
b. The certificate holder should designate a safety officer. This individual should be familiar with each aspect of an EMS/H operation with particular emphasis on the safety requirements involved in the operation of helicopters. This individual should plan, organize, and disseminate information about the safety program to all involved persons.
c. The program should encompass at least the following areas: Safety in and around helicopters, site evaluation/preparation, weather analysis, communication equipment and procedures, facilities, and other areas deemed appropriate by the certificate holder and local FSDO.
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Appendix 1 APPENDIX 1. SAMPLE RECORD FOR FLIGHT AND DUTY TIME
FLIGHT HOURS DAY NIGHT TOTAL TYPE APCH Quarterly Total Yearly Total LDGS DUTY ASSIGNMENT UNDER FAR 135
COMPANY PILOT NAME DATE 1 (and 2)
Appendix 2 APPENDIX 2. SAMPLE OPERATIONS SPECIFICATIONS A21. Emergency Medical Service - Helicopter (10/03/89).
a. The certificate holder is authorized to conduct. VFR helicopter emergency periorovided the takeof landing site to be used is adequate for tha including takeoff and landing proposed operaand lightingflights unless the pilot-in-command has proposed operatnd lightingflights unless the pilot-in-command has condering tet caterer shall not conduct surrounding obstructions, emergency medical service satisfactorily completed the certificate holder's approved training program for such operations. If the operation is to be conducted at night, the tie era potent a nazare buring apresch, hovering, taxing, and departure operations.
D. The certificate holder is authorized to use the following VFR weather minimums for the conditions specified below when conducting emergency medical service (evacuation) flights. The certificate holder shall not use any lower A weather m Aimum VFR weather minimums for this type of operation.
INSERT: Conditions, Areas, & VFR weather minimums for evacuation flights
CONDITION AREA
DAY/NIGHT LOCAL/CROSS
COUNTRY CEILING VISIBILITY
c. for escued be of than fight operapifications the deal get is a cares country operation.
INSERT: Description of Local Area Day/Night
DESCRIPTION OF LOCAL AREA DAY/NIGHT
ADDITIONAL TEXT ALLOWED
6/20/91 AC 135-14A Appendix 2 APPENDIX 2. SAMPLE OPERATIONS SPECIFICATIONS (Continued) Sample Weight and Balance Loading Schedule
PART E - WEIGHT AND BALANCE £96. weight and Balance Control Procedures 210/89).
been established to maintain control of weight and balance of the certificate holder's aircraft operated under the terms of these specifications (identitied below) and to ensure that these aircraft are loaded within the gross weight and center of gravity limitations:
a. Prights may be us a. Procedures by which either actual or approved average passenger and crew weights may be used are in the operator's weight and balance control program.
D. Procedures by which either actual or approved average baggage weights may be used are in the operator's weight and balance control program.
:. The actual passenger and baggage weights shall be used in computing thi weight and balance of charter flights and other special service involving th carriage of special groups.
d. All aircraft shall be weighed in accordance with the procedures for establishing individual or fleet aircraft weights outlined in the operator's weight and balance control program.
e. The following loading schedules and instructions shall be used for routine operations:
INSERT: Aircraft, loading schedule info, and weight & balance control procedures