Industry voice: Devon Air Ambulance responds to AAIB report for helicopter ambulance landing sites

Each operator will engage with their local hospitals in their own way, but as DAA operates under its own air operator certificate (AOC), the Landing Site Manager is in the privileged and beneficial position of being able to liaise directly with not only DAA’s line pilots, critical care paramedics and doctors but the hospital teams as well.

DAA operates into 10 hospitals across southwest England and, on occasion, into Hampshire in the southeast. I am required to survey each site annually and ensure that our documentation is up to date with any relevant standard operating procedures (SOPs) issued by the hospital.

The AAIB report has brought hospital helipads into wider conversation among hospital trusts and their staff

Understandably, expertise among hospital staff involved with operating their helipad does not naturally include aviation knowledge nor an understanding of downwash on the areas surrounding the helipad. Part of my role is, therefore, to help ensure that the mitigation steps in place to prevent downwash incidents are effective and commensurate with the risk at that hospital.

While the AAIB report has brought hospital helipads into wider conversation among hospital trusts and their staff, this hasn’t always been the case, and I think it’s fair to say that most hospitals are going through a steep learning curve to ensure that the guidelines in CAP1264 are adhered to and that they are responding appropriately to the safety recommendations in the report.

Different hospitals, different challenges

The 10 hospitals across the southwest that DAA regularly operates into all present their own challenges and nuances, which need to be documented for our pilots and crew, and communicated back to the hospitals so they can provide a safe environment for us to land in. We maintain a database of HLS plates with site sketches containing key details, and these plates are also available at any time to the crew via the onboard ACANS system.

Some HLSs have public highways running alongside them; others are very clearly within hospital grounds and tucked away. Some have downwash walls, lighting for night landings, and clearly defined SOPs for staff to follow, while others are a flat green area surrounded by car parks and trees.

Every HLS is there to provide an opportunity to improve patient outcomes, but some have been developed with a clear focus, such as at the Derriford major trauma center. Others are located further from the emergency department than is perhaps preferable for a swift patient transfer when required. Not all HLSs are equal!

Every HLS is there to provide an opportunity to improve patient outcomes, but some have been developed with a clear focus, such as at the Derriford major trauma center

In response to the AAIB report, and to highlight the importance of CAP1264 to each hospital, we’ve issued a downwash map highlighting the 30m zones and 50/65m zones around their HLS that need to be clear of people and foreign object debris (FOD) when we operate into them. The downwash maps also highlight the approach/departure paths that DAA would use and, in addition, we have held meetings to answer any questions or offer any support to the hospital.

DAA’s EC135 and H145 aircraft might fall into the 30m zone, but why would we not also provide hospitals with the downwash zones for larger helicopters? This leads nicely on to the second challenge for HLSs.

Different operators, different challenges

The onus is on both the operators and the hospitals to ensure they have good working relationships and are sharing best practice and learnings regularly

Each HLS is different, and there are also 21 different air ambulances across the UK, with around 10 different aircraft types. Each operator and air ambulance will have its own SOPs. In the southwest UK alone, each HLS needs to be able to cope with four regional air ambulances and potentially some national operators, such as the Coastguard and the Children’s Air Ambulance. Among the four southwest air ambulances, there are four different aircraft types requiring downwash mitigation in the 30m and 50m zones.

It is very clear just how complex the air ambulance industry can be, and the onus is on both the operators and the hospitals to ensure they have good working relationships and are sharing best practice and learnings regularly.

Different challenges, different opportunities

To achieve a consistency of approach across HLSs, each hospital ideally needs to have a standard management approach to their helipad, which their local operator can then inform and develop with them.

From our little corner in the southwest of England, DAA is ensuring that we share best practice from one hospital to another across our region. We’re offering time and support at meetings to aid decision-making at the hospital and to explain the impact of the 30m/50m zones. We’re making the introductions of key staff across different hospital trusts and pushing for each hospital to clearly define their senior responsible person, as well as their day-to-day helipad manager that we can work alongside.

We’re also reaching out to other operators to share concerns and learnings if we’ve landed at an HLS not typically within our area.

We are very conscious of the impact that downwash could have, and through a combination of training and safety reporting, we do our best to mitigate its impact

Slowly, this is beginning to get traction; hospitals without regular HLS working group meetings are looking into setting them up and inviting us along. Hospitals that have yet to determine their responsible people are inviting us to have those discussions. Hospitals that require improved downwash mitigation for their HLS are actively seeking us out for advice and consideration and we’re making key introductions from across the region so different hospitals can share their own best practices.

Our next step alongside those already listed is to establish key links with other operators and their teams responsible for HLSs.

At DAA, we are very conscious of the impact that downwash could have, and through a combination of training and safety reporting, we do our best to mitigate its impact, but the AAIB report has produced some clear learnings that all operators and hospital teams are responsible for taking onboard.

There are clear steps and recommendations as well as guidelines from the CAA within CAP1264, and, while there will of course be a national response from the Onshore Safety Leadership Group, how operators at regional and local level engage with their hospitals will be crucial to ensuring that the national response is taken onboard and acted upon.