If a pilot is knocked out of action mid-flight, helicopter EMS crews flying for the Roanoke, Virginia-based Carilion Clinic Life-Guard have trained to operate an EC135’s autopilot, and could soon learn to fly and land the aircraft.
Pilots and medical crew from the clinic two years ago formed a pilot incapacitation working group (PIWG) after attending a seminar hosted by Air Evac Lifeteam, which learned the hard way that operators should at least prepare medical crew in the back for a pilot to suffer a medical or some other emergency in flight.
In January 2018 an AEL pilot suffered a medical emergency mid-flight but a cool-headed, highly trained medical crew and a functioning autopilot kept the Bell 206L LongRanger stable until the pilot recovered enough faculties to land in an open field.
After attending a series of lectures on the incident, pilots and crews at Carilion clinic began asking themselves how they would deal with an incapacitated pilot.
“Up until this point, med crews and pilots had engaged in some cursory conversations about these what-ifs with no formal process or training discussed or developed,” flight nurse Sid Bingley said Nov. 2 in an online presentation to the 2020 Air Medical Transport Conference. “It was clearly a delicate subject that could open a potentially very large can of worms.”
“We needed to determine what we wanted or needed to do if the pilot became incapacitated,” Bingley added. “We began to discuss how to stabilize the aircraft, how to avoid terrain and obstacles, with whom to communicate and the importance of reviving the pilot. We needed to develop a set of protocols that would give our medical crews hope in an otherwise hopeless situation.”
Based in the southwest Virginia city of Roanoke, Carilion Clinic has a fleet of three Airbus EC135 P2+, IFR-capable helicopters each equipped with three-axis autopilots. Partnered with operator MedTrans, the program provides HEMS coverage to a fairly large, rural, mountainous area that reaches into bordering West Virginia and North Carolina.
The clinic has three rotorcraft bases centered on the Roanoke-Blacksburg Regional Airport, but otherwise has few suitable emergency landing spots aside from sporadic rural airports without round-the-clock supervision. Pilots also must deal with undulating mountainous terrain and associated obstacles.
In such challenging conditions, Carilion crews and pilots studying the issue recognized the use of the EC135’s autopilot would be critical for non-aviation personnel to stabilize the aircraft in an emergency.
First, the effort needed buy-in from the principal stakeholders involved, namely the clinic, operator MedTrans, the FAA and not least the medical crews, said Wade Dunford, pilot and base aviation manager.
“After framing the issue, we determined that we were going to have to develop an incremental solution that was well thought out, verified and trainable,” Dunford said. “Some pilots were caught up in the belief that medical crews could not or should not be trained to operate aircraft systems and there were some medical crew members that were just not initially interested in accepting the risks or challenges of learning and implementing incapacitated pilot procedures. Through ongoing discussions we were able to win them over.”
With almost immediate support from clinic administration and MedTrans to pursue pilot incapacitation protocols, the first “crawl” phase was complete. The FAA signed off on the plan at AMTC in Atlanta in 2019, Dunford said.
Carilion began to then “walk” toward a suitable set of verifiable, trainable, easily performed protocols for medical crews to implement should a pilot suffer a medical emergency or be knocked out of action by some other means such as a bird strike.
The second phase priumarily involved developing procedures to stabilize the aircraft, thereby permitting the crew time to treat an incapacitated pilot in an attempt to revive the pilot so that they could either land or assist in landing the aircraft.
“Most of our pilots spend the vast majority of each flight with the aircraft coupled to the autopilot,” Dunford said. “In the event the aircraft was not coupled to the autopilot, the medical crew could stabilize the aircraft by engaging altitude hold to capture altitude, engaging heading hold to capture heading and by making small adjustments to the collective lever to ensure the aircraft was operating at the correct power setting.”
Medical crews train to press the altitude hold button on the EC135’s autopilot, then the heading hold button. Those two tasks will bring the aircraft to steady, level flight at its current altitude. Next the collective is set at a constant power setting for cruise flight. Because the clinic operates in the mountains, the next prescribed action is to dial in a new minimum safe altitude of 6,500 feet (1,980 meters) to ensure clearance.
Unless the pilot has resumed consciousness, the medical crew are then instructed to set the transponder to 7700 to indicate an emergency, call the Carilion operations center to consult with an on-duty pilot and contact air traffic control. Only then, and after setting a new heading for the nearest suitable landing spot prescribed by ATC, they are to assess and treat the unresponsive pilot.
Carilion printed these procedures on a set of laminated quick-reference cards that were distributed to medical crew members. MedTrans adapted the procedures for all 100 aircraft it operates, which includes all versions of the Airbus 135, H130 and H145, and Bell 407. Similar protocols and training are now required for all medical flight crews whose operator is Med-Trans Corporation.
In the final “run phase,” medical crews will train to take control of and land the aircraft.
Carilion clinic’s IPWG has drafted a set of procedures specific to the EC135 with three-axis autopilot to allow the medical crew to land the aircraft at a time and place of their choosing. Carilion and MedTrans plan to soon present the procedures to the FAA for approval.
“If we accomplish nothing else beyond the walk phase, we can still rest easy knowing that we’ve made a difference that could save lives,” Dunford said. “We hope to take these procedures a step further in the near future. The scenario exists where an incapacitated pilot, despite the best efforts of the medical crew, can’t be revived. The only option, then, would be for the medical crew to utilize a set of procedures to land the aircraft, because the alternative is not acceptable.”
