AVIATION SAFETY by Kendra Tjelmeland, RN, BSN I I I

When Whirling Blades Cause a Wash of Confusion and Injury

T he helicopter blades are whirling; their noise adds to the confusion as people rush

-----,--. chaotically toward the aircraft to help you unload the patient. The hurr ied movements and the inabili ty to communicate effectively threaten the vital IV lines and the endotracheal tube. Does this scene sound familiar?

Do you hot unload or wait for the two to three minute cool down period? Do you hot load the patient at the scene if he is ready to go? These questions and others are being asked by many flight programs across the country. With the exponential growth of the number of hospitals providing air transport services, safety issues including "hot loading and unloading" have become a major concern.

Very little information has been published on the concept of hot loading and unloading. A preliminary survey was done in November 1984, with results disclosed a year later. ~ Because hot loading and unloading is an issue that all flight programs must address at some point, it is important to provide documentation of the current approach taken by flight programs to deal with this safety issue. In order to provide complete information on hot loading and unloading, Phoenix-based Samaritan

Kendra Tjelmeland, RN, BSN, CCRN has been a f l ight nurse with Samari tan Air Evac in Phoenix, Ar izona f o r the pas t three years.

Air Evac sponsored a nat ionwide survey at the request of NFNA. The objectives were as follows:

• Document the number of flight programs which do hot load/unload.

• Compare written policies returned with the survey.

• Determine circumstances under which each program hot loads/unloads.

• Identify problems created with hot loading/unloading.

• Determine methods of education of non-flight personnel.

C u r r e n t Pol ic ies A questionnaire was mailed to 125

hospital and non-hospital-based

Figure 1.

flight programs across the country. Eighty-seven survey forms (70.1 percent) were returned.

Survey results indicated that the majority of flight programs do indeed hot load (57 percent) and unload (73 percent) under limited circumstances, while a few programs reportedly always hot load (14 percent) and unload (15 percent) patients on a routine basis.

Of the returned surveys, only eight percent were accompanied by writ ten policies on the hot load/unload issue. A writ ten policy is important to ensure the safety of all people involved in hot loading and unloading the helicopter. Crew members, hospital staff and the EMS

Very little information has been published on the concept of hot loading and unloading. However, the number of programs that hot load and unload is depicted here by aircraft type.

26 MAY/JUNE1987 AMJ

communi ty should be educated in the policy and the role of each individual in the hot loading and unloading procedure. Of the writ ten "hot load/unload" policies returned, the common components included a definition of hot loading/unloading, a list of circumstances under which hot loading/unloading will and will not occur, detailed procedure for non-flight personnel to approach a "ho t " helicopter (including the maximum number of people allowed under moving blades), and general helicopter safety rules.

The survey showed a general consensus among flight programs as to the circumstances under which patients are to be hot loaded. These include situations where:

• The patient is packaged and ready to go with a ground time of five to 20 minutes.

• CPR is in progress. • An unstable landing zone exists. • Impending adverse weather

conditions exist.

The circumstances under which patients are to be hot unloaded include:

• A two-to-three minute helicopter cool downtimelthat would be detrimental to the critical patient on board;

• Back-to-back flights; • Impending delivery of an

obstetrical patient; • An aircraft problem; • Immediate l i f toff for refueling; • Decrease start cycles on the

helicopter.

Figure 1 depicts, by aircraft type, the number of programs that hot load and unload. This is only a reflection of the returned surveys. The factors influencing whether a program hot loads/unloads based on aircraft type were: • L o n g o r s h o r t c y c l e t i m e s - - the

longer the cycle time the more likely a critical patient was to be hot unloaded.

• A d e q u a t e o r i n a d e q u a t e m a i n o r

t a i l r o t o r c l e a r a n c e - - flight personnel felt safer when the aircraft was on high skids or the main rotor was 10 to 14 feet high. The rigid rotor systems on the BKll7 and BO105 were also positive reasons for hot unloading.

• M e t h o d o f l o a d i n g - - if the patient was easy to load or unload, hot loading and unloading were more likely to OCCUr.

Warm-up and wind d o w n t i m e m a y be detr imental to pa t i en t survival a t the scene or upon arr ival at the hospital.

The primary problem identified by flight personnel in hot loading and unloading was the presence and assistance of non-flight personnel who were unfamiliar with the aircraft. Other compounding problems were:

• Difficulty of communicat ion due to the noise level;

• Confusion associated with a less controlled atmosphere;

• Increased risk of injury to those assisting in the procedure;

• Increased anxiety and responsibility of the flight crew;

• Loss of patient lines and tubes in the chaotic rush;

• Wind chill; • Aircraft damage, especially doors.

Because the primary concern for flight personnel is untrained, non- flight personnel around the helicopter, education is extremely important. Of responding programs, 93 percent reported that they routinely provide in-service training for the non-flight personnel who assist them. These people include emergency department personnel, security officers, ambulance crews and firefighters. This was performed, on an average, every six months to one year, though many programs felt the need for education on every call.

There were several different methods of education used by flight programs. These included on the spot training with public relations (PR) and outreach programs;

including written guidelines distributed to hospitals and EMS communities; practice runs on a regular basis at the hospital; films, slide presentations, lectures, and demonstrations; and video presentations. (The limitation of this method of education is the inconsistency of information being distributed due to the varied personnel doing the PR, i.e., if no specific guidelines exist, each person teaches from their own perspective.)

Since the completion of this survey, Samaritan Air Evac recognized the need to have a consistent and stimulating presentation that demonstrated the pertinent safety aspects of hot loading and unloading a patient. To fulfill this need, a training video was developed which covered the specifics of the helicopter model type including tail and main rotor height, safety rules, Air Evac landing zone requirements, demonstration of the correct method of hot loading at a scene, and demonstration of the correct method of hot unloading at a hospital.

When the video was completed, education of the non-flight personnel began by presenting the videotape during staff meetings at receiving hospitals. The security and maintenance personnel were included in the education process if they assisted with hot unloading. The video also was shown to the various fire departments and ambulance companies during their monthly tape and chart reviews. The training video seems to have been very successful in educating the non-flight personnel about the hot load/unload procedure.

C o n c l u s i o n Hot loading and unloading is a

safety issue that has not been addressed directly in the past by many programs. To reduce the risk of accidents, flight programs in the aeromedical arena should develop a writ ten policy and implement it with a standardized education program for the hospitals and EMS communities in their area.

F o o t n o t e s 1. Bullock-Loughran, P: "Hot Unloading Risk or Benefit". HospitalAviat ion, November 1985; 26-28.

B i b l i o g r a p h y Taylor Jr., JE, RN: "Safety at the Helicopter Landing Site: Preventing Injuries to Emergency Personnel and Patients." Journ o f Emerg Med Nurs. Nov/Dec. 1985; 325-327. Wiltse, O: "Helicopter Safety for EMS Personnel." Fire Engineering. August 1986; 49~56.

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