Cutting the toll

The screams are deafening… no time to think… a huge shot of adrenaline pulses through the parent’s body. They’re frantic, running to the noise; to their baby boy.

‘Once on board the helicopter, the medical team has no time to rest or think.’

The kettle… boiling water everywhere… the little boy’s face and chest are horribly scolded. Panic rises and the parent wants to scream, but they know they must stay calm to help the little one manage his pain. Both parents are now there, putting him under cold running water, yet still hearing such terror reverberate through the still morning. The father reaches for the telephone and calls triple zero, his hand shaking almost uncontrollably, while the screams of the little boy continue as he starts talking to the operator.

For anyone living in remote areas, the sound of a helicopter arriving to provide lifesaving medical care is something you hope you never need to call on. But when confronted with the terror of an injured or sick loved-one – even worse when it’s the uncontrollable screams of your own child – the relief of specialist medical support can be the difference between life and death.

Professionalism at its finest

The professionalism and specialist skills of rescue pilots, crewmen, paramedics and doctors is something we may take for granted. These small teams typically work under intense pressure.

Imagine it’s 3am and you’ve just made an emergency landing to a remote field using night vision goggles (NVGs). This takes a high cognitive workload where all crew play a role to ensure the helicopter avoids external obstacles to make a safe landing. Once on the ground, minutes can define the difference between life and death, especially if the patient has traumatic wounds that require immediate action to stabilise blood loss and to manage post traumatic shock. Once on board the helicopter, the medical team have no time to rest or think, with every action focused on stabilising the patient and keeping them alive until they arrive at a specialist hospital.

It’s now very early in the morning and fatigue is creeping in but the ongoing release of adrenalin helps keep this crew alert. The acute stress hangover will kick in later in the morning. Tasks such as this, driven by the sympathetic nervous system, tap into stored reserves and drain the body of the critical irons and chemicals needed to allow the brain to continue to function at its best. It keeps them alert in the moment but there will be a price to pay once they’re back inside the confines of their home base that will eventually involve a long period of deep sleep.

Putting their lives on the line to rescue you

Back in the helicopter as the rescue continues to unfold, there is a brief moment of quiet when the autopilot steps in to manage the workload at cruise, and this affords the pilot a brief opportunity to relax prior to planning the approach into the hospital. Yet in an instant, there is an orange light and a master caution alarm. Subconscious decision-making kicks in – the alarm and caution light are cancelled and it’s straight into the emergency checklist.

It’s a chip light (a possible indication of impending mechanical failure) and the adrenaline is now pumping back into the bodies of the aircrew, while the paramedic and doctor are still focused on the patient’s needs as the pilot and aircrewman consider their options. The aircrew know that any further delays may cost the life of this patient, but the chip light has other implications for the ongoing safety of the crew and the helicopter. It’s dark, everyone is busy and tired, and several time-critical decisions will now need to be made under intense pressure to manage everyone’s safety.

Although what I have just described could easily be a real event, it is taken from one of the recent virtual reality (VR) training scenarios that crews must deal with, to assist them to develop their non-technical skills (NTS) during their regular NTS training program at the Aeromedical Crewing Excellence (ACE) training centre.

Welcome to the world of emergency medical services. These men and women put their lives on the line every day to help save your loved ones. There is no doubting the professionalism and the track record in delivering successful outcomes, even when confronted with high pressure, high stress and time-critical situations.

A real-life cost

While my example shows the intense pressure faced and the professionalism required to get people to safety, there are situations where rescues do go wrong.

You may remember the tragic event from Christmas Eve in 2011, when a paramedic, Michael Wilson, a loving and doting husband and father of three, was tragically killed during a cliff rescue on the NSW south coast. He was inadvertently dragged off a cliff ledge by a rescue helicopter that was meant to winch him and his patient to safety. He was the first NSW paramedic to have died on duty in 30 years.

The Australian Transport Safety Bureau (ATSB) investigation report identified several safety issues relating to training and use of the helicopter’s lighting and radios. The report identified, “a number of organisational issues that could adversely influence the way crews act in similar circumstances”.

This accident was devastating and came as a shock to all emergency rescue teams. But it served as a catalyst that led to a significant investment by NSW Health to learn lessons from this tragedy and to build, in my opinion, a training facility and operations support centre that is second to none – easily up there with the best on any international stage. When I toured the training facility, I passed a memorial to Michael; an ongoing reminder that from tragedy comes opportunity.

Toll Helicopters’ ACE Training Centre – setting the new benchmark

Australian Aviation regularly ‘road tests’ aircraft and this is our first ‘road test’ of a human factors training centre, in this case the ACE Training Centre, supported by Convergent Safety, which delivers an impressive balance of experiential technical and non-technical skills (NTS). It offers training that maximises the ability of the crews to enhance their standards of professionalism and their ability to perform well under intense pressure.

