Power Points for EMS Education

1. Annual Aircraft
Safety Training

2. 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.

3. OUTLINE

4. DEFINITIONS
MEDEVAC 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

5. MEDEVAC OPERATIONS
Ambulance Parking
Ambulance Movements
Ambulance Repositioning
Patient Packaging
Load / Unload Procedure

6. 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.

7. Ambulance Movements
Immediately 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.

8. 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.

9. 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.

10. Patient Load/Unload
The 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.

11. 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.

12. 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.

13. The King Air 200 - Exterior

14. The King Air 200 - Cabin

15. The King Air 350 - Exterior

16. The King Air 350 - Cabin

17. 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.

18. The Twin Otter - Exterior

19. The Twin Otter - Cabin

20. June 20, 2014
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)

21. June 20, 2014
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

22. 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.c
om
/he_bell%20205.htm

23. 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:

24. STANDARD FLIGHT
OPERATIONS

25. Pre-Flight Briefings
Any 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/Landing
Main Door – Open/Close
Emergency Exit Operation
Emergency Egress Procedure
Fire Extinguisher Location (2)
Emergency Locator Transmitter Location
Cabin Security Requirements
Location of Survival Equipment

26. Seatbelts
Seatbelts 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.

27. 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.

28. Loading Cargo
Generally 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.

29. Upon Landing
Never 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.

30. Patient Load / Unload
1. 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.

31. 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

32. 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

33. Internal Loading
Flammable 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.

34. Cargo in the Tail Boom
Secure 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.

35. 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.

36. 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.

37. NON STANDARD OPERATIONS
Extreme Cold Weather Operations
Bariatric Medevacs
Remote Site Medevacs

38. 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.

39. 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.

40. Bariatric Medevacs
The 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.

41. Remote Site Medevacs
In 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

42. PROHIBITED OPERATIONS
Hover Entrance / Exit
Helicopter Refueling
Hot Refueling

43. 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

44. Hover Entrance/Exit
are 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.

45. Refueling
Refueling 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

46. EMERGENCY OPERATIONS
Ditching
Crash Positions
Emergency Egress
Aircrew Survival
In-Flight Code

47. 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.

48. Crash Positions

49. 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.

50. Overwing Egress

51. Aircrew Survival Tasks
(prioritized)
1. First Aid
2. Fire (for warmth and signaling)
3. Shelter
4. Signals
5. Water
6. Food
7. Communications

52. 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.

53. 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.

54. QUESTIONS?

55. THANK YOU