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Mid-pacific international medevac.

On every Helicopter Aircraft Commander Board, the question inevitably comes up, "When can you deviate from (insert publication here)"? Just months after qualifying, I found myself answering this after knowingly violating two major rules on a medevac flight during RIMPAC 2014. First, I conducted a night NVD landing on a vessel authorized for daytime-only operations. And second, I embarked a medical attendant suspected of not having approved water survival or egress training to assist with the night overwater medevac. Why did I break the rules and take those risks? Well, let me paint the picture to explain.

Our SH-60B detachment was operating on USS Gary (FFG 51) during Group Sail transiting from San Diego to Hawaii to participate in the 2014 Rim of the Pacific (RIMPAC) multi-national exercise. We had completed the basic phase of Initial Ship Aviation Team Training (ISATT) just three days prior, and were the only ones in the group of five US and foreign ships whose helicopter detachment had completed the required initial training. As such, we were the only detachment that could accept operational tasking.

After a full day underway, I had recently just hit the rack when at around 0100 my curtains opened and a voice said, "Langan, Langan! Your alert crew has a possible medevac!" My co-pilot, racked out above me in our stateroom, jumped to his feet and started get ting dressed. Still in a haze, I climbed out of my rack and stumbled around the room for a few seconds before getting my bearings. Soon I was dressed and headed to Combat Information Center (CIC).

My mind raced back to many of the questions and scenarios that I had prepared for on my HAC board, just two months prior. Is our aircraft ready? What's the patient's condition? Where are we picking him up from? Where are we taking him? What's the distance?

Quickly we started piecing together the details. We were to pick up a Norwegian Sailor from his vessel, Fridtjof Nansen, and transport him plus their English-speaking doctor to a big deck Amphib for emergency surgery. The information said the patient was suffering from a ruptured appendix, that he was in critical condition, and that he was to be transferred to USS Peleliu (LHA 5).

As we readied for the mission, it crossed my mind that I'd be undertaking a lot of firsts: first time performing a non-ambulatory medevac, first time flying any medevac as the HAC, first time operating on a foreign ship at night, and my first time landing on an LHA. I was excited yet also nervous. It was quickly obvious that we had two big obstacles to this mission: landing aboard the Fridtjof Nansen and whether or not to transfer their doctor along with the patient.

The first obstacle was the Fridtjof Nansen's certifications. According to the HOSTAC (Helicopter

Operations from Ships other than Aircraft Carriers), the Fridtjof Nansen was certified for VMC day/night landings of the NH-90 helicopter only. Our SH-60B was only certified for vertrep (Vertical Replenishment) and HIFR (Helicopter In-Flight Refueling) on the Norwegian ship. I had never even heard of the NH-90 and did not know if it was comparable in size or weight to the Sikorsky H-60. As part of the planned RIMPAC exercises, we had received authorization to conduct daytime landings aboard the Fridtjof Nansen, so we knew someone had determined that their flight deck could handle the SH-60B but that did not mean a nighttime landing would be easy. We planned to use NVDs, but were unsure whether their lighting would be compatible. The HOSTAC said they would have a stabilized horizon bar, but would it be like the horizon reference system (HRS) bar we are used to, and would it be NVD compatible? Would their deck lighting be NVD compatible? How would we shoot our approach, since they did not have a TACAN?

Because I was a junior HAC, certainly without much medevac experience, I had limited resources to guide my decision process on whether or not to try for an unauthorized nighttime landing. Sure, my detachment's OIC and Gary's CO wanted this medevac to happen, but I was in the hot seat; it was my decision to make. And yet even as a junior HAC, I knew the answer to my dilemma was ORM. I needed to apply the steps and abide by the principles to do what I could to minimize the risk to the lowest level.

Having authorization that the SH-60B could land on the Fridtjof Nansen helped mitigate that the ship wasn't certified for the SH-60B. But what controls could I put in place to minimize the risks associated with landing there? A good thorough NATOPS brief was a great start. We briefed that we would don NVDs and perform a Self-Contained Approach to the ship using the SH60B's APS-124 radar. We would execute strict radar altimeter adherence and follow NATOPS procedures for night overwater descent. We would use FLIR to help with alignment if needed. We would have the co-pilot back the pilot up on instruments, being especially ready to call for the wave-off if necessary. We would also take the transition to landing much slower than usual in order to allow our aircrewman to clear the tail and get a better feel for our position over the flight deck.

Our other concern was whether or not to transfer their doctor along with the patient. The patient would need to be transported via litter, and we knew he was in critical condition. We knew a recent interim change to OPNAVINST 3710.7U says "a qualified medical attendant who is current in approved water survival training, and has been properly briefed on emergency egress procedures for that aircraft, may be transferred at night with approval from the ship's Commanding Officer."

But what about a medical attendant without water survival training? We had to assume the Norwegian doctor lacked any US Navy approved water survival training. The same section of 3710.7U does allow certain commanders to waive the restriction that prohibits nighttime ship launches/recoveries with passengers, but only in cases of operational necessity. And as far as I knew, we certainly hadn't crossed into the realm of operational necessity for this medevac. Of course there is always the "military exigency may require on-site deviations" caveat, but I did not want to willingly violate the rules just because I could.

So should I take the doctor? My instinct told me yes due to the nature of the emergency and condition of the patient, and both my OIC and the CO of the Gary agreed. I still needed to minimize as much risk as possible through ORM. The biggest control we could think of was to give the doctor a thorough passenger brief, emphasizing egress procedures. We also knew that the takeoff from the Fridtjof Nansen would, in theory, be safer than the initial landing. And we assessed that the landing on the Peleliu would be pretty straightforward, even if I'd never been to an Amphib before. I knew the procedures from the LHA/ LHD NATOPS Manual and we knew we could ask for a precision approach as needed.

Besides, landing on the Peleliu's giant flight deck would be the safest type of landing we could do with the doctor onboard. The last control we discussed was that the forecasted weather would allow us to maintain altitudes that would keep us in communications and navigation ranges with the various ships during our 120nm transit from the Fridtjof Nansen to the Peleliu.

Having the doctor on board the helicopter would be of tremendous benefit to our aircrewman, in case the patient's condition worsened. We also knew that the Peleliu might need the doctor's language skills to communicate with the patient. I assessed that the risk to the doctor was something I could not completely eliminate, but the benefit of transferring him with the patient outweighed that risk.

Not wanting to delay our initial launch, we agreed in the brief that we'd attempt the landing on the Norwegian vessel and that we would indeed pick up the doctor with the patient. Our detachment's maintenance team readied the aircraft, we preflighted, and launched uneventfully. The landing on the Fridtj of Nansen was smoother than I anticipated, the patient was loaded and the doctor was briefed, and the 120nm transit to the Peleliu was as quick as we could make it. The patient needed morphine during the flight, which the doctor was able to administer. Finally, the landing aboard Peleliu was without incident and their medical team took charge immediately. Later we learned the patient underwent successful surgery onboard the Peleliu and was recovering well.

While most Aircraft Commanders would have made the same decisions I made that night, it was my first time really straying into the gray area between the black-and-white rules and regulations we abide by. Weighing the risks versus the benefits and using ORM was invaluable in helping me make those decisions. Being a helicopter pilot in the Navy is an inherently dangerous job, but with the right thought process and controls set in place, we minimized the risks in order to increase our chances of having a successful mission and ultimately saved a Sailor's life,

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Title Annotation:ORM corner: Operational Risk Management
Author:Langan, Justin
Geographic Code:1USA
Date:Jul 1, 2015
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