It’s well known that good management of NTS – essentially human factors such as stress, fatigue, human error, critical decision making under time pressure, crew dynamics and communication – are critical in achieving optimum performance. Equally, inadequate management of NTS continues to be cited as a primary contributor to serious incidents and accidents. This is why the International Civil Aviation Organization (ICAO) requires aviation regulators to integrate NTS within safety management systems (SMS) and training programs.

The ACE Training Centre, located at Bankstown airport, provides fresh insight into the standards that must be achieved by any operator seeking the high standards required by aviation operators. My observation from several civil and military NTS training programs is they reached their peak 10 to 15 years ago and continue to involve too much classroom-based, case study driven generic discussions. While this style of training is a good start, it is not adequate to bridge the gap between attitudes and knowledge with experiential, skills-based application. Good NTS training programs provide tangible and practical tools that you can take away to better understand yourself, your team and a realistic opportunity to apply these new skills.

In addition, when NTS programs were first introduced (formerly known as crew resource management (CRM) or team resource management (TRM)) they warranted a degree of trust when implementing formal training and assessment. Trainees could only fail on a technical consideration, not an NTS failure. As programs have matured, so have standards and inter-rater reliability (making sure all check and training personnel assess to a similar standard). Put simply, in the past, you could fly a simulator task within technical limits, use some profanities to belittle the first officer, and still not fail the sequence.

ACE bright spots

If we review a relatively simple definition of human factors, the application can be defined as the minimisation of human error and its consequences by optimising the relationship within systems between people, activities and equipment.

The experience of many aviators is they find human factors training interesting, but it can lack the practical tools to help optimise the performance of personnel. The ACE Training Centre alone provides many examples of embedded support systems that maximise team communication and situational awareness, such as:

An engineering tool control utilising automation to help monitor and track the use of various tools across different aircraft. A licensed maintenance engineer swipes their identification card to open the toolbox, selects the relevant tools and allocates them to the aircraft they’re working on. In some cases, where a tool is identified as missing, video footage from the maintenance facility can help identify if the tool has been misplaced and where it is located, significantly reducing the risk of foreign object damage (FOD) from a tool being left in an engine compartment. It creates a workplace culture aligned with professional tool control.

A purpose-built work platform that has been further modified based on the feedback of the aircraft maintainers.

A bird bath for washing helicopters post-flight, removing deposits of salt water. It is linked to a mobile phone application, making it easy for the crew to keep the aircraft in good shape, day or night, particularly given the potential impact of corrosive salt.

Innovative Australian-designed work stations, including electronic screens interconnected through a master display to ensure relevant information can be displayed to manage the myriad of tasks completed by the small support team. This includes rostering across four bases, fatigue risk management, refuelling, debriefs, flight data analysis, liaison with engineering, base security, and many more.

A Complete Aircrew Training System (CATS) that utilises virtual reality (VR) to deliver experiential training, including decision making under stress.

Helicopter Underwater Escape Training (HUET) that can replicate sea state three. A far more experiential setting surrounded by waves, mist, 40 knot winds, thunderstorms (strobe lights, thunder clap sounds). Many previous HUET trainees have only been in stable swimming pools.

Appropriate crew rest facilities such as 24 rooms with ensuites to ensure fatigued crews can gain access to sleep prior to their drive home.

And if the pressure to be home remains too high, all crew have access to taxi vouchers to and from work to further manage the risk.

The ability for personnel at all levels to seek better, more efficient, innovative ways of doing business is clear. Contributing to this very professional workplace culture is an NTS program that goes well beyond minimum regulatory compliance by empowering all personnel to understand how their own human factors contribute to a culture of professionalism, continuous improvement and high-performance teams.

Developing a culture of professional excellence

Convergent Safety’s Managing Director, Mr Rick Sellers, developed the Toll Helicopters’ NTS training package. Rick and his team have extensive experience with NTS for high performance teams, and the opportunity to tailor a program from the ground up and to learn from the lessons gained from the past 35 years of human factors training was an opportunity like no other.

The full integration of NTS within Toll Helicopters provides a whole new generation of training quality, which importantly includes practical strategies to transition key training lessons into skills-based application within an actual helicopter.

From a Convergent Safety perspective:

Before we develop a course of training for a client, we take the time to discuss their specific requirements and work with their safety management team to identify the key areas of risk within their operational context. In addition to this, we normally conduct a review of recent incidents within similar areas of operation using both Australian and international data. Based on this review, we build an NTS training program which is customised for the client and is designed to assist the organisation by providing appropriate training, tools and processes which can be used to help mitigate the identified operational risks. This was part of the process we used to develop our current NTS training programs in support of Toll Helicopters.

Properly integrating new training programs will always present challenges. Having said that, we make sure that all our training is relevant to the context of operations and is linked to both the SMS and the technical checking and training system. We also use surveying and feedback to keep the training material relevant and up to date. In any high hazard operation it is vital that these training programs remain up to date and relevant to current operational risks, this is why these continuous improvement processes are so important. If you just stay with what has been done in the past, you are steadily going backwards.

NTS essential skills

Toll Helicopters, through Convergent Safety, has developed a number of essential technical and non-technical skills:

Technical Skills

Non‐Technical Skills (NTS)

Manipulative Skills

Communication and Teamwork

Knowledge of Systems and Procedures

Leadership Authority and Assertiveness

Automated System Usage

Situational Awareness

Execution of Procedures

Decision Making

Hazard (Threat) Awareness and Risk Management

Given the high professional standards required from their crews, the system assesses each on their own merit and ultimately a failure can result if a standard in either category is not adequate. If there is any outcome (technical or NTS) that compromises safety, the result is a fail. A single zero in an NTS assessment criteria or two or more scores of one is an outcome of not yet competent, requiring remedial training and re-assessment. For example, consider a pilot is flying a standard instrument departure and makes an abrupt or aggressive comment to the aircrewman. Then consider this assessment criteria:

Communication/Teamwork: scores a zero when unable to work as a team member, creates barriers between crew thereby not using feedback or input from others.

‘People speak up because they know it leads to action being taken.’

The pilot in this case would score a zero, and the crew would be collectively debriefed with further remedial training conducted to address the feedback. These processes are necessary for establishing a culture that expects and requires high professional standards.

The Convergent Safety – Toll Helicopters’ NTS program is setting a new benchmark for professional excellence. Its strengths are:

All staff, including senior management, are provided training to understand their role in contributing to high performance outcomes for the entire team. The training system is adapted and contextualised to align to their separate needs.

The NTS element is not a regulatory ‘bolt-on’, but rather a key contributor to making sure the system tailors programs aligned with workplace needs. This includes regular feedback from operational crews on the types of scenarios that should be placed into the cyclic training system. There is a strong link between the NTS Program Manager and key decision makers, including the Managing Director, Head of Check and Training, Safety Managers and the crew.

Heavy emphasis on inter-rate reliability delivers consistent standards across all four bases, making for seamless transitions when any member is required to provide support at other bases.

It is one main training location and program, so there is reduced duplication of effort by smaller organisations developing and delivering their own NTS training.

There is extensive use of lead indicators to ensure the system doesn’t just react to known hazards and risks but is proactively learning new lessons prior to an incident.

Advanced training systems and tools including a full motion simulator.

The testimonials from trainees speaks for themselves:

“First CRM/ARM course that I’ve done that is Helo specific – GREAT! Nice to see data drawn from various sources not just American/Canadian sources or from Airlines. Puts it all in perspective and makes it all relevant, which makes it much easier as an audience to listen, participate and retain. Thank you Rick and Natalie.”

“I’ve done many Human Factors/CRM/MCC courses in the last 10 years. This one was a great mix, the most enjoyable and involved that I’ve done! CONGRATS!”

NTS and high reliability

Every organisation can benefit from an integrated, experiential NTS program. From my experience not only does the organisation inculcate a culture of professionalism and continuous improvement for enhanced business efficiency, but the outcomes are aligned with high reliability. Highly reliable organisations, such as Toll Helicopters, are those that have less than their ‘fair share’ of failures despite:

managing complex and demanding technologies

meeting peak requirements and time pressures

routinely handling significant risks and hazards

executing dynamic/intensely interactive tasks.

The investment in experiential NTS programs ensures personnel understand the human factors that underpin and enable the establishment of high performance teams, while empowering all personnel to truly believe in a drive at all levels to establish a culture of excellence and continuous improvement. The link between integrated NTS is also critical in establishing the six key characteristics of a highly reliable safety culture, as obtained from Professor Patrick Hudson (Integrated Safety Management Systems (ISMS) Training Course, Singapore, 2008) and shown in the figure below.

The Toll Helicopters’ training system is one of the few that is truly integrated across other critical departments to ensure actions are taken quickly to address known or perceived hazards and risks. This empowers personnel to know they’re being heard and resources are made available to address known risks, including an investment in new ways of doing business. People speak up because they know it leads to action being taken – increased knowledge of human factors through NTS ensures the root causes are identified, ensuring management at all levels are kept well informed.

In summary, the following from a trainee encapsulates what can be possible when delivering high quality training that allows emergency medical services teams to perform well under extreme levels of pressure:

“I was somewhat sceptical but can say with confidence I am now alarmed that in my 10,000-plus hours I had not undergone training on the system in such a realistic environment.”

The ACE Training Centre is an investment in excellence, empowering and enabling future generations of emergency helicopter pilots, aircrewmen, paramedics and flight doctors to continue to protect our loved ones when confronted with a crisis. It’s a true testament to an investment in professional standards and a lasting legacy to Michael Wilson.

Do you have an example of contemporary, innovative human factors training programs in operation? Tell us more at ([email protected].).