Riding With Haiti Air Ambulance Part 3: Safety Is No Joke

EMS World contributor and advisory board member Kevin Collopy is volunteering this month with the first air ambulance service in Haiti. He’s chronicling the experience with a series of blog posts. Find Part 1 here and Part 2 here.

Every EMS system, ground or air, strives to engage in safe practices at all times. We perform preventive maintenance on our vehicles, discuss our emergency procedures and prepare our incident action plans. However, when an entire country considers your program the ultimate strategy for help, and the backup plan is to use your own resources, safety reaches an entirely new level of importance.

Like U.S.-based helicopter services, Haiti Air Ambulance flight teams begin each shift with a daily briefing. Routine briefs review the flight crew and communication specialist, planned maintenance, the weather and safety topics. In addition to a daily safety topic, we spend considerable time discussing hazards and habits. Today our pilot spent 15 minutes explaining to me how our communication specialist, Ailhaud, never makes assumptions. Ailhaud (like all HAA communication specialists) tracks our every movement with satellite tracking via the Sky Connect system, and if we change our route in the slightest from what we agreed upon prior to departure, he calls us and asks 1) if we are OK and 2) what our intentions are. We typically fly at 4,500–6,000 feet, which keeps us in radio communications as we travel through mountain passes; below this level we can lose radio communications. Thus, even though Sky Connect allows Ailhaud to see when we land, he waits five minutes (the time our aircraft takes to shut down), then calls our cell phones to make sure we landed safely and our landing zone is secure. During radio communications, he doesn’t just say “copy” (they don’t have 10 codes); he repeats everything back to confirm it was heard correctly.

Often U.S.-based programs strive to launch within 10–15 minutes of a flight request being received. During this time there is a quick weather check, walk-around of the aircraft and route planning. In Haiti, unlike the United States, the only weather reporting station is a mile from the HAA base, and while we can see the mountain ranges to the north and south of our valley, the remainder of the country’s weather is largely obscured by the 5,000–6,000-foot peaks rising from the sea. Thus, evaluating the weather requires additional resources and a low threshold for turning around should the weather change once airborne.

I’m impressed to see that in addition to all flight crew members completing a preflight inspection of the aircraft, the HAA mechanic is the first and last person to check every inch prior to departure. As one of the pilots eloquently puts it, “Time has little meaning here. If every step in our process isn’t deliberate and carefully executed, then we put ourselves at risk. Moving slowly is how we can be fast.”

When I ask about landing zones in a country where few dedicated helipads exist, our pilot smiles and hands me a book of landing zones. The HAA staff works with local hospitals, EMTs and police departments to identify a landing zone at every hospital and clinic, determine its coordinates, photograph it and list its hazards, size and resources. There are now more than 50 approved landing zones for the program. They try to land only at these approved zones and work continuously to expand their availability. All sites are also listed at the Haitian site of LZControl.com.

Just because they list the hazards today, the pilot tells me, doesn’t mean anything tomorrow; they can’t take anything for granted. Every day people are rebuilding from the 2010 earthquake, and new towers and wires can show up anywhere. He cautions me to always assume there are more wires than I see, and always assume they are electrified. Haitians have been known to use barbed wire to hack into the country’s electrical grid.

Following each flight, the first person out to the aircraft (while we unload our patient) is the mechanic once again. While he assists in unloading the patient, he asks how the aircraft did and if we had any problems, and then proceeds to check the entire aircraft. He worked overseas during previous military conflicts, and he tells me he learned that when operating in third-world countries, you have to assume there is a problem that hasn’t been found yet, and find it now before a warning light makes you land somewhere not reachable easily (if at all) by ground.

The mechanic is also our best friend in the realm of personal safety. Immediately after I landed in the country (he picked me up), he asked where my water bottle was and told me that if I didn’t drink water constantly throughout the day (he recommended 750 mL/hr), I’d become dehydrated in the heat and humidity so close to the equator. Personal health and safety are on everyone’s minds. The Haitian EMTs don’t just talk about safety; when they are asked about a topic, they go home, research it and bring back a paper. When anyone (myself included) drifts from a safety practice, someone is there to catch it, back them up and correct it. It’s no surprise that the chief flight paramedic also happens to be the Vision Zero chair. In the evenings, the pilots and medical crew (who share a living space) talk about safety best practices and provide insight to their volunteers on how to take their safety to new levels.

Kevin T. Collopy, BA, FP-C, CCEMT-P, NREMT-P, WEMT, is an educator, e-learning content developer and author of numerous articles and textbook chapters. He is also the clinical education coordinator for AirLink/VitaLink in Wilmington, NC, and a lead instructor for Wilderness Medical Associates. Contact him at ktcollopy@gmail.com.