Mike Hurst, PHI - IHST

united
in safety
Air Medical Operators Association (AMOA)
Med-Trans Corporation (MTC) – Larry Bugg
PHI Inc. – Mike Hurst

U.S. HEMS Industry
• 400,000 Patient Transports Annually
• More than 500,000 Flight Hours
• Approximately 800 Helicopters - 49 States
• Operate Approximately 20 Different A/C Models*
– Single Engine: ~40%
– Twin Engine: ~60%
*Examination of Make, Model, and Pilot Staffing for the U.S. Air Medical Rotor Wing Fleet Using ADAMS
Data; Flannigan, Blatt, Miller, Eastlee 2008

AMOA & Air Medical Industry
• AMOA Genesis
– Formalization National EMS Executive Operators Forum (2000)
• AMOA Represents Over 90% of Air Medical Helicopters
• AMOA Supports & Collaborates
– Helicopter Association International (HAI)
– Association of Air Medical Services (AAMS)
– Other Industry Stakeholders – Initiatives & BSPs
• AMOA Safety Enhancements & Positions
– Voluntary Implementation of Safety Enhancements Ahead of FAA Regulation
• Terrain & Obstacle Avoidance Technologies
• Enhanced Training
• Enhanced Operational Control & Oversight
• Safety Management Systems (SMS)

AMOA HEMS Enhancements & Commitments*
• Approximately 50% HEMS Fleet NVG
• Approximately 40% Terrain & Obstacle Avoidance Systems
• 100% Commitment – SMS Implementation
• 100% Commitment Implementing FDM/FOQA
• 100% Commitment – Enhanced Operational Control
Procedures & Central or Regionalized OCCs
• 100% Commitment – Satellite Tracking or ADS-B Capability
• 100% Participation Pre-Flight Risk Assessment Procedures
& Risk Management Methodologies
• 100% Operating All Legs Under Part 135 Standards
*Recent 2009 AMOA Survey & Industry Input

Governmental Safety-Related
HEMS Activity
• NTSB Hearing & Recommendations
– AMOA, HAI, & AAMS Provided Input & Published Positions
• FAA HEMS Rulemaking
– AMOA Supports Previous FAA Rulemaking Announcements
– Stakeholder Collaboration
• A021 Operations Specifications (WX & Obstruction Avoidance)
• HEMS Safety Task Force
– “Raising The Bar” Sharing & Reinforcing Best-Practices
• House & Senate Legislation
– AMOA Supports Legislation Reinforcing Rulemaking Process
– Actively Provides Input & Publishes Position Papers

AMOA Contact
Chris Eastlee
Managing Director
Phone: (219) 743-3188
3188
Email: ceastlee@airmedicaloperators.com
Web: www.airmedicaloperators.com

IHST - 2009
Larry Bugg
VP Flight Operations & Safety

MTC Background & Service Area
• Founded October 1982
◦ Headquarters - Dallas, TX
◦ PBO - Tucson, AZ
• Approximately 300 Employees
• Operating 33 Bases - 14 States
• 37 Aircraft
◦ EC-135P2+
◦ BH-407
Providing Customized Solutions To Meet Unique Customer Needs For 27 Years

Standardization & Fleet Enhancements
• MTC Standardization & Training
◦ Exceed FAA Standards - Quarterly Hands-On Flight & Ground Pilot Training (NVG, Emergency
Procedures, & Instruments/IIMC)
◦ Crew Resource Management (CRM) and Air Medical Resource Management (AMRM) Training
(Pilots, Medical Crew, Maintenance Technicians, Communication Specialists & Administration)
◦ FAA Approved - Web/Computer-Based Training (AVSTAR)
◦ Simulation & OEM Schools
• MTC Standardized Equipment & Fleet Enhancements (Current & Retrofit Goals)
◦ 100% NVG Equipped
◦ Autopilot - EC-135P2+
◦ Traffic Collision Alerting System (TCAS) - EC-135P2+
◦ Garmin GNS-530/430 Dual GPS, Radar Altimeter, & XM Weather
◦ Honeywell Mark XXI EGPWS/HTAWS – 55%
◦ Satellite Tracking System (SkyTrac) – 100%
◦ Satellite Communications (SAT Phone) – 65%
◦ Emergency Locator Transmitter (406-ELT)
◦ Technisonic TDFM-6158 (VHF, UHF High & 800 MHz)
◦ Wire Strike Protection System (WSPS)
◦ FDM/FOQA
Standardization, Training, & Effective Utilization of Technology

Safety Management System (SMS)
• MTC SMS – Doctrinal Underpinnings & Design
◦ ICAO Safety Management Manual (Doc 9859-AN/460)
◦ FAA AC 120-92, Introduction to Safety Management Systems For Air Operators
• MTC SMS – Four Core Pillars
◦ Policy - Compliance-Based: Procedures, GOM, Policy, Safety Manual, etc…
◦ Risk Management – Cyclic, Dynamic, Systematic Risk Mitigation Process
• Aviation Risk Assessment
• CRM Checklist & Four (4) To Go - One (1) To Say No Policy
◦ Assurance – Internal & External Surveys/Audits & Inspections
• Collect And Analyze Data & Identify Systemic Issues/Trends - Leading Indicators
• Success Measured Through Lagging Indicators (Safety Scorecard)
◦ Safety Promotion – Resourcing, Advocacy, Climate, Culture, Core Values
• MTC SMS Element Examples
◦ Base Site Safety Officer (SSO)
◦ Regional Aviation Manager & Base Aviation Manager Oversight & Quarterly Safety Surveys/Audits
◦ Hazard Communication (HAZCOM) Program - Material Safety Data Sheets & Online Tool
◦ MTC Safety, Operations, & Maintenance SharePoint Sites - Web-Based Repository SMS Elements
◦ MTC Safety Learning Management System (LMS) - Web-Based Safety-Related & OSHA Training
◦ MTC Reporting – Proactive Hazard Identification & Root Cause Analysis
◦ Etc…
SMS – User Level Accessible Safety Tools & Technology

Way-Ahead
• Sustain Industry Involvement - Safety
◦ AMOA, AMSAC, OSI-HEMS, AAMS, etc…
• Enhance SMS – Continuous Quality Improvement
◦ Share & Adopt Best Safety Practices (BSPs)
◦ FAA Rule-Making & SMSFG
• Compliance-Based Safety & Art of Safety
◦ OSHA, EPA, FAA, Etc…
◦ CRM/AMRM
• Risk Management
◦ Hasty (In-Process) & Deliberate
◦ Habitual
◦ Proactive Informed Risk Decisions
• Human Factors Initiatives
◦ BSPs – Industry, DoD, etc…
• Audit, Reporting, & Root-Cause Analysis
◦ Comprehensive & Continuous Audit & Assessment
◦ Accurate Reporting & Data Collection
◦ Thorough Event Investigation & Identify Causal Factors
◦ Identify Trends & Systemic Problems (Leading Indicators)
◦ Develop Targeted Prevention Measures (Proactive & Preventative)
• Collect, Evaluate, & Apply Lessons Learned
• Safety Enculturation
◦ Measure Culture & Climate (ARAP)
◦ Individual Ownership
◦ Personal Accountability

PHI
IHSS
October 1, 2009

PHI Today (at age 60)
l Approximately 2,300 employees
‣ 716 Active Pilots
‣ 644 Certified AMTs
l Average Pilot Tenure: 10.6 years
l Pilots Average 7,200 flight hours
l Average AMT Tenure: 15.9 years
l Average Pilot age: 48.5
l Average AMT age: 45.2

PHI’s Active Fleet Breakdown
Gulf of Mexico Aircraft 139
Medium/Heavy IFR (dual pilot) - 56
Light (single pilot 1 ) – 83
1
flown dual pilot - 8
Air Medical Aircraft 88
Helicopters – 82 (pilot, nurse, paramedic)
All programs NVG
Fixed Wing – 6 (pilot, nurse, paramedic)
International Aircraft 6
Total Active Fleet 233

PHI Initiatives
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SMS
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Policy
Hazard Identification and Analysis
Safety Assurance
Safety Promotion
Equipage
n
n
n
n
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NVG
HTAWS/AVAD
TCAS/TAS
Flight Tracking
HUMS/VXP/Intellistart
Enhanced Operational Control
n
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Risk assessment tools
Flight locating (real time)
Intervention (EOCC)
Automated Weather Alerts (Software)

Assurance Program Example
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Aircraft Data Monitoring
Systems (ADMS)
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Responsible for analysis of
collected data from various
systems – currently 80
aircraft
– S-92A HUMS
– S-76C++ VXP (Vibration
Monitoring)
– EC-135 VXP
– B206L-4 VXP
– B206 Series Intellistart
(Engine Monitoring)
– BH-407 (6 ALERTS
Systems)
Crossover
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Line Activity Monitoring
Program (LAMP)
n Monitoring of 50 aircraft
n Storage of over 100GB FDM
information
n Handling of more than 50,000
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files of flight data
Detailed analysis of all flight
data
Confidential feedback to
aircrews
Incident review at request of the
Director of Safety
Flight data review for
Standardization and Training
Operational analysis for Policies
and Procedures
Assistance to maintenance
identifying equipment failures
Evaluation of emerging
technology

FDM-Closing the Loop
FD 2 Cue During Climb/Descent (S‐92A)
FD CPL On; Absolute Vertical Speed ≥ 500'/min; RADALT > 1000'
Number of FD Modes Engaged < 2; Duration ≥ 10 seconds
50%
LAMP / Standards meeting
Training program adjusted
Recurrent / Initial Training
Training Captain observations
Implemented
FON 08-17 Issued
40%
Event Altered
30%
20%
1 Qtr 2009 KPI
10%
0%
2 Qtr 2009 KPI
December
January
February
March
April
May
June
July
August
September
October
November
December
January

Operational Control
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Uses tier system, listed in operations Specifications
A008
Ultimate operational control authority rests with
Director of Operations
n
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Qualified crews assigned
Part 135 crew rest requirements assured
PHI developed “Enhanced Operational Control”
procedures in the 1990’s to insure adequate day to
day operational safety
System has been continuously improved since that
time
One of the most important controls over decision
error and compliance.

TIER SYSTEM (EOC)

Lafayette Communications
Center

EOC+Risk Assessment
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A Crew and Management Decision Tool
A “Checklist” of Significant Events/Situations
A Risk Assessment Tool
Does NOT supersede PIC Authority or
Responsibility
Provides Intervention Opportunity
A Communication Enhancer
A Pressure Reducer
“To assist good pilots from ending up in bad
situations, facing tough decisions.”

Condition Status Overview – Air Medical
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Procedures established and published in the EOC Manual and
GOM
Utilizes Risk Matrix (Score)
Involves Management
Requires Communication Between EOCC and Crew
All crewmembers involved in risk management and inadvertent
IMC recovery planning
Requires verification of competing program flight turndowns
Establishes guidelines on routes of flight (hostile terrain)
Our system was one of the models used to establish the
guidelines in FAA Order 8900.1 CHG 22
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Volume 4 AIRCRAFT EQUIPMENT AND OPERATIONAL
AUTHORIZATIONS Chapter 5 AIR AMBULANCE OPERATIONS
Section 5 Operational Risk Assessment Programs for Helicopter
Emergency Medical Services

Closing Points
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We Support Government and Industry
Safety Initiatives.
Today, anyone’s accident is everyone’s
accident.
SMS is a process not a program, and is
integral to our business.
We must spend our “Safety Dollars”
wisely